PROJECT TITLE: PROVISION OF HEALTH, NUTRITION, AND PROTECTION
LIFE-SAVING SERVICES FOR VULNERABLE POPULATIONS IN THE NORTHERN (TIMBUKTU AND TAOUDÉNIT) AND CENTRAL (SÉGOU) MALI
Country: Mali Donor: USAID/Office of U.S. Foreign Disaster Assistance (OFDA) Award Number: 72OFDA19GR00053 Reporting Period: October 1, 2019 to March 31, 2020 Submitted By: International Medical Corps
SEMI-ANNUAL REPORT
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Program Goal: Total Number of People Affected in the Target Area: 525,746 Total Number of People Targeted (Individuals): 367,010 Total Number of Internally-Displaced Persons (IDP) Targeted (Individuals) as subset of above: 16,263 Program Objectives: Health: To improve access to free, quality, lifesaving health services and ensure the sustainability of the health services for targeted conflict-affected populations Nutrition: To contribute to mitigating excess mortality and morbidity due to malnutrition among children under five and pregnant and lactating women by providing preventive and curative nutrition services Protection: To improve access to services and support for survivors of gender-based violence (GBV) and strengthen communities’ capacity to mitigate GBV in the Northern region (Timbuktu), Mali WASH: To contribute to improved drinking water quality, hygiene practices, and sanitary environment in supported health facilities and households
1. PROGRAM SUMMARY
Since May 2019, International Medical Corps (IMC) has been implementing a health, nutrition (with WASH), and protection project through OFDA funding to save the lives of vulnerable people in Timbuktu, Taoudénit and San. Many activities have been completed in all targeted sectors during the reporting period of this second semi-annual report.
In the Health sector, IMC continued to maintain 12 health facilities in providing free and quality primary and secondary health care. This was done through capacity building of the centers, based on the six World Health Organization (WHO) pillars. This project aimed to initiate cost recovery in Timbuktu and Taoudénit. Different discussions were carried out with OFDA during the reporting period, which resulted in a transition back in favor of cost-free care for all persons, continuing until the end of this project in 2021. During the reporting period, 18,426 people, including 4,934 men; 5,657 women; 4,099 girls; and 3,736 boys directly benefited from health services supported by IMC in the Timbuktu and Taoudénit Regions.
International Medical Corps also contributed to the management of Severe Acute Malnutrition (SAM) with and without medical complications in 24 outpatient therapeutic programs (OTP) and 2 stabilization centers (SC) in the Timbuktu, Taoudénit and Ségou regions. International Medical Corps carried out activities with community-based organizations to educate the population on good infant, young and child feeding (IYCF) practices. In total, 23,319 people, including 3,027 men; 18,791 women; 652 girls; and 849 boys directly benefited from nutrition services.
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International Medical Corps has been working with Community Health Workers (CHWs), Community Health Volunteers (CHVs) and ASACOs (Associations de santé Communautaire – French acronym for community health associations) to promote hygiene, ensure nutrition community based activities and behavioral changes within households and communities. Key activities included training committees on Infection Prevention and Control (IPC); awareness campaigns; individual awareness; and household and community discussions on specific hygiene and sanitation behaviors. These activities reached 24,899 people, including 8,002 men; 9,427 women; 4,040 girls; and 3,430 boys who directly benefited from WASH services.
International Medical Corps reinforced the prevention of gender-based violence (GBV) and GBV survivors’ case management in close collaboration with community-based organizations, including three women and girls' safe spaces (WGFSs) in two districts. International Medical Corps also supported two international campaigns (i.e. “16 Days of Activism” and “International Women’s Day” on March 8, 2020). General GBV prevention community awareness-raising activities were also conducted. A total of 35,359 people, including 21,132 women; 9,415 men; 1,867 girls; and 975 boys were reached with GBV messaging.
International Medical Corps participated in several field coordination meetings with relevant stakeholders, such as with health authorities, other NGOs, ASACOs, the Regional Directorate of Women, Children and Family Promotion and traditional leaders in all targeted sites. At the national level, IMC attended Cluster meetings (i.e. Health, Nutrition and Protection) as well as meetings with OFDA.
In March 2020 COVID-19 pandemic cases were officially reported in Mali. This situation became a critical health priority for the Government of Mali, humanitarian actors, donors and the Malian population. The regions of Timbuktu and Ségou, which had initially remained on the fringes of the epidemic, recorded three and one cases respectively. The pandemic will raise new constraints concerning project implementation as all activities with a gathering of individuals, such as meetings, workshops, and awareness-raising sessions will need to be adapted or cancelled. Local authorities may also not be as available with some activities therefore needing to be rescheduled. The availability of partners may also be impacted due to shifting priorities. Most importantly, the pandemic may change priorites for some time, thus impacting household circumstances (e.g. agriculture, access to income, malnutrition) and impacting their health.
1.1 AWARD LEVEL BENEFICIARIES Cumulative Targeted Total 367,010 IDP 16,263 (from Baseline) Reporting Period Total 77,389 IDP 11,608 Reached (SAR 1: May 7 to September 30, 2019) Reporting Period Total 101,459 IDP 15,219 Reached (SAR 2: October 1, 2019 to March 31, 2020) Cumulative Reached Total 178,848 IDP 17,564 (May 7,2019 to March 31,2020)
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1.2 SECTOR LEVEL BENEFICIARIES Cumulative SAR 1 Reporting SAR 2 Reporting Cumulative Targeted Period Reached Period Reached Reached in the (May 7 to (October 1, 2019 to Project (May 7, September 30, March 31, 2020) 2019 to March 31, 2019) 2020) Sector Total IDP Total IDP Total IDP Total IDP Health 105,448 9,380 20,070 3,011 18,426 2,764 38,496 5,775 Nutrition 201,183 5,079 21,134 3,170 23,319 3,498 44,453 6,668 Protection 59,784 8,968 26,943 4,041 34,815 5,222 61,758 9,263 WASH 248,010 8,105 9,242 1,386 24,899 3,735 34,141 5,121
2. EXECUTIVE SUMMARY – PROGRESS TO DATE HEALTH Health Systems and Clinical Support
i. Mobile Medical Unit (MMU) Intervention
From October 2019 to March 2020, the Mobile Medical Unit (MMU) deployed by IMC in the Taoudénit Region conducted eight visits in each of the three targeted health districts (Araouane, Al-Ourche and Boujbeha). Through the MMU interventions beneficiaries received curative, preventive and promotional activities. There were 4,814 curative consultations, of which 2,671 were women and 2,143 men. Children under 5 years represented 22% of total consultations (1,083/4,814). The predominant diseases were: acute respiratory infection (ARI – 28%); malaria (15%); diarrhea (14%); high blood pressure (12%); trauma (14%); sexually transmitted infection (STI – 12%) and mental health conditions (0.5%).
The Mobile Clinic's maternal health service reached 92 women and included: 55 women for the first antenatal care visit; 18 women for the second antenatal care visit; one for assisted delivery and 23 women for post-natal care. Among these women, 31 received the first dose of anti-tetanus vaccine (ATV1) and 13 received the second dose (ATV2). The Mobile Clinic also registered 18 new users of family planning services and 492 mothers received nutritional advice for themselves and their children.
As part of an expanded program on immunization and vaccinations for children, 139 children were vaccinated with tuberculosis vaccine (Bilié de Calmette et Guérin - BCG); 131 children with Penta3; 27 children against measles; and 57 children against yellow fever. In March 2020, the MMU was deployed to investigate suspected measles cases in the Al Ourche area, conducted in collaboration with the Taoudénit Regional Directorate of Health. Five cases were confirmed in this measles outbreak. International Medical Corps will support the immunization response campaign currently being planned to reduce the spread of the outbreak. During curative activities, 879 children aged 6-59 months were screened; among these, 32 were identified with moderate acute malnutrition (MAM) and 19 others with SAM. These cases were referred to the nearest nutrition centers for treatment while their mothers also received nutritional education.
ii. Strengthening Health Information Systems
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A shortcoming noted during the first semester of the project related to delays in uploading health data on to the District Health Information System 2 (DHIS2) online platform. To improve this, IMC supported the Timbuktu Health District in organizing a three-day data validation workshop (from October 14 to 16, 2019) covering 2019 third quarter data. A total of 23 participants (5 women and 18 men), including health workers (8 doctors, 5 nurses, 10 technicians) from all health facilities in Timbuktu district attended the workshop. At the workshop data was analyzed, indicators improved and recommendations made by health authorities, the World Food Program (WFP), and IMC, including:
- Providing all URENAMs with MAM inputs to reduce dropouts - Strengthening Family Planning activities in all health areas - Updating program data entry in DHIS2 - Preparing a template for CSCom data presentation - Involving ASACOs in future data analysis workshops
iii. Strengthening the Pharmaceutical / Medical Commodity Supply Chain and Financial Management Through ASACOS / FELASCOM Empowerment / Cost Recovery
The initial project policy strategy included the transition from total-free healthcare towards targeted-free healthcare (targets including children under 5 years old, pregnant and lactating women and survivors of gender-based violence) as well as cost recovery for other beneficiaries. In the first semester, the capacities of the main stakeholders (including ASACO members, local mayors, and CSCOM health staff) was strengthened through training and regular supervision in following areas: i) health policy and the roles and responsibilities of the various actors in its implementation; ii) the organization and functioning of ASACOs; iii) the general organization and functioning of the CSCOM; and iv) the mutual assistance convention.
Discussions were held with OFDA to seek agreement on the best way to implement the cost recovery strategy. Following these discussions, IMC and OFDA agreed that it would not be possible to implement cost recovery during the lifetime of this project for the following reasons: • Supporting ASACOs to purchase pharmaceuticals locally (intended for cost-recovery) through the use of OFDA funds is not allowed • The main priority objective of OFDA for this grant is that of saving lives through the provision of total free health care for all beneficiaries
It was therefore ultimately decided that total free healthcare will be applied for the entire duration of the two-year project. International Medical Corps will continue to support ASACOs for the running costs of the supported Health Facilities (HF), and for the payments of incentives to the 22 non-MoH salaried staff working in the targeted HF.
iv. Improvement of Health Care Services
The project carried out health needs assessments in several health structures. The following rehabilitation actions were taken at two of these (the Agouni Health Center and the CSRef SC in Timbuktu), which benefited from minor rehabilitations consisting of: • Agouni Health Center: roof repairs, painting, plumbing and toilet maintenance • Timbuktu CSRef SC: painting, space partitioning, replacement of defective electrical circuits
All the supported HF (i.e. Toya, Hondoubomo, Aglal, Bori, Agouni and the Timbuktu CSRef)
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received medical equipment such as blood glucose meters; hemoglobin photometers (HemoCue Hb 301); gynecology examination kits; operating theater lights; binocular microscopes; an otoscope set; oxygen concentrator and other.
There were 84 referrals of complicated diseases from the CSCOM to the CSRef of Timbuktu during this reporting period. Among those referred, 20 were children under 5 years old, 34 were pregnant women, and 30 were other cases. Pathologies referred and transported to the hospital for secondary care were primarily for: • Children under 5: SAM with medical complications; • Pregnant women: preeclampsia and eclampsia, extended labor, acute fetal distress; • Adults: trauma, severe anemia and hypertension
International Medical Corps provided fuel for the CSRef ambulance as well as meals for persons accompanying their stay in the hospital.
v. Strengthening Human Resources and Governance
To assist in HF functionality and the permanence of health care services, support for the human resources pillar was achieved through payments of incentives for 22 health personnel (who were not MoH employees). This support guaranteed the presence of an adequate number of health personnel at each HF to provide service packages adapted to the needs of the population. ASACOs were initially expected to take over 100% of these incentives once cost-recovery had started, but since the decision was taken for that policy no longer to apply, International Medical Corps will continue assuming 100% of these incentives until the end of the project in May 2021.
During the reporting period, human resources capacity strengthening was also achieved through the Training on Basic Emergency Obstetric and Newborn Care (BEmONC) session, conducted in early October 2019, targeting 8 health personnel involved in reproductive health (6 midwives and 2 nurses). The post-test showed that all participants improved on their level of skills, with an average score of 15 out of 20.
To strengthen the health governance system capacity, International Medical Corps supported in the organization of a two-day workshop (from February 28 to 29, 2020) on the management of the Timbuktu Health District. Workshop objectives, initiated by health authorities, were to: Present and validate the technical and financial 2019 assessment of the socio-health services in Timbuktu circle; Solidify programming of the operational plan for 2021; Validate the main guidelines for 2021 socio-health team Operational Plans in Timbuktu circle; Identify difficulties and make recommendations.
The main recommendations from this workshop were to: Revitalize consultations between technical partners, local authorities, health districts, ASACOs and mayors; Make functional the medicine warehouse of the Timbuktu circle; Reactivate the joint committee of the health district management; Put in place a plan to finance salaries of health personnel (those not employees of the MOH) to reduce turnover; Share regularly minutes of ASACO monthly meetings with town halls and the Local Development Service;
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Revitalize the mutual health insurance within the ASACOs; Estimate the needs of each CSCOMto make the advocacy with municipal authorities. vi. Reinforcing Districts Emergency Preparedness and Response Plan
Within this component, the main achievements during the reporting period were as follows:
. Surge Approach: Implementation of the surge approach progressed in the reporting period through the: Training of 17 health personnel from 5 health facilities on fundamentals of the Surge approach; Analysis of health and epidemiological data for each health area; Setting alert thresholds corresponding to the different phases (i.e. normal, alert, serious and emergency phases) for the most common diseases (i.e. malaria, acute respiratory infections, diarrhea, and severe acute malnutrition) for each health area; Defined action plans to be triggered when thresholds are reached, as well as estimated costs related to the action plans.
The next steps will consist of mobilizing necessary funds for the execution of each action plan while also working in collaboration with ASACOs and CHWs to ensure that they carry out community monitoring of the deadliest diseases (malaria, ARI and diarrhea and an increasing number of SAM cases).
. COVID-19 Pandemic Response Plan International Medical Corps is a key actor within the health sector in the Timbuktu region, and as such actively participated in the technical validation of the regional response plan for the outbreak of the COVID-19 pandemic. This response plan incorporates several objectives, including to: Strengthen multi-sectoral coordination of the various actors; Strengthen the epidemiological surveillance system and the capacity to respond to any alert; Develop a COVID-19 communication plan; Strengthen communication and social mobilization for behavior changes at all levels; Inform and sensitize the population; Promote prevention measures and ensure rapid isolation and treatment of suspected COVID-19 cases.
The first draft of the plan, completed in mid-March 2020, had a budget of 106 million FCFA (USD176,667); 100% of which was not covered. Resource mobilization is therefore necessary with the State and its humanitarian partners. Regarding next steps, International Medical Corps intends to contribute in the implementation of this response plan, particularly through: Disseminating national technical directives, communications, and case definitions; Supporting health worker training and COVID-19 IPC committees; Participating in information and awareness-raising of religious leaders, village chiefs and traditional healers; Ensuring the availability of hand-hygiene supplies such as disinfectants and other prevention products (e.g. hand-washing devices, soap, bleach, hydro-alcoholic solutions) in the supported health facilities; Ensuring the availability of PPE (personal protective equipment – i.e. gowns, gloves, glasses, boots, aprons, coveralls, 3M type bibs, etc.) in supported health facilities.
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At the time of writing, no COVID-19 cases had yet been confirmed in Timbuktu. But IMC aims to be ready to face the pandemic and mitigate its impacts on the population; discussions have been initiated with OFDA in this regard to integrate a mitigation and response plan into this grant.
Communicable Diseases
i. Strengthening Communicable Disease Prevention and Surveillance System
. During the reporting period the surge approach commenced (as detailed above). This will contribute toward anticipating the seasonal peak for the most common communicable diseases (i.e. malaria, ARI and diarrhea). Community Health Workers (CHWs) are involved in this approach, allowing them to establish rapid response systems at the community level for all alert cases.
. The collection and transmission of weekly epidemiological data was made regularly and in a timely manner for all supported HF. By the end of March 2020, 5 suspected measles cases had been reported in the Al Ourche health district. In collaboration with health authorities, IMC supported the investigation of these cases, all which had positive laboratory test results. Other positive measles cases were recorded in Timbuktu and Gourma Rharous health districts. During the reporting period, the measles outbreak continued evolving in these 3 health districts, with 5 cases in Timbuktu (0 deaths), 7 cases in Gourma Rharous (0 deaths) and 3 cases in Al Ourche (0 deaths). An immunization campaign is planned in Taoudénit for April and May 2019, by the regional directorate of health; IMC will contribute to its implementation in the upcoming period.
. San health district in Ségou also recorded 2 cases of measles in the rural commune of Madina; following an investigation, an immunization campaign was organized in the Madina health area, reaching 2,360 children aged 9 to 59 months.
. Strengthening the epidemiological surveillance system in light of the COVID-19 pandemic constitutes an essential strategic objective in the Timbuktu regional response plan; IMC actively plays a key role through its continuous field presence in the HF and through support provided.
. During the reporting period, 20,974 new curative consultations in communicable diseases, both within supported health facilities and in the MMU were carried out. These included 7,366 men; 9,353 women; 2,135 boys; and 2,120 girls. The main diseases were malaria (25%), ARI (21%) diarrheal diseases (19%), ENT infections (10%) and STI (4%).
ii. Improved Health Services Quality Through Joint Integrated Supervision
Throughout the second semester, supportive supervision visits were regularly carried out by the IMC team dedicated to this activity. The team included 1 Health and Nutrition Manager, 1 Nutrition Supervisor, 1 Sexual Reproductive Health Supervisor and 1 WASH Officer under the lead of the Health and Nutrition Coordinator. They were focused on the quality of curative care per the technical protocols, the rational use of medicines, hospital hygiene management and the functioning of the CSCOMs. Each CSCOM was visited at least eight times in these past six months, reaching a total 25 health staff.
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During the supervisory visits, the team used checklists including several sections (e.g. presence of staff; effectiveness and quality of curative and preventive activities; management of stock; hygiene; nutrition activities; reporting; etc.). Their main objective was in identifying deficiencies in the quality of services offered and in proposing solutions. Deficiencies identified during the visits concerned correlations between symptoms and prescriptions, as well as between diagnoses and prescriptions; the completion of tools; facility hygiene; and admission and discharge criteria in nutrition programs, etc. Actions plans were then put in place for each CSCOM, with corrective measures to fix deficiencies. Several on-the-job training sessions were organized in the CSCOM jointly with district technical focal points. The supervisory team also carried out individualized coaching sessions for health workers to improve their technical knowledge.
Aside from these regular formative supervisions, a bi-annual joint and integrated supervision (including IMC with the District Management Team and FELASCom) was carried out from November 26 to December 6, 2019 during which time all 6 pillars of the health system as well as the main actions of the project were reviewed for each of supported HF in the Timbuktu health district. An action plan was set up based on key recommendations from this supervision, and will be implemented in upcoming months.
Reproductive Health
i. Provision of Antenatal Care, Assisted Deliveries and Postnatal Care
Four CSCOM, one CSRef, and seven mobile clinic sites were supported in providing quality reproductive health services during the reporting period. This resulted in: . 3,300 pregnant women who received antenatal care services (ANC1: 1537, ANC2: 858, ANC3: 549, and ANC4: 363). Regarding the project sub-sector indicator, 1,770 pregnant women received at least two comprehensive antenatal consultations within these six reported months. . 702 assisted deliveries by a skilled birth attendant (76 by doctors; 296 by midwifes; and 330 by nurses). Some deliveries were conducted in health centers but did not meet the definition of being “assisted by qualified staff” (i.e. midwives, doctors, nurses) as the deliveries were assisted by TBAs (Traditional Birth Attendants). 41 such deliveries were conducted in centers by matrons and health assistants, with 53 births recorded at home. . 532 women and their newborns receiving postnatal care in the days following delivery; of whom 387 were in the 72 hours following the delivery. . Family Planning services provided in supported HF reached 284 new contraceptive users. . The training on BEmONC conducted in early October 2019 and supportive supervisions helped to improve the quality of reproductive health services provided for this reporting period.
ii. Clinical Management of Rape
A total of 4 cases of rape (1 teen girl and 3 adult women) benefited from clinical treatment between October 2019 and March 2020. Only one case received PEP kits within the 72 hours of the incident; the delay due primarily to the survivors and their families residences being in in remote places with high security constraints, and difficulty in accessing health centers more than 5 km away. The PEP kits were provided by the partner UNFPA. All the survivors received a psychological first aid and IMC ensured the reimbursement of referral fees for each survivor.
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Community Health
Reinforce Management and Coordination Capacity of ASACOs
Seventeen members of ASACOs were trained in the reporting period on the following topics, the: i. Health policy and roles and responsibilities of various actors in its implementation; ii. Organization and functioning of ASACOs; iii. General organization and functioning of CSCOM; iv. Mutual assistance convention
Notably, ASACOs are under the supervision of the FELASCom and the Local Development Services (DS). From February 22 to 24, 2020, IMC, jointly with the FELASCom and DS, organized a supervision of the supported ASACOs with the main objective of assessing their functionality and levels of commitment toward managing the CSCOMs. Although it appeared that all ASACOs were well aware of their roles and responsibilities in the management of the health facilities, some points needed improvement: • Low participation rates of all ASACO members in regular monthly meetings • Lack of communication with the community • Failure to take into account the quota of women and young people as ASACO members • Insufficient financial support from the municipalities • No annual meetings for any ASACOs with their line supervisory and technical services (Felascom, SLDSES, municipalities and health district management teams)
International Medical Corps and partners will work together to improve these shortcomings.
Support and Strengthen the Progressive Empowerment of the Network of Community Heath Volunteers Community volunteers are essential stakeholders in the implementation of actions for all sectors targeted in this project: Health, Nutrition, WASH and Protection. All community health actions started in the first semester continued into the second semester through the rigorous involvement of community volunteers – namely: community health volunteers (10 CHV in each health area), the Family MUAC approach and nutrition support groups (see details in the nutrition section of this report).
Update on the Husband School Approach The school of model husbands is an activity that the gender-based violence program (GBV) established to allow men to be more involved in helping women through reducing and solving population problems linked to the health and protection of their communities. During this period a series of actions were successfully initiated:
Training of 8 IMC staff and 10 partner staff working in health and protection; Increasing the skills of 10 husbands school coaches through training (staff, including government partners, were identified as husband school coaches); Choosing 4 health areas for the implementation of the strategy based on accessibility and health and protection indicators: two in Timbuktu (Toya and Hondoubomo) and two in Rharous (Benguel and Banikane); Orientation briefings which explained the husband school approach and selection criteria for participation in the school;
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Establishment of 4 husband schools, each consisting of 12 model husbands; Meetings held by each school with coaches to set up action plans related to specific health and protection problems within their communities. Pharmaceuticals and Other Medical Commodities
i. Strengthen Pharmaceuticals/Medical Commodity Supply Chain Management
To make the provision of healthcare services possible during this reporting period, IMC continued to supply supported health facilities with essential medicines and medical consumables. The international pharmaceutical order made at the beginning of the project (per quality policy required by both OFDA and IMC on this matter) was received in the field by the end of October 2019. The health facilities and mobile clinic were regularly provided with needed quantities of medicines and consumables from the main warehouse located in Timbuktu (managed by two IMC pharmacists). The rational use and distribution of these essential medicines by pharmacists in the health centers was monitored by supervision teams in collaboration with the Ministry of Health. During formative supervision, the team worked with DTCs on rational prescribing as well as standards for medical warehouses. Selected tracer medicines (i.e. Oxytocin, Amoxicillin, Artemether, Lumefantrine, Ferrous salt, Folic, Albendazole, Metronidazole, Oral Rehydration Salts, etc.) were tracked as indicators to measure the availability of essential medicines at all times. Thus for this reporting period no stock-outs of essential medicines were recorded.
Medical equipment such as blood glucose meters; haemoglobin photometer (HemoCue Hb 301); gynecological examination kits; lights for operating theaters; binocular microscopes; otoscope sets; oxygen concentrator and others were also provided to health facilities in this period. As a medical commodity supply management training session was organized in the previous OFDA project for health staff, a refresher training will be organized during Year 2 of this project.
WASH in Health Facilities
Activity 1: Collection and Disposal of Waste Generated from Health Facilities
In Timbuktu, under the 2018 OFDA-funded project (“Emergency Assistance to Provide Lifesaving Health, Nutrition and Protection / GBV services for Vulnerable Populations of Timbuktu and Taoudenit Regions, Northern Mali”), 4 IPC committees were established in the 4 supported CSCOMs, comprised of 7 members: 1 CHW, 1 care group representative, 1 ASACO representative, 1 municipality representative,1 health worker, 1 hygienist responsible of the health facility and 1 community leader. A key responsibility was to work closely with health personnel to ensure compliance with good hygiene practices in supported HFs; waste management; latrine cleanliness; the proper functioning of hand-washing devices and provision of potable drinking- water. Each IPC committee was provided with waste collection materials which incuided color coded waste bins with bin liners, brooms with handles, rakes, shovels, etc. These materials were intended to improve infection prevention and control at the health facilities.
Regular Awareness-Raising and Supervisory Actions During the month of August 2019, IMC Mali conducted a WASH in health facilities assessment to review the statuses of the WASH activities at the supported health facilities. the Assessment was led by the WASH in Health facilities specialist with the support of IMC Mali WASH officers. The
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assessment report revealed the needs for improvements as it relates to WASH in health facilities at the CSCOMs. To this effect, IMC has worked with the IPC commitees, health facilities staffs and the ASECO to device an action plan aimed at improving the WASH statuses of the health facilities. The action plan include, regular collection and disposal of waste in the health facilities, regular transportion of sharps to the CSRef for disposal, minor repairs of WASH infrastructures and regular awareness sections with patients, visitors and caregivers at the health facilities Every month IMC provided WASH kits (including soap, bleach, and gloves) to 4 CSCOMs and the CSRef. In this reporting period, IMC WASH officers visited each HF at least 3 times. Through these supportive supervisory visits, the WASH Officer, in collaboration with the IPC Committee, DTC and ASACOs, put together a separate action plan to reduce open defecations. Despite the availability of gender-segregated latrines at the health facilities, curtailing open defecation within the compound of the CSCOM remains a challenge at the health facility. The practice of open defecation by patients and caregivers is deeply rooted into the culture and traditions. To discourage open defecation within the compound of the health facilities and encourage the use of the latrines, IMC and the health facilities have initiated measures which include regular cleaning and monitoring of the compounds of the health facilities, directing patients and caregivers to the latrines, ensuring that lactating mothers take their children to the latrines, provision of hand washing station at the latrines to ensure access to water and soap for hand washing after the use of the latrine and awareness raising around the effective use of the latrines as well as the health benefits of using a latrine. During the next reporting period, aimc will distribute WASH IPC supplies to the CSCOMs to improve the hygienic conditions of the health facilities. Organizing Equipment During the reporting period, IMC provided color-coded waste collection bins with liners in Ségou. These materials were intended for the safe collection, segregated storage, treatment and disposal of biomedical waste collected within HFs. Waste management materials supplied during this period included: 106 red garbage bins (30-liter); 44 yellow waste collection bins (30-liter); and 80 black waste collection bins (30–liter). To avoid the mixing of waste at the disposal point after segregation, IMC installed color-coded metallic waste collection containers within the waste management zones. These included: red, yellow and black metallic bins at 21 units each. During this period, 21 wheelbarrows, 23 shovels with handles and 23 rakes were provided to CSCOMs to improve the environmental sanitation of HFs. WASH IPC kits were also provided to 20 supported HFs. These kits contained: 21 cartons of soap (48 pcs each); 21 cartons of powdered soap (500g packets); 21 cartons of bleach; 38 brooms with handles; 19 rakes; 57 industrial brush brooms; 57 rubber buckets (15-liter); and 76 mops. Activity 2: Construction of Waste Management Zones (Incinerators, Ash Pits, Sharp Pits and Placenta Pits) No new construction of waste management zones were done in either Timbuktu or Ségou during the reporting period; the amount budgeted for this activity (USD3,000) was insufficient to cover the cost of new constructions. An analysis was also done considering actions which would best contribute toward improving HF waste management, and priorities went toward providing sufficient WASH kits to all supported facilities; ensuring the functionality of each IPC committee; and constructing new latrines segregated by gender in Bori (Timbuku region). Following a more in-depth analysis of the budget and the priority needs for the entire project, IMC will reassess the feasibility of building / rehabilitating incinerators, and ash, sharp and placenta pits in Year 2 of the project.
Activity 3: Healthcare Waste Management Training
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No new trainings were conducted in Timbuktu between October 2019 and March 2020; however the hygienists and IPC committee members (all trained in the previous OFDA-funded project to oversee waste destruction in the incinerators following segregation) were technically supervised by the IMC WASH Officer in close collaboration with the district WASH focal point.
In Ségou, 47 staff (hygiene managers, laboratory agents, those in charge of incinerations, hygienists and vaccinators) from 19 health areas, including 4 women and 43 men, were trained on biomedical waste management. This training took place in February 2020 and contributed to significantly improving the capacity of these health workers concerning biomedical waste management.
Activity 4: Training of Infection Prevention and Control (IPC) Committees As the IPC committees in Timbuktu had recently been trained in the previous OFDA project ending in 2018, technical supervision initiated in the first semester of this project was a priority. Following an assessment which determined that all IPC committees in Timbuktu were functioning well, another joint assessment was conducted in March 2020 by IMC and the health district to update needs regarding WASH kits, equipment / rehabilitation / repair of infrastructure and equipment in health centers to ensure these committees continued operating well. Priority needs were identified primarily for the need of COVID-19 prevention kits.
In Ségou, members of the 19 Infection Prevention Committees (established in 19 health areas in San health district in the first semester) were trained during this second semi-annual reporting period. A total 203 members, including 130 men and 73 women, were trained on WASH aspects linked to IPC. Training topics included: water quality and treatment, management of excreta at the health facility level, wastewater management, biomedical waste, hand and food hygiene, vector control, generality of infection, the chain of infection transmission and hygiene promotion. Training sessions were organized on-site by the IMC technical team jointly with the WASH focal point in Sanin Health District.
NUTRITION
Infant and Young Child Feeding (IYCF)
i. Mother Support Groups
In Timbuktu, 48 mother support groups were active and organized IYCF education sessions, home visits and cooking demonstrations; the mother support groups organized 284 group education sessions and reached 2,912 people (732 men and 2,180 women); they carried out 53 home visits with 263 people visited (including 46 men and 217 women).
The mother support groups were in charge of sessions about on: • The different aspects of exclusive breastfeeding; • Introduction of complementary foods; • Early initiation of breastfeeding and the benefits of colostrum; • Nutritious diets for PLWs (pregnant and lactating women); • Nutritious diets for malnourished or ill children; • Dietary diversity; • Handwashing with soap; • Sleeping under impregnated mosquito nets
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Monthly meetings were held during this period, gathering care groups members, the DTC, ASACOs members, municipal councilors, IYCF and health promotors, GBV focal points and CHWs.
In Ségou, 132 members of 22 GSAN were trained and supported with kits for cooking demonstrations. These kits were composed of kettles, spoons, pots, and plates. Nutrition education activities were organized, including cooking demonstrations in the health areas of Jebala, Jeguèna, Dah, N'Torosso, Niamana, Lafiabougou, and Sourountouna. A total of 920 people participated in these IYCF activities at the community level, including 416 women, 57 men, and 447 children; 58 children were screened for nutrition, which led to the identification of 10 MAM cases and 3 SAM cases which were admitted tointo OTPs/TSFPs for treatment.
Cooking Demonstrations: In Timbuktu, 17 cooking demonstration sessions were organized in which 663 people (139 teenage girls, 469 women and 55 men) participated. In Ségou, 22 sessions were done in the 19 health catchment areas, with a total of 1,051 people participating, including 505 teenage girls and 546 adults (503 women and 43 men). The various recipes demonstrated used locally available and accessible foods, including peanut-enriched porridge, potato soup, and fish soup. The GSAN provided some food items, while participants were asked to bring some as well.
ii. Other IYCF/IYCF-E Activities in Supported Communities
In Timbuktu, IMC continued to work with community-based organizations in all activities to prevent malnutrition as well as the promotion of optimal IYCF practices and prevention of related diseases. Among these CBOs, the husband schools were set up. This strategy will ideally help strengthen community volunteer networks and have impact on nutrition practices.
In Ségou, all project period long, education activities on IYCF and hygiene have been conducted including messages on the importance of breastfeeding, complementary feeding and hand- washing using soap in which 4,549 people were reached (including 607 men, 1,912 women, and 2,030 children) from the Niasso, N'Gao, Djèguèna, Baramandougou, Diakourouna, Niamana and Sourountouna health catchments areas. The objective was to increase community knowledge on preventing malnutrition.
iii. Family MUAC Approach
In Timbuktu, within 779 households, 1,230 MUAC mothers were trained and provided with MUAC tapes. In the first six months of this project 465 others had already been trained in Ségou, then 344 new mothers were trained on using MUAC tape in this reporting period (primarily in the 11 health areas of Bounoumba, Baramandougou, Jeguèna, Djèbala, Dah, Kononso, Koro, Lafiabougou, Ouolon, Somo and Sy). This brings the total number of trained MotherMUAC Mothers to 2,039 under the auspices of this project (1,230 in Timbuktu and 809 in Ségou). The MUAC Mothers contributed to an increase the number of children screened for acute malnutrition, as explained below.
Management of Acute Malnutrition
i. MUAC Screening to Idenitify Children 6-59 Months with Acute Malnutrition
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Screening activities continued during this reported period through: i) systematic screening by health workers during routine activities such as curative consultations, child growth monitoring, vaccinations, and antenatal consultations; ii) routine screening by the community health volunteers, including the 41 CHWs and the 2,039 MUAC mothers; and iii) active screening coupled with the seasonal chemoprophylaxis of malaria campaigns. As a result of these activities, a total of 46,004 children 6-59 months were screened within the 23 supported health areas in Ségou and Timbuktu, including 26,753 girls and 19,251 boys. Among them, 1,332 cases of MAM and 576 cases of SAM were identified and referred toward the nutrition treatment programs. Also, 2,502 pregnant and lactating women were screened during these activities.
ii. Treatment of Acute Malnutrition With and Without Medical Complications According to the National Protocol
. The management of SAM without medical complications continued during this reported six months through supporting 23 OTP (19 in Ségou and 4 in Timbuktu). A total of 1,501 children 6-59 month (849 boys + 652 girls) were admitted and treated for SAM without medical complications in the 23 supported URENAs (OTPs).
To make this possible, UNICEF provided the ready-to-use therapeutic food (RUTF), for which IMC facilitated transport and deliveries at the CSCOMs. International Medical Corps’ support also included: • Formative supervisions by the technical team (health and nutrition supervisors, managers and coordinators), who contributed to improving the quality of treatment provided. These supervision visits allowed the identification of and solving of inadequacies such as i) non- compliance toward admission and discharge criteria; ii) non-rational usage of nutritional supplies; iii) mistakes in filling the reporting tools. • Provisions of essentials drugs for routine treatments of SAM. • Ensuring the referral of complicated cases to the stabilization center (SC).
The analysis of the cumulative performance indicators since the beginning of this project showed the following: recovery rate of 98%; defaulter rate of 1.5%; death rate of 0.5%; and an average length of stay of 6 weeks.
. The treatment of SAM with medical complications was done at the Timbuktu and San SCs. Throughout this reporting period, 181 children suffering from SAM with medical complications (87 boys and 94 girls) were admitted and treated in the 2 SCs (146 in San and 35 Timbuktu). Of these 181 admissions, 102 were direct admissions from pediatric consultations, while 79 were referred from the CSCOM. To support the SC, IMC provided the essential drugs and consumables for the treatment of medical complications and medical equipment to ensure the daily functionality of the SCs. UNICEF provided RUTF, therapeutic milk (F75 and F100) and anthropometric materials. The 12-month cumulative performance indicators are: o stabilization rate 94.3% (these cases were returned back to OTP to complete the treatement of the SAM); o defaulter rate 0%; o death rate 5.7%
The average length of stay was 9 days; and the average weight gain per day was 7.2g/kg body weight. International Medical Corps also conducted promotional activities at the SC, reaching 189 women through 32 nutrition education sessions; 193 mothers or accompanying
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children to the URENI were trained as PB-mothers. 32 cognitive stimulation sessions were also organized.
. Other activities were conducted to ensure a comprehensive management of SAM including:
• the training of 10 SC staff on the specific care of children less than 6 momths old. All 10 participants (including 6 women and 4 men) improved their level of skills; • the distribution of 146 WASH kits to children admitted to the URENI (bed sheets, bleach, soaps, plates, spoons, 250 ml bowl with covers, 10-litre cans, 20-litre buckets with covers, medium and large-format jars); • the provision of the 19 San OTPs with WASH kits (bleach, soap, 250 ml bowls with closures, 10-litre cans, 20-litre buckets with closures) for severely, acutely malnourished children without medical complications admitted in the program; • the provision of data collection tools to the 19 CSCOMs and the URENI of the CSRef; • the provision of medicines and equipment (Hemocue, oxygen extractor device, blood pressure monitor, thermometer, Glucometer, otoscope, etc.) to the SC to improve the quality of the treatment of SAM with medical complications.
iii. Continue the Referral System for Cases of SAM with Medical Complications to SCs and Back to URENAS for Continuation of SAM Treatment
During this second semester, IMC continued to support the referral system and transportation for cases of SAM with medical complications from the OTPs to the SCs and then from the SCs to the OTPs. This was made through providing fuel for the ambulances every month, supporting the maintenance and repair fees of the ambulances, and ensuring that the accompanying caretakers receive meals during their stay at the hospital. Out of 181 children admitted in the two SCs, 102 were directly admitted from pediatric consultations and 79 were referred from the CSCOM. At the end of their stays in the hospital, IMC also ensured that all were safely returned home and continued their treatment of SAM within the OTPs.
iv. CMAM Surge Approach
Please refer to the section “Reinforcing Districts Emergency Preparedness Plan and Response.” WASH
Hygiene Promotion
Activity 1: Hygiene Promotion Sensitization and Awareness Campaigns Over the past six months hygiene promotion activities were organized in all supported Timbuktu and Ségou health areas by IPC committees with the technical support of the WASH Officers, the Community health promotors and the IYCF Supervisor. Key topics covered included:
Proper handwashing techniques; Critical moments for handwashing; The importance of handwashing; The water chain: collection, transport, storage, use and consumption
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Domestic water treatment methods; Chemical methods of water treatment: use of liquid bleach and water purification tablets (Aquatabs); Using and maintenance of latrines/toilets.
A total of 26,692 people, including 16,447 women and 10,245 men, were reached.
Activity 2: Promotion of Handwashing with Soap In the first semester, hand washing devices were set up in all 47 health centers (5 in Timbuktu, 12 Gourma Rharous and 20 in San). The devices were placed at consultation points, next to toilets and at entrances of health centers. This contributed to improving the hand washing in these HF during the second semester.
On the occasion of celebrating Global Hand Washing Day on October 15, 2019, International Medical Corps organized an awareness-raising campaign in both Timbuktu and Ségou; involving local authorities and some community leader groups (ASACOs, health personnel, mayors, village chiefs, Imans, pupils and volunteers). In Timbuktu approximately 1,114 people, received awareness messages on handwashing with soap, while in Ségou 2,900 people from the communities of Sy and Djéli participated. The practice of hand washing with soap became a highly recommended measure since the outbreak of COVID-19. Added to the use of hydroalcoholic solution and personal protection equipment, hand washing is now a priority hygienic practice to hinder the spread of COVID-19. Sanitation Infrastructure
Activity 1: Construction of Latrines Segregated Per Gender In Timbuktu the construction of the new gender-segregated latrine was completed in the Bori CSCOM. The IPC committee and the hygienist will be in charge of ensuring the cleanliness of the new latrine. The construction of six blocks improved pit latrines in six health centers in Ségou is ongoing, with the main objective of ensuring effective management of excreta and improving access to sanitation for patients, visitors, and staff. Indeed, as previously explained, this aims to improve patient comfort as the risk of nosocomial diseases transmission increases. International Medical Corps has opted for sustainable latrines designed to eliminate odors and reduce the proliferation of vectors (i.e. flies and insects). During this period IMC selected the sites for latrines construction in collaboration with the DTC (Directeur Technique du Centre) and the regional Directorate. Health centers and communities without access to latrines were prioritized for construction. The building should be completed within several months.
Water Supply
Activity 1: Rehabilitate and upgrade water sources and distribution systems The rehabilitation of the Aglal CSCOM water tower was completed in December 2019, with a 10,000-liter water storage capacity. The rehabilitated water tower will contribute to ensuring the constant availability of water within the Aglal health facility, thus improving the quality of health care provided to beneficiaries. The patient load of the health facility is estimated at 690 monthly and this water storage capacity is sufficient to cover this CSCOM’s needs.
Activity 2: Improve water quality testing and monitoring
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The procurement process for water testing kits is ongoing. International Medical Corps will purchase these tests internationally or with a national prequalified vendor to meet minimum standars of qualify for these test kits.
PROTECTION
1. Sub-Sector 1: Prevention and Response to GBV Community Outreach Activities: International Medical Corps, in collaboration with three womens’ associations committee (CAFO) volunteers and community health workers (CHW), carried out several outreach activities during this reporting period. All stakeholders were previously trained on GBV principles and techniques to assist them to communicate effectively in local languages concerning GBV. The womens’ associations have been involved both in the elaboration of GBV prevention messages and their dissemination throughout the community.
Activities were done through: • 28 discussion sessions with men (14 in Timbuktu and 14 in Gourma Rharous), covering topics such as positive masculinity; consequences of early and forced marriage; and the importance of communication within the couple. These reached 423 men (224 in Timbuktu and 199 in Gourma Rharous) • 26 discussion sessions with boys (13 in Timbuktu and 13 in Gourma Rharous), on topics such anger management; types of GBV; equality and equity. These reached 393 boys ( 218 in Timbuktu and 175 in Gourma Rharous) • 24 discussion sessions with girls (12 in Timbuktu and 12 in Gourma Rharous), on topics including positive ambition; rape; consequences of sexual violence; and types of GBV. These reached 312 teen girls (189 in Timbuktu and 123 in Gourma Rharous) • Weekly awareness-raising sessions with women's associations. The main topics were types of GBV; the importance of communication within the couple; women's rights; the participation of women in the proper management of the household expenses. ; the consequences of sexual violence, the referral system of GBV cases. This reached 2,242 women (1,322 in Timbuktu and 920 in Gourma Rharous). • Four radio broadcasts with local stations and large-scale (2 jinglles in Timbuktu and 2 live discussion in Gourma Rharous). Two topics were developed for these 4 broadcasts: the involvement of community leaders in actions against GBV, and the involvement of women's associations against GBV. • Awareness-raising during international campaigns (March 08 - Women's Rights Day, October 11 - International Day of the Girl, 16 Days of Activism). Several activities were organized by IMC with partners, which are the CAFOs and the Regional Directorate for the Advancement of Women, Children and the Family (DRPFEF): poetry competition in local languages; mass awareness at women's centers; live radio broadcasts; inter-school sketch competitions on GBV topics; a caravan of men's groups; a sketch competition between women and girls at WGFS; and round table discussions with community leaders on women's rights. Around 8,265 people, including 4,958 women, 2,479 girls, 250 boys and 578 men participated. Topics covered during the celebration of these international campains included the consequences of GBV, community-based actions to end violence, services availability and survivor support strategies. Some activities were tailored to be addressed only to women or men; others were general information and open participation.
To reach more people, Community Health Volunteers (CHV) were assigned door-to-door awareness raising on key messages: early referral, and services available at the health center.
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Approximately 5,509 people were reached, including 2,755 women, 1,387 girls, 816 boys and 551 men. Program staff also organized group discussions about topics challenging cultural norms, including early marriage and the confinement of women.
All community outreach activities conducted on the GBV program reached around 34,815 people (13,807 women; 6,306 men; 8,648 girls; 6,054 boys), detailed as follows:
• Activities conducted by the volunteers within the villages reached 13,774 vulnerable people, including 5,069 women, 3,392 girls, 2,860 boys and 2,453 men. These also included achievements during the celebration of the three international campaigns: March 08 - Women's Rights Day; the International Day of the Girl on October 11; and the 16 Days of Activism from November 25, to December 10. • Activities with CHW within HFs and villages reached 19,303 people, including 7,829 women, 4,427 girls, 3,194 boys and 3,853 men. • Activities in the WGFS led by women and girl members of associations reached 1,738 people, including 909 women and 829 girls.
Activities Men Women Girls Boys Total Conducted by volunteers 2,453 5,069 3,392 2,860 13,774 in the villages Conducted by CHW in the heath 3,853 7,829 4,427 3,194 19,303 facilities and villages in the WGFS 0 909 829 0 1,738 Total 6,306 13,807 8,648 6,054 34,815
Supportive Supervision: During this reporting period the GBV team (Manager and Officers) conducted several field visits to monitor program activities and meet main stakeholders in both Timbuktu and Gourma Rharous. These field visits were organised to identify strengths and weaknesses and propose solutions / corrective actions. GBV officers organised the supervision visits and GBV focal points ensured the support of survivors and awareness-raising activities in field sites. During the visit, staff (social workers) organised individual meetings with focal points to discuss specific cases and provide guidance. Program staff provided support to both GBV focal points and community health workers for awareness activities, while also managing the stock of dignity kits and other inputs (NFI and Food) purchased in program for vulnerable women and girls and some survivors. GBV focal points in the supported health facilities (who are in charge of providing GBV services in these HF) are encouraged to liaise with other health facility staff to ensure other GBV survivors are treated in the health facility.
The main recommendations from these field visits were to organize: - refresher trainings for CHWs on the basic concept of GBV and communication techniques; - a more in-depth training of husband models and community leaders on the different aspects in the fight against GBV; - refresher trainings of health personnel on the CMR.
Trainings:
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During this period, service providers and influential community members, as well as other partners, participated in trainings to learn about the causes of GBV, its impact on women and girls and their role as instruments of change in the protection of their rights.
Topics Trained Persons Women Men Girls Boys Total Husbands schools’ approach IMC Staff training 7 13 20 and partners in Timbuktu
Husbands school approach Coaches in charge of training the supervising the 6 10 16 model husbands
General concepts in GBV Pupils from Timbuktu and communication technics 10 30 20
General concepts in GBV Pupils from Gourma and the referral pathway 6 15 Rharous 9 Total 13 23 29 16 81 A key component of the capacity building consisted to work with women from women's associations group within CAFO (coordination of women's associations and NGOs in Mali). In fact, the management of the WGFS is done by committees set up by the various women's associations of Timbuktu and Gourma Rharous. Each committee is composed of case managers and facilitators responsible respectively for psychosocial care and GBV awareness-raising within the center and villages when necessary. Such collaboration for care is a success because it involves the leadership of women and increases their skills in promoting the rights of women and girls.
2. Sub-Sector 2: Psychological Support Services Between October 1, 2019 and March 31, 2020, 71 GBV survivors were assisted and documented (58 adult women + 13 minor girls). They benefited from individual psychosocial support and referral to other services when necessary. This support has been provided through the 3 WGFS which included private counselling rooms to offer a space for counselling for GBV survivors. Activities were organized confidentially to increase women’s confidence to disclose their GBV experiences with social workers and to seek support from peers if they wished.
Type of GBV Total Cases (October – March) Rape 4 Sexual Assault 2 Physical Assault 15 Early / Forced Marriage 6
Denial of resources and 21
opportunities Emotional / psychological 23 abuse Total 71
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The 71 GBV survivors received basic psychosocial support from focal points and volunteers at the WGFS and referred to other services (socio-economic and legal) according to their identified needs and consent. All of the 4 cases of rape were adults. Only one case was reported within 72 hours and received appropriate clinical management of rape. The 3 other cases were reported more than 3 months following the incident. The delay was mainly linked with the fact that survivors and their families’ lives in remote places with high security constraints, and access to health centers is more than 5 km. The program considered this to be a challenge and will continue increasing information-sharing through outreach activities (including through radio programs) on the importance of appropriate care within 72 hours, with the expectation that the information reaches more beneficiaries.
The WGFSs have also been a space for group PSS activities in the adjacent space for skill building. In the dynamic of supporting the social reintegration of the survivors, they are encouraged to participate in various activities carried out in the different centers to acquire the necessary knowledge and skills in sewing, literacy, embroidery, transformation of local products (dried vegetables etc.). 475 vulnerable women and girls enrolled in the two WGFS in Timbuktu and Gourma Rharous and participated in GBV awareness-raising activities, including early marriage and the importance of schooling for girls.
The WGFSs in Timbuktu region also served as a space where GBV survivors could receive PSS to promote positive coping mechanisms, build social support networks, and alleviate isolation and stress often experienced by women and survivors of violence. Women meet daily with their peers and participate in education sessions.
Also, the IMC GBV program was implemented in collaboration with the DRPFEF (Direction Régionale de Promotion de la femme, de l’enfant et la famille), women leaders and selected volunteers from the community.The DRPFEF is the regional representation of the ministry in charge of promoting women's rights and fighting against GBV. It constitutes the State stakeholder involved in the implementation of the IMC's GBV program.
All partners benefited from the capacity building (trainings, coahing and supervisions) to be able to provide PFA and to refer survivors safely to social workers for case management services and support. In case management, support was given to survivors according to her needs and choices. Frequently, certain family members identified by the survivors were associated with the psychological care and reintegration of survivors.
Coordination: International Medical Corps supported the GBV regional monthly coordination meeting, ensuring the role of GBV regional co-lead in collaboration with the government counterpart (DRPFEF) in Timbuktu. Support included meeting preparation agendas; printing and invitation distribution; and the sharing of standards during international events and local activities. International Medical Corps was also actively engaged in all relevant humanitarian coordination meetings and inter- sectoral meetings to promote high quality standards of delivered assistance at the regional level. The GBV program will continue to provide national and global information on GBV through regular update of the GBVIMS tools.
At the Timbuktu field level, the program team continued actively participating in coordination mechanisms put in place by UNFPA and the DRPFEF to ensure that activities align with priorities and to harmonize interventions with other implementing actors and government line ministries to avoid duplication. Additionally, to strengthen the existing referral pathway, IMC worked with
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DRPFEF and UNFPA to review focal point contact lists and to discuss challenges related to survivor referral (as there are many different entry points for a survivor to disclose).
3. PROGRAM ADMINISTRATION
A. SECURITY
Socio-political context: The Abduction of the leader of Mali’s political opposition and members of his campaign team by unidentified gunmen in the north. Soumaila Cissé and members of his campaign team were abducted on March 25, 2020 in the Niafunke circle area where he was campaigning for legislative elections. The socio-political context during this semester was mainly characterized by:
Inclusive National Dialogue: Organized by the Malian government, this took place in December 2019 with the objective of establishing a rigorous assessment of the issues that Mali is facing and analyzing them (causes and consequences) in a participative and inclusive manner. The purpose of this initiative is to propose solutions to end the crisis, including an action plan and implementation timeline. Several actors were consulted, both inside and outside the country. Decentralized debates were organized in municipalities, circles, regions, Embassies and Consulates. Six themes were widely discussed in various working groups: 1. Peace, Security and Social Cohesion; 2. Political and Institutional 3. Governance, 4. Social; 5. Economy and Finance and 6. Culture, Youth and Sport. Four resolutions were recommended at the end of this dialogue, the:
1. Organization of legislative elections (before May 2, 2020); 2. Organization of a referendum for the revision of the constitution of February 25, 1992; 3. Immediate redeployment of the reconstituted armed and security forces throughout the territory; 4. Revision of certain provisions of the agreement for peace and national reconciliation according to Article 65; as well as negotiations with Amadou Koufa and Iyad Ag Ghali (leaders of armed groups linked to Al-Qaeda) to "bring peace back to Mali."
The COVID-19 Pandemic: The first positive case of COVID-19 in Mali was recorded in March 25, 2020. By March 31, a total of 31 positives cases were confirmed with reportedly 3 deaths. The Government of Mali has implemented measures to limit the spread of COVID-19. Schools and universities are closed until April 9, 2020. Sporting events, festivals, and gatherings larger than 50 people have been banned, and bars and nightclubs have also been closed. The government has imposed a curfew from 9:00 p.m. until 5:00 a.m. daily. Effective March 20 at midnight, the Government of Mali has prohibited flights coming from countries with confirmed cases of COVID-19.
The Legislative Election: Despite the COVID-19 crisis and the abduction of key opposition political leader in Timbuktu/Niafunke, the first round of the 2020 Malian parliamentary election took place on March 29, 2020, and the second is scheduled for April 19.
Security Context:
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The security context remained a concern during this semester, especially in the northern (Gao, Kidal, Menaka, Timbuktu) and the central (Mopti and Ségou) parts of the country, with various and numerous incidents.
At least 183 security incidents (of various types) were reported by INSO in the Timbuktu and Taoudeni regions, of which 18 directly involved NGOs. These included: targeted attacks, clashes between armed groups, improvised explosive devices, targeted assassinations, increase of inter- ethnic tensions - criminal acts, like theft of vehicles belonging to NGOs, UN organizations, the Malian state, and also individuals). In the Timbuktu region the main security constraint is relative to the Gourma Rharous Circle where the situation got deteriorated during 2019 with numerous incidents and the intensification of military operations. As part of its projects (OFDA / GBV and ECHO) IMC teams have to conduct daily programmes ops in the Gourma Rharous circle. Security situation in this ops area is becoming more and more challenging as follows depicted: - Gossi: Access to Gossi remains hampered: confirmed presence of radicals - presence of soldiers - attacks of civilian populations – life threats - desertion of local authorities etc;; - Tintadenit: the situation in Tintadenit is almost similar to Gossi;; - Bambara Maoude- Korobella and Haribomo: so far, our teams had been able to go there with increased alertness and situational awareness, but in recent months the situation has further deteriorated: confirmed presence of radicals- increase in the number of incidents (even the vehicles of the 2 mayors of Bambara and Haribomo have been snatched in the past few weeks) - desertion by the local authorities, etc. It is now very risky to go to this area. A visit has been conducted by IMC security manager to assist the Sub-office in monitoring the security situation in the Gourma Rharous , understand the criminality increase in Timbuktu and recommend best mitigations to ensure compliance with staff Duty of Care.
In Ségou region, the security situation remained stable but volatile and precarious. Most reported incidents include targeted assassination by radical groups or intercommunity revenge between Bambara/Dozo hunters and Fulani, robbery, attacks on national security force by radical groups. There has been in increased security incidents for the reporting period in Ségou region at high level in comparison with last semester. For the reporting period, a total of 154 incidents occurred in Ségou region within 20 were for San (13%) while only 60 were ported last semester. Major incidents in San were characterized by robbery of cattle from Fulani, kidnapping of men from the Bozo community by Bambara hunters and Fulani, intimidation on population and attacks by groups of self-defence from Bambara/Dozo hunters and Fulani communities resulting on internal population displacement.
Political violence remained the critical threat in the central and northern regions in Mali. The intercommunity clashes and the presence of radical groups in the San Circle has negatively impacted the economy of residents mostly in rural areas while the national security forces retain only limited control over territory outside of urban centers in large parts of the region.
B. POPULATION MOVEMENTS - BENEFICIARIES UPDATE Due to the various security incidents mentioned above, some displacements of groups of the population have been recorded during this reported semester. The most concerned Circle is Gourma Rharous were the security context deteriorated. Around 10,587 IDPs corresponding to 1,760 households were reported in Timbuktu during this period; detailed as follows: • In October 2019, around 1,863 IDPs (306 households) recorded in the Commune of Ber (Circle of Timbuktu); • In November 2019 around 1,884 IDPs (314 households) recorded in the Commune of Hamzakoma (Circle of Gourma Rharous);
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• In January 2020 around 5,220 IDPs (870 households) recorded in the Commune of Bambara maoude (Circle of Gourma Rharous); • ) In January 2020 around 1,620 IDPs (270 households) recorded in the Commune of Haribomo (Circle of Gourma Rharous).
Under the coordination of OCHA several NGO including IMC contributed to assist these IDPs.
In Ségou, according to the Local Service for Social Development and Solidarity Economy, the situation of Internally Displaced Persons (PDIs) during this semester in the San health districtwas marked by an increase in new arrivals compared to the last semester. There are 1878 IDPs composed of 305 households including 234 children, 875 Men and 769 Women. The areas concerned are: Lafiabougou, Farakolo, Medina, Dabani. The main reason for PDI was the threats and attacks by conflicting communities (Donzos and Peulh Hunters) in the Mopti region and the Niono and Macina Circles.
C. COMMUNITY PARTICIPATION As in the previous semester, community mobilization, participation and involvement of local governance structures remained high in the implementation period. Also, IMC continued to work in close collaboration with ASACO in each health catchment area. Through collaboration with IYCF Support Groups, CHWs, ASACOs, FELASCOM, IMC receives feedback from the community, so during this reporting period, the most common feedback was focused on the start of cost recovery. During the month of September, a radio message designed with health authorities and the ASACO was broadcasted during two weeks to explain how the recovery was done.
For the region of Taoudénit, IMC has received several requests for support without immediate solution. These include: the integral construction of health centers, the drilling. Besides, several tribal leaders came to the office to express their gratitude and support for IMC's interventions in the region and have taken the opportunity to reassure IMC of their support in terms of security.
In order to sustain GBV response and prevention activities, 76 women leaders from associations are part of the committees of the WGFSs in Gourma Rharous, Diré and Timbuktu. They are trained on GBV concepts, psychosocial support and how to manage a women’s center /how to organize a committee and they are fully at the center of International campaign related to women and girls’ rights.
On the same note, boys and girls are also reached through their participation in activities developed for their age group. The GBV program carried out community outreach activities to mobilize men and women to prevent and respond to GBV in culturally appropriate ways (sex specific group sessions or community leader separate groups).
The community of San health district is involved in this project from conception to implementation through the involvement of more than 900 community volunteers, 42 Community Health Workers and 19 ASACO members who cover the 19 clinics supported by IMC; These community volunteers and Community Health Workers participate in all active screening, referral, Mother MUAC training, community edema research in the fight against severe acute malnutrition and all activities linked with WASH. IMC established feedback mechanism in clinics to ensure all comments and feedback from beneficiaries of current actions are shared with the agency ensuring accountability towards them. Weekly visits to health facilities have also enabled to IMC staff to discuss with communities and health staff to identify priority needs.
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D. GOVERNMENT SUPPORT During this second semester, IMC continued to maintain a strong partnership with stakeholders such as ASACOs, DTCs, CSRef and the Regional Directorate of Health. Through the launching Workshop, IMC explained the outline of the MoUs and how each party would be involved including the regional direction of women, children and family (DRPFEF).
In Ségou IMC has the full support of the administrative and ministry of health authorities of the San health district through the Prefecture, the Circle Council, the Social Development and Solidarity Economy Department, the City Council and the staff of the San Health District. Support include: availability of working space in CSRef for IMC staff, sharing security information, provide an update on the IDPs situation, their full involvement in the implementation of project activities, sharing malnutrition data; WASH needs assessment and Strengthen the capacity of Ministry of Health staff.
At regional level, IMC continued working in collaboration the Regional Health leading Office (DRS) that provides the full support for the project. At health district and Regional level, IMC continued working closely with state partners and other humanitarian actors to maintain synergy and complementarity with other interventions, and explore avenues to have new donors able to provide structuring interventions.
E. FIELD COORDINATION/ COLLABORATION WITH OTHER ACTORS To ensure optimal synergy and complementarity and avoid overlap in partner interventions, field coordination was essential. Regarding the coordination with the health authorities, IMC worked in collaboration with the district management team, and the regional health department, so that the efforts of the Ministry of Health and those of IMC are combined. Meetings between these entities and IMC were held on a routine basis, and all project activities were conducted with MoH staff. The signing of the MoU has formalized this close collaboration. During the activities of the mobile clinics, IMC solicits the support of the regional directorate of health of Taoudénit to make available for the team a vaccinator and a guide. Also before any MMU, the mobile team held a meeting with the health authorities to collect their needs. This mechanism has strengthened collaboration and information sharing.
In Timbuktu IMC participated in various meetings, organized as part of humanitarian coordination under the lead of OCHA or the MoH (monthly meeting of the Health -Nutrition thematic group - monthly meeting of GIAC members)- IMC had several bilateral meeting and exchanges with WFP, UNICEF and other NGO (NRC- HI- Action Against Hunger – Plan International Mali, AMSS, etc.).
In Ségou, IMC participates actively in the Cluster system (Health, Nutrition and WASH) and was assigned as coleader at regional level. In addition, IMC has close contacts with other humanitarian actors (UN agencies, NGOs and donors) in Ségou to ensure that response activities do not overlap. IMC intends to ensure quality coordination between Health actors operating in the region and to create synergies between them. Besides, IMC coordinates with other local NGOs such as: World Vision, MSI, PSI, which are also operating in San as part of the implementation of the Nutrition Support Program - Health - WASH and Family Planning. Also, at national level, IMC actively participated as key partner for several coordination meetings such as: Sub Cluster GBV monthly coordination meetings; WASH Cluster coordination meetings and Common health framework meetings. Some keys actions of this meetings are: • Share updated on interventions package; • Ensure there is no duplication on partners’ actions;
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• Formulate recommendations.
F. HUMAN RESOURCES The project management team includes dynamic staffs and 98% of the positions were filled. both in the field and at Bamako.
In Timbuktu/Taoudénit the team is composed of: 1 Health / Nutrition Coordinator, a Health/Nutrition Manager, 1 IYCF Supervisor, a Reproductive Health Supervisor, a WASH Officer and a mobile team composed of a Medical Doctor, a nurse and a Midwife. For the GBV component: a coordinator accompanies a manager, 2 officers, 2 social workers. This team is assisted by a support team composed of: 1 Financier, 1 Logistician, 1 HR, a Liaison Officer and a Logistics Assistant. On the side of the pharmacy, 1 Pharmacist and an Assistant ensure the proper functioning of the supply chain.
In San, IMC made available 1 health and nutrition manager, 1 Monitoring and Evaluation officer, 1 nutrition supervisor, 1 WASH officer, 2 community Mobilizers. Furthermore, to improve operational support to field staff, IMC made available an international field coordinator as team leader for the agency interventions in Ségou region.
The field team is supported by a coordination team in Bamako. IMC Mali is headed by a Country Director, who is supported by a senior management team (SMT). The SMT meets weekly for cross-cutting discussions and formal decision-making. The SMT drives the country's program policy and strategy and also ensures that activities are aligned with the broader strategy and policy of the organization. During the reporting period, IMC ensured that human resources are used efficiently to maximize results.
G. MONITORING AND EVALUATION During the first semester of project, the program baseline values for performance indicators were determined through a baseline evaluation. This evaluation was conducted through a desk review of the past program data, collection of complementary data, and a WASH Knowledge, Attitude and Practice (KAP) Survey.
As for the first semester, the monitoring and evaluation of the project during this second semester consisted in the IMC's internal monitoring system which includes coordination meetings, field supervision, data collection, analysis and validation at different levels. At the end of each month, the activity data are compiled in a monthly database and the Indicator Performance Tracking Table (IPTT). The monitoring and evaluation team is composed of a Monitoring, Evaluation, Accountability, and Learning (MEAL) based in Bamako, two MEAL Officers based in Ségou and Timbuktu, and a MEAL Assistant based in Gourma-Rharous, who are responsible for the compilation and analysis of data in collaboration with the Health and Nutrition Coordinators and the Medical Director.
In addition to routine data collection, compilation and reporting, the monitoring of the program implementation progress was insured by continuous supervision of activities by the field program team (Health and Nutrition Coordinators, Health, Nutrition and GBV Managers, and Nutrition and WASH Supervisors). The Field Coordinator based in Timbuktu and Ségou and the members of the Senior Management Team based in Bamako (Country Director, Finance and Admin Director, Medical Director, Program Coordinator and Logistical Coordinator) provided various support to the team based in Timbuktu and Ségou, remotely and through onsite supervisions.
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In Timbuktu, one joint supervision was completed during the project period, involving IMC’s technical team, the regional health Directorate (DRS), the CSREFs, the ASACOS, Mayor, the CHVs, the GSAN and the IPC Committees.
The GBV team is using the GBVIMS tool for data collection concerning survivors. Intake and consent forms are kept in locked drawers to ensure privacy and confidentiality of the beneficiaries. Other activities are implemented according to the work plan and country program strategy.
4. ANALYSIS OF PROGRESS AGAINST INDICATORS For this second semi-annual report, the update of the project indicators is based on a compilation of data for the period from May 7, 2019 to March 31, 2020. In each sector, the different tables below show for each indicator, the target value, the achievements for each semester and the cumulative achievement for the entire project.
HEALTH SECTOR
*Reporting Cumulative Period Reached in the Reporting Period Reached SA 2 Project Indicators Cumulative Reached SA 1 (from October (from May 7, 2019 Targeted (from May 7 to 1, 2019 to to March 31, for all the September 30, March 31, 2020) project 2019) 2020) Case fatality rates for 0 1 (0.004%) 5 (0.024%) 6 (0.014%) communicable diseases Number of communicable 30,782 22,598 20,974 43,572 (141.6%) disease consultations Number and percentage of CHWs conducting 36 41 (100%) 41(100%) 41 (100%) public health surveillance Number and percentage of community members who can recall target 10,674 9,393 5,057 14,502 (136%) health education messages Number of Community Health Workers (CHW) supported (total within 40 41 41 41 project area and per 10,000 population) Number of ASACO enabling to cover 75% of Health facility running 5 0% 0% 0% cost (including staff salaries and drugs) (Custom Outcome) Number of health care 35 26 47 47 (134%) staff trained
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Number of health 2 0 2 2 (100%) facilities rehabilitated
Number of health 43 43 43 43 (100%) facilities supported Number of outpatient 105,448 20,070 18,426 38,496 (36.5%) consultations Percentage of total weekly surveillance 97 100% 100% 100% reports submitted on time by health facilities Number of consultations for any mental health 26 17 20 37 condition Number of consultations for non-communicable 5,384 2,430 2,212 4,642 (86%) diseases Number of consultations 1,610 2,715 1,695 4,410 (274%) for trauma-related injuries Number of health facilities out of stock of any medical commodity tracer products, for longer than one week, 7 consecutive days. (Note: In initial proposal, suggest and justify 5 5 0 0 0 tracer products, the stock of which will be reviewed weekly and how organization will address out of stock situations within a delivery period and longer than one delivery period.) Number of people trained in medical commodity 0 0 0 0 supply chain management Number of people treated for the restricted use NA NA NA NA indication Quantity of pharmaceuticals purchased to treat NA NA NA NA individuals for the restricted use indications- Number and percentage of newborns that received 5,203 542 (98%) 532 (90%) 1,074 (81%) postnatal care within three days delivery
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Number and percentage of pregnant women who deliver assisted by a 2,838 569 702 (84%) N:1,271 P: 82% skilled (not traditional) attendant at birth Number and percentage of pregnant women who have attended at least 5,225 (1,454) 49% 1,770 (70%) N:3,224 P:62% two comprehensive antenatal clinics Number of cases of 24 6 6 12 sexual violence treated
Comments Since the beginning of the project, 12 health facilities were supported to deliver quality health care services. Thus, 100% of supported health centers have submitted the report on time. This percentage was reached thanks to IMC’s supervision team, which has helped health workers to produce reports promptly. For most of the indicators in the health sector, the achievement on March 31, 2020 is good, when comparing to their targeted values. Those with low achievement are the followings:
Outpatient Consultations: As of March 31, 2020, a total of 38496 people benefited from outpatient curative consultations (19871 women and 18625men). From this number, 8,134 are children under 5 years (21.12%). The total achievement value for this indicator is of consultation represents 36,15% comparing to the expected number for two years. This achievement remains low compare to the target of almost 50% of the curative consultation covered. This low number was linked to the security issues in the areas of intervention, especially in Aglal and Bori.
For the upcoming period, IMC will work closely with the MoH to cover more patients and improve the data collection system as well. The main issues are mainly about correctly reporting the diagnosis during each consultation, (as illustrate in the high proportion of diagnosis “other” below) and also the promptness in the transmission of the monthly activity reports. As the total free care policy will be continued until the end of project, the number of outpatient consultation is expected to increase during the next coming six months.
Number of ASACOs able to cover 75% of health facilities’ running costs (including staff salaries and drugs) (Custom Outcome). This 0% of achievement is due to the fact that the cost recovery didn’t start so far, and will not be applied until the end of this project.
The number and percentage of pregnant women who deliver, assisted by a skilled (not traditional) attendant at birth. After 11 months of implementation, the achievement value for this indicator is 1,271 (45%), over the 2,838 assisted birth expected for the total project. It should be noted that the 1,271 assisted births represent 82% of the total number of births recorded in the project (1,331). The 236 other births were assisted by traditional attendant (84 at home and 152 within health facilities).
The number and percentage of newborns that received postnatal care within three days following delivery: A total of 1,074 newborns received postnatal care within three days after delivery, representing 81% of the total number birth recorded in this area for the same period. In the context of Timbuktu, some customs recommend that a woman who has just given birth should
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not leave the house for 40 days. Also, for many home deliveries, mothers rarely come at health centers.
The cumulative number of curatives consultations for communicable diseases is 43,572 at this stage of second semi-annual report, representing 141% of the expected number for the entire project. This figure includes 10,105 (23%) children under 5 years old. By type of pathologies the numbers of cases were: 1. ARI: 6,551 (15% of total communicable diseases combined) persons were treated, among them 48% were children under 5 years; 2. Diarrhea: 2,251 cases (5,2% of total communicable diseases combined) were treated in 11 months. Under five children represents the major part of the treated persons (66%); 3. Malaria: 7,887 cases (18% of total communicable diseases combined) benefited from the treatment of Malaria Children under 5 years represents 18%; 4. Other: 26,883 people (15% of them were children under 5 years) was treated for other diseases, representing 61,7% of total communicable diseases combined. The other diseases included skin diseases, ENT infections, dental diseases, STIs, typhoid fever The case fatality rate recorded for the communicable disease is 0.014%, mostly due to malaria and typhoid fever.
NUTRITION SECTOR
Cumulative Reached in the Cumulative *Reporting Period Project Indicators Targeted Reporting Period Reached SA 1 Reached SA 2 (from From May for all the (from May 7, to September 30, October 1,2019 to 2019 to March project 2019 March 31, 2020) 2020) Proportion of children 6-23 months of age who receive 78 29.0% NA 29.0% foods from 4 or more food groups Proportion of infants 0-5 months of age who are fed 63 48.5% NA 48.5% exclusively with breast milk Number of health care staff trained in the prevention and 63 144 207 management of acute malnutrition Number of people -Number admitted, rates of admitted: 2,882 -Number admitted: recovery, default, - recovery rate - Number admitted: 1,381 1,501 death, relapse, and 98% - recovery rate: 97%, -recovery rate 98%, average length of - Defaulter rate 5,104 - defaulter rate: 1.08%, - Defaulter rate 1.5% stay for people 1.7% - death rate: 1%, - Death rate 0.5% and admitted to -death rate -average length of stay: 6 weeks average length of Management of 0.3%, stay: 6 weeks Acute Malnutrition -average length sites of stay 6 weeks
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Number of people screened for malnutrition by 40,270 10,154 46,004 56,158 community outreach workers Number of supported sites managing acute 25 25 25 25 malnutrition
Comments
Proportion of children 6-23 months of age who receive foods from 4 or more food groups During the first semester, 29% of 6 to 23-month-old children received foods from four more food groups (figure from the baseline assessment conducted in the first three months of the project). No new ICYF surveys were conducted during this second semester to provide an update, so the value from the first semi-annual is kept until another IYCF survey is conducted. However, a better achievement is expected in the next quarter for this indicator since in the past 11 months of implementation International Medical Corps has placed a particular emphasis on IYCF activities to improve practices.
Proportion of infants 0-5 months of age who are fed exclusively with breast milk For the same reason as for the indicator above, (no new IYCF survey has yet been conducted) the figure from the first semi-annual report (48.5%) has been kept in this second report. A better achievement is expected for this indicator as well.
Through the 23 OTP supported (19 in Ségou and 4 in Timbuktu) a total of 2,882 children 6-59 months (1,452 boys and 1,430 girls) were admitted and treated for SAM without medical complications. Comparing to the target value for the entire project this represents 56.4% of the originally calculated caseload. The cumulated performance indicators for the 23 OTPs since the beginning of this project were satisfactory; recovery rate was 98%, defaulter rate 1.7%, death rate 0.3%, and average length of stay was 6 weeks.
For the treatment of cases of SAM with medical complications, 332 children suffering from SAM with medical complications (159 boys and 173 girls) were admitted and treated in the 2 supported stabilization centers in Timbuktu and Ségou. The 11-months cumulated performance indicators are: - recovery rate 94.3%; - defaulter rate 0%; and - death rate (5.7%). The- average length of stay was 9 days; and the average weight gain per day was 7.15g/kg body weight. Achievements in the screening for acute malnutrition were good compared to expectations (56,158 screened for 40,270 expected); this was the same concerning the number of people trained (207 trained for 63 expected).
WASH SECTOR
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*Reporting Reporting Period Period Cumulative Cumulative Reached SA 1 Reached SA 2 Reached in the Targeted Indicators (from May 7, to (from October Project for all the September 30, 1,2019 to From May 2019 project 2019 March 31, to March 2020) 2020) Number of people receiving direct hygiene promotion (excluding 111,765 1,480 26,692 28,172 mass media campaigns and without double- counting) Percent of people targeted by the hygiene promotion program who 75 75% 75% 75% know at least three (3) of the five (5) critical times to wash hands Percent of people targeted by the hygiene promotion program who 89 89% 89% 89% report using a latrine the last time they defecated Average number of users 14 14 14 14 per functioning toilet Number of people directly utilizing improved sanitation services 65,203 9,242 24,899 34,141 provided with OFDA funding Percent of latrines/defecation sites in the target population 100 100% 100% 100% with handwashing facilities that are functional and in use Number of people directly utilizing improved water NA NA NA services provided with OFDA funding Percent of households whose drinking water supplies have a free NA NA NA residual chlorine (FRC) > 0.2 mg/L Percent of water points developed, repaired, or rehabilitated with 0 fecal NA NA NA coliforms per 100 ml sample
Comments
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After 11 months of implementation the number of people receiving direct hygiene promotion (excluding mass media campaigns and without double-counting) was 28 172, representing 25,2% of the targeted number for the two years of project. This achievement is relatively lower than expected, due to the low achievement of WASH activities during the first six months of the project (only 1480 people reached at the first semi-annual report stage).
As explained in the first SAR, the IPC committees in Ségou were just set up and were not yet fully active as they had not yet been trained. However, 26 692 people were reached during the second semester, and the effort will be maintained to further improve this indicator during the upcoming months.
For the following 3 indicators in July 2019 an assessment showed 75% of people targeted by the hygiene promotion program know at least three (3) out the five (5) critical times to wash hands. This percentage is from the baseline assessment used for the reporting period until the end line assessment is done. The same process for the indicator on Percent of people targeted by the hygiene promotion program who report using a latrine the last time they defecated. and the average number of users per functioning toilet.
At this stage of the project the cumulated number of persons directly using the improved sanitation services providing by OFDA is 34 141, representing 52,3% of the targeted number in the entire project.
It should be noted that due to the COVID-19 pandemic, all of the WASH activities will be given priority in the coming months. This will boost the level of the various indicators in the WASH sector.
Protection /GBV Sector
Reporting Period *Reporting Period Cumulative Cumulative Reached SA 1 Reached SA 2 Reached in the Targeted Indicators (from May 7, to (from October Project for all the September 30, 1,2019 to March 31, From May 2019 to project 2019 2020) March 2020) Number of dollars
allocated for GBV 1,125,815 610,000 programming Number of 34,886 35,359 individuals 57,642 473 accessing GBV response services Number of individuals accessing GBV Total: 26,943 Total: 34,815 Total: 61,758 risk mitigation 10-14 years: 1,880 10-14 years: 2,746 10-14 years: 4,626 activities, by sex; 78,982 15-19 years: 8,435 15-19 years: 9,456 15-19 years: 17,891 age: <5, 5-9, 10- 20-49 years: 11,393 20-49 years: 17,065 20-49 years: 28,458 14, 15-19, 20-49, 50+ years: 5,235 50+ years: 5,548 50+ years: 10,784 50+ (Custom Outcome)
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Percentage of people trained on GBV case management who demonstrate improvement in 85 84% 93% 89% knowledge from pre- to post- training test (Custom Outcome) Number of individuals participating in NA NA NA psychosocial support services Percentage of survivors who received case management who report improvements in NA NA NA NA their feelings of well-being through a voluntary exit interview(Custom Outcome)
Comments The Number of individuals accessing GBV response services at the project reporting period is 35359 people, including 21132 women, 9415 men, 1867 girls and 975 boys. The achievement rate for this indicator is 61,3% comparing to the targeted value for the two years of project.
This figure takes into account the data from case management which is 71 survivors of gender- based violence were assisted and documented as follows: rape / penetration (4 cases); sexual assault (2 cases), physical assault (15 cases); early / forced marriage (6 cases); denial of resources and opportunities (21 cases); emotional / psychological abuse (23 cases).
GBV risk mitigation services reached a total of 61758 people representing 78% of two-year project target. For the trainings 89% of people trained on GBV case management have demonstrate improvement in knowledge from pre- to post-training test; the targeted value of 85%.
5. PLANNED ACTIVITIES FOR NEXT REPORTING PERIOD – BY SECTOR
Health - Continuing to support 12 HF to provide free and quality primary and secondary health care services; - Reinforcing epidemiological surveillance; - Contributing to reduce the spread of the COVID-19 pandemic outbreak.
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Nutrition - Monthly Joint Supervision visits –health district and IMC in the 25 CSCom; - Tracking the activities of the all care groups (GSAN); - Continue Support for nutrition/cooking demonstrations of the GSAN; - Training 77mothers on using MUAC to screen their children for acute malnutrition (Niamana and N'Torosso); - Technical support to the management of SAM without medical complications through the 25 OTPs; - Continue support to the SC for the management of SAM with medical complications; - Continue support for the cost of referencing; - Continue the provision of data collection materials to CSCOM and CSRéf (individual files, scorecards, summary sheets, Community Relay /CSA reference sheets...); - Organize the Project's restitution workshop.
WASH - Provision of WASH kits to all the supported health facilities; - Reinforcing the awareness raising activities in WASH sector, following the Covid-19 priorities; - The continuation and follow-up of the rehabilitation of latrines in the 6 CSCom: Niasso, Kononso, Bounoumba, Sourountouna, Koro and Ouolon. - Supervision of ICP committees’ members in the 19 health areas covered by OFDA.
PROTECTION - Maintaining the provision of GBV management services in close collaboration with the DRPFEF, the women associations and the community volunteers and leaders; - Reinforcing the GBV risk mitigation services.
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