USAID Health Service Delivery Quarterly Progress Report

January 1, 2020 to March 31, 2020

Submission Date: April 30, 2020

Agreement Number: AID-278-A-16-00002 Agreement Period: March 15, 2016 to March 14, 2021 Agreement Officer’s Representative: Dr. Nagham Abu Shaqra

Submitted by: Dr. Sabry Hamza, Chief of Party Abt Associates 6130 Executive Blvd. Rockville, MD 20852, USA Tel: +1-301-913-0500/Mobile: +962-79-668-4533 Email: [email protected]

This document was produced for review and approval by the United States Agency for International Development/Jordan (USAID/Jordan).

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

TABLE OF CONTENTS

ACRONYMS AND ABBREVIATIONS ...... III

GLOSSARY ...... VI

1. ACTIVITY OVERVIEW ...... 1

A. ACTIVITY DETAILS ...... 1 B. VISION ...... 2 C. MISSION ...... 2 D. IMPLEMENTATION APPROACH ...... 2

2. EXECUTIVE SUMMARY ...... 4

A. SUMMARY OF REPORTABLE Q2 INDICATORS ...... 4 B. CORONA VIRUS DISEASE 2019 (COVID-19) AND USAID HEALTH SERVICE DELIVERY’S RESPONSE ...... 5 C. RMNCH+ SERVICE DELIVERY IMPROVEMENT ...... 5 D. COMMUNITY ENGAGEMENT ...... 6 E. RMNCH+ COMMUNITY OUTREACH PROGRAM ...... 6 F. INNOVATION GRANTS ...... 7 G. JORDAN’S MATERNAL MORTALITY SURVEILLANCE AND RESPONSE SYSTEM ...... 8 H. STRENGTHENING SELF-RELIANCE ...... 8

3. CORONAVIRUS DISEASE (COVID-19) PANDEMIC AND USAID HEALTH SERVICE DELIVERY PREPAREDNESS ...... 9

A. ADVENT OF COVID-19 AND USAID HEALTH SERVICE DELIVERY’S RESPONSE ...... 9 B. GOVERNMENT OF JORDAN ACTIONS TO PREVENT THE SPREAD OF COVID-19 ...... 9 C. USAID HEALTH SERVICE DELIVERY’S RESPONSE TO COVID-19 ...... 10

4. ACTIVITY IMPLEMENTATION ...... 12

SUMMARY OF FY20 Q2 DELIVERABLES ...... 12 RESULT 1: EXPANDED AVAILABILITY OF AND ACCESS TO INTEGRATED RMNCH+ SERVICES ...... 14 Sub-result 1.1: Increased Uptake of Integrated RMNCH+ Services ...... 14 Sub-result 1.2 Increased community involvement to promote and increase demand for RMNCH+ services ...... 26 RESULT 2: IMPROVED QUALITY OF INTEGRATED RMNCH+ SERVICES ...... 35 Sub-result 2.1: Improve provider competency and behavior to deliver evidence-based RMNCH+ services ...... 35

i USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

Sub-result 2.2 Strengthening management to support delivery of high-quality RMNCH+ services ...... 38

5. COLLABORATION AND KNOWLEDGE SHARING ...... 44

A. PARTNER ENTITIES IN HOST GOVERNMENT AND OTHER DONOR AGENCIES ...... 44 B. PRIVATE SECTOR AND ASSOCIATIONS ...... 45

6. PLANNED ACTIVITIES FOR NEXT QUARTER ...... 46

7. BRANDING, COMMUNICATIONS AND DISSEMINATION ...... 47

A. KEY COMMUNICATION ACTIVITIES IN FY20 Q2 ...... 47 B. CALENDAR OF PLANNED OUTREACH AND COMMUNICATION EVENTS FOR FY20 Q3 ...... 47

ii USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

ACRONYMS AND ABBREVIATIONS

AAFP American Academy of Family Physicians ANC Antenatal Care ALSO Advance Life Support for Obstetrics CBC Complete Blood Count CBOs Community Based Organizations CHWs Community Health Workers CHC Community Health Committee CME Continuing Medical Education COVID-19 Corona Virus Disease 2019 CPD Continuous Professional Development C/S Caesarean Section CSC Community Scorecard CSS Client Service Station CSPD Civil Status and Passport Department CYP Couple Years of Protection DAG Directorate Advisory Group EMPHNET Eastern Mediterranean Public Health Network ETITD Electronic Transformation and Information Technology Directorate FBSS Facility-Based Supportive Supervision FGAC Family Guidance and Awareness Center FPCM Family Planning Compliance Monitoring FY Fiscal Year GBV Gender Based Violence GFA Geographic Focus Area GP General Practitioner HAD Health Affairs Directorates HC Health Center HCC Healthy Community Clinic HCAC Health Care Accreditation Council HCAD Health Communication and Awareness Directorate HMIS Health Management Information System HPC Higher Population Council HPS Health Promotion Supervisors iii USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

HPYC Health Promotion Youth Clinic IEC Information, Education and Communication IFH Institute for Family Health IRC International Rescue Committee IS Information System ISD Integrated Service Delivery ISDIC Integrated Service Delivery Improvement Collaborative IPC Infection Prevention and Control IUD Intrauterine Device IV Intravenous JAFPP Jordanian Association for Family Planning and Protection JMMSR Jordan Maternal Mortality Surveillance and Response JMMSR-IS Jordan Maternal Mortality Surveillance and Response Information System JPA Jordan Pharmacists Association KAP knowledge, attitude, and practices LARC Long Acting Reversible Contraceptive MCH Maternal and Child Health MIYCN Maternal, Infant, and Young Children Nutrition MOH Ministry of Health MtMBSG Mother to Mother Breastfeeding Support Groups NAG National Advisory Group NCDD Non-Communicable Diseases Directorate NGO Non-Governmental Organization NICU Neonatal Intensive Care Unit NRP Neonatal Resuscitation Program NWHCC National Woman Health Care Center OTJ On-The-Job PHC Primary Health Care Q Quarter QMS Queue Management System RMNCH+ Reproductive, Maternal, Newborn and Child Health including Nutrition, Non-Communicable Diseases and Gender Based Violence RMS Royal Medical Services RHAS Royal Health Awareness Society

iv USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

SBCC Social Behavior Change Communication SDP Service Delivery Point TOT Training of Trainers TPN Total Parental Nutrition TWG Technical Working Group TWCS Tafilah Women Charitable Society UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund USAID United States Agency for International Development WCH Woman and child Health WCHD Woman and Child Health Directorate WHO World Health Organization

v USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

GLOSSARY

Baseline A method used to assess a current situation to help USAID Assessment: Health Service Delivery identify gaps in delivery of reproductive, maternal, newborn and child health services, and measure progress against the baseline over time.

Change Package: A group of interventions designed to improve the health service delivery process and address gaps indicated in the baseline assessment findings as part of the Integrated Service Delivery Improvement Collaborative (ISDIC).

Client Service A functional triage unit or station established within the health Station (CSS): facility using existing resources with the aim of improving and organizing client flow to ensure receipt of integrated health care services.

Continuum of Public health framework based on integrated service delivery Care: (ISD) throughout the lifecycle (adolescence, pregnancy, childbirth, postnatal period and childhood) and between places of care (including households, communities and clinical care settings).

Data-Driven The use of assessment and research data to improve the delivery Approach: and management of services for reproductive, maternal, newborn and child health, including nutrition, non-communicable diseases and gender-based violence (RMNCH+), by promoting evidence- based decision-making and informed strategic planning.

Decision Support An information system that aggregates and reports on key System: performance indicators in an easy-to-use format for RMNCH+ program managers at all levels.

Facility-based A process of guiding, helping, training and encouraging staff to Supportive improve their performance continuously; it is a group Supervision collaboration effort at the facility level. The FBSS uses open, two- (FBSS): way communication and team-building to facilitate problem- solving, by focusing on monitoring performance through the use of clinical performance checklists for service providers at the facility, according to a supervisory plan.

Innovation The Innovation Grants Program is intended to support a wide Grants: range of innovative approaches and activities to improve access to, quality of, and use of RMNCH+. “Innovations” are defined as service delivery, community interventions, or technology applications that are not currently part of ongoing programs throughout Jordan, and which intend to achieve improved health results.

vi USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

Integration of From the client's perspective, integration means health care Care: that is seamless, smooth, and easy to navigate. From the provider's perspective, integration means that separate technical services and their management support systems are provided, managed, financed, and evaluated either together or in a closely coordinated way. Evidence-based clinical pathways reinforce compliance with key steps in service delivery. Structured interactions with clients are based on an initial assessment of their needs. Documentation provides useful information for each client and service. From a community’s perspective, health care responds to priority needs with good access to and quality of care, and more engagement in planning and monitoring of health services. From a health manager’s perspective, information on overall service provision is readily available, aggregated as needed for each level of care. This should lead to prompt identification of gaps or challenges, and better use of resources.

Integrated Service An integrated, preventive, and curative package developed to Delivery Package: enhance access to care, and quality, integration, and consistency of care. This integration is essential to improving the delivery of RMNCH+ services at Service Delivery Points (SDPs) and avoiding missed opportunities for comprehensive service delivery.

Integrated Service USAID Health Service Delivery uses a customized collaborative Delivery approach to introduce and implement the ISD package in selected Improvement SDPs. The ISDIC is a dynamic, data-driven approach that uses a Collaborative: cycle of performance-based monitoring, analysis, and change implementation. Each ISDIC cycle includes a collaborative session, a change package, and an action period that allows SDP teams to implement and monitor progress in improving RMNCH+ services according to results.

Collaborative Each ISDIC cycle includes a collaborative session in which several Sessions: SDP teams present their progress and discuss how they overcame challenges. This collaborative approach allows exchange of productive ideas and experiences, facilitating greater improvement for SDPs. Jordan Maternal The JMMSR is a national system to quantify the maternal mortality Mortality ratio for Jordan through active surveillance, and to eliminate Surveillance and preventable maternal deaths. Bylaw 10 mandates implementation Response of the JMMSR system for all sectors, and technical steps cover the (JMMSR) System: notification of deaths among women of reproductive age, identification of maternal deaths, review, analysis, response, and dissemination. Service Delivery SDPs are the health facilities (clinics and hospitals) selected by Points (SDPs): USAID Health Service Delivery to implement improvements related to RMNCH+ services.

vii USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

1. ACTIVITY OVERVIEW

A. ACTIVITY Details

Activity Name USAID Health Service Delivery Activity Start/End Date March 15, 2016–March 14, 2021 Name of Prime Implementing Abt Associates Partner Contract/Agreement Number AID-278-A-16-00002

Jordan Health Care Accreditation Council (HCAC), Eastern Mediterranean Public Health Partners Network (EMPHNET), Population Council, American College of Nurse-Midwives Geographic Coverage Nationwide (Governorates/Districts) Fiscal Year 2020 Quarter I (October 1, 2019 to Reporting Period December 31, 2019)

The five-year USAID Health Service Delivery is funded by the United States Agency for International Development/Jordan (USAID/Jordan). The objective is to improve health outcomes for women of reproductive age and children under the age of five, including Syrian refugees living in Jordanian host communities. Abt Associates and its partners implement USAID Health Service Delivery.

In partnership with the Government of Jordan and other international and local partner organizations, USAID supports programs that expand access to and availability of integrated health services and improve the quality of essential health services at the national and sub- national levels in Jordan. Multiple initiatives are under way to improve the health of both Jordanian nationals and non-Jordanians living in Jordan. The main guiding frameworks are the Ministry of Health (MOH) Five-Year Strategic Plan, the Jordan Response Plan, and the USAID Country Development Cooperation Strategy. USAID Health Service Delivery supports and reinforces many of the themes and concepts in these strategic documents.

USAID Health Service Delivery directly supports USAID/Jordan’s Results Framework Intermediate Result 3.1 (Health Status Improved) by expanding access to and availability of integrated health services. USAID Health Service Delivery works in the public, nongovernmental, and private sectors in its geographic focus areas (GFAs) to improve the quality of RMNCH+ services.

USAID Health Service Delivery also contributes to improving health-seeking behaviors and practices by increasing health services’ accountability to and engagement of communities and helps alleviate impacts of rapid population growth by increasing access to quality health services and by improving availability and quality of family planning services.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

B. VISION

Women of reproductive age and children under five years of age in Jordan will access and receive comprehensive, integrated quality health services across a continuum of care, resulting in improved health status.

C. Mission

USAID Health Service Delivery aims to improve health outcomes for women of reproductive age and children under five years of age, including Syrian refugees living in Jordanian host communities. Abt Associates and its partners implement the programs and interventions. The USAID Health Service Delivery approach will stimulate management, clinical, and behavioral changes within Jordan’s public, nongovernmental organizations (NGOs), and private health services that will lead to better RMNCH+ outcomes.

Integrated, efficient, and effective health service delivery is an essential instrument to enhance the health status, health protection, and social welfare of women of reproductive age and children under five years of age.

USAID Health Service Delivery works with Jordanian counterparts at all levels of the health system to ensure that they assume full ownership of all programs. Building capacity to sustain performance improvements is a core component of every level and intervention. By engaging health managers and health teams in improvement processes, USAID Health Service Delivery builds their capacity to engage in continuous improvement cycles.

USAID Health Service Delivery provides clinical training to address identified gaps or weaknesses and strengthens supportive supervision at each level of the system to sustain clinical and managerial competencies in the future.

D. Implementation Approach

USAID Health Service Delivery has two main results under the objective of improving health outcomes for women of reproductive age and children under five years of age, as shown in the results framework below (Figure 1).

Result 1 addresses expanding availability of and access to integrated reproductive, maternal, neonatal, and child health services. USAID Health Service Delivery designs and implements interventions to increase uptake of RMNCH+ services by the targeted population (Sub-result 1.1). The interventions also increase community involvement in raising awareness of RMNCH+ information and services available in the public, non-governmental, and private sectors (Sub-result 1.2).

Result 2 addresses improving the quality of integrated reproductive, maternal, neonatal, and child health services. This requires complementary and parallel interventions to improve provider competency in delivering high quality, evidence-based services (Sub-result 2.1), and to strengthen management of RMNCH+ services (Sub-result 2.2).

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

Objective: Improved health outcomes for women of reproductive age and children under five

Result 1: Expanded availability Result 2: Improved quality of of and access to integrated integrated RMNCH +services RMNCH+ services

Sub-result 1.1 Sub-result 1.2 Sub-result 2.1 Sub-result 2.2 Increased uptake of Increased community Improved providers’ Strengthened integrated involvement to promote, and competency and management to RMNCH+ services increase demand for, quality behavior to deliver support delivery of RMNCH+ services evidence-based high-quality RMNCH+ services RMNCH+ services

Figure 1: USAID Health Service Delivery Results Framework

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

2. EXECUTIVE SUMMARY

A. SUMMARY OF REPORTABLE Q2 INDICATORS

Overall, six out of the eight reportable indicators for this quarter (R1, A2, A1, Q7.2, Q7.2 and Q8) were within ±10 percent of the set targets, while R3 and A3 indicators were lower than 10 percent of the set targets. The latter two indicators are numeric and the low scores reflect lack of data given the government shutdown during March. USAID Health Service Delivery reports on R1 and A2 semiannually, while reporting on the other six indicators quarterly.

• Hospital staff discharged alive approximately 93 percent of neonates suffering from respiratory distress or sepsis admitted to Neonatal Intensive Care Units (NICUs) in GFA hospitals (R1indicator). The overall figure for this indicator was about two percent below the annual target of 95 percent.

• Approximately 88 percent of postpartum clients received counseling on modern family planning methods before discharge from GFA Hospitals (A2 indicator-semiannual). The value for this indicator was about two percent below the target of 90 percent.

• About 89 percent of all primary healthcare facilities were providing five modern family planning methods including Intrauterine Devices (IUDs) and implants (A1 indicator). The value for this indicator was approximately one percent below the target of 90 percent.

• The total Couple Years of Protection (CYP) for all SDPs (R3 indicator) reached 21,314, which is more than 10 percent below the projected quarterly target of 36,250 and the two-month projected target of 24,166. The lack of available March data due to government shutdown played an important role in the noticeable reduction in CYP this quarter.

• The 122 primary healthcare facilities achieved 8,379 new family planning visits (A3 indicator) during the second quarter of FY20, which is more than 10 percent below the projected quarterly target of 15,000 new visits and the projected two-month target of 10,000 visits. Similar to R3 indicator, the A3 indicator data was not available during the month of March due government shutdown.

• Jordan’s Maternal Mortality Surveillance and Response (JMMSR) reporting sites notified about 57 percent of deaths among women of reproductive age within 24 hours of death time (Q7.1 indicator). The reported figure is approximately 5 percent below the set target of 60 percent.

• Approximately 92 percent of the 126 JMMSR facilities notified deaths of women of reproductive age or submitted zero-reporting (Q7.2 indicator). The reported figure was about three percent below the set target of 95 percent.

• The Directorate Advisory Groups (DAGs) reviewed 100 percent of maternal deaths within one month of completion of the household survey (Q8). The value of this indicator matches the annual target of 100 percent.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

B. CORONA VIRUS DISEASE 2019 (COVID-19) AND USAID HEALTH SERVICE DELIVERY’S RESPONSE

In March 2020, COVID-19 became a global pandemic. Governments across the world took concerted actions to protect their citizens and flatten the curve to stop the spread of the virus. The Government of Jordan took swift actions to stop the spread of COVID-19, including shutting down the government and directing citizens to stay home and practice social distancing. USAID Health Service Delivery took actions at the end of FY20 Q2 to prepare for inevitable COVID-19 disruptions and brainstormed with USAID about how best to support the Ministry of Health (MOH) and Government of Jordan to respond to COVID-19, leveraging existing relationships across the governorates.

C. RMNCH+ SERVICE DELIVERY IMPROVEMENT

USAID Health Service Delivery partners with the MOH, Royal Medical Services (RMS), and NGOs to improve RMNCH+ services through ISDIC cycles that allow staff in hospitals, Health Centers (HCs), and NGO clinics to identify their own performance gaps in RMNCH+ services and develop and implement interventions to resolve them. USAID Health Service Delivery also engages private sector providers through training and technical support to increase their understanding and use of RMNCH+ best practices. a) Primary Health Care Service Delivery Improvement

As part of the ISDIC cycle and to assist with change package implementation, USAID Health Service Delivery and the Health Affairs Directorates (HADs) continued conducting joint follow-up field visits, on-site coaching, technical assistance, and HC staff performance monitoring. USAID Health Service Delivery conducted 378 field visits for MOH HCs and 69 field visits for NGO clinics. However, USAID Service Delivery did not perform planned data collection visits during the end of this quarter, due to the government shut down. During FY20 Q2, USAID Health Service Delivery also continued to classify targeted SDPs according to their performance indicators, leadership commitment, teamwork, and Client Service Station (CSS) functionality. USAID Health Service Delivery also continued to conduct in-depth analysis and identified the SDPs’ main unresolved challenges. At the request of the Director, Woman and Child Health Directorate (WCHD), USAID Health Service Delivery conducted two CSS Training of Trainers (TOT) workshops, using the updated CSS training manual, to support the MOH to sustain its CSS implementation. b) Private Sector Providers

In FY20 Q2, USAID Health Service Delivery delivered two lectures as a part of its private sector lecture series. At Al-Amal Maternity Hospital, Dr. Abeer Ennab, an obstetrics and gynecology specialist, presented the first lecture on the pros and cons of Cesarean Section versus vaginal delivery. Mr. Mohammad Al Hawamdeh, an infection prevention expert, also presented on identifying and reducing the risks of infections at private clinics. The second workshop, conducted virtually as a webinar, included Dr. Suha Khalifa, a family medicine specialist, and Dr. Wael Khalifa, an obstetrics and gynecology specialist, who presented on hypertension in pregnancy and the risk and management of gestational diabetes. Both lectures provided physicians with three continuing medical education (CME) hours.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

Additionally, USAID Health Service Delivery finalized a customized IUD insertion and removal training manual and the training materials needed to conduct a refresher training for interested private physicians. In FY20 Q2, USAID Health Service Delivery also worked with Jordan Pharmacists Association (JPA) to conducted two workshops with 41 private community physicians as part of the “Consult a Community Pharmacist” program. c) Hospital Service Delivery Improvement

In FY20 Q2, USAID Health Service Delivery supported the MOH and RMS heads of maternal specialties to conduct two collaborative sessions on maternal services. To increase RMNCH+ services uptake, USAID Health Service Delivery coordinated between four hospitals and HCs to provide technical assistance. USAID Health Service Delivery also conducted a family planning counseling training workshop for midwives and nurses who provide family planning counseling services within postpartum departments and outpatient clinics at RMS hospitals. Additionally, the Oversight Committee for the Unnecessary Cesarean Section Deliveries Reduction Program met and finalized the Primary Reduction Action Roadmap. Over three sessions, USAID Health Service Delivery facilitated developing technical materials, including guidelines and information, education, and communication (IEC) materials. USAID Health Service Delivery also collected baseline data for the Unnecessary Cesarean Section Deliveries Reduction Program in ten selected hospitals.

D. COMMUNITY ENGAGEMENT

During Q2, USAID Health Service Delivery collaborated with the Health Communication and Awareness Directorate (HCAD) of the MOH to strengthen the capacity and performance of 80 active Community Health Committees (CHCs) within MOH HC catchment areas. The teams used the Community Mobilization Manual to train 665 participants from 32 CHCs. The 80 CHCs conducted 250 RMNCH+ health education events. The USAID Health Service Delivery community engagement team continued supporting 16 mother-to-mother breastfeeding support groups (MtMBSG). The MtMBSG held 30 sessions during Q2. To strengthen community feedback mechanisms, USAID Health Service Delivery worked with the HCAD to follow up on 28 existing community scorecard (CSC) improvement plans. USAID Health Service Delivery worked with the HCAD to strengthen the role of the CHCs in ISDIC sessions to represent community voices. In Q3, USAID Health Service Delivery will support the HCAD to conduct a quarterly Health Promotion Supervisors (HPS) coordination workshop.

E. RMNCH+ COMMUNITY OUTREACH PROGRAM

The RMNCH+ Community Outreach Program has supported health promotion and health education activities through sub-agreements with the Institute for Family Health (IFH) and the Jordanian Association for Family Planning and Protection (JAFPP). Under the program, female Community Health Workers (CHWs) visit households to provide information on RMNCH+ topics, and guide women of reproductive age and children under five to relevant health services. In FY20 Q2, the CHWs conducted 67,869 household visits for women of reproductive age and children under five. The number of women reached with RMNCH+ messages was 30,317, with Syrian women constituting around 9.88 percent and other nationalities approximately 6.56 percent. By the end of FY20 Q2, the two partners were active in 29 districts across all governorates.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

Throughout FY20 Q2, USAID Health Service Delivery continued to strengthen the RMNCH+ Community Outreach Program through active monitoring and quality assurance activities (shadow visits and quality calls) in addition to raising the capacities of the implementing partners through training topics relevant to the RMNCH+ Community Outreach Program.

On March 15, 2020, USAID requested CHW household visits stop due to COVID-19 concerns related to community transmission. Soon after, USAID terminated the Community Outreach program. During next quarter, the USAID Health Service Delivery will work with the implementing partners to successfully complete the closeout of the Community Outreach program.

F. INNOVATION GRANTS

In FY20 Q2 USAID Health Service Delivery continued to manage the implementation of the five Innovation Grants listed below aimed to improve access to and quality of RMNCH+ services targeting underserved communities. Two grantees’ agreements and activities ended in February 2020. At USAID’s direction, USAID Health Service Delivery terminated the remaining three grantees’ activities at the end of March 2020 due to COVID-19.

1. Healthy Community Clinic (HCC) implemented by the Royal Health Awareness Society (RHAS), to promote positive RMNCH+ health behaviors at MOH comprehensive HCs (Terminated March 22, 2020).

2. Health Promotion Youth Clinic (HPYC) also implemented by RHAS, targeting youth at the University of Jordan with positive RMNCH+ health behavior messaging and information (Completed February 28, 2020).

3. Technology to Improve Access to RMNCH+ Services implemented by IFH, to increase awareness and improve access to RMNCH+ services within their clientele and beyond by developing a phone application and Queue Management System (QMS) to facilitate client scheduling, queuing within the clinics, track contact time, and patient satisfaction (Completed February 28, 2020).

4. Breaking the Wall of Silence implemented by the Tafilah Women Charitable Society (TWCS) to promote a family environment safe and free of domestic violence in Tafilah Governorate by providing counseling to victims of domestic violence, and raising awareness of domestic violence, including gender based violence (GBV) broadly in the Tafilah Governorate (Terminated March 22, 2020).

5. Improve and Expand Existing GBV Services in Zarqa implemented by the Family Guidance and Awareness Center (FGAC) to improve the wellbeing of the victims, survivors, and women at risk of GBV in Zarqa governorate (Terminated March 22, 2020).

During FY20 Q2, USAID Health Service Delivery continued to provide technical assistance and supervision for the five active grants, including support with close out procedures and documentation.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

G. JORDAN’S MATERNAL MORTALITY SURVEILLANCE AND RESPONSE SYSTEM

In FY20 Q2, USAID Health Service Delivery coordinated with the National Advisory Group (NAG) to present the National Maternal Mortality Report for 2018 findings in several forums, including discussions on linking JMMSR system responses to actions. The USAID Health Service Delivery JMMSR team assisted the heads of MOH and RMS maternal specialties to disseminate National Maternal Mortality Report 2018 results to the heads of the maternal services units at public hospitals during the collaborative sessions. Additionally, USAID Health Service Delivery, in coordination with the NAG, held a response workshop for stakeholders in late February. The workshop mobilized relevant stakeholders to discuss and support JMMSR system responses to avert future maternal deaths. The workshop participants also worked together on a draft JMMSR action plan. A series of training workshops in March followed the JMMSR response workshop. Participants from ten HADs attended, including Health Affairs Directors and their DAG members as well as selected Hospital Directors. Participants discussed the JMMSR system findings from the National Maternal Mortality Report 2018. Then, attendees translated JMMSR system responses into actions at the HAD level. In January 2020, the MOH with USAID Health Service Delivery support tested and launched the enhanced version of the JMMSR Information System (JMMSR IS). This version is more user friendly with improved security controls to ensure system data confidentiality. The USAID Health Service Delivery team strengthened the MOH’s capacity to manage and operate the enhanced JMMSR IS system.

H. STRENGTHENING SELF-RELIANCE

USAID Health Service Delivery continued working with counterparts in the MOH, RMS, NGOs, and the private sector to strengthen technical and management capacity at every level of their systems. For RMNCH+ service delivery, this included not only technical training but also TOTs, adaptation of monitoring processes, supervisory functions to maintain quality, and leadership training. For community engagement, this included fostering greater oversight and engagement of MOH managers at different levels, with technical manuals to replicate key aspects of the program. For the JMMSR, this included high-level ownership and support of the system, well-trained and oriented staff at every level, and a robust but flexible IS. USAID Health Service Delivery worked with all key counterparts in FY20 Q2 on self-reliance elements and supported key counterparts to engage their decentralized staff to strengthen their commitment. During FY20 Q2, USAID Health Service Delivery built the capacity of HADs and NGO counterparts to conduct collaborative sessions on their own. In March 2020, HAD Woman and Child Health (WCH) Unit Heads, Maternal and Child Health (MCH) supervisors, and NGO headquarters staff took the lead to facilitate collaborative sessions.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

3. CORONA VIRUS DISEASE (COVID-19) PANDEMIC AND USAID HEALTH SERVICE DELIVERY PREPAREDNESS

A. ADVENT OF COVID-19 AND USAID HEALTH SERVICE DELIVERY’S RESPONSE

In March 2020, COVID-19 became a global pandemic. Governments across the world took concerted actions to protect their citizens and flatten the curve to stop the spread of the virus. The sections below provide a brief timeline of the Government of Jordan’s swift actions to stop the spread of COVID-19, and USAID Health Service Delivery’s actions at the end of FY20 Q2 to prepare for inevitable COVID-19 disruptions. For more details on USAID Health Service Delivery’s response, please refer to the below Annexes:

• Annex 14: SOW for USAID Health Service Delivery to Support the National COVID- 19 Response Plan,

• Annex 15: USAID Health Service Delivery Activities, Impact and Mitigations Mid–End of March 2020, and

• Annex 16: USAID Health Service Delivery Continued Assistance to Facilitate Access to RMNCH Services.

B. GOVERNMENT OF JORDAN ACTIONS TO PREVENT THE SPREAD OF COVID-19

On February 24, the Government of Jordan temporarily denied entry to people from COVID- 19 hotspots including China, South Korea, and Iran. Every person entering Jordan received an examination, with mandatory chest, throat, and temperature checks. The government required each person with a positive test result to follow a 14-day quarantine. Using these protocols, on March 2, the MOH discovered the first COVID-19 positive case returning from Italy.

On March 14, the Prime Minister announced all incoming and outgoing flights to Jordan would stop as of March 17. The government announced mandatory closures for all public spaces including schools, places of worship, cinemas, sports club, malls, tourist sites, etc. In addition, the government announced all social events and public gatherings should cease and emphasized the importance of limiting citizen movements. On March 16, the government imposed measures that included a compulsory 14-day quarantine for all arrivals to the Kingdom. On March 17, His Majesty the King initiated the defense law, allowing him powers to take necessary measures to secure public safety without being bound to the provisions of existing laws. On March 17, the Jordanian government announced several additional precautions after the number of COVID-19 cases increased including inter alia:

• Closing all official institutions and departments except for identified vital sectors, • Closing the private sector, except for the health sector and the vital sectors, including pharmacies, bakeries, groceries, utilities, and critical supply chain infrastructure, • Preventing citizens from leaving the house, except in cases of extreme necessity, • Suspending gatherings of more than 10 people, preventing movement between governorates, and suspending medical operations except in cases of emergency, and

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

• Halting the printing of paper newspapers, contributing to the transmission of infection, along with suspending mass transportation systems.

On March 21, the government implemented a curfew on the movement of citizens, stopped the use of public transportation in the entire Kingdom, and closed all commercial stores in all regions of the Kingdom, except for vital sectors identified above. On March 27, the government isolated Irbid Governorate due to several COVID-19 cases discovered there.

On March 31, the government launched the "Himmat Watan" Fund to unify national and institutional efforts to eradicate the disease.

C. USAID HEALTH SERVICE DELIVERY’S RESPONSE TO COVID-19

As soon as the WHO deemed COVID-19 a global pandemic, the USAID Health Service Delivery team took specific actions to prepare for the inevitable disruptions COVID 19 would bring including:

• Creating an internal COVID-19 response team, including senior medical doctors on the team, who could put together the latest evidence, develop new Infection Prevention and Control (IPC) protocols for operating at the office, and educate the staff, • Creating a COVID-19 Response Cell, specifically to answer staff questions or to help in case of an emergency, • Conducting education sessions with all staff, including IPC measures staff can take to prevent the spread of COVID-19, and • Planning for the potential of the USAID Health Service Delivery team having to work remotely in the coming months.

USAID Health Service Delivery senior managers began working with their teams to determine how COVID-19 disruptions would affect their activities and what implementation strategies would need to change for teams to continue to provide technical assistance to the public and private sectors to improve the quality of RMNCH+ services for women of reproductive age and children. USAID requested USAID Service Delivery to terminate the innovation grants and outreach programs to mitigate community transmission of COVID-19. USAID Health Service Delivery prepared a plan to continue meeting approved work plan activities and deliverables while working with existing grantees and sub-awardees to close the outreach and grants programs.

At the request of USAID, USAID Health Service Delivery began brainstorming how it could support the MOH and the Government of Jordan to respond to COVID-19, leveraging existing relationships across the governorates. USAID Health Service Delivery proposed activities in support of Jordan’s COVID-19 Preparedness and Response Plan including:

• Pillar 8: Operation Support and Logistics

o Providing support to establish rosters of medical teams for rapid deployment where needed, drawing from both public and private sector.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

o Mapping of health facility capacities to respond to the pandemic and different caseload scenarios, including mapping equipment, human resources, and supplies.

o Supporting the development of microplanning for hospital level COVID-19 response and case management, including triage, referral protocols from primary, secondary to tertiary level care and clinical protocols.

• Pillar 7: Case Management

o Customizing and sharing guidance on case management of COVID 19, including self-care for patients with mild to moderate symptoms, and developing customized online training and materials on COVID 19 case management.

• Pillar 6: Infection Prevention and Control

o Customizing IPC refresher training and materials to provide online and providing training of trainers to hospital staff.

• Pillar 2: Risk Communication and Community Engagement

o Providing support to HCAD to generate and disseminate messages for citizens using mobile and virtual methods, and working through CHCs.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

4. ACTIVITY IMPLEMENTATION

SUMMARY OF FY20 Q2 DELIVERABLES

Table 1 summarizes the status of FY20 Q2 deliverables. USAID Health Service Delivery presents a complete report on indicators in Annex 1: Monitoring and Evaluation Report.

Table 1: Summary of the Main Deliverables/Milestones for FY20 Q2 No. Deliverable Status Family planning IEC materials targeting 1) Completed traditional methods users developed. Meeting and workshop reports on 2) Completed private providers’ engagement generated. Supervision tools to monitor woman and 3) child health services comprehensive Completed counseling at PHC SDPs developed. Completed Summary report on TOT workshop on USAID Health Service Delivery planned the 4) women and child health services training for Q3. However, USAID Health comprehensive counseling developed. Service Delivery conducted it during Q2 according to MOH request. Summary reports on women and child 5) health services comprehensive counseling Completed training workshops developed. Summary reports on long-acting 6) reversible contraception (LARC) training Completed workshops developed. Completed. Community mobilization and health CHC community mobilization and health 7) promotion report generated. Eighty CHCs promotion reports generated. conducted 251 RMNCH+ health educational events. A total of 4,981 women of reproductive age participated in these events. Completed. Health promotion TOT report 8) generated. Thirteen participants from HCAD and HPS attended this training. Ongoing National clinical practice guidelines for 9) reduction of Cesarean Section (C/S) The national guideline developed and discussed developed with the oversight committee. The committee needs to approve the branded guideline. Ongoing USAID Health Service Delivery began Training packages for reduction of C/S 10) developing training material, and will finalize based on approved guidelines developed. them once the Oversight Committee approves the clinical practice guidelines for reduction of C/S.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

Table 1: Summary of the Main Deliverables/Milestones for FY20 Q2 No. Deliverable Status Dissemination and response workshop 11) report for the national maternal Completed mortality developed 12) JMMSR training reports developed. Completed Outreach implementing partners Completed. 13) progress quarterly reports generated. (See Annex 11 for details). Community Outreach Program training 14) Completed reports generated. 15) JMMSR IS deployed. Completed. JMMSR documentation development 16) Completed. completed. 17) JMMSR IS users training implemented. Completed. MOH ETITD staff training on 18) cybersecurity, development, and Completed. networking completed. Grantees quarterly progress reports Completed. 19) generated. See Annex 6 for details. Family planning IEC materials targeting 20) Completed traditional methods users developed.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

Result 1: Expanded Availability of and Access to Integrated RMNCH+ Services

Sub-result 1.1: Increased Uptake of Integrated RMNCH+ Services

A. Improving RMNCH+ Services through the Integrated Service Delivery Improvement Collaborative (ISDIC)

Using the ISDIC, USAID Health Service Delivery collaborates with MOH, the Royal Medical Services (RMS), and NGO counterparts to improve their RMNCH+ services. The ISDIC cycles allow hospital, HC, and NGO clinic staff to identify their own performance gaps, develop and implement a change package, and develop a set of interventions to resolve identified gaps. The change packages make it easier to verify and measure positive changes.

B. Primary Health Care Service Delivery Improvement

a) Integrated Service Delivery Improvement Collaborative (ISDIC)

Previously USAID Health Service Delivery led ISDIC sessions with key MOH, RMS, and NGO counterparts. To support the MOH’s journey to self-reliance, in FY20 Q1, USAID Health Service Delivery conducted training for all HADs to strengthen their capacity to lead and sustain the ISDIC approach. During early FY20 Q2, the same trainings were conducted for 12 NGO headquarters’ staff. The training workshops focused on preparing visualizations and interpreting the monitoring indicators. NGO headquarters’ staff developed action plans which included specific roles and responsibilities and timelines, relevant for their respective clinics.

In March, MOH HADs, except for Irbid (due to the government shutdown), conducted the collaborative sessions with minimal support from USAID Health Service Delivery. The HAD WCH unit heads and MCH supervisors took the lead to facilitate sessions. They enthusiastically and capably guided HC staff and CHC representatives to presenting their achievements and success stories. The discussions during collaborative sessions included presentations on HC Photo 1: WCH Unit Head and MCH performance progress, monitoring Supervisor leading the collaborative session for indicators, gaps in services, and suggested HCs in Zarka HAD on March 2, 2020 in Zarka HAD Meeting Room solutions for improvement. During these collaborative sessions, USAID Health Service Delivery presented on traditional methods versus modern methods, to raise awareness of the high use of traditional methods in Jordan (14.4%). USAID Health Service Delivery highlighted the high failure rates of traditional methods compared with modern methods, which are more effective. USAID Health Service Delivery also presented on preparedness for pregnancy.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

USAID Health Service Delivery encouraged HC staff to provide preparedness for pregnancy counseling and despense folic acid to select clients: HCs will provide these services to clients who want to get pregnant and ask to have their Intra Uterine Device (IUD) or Implanon NXT removed.

The MOH’s WCHD will monitor this service by requesting HCs to add relevant data to the monthly MCH reports. USAID Health Service Delivery recommended that HC staff should include the topics presented, within their change packages.

Similarly, the NGOs’ headquarters and clinics conducted collaborative sessions. International Rescue Committee (IRC) and IFH showed their willingness to take ownership to lead the collaborative sessions. They presented on traditional methods versus modern methods and preparedness for pregnancy and also guided clinics, as each clinic presented achievements. Seven of 20 JAFPP clinics attended the collaborative sessions. JAFPP headquarters requested to postpone the rest of the clinics’ sessions due to a shortage of staff.

The HADs and NGO headquarters conducted 27 collaborative sessions for Primary Health Care (PHC) HCs and NGO clinics. Five hundred and fifty-three staff members from the WCHD, HCAD, HADs, HCs, and NGO headquarters and clinics participated in these sessions. The Irbid HAD postponed the collaborative sessions, scheduled during the last two weeks of March, due to the government shutdown. However, Irbid HAD plans to conduct the collaborative sessions during FY20 Q3.

“Taking the responsibility of preparing for the collaborative sessions built our capacities to analyze available data, identify challenges and find solutions. The USAID Health Service Delivery officers, during their field visits, drew our attention to registration errors due to a misunderstanding. This helped us to direct our efforts towards the quality and accuracy of data. I will expand all of that excellent work to other centers.” Dr. Amal Khader, WCH Unit Head in Balqa HAD Collaborative Session – Balqa, March 8, 2020

“The work is the same, however after we started working with the USAID Health Service Delivery, our work became more organized. The evidence-based training we received improved our knowledge and skills to provide efficient educational and counseling sessions. This made our clients enjoy these services and improved the quality of our work” Midwife Amera Al-Amer, Aqaba Comprehensive HC Collaborative Session in Aqaba on March 10, 2020

As part of the ISDIC cycle, and to assist with change package implementation, USAID Health Service Delivery and HADs continued conducting joint follow-up field visits, on- site coaching, technical assistance, and HC staff performance monitoring. USAID Health Service Delivery conducted 378 field visits for MOH HCs and 69 field visits for NGO clinics. However planned data collection visits were not performed during the end of this quarter due to the government shut down.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

During FY20 Q2, USAID Health Service Delivery also continued to classify targeted SDPs according to their performance indicators, leadership commitment, teamwork, and CSS functionality. This classification showed 74 HCs and NGO clinics out of 1211 were able to consistently sustain their performance improvement. Additionally, 42 HCs and NGO clinics, with the potential to sustain their improvement, showed fluctuating performance improvement. Only five HCs continuously failed to improve their performance.

USAID Health Service Delivery continued to conduct in-depth analysis and identified the SDPs’ main unresolved challenges. During FY20 Q3, the USAID Health Service Delivery will communicate these challenges with HADs and WCHD, so they can develop improvement plans.

b) Client Service Stations

USAID Health Service Delivery continued supporting MOH HCs and NGO clinics to implement CSS to increase clients’ awareness of RMNCH+ services and minimize women and families’ missed opportunities to receive the services. Upon the WCHD Director’s request, USAID Health Service Delivery conducted two CSS TOT workshops, using the updated CSS training manual to support the MOH to sustain CSS implementation. Twenty-five staff from the WCHD Directorate, HAD’s WCH unit heads and MCH supervisors along with trainers attended these workshops. Trainees will use what they learned to roll-out CSS at their HCs.

During FY20 Q2, CSS was fully functional (operating for eight hours, six days per week) in 66 percent of SDPs; partially functional (operating certain days per week and/or certain hours per day) in 24.2 percent of SDPs; and the remaining 9.8 percent of SDPs did not have a functional CSS. The main reason that CSS was categorized as not functional or partially functional was due to a shortage of staff assigned to implement CSS. Many of the HC managers decided to move the assigned CSS staff to fill other service delivery gaps.

Table 2 shows that during January and February 2020 (March data is not available due to the difficulty collecting data during the government shutdown), 13,531 women of reproductive age, children under five, and their companions received referrals for additional services. About 88.1 percent received at least one of the recommended services in addition to the intended service. Children constituted the majority of referred primary clients, at 81.7 percent, with 95.7 percent receiving at least one additional service. Furthermore, 18.3 percent of the primary clients were women of reproductive age, with 87.5 percent receiving an additional service. While 94.2 percent of primary clients received additional services, 71.9 percent of companions also received an additional service. Syrian clients constituted about 7.6 percent of the total referred clients, with 69.9 percent receiving additional service compared to Jordanians at 89.6 percent.

1 The total SDPs is 121, as the IFH Clinic in Hashmi closed in January 2020.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

Table 2: CSS Referrals and Additional Services Received in FY20 Q2 # Referred by CSS to # Received % Received Category receive additional Additional Additional MCH service (%) Service Service Primary Clients and Companions Primary Clients – Women 1,795 1,575 87.7% Primary Clients – Children 8,041 7,696 95.7% 9,841 9,271 Total Primary Clients 94.2% (72.7%) (77.7%) Companions to Women 864 592 68.5% Companions to Children 2831 2065 72.9% 3,695 2,657 Total Companions 71.9% (27.3%) (22.3%) Nationality 12,499 11,207 Jordanian Clients 89.7% (92.4%) (94%) 1,032 721 Syrian Clients 69.9% (7.6%) (6%) 13,531 11,928 Total 88.2% (100%) (100%)

The USAID midterm evaluation recommended that USAID Health Service Delivery strengthen providers’ capacity to offer clients evidence-based RMNCH+ service counseling. In response, USAID Health Service Delivery assisted the WCHD to conduct a third TOT for 20 trainers from various HADs on Woman and Child Health Services Comprehensive Counseling. The purpose of the TOT was to expand the core of trainers to mitigate the retirment of existing trainers. Currently, each HAD has a core group of trainers who can train other HAD staff.

USAID Health Service Delivery also assisted MOH HAD trainers with logistical support to conduct seven training workshops for 133 physicians, midwives, and nurses on Woman and Child Health Services Comprehensive Counseling. HAD trained certified trainers led the workshop technical preparation. Currently, the trained staff have the knowledge and skills to provide comprehensive RMNCH+ counseling, and thus to improve the quality of RMNCH+ services in their SDPs.

To better evaluate the quality of comprehensive counseling provided to woman of reproductive age and children under five, USAID Health Service Delivery, in close collaboration with the WCHD, finalized and approved counseling competencies monitoring checklists. These checklists will be integrated into the updated supportive supervision manual and used during supervisory visits.

As a result of implementing the ISDIC approach and related evidence based tools and procedures, e.g. clinical pathways, the National Woman Health Care Center (NWHCC) in Tafila showed remarkable improvements in increasing access to and quality of services. NWHCC senior management showed an interest in adopting and expanding the ISDIC approach to three military PHC woman friendly centers (Al-Shoubak, Al- Qwera, and Madaba). USAID Health Service Delivery responded by conducting several meetings with NWHCC senior management, and engaged three managerial staff in a

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

TOT to build their training capacity. The NWHCC took the initiative to print and distribute RMNCH+ materials, including clinical pathways and procedures, woman and child health services comprehensive counseling manuals, and the CSS tools.

As part of this technical support, USAID Health Service Delivery conducted a joint visit with NWHCC to Madaba Medical Center. During this visit, USAID Health Service Delivery conducted on-the-job training (OJT) on how to correctly fill in clients’ medical records and logbook documentation. OJT also included an orientation on quality improvement indicators used to monitor the progress of RMNCH+ services. To implement CSS at this center, USAID Health Service Delivery conducted a didactic training for 8 staff members. The NWHCC will train the other two HC staff on CSS, and provide them with the required tools.

c) Facility Based Supportive Supervision (FBSS)

During FY20 Q2, HC managers continued to conduct FBSS and sent reports to HADs for their review and feedback. The HADs responded to the reports and sent them back to HCs with the feedback included. During FY20 Q2, 51 HCs conducted FBSS and sent reports to their respective HADs. Only two HADs out of 14 were able to send their FBSS reports to the WCHD due to the government shutdown. For NGOs, 19 JAFPP clinic managers sent FBSS reports to their headquarters and received feedback. Due to the unavailability of physicians during the quarter, Nazzal JAFPP clinic did not conduct FBSS. All IRC and IFH clinics sent their FBSS reports to their headquarters, except for two clinics that closed in FY20 Q2.

USAID Health Service Delivery assisted the WCHD to start a Technical Working Group (TWG) that integrates the FBSS training manual and tools with the central supervision manual. The TWG conducted its first meeting on March 3, whereby they agreed to standardize the supervision tools and checklists. During FY20 Q3, USAID Health Service Delivery will conduct virtual meetings with the TWG to finalize the manual.

d) HC Leadership Certification Program

The RMNCH+ Manager Certification Program is a prerequisite for the Leadership Certification Training Program. During FY20 Q2, USAID Health Service Delivery and its implementing partner Health Care Accreditation Council (HCAC) trained 28 HC managers who had not previously received the training.

USAID Health Service Delivery trained 53 HC managers on the Leadership Certification Training Program. The training focused on building participants’ capacity to improve their leadership and supportive supervision skills, and their capacity to lead RMNCH+ service provision.

To make attendance more feasible for HC managers, USAID Health Service Delivery flexibly scheduled the training for one day per week for five continuous weeks.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

e) Preconception Care

To facilitate the preparedness for pregnancy service, USAID Health Service Delivery, in collaboration with the WCHD, developed a job aid containing the main pillars of Preparedness for Pregnancy. During this quarter, 189 clients received this service from the 91 HCs and 30 NGOs clinics.

Photo 2: Service Provider Job Aid “Preparedness for Pregnancy”

f) Family Planning within Integrated Care

In close collaboration with MOH, USAID Health Service Delivery implemented different interventions to increase traditional method users’ uptake of modern family planning services. To ensure that HCs and NGOs clinics included change package activities that focus on traditional methods users, USAID Health Service Delivery presented this topic to session participants.

Starting in February 2020, the Royal Health Awareness Society (RHAS) clinics, the Outreach Program, and some CHCs started using a direction slip developed by USAID Health Service Delivery. The direction slip directs beneficiaries to receive family planning services. The direction slip consists of two parts; the first part the CHWs keep as part of the Community Outreach Program, while the other part CHWs give to women to take to SDPs. Women who are seeking family planning and other MCH services deliver the slip to the SDP. The direction slip supports clients to receive an intended service and allows USAID Health Service Delivery to monitor clients’ referrals for services.

USAID Health Service Delivery, in collaboration with WCHD, developed two family planning pamphlets. The first one, “How I Can Help My Wife in Planning Our Family,” targets men. It provides simple messages for men on the benefits of family planning and encourages men to support their wives in using modern family planning methods. The purpose of the second pamphlet is to increase awareness about unwanted pregnancy. It focuses on the effectiveness of modern methods compared with traditional methods. Next quarter, the pamphlets will be printed and distributed to SDPs, RHAS Clinics, and CHCs, so they can use them during their activities.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

Additionally, USAID Health Service Delivery adopted the USAID job aid “NORMAL” that contains messages on menses changes. This job aid will be printed and distributed to SDPs next quarter.

USAID Health Service Delivery continued to follow up on family planning services uptake in Mafraq Governorate. According to the 2017-18 Jordan Population and Family Health Survey, Mafraq Governorate has the highest total fertility rate of 4.1 and unmet need for family planning at 17 percent, including high use of traditional methods (19 percent). To ensure that clients receive their method of choice, the HAD, HCs, NGOs, RHAS clinic and CHCs are providing referrals for LARC among different SDPs. During this quarter, Al-Mafraq HC and its CHC focused their efforts on raising family planning awareness. The CHC conducted five family planning education sessions. Ninety-three women of reproductive age participated in these sessions, and the CHC directed15 women to a SDP to receive family planning counseling and services.

Photo 3: Family Planning Pamphlets targeting Traditional Methods Users and Men

g) Breastfeeding Promotion

During FY20 Q2, USAID Health Service Delivery continued to strengthen the capacity of MOH PHC service providers in Maternal, Infant, and Young Children Nutrition (MIYCN), through the Woman and Child Health Services Comprehensive Counseling training workshops. USAID Health Service Delivery also strengthened MtMBSG capacity by attending sessions, providing supportive feedback, and providing technical assistance.

During FY20 Q2, USAID Health Service Delivery conducted a TOT on MtMBSGs for 19 MOH HCAD staff, HPS, and HC health promotors from six HADs including Amman, Zarka, Balqa, Ajloun, Jerash, and Mafraq. The purpose of the training was to enable participants to facilitate, support, and monitor these groups. The TOT agenda included facilitation skills, mechanisms to establish support groups, reporting, MtMBSG facilitator responsibilities, breastfeeding techniques, and information on complementary feeding.

Additionally, to improve the existing MOH Breastfeeding Support Groups’ functionality in their HCs, and at the request of the WCHD, USAID Health Service Delivery conducted an assessment to identify how many HCs had operational Breastfeeding Support Groups. The assessment showed 59 percent of HCs have Breastfeeding Support Groups. However, most of the groups still need a technical assessment to determine any gaps in the information and support offered by the groups.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

During Q2, USAID Health Service Delivery, in collaboration with the WCHD, built the capacity of Madaba and Zarqa HC midwives to enable them to facilitate, support, and monitor Breastfeeding Support Groups. The training included the same topics mentioned previously for the MtMBSG training.

h) Gender

During FY20 Q2, JAFPP promoted male engagement at five of their clinics. Previously, husbands were unable to accompany their wives while they received reproductive health services. Clinics used to have a separate waiting area for men, and it was a cultural norm not to allow men to be with their wives while they received services. During this quarter, JAFPP started encouraging couples’ full participation.

To date, five clinics (Karak, Irbid I, Ajloun, Jerash and Mafraq) are inviting husbands to be with their wives while they are receiving services. Now, men are more comfortable in discussing FP and feel that their role is important on FP decisions.

In FY20 Q3, USAID Health Service Delivery will start conducting virtual gender training for MOH staff members from central directorates, HADs, and HCs, as well as NGO staff. The training will include gender concepts and definitions such as gender equality, gender equity, and female empowerment, with a focus on GBV.

i) Integrated Service Delivery (ISD) Recognition Program

USAID Health Service Delivery, in collaboration with HCAC, is implementing the ISD recognition program. This program assesses SDPs’ work and initiative using the ISDIC approach. It motivates SDPs by acknowledging their efforts to improve the quality of RMNCH+ service provision. The program monitors the SDPs’ performance in four areas: excellent maternal and child services, qualified management, integrated client services, and effective community engagement.

To date, HCAC has recognized 87 HCs and seven NGO clinics for achieving these program requirements, including achieving outstanding performance in at least one of the four areas.

j) Strengthening Self-Reliance

To improve the self-reliance of MOH HADs and NGOs, USAID Health Service Delivery built their capacity to own and lead the collaborative sessions. The HADs and NGO headquarters staff led the preparations and conducted the sessions in March 2020.

Additionally, MOH trainers conducted the technical PHC training workshops for MOH, RMS, and NGO staff. During FY20 Q2, these trainings included Woman and Child Health Services Comprehensive Counseling, Implanon NXT insertion and removal.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

C. Hospital Service Delivery Improvement

a) Integrated Service Delivery Improvement Collaborative (ISDIC)

In FY20 Q2, USAID Health Service Delivery supported the MOH and RMS heads of maternal specialties in their journey to self-reliance by conducting two collaborative sessions on maternal services. During the maternal collaborative sessions, the MOH and RMS heads highlighted their achievements using the maternal clinical pathways. The MOH Head of Obstetrics and Gynecology, Dr. Abdel Manie’ Al- Suleimat, emphasized the importance of the findings and recommendations of the National Maternal Mortality Report 2018, and how compliance with clinical pathways can help avert maternal deaths. USAID Health Service Delivery highlighted lessons learned through presenting maternal mortality case scenarios.

“In order to avert avoidable maternal deaths, it is crucial to adhere to the best practices according to the approved maternal clinical pathways.”

Dr. Abdel Al-Manie’ Suleimat, Chief of Ob/Gyn Specialty / MOH

In addition, USAID Health Service Delivery assisted MOH and RMS heads of neonatal specialties to conduct collaborative sessions using practical examples. These sessions focused on progress in implementing the neonatal clinical pathways, the Aseptic Preparation and Administration of Intravenous (IV) Medications and Fluids program, and the irrational use of antibiotic in NICUs.

During FY20 Q2, USAID Health Service Delivery conducted 42 follow-up field visits with hospitals, assessed the current practices, and identified areas for improvement within hospitals. The team also conducted OTJ training wherever needed. In FY20 Q3, USAID Health Service Delivery will collaborate with the MOH and RMS heads of obstetrics and gynecology and pediatric specialties to develop comprehensive change packages that meet actual hospital needs.

In FY20 Q2, USAID Health Service Delivery’s hospital team, in collaboration with the MOH’s Nursing Directorate, successfully supported the MOH to conduct four Maternal Clinical Pathway training sessions. These sessions targeted 80 nurses and midwives from all MOH hospitals. The sessions focused on compliance with the 2019 updated clinical pathways. Additionally, the sessions addressed communication skills, documentation practices, and utilizing the Partograph as a best practice for monitoring women in labor.

During FY20 Q2, USAID Health Service Delivery also conducted a family planning counseling training workshop for midwives and nurses who provide family planning counseling services within postpartum departments and outpatient clinics at RMS hospitals. The main objectives of the training included highlighting the importance of client-focused family planning counseling to improve family planning services, practicing client-provider interaction skills, and helping providers to assist clients to take voluntary informed decisions related to family planning services.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

“Focusing on the clients’ needs is crucial. Adapting to the circumstances of the beneficiary qualifies the service provider to support the beneficiary using the method that has been successfully selected as well as the tolerance and handling of side effects correctly.”

Ms. Rima Kiwan, Family Planning Coordinator / RMS

Figure 2 presents the semiannual data for Q1 and Q2 for the percent of postpartum clients receiving counseling on modern family planning methods before discharge from RMS hospitals.

100% 95% 97% 94% 86% 73%

Prs. Haya Al-Hussein Pr. Hashem Pr. Rashed Pr. Zaid Q. Alia

Figure 2: Percent of Women Receiving Family Planning Services in RMS Hospitals during FY20 Q2

In FY20 Q1, USAID Health Service Delivery, in collaboration with the MOH and RMS TWG, finalized and submitted the Aseptic Preparation and Administration of IV Medications and Fluids Guideline, and created a pool of MOH and RMS TOT trainers. In collaboration with TOTs, USAID Health Service Delivery successfully conducted two two-day didactic training sessions for senior nurses working in the NICUs. Twenty-eight MOH and 40 RMS participants attended these sessions (68 participants). The training focused on the interactive learning required to build participants’ knowledge and skills to effectively implement aseptic techniques, and prepare and administer IV medications and fluids in NICUs. The sessions also highlighted evidence-based best practices on Total Parental Nutrition (TPN) and drug calculation.

In Q3, the Director of the Clinical Pharmaceutical Directorate will collaborate with hospitals heads of NICUs to facilitate establishing a suitable environment to deploy the Aseptic Preparation and Administration of IV Medications and Fluids Guidelines within their facilities.

Furthermore, USAID Health Service Delivery advocated establishing safe practices when preparing compounded sterile medication and fluids. HCAC updated the Hospital Standards Fourth Edition, adding a new section on medication management standards. These standards explain the need for compounding sterile preparations in a safe environment performed by qualified nurses working in the NICU, pharmacists, or clinical

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

pharmacists. The hospital team continued its efforts working with public hospitals to transform the routine use of episiotomy to selective/restrictive use, as one element of respectful maternity care during childbirth. In FY20 Q2 USAID Health Service Delivery, in collaboration with counterparts from MOH and RMS, developed a new clinical pathway to promote selective/restrictive use of episiotomy. In FY20 Q3, USAID Health Service Delivery will train Ob/Gyn physicians and midwives on the episiotomy clinical pathway, focusing on assessment of women during the childbirth stage, and implement risk-reduction strategies.

b) Introduce a Framework to Link USAID Health Service Delivery Indicators with MOH and RMS Monitoring

During Q2, USAID Health Service Delivery arranged several meetings with the central MOH and RMS to promote their self-reliance. MOH’s Institutional Development and Quality Directorate reviewed the monitoring framework and data collection tools that USAID Health Service Delivery and MOH previously worked on together. Upon MOH’s selection of indicators to adopt, USAID Health Service Delivery conducted a workshop for MOH hospitals, targeting healthcare providers who work in quality assurance departments. The purpose of this training was to orient participants on selected maternal and neonatal performance Photo 4: Meeting with the MOH Institutional indicators that USAID Health Service Development and Quality Directorate on Delivery proposed to the central MOH. February 2, 2020 in MOH Central Building

Correspondingly, The RMS Quality Assurance Department agreed to support adopting selected maternal and neonatal indicators at the hospital level. Additionally, the heads of Ob/Gyn and neonatal specialties in RMS hospitals will now be responsible for carrying out follow-up processes, ensuring staff compliance with the clinical pathways.

c) USAID Health Service Delivery Efforts to Improve Linkages between PHCs and Hospitals

During FY20 Q2, in four HADs, USAID Health Service Delivery coordinated between hospitals and HCs to provide technical assistance. The purpose was to help them to increase the uptake of integrated RMNCH+ services. USAID Health Service Delivery, in coordination with Al-Karak and Al-Balqa WCH unit heads and MCH supervisors, executed joint follow-up visits with relevant hospitals and HCs. The joint teams discussed the progress of developing an integrated care plan, agreed on collaborative decisions to increase uptake of family planning methods, and discussed ways to virtually communicate and share feedback about high-risk case referral and strengthen postnatal referral links. To support the continuum of care approach between participating hospitals and HCs and to develop a joint collaborative integrated care plan, USAID Health Service Delivery conducted joint collaborative sessions. These sessions addressed recommendations from Jordan’s Maternal Mortality Surveillance and Response Report results and RMNCH+ continuum of care approaches.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

USAID Health Service Delivery also further expanded its joint collaborative approach to two additional HADs (Mafraq and Jarash). USAID Health Service Delivery also asked two RMS hospitals to participate with the MOH hospitals and HCs in those areas.

USAID Health Service Delivery noted that private physicians referred a significant number of patients to the hospital, who did not bring their relevant clinical information. USAID Health Service Delivery learned this while holding a collaborative session with the Jarash HAD, and during technical follow-up visits. As a result, the HAD communicated with private sector physicians to mitigate any Photo 5: Joint ISDIC for Jarash HAD on January 13, potential gaps in patient clinical 2020 in Jarash HAD Meeting Room information and documentation. One of the recommended action points from the Jarash HAD, in the integrated care plan, was for the private sector to start using the MOH Antenatal Care Mother card. This card includes pregnancy history data for the mother that is used by the MOH’s HCs and hospitals. Using this card will help to better account for and document the number of mothers the private physicians refer to public hospitals, and will help to foster the linkages between primary health care and hospital levels. USAID Health Service Delivery also presented the JMMSR findings and responses during the joint collaborative sessions. The team explained how the integration between HCs and hospitals would address the report’s recommended responses, and the role this coordination will have in reducing rates of avoidable maternal deaths.

d) Unnecessary Cesarean Section Reduction

To implement and monitor the quality improvement program on reducing unnecessary cesarean section deliveries, during Q1, USAID Health Service Delivery, in collaboration with the public health sector, formed an Oversight Committee. The committee met and developed the Primary Reduction Action Roadmap and nominated five public hospitals, five private hospitals, and two educational hospitals to be enrolled in the Cesarean Section Deliveries Reduction Program.

In Q2, over three sessions, USAID Health Service Delivery supported the Unnecessary Caesarean Section Reduction Oversite Committee in developing technical materials, including guidelines and IEC materials. The Committee provided valuable evidence-based feedback on the technical materials.

“The key to successfully implementing these Guidelines relies greatly on physician-client trust. These Guidelines will act as a pillar towards proving evidence-based services that eventually are in the best interest for both the physician and the mother-to-be.” Dr. Mazen Zibdeh, Oversight Committee’s Chair and Private Sector Ob/Gyn Consultant

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

USAID Health Service Delivery collected baseline data for the Unnecessary Cesarean Section Deliveries Reduction Program in ten selected hospitals. The USAID Health Service Delivery hospital team planned to present the results of the data collection in the improvement collaborative session. However, this presentation was postponed due to the government shutdown. In Q3, USAID Health Service Delivery will commence training of health service providers in the selected hospitals on using the developed technical materials.

Photo 6: Meeting with the Unnecessary Cesarean Section Deliveries Reduction Program Oversight Committee on February 10, 2020 at the USAID Health Service Delivery premises

Sub-result 1.2 Increased community involvement to promote and increase demand for RMNCH+ services

A. Community Engagement

During FY20 Q2, USAID Health Service Delivery continued to strengthen the capacity of HAD and CHC HPS. USAID Health Service Delivery worked with HCAD counterparts at different levels to mobilize communities, further develop their capacities for health promotion, and obtain community feedback to support RMNCH+ services.

a) Community Mobilization and CHCs

During FY20 Q2, USAID Health Service Delivery worked in close collaboration with the HCAD to strengthen 80 active CHC members’ capacity and performance within MOH health center catchment areas. These CHCs provided platforms to reach out to RMNCH+ service users. The community engagement team helped HCAD to raise awareness and mobilize RMNCH+ service users to develop local solutions for health gaps and problems (see Annex 12 for a list of active CHCs).

To strengthen further the capacity of CHCs to mobilize and engage their communities, USAID Health Service Delivery and the HCAD used the Community Mobilization Manual to train 32 CHCs. The manual includes sections on community engagement and asset mapping, planning and activity design, event management, advocacy, networking, and communication skills. The training emphasized the power of the community to promote change and contribute to RMNCH+ service improvement.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

USAID Health Service Delivery and HCAD trained 665 participants (494 female and 171 male). Five hundred thirty-one were community members and 134 were HC staff who are also CHC members.

Additionally, USAID Health Service Delivery in close collaboration with the HCAD worked with CHCs to focus more on RMNCH+ session plans. The CHCs started to conduct coaching sessions during their progress review meetings. Moreover, USAID Health Service Delivery coached CHCs to identify traditional methods users, and direct them to HCs for further counseling.

During FY20 Q2, the 80 active CHCs conducted 250 RMNCH+ health education events, including awareness raising events, lectures (interactive education sessions), and support groups. CHCs carried out 63 (25%) of these events on their own initiative without any direct support from USAID Health Service Delivery.

“CHCs played a great role in raising health awareness within their communities, and Rofidah College will always provide support to the CHCs” Dr. Saleh Al-Ajlouni Advisor to the Minister of Health and Director of the Rafidah College

A total of 5,415 women participated in the events, 4,981 of whom were women of reproductive age. A total of 1,863 women of reproductive age participated in family planning education sessions, while 3,576 women of reproductive age participated in nutrition and breastfeeding awareness raising events taking into account that some women participated in more than one event. Additionally in FY20 Q2, USAID Health Service Delivery in collaboration with HCAD started distributing direction slips through 22 CHCs.

Prince Hamza CHC/Zarqa held a health education event about Nutrition to Prevent Anemia for pregnant women and children under five; 25 women of reproductive age attended the event. The CHC note taker distributed 11 direction slips to attendees, who showed interest in going to the health center. This event was an opportunity for mothers to share their experiences and ask questions about MCH services at the HCs. At the end of the event, the facilitators encouraged attendees to visit HCs, so they could benefit from mother and child services. The head of Photo 7: Distributing the direction slip through the host association, “White Mountain Ramtha CHC in Irbid in February 2020 Women Association” knew some attendees wanted to go to the Prince Hamza HC, but transportation was the real barrier. She took the initiative and contacted a member of the Decentralization Council, who in turn provided a bus for attendees who wanted to benefit from the HC’s services. As a result, the HC screened 20 children under five for anemia.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

USAID Health Service Delivery continued supporting 16 MtMBSG who held 30 sessions during the quarter. Female community volunteers lead these sessions to raise awareness on the advantages of breastfeeding and provide social support and information for pregnant and breastfeeding women. Two hundred and eighty three women participated in the community-based MtMBSGs.

As part of supporting the MOH’s journey to self-reliance, USAID Health Service Delivery in collaboration with the HCAD conducted a TOT workshop for 19 HCAD staff, HPSs, and Health Promoters. Participants came from six HADs, including Amman, Zarqa, Balqa, Jarash, Ajloun, and Mafraq. The purpose of the TOT was to establish a core group of MOH trainers equipped with the required skills and knowledge regarding training principles, breastfeeding, and facilitation skills.

“"I really liked the idea of (MtMBSG) and I’m glad that we have such programs. I believe that after the TOT, the trainees became the foundation stone for this program at the ministry, which means that we as trainers can train other people to be facilitators and transfer expertise to them so that we can continue and expand the experience.” Eng. Amani Al Zoubi, HCAD Staff / MOH

In FY20 Q2, USAID Health Service Delivery in collaboration with the HCAD conducted a CHC peer exchange visit for three CHCs. The host was Al Msheirfeh/Zarqa CHC, and Al Razi/Jarash and Al-Sbeihi/Balqa CHCs attended. This peer exchange activity provided an opportunity for the attending CHCs to demonstrate successes, exchange ideas, and support the diffusion of successful events to other areas. After the peer exchange, based on their observations, each CHC in coordination with the Community Engagement Officer developed a peer-to-peer action plan with a time line.

b) Health Promotion Program

USAID Health Service Delivery supports the MOH Health Promotion Program to enhance and increase HCs’ awareness of RMNCH+ services by sharing effective ways to educate and motivate clients to use health services and commit to healthy behaviors.

In FY20 Q2, USAID Health Service Delivery collaborated with the HCAD to conduct a second TOT using the updated Health Promotion Manual.

The HCAD selected 13 staff and HPSs to participate in the TOT. The purpose of the training was to enhance participants’ capacity to plan and implement RMNCH+ promotion activities. The workshop aimed to mitigate high MOH staff turnover and focused on skills development in areas such as facilitation, interpersonal communications, mentoring, and presentation skills. In addition, trainers oriented participants on the updated “Health

Promotion Manual”. Photo 8: TOT for the Health Promotion Manual in Amman in February 2020

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

“This TOT on health promotion program provided us with the necessary skills for planning and implementing the upcoming didactic HP trainings.” Eman Al-Shobaki, Head of the Awareness Department in HCAD / MOH

To strengthen the MOH’s capacity to plan, implement, and document RMNCH+ activities, in FY20 Q2, USAID Health Service Delivery collaborated with the HCAD to train 29 workshop participants on “Planning and Electronic Documentation Process for Health Promotion Activities.” The HCAD and the MOH Electronic Transformation and Information Technology Directorate (ETITD) staff facilitated the workshop. The main objectives included presenting the health promotion electronic reporting and documentation process and training HPSs and health promoters on how to generate and submit electronic reports to the HCAD.

In FY20 Q3, USAID Health Service Delivery planned to support the HCAD to conduct a quarterly HPS coordination workshop to give HPSs an opportunity to present achievements, challenges, and lessons learned. However, the HCAD postponed this workshop due to the government shutdown.

c) Community Feedback

In FY20 Q2, USAID Health Service Delivery continued working with the HCAD to follow up on 28 CSC improvement plans. USAID Health Service Delivery’s community engagement team also worked with the HCAD to strengthen the role of CHCs in ISDIC sessions, so they can better represent community voices and community feedback on health service delivery.

USAID Health Service Delivery, in response to the mid-term evaluation, worked on modifying the CSC methodology. The purpose of these modifications was to better engage CHCs in the CSC process, by encouraging their ownership in the process, so CHCs are prepared to take the lead on the CSC in the future. To prepare these modifications, USAID Health Service Delivery held discussions with its counterparts to understand how to improve the process. Based on the feedback received during these CSC discussions, USAID Health Service Delivery added specific enhancements to the CSC methodology. First, USAID Health Service Delivery and HCAD staff conducted an orientation session during the CHC’s monthly progress review meeting to make sure all CHC members are present, and they are aware of the CSC process and methodology. USAID Health Service Delivery sought to ensure that every CHC member has an understanding of the CSC process, not only those who will participate in a CSC activity. Second, USAID Health Service Delivery modified the CSC facilitation training to improve the CSC facilitation skills of HPS and CHC members; however, USAID Health Service Delivery postponed this training due to the government shutdown.

“From my previous experience with community score cards, I believe that it is one of the most successful tools to get feedback from both; service providers and clients. In addition to that, to draft improvement plans that required joint effort form the HC and the CHC.” Eng. Sana Abu Shameh, Former Head of HCAD Awareness Department / MOH

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

B. RMNCH+ Community Outreach Program

USAID Health Service Delivery implements the RMNCH+ Community Outreach Program to support health promotion and health education activities as part of the continuum of care for RMNCH+ services. The program focuses on raising awareness, increasing access, generating demand for comprehensive and high quality RMNCH+ services, and changing behavior toward positive RMNCH+ practices. Under the Community Outreach Program, female Community Health Workers (CHWs) provide information on RMNCH+ topics for women of reproductive age and children under five using social and behavior change communication (SBCC) techniques, encouraging women and children in these age groups to seek services from qualified providers when necessary. The household visits provide an opportunity for one-on-one interpersonal communication, providing a safe and private environment for the women of reproductive age to ask questions, seek information on various health issues, and identify appropriate health services nearby. CHWs receive continuous training and coaching to raise awareness, promote healthy behaviors, and generate demand for RMNCH+ services among the beneficiaries. The Community Outreach Program focuses on lower income households that have an unmet need for RMNCH+ information and services in Jordan.

USAID Health Service Delivery began the Community Outreach Program in FY18 in 19 districts through sub-agreements with two Community Outreach implementing partners, IFH and JAFPP. In FY19, USAID Health Service Delivery added a third implementing partner, Blumont. By FY19, the program was active in 37 districts, and continued to be active until FY20 Q1. Following that, Blumont’s period of performance ended on January 31, 2020. As a result, their work ceased in 11 districts.

In FY20 Q2, IFH and JAFPP continued implementing in 29 districts. On March 15, 2020, the CHW household visits ceased due the government shut down. Soon afterwards, USAID terminated the Community Outreach program. The details below depict progress and achievements that occurred before the termination of this program.

During FY20 Q2, IFH and JAFPP were active in 29 districts across all 12 governorates, with a total of 117 CHWs, 14 supervisors, and their supporting management structure. CHWs employed by both implementing organizations conducted 67,869 household visits for women of reproductive age and children under five (44,181 visits for women of reproductive age and 23,688 visits for children under five). The implementing partners reached 30,317 women with RMNCH+ messages, including 9.88 percent Syrian women and 6.56 percent of other non-Jordanian nationalities.

During this quarter, USAID Health Service Delivery also launched the direction slip initiative to better track and monitor beneficiaries directed by the Community Outreach program.

Since CHWs provide a critical link between their communities and the health system, USAID Health Service Delivery decided to distribute direction slip booklets to the outreach implementing partners in late January 2020. CHWs distributed direction slips during household visits to any beneficiary who showed interest in the services below provided by SDPs (MOH HCs, NGO clinics, or private doctors):

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

o Antenatal Services o Postnatal Services o Children Under Five (growth and development services and Anemia Screening) o Family Planning Contraceptives.

Implementing Partners commenced distribution of direction slips in February 2020 to eligible beneficiaries during household visits. The outreach implementing partners, with USAID Health Service Delivery, selected certain catchment areas to begin the distribution, depending on where their CHWs and SDPs were located. JAFPP and IFH distributed 1712 direction slips.

To maintain the momentum of continuous training and coaching, in FY20 Q2 USAID Health Service Photo 9: RMNCH+ Community Outreach Delivery conducted a one-day training workshop for Training Session at IFH in March 3, 2020 the entire IFH outreach team, including all CHWs, supervisors, team leads, and management staff. The team delivered the refresher training to three different groups of IFH outreach teams in March. The training highlighted the importance of effectively directing beneficiaries to SDPs, and explained the guidelines and instructions related to distributing direction slips. The training also further reviewed the SBCC principles and explained to participants the approach to write effective success stories. During the training, USAID Health Service Delivery also shared Photo 10: RMNCH+ Community Outreach Training Session at USAID Health Service necessary areas of improvement observed during Delivery in March 12, 2020 shadow household visits with the outreach implementing partners.

Following the FY20 Q1 USAID Health Service Delivery led TOT focused on Gender delivered to implementing partner supervisors and team leads, the implementing partners replicated the training for their CHWs and respective teams in FY20 Q2.

USAID Health Service Delivery held its regular Senior Management meeting with IFH and JAFPP leadership in February. The meeting participants discussed progress, challenges, introduced the direction slip, and brainstormed on ways to improve data collection and reporting for the USAID Health Service Delivery outcome indicator.

During Q3, USAID Health Service will work closely with IFH and JAFPP on the financial and technical closeout of the Community Outreach program, including documenting lessons learned and the results of implemented activities.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

Innovation Grants

USAID Health Service Delivery developed the Innovation Grants program to attract and fund grants that support a wide range of innovative approaches or interventions to improve access to and quality of RMNCH+ services, targeting underserved communities including both Jordanians and Syrians living in Jordanian communities. USAID Health Service Delivery defines “innovation” as the use of service delivery, outreach, community, research, or interventions that were not part of ongoing programs in Jordan, and that had the potential to achieve improved health results.

During FY20 Q2, the five grantees continued the implementation of their planned activities. Two grant activities implemented by IFH and RHAS ended at the end of February 2020. On March 15, 2020, USAID terminated the other three innovation grants due to COVID 19. The three remaining grantees began preparing for rapid close out of programs. Below includes the final progress made by grantees in Q2:

a) Technology to Improve Access to RMNCH+ Services – IFH (ended 02/28/2020)

In the final quarter of IFH’s grant, IFH’s Queue Management System (QMS) and the mobile application facilitating appointments operated in nine IFH facilities. The numbers below indicate IFH’s technological innovation is improving service delivery at IFH facilities:

o IFH recorded 32,765 QMS tickets in the nine clinics in the last six months, indicating IFH clinics’ extensive use of the QMS in a short period.

o IFH clients spent on average 25 minutes with the service provider. IFH’s baseline for encounter time was 20 minutes. The recorded average encounter time increased in part because of the efficiency of the new QMS and mobile application facilitating appointment setting.

o IFH client’s average waiting time to receive a requested service included 16 minutes for walk-in tickets, and seven minutes for mobile appointment tickets. IFH’s baseline for wait times was 40 minutes, indicating the mobile application that facilitates clinic appointments for clients is highly effective in substantively shortening wait times for IFH clients who use the system for appointments.

IFH executed a social media campaign in Q2 to increase awareness of the application among IFH clients. The USAID Health Service Delivery communication team reviewed and approved the campaign, including all media messages and the short videos to ensure appropriate branding and marking before dissemination.

IFH also conducted satisfaction surveys for the beneficiaries in the nine clinics, including seven questions related to the QMS and mobile application facilitating appointments. Clients’ satisfaction levels related to the QMS and mobile application include the following:

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

o The queue at IFH facilities is well-organized using QMS: 65% strongly agreed

o The queue line and order are acceptable: 60% strongly agreed

o The IFH mobile application improves the process for receiving services: 41% strongly agreed/ 38% N/A

o The IFH mobile application is saving client time and effort: 38% strongly agreed/ 42% N/A

o The IFH staff understand and can support clients in using the IFH mobile application: 54% strongly agreed

o IFH is introducing QMS in a way that makes sense: 42% strongly agreed/ 27% N/A

o IFH health services can be easily evaluated using the IFH mobile application: 37% strongly agreed/ 40%N/A

The IFH grant ended on February 28, 2020. The IFH and USAID Health Service Delivery grants teams are working on the financial and technical close out of the grant activity, including documenting lessons learned and the results of grant activities. As part of the close out process, USAID Health Service Delivery grants team conducted spot check visits to four of IFH clinics to assess the QMS implementation.

The USAID Health Service Delivery grants team is developing a success story including a link to the code for the QMS and mobile application facilitating appointments to disseminate to the MOH as part of handover of activities (the technological innovation is open source).

b) Health Promotion Youth Clinic (HPYC) – RHAS (ended 02/28/2020)

In FY20 Q2, RHAS held a program graduation ceremony for the third cohort of students who completed the HPYC program. During the graduation ceremony, RHAS recognized 109 students of 162 recruited to attend the HPYC course. The University of Jordan continues the process of adopting and sustaining the HPYC program within the School of Nursing.

The grant ended on February 28, 2020. RHAS and the USAID Health Service Delivery grants team are working on the financial and technical close out of the grant, including documenting lessons learned and results of grant activities. As part of the close out process, USAID Health Service Delivery grants team conducted two spot check visits: one at the HPYC program site at Jordan University and another at the RHAS headquarter office to assess the grant activity and closeout processing underway.

c) Healthy Community Clinic (HCC) – RHAS (terminated 03/15/2020)

In FY20 Q2, RHAS worked closely with the MOH WCHD and completed the trainings for midwives in the original and new 35 comprehensive HCs. The training provided an overview of the HCC model and activities, and provided skills building to the midwives to offer interactive awareness sessions to clients to address topics related to RMNCH+.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

In FY20 Q2, RHAS began implementing the HCC in the 35 HCs. In addition, RHAS completed Knowledge, Attitude, and Practices (KAP) assessments for the 35 comprehensive HCs.

d) Breaking the Wall of Silence - TWCS (terminated 03/15/2020)

In FY20 Q2, the TWCS continued implementing program activities by conducting three GBV awareness-raising sessions attended by 70 women from Tafilah Governorate. The TWCS received 48 GBV cases at the Al Amal and Erwaim centers for GBV services. In addition, the TWCS conducted two awareness sessions for married women of reproductive age (15- 49) on family planning concepts attended by 39 women from Tafilah Governorate.

e) Improve and Expand Existing Gender-Based Violence Services in Zarqa - FGAC (terminated 03/15/2020)

In FY20 Q2, the Family Guidance and Awareness Center (FGAC) continued implementing program activities in collaboration with partner CBOs by conducting 55 GBV awareness-raising sessions, attended by 7,368 women from Zarqa Governorate. The FGAC’s Rehabilitation & Integration Unit received 66 cases for GBV services. The FGAC conducted awareness sessions for 89 committers of GBV and potential GBV perpetrators. The FGAC’s Rehabilitation and Integration Unit provided counseling for five GBV cases.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

Result 2: Improved quality of integrated RMNCH+ services

Improving RMNCH+ services requires strengthening provider competency in delivering high quality, evidence-based RMNCH+ services (Sub-result 2.1) and strengthening the management of services delivered (Sub-result 2.2). Both results require capacity building and use of data for decision-making.

Sub-result 2.1: Improve provider competency and behavior to deliver evidence-based RMNCH+ services

A. Primary Health Care

During FY20 Q2, to compensate for high turnover and retirement of trained staff, USAID Health Service Delivery and the MOH conducted two training workshops on Implanon NXT insertion and removal. The USAID Health Service Delivery and the MOH conducted the workshop for 27 physicians from different HAD SDPs and NGO clinics. Additionally, USAID Health Service Delivery conducted two Implanon NXT insertion and removal OTJ training for two female physicians, from Mafraq and Irbid HADs. Due to the government shut down, USAID Health Service Delivery did not conduct an additional planned training on IUD insertion and removal.

WCHD Director also requested postponing a TOT about proper documentation for WCH unit heads and MCH supervisors planned for FY20 Q2. Responding to a WCHD request to expand the core group of trainers, during FY20 Q3, USAID Health Service Delivery will assist the WCHD in conducting a TOT on LARC. The USAID Health Service Delivery will assist the WCHD to conduct this training in Q3.

To address high SDP staff turnover and to ensure that HC newly assigned staff, especially physicians, are working in compliance with the PHC clinical pathways and procedures, USAID Health Service Delivery conducted 18 OTJ trainings on clinical pathways and procedures for 32 physicians, midwives, and nurses from HCs and NGO clinics. USAID Health Service Delivery also conducted seven didactic OTJ trainings on CSS for 25 nurses and clerks from HCs and NGO clinics.

B. Training Program for Newly Hired General Practitioners (GPs)

USAID Health Service Delivery and HCAC, in collaboration with the MOH, developed a training program for newly hired MOH GPs. The purpose of the training program is to build GP capacity to provide and manage high quality PHC services as well as meet client expectations. During FY20 Q2, his Excellency, the Minister of Health, signed the final updated version of the Newly Hired GP training package, which includes Trainer and Trainee Manuals in Arabic.

During next quarter, USAID Health Service Delivery will print copies for the Central MOH. USAID Health Service Delivery will also provide flash drives with electronic versions of the manuals, power point presentations, and most cited references to trainers and trainees.

To complete instituting core team of trainers at each of the14 HADs with at least three members (Administrative employee, Nurse/Dentist/Pharmacist, and Physician), USAID Health Service Delivery conducted the third and final TOT workshop that included 15

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

participants. In Q3, trainees will finish the TOT requirements, and the MOH will certify the trainees as trainers. During FY20 Q2, USAID Health Service Delivery also conducted the third and last regional workshop for newly hired MOH GPs, in five HADs (Amman, Irbid, Tafila, Ma’an and Aqaba). One hundred and seven newly hired GPs attended the workshop and all were certified.

C. Private Sector Providers

In FY20 Q2, as per the approved training and trainers plan, USAID Health Service Delivery continued conducting a series of lectures with the private sector. During FY20 Q1, USAID Health Service Delivery conducted a workshop for private physicians and presented the key findings of the National Maternal Mortality Report 2018. During FY20 Q2, USAID Health Service Delivery conducted second and third workshops.

The second workshop conducted at Al-Amal Maternity Hospital included two lectures. Dr. Abeer Ennab, an obstetrics and gynecology specialist from Al Amal Maternity Hospital, presented the first lecture and talked about the pros and cons of C/S versus vaginal delivery. During the second half of the workshop, Mr. Mohammad Al Hawamdeh, infection prevention expert, presented how to identify and reduce the risks of infections at private clinics. This workshop provided physicians with three CME hours. Twenty-eight physicians participated actively from Amman, Zarqa, Irbid, and Aqaba.

Photo 11: Addressing JMMSR Key Findings Second workshop for Private Physicians at Al Amal Maternity Hospital in Amman on February 13, 2020

To make it more feasible for private sector physicians who live in remote areas to attend, USAID Health Service Delivery distributed 35 tablets to physicians in the North and South, and to a selected number of physicians in Amman and Zarqa. In some clinics, USAID Health Service Delivery provided two physicians with the same tablet to share. Then the USAID Health Service Delivery team trained physicians using a virtual platform. Forty private physicians attended the scheduled lectures using this virtual approach.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

USAID Health Service Delivery conducted the third workshop using a virtual platform. USAID Health Service Delivery was able to reach 18 physicians from four governorates. During this workshop Dr. Suha Khalifa, a family medicine specialist, and Dr. Wael Khalifa, an obstetrics and gynecology specialist, presented on hypertension in pregnancy, the risk of gestational diabetes, and management of both conditions.

The Jordan Medical Council credited the interactive workshop with three CME hours. USAID Health Service Delivery received positive feedback on the use of webinar and on the workshop as a whole.

“Thank You USAID Health Service Delivery for the tablets and for this lecture, your efforts are appreciated and you are always creative in finding ways that can improve quality of our practice. We will continuously be looking for such lectures.

Dr. Akram Abu El-Haj – Private Clinic in Amman

During FY20 Q2, USAID Health Service Delivery finalized a customized IUD insertion and removal training manual, and the training materials needed to conduct a refresher training for interested private physicians. USAID Health Service Delivery planned to conduct the two-day practical and didactic refresher training in March. However, USAID Health Service Delivery postponed the training due to the government shutdown. USAID Health Service Delivery plans to conduct the didactical part, using a virtual webinar in April, while postponing the practical part until the government shutdown ends.

In FY20 Q2, in close collaboration with the Jordan Pharmacists Association (JPA), USAID Health Service Delivery conducted two workshops as part of the “Consult a Community Pharmacist” program. USAID Health Service Delivery trained 41 private community pharmacists from Jerash, Madaba, Balqa, and Amman governorates. In addition, representatives from the JPA including from JPA’s Continuous Professional Development Committee attended. Workshop topics included communication skills and behavior change, family planning, antenatal care, maternal anemia and anemia in children under five. The workshop covered health messages that pharmacists should know and provide to their clients about the above-mentioned topics. During these workshops, pharmacists identified specific interventions to implement at their pharmacies, including delivering family planning health education while considering client privacy. Pharmacists also discussed initiating a WhatsApp group to communicate specific messages to their clients. During FY 20 Q3, USAID Health Service Delivery will conduct joint field visits with JPA to follow up on these initiatives. USAID Health Service Delivery provided pharmacists with IEC materials including a Family Planning Global Handbook for Providers 2018 and the Family Planning All Methods Booklet to support the reinforcement of family planning messages to pharmacists’ clients. Both workshops credited the attendees with two CME hours.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

Photos 12 and 13: Group Photos during the Consult your Community Pharmacist workshops for Private Pharmacists at Geneva Hotel in Amman on February 1st and 29th, 2020

“On Behalf of Jordan Pharmacists Association, I would like to thank USAID Health Service Delivery for this great program; pharmacists always have a role in improving the quality of provided services. Jointly JPA and USAID Health Service Delivery will support community pharmacies to more actively participate in health promotion, particularly in the areas of RMNCH+” Dr. Rula Darwish, Head of Continuous Professional Development (CPD) Committee / Jordan Pharmacists Association

Sub-result 2.2 Strengthening management to support delivery of high-quality RMNCH+ services USAID Health Service Delivery supported a suite of activities to strengthen leadership and management of RMNCH+ services at all health system levels, including facilities, HADs, hospitals, NGOs, and at central level. This work includes the Manager Certification Program, FBSS, and the ISD Recognition Program. All of these activities continued into FY 20 and this Quarterly Report describes them in more detail under Sub-result 1.1.

A. Jordan’s Maternal Mortality Surveillance and Response System

During FY20 Q2, USAID Health Service Delivery worked with its counterparts to enhance the quality of data collection related to maternal deaths. USAID Health Service Delivery collaborated with the MOH Non-Communicable Diseases Directorate (NCDD) and implementing partner, Eastern Mediterranean Public Health Network (EMPHNET) to hold a training workshop for selected DAG members. The MOH NCDD nominated participants, so they could work together to enhance the quality of maternal death data collection. The main objectives for the training included strengthening the DAG members’ capacity to lead JMMSR system implementation, enhancing knowledge and skills on data collection, understanding the importance of comprehensive data collection, highlighting the main elements of a comprehensive case summary, and discussing lessons learned and experiences from the 2018 data collection process.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

During the workshop, USAID Health Service Delivery provided a checklist for participants to use while collecting maternal death data in the field. This checklist will guide them in writing comprehensive case summaries; allow for better maternal death review; ease the process of maternal death data interpretation and analysis; and more accurately assign the causes of deaths and contributing factors. Photo 14: JMMSR DAG members discussing how to As a part of the JMMSR engagement activities, write comprehensive case summaries during the workshop on January 20, 2020 in collaboration with the NCDD at the MOH and EMPHNET, USAID Health Service Delivery held two workshops during Q2 for nominated Civil Status and Passports Department (CSPD) staff. The objective of these workshops included engaging members of the CSPD and establishing coordination between the CSPD and the MOH NCDD to improve the accuracy of the JMMSR data collected through the JMMSR IS. Further information on the JMMSR IS is included in the Photo 15: CSPD and NCDD members discussing ways for future coordination during the JMMSR next section. engagement workshop on January 28, 2020

During the workshop, the participants discussed ways that the CSPD and MOH NCDD could continue to collaborate to improve the system and better ensure data accuracy. The group discussed data issues, such as several records for the same person, which occur when non-Jordanians seek healthcare services, given their lack of a unique identifier. The group suggested it would be useful to use the same classification system for coding the causes of death, so the CSPD and JMMSR IS records will easily match.

The NCDD and CSPD also discussed the possibility of meeting on a quarterly basis to compare death records. Previously the NCDD obtained the CSPD records at the end of each year to verify the JMMSR IS data.

a) National Advisory Group Meetings

In FY20 Q2, the NAG held meetings in January and February to review 11 maternal death cases. The group assigned causes of death to ten of these cases. Eight cases were due to direct causes, including obstetric complications, while two were due to indirect causes resulting from a pre-existing condition. For one case, the NAG could not specify the cause of death. Due to the government shutdown, the NAG could not meet again during FY20 Q2 to continue reviewing the remaining maternal death cases for 2019. In Q3, USAID Health Service Delivery will facilitate virtual meetings of the NAG.

During FY20 Q2, USAID Health Service Delivery and EMPHNET, conducted 15 field visits to support DAG members to identify maternal death cases. Moreover, the DAG held five meetings to review maternal death cases.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

b) USAID Health Service Delivery Efforts on JMMSR System Disseminate Findings and Responses

Following the dissemination of the first National Maternal Mortality Report for Jordan in FY20 Q1, USAID Health Service Delivery, in collaboration with its counterparts, led the effort to disseminate the report findings and initiate responses to avert maternal deaths.

In FY20 Q2, USAID Health Service Delivery coordinated with the NAG to present the National Maternal Mortality Report for 2018 findings in several forums, including discussions on linking JMMSR responses to actions.

The USAID Health Service Delivery JMMSR team assisted the heads of MOH and RMS maternal specialties to disseminate the National Maternal Mortality Report 2018 results with the heads of the maternal services units at public hospitals during the collaborative session (mentioned previously).

During Q2, USAID Health Service Delivery also held a meeting with representatives from the WHO and the UNFPA. The purpose of the meeting was to engage participants further on the JMMSR IS, and to discuss how stakeholders could link JMMSR responses to actions.

Additionally, USAID Health Service Delivery, in coordination with the NAG, held a response workshop for stakeholders in February. The workshop mobilized relevant stakeholders to discuss and support JMMSR system responses to avert future maternal deaths. The workshop participants also worked together on a draft JMMSR response action plan.

Representatives from the MOH, the RMS, the University teaching hospitals, the private and NGO sectors attended the JMMSR response workshop. NAG Chairman, Dr. Abdel Manie’ Al-Suleimat, led the workshop.

During the first half of the workshop, facilitators presented an overview of the JMMSR system and the National Maternal Mortality Report 2018 methodology and key findings. After the presentations, participants worked in four small groups to discuss different parts of the proposed response action plan, linking the NAG developed JMMSR responses to avert future maternal deaths to the National Maternal Mortality Report 2018. In the small groups, participants discussed specific responses that included strategies to standardize prevention and management practices for the most common causes of maternal deaths; enhancing quality of ANC services; strategies to reduce unnecessary primary cesarean section deliveries; and increasing the uptake of quality family planning methods.

“Today’s action plans reflect the commitment of all stakeholders. With endorsement from HE the Minister of Health, Jordan’s health sector will have a clear path towards eliminating preventable maternal mortality.” Dr. Abdel-Manie’ Al-Suleimat, Chairman of the JMMSR NAG

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

Participants showed a high level of engagement during the presentations with fruitful discussion throughout. Dr. Abdel-Manie’ expressed the Minister’s full support of the JMMSR system. He committed to obtaining the Minister’s endorsement on the final JMMSR System Response Action Plan.

A series of training workshops in March followed the JMMSR response workshop. Participants from ten HADs attended, including Health Affairs Directors and their DAG members and selected Hospital Directors. Participants discussed the JMMSR system findings from the National Maternal Mortality Report 2018. Then, attendees learned how to translate JMMSR system responses into actions at the HAD level. The workshop also highlighted JMMSR IS security measures and data confidentiality, and provided an overall JMMSR IS orientation.

Due to the government shutdown, USAID Health Service Delivery postponed the training workshops scheduled for March 15, 16, and 17 in Ma’an, Petra, Tafila, and Aqaba until the lockdown is over.

Additionally, in response to the National Maternal Mortality 2018 findings, USAID Health Service Delivery coordinated a discussion with obstetrics and gynecology specialty managers from the MOH, the RMS, Jordan University Hospital, and the private sector on institutionalizing the Advance Life Support for Obstetrics (ALSO) training in Jordan.

Photo 16: ALSO Meeting with Ob/Gyn managers from all sectors in USAID Health Service Delivery premises on February 9, 2020 Meeting attendees agreed to coordinate with the American Academy of Family Physicians (AAFP) to discuss technical material re-production, trainees’ nomination, and certificate issuance. Jordan University Hospital and the RMS indicated their interest in leading and supervising ALSO trainings, as both institutions had already contacted AAFP to have their staff trained as trainers.

Additionally, USAID Health Service Delivery agreed to procure mannequins for the Jordan University ALSO lab to further support ALSO training workshops. The members will meet again in Q3 to discuss training progress and next steps.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

B. Health Management Information Systems

In FY20 Q2, the USAID Health Service Delivery Health Management Information System (HMIS) team made significant enhancements to the JMMSR IS which are detailed in the section below. In addition, during the government shutdown, the HMIS team supported USAID Health Service Delivery staff to work remotely including online meetings and seminars, enabling staff to continue key activities, including work with the private sector.

a) JMMSR Information System (JMMSR IS)

In January 2020, the MOH tested and launched the JMMSR IS enhanced version. This version is more user friendly with improved security controls to ensure system data confidentiality. To improve data accuracy, the USAID Health Service Delivery HMIS team successfully linked the JMMSR IS database directly to the CSDP database through a government-to-government agreement. This allows users to get the most updated identification data directly from the CSPD database. The HMIS team also strengthened the MOH’s capacity to manage, operate, and update the JMMSR IS. The new version allows the MOH to monitor the implementation and generate required reports. The MOH’s ETITD now has the programming capability needed to sustain the new version of JMMSR IS.

To ensure that the MOH NCDD and the ETITD are equipped to maintain the JMMSR IS in the future, the HMIS team supported them to operate the enhanced version. USAID Health Service Delivery met with the NCDD and the ETITD jointly on multiple occasions to discuss their roles and responsibilities, so they can best manage and maintain the JMMSR IS. For example, they discussed the responsibility of generating reports, granting access privileges, and resetting passwords. Both teams agreed to continue to hold joint meetings until the handover is complete.

Due to high turnover of health facility focal points, USAID Health Service Delivery also conducted OTJ training with new focal points. The HMIS team created a help page on the JMMSR IS platform with contact details of MOH ETITD members so users can directly reach out for support, and provided an electronic form where users can request support by filling out the form. During Q2, the MOH ETITD added three new health facilities to the JMMSR IS, and the new focal points received training from the HMIS and the MOH ETITD staff.

To further promote the MOH’s self-reliance, the HMIS team actively involved the MOH ETITD in responding to JMMSR IS related requests coming from technical users. Moreover, USAID Health Service Delivery conducted workshops for DAGs in ten HADs. During these workshops, a representative from the MOH ETITD presented the concepts of cybersecurity and its applications within the JMMSR IS to maintain the system’s security and data confidentiality.

During FY20 Q2, the HMIS team supported the ETITD in configuring the JMMSR IS servers at the MOH data center. The HMIS team assisted the ETITD in fixing connectivity issues, leading to improved efficiency of the system networking.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

The HMIS team developed a new module for easier generation and visualization of JMMSR IS indicators. The MOH NCDD will rely on this module to view, extract, and report on JMMSR indicators directly from the system’s interface. Moreover, the HMIS team finalized the first draft of JMMSR IS documentation and will finalize and disseminate it next quarter.

C. Integrated Service Delivery (ISD) Recognition Program

During FY19, HCAC assessed 17 MOH and RMS hospitals, issuing recognition certifications to those hospitals who met the criteria. These criteria for hospital SDPs reflect staff efforts through the ISDIC cycles, including essential elements in three areas: maternal services provision, neonatal services provision, and health care management. In FY20 Q2, HCAC assessed two additional hospitals: RMS Queen Alia hospital and MOH’s Prince Hussein Bin Abdullah II Hospital. The assessment team will provide an opportunity to reassess three hospitals (Al-Bashir Hospital, Princess Bade’a Hospital and Al-Mafraq Obstetrics and Gynecology Hospital) that did not meet the criteria in maternal services. HCAC completed the assessment for one hospital and postponed those remaining due to the government shutdown.

D. RMNCH Manager Certification Program

During FY20 Q2, USAID Health Service Delivery and HCAC conducted the RMNCH+ Manager Certification training with staff in ten hospitals including hospital directors, midwives, and nurses. This program teaches management knowledge and skills to encourage increased competency and a high level of performance. The program training also shares quality improvement methodologies.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

5. COLLABORATION AND KNOWLEDGE SHARING

A. PARTNER ENTITIES IN HOST GOVERNMENT AND OTHER DONOR AGENCIES a) MOH

USAID Health Service Delivery works with multiple central MOH and HAD departments to strengthen their technical capacity and to support their long-term self-reliance. For example, USAID Health Service Delivery conducted the Sustaining ISDIC Approach workshops, at HAD level, to build their capacity on how to implement the ISDIC approach in an efficient and effective way.

During FY20 Q2, USAID Health Service Delivery supported Al-Bashir Hospital’s Administration to conduct the Neonatal Resuscitation Program (NRP). USAID Health Service Delivery’s hospital team conducted training workshops for 36 health care providers from all MOH hospitals. The training workshops targeted pediatric physicians and nurses working in the NICUs, and focused on improving newborn health outcomes. The program used evidence- based newborn care approaches and facilitated effective team-based care for healthcare professionals who care for newborns at the time of delivery. The workshop adopted a blended learning approach that includes testing, case-based simulations, and hands-on case-based simulation with immediate debriefing that focuses on teamwork skills. b) The Higher Population Council (HPC)

In FY20 Q2, the HPC invited representatives from USAID Health Service Delivery to attend several workshops, to continue developing the National Reproductive Health Strategy 2019- 2023. During the last workshop, participants discussed and modified strategic indicators, building on the previously agreed upon goal and objectives. c) The United Nations agencies: United Nations Population Fund (UNFPA), United Nations Children's Fund (UNICEF), the World Health Organization (WHO), and other donors

During FY20 Q2, UNFPA conducted a meeting to discuss and agree on activities for those working under the UNFPA umbrella in 2020. A USAID Health Service Delivery representative attended. The meeting participants developed a list of priorities, including antenatal care, family planning, postpartum, delivery, cash for facility based delivery (Cash for Delivery is a UNFPA funded program, in which they provide cash to Syrians for specific medical services), and gender based violence.

USAID Health Service Delivery also met with the WHO and UNFPA to discuss the NAG-led JMMSR response action plan based on the National Maternal Mortality report 2018. USAID Health Service Delivery asked the organizations for their input and contributions.

UNFPA showed an interest in supporting the MOH to update clinical guidelines and clinical pathways related to the most common causes of maternal death. A multi-sectoral committee drafted the original guidelines in 2017, but the MOH did not approve the final guidelines. UNFPA indicated that their consultant had already started updating the guidelines.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

Once UNFPA finished updating these guidelines, USAID Health Service Delivery guided UNFPA in organizing a consultation workshop with NAG and C/S Oversight Committee members. At the workshop, participants reviewed the revised clinical guidelines and pathways and provided feedback. USAID Health Service Delivery participated in this two-day workshop, and collaborated with UNFPA and the NAG to review and further update the guidelines for the prevention and management of maternal mortality causes in Jordan. d) RMS

In FY20 Q2, USAID Health Service Delivery assisted the central RMS to scale up maternal and neonatal clinical pathways for three additional selected hospitals (King Talal Hospital in Mafraq, Pr. Ali Hospital in Karak, and Pr. Hashem Hospital in Zarqa). The USAID Health Service Delivery hospital team joined RMS central staff on field visits. The visits to RMS hospitals supported the hospital staff to strengthen their capacity to comply with the evidence- based clinical pathways and procedures. These clinical pathways and procedures guide staff to achieve better maternal and neonatal health outcomes. Three hospital managers shared their appreciation of USAID Health Service Delivery’s support and expressed their desire to adopt the clinical pathways and provide the needed support to enable health care providers’ compliance.

B. PRIVATE SECTOR AND ASSOCIATIONS a) Jordan Pharmacists Association

In FY20 Q2, USAID Health Service Delivery and the JPA jointly identified and engaged a number of private pharmacists who work at community pharmacies to enhance the quality of health care promotion and pharmacy practice in Jordan. According to their signed Memorandum of Understanding, USAID Health Service Delivery and the JPA conducted two workshops as part of the “Consult a Community Pharmacist” program. Working with the JPA Continuous Professional Development Committee, USAID Health Service Delivery submitted all the training materials to the Jordan Medical Council, and the Jordan Medical Council approved the workshop for three CME hours. b) Al-Amal Maternity Hospital

In FY20 Q2, USAID Health Service Delivery, in close collaboration with Al-Amal Maternity Hospital, conducted four lectures for private physicians in addition to select residents at the hospital, using the hospital’s training hall. Moreover, the hospital submitted all the lectures to the Jordan Medical Council, and the Jordan Medical Council accredited the workshop for CME.

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

6. PLANNED ACTIVITIES FOR NEXT QUARTER

In FY20 Q3, USAID Health Service Delivery will achieve the following deliverables in accordance with the FY20 Work Plan:

Table 4: List of Planned Deliverables/Milestones for FY20 Q3 1) Summary report on PHC collaborative sessions for each ISDIC cycle developed 2) Meeting and workshop reports on private providers engagement generated Supervision tools to monitor woman and child health services comprehensive counseling at 3) PHC SDPs developed Summary reports on women and child health services comprehensive counseling training 4) workshops developed 5) Summary reports on LARC training workshops developed 6) Central and HAD supportive supervision manual updated 7) Summary report on customized leadership training workshops for HCs managers developed 8) Mother to mother breastfeeding support training package disseminated 9) CHC community mobilization and health promotion reports generated Summary report for joint collaborative sessions between PHC and hospitals report 10) developed 11) Summary report on hospitals collaborative sessions for each ISDIC cycle developed 12) Selective/restrictive episiotomy practices protocol developed 13) Outreach implementing partners’ final reports generated 14) Enhanced Outreach Information System developed 15) Enhanced Health Map Mobile Application developed Strengthened capacity of the MOH ETITD team to maintain and support the 16) implementation of the enhanced Mobile Health Map Application developed 17) Final grantees’ progress reports generated 18) End of grant assessment reports generated for completed grants

USAID Health Service Delivery FY 20 Q2 Progress Report Submitted to USAID on April 30, 2020

7. BRANDING, COMMUNICATIONS AND DISSEMINATION

A. KEY COMMUNICATION ACTIVITIES IN FY20 Q2

Table 5: Key Communication Activities in FY20 Q2 No. Event Date 1. JMMSR Response Action Plan Workshop February 27, 2020

Please see Annex 13 for more details about this key communication activity.

B. CALENDAR OF PLANNED OUTREACH AND COMMUNICATION EVENTS FOR FY20 Q3

In FY 20 Q3, USAID Health Service Delivery will conduct the following events:

Table 6: Activities Planned for Next Quarter No. Event Timing Audience April 2, 2020 JMMSR NAG Virtual Meetings to April 3, 2020 1. Complete the Review of Maternal April 19, 2020 JMMSR NAG members Death Cases in 2019 Two more meetings in FY20 Q3

USAID Health Service Delivery is implemented in Jordan by Abt Associates Address: Wadi Saqra, Arar Street, Building No. 201 P.O. Box: 851275, Sweifieh 11185, Amman, Jordan Landline: +962 6 5687730/ Fax: +962 6 5687731 [email protected]