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Feed the Future Tajikistan Health and Nutrition Activity

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FEED THE FUTURE TAJIKISTAN HEALTH AND NUTRITION ACTIVITY Annual Progress Report October 2017 to September 2018 Submitted October 30, 2018 Table of contents Acronyms and Abbreviations ................................................................................ 4 Activity Implementation Summary ....................................................................... 5 IR 1: IMPROVED QUALITY OF HEALTH CARE SERVICES FOR MNCH ...................... 7 Outcome 1.1: Improved quality of health care services being provided in the FTF ZOI ................ 7 Outcome 1.2: Improved patient access to health care services in the FTF ZOI due to improved quality .................................................................................................... 14 Outcome 1.3: Stronger facility and provider networks ................................................................ 18 1.3.1. Hospital-level activities .................................................................................................................. 18 1.3.2. Primary health care activities ......................................................................................................... 19 IR 2: INCREASED ACCESS TO A DIVERSE SET OF NUTRIENT-RICH FOODS ............ 20 Outcome 2.1: Diversified food consumption during the growing season and beyond ............... 20 Outcome 2.2: Nutrition integrated into agriculture-focused programs and linked to value chains supported through FTF activities ....................................................... 23 IR 3: INCREASED PRACTICE OF HEALTHY BEHAVIORS AROUND MNCH .............. 30 Outcome 3.1: Increased consumption of nutrient-rich foods among adolescent girls, women, and children under two ............................................................................ 30 Outcome 3.2: Improved sanitation and hygiene-related behaviors ............................................ 40 Outcome 3.3: Increased use of health services for MNCH, including nutrition, sanitation, and hygiene .......................................................................................... 46 Community level. Involvement of CHPs on MNCH issues related to nutrition and health ..................... 46 Facility level. Improve quality of care through increased use of health care services ............................ 50 IR 4: INSTITUTIONALIZE EVIDENCE-BASED MNCH SERVICES............................... 54 Outcome 4.1: Ensure cadres of academics and national/regional clinical trainers are skilled in teaching evidence-based clinical practices for MNCH ............................ 54 Outcome 4.2: Ensure sustainability of evidence-based approaches for MNCH .......................... 56 Outcome 4.3. Improving linkages across sectors supporting poverty alleviation, agriculture, nutrition, and health ........................................................................... 59 Monitoring and Evaluation ................................................................................. 61 Progress towards targets .............................................................................................................. 62 Communications and knowledge management ........................................................................... 62 Budget Vs. Expenditure Analysis ......................................................................... 66 SUB-GRANTS ................................................................................................................................ 67 CHALLENGES ENCOUNTERED AND ACTIONS TO OVERCOME ............................. 67 GENDER ............................................................................................................... 68 Management and Staffing ................................................................................... 69 PARTNERS............................................................................................................ 69 Collaboration with FTF activities ................................................................................................... 70 Collaboration with the international community ......................................................................... 70 Annexes ............................................................................................................... 72 THNA Annual Progress Report: October 2017–September 2018 3 ACRONYMS AND ABBREVIATIONS ANC Antenatal Care MOHSPP Ministry of Health and Social BPS Birth Preparedness School Protection of the Population BTN Beyond the Numbers MOU Memorandum of Understanding CDH Central District Hospital MUAC Mid-Upper Arm Circumference CE Community Educator OB/GYN Obstetrician/Gynecologist CHE Community Health Educator OFSP Orange-Fleshed Sweet Potato CHP Community Health Promoter PHC Primary Healthcare Center CIP Centro Internacional de la Papa QI Quality Improvement (“International Potato Center”) RHC Reproductive Health Center DCC Donors Coordinating Council RHS Recurring Household Survey DOH Department of Health SUN Scaling Up Nutrition DQA Data Quality Assessment TAWA Tajikistan Agriculture and Water EG Economic Growth (USAID Activity indicator) THNA Tajikistan Health and Nutrition EmONC Emergency Obstetric and Activity Newborn Care TOT Training of Trainers EPC Effective Perinatal Care TWG Technical Working Group FTF Feed the Future UNICEF United Nations Children’s Fund GIZ Deutsche Gesellschaft für USAID United States Agency for Internationale Zusammenarbeit International Development (“German Society for USG United States Government International Cooperation”) VDC Village Development Committee GMP Growth Monitoring and VIP Ventilated Improved Pit Promotion WASH Water and Sanitation Hygiene HCW Health care worker WFP World Food Programme HL Health (USAID indicator) WHO World Health Organization HLSC Healthy Life Style Center ZOI Zone of Influence ICATT IMCI Computerized Adaptation and Training Tool IEC Information, Education, and Communication IMAM Integrated Management of Acute Malnutrition IMCI Integrated Management of Childhood Illness IR Intermediate Result IYCF Infant and Young Child Feeding JICA Japanese International Cooperation Agency KfW Kreditanstalt für Wiederaufbau (“Credit Facility for Redevelopment”) M&E Monitoring and Evaluation MNCH Maternal, Newborn, and Child Health ACTIVITY IMPLEMENTATION SUMMARY IntraHealth International and its partner, Abt Associates, are pleased to submit to the Tajikistan Mission of the United States Agency for International Development (USAID) the Year Three (Y3) annual activity report (October 1, 2017–September 30, 2018), combined with the Quarter Four (Q4, July 1–September 30, 2018) activity report for the Feed the Future (FTF) Tajikistan Health and Nutrition Activity (THNA). THNA is being implemented in partnership with the Ministry of Health and Social Protection of the Population (MOHSPP) of the Republic of Tajikistan. THNA’s goal is to improve the health status and nutrition of women and children who live in 12 southwestern districts of Khatlon Region, known as FTF’s zone of influence (ZOI). This progress report is largely consistent with the structure and content of THNA’s approved Y3 workplan (Figure 1). Figure 1. THNA results framework Due to its high rates of childhood stunting, Tajikistan was one of 19 focus countries of the U.S. government’s FTF initiative. The 2012 Demographic and Health Survey revealed that 24.6% of children under five in the ZOI were stunted. FTF activities, which have been continuously implemented in the ZOI, including by THNA, contributed to a decrease in the rate of stunting in children under five in the ZOI to 17.6%, according to 2017 Demographic and Health Survey results. Inspired by this achievement, THNA will continue its efforts to improve the nutritional and health status of children and their mothers in the next two years by integrating quality interventions at the community, primary healthcare center (PHC), hospital, regional, and national levels. Project highlights from Y3 include the following: THNA improved nutrition-related professional knowledge and skills of a total of 2,893 health care workers (HCWs) and community volunteers (116% of the annual target). THNA Annual Progress Report: October 2017–September 2018 5 THNA improved the capacity of a total of 599 HCWs on maternal, newborn, and child health (MNCH) and nutrition topics. THNA has improved effective perinatal care (EPC) and emergency obstetric and neonatal care (EmONC) in 12 central district hospitals (CDHs) by more than 30% since 2016, as demonstrated by facility scorecards. Implementation of hospital-based integrated management of childhood illness (IMCI) efforts reduced the number of unnecessary hospitalizations by 23% and the number of hospital pediatric deaths by 39%. Government HCWs and community volunteers supported by THNA provided improved services to 52,162 pregnant women (104.3% of the annual target) and 138,911 children under five (99.2% of the annual target). THNA selected and trained a total of 1,391 volunteer community health promoters (CHPs, 150% of the annual target) from the 12 districts over 64 five-day training sessions. CHPs conducted 80,079 individual home visits, providing counseling and education on maternal and child health and nutrition topics, which benefited over 53,000 children under five and 8,846 pregnant women. THNA facilitated the identification of 2,650 children with signs of malnutrition by HCWs, and 808 children by CHPs. CHPs facilitated 199 peer support groups in 158 villages for mothers-in-law,
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