p~ Projet de Gestion Regionale des Services de Sante c/o Minish3re de la Sante, km 4,5 route de Casablanca, Rabat, Maroc. Tel: (212)37298423/31 Fax: (212)37690664

Quarterly Performance Report

./ Q-3

January 1 to March 31, 2001

Submitted: July 12, 2001 , "'"

TABLE OF CONTENTS

Acronyms ...... 3 Introduction ...... 4 Technical Activities ...... 4 Result I: Roles, Responsibilities and Capabilities Identified, Defined and Developed at the Various Levels of the Ministry of Health ...... 5 Institutional· Environment ...... 6 IA 1 Central Level ...... 6 I.B.1 Souss-Massa-Draa ...... 7 I.C.1 Tanger-Tetouan ...... 8 Planning and Evaluation ...... 9 1.A.2 Central Level ...... 10 I.B.2 Souss-Massa-Draa ...... 10 I.C.2 Tanger-Tetouan ...... 11 Human Resources and In-service Training ...... '" ...... 13 IA3 Central Level ...... 13 I.B.3 Souss-Massa-Draa ...... 13 I.C.3 Tanger-Tetouan ...... 14 Quality Assurance ...... 15 I.AA Central Level ...... 15 I.BA Souss-Massa-Draa ...... 16 I.CA Tanger-Tetouan ...... 17 Logistics ...... 17 lAS Central Level ...... 18 I.B.5 Souss-Massa-Draa ...... 18 Result II: Innovative Models to Improve the Accessibility, Utilization, Quality and Efficiency of Services Developed and Tested by Regional and Local Teams ...... 18 Maternal Health ...... 19 II.B.1 Souss-Massa-Draa ...... 19 II.C.2 Tanger-Tetouan ...... 20 Child Health ...... 22 II.B.2 Souss-Massa-Draa ...... 22 II.C.2 Tanger-Tetouan ...... 23 Family Planning ...... 23 II.B.3 Souss-Massa-Draa ...... 23 II.C.3 Tanger-Tetouan ...... 23 STIIAIDS ...... 24 Partnership ...... 24 II.B.5 Souss-Massa-Oraa ...... 25 II.C.S Tanger-Tetouan ...... 25 Information Sharing and Dissemination ...... 26 lilA Central Level ...... '" ...... 26 III.B. Souss-Massa-Oraa ...... 27 III.C. Tanger-Tetouan ...... 27 Support Activities ...... 27 In-service Training ...... 28 Family Planning ...... 28 Information System ...... 28 Partnership ...... 29

Contract No.: HRN·I-OO-98-00032 1 Administrative Activities ...... 29 Project Management ...... 29 Personnel ...... 30 Finance ...... 30 - Procurement and Refurbishments ...... 30 Training/Study. Trips ...... 30 Annexes ...... 31 Annex 1 Consultants List...... 32 Annex 2 Local Training ...... '" ...... 35 Annex 3 Invitational Travel and Participant Training ...... 38 Annex 4 Procurement and refurbishments ...... 40 Annex 5 List of documents, reports and training and IEC materials ...... 42

Contract No.: HRN-J-OO-98-00032 2 Acronyms

AIO Agadir Ida Outanane AIDS Acquired Immune-Deficiency Syndrome CRAQ Commission Regionale d'Assurance Qualite CRESP Comite Regional Sante et Population CTF Conduct To be Followed DPRF Direction de la Planification et des Ressources Financieres DRH Direction des Ressources Humaines EOC Emergency Obstetric Care FP Family Planning FP/MCH Family Planning and Maternal and Child Health GIQua Gestion Integrale de la Qualite (Integrated Quality Management) lAM Inezgane Ait Melloul IFCS Institut de Formation aux Carrieres de Sante IMCI Integrated Management of Childhood Illnesses INAS Institut National d'Administration Sanitaire IS Information System 1ST In-service Training IUD Intra-Uterine Device JSI John Snow Inc. MCH Maternal and Child Health MOH Ministry of Health NGO Non-Governmental Organization PMU Project Management Unit PNAQ Programme National d'Assurance Qualite (National Quality Assurance Program) p~ Projet de Gestion Regionale des Services de Sante QA Quality Assurance QAP Quality Assurance Project RCC Regional Coordination Committee SEIS Service des Etudes et de l'lnformation Sanitaire SIAAP Service d'infrastructure des Actions Ambulatoires Provinciales SM Safe Motherhood SMD Souss-Massa-Draa SP07 Special Objective 7 SONU Soins Obstetricaux et Neonatals d'Urgence (Emergency Obstetrical and Neonatal Care) STI Sexually Transmitted Infection TT Tanger-Tetouan URC University Research Corporation USAID United States Agency for International Development VLAN Virtual LAN VSC Voluntary Surgical Contraception WHO World Health Organization

Contract No.: HRN-I-OO-98-00032 3 QUARTERLY PERFORMANCE REPORT

Contractor: John Snow, Inc. Reporting period: January 1 to March 31, 2001 Contract nO: HRN-I-00-98-00032 Report nO: 0-3

Intro,duction

This third quarterly report presents the achievements, constraints and opportunities of the January-March 2001 period, as well as the activities programmed for the coming quarter. The report is presented in two parts, namely the technical and administrative activities of the project. It follows the logical order of the 2001 Work Plan (WP01). However, to make reading easier, the analyses of activities follow a topical order. Each component groups the activities of all the intervention levels, i.e. central, SMD and TT, and the reader will thus be able to read about the achievements under each component for the three levels during this quarter.

The administrative activities are presented in the second part of the report. This section mainly describes the project management meetings as well as the financial situation.

The annexes summarize information on local training, consultancies, invitational travel, procurements and documents produced this quarter.

The first quarter of this project produced the transition from Phase V to P~. Efforts during the second quarter were mainly aimed at the development of "'" strategies and the planning of activities for 2001. This third quarter was the first phase of project implementation.

The implementation of activities aimed at decentralized management, in the context of a centralized legacy, required the deployment of additional resources and efforts. C1iI The project is now in working order and benefits from the collaboration between the different intervening parties, the central administration, the region and the provinces. However, constant efforts are still underway to achieve a symbiosis of the actions of all the intervening parties.

Technical Activities

The first semester of the project, July-December 2000, saw the implementation of working mechanisms as well as the development of regional strategies in the context "" of USAID SP07. These strategies comply with the national orientations of the Ministry of Health (MOH) and are the basis of activities proposed for the 2001 Work Plan (WP01). Development of these activities was achieved through planning workshops by objective, in which all the managers of the provincial delegations of each region participated. With this participatory process, it was possible to prioritize the activities for each region, mobilizing the regional teams around the basic principles of P~.

Contract No,: HRN-I-OO-98-00032 4 This first planning phase resulted in the meeting of the decentralization commission on January 4, 2001, as provided for by the cooperation agreement between the MOH and USAID. The representatives of the relevant MOH directorates, as well as those of the Souss-Massa-Draa (SMD) and Tanger-Tetouan (TT) regions, participated in this working session. During this meeting, all proposed activities were reviewed by central-level managers so as to enhance the proposals. The presentation of regional work plans was an innovative exercise, and this enhanced the spirit of regionalization. All the participants appreciated the quality and relevance of the regional work plans. Indeed, these work plans display the specific needs of the regions, as well as their adherence to national strategies and standards. Moreover, the activities proposed by the central level enhance the perspectives of the regions. Their objective is, on the one hand, to build up the decentralized management of health services and, on the other, to support the activities of the regions. Activities supporting reproductive and child health programs have also been presented. These activities, of a national scope, meet the priorities set by the MOH in the framework of strengthening the achievements of the Phase V Project.

On February 12, 2001, the board of directors validated WP01, in the presence of HE the Minister of Health, the Director of USAID, all central level directors of MOH, as well as regional coordinators.

This quarterly report describes the activities of the first quarter of WP01. It also presents the achievements and constraints connected with implementation, and it summarizes the activities programmed for the second quarter, April-June 2001.

Result I: Roles, Responsibilities and Capabilities Identified, Defined and Developed at the Various Levels of the Ministry of Health

Currently, regionalization has become an essential tool for improving the conformity of organizational strategies of health services and of resource allocation with the realities of the different regions of the Kingdom. In this context, and despite all their improvements, health services still require development and extension to meet the specific needs of the population.

The involvement of the regions on the basis of a national strategy is still the best means for ensuring maximum efficiency in the utilization of resources and improved health coverage.

At present, the strategy for managing public health programs is an integral part of the regionalization logic. Activities under this result are connected to the deconcentration initiated by the Ministry to prepare the effective transfer of roles and responsibilities from the center to the periphery. This is taking place in the following fields: in-service training, planning and evaluation, quality assurance or logistics management. Implementation of these activities can be more easily achieved in a constructive institutional environment.

Contract No.: HRN-I-OO-98·00032 5 ,... Institutional Environment Decentralized management is not an end in itself, but an integral part of the ... promotion of health in general. In this context, p~ enters entirely into the logic of the 1999-2004 sector strategy developed by the Ministry of Health. Indeed, this sector strategy identifies building up decentralization as a key element for achieving the objective "Health for All". The concomitant measures proposed for an effective decentralization are those adopted by P~, namely:

• Identification of all aspects related to deconcentration and decentralization; • Design and adoption of the organization of the Regional Directorate of health services; • Definition of an implementation process of regional structures and deconcentration; and • Re-organization of the central administration and the provincial delegations on the basis of the new attributions devolved upon the regions, as well as on that of the roles to be deconcentrated or decentralized." (Sector Strategy 1999-2003: Ministry of Health).

In the absence of a legal framework defining the organization of the "medical ... region", and taking into account the opportunities provided by the decentralization process, p~ supports the SMD and TT regions in the implementation of a regional management mechanism. This mechanism is outlined in an organizational diagram that includes the representation of all the provinces and management efficiency.

Regional management and coordination of the project will be ensured through he following structures:

• Regional Coordination Committee • Regional Project Management Unit • Thematic commissions on in-service training, quality assurance, management and promotion/partnership.

I.A.1 Central Level

The main activity during this quarter was the preparation of a synthetic document on the various MOH experiences in deconcentration. An international consultant in this field worked in March 2001 with a MOH team to document this process and to propose opportunities in the form of two scenarios. The first option consists of deconcentrating functions in the present context. The alternative option envisions a more devolved environment, and assumes that the chart delegating more power to local communities will be adopted. To be able to prepare this report, the consultant reviewed all the MOH documentation on this subject. He also held working meetings with most of the MOH directorates as well as with some delegates. The final version of the report is currently being revised by the principal concerned parties. The consultancy report proposes specific activities to accompany the MOH deconcentration process.

Contract No.: HRN·I-OO-98-00032 6 A study tour organized for central and regional level managers to the United States on decentralization will address part of the recommendations of this report. However, this study tour is still awaiting the MOH decision on its date and participants. The JSI team is collaborating with the consultant on an initial program proposal.

.... The allocation of budgets, as well as their management at the different levels of the MOH, has emerged as an essential element during the preparation of the synthetic ... document. Discussions are strengthening the relevance of the activity planned for . budget allocation to the medical provinces. Achievement of this action, on the one hand, will enhance the understanding of the relation between the planning and allocation of resources and, on the other, their utilization according to the needs expressed by the field. This activity will be carried out at the provincial level with the technical assistance of DPRF senior staff. Inception of this activity is planned for the coming quarter.

The last activity under this component at the central level is reflection on the implementation of an IEC approach adapted to the needs of the regions. The IEC Division has programmed implementing this activity in June. The first step will be a meeting with the IEC intervening parties in the regions in order to develop a regional IEC action plan.

I.B.1 Souss-Massa-Draa

The development of a strategic plan for the Souss-Massa-Draa region in November 2000 resulted in the implementation of an organizational diagram. Consequently, the management and coordination of the project at the regional level will be the responsibility of a Regional Coordination Committee (RCC), a Project Management Unit (PMU) and four thematic commissions (in-service training, management, quality and promotion).

To initiate the implementation of the regional work plan, the different project management units held meetings during this quarter.

The initial meeting of the RCC was held on February 22, to review activities under ... WP01, as well as the tasks of each thematic unit planned for this quarter. The RCC will meet each quarter. During their first meeting, the provincial delegates underscored the following points;

• Decentralize SONU training at the level of distant provinces such as Ouarzazate and Zagora; • Highlight the magnitude of neonatal mortality in the region and prioritize this in terms of actions to reduce it; • Review the various experiences in partnerships so that other provinces may benefit from this; • Raise the awareness of all the managers and staff involved in project management on the importance of teamwork through workshops on group dynamics.

Contract No.: HRN-I-OO-98-00032 7 :,iI-1

Since the RCC meetings are held on a quarterly basis, the next one is planned for May 17, 2001. i:lli As to the RPMU meeting, it was held in Agadir on March 1. Besides discussing activities under the work plan, the agenda of the meeting aimed at achieving a consensus on the terms of reference of this unit. The RPMU is composed of ""' persons in charge of p~ at the level of each province of the region and has the following missions:

• Implementing, in the provinces, activities approved by the RCC; • Coordinating the activities of the different commissions; • Coordination with the different partners; • Proposing tasks to be implemented by the RCC, follow-up of the work plan and coordinating the activities of the different commissions.

RPMU meetings are held monthly, and the next one is scheduled for April 3, 2001.

As for the thematic commissions, a number of meetings were held in January to appoint their members and determine the terms of reference of each unit. They meet regularly on the implementation and follow-up of activities. Each commission has developed a performance plan for its activities to provide for an improved follow­ up of the work plan.

Considering the diversity of the profiles and origins of the members of the different units (RCC, RPMU and thematic cells), teamwork, dialogue and communication require enhancement. In this context, it has been planned to organize workshops on group dynamics for members involved in project management, in particular the RPMU and thematic cells. These meetings on communication will contribute to the creation of a coherent team around common objectives.

I.C.1 Tanger-Tetouan

Following the example of the SMD region, a strategic planning workshop in the TT region resulted in the implementation of an organizational project management diagram adapted to the region. During this quarter, several meetings were held by the different groups.

The Regional Coordination Committee met twice during this quarter. The first meeting of the RCC took place on January 30, 2001 to present the 2001 Work Plan. This first RCC meeting was extended to the senior SIMP physicians and the hospital directors of the 5 provinces. Owing to extensive attendance, this meeting resulted in the finalization and endorsement of WP01 before its submission to the Board of Directors.

The second meeting took place on February 21, 2001. The major objective was to initiate reflection on an inter-sector collaboration and community participation strategy during the World Education conSUltancy.

Following the RCC meetings, several other meetings were held that resulted in the creation of the thematic commissions. The partnership and community participation

Contract No.: HRN·I·OO·98·00032 8 (PCP) commiSSion, composed of resource persons in this field from all the provinces, was created on March 12. It has developed a draft plan for implementing the activities of the partnership component.

The thematic cells for Safe Motherhood (SM), In-service Training (1ST), Quality ... Assurance (QA) and STIfAIDS were created during a meeting on March 15, 2001 . During this meeting, the cells worked in groups on implementation plans for each theme, and a regional manager was appointed for each cell. .

. --- " The next meeting of the RCC has been scheduled for April. During this meeting, the implementation plans of the SM, 1ST, QA, STI/AIDS and PCP cells will be presented. This next meeting will provide an opportunity to establish the monitoring/evaluation commission as well as the child health commission.

To achieve the dedication of health professionals to the strategic plan of p~ and create an environment favorable to the implementation of the selected strategic axes, meetings had been scheduled at the provincial level for this quarter. The regional work plans had also been presented during these meetings.

Two out of five of the planned presentation days took place:

• A meeting on January 13, 2001 in Tetouan, which was attended by 40 health professionals of the medical province of Tetouan; • A meeting on January 25, 2001 in Tangier, which was attended by 50 health professionals of the medical province of Tangier.

In the coming quarter, similar information days will be organized in the provinces of Chefchaouen, Larache and Fahs-Beni-Makkada.

Planning and Evaluation

In the framework of regionalization, the planning, monitoring and evaluation functions will be assigned to the regions. Consequently, decision-makers and managers at this level will require access to reliable and quality health data. Moreover, the capabilities of regional technicians require enhancement to enable the improved utilization of existing analytical tools.

In the framework of p~, the objective of activities under the Planning and Evaluation component is to provide opportunities for improving health planning and supervision and evaluation of programs at the regional level.

Activities planned at both the central level and the SMD and TT regions aim at:

• Strengthening regional planning; • Promoting the utilization of reliable data for decision-making at all the levels; • Improving the utilization of the SMIPF information system within the region; • Giving greater priority to training in research methodology; and • Developing partiCipatory and sustainable supervisory models.

Contract No.: HRN-I-OO-98-00032 9 I.A.2 Central Level

Information and computer technology as a vector for circulation are part of the prerequisites for efficient planning and management. As planned, and despite its limited resources, p~ is considering supporting the computerization strategy underway within the MOH.

However, to achieve complementarity with MOH efforts and equity between the regions and provinces, a needs assessment study on the computer pool has been undertaken in the two regions.· . . ..

The overall objective of this study is to assess the technological and financial needs to enable the upgrading of the computer pool in the provinces of the SMD and TT regions.

The two computer experts who undertook this study visited all of the provinces in the two regions in February in order to:

• Assess the situation of the computer pool in the 12 provinces and prefectures of the SMD and TT regions. The relevant departments are provincial ... delegations, SIMP, provincial reference maternities and the IFCS; • Recap the procurement plans programmed by p~; • Make recommendations on the technological choices in compliance with available resources and the information master plan of the MOH.

The preliminary results of the survey on the computer pool were presented during a PMU meeting on March 1. These results covered information material, training, management software and maintenance.

The survey report will be finalized in April. It will comprise a diagnosis of each province as well as recommendations on future steps. On the basis of these recommendations, the regional teams will optimize the limited resources available through the project to prioritize the technological choices at the level of each province.

The other two activities under the planning and evaluation component have been programmed for the coming quarter.

I.B.2 Souss-Massa-Draa

To achieve a diagnosis on the utilization of the information system, in general, and the SMIPF application, in particular, Dr. Theo Lippeveld visited Morocco on a consultancy from January 14 to 27.

At the level of the two regions, this conSUltancy allowed: (i) the evaluation of the situation of the SMIPF system; (ii) the analysis and formulation of recommendations on perspectives and constraints based on current utilization; and (iii) the planning of future steps to prepare a regional management team for the health information system.

Contract No.: HRN-I-OO-98-00032 10 '.-'rt

The major success achieved through the re-structuring of the SMIPF information sub-system is that, except for some southern provinces (which will initiate it this year), all the provinces now enter FP/MCH data provided by the health facilities in their own computers and transmit monthly reports electronically to SEIS within the time limits.

The main problems relevant to the information system in the provinces are:

• The quality of entered data, due to the deficient training of service providers and thelack"of data checking and cleaning by statisticians and FP/MCH facilitators at the provincial level; • The absence of analysis and utilization of data at all levels; and • Frequent stock-outs of information supports.

The level of understanding of the new data collection supports is good in general, except for the obstetrical register. At the level of the two regions, the service providers have not understood well the definitions of obstetric complications. The number of obstetric complications has therefore been over-estimated since minor obstetric complications have also been reported. Since the management of obstetric complications is an important indicator for the SONU strategy, actions were undertaken in February and March to resolve this problem and obtain reliable basic data.

Indeed, refresher courses in the correct filling-in and utilization of the obstetric register have been organized for the midwifery staff of the maternities and birthing centers (maisons d'accouchement) in the region. The refresher module and its syllabus have been developed by Prof. Bezard, ilJ collaboration with the in-service training commission. A nucleus of local trainers has been established for the training of provincial staff. Five provinces of the SMD region have already been covered. Coverage of the Ouarzazate and Zagora provinces is planned for the second quarter of this year.

However, the limitations of the strategy have been revealed through the fact that it is based solely on the work of a regional team, whereas the training and follow-up tasks require a continuous presence in the field. An alternative strategy in this field has therefore been planned. This strategy proposes two types of action. On the one hand, a trainer/resource person pole will be set up in each province. This pole will comprise the obstetrician of the reference maternity, the PSGA facilitator and the provincial statistician. This team will be in charge of the in-service training of the midwifery staff of the birthing centers at the level of their province, and of raising their awareness on the importance of the collected data. With this follow-up it will be possible to ensure the correct collection, entry and processing of data. On the other hand, it is planned for the monthly reports to be evaluated by the team in order to ensure data quality.

I.C.2 Tanger-Tetouan

Dr. Theo Lippeveld also visited the different provinces of the TT region to assess the utilization of the information system, in general, and of the newly installed SMIPF application in the region, in particular.

Contract No.: HRN·I-OO-98-00032 11 ''E'

During his visit, the consultant conducted a one-day workshop where the senior SIAAP physicians and matrons, the statisticians and senior hospital physicians participated. Workshop participants discussed their information needs at the regional level as well as the current situation of the SMIPF information sub-system.

The consultant also made field visits where he interviewed staff and reviewed the IS reports of several health facilities.

Just as in the SMD region, the obstetrical register is a problem. A lack of precision of the notion of obstetric complications has resulted in exaggerating the complicated cases.

A training workshop on the utilization of the obstetrical register and monthly reports in the birthing centers and hospital maternities has been programmed to improve the collection of data on obstetric complications. This step is necessary to provide a database for the monitoring of the SONU component. The first workshop was organized in Tangier with the technical assistance of Prof. Bezard. A group of 5 regional trainers has been identified, three midwives teaching at the Tetouan IFCS and two gynecologists at the Tetouan maternity. The applied approach consists of supervising this group of trainers during a session in Tangier, reviewing supports with them, evaluating the session and fixing a schedule for the other provinces.

All the provinces were involved in this refresher training during this quarter. Each workshop was conducted by two teacher-midwives and a gynecologist. The contribution to the sessions by the gynecologist was highly appreciated by the teachers and service providers, especially concerning the definition of obstetric complications and emergencies .

.t The next step consists of assessing the impact of refresher training on the utilization of the obstetrical register. Follow-up will be undertaken by the PSGA facilitators in each province, accompanied by one of the trainer-gynecologists to rectify possibly persistent errors at the level of data and information reporting in the supports. This follow-up will be completed by the evaluation of the collected monthly reports to assess data quality.

During the coming quarter, a workshop will be organized to develop a procedures schedule. This workshop will take into account the results of the survey on the computer pool in the different provinces to achieve a better response to IS needs.

Inception of training in qualitative research was planned for March 2001 with the objective of:

(i) Developing a qualitative research capacity, besides the quantitative tools in the region, by inducing the provinces to work on a common research project; (ii) Identifying a health problem following the utilization of data and the chart­ book, which can be produced with the SMIPF application; (iii) Defining a methodological approach from study protocol to analysis of results, via field survey; . (iv) Making specific recommendations for problem solving.

Contract No.: HRN-I-OO-98-00032 12 To initiate this activity, historical data must be available for the past 5 years so as to enable the development of the chart-book with the SMIPF application, which, in its turn, will enable the regional team to identify a research topic. Follow-up will take place during the next quarter to enter all the data and organize a workshop on the utilization of the chart-book, in collaboration with the DP and DPRF.

Human Resources and In-service Training

In-service training is one of the most obvious functions to be delegated to the regional and provincial levels. A national strategy and quality standards have been developed for in-service training and disseminated in most of the 16 regions. To harmonize the understanding of the spirit of this strategy and to achieve its objectives, p~ has worked with the in-service training division to achieve better dissemination at the level of both the central administration and the regions having expressed such needs.

1.A.3 Central Level

The in-service training division has actively participated in the finalization of the 2001 work plan. This participation has allowed the programming of several activities aimed at an improved dissemination of the national in-service training strategy at both the central and regional levels.

To achieve this, the in-service training division will organize a dissemination workshop in April in the SMD region. The meeting will be organized in conjunction with the regional in-service training commission.

It has been programmed to introduce IMCI in the IFCS curriculum in the SMD and TT regions. Several health facilities in the Agadir prefecture have adopted the IMCI approach. In this context, a workshop to launch the IMCI in the Agadir IFCS is scheduled for April. This will be preceded by the dissemination of the evaluation findings of the clinical component of the IMCI pilot and test sites. Extension of the IMCI sites is also planned in the SMD. The sites will be selected during the workshop.

In the TT region, a workshop on information, via the presentation of the evaluation findings and planning for the selection of IMCI sites, will be held in June. The integration of IMCI into the curriculum of the Tetouan IFCS will take place after the implementation of a site providing IMCI.

I.B.3 Souss-Massa-Draa

For P~, in-service training is a major tool in the improvement of health program management. Consequently, the regional teams, following discussions with the central level, have considered introdUcing means to better address the 1ST needs of all the provinces in the region. To achieve this, a database on 1ST needs in all public health fields and for all the profiles has been planned. This database will also provide an efficient means to accompany the operationalization of in-service training

Contract No.: HRN-I-OO-98-00032 13 at the regional level. To address these needs, the database developed by the Training Division (DF) will be tested at the level of the two regions. ... To augment this database, an initial action consisted of surveying the needs in SONU training since, indeed, some 350 service providers are concerned in such training. The same operation is underway to determine the training needs in IUD insertion.

A day has been scheduled in April for the dissemination of the nationaliST strategy. Such a seminar meets the demand of the SMD region for an improved dissemination of the in-service training strategy within the region. The agenda has been prepared in collaboration with the in-service training division.

As to the qualitative research component, the study on the relationship between service providers and parturients has been initiated this quarter. A sociologist has been recruited to participate in this study in a supervisory role, together with the IFCS professors. The scope of this study is the entire SMD region. The data collection tools, including the interview guides, questionnaires and partiCipatory observation supports, have been developed, tested and finalized with the female students of the IFCS. Data collection took an average of two weeks. These students are currently transcribing and translating the collected information. The consultant and the IFCS supervisors will initiate the analysis and monitoring of the report editing by the beginning of May. In June, the final report of this study will be presented in the form of memoirs by the students who are participating in the study. More specifically, this experience will initiate the students to qualitative research techniques. These memoirs will also provide an information basis and a reference on the relationship between service providers and parturients in the management of pregnancy and childbirth.

I.C.3 Tanger-Tetouan

This quarter, efforts have been made to determine the prerequisites of the institutionalization of 1ST at the regional level. To this effect a survey of in-service activities over the past three years is underway. Information is being collected in collaboration with the In-service Training Division since it was only in 2000 that the Tetouan IFCS became the coordinator for 1ST activities. The collected information will be used to create a database aimed at the improved management of in-service training activities. With this database it will also be possible to determine more precisely the 1ST needs of the region.

A survey is underway to determine the actual needs in SONU training. Data collection sheets have been developed in conformity with the standard models of the nationaliST strategy. Collection and processing of these sheets has been initiated to assess the needs of each province within the TT region.

Building up the competenCies of heads of administrative and economic services in the region is a prerequisite to the implementation of regionalization. Under the Project, this reinforcement will be achieved through an in-service training program. To determine the major topics to broach, several meetings and interviews were held with the financial administrators in the region at both delegation and hospital level.

Contract No.: HRN-I-OO-98-00032 14 '.. :,")

The two major components are human resource and financial management and bookkeeping. The next step will be the development and initiation of the selection process of a training facility.

To arrive at a more global vision, a strategic planning workshop on in-service training will be conducted in the region this coming May.

Quality Assurance

Quality assurance is an explicit priority of the MOH. Major progress has been achieved these past years through the introduction and institutionalization of QA in the various central, regional and provincial units, especially through the implementation of the national quality assurance program (PNAQ).

This last quarter, p~ continued these efforts through the implementation of activities planned under WP01.

Many discussions and consultations also took place this quarter on the implementation of activities in accordance with the priorities and specifications of each region.

1.A.4 Central Level

The major activity this quarter was a study tour to the USA by a DHSA executive and a QA trainer from the Tetouan province. This visit was co-financed by p~ and QAP. The project has provided TA to several countries throughout the world to help them introduce the QA approach to improve health services. During this trip, the two MOH staff members were also able to present the PNAQ and the Tetouan experience to QAP staff and several JSI executives.

The main achievement of this study tour was, however, that it enabled the MOH staff to participate in the finalization of the QA cost-efficiency study and prepare a presentation on this study for the forthcoming workshop. In this workshop, the reports on QA experiences in Morocco will be presented. Given the DHSA's intense activity this quarter, organization of this meeting had to be deferred.

A reflection day is planned on the standardization system this coming June. Planning of this day will be undertaken with the technical assistance of a URC consultant. This meeting will discuss the modalities for developing expertise in standardization and define the strategic axes to implement the standardization system.

The DP has asked URC for technical assistance to undertake a number of actions to achieve a better management of these activities. The first action consists of developing a charter by which all the DP personnel pledge to promote quality services on a daily basis.

The IEC division wishes to introduce a QA approach to control the quality of the documents produced by its services. With this approach it will be possible to better

Contract No.: HRN-I-OO-98-00032 15 meet the increasing demand for its design and production services by MOH structures, other ministries, NGOs, etc. With all the investments under Phase V, the DIEC indeed has the necessary capacity to produce IEC support materials and documents. The URC consultant has asked the DIEC to: 1) analyze the different constraints emerging throughout the production process, and 2) prioritize the problems that need solving.

I.B.4 Souss-Massa-Draa

Following discussions between the regional team and the URC consultant, the collaborative model has been selected as the best approach to improve the quality of health care services in the SMD region. This model has been chosen for the rapid results achieved by its approach. This model does not require any long training cycles, but encourages self-assessment during its implementation, thus reducing the need for supervision. Indeed, since the provinces in the SMD are very scattered, regular supervision raises a problem. One of the basic principles of the collaborative model is that the problem to be solved must be clinical, thus contributing directly to improving the health of the population. By solving the clinical problem, all of the system components are analyzed.

The collaborative model was introduced in the SMD region in January during a meeting facilitated by URC consultants. In agreement with the different provincial teams, and based on the major health indicators of the region, the model has been implanted in 8 sites: 4 SONU sites and 4 STIIAIDS sites. The first step of the approach consists of monitoring, for two months, the indicators defined during the inception workshop. However, because of logistics problems and the novelty of the model introduced, data collection had to be postponed to March. This initial basic data collection phase will be completed by May. The second phase of the model consists of introducing changes that will improve the quality of health care. This phase is programmed for May with URC assistance.

Apart from the new approach introduced for quality improvement in the region, two other innovative initiatives have been programmed. The first consists of encouraging service providers to participate in the improvement of their services. This participation will be achieved through the collection of the best proposals by the teams to solve priority clinical problems. The collection of proposals will be made through a tender in the different health structures in the 7 provinces and prefectures of the SMD. Among all the suggested projects, two will be retained for each province. Implementation of the 14 selected projects will benefit from project assistance. The pattern of the tender has been developed with URC technical assistance and in agreement with the Regional Quality Assurance Commission (CRAQ). The "specifications" are programmed to be sent to the provinces by the beginning of April. The collected proposals will undergo an initial selection at the level of the province, followed by a final selection by the regional PMU and approved by the RCC.

The second innovation is the development of quality tools to maintain the performance of service providers after SONU training. The 3 proposed tools are memorandum books, health cards and self-assessment fiches. These tools will help

Contract No.: HRN-I-OO-98-00032 16 to better assimilate training contents and adopt appropriate Conducts To be Followed (CTF) when confronted with any SONU related situation.

To develop the memorandum books, the URC consultant has worked with CRAQ, the SONU teams of the Hassan II and Inezgane An Melloul maternities as well as with the central team in order to: (1) review existing memorandum books in the ... context of the SM program; (2) identify the needs in memo books of service providers in the field; and (3) develop drafts of memo books in compliance with SONU norms and standards. These newly developed memo books as well as the existing ones'will be tested during SONU training sessions in the SMD and n regions to finalize them and especially to devise a strategy for their effective utilization. The development of the health cards and self-assessment tool have been scheduled for the coming quarter.

The planning and implementation of activities this quarter were achieved with a major involvement of CRAQ and central-level staff. At present, CRAQ is developing an implementation plan for the different scheduled activities to ensure better follow­ up. Efforts are still required in awareness-raising and mobilization of all the provinces. To achieve this, CRAQ will establish QA expertise poles at the level of each province. These poles will be the provincial extensions of CRAQ.

I.C.4 Tanger-Tetouan

Through the Tetouan province, the n region possesses resource persons capable of ensuring extension of QA to all the provinces. Owing to the successful experience ... with the GIQua approach in the Tetouan province, there are now 6 QA trainers and several problem-solving cycles, which are a wealth of information for the entire region.

The objectives defined for the region during the strategic planning workshop are:

• To develop regional QA skills and capacities; • To extend the approach to all facilities by 2003; • To implement mechanisms to raise awareness on and stimulate quality; • To support adherence to QA by staff at all levels.

Before initiating the training of 80 new facilitators planned under WP01 in the other TT provinces, the Tetouan team will complete the coverage of all the health facilities in this province. The 6 trainers will therefore be available to support the other provinces. An initial session has been programmed for 20 facilitators in April. Three other training sessions will be held before the end of this year.

Logistics

During the past decade, the MOH developed a logistics system that is exemplary in its efficiency, reliability and sustainability. Collaboration between the MOH and USAI D has greatly contributed to the achievement of these impressive results.

Contract No.: HRN·I-OO-98-00032 17 i-'.Q

In the context of regionalization, the system requires decentralizing to better address the needs of the different regions. The major objective of activities programmed under this component is to enhance the regional integrated management of the logistics system.

... 1.A.5 Central Level The activity planned for the central level aims at using the new training modules in contraceptive logistics. These modules are the product of a collaboration between the DP and the training division.

With the support of p~, the FP division has programmed the testing of these .. modules at the level of the provinces of the IT and SMD regions.

The date for the inception of this activity remains to be fixed by the FP division in agreement with the training division.

I.B.5 Souss-Massa-Oraa

Implementation of a regional warehouse for pharmaceutical and contraceptive products received major support under Phase V. In the framework of regionalization, p~ continues supporting the completion of this warehouse, which will mainly facilitate the management of contraceptive products as a first step. Consequently, the premises have been painted. The Ministry of Health has supplied a truck for the transport of medications and contraceptives to the provinces of this region. To achieve its operationalization, an information day for regional logistics managers has been programmed for April. This meeting will provide an opportunity to share the new procedures for contraceptives orders. Following this information day, the personnel of the Agadir warehouse will participate in a 3-day training in regional stock management. These various events will be organized with the technical assistance of resource persons from the FP division.

Result II: Innovative Models to Improve the Accessibility, Utilization, Quality and Efficiency of Services Developed and Tested by Regional and Local Teams

'. In the framework of P~" the tendency to program integration and decentralization of responsibilities will permit the development and implementation of innovations in service delivery and health program management. This result supports technical and programmatic innovations in health care delivery and management. The intervention models successfully tested under Phase V as well as other innovative approaches are being encouraged under this result.

The majority of the chosen approaches promote proximity management to better address the unmet needs of the population, with the effective participation of health

Contract No.: HRN·I·OO·98·00032 18 personnel. These innovations support the deconcentration process and contribute to the improvement of health care quality in reproductive and child health.

This quarter, the major activity was the implementation of a SONU strategy, including clinical training, training in communication, quality assurance and the information system. All the central and regional teams have made major efforts to ... launch this strategy on the basis of dialogue and coordination.

Maternal Health

Given the magnitude of maternal mortality in all the regions of Morocco, the SONU strategy has been identified as a priority for this year. This strategy is the result of the three-delays model introduced in Fez-Boulemane and Taza-AI Hoceima­ Taounate. This model prioritizes the third delay related to the improved treatment of obstetric complications at maternity level.

SONU training is a key element in the upgrading of the competences of midwifery staff and ensures the improved treatment of parturients. Better reception can be achieved via a good communications strategy to raise the awareness of health staff and humanize the obstetric environment.

This quarter, the majority of SONU activities were initiated, mobilizing the regional ... teams, the relevant central directorates and several universities. The major objective is to improve the management of parturients and train, at the level of the region, a nucleus of resource persons to achieve the sustainability of these activities.

11.8.1 Souss-Massa-Oraa

The first quarter of this year has been essentially dedicated to developing a schedule for training in emergency obstetric and neonatal care. A meeting on SONU planning was conducted in Agadir on February 23. This meeting was attended by representatives of the different provinces of the region, the central level and university professors in obstetrics and neonatology.

Following this meeting, several decisions were taken on the duration, contents and modules of this training, as well as on the role of each partner. The objective of the faculty staff will be building up the regional capacity in SONU training through a nucleus of local trainers. In this context, faculty staff, together with the Training Division, will mainly be concerned with the training of trainers and the upgrading of training sites. Faculty staff will also accompany the obstetricians, pediatricians and teaching midwives in the training of service providers.

The upgrading of training sites has begun with the rehabilitation of the IFCS, which will host the participants from the 6ther provinces of the SMD region. The needs for the upgrading of the Hassan II and Inezgane An Melloul maternities have been ascertained. The organization of the obstetrical circuit seems to be the focus for the upgrading of the maternities that are also training sites. To improve this situation, norms and standards have been communicated to the teams of the selected maternities. Workshops on group dynamics have also been scheduled for the teams

Contract No.: HRN·I·OO·96"00032 19 of the Hassan II and Inezgane An Melloul maternities. The first workshop has been programmed for April. The process of improving the obstetrical circuit will continue with the technical assistance of faculty staff in the context of SONU.

To afford service providers a better understanding of the various physical and emotional behaviors, training in assistance and communication skills (ACS) has been programmed. Building up relational skills within the team and with the parturients will complete the upgrading of the technical skills of midwifery staff through SONU training.

Training in assistance and communication skills will concern all the midwifery personnel and will be completed in collaboration with the regional team and the IEC division in order to create a nucleus of trainers at the regional level and possibly at the level of each province to ensure training in the long term.

This quarter, the modules for trainers and participants have been reprinted. DIEC representatives coordinated, with the region, the training of local trainers, involving the female trainers used for ACS training, particularly in the Fez-Boulemane and Taza-AI Hoceima-Taounate regions. Participants in the training of trainers sessions have been selected. The first ACS training workshop has been scheduled for April.

Self-assessment, as well as the analysis of the different situations by the maternity teams, is a basic component in the improvement of health care quality. Consequently, implementation of the near-miss approach is scheduled in the hospital maternities of the region. In this context, a team of resource persons of the SMD region has been invited to participate in a consensus seminar on the audit of critical cases that was organized by INAS in Rabat on March 19-20, 2001. This workshop was an opportunity to present the near-miss experience implemented in the Tetouan province. To implement the near-miss approach in the SMD region, an INAS representative will work with the regional team to define the implementation phases and the activities to be supported by P~. Dr. Lardi has proposed an action plan for the SMD that will be reviewed by CRAQ and the JSI team before its implementation. It has also been planned to base this activity on the internal neonatal audit project (PAIN) initiated under Phase V.

The last item to be implemented under this component is the refurbishment, and renovation of birthing centers within the region. To achieve this, the management commission has established a team composed of a civil engineer and a building specialist who will tour the region and survey the refurbishment requirements of the birthing centers. The team has been informed about the USAID regulations in refurbishments and the budgetary restrictions of this project. The team is scheduled to tour the region during the second quarter and the results of this needs­ assessment study will be submitted for review to the RCC members.

II.C.2 Tanger-Tetouan

To reduce maternal and neonatal mortality, the TT region has also adopted the three-delays approach initiated in the Fez-Boulemane and Taza-AI Hoceima­ Taounate regions. The pillar of this process is the improved management of Emergency Obstetric and Neonatal Care (SONU).

Contract No.: HRN-I-OO-98-00032 20 In this context, several intervention levels have been programmed, the principal ones being:

• Improving the technical set by equipping the hospital maternities and birthing centers; • Improving the technical skills of the staff; • Renovation and refurbishment of maternities and birthing centers; • Irnplementing the audit of critical cases.

The upgrading of technical competencies of the midwifery personnel is a critical component of the SONU strategy adopted by the project. To prepare for this training, a planning workshop was conducted on February 1, 2001 in Tetouan. Its objectives were to: 1) devise a SONU training curriculum, taking into account the training needs and capacities of the region; 2) specify the roles of the different partners in the field of training (central, regional, university) in the organization and the holding of training sessions; 3) determine the place of ACS, IS and QA training within the SONU training curriculum; and 4) develop a training schedule for the training of trainers and the training of service providers.

The workshop was attended by the various SONU intervening parties:

• The Tetouan IFCS as the 1ST manager. • The Tetouan maternity as the potential practical training site. • Potential trainers: gynecologists and midwives from Tetouan. • The regional QA unit for the quality component. • The Rabat IFCS. • The DIEC. • The training division of the DRH. • Two faculty staff from the Rabat medical faculty. • Three representatives of the 1ST management cell of the SMD region.

The schedule has been prepared, the first action being the implementation of a partnership between the region and the university institution in charge of the training of trainers, accompaniment and training follow-up. Indeed, such a contract will address the need to develop a regional competence in SONU training while ensuring quality training. This objective will be achieved through the partnership with a training institution capable of ensuring the quality and capacity of having this training accredited at the level of the region.

A selection process has been initiated on the basis of the specifications developed to define the role and tasks of the institution as well as the selection criteria.

The training of 150 service providers in the TT region will take place in the region. The upgrading of training sites is essential to providing adequate training conditions. Efforts have been deployed this quarter in this sense. An initial evaluation mission of the theoretical (Tetouan IFCS) and practical (Maternity of the Civil Hospital of Tetouan) training sites was conducted on January 11. Evaluation tools have been developed by the consultant in the form of an observation record of the maternities and an interview guide with service providers.

Contract No.: HRN-J-OO-98-00032 21 Evaluation of the practical training site in Tetouan shows that this maternity provides all the conditions required for training. However, a few organizational restructurings at the level both of organization and the facility are necessary .

... This quarter, the renovation, and refurbishing process of maternities and birthing centers has also been initiated. Two sites are scheduled for renovation: the Mohamed V maternity in Tangier and the Bab Berred birthing center.

Based on a regional consensus, the renovation of this reference maternity, with over 6,000 childbirths a year, has been planned. This facility is also <} SONU training site. The provincial delegation has developed a renovation project, which has been submitted for study and approval to DEM and USAID. The proposed project was reviewed during a field visit, on March 2, 2001 by USAID representatives and the JSI technical consultant. Recommendations have been made, on the one hand, to improve the obstetrical circuit for a better management of the parturient and, on the other hand, to comply with USAID procedures on rehabilitation.

As to the Bab Berred birthing center, a field visit is scheduled for April with USAID participation. Following this visit, it will be possible to determine the rehabilitation requirements while complying with USAID procedures.

A consensus and presentation workshop on the experiences in the audit of critical incidents was organized by INAS in Rabat on March 19-20, 2001. This workshop was an opportunity to present the near-miss experience implemented in the province of Tetouan. For the extension of the near-miss approach to the two maternities of Larache and Chefchaouen, restitution is programmed at the level of the region in May. An INAS-Region collaborative mechanism will be implemented and an action plan developed.

Child Health

The improvement of child health indicators is one of the major intervention axes ,... defined in the context of strategic planning for the two regions and supported by P~.

Under the 2001 Work Plan, the objective of activities to improve child health is to define a strategy for the dissemination and introduction of IMCI, taking into account regional specificities.

II.B.2 Souss-Massa-Draa

The province of Agadir Ida Outanane is one of the two provinces where IMCI was introduced under Phase V. This experience is therefore an asset for the region and a basis for extending the approach to the other provinces. To initiate the IMCI dissemination and introduction process in the SMD region, a meeting to disseminate the results of the evaluation of the IMCI approach is planned for April. This meeting has been prepared by the regional team in collaboration with the Maternal and Child Health Division.

Contract No.: HRN·I·QQ·98·QQQ32 22 On the basis of this meeting, the modalities for planning the introduction of the IMCI in the SMD region will be determined.

Moreover, the IMCI approach will be introduced by the Agadir and Tetouan IFCSs in collaboration with the training division.

II.C.2 Tanger-Tetouan

Following the example of the SMD region, implementation of the IMCI approach is also scheduled for the TT region.

In this context, a strategic planning workshop has been programmed for May. It will provide an opportunity for presenting the results of the IMCI evaluation and decide on the steps for its extension to this region. Extension will be progressive and take into account the specifications of each province.

Family Planning

To strengthen service delivery and improve Family Planning services, the following intervention axes have been selected:

• Consolidation of achievements; • Strengthening the utilization of long-term contraceptive methods; • Improving the quality of management and service delivery.

In this context, the interventions of p~ for 2001 will continue with the promotion of long-term methods through the training of newly recruited service providers in IUD insertion and the newly appointed surgeons, gynecologists and nurse-anesthetists in VSC.

II.B.3 Souss-Massa-Draa

This quarter, the list of service providers to be trained in VSC has been defined, taking into account the needs of all the provinces of this region. Consequently, 15 persons have been designated. A training schedule from May to December has been established with the CNFRH for the supervision of this training.

As to IUD training, the Taroudant province wishes to train 47 newly appointed service providers. A needs assessment of the other provinces is underway. The IUD training strategy will be discussed with the regional team and, in particular, the in­ service training unit in collaboration with the FP division. Training could take place either in the Agadir reference center or in the provinces, making sure that the conditions required by the theoretical and practical aspects of this training are met.

II.C.3 Tanger-Tetouan

There are 5 people to be trained in VSC in the TT region. These 5 service providers will be trained in coordination with the SMD region in the framework of the program of 4 sessions fixed by the CNFRH. The first session is scheduled for May 21.

Contract No.: HRN-I-OO-98-00032 23 IUD training concerns 40 service providers throughout the TT region. Training will take place in 4 sessions with supervision in the Tetouan reference center.

STIIAIDS

STI/AIDS is a major component of reproductive health and, in particular, in the SMD ... and TT regions . The Souss-Massa-Draa and Tanger-Tetouan regions are more particularly affected by the increase in STI/AIDS. Tangier, Tetouan, Agadir and Ouarzazate, for example, are known for high STI/AIDS prevalence rates and will require particular attention. Other urban and peri-urban regions will probably experience an increase in prevalence rates. About 20% of all HIV-positive cases in Morocco are in the Souss­ Massa-Draa (722 by end-1999).

A complete strategy has been programmed for STI/AIDS activities in 2001, in close collaboration with the DELM, DP and specialized associations. The objective of these activities is to provide an STI/AIDS services package together with other reproductive health services and, in particular, in urban health centers, on the basis of the syndromic approach disseminated by the MOH.

Meetings have been held with the DELM this quarter to initiate the STI/AIDS activities. In this context, workshops have been scheduled in the two regions to develop an operational regional plan on STI/AIDS control. The meetings are scheduled for April at the level of Agadir and Tangier. Following these workshops, regional work plans will be developed for activities supported by p~ under the 2001 Work Plan.

The other activities of the STI/AIDS component have been programmed for the next quarter.

Partnership

Both decentralization and regionalization provide a favorable context for p~ to establish a sustainable partnership with local parties intervening in the field of health. These initiatives can playa major role in the improvement of service availability and adapting services to the needs of the population in the two regions.

During their strategic planning, both regions had identified community participation and partnerships as means of improving the utilization of health services. The number of projects developed with partners therefore complies with the intermediate result of p~ on the implementation of innovative models to improve the accessibility, utilization, quality and efficiency of services developed and tested by regional and local teams.

Therefore, and as planned under the p~ technical proposal, World Education was invited in February to work with regional and central-level MOH teams to

Contract No.: HRN-I·OO-98·00032 24 ""I

analyze partnership opportunities among the different parties intervening in the health sector and to propose mechanisms to implement these opportunities.

The development of "health commissions" around health structures in collaboration with village and area (quartier) associations was among the major proposals made by World Education consultants. These commissions will collaborate with health care providers at local level to conduct IEC activities, identify the health needs of the community and contribute to the management of non-clinical needs in future facilities.

The mission report provides details on the implementation and enhancement of these commissions. It also suggests different activities and roles for each level, both central and regional. These recommendations will be discussed this coming quarter with the regional teams to determine the modalities of implementing the major actions, using the assets available at the central level and the SMD and TT regions.

Concurrently with this consultancy, actions were undertaken in the two regions to implement several activities under the Work Plan.

II.B.S Souss-Massa-Draa

In order to revitalize the CRESP, an information day for members was organized in March by the regional promotion commission in Agadir. The meeting was an opportunity for presenting p~ and initiating the debate on collaboration axes between the project and CRESPo The participants recommended the implantation of CRESP agencies at the level of each province through the organization of meetings. During the latter, it will also be possible to investigate partnership opportunities with p~ at the level of the provinces. A local consultant has been recruited to conduct these meetings. Field trips to the provinces are scheduled to begin in May.

Media are a major channel for the dissemination and out-reach of MOH priority strategies. An information day was planned in this context for March with media at the regional level. This information day had to be reported and its organization is awaiting the approval of H.E. the Minister of Health.

The regional health promotion commission held several meetings this quarter to develop an implementation plan for the programmed activities.

II.C.S Tanger-Tetouan

To achieve social mobilization and collaboration around health issues, the intermediate objective for 2001 in the TT region is the organization of a Population­ Health colloquium in September. Following the example of CRESP in the SMD region, this colloquium will help create a dialogue and consultation forum for the various partners and actors of civil society. Prerequisites for this colloquium are to:

• Initiate a diagnosis at the level of each province to identify potential partners; • Organize meetings to present p~, inform the partners about the health objectives of each region;

Contract No.: HRN-I-OO·98-00032 25 • Identify common areas of collaboration; I;;DII • Define a common strategy; and • Develop a synthesis document, which will be the reference document for the colloquium .

. During the visit of the World Ed miSSion, an initial meeting took place with the regional team during the RGG meeting on February 21. During this meeting, the regional managers formulated their needs in terms of their expectations in this field. Meetings with partners were organized in the different provinces.

The diagnosis at provincial level to select NGOs and departments having the management capacity and disposition to collaboration was initiated after the meeting, on March 12, of the regional partnership and community participation commission. During this meeting, intermediate actions for the organization of the colloquium were programmed.

Information Sharing and Dissemination

The sharing of information is the foundation of the strategic objective of P~.

This quarter, the finalization of the 2001 Work Plan, as well as its sharing with the different teams both at central level and of the two regions, was among the major achievements. This finalization provided an opportunity for making p~ better known, as well as its objectives, its basic principles and the important role played by all intervening parties in its implementation and success. Several project presentations were developed and shared during the meetings organized in the context of strategic planning of the two regions, and in finalization and WP01 validation meetings.

The p~ brochure was produced through a participatory effort. The design and printing of the brochure in three languages (Arabic, French and English) were completed by the DIEG. Distribution of the brochure was begun concomitantly with the dissemination of copies of the work plan. Dissemination will continue during the different events organized to improve the knowledge of p~ and its role in decentralization to better meet the needs of the population in reproductive and child health.

III.A. Central Level

The meeting of the p~ decentralization commission was organized in January. This was the first time that all of the central structures and the teams of the two regions were assembled in the same meeting. It provided an opportunity for reviewing and finalizing WP01. The target of the next meeting of this commission, planned for July, is to review the progress of activities.

This quarter, the project supported the production of the bulletin "Sante et Population", which has been published by the DP since 1993. The two issues of the

Contract No.: HRN-I-OO-98-00032 26 bulletin published this quarter were enriched by several articles on health indicators, 1.011 the information system, partnership with the private sector, quality assurance, etc. This bulletin will be a vector for disseminating the major events at the level of the '''' 8MD and TT regions. To achieve a more attractive presentation and design of this bulletin, meetings were held with the DIEC and the DP's documentation unit.

Discussions have also been initiated with the DIEC to prepare video documentation onP~. Working meeti~gs will be organized next quarter to develop a scenario for this video documentary.

To utilize the new technologies in information sharing and dissemination more effectively, efforts were made this quarter to find agencies that could provide training in the development of websites and pages,

... This training, programmed for the coming quarter, will enable the information resource. persons at central and regional level to provide the MOH website with information on all the activities undertaken by P~. Meanwhile, the e-mail address [email protected] is available for contacting the project.

III.B. Souss-Massa-Draa

Inception of activities under this component is scheduled for the coming quarter.

To share experiences and information, several managers and service providers from the TT region participated in various events organized at the level of the 8MD region, particularly on the 80NU strategy and quality assurance.

III.C. Tanger-tetouan

,. Inception of activities under this component is scheduled for the coming quarter.

A major activity is p~ support to the organization of the 6th National Congress of the Association Marocaine des Sciences Infirmieres et Technique Sanitaire, which coincides this year with the World Nurses Day to be organized from May 11 to 13, 2001 in Tetouan. This event will be attended by over 350 participants and provide an opportunity for disseminating the experience initiated by P~ in the 8MD and TT regions in the context of the decentralization of health services in Morocco, strengthening the MOH achievements in In-service Training, Quality Assurance, 8M and the syndromic approach to the management of 8TI/AID8.

Support Activities

The purpose of support activities is to consolidate past activities with a national scope. This mechanism affords support to activities that consolidate interventions initiated under the Phase V project. Activities have been programmed and validated

Contract No.: HRN-I-OO-98-00032 27 under WP01. Other activities are financed upon the request of the relevant MOH structure, its communication to USAID through JSI and approval by the MOH and USAID during the PMU meeting.

Besides a number of support activities programmed under WP01, two new activities have been initiated.

Support was provided for the participation of a senior member of the maternal ... protection service in a course on the utilization of mother and child health indicators which took place in Cairo on January 16-22. This course' provided an opportunity for presenting the experience with the information system tested at the level of the Fez­ Boulemane and Taza-AI Hoceima-Taounate regions under the EOC project. roi The promotion of child health was the theme of the 2001 calendar. The project supported the printing of 5,000 copies of this calendar at DIEC level. This calendar has been distributed to all the MOH structures as well as to the different partners. Both the relevance and quality of its design contribute to extending key messages on child health for awareness raising. This calendar was produced together with the MCH division.

In-service Training

Under Phase V, the Training Division worked with the DHSA on the introduction of a QA module in the IFCS curriculum. A draft module has been produced and tested. To finalize this module, it will be necessary to insert the changes proposed by various teachers to facilitate assimilation by the students. In this context, the Training Division has required URC technical assistance in the finalization of the QA module. Dr Karki has been chosen, since he has been involved since the inception of the design and production process of this module. His consultancy has been scheduled for next June.

The date for the dissemination of the national in-service training strategy in the Rharb Chrarda Bni-Hssin region has not yet been fixed by the Training Division.

Family Planning

This quarter, a team of the FP division broached the changes to be made in the re­ issue of "FP Standards in Morocco". Adding these changes to the reprint of this document will meet the needs expressed throughout the country. Next quarter, the FP division will consider an appropriate strategy to disseminate the standards document to service providers.

Information System

The DP network is a shared one and suffers from various problems that cause often months-long disruptions. The solution proposed by DIM and DP computer technicians is to introduce VLAN technology. This will assist in solving all past problems.

Contract No.: HRN-I-OO-~8·00032 28 ;,j~

This quarter, this technology was introduced by a firm chosen among several others. The network is now operating well and to the satisfaction of all the users.

Partnership

This quarter, p~ supported the organization of a meeting with a number of NGOs active in Fez. This provided an opportunity for reflecting on the implementation of support committees to the birthing centers and maternities .. created or. upgraded under Phase V in the context of the EOC project. ..

Development of a work plan was the outcome of this meeting. This plan will be implemented in rural areas around 3 birthing centers and 30 douars.

This year's major activities will focus on the follow-up of parturients to raise their awareness, and that of their families/friends, on the importance of monitoring pregnancy and childbirth. Completion of these actions will involve the associations and the personnel of the selected birthing centers. To build up the capacities of the involved NGOs, several information and training meetings have been programmed throughout the year. All these activities will be completed with the major involvement of the IEC team of the Zouagha Moulay Yacoub prefecture and the support of officials of this delegation.

In the framework of the South-South partnership, eight Malian service providers received SONU training as well as training in assistance and communication skills this quarter. Other groups have been planned for the next quarter.

Other activities supporting the development of the health chart have been initiated this quarter.

Administrative Activities

Project Management

Two PMU meetings were held this quarter. The first meeting was principally concerned with reviewing the p~ and CMS work plans and the consultancy of Dr. Theo Lippeveld's. During this meeting, the date of the board of directors meeting was fixed for February 12.

During the second meeting, held in March, the preliminary results of the study on the computer pool were presented,. as well as the results of the World Education mission. These meetings provided an opportunity to answer various questions asked about the management of activities under the work plan and outside the work plan.

Given the intensity of activities this quarter, a single official meeting was held with USAID. This allowed progress review of the major activities and addressed issues relevant to the administrative management of the project. Several briefing and

Contract No.: HRN-I-OO-98-00032 29 debriefing meetings were also organized this quarter on the different programmed consultancies.

Team meetings were held regularly in Rabat with the participation of the coordinators of the two regions.

Personnel

No change in personnel took place this quarter.

Finance

The budget situation as of March 31,2001 is as follows:

Total estimated cost: $ 7,914,369 Expenditures (last three months): $ 306,985 Cumulative expenditures: $ 666,274 Balance: $ 7,248,095

To provide regular budget follow-up for the regional teams, financial reports on the expenditures by region, component and activity will be prepared and transmitted to the SMD and TT regions.

Procurement and Refurbishments

Please refer to the annex on procurement.

Training/Study Trips

Please refer to the annexes on local training and on invitational travel and participant training.

Contract No.: HRN·I-OO-98-00032 30 ...

Annexes

Annex 1: Consultants List Annex 2: Local Trainings Annex 3: Invitational Travels and Participant Trainings Annex 4: Procurement and refurbishments Annex 5: List of documents, reports and training and IEC materials

Contract No.: HRN·I·OO·98·00032 31 Annex 1 Consultants List

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p~ CONSULTANT LIST JANUARY - MARCH 2001

To assist the two regions in the implementation of safe · TyaneiZerrari motherhood activities Activities Fasla/Bekkali Wright:Bakkali Cakir/Laasri/Sayah

IIV""ooaf Belabdia, March December To ensure regular maintenance and troubleshooting of the I.A.2.2 JSI · Tyane/Hajra (20 days) network in the JSl/Rabat Office F asla/Bekkali

Lippeveld, 1/15/2001 1/26/2001 To assess the state of the art of systeme SMIPF and to I.B.2.1 JSI · Tyane/AzelmaVHajra Yes JSI evaluate the information need for regional management I.C.2.1 · FaslaiBekkali I.C.2.2

Bouchet, 1/21/2001 2/10/2001 To assist the regional teams to initiate quality improvement I.B.4 · Tyane/Jrondi Yes '" projects and to support the initiated projects for their FaslaiBekkali '" extension

Edson, 1/24/2001 213/2001 assist the regional teams to initiate quality improvement I.B.4 · Tyane/Jrondi Yes and to support the initiated projects for their I.B.4.5 FaslaiBekkali

Moghli, 1/24/2001 216/2001 facilitate the Sociata Civile Rurale et Dave/oppement II.B.5.3 JSI 1. Tyane workshop of CRS 2. FaslaiSbayou 3. WrighVBakkali 4. Cakir/Laasri Yanulis et Dan Devine, 2119/2001 3/3/2001 study the potential contribution of WE in the II.B.5.3 JSI 1. Tyane/Maadi World Education I of workplan activities, analyze partnership II.C.5.5 2. Fasla/Bekkali among different actors in the health sector, Wrig hVBakkali elaborate and submit an implementation plan for the Cakir/EI Omari activities

1. MOH (centre) 2. MOH (regions) 3. USAID 4. JSI t l I t it I l l t I t l I l l t l ! !il

p~ CONSULTANT LIST JANUARY - MARCH 2001 i"" assist the JSI team to develop an integrated project · Tyane/AzelmaVHajra and evaluation (M&E) plan FaslaiBekkali WrighVBakkali Cakir/EI Omari

Edson, 3/1812001 3/31/2001 assist the regional teams in the design and the I.B.4.1 · Tyane/Jrondi URC of different materials mentioned above; and Fasla/Bekkali follow up in the implementation of the collaborative WrighVBakkali linSMD Cakir/EI Omari

Bossert, 311912001 3/3012001 offer a technical assistance for the elaboration of a 1.A.1.1 JSI · Tyane/Belghiti HSPH document on regionalization experiences, as FaslalBekkali I as the organization of the round table WrighVBakkali CakirlEI Omari

...GO

1. MOH (centre) 2. MOH (regions) 3. USAID 4.JSI ...

Annex 2 Local Trainings

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Local Trainings at SMD f January- March 2001

", :. I.B.2.1 2119/2001 2119/2001 Tiznit Completed 9 25 34

I.B.2.1 3/16/2001 3/16/2001 Taroudant Completed 35 22 57

1 Planned, cancelled, Tennlnaled, Completed, or Ac\lVe. 2 Conference, Doctoral Degree, English language Training, MastelS Degree, Observational Study Tour, Seminar, Short Course, other.

3 JSI, MOH, URC, etc. l l I I I I l I

Lisle des Formations Locales a IT JANVIER - MARS 2001

in the use of Maternal System materials '" First session 3/20/2001 3/20/2001 Tetouan Completed Workshop 4 16 MOH 3/2212001 3/2212001 Tetouan 4 7 MOH 3/21/2001 3/21/2001 Workshop 10 25 35 MOH

iu z ~ I ;u l' io 8 1 Planned, Cancelled, Terminated, Completed, or Active. '" 2 Conference, Doctoral Degree, English Language Trninlng, Masters Degree. Observational Study Tour, Seminar, Short Course, other. 3 JS1, MOH. URC. etc. -d

Annex 3 Invitational Travels and Participant Trainings

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"Invitational Travel/Participant Training" List JANUARY - MARCH 2001

Aouragh M Rabat 219/2001 participate to the training course on using date decision Cairo IVA.2. JSI/MOH making in maternal and perinatal health Egypt Training . ".:' .. :"" . .. M Tetouan 2/9/2001 2/18/2001 finalize the analysis and the presentation of the QA cost- Bethesda Study I.AA.1 JSI study results in Morocco, supported by the Quality USA Tour Project(QAP) ; and to be exposed to QA international experiences

Malki M Rabat 219/2001 2/18/2001 finalize the analysis and the presentation of the QA cost- Bethesda Study I.AA.1 OAP efficiency study results in Morocco, supported by the Quality USA '"CD Tour Assurance Project(QAP) ; and to be exposed to QA international experiences -

Annex 4 Procurement and refurbishments

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Procurement and Refurbishments January ~ March, 2001

$30 i I Dormiltorv equipment rehabilitation work

$20

room Tangier $9

process \,~

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Annex 5 List of documents, reports and training and lEe materials

Contract No.: HRN-J-OO-98-00032 42 List of documents, reports and training and lEe materials ..I

... 1. JSI Contractual Reports Author/Organization Date

p~ 2001 Work Plan JSI March 21, 2001

2. Consultancy Reports Author/Organization Date Consultancy report, January 15 to 26 Thea Lippeveld, JSI Feb.15,2001 Consultancy report, Jan 21 to Feb 10 Bruno Bouchet and Wendy Feb.2,2001 Edson, URC Consultancy report Jan-Dec Rachid Bezad Underway Consultancy report, Jan 24 Feb 3 Wendy Edson, URC Underway Consultancy report, Feb 9 to March 3 John Yanulis and Dan Underway Devine, World Education Consultancy report, March 19 to 30 Tom Bossert, HSPH Underway

3. Thematic Documents and Studies Author/Organization Date

Strategic plan SMD SMD region Underway Strategic plan TT TT region Underway Monitoring and evaluation plan Helene Rippey Underway The 90 Decade dedicated to child MOH Underway health: translation into Arabic and English (.oj 4. Training Manuals Author/Organization Date

ACS Folder - reprinted Sylvie Collin, SIPDT March 2001 5. IEC Materials Author/Organization Date 2001 Calendar (La sante de l'Enfant) DIEC February 2001 (Child Health)

p~ brochures (Arabic, English and French)

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