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ZIKA RESPONSE in ECUADOR and PERU FINAL PROGRESS REPORT USAID ZIKA PROGRAM Period: September 30, 2016 to September 29, 2019 Submission Date: December 29, 2019

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ZIKA RESPONSE in ECUADOR and PERU FINAL PROGRESS REPORT USAID ZIKA PROGRAM Period: September 30, 2016 to September 29, 2019 Submission Date: December 29, 2019 ZIKA RESPONSE IN ECUADOR AND PERU FINAL PROGRESS REPORT USAID ZIKA PROGRAM Period: September 30, 2016 to September 29, 2019 Submission Date: December 29, 2019 (DELETE THIS BLANK PAGE AFTER CREATING PDF. IT’S HERE TO MAKE FACING PAGES AND LEFT/RIGHT PAGE NUMBERS SEQUENCE CORRECTLY IN WORD. BE CAREFUL TO NOT DELETE THIS SECTION BREAK EITHER, UNTIL AFTER YOU HAVE GENERATED A FINAL PDF. IT WILL THROW OFF THE LEFT/RIGHT PAGE LAYOUT.) Contents ACRONYMS AND ABBREVIATIONS III ACTIVITY OVERVIEW VI ZIKA PROGRAM ACTIVITY DETAILS VI ANNUAL HIGHLIGHTS/EXECUTIVE SUMMARY VIII ACTIVITY IMPLEMENTATION XI PROGRESS NARRATIVE XI REPORTING PROJECT IMPLEMENTATION DATA XX COLLABORATION XXV COLLABORATION WITH OTHER USAID OR USG ACTIVITIES XXV LEARNING FOCUSED COLLABORATION AND ENGAGING IN LEARNING APPROACHES XXVI CHALLENGES OF THE COLLABORATION XXVII COLLABORATION AND/OR KNOWLEDGE SHARING WITH PARTNER ENTITIES IN HOST GOVERNMENT AND OTHER DONOR AGENCIES XXVII KEY HIGHLIGHTS OF THE COLLABORATION XXIX CHALLENGES OF THE COLLABORATION XXIX LEARNING XXX RESEARCH AND PUBLICATIONS XXXII COMMUNICATIONS AND PROMOTION XXXVI KEY COMMUNICATION ACTIVITIES - PROJECT PROMOTIONAL, PUBLIC OR MEDIA EVENTS/ENGAGEMENTS FOR THE PROJECT XXXVI SUSTAINABILITY AND EXIT STRATEGY XL ANNEXES XLII ANNEX IA. PERFORMANCE INDICATOR REPORTING SHEET XLIII ANNEX IB. OTHER ZIKA ACTIVITY INDICATORS XLIX ANNEX II SUCCESS STORIES LIV ANNEX III TRAINING REPORT LVIII ANNEX IV PICTURES (EVENTS, TRAININGS ETC.) LXXXVI ANNEX V SUB-GRANTS UNDER THE ACTIVITY XC ANNEX VI INTEGRATION OF CROSS-CUTTING ISSUES XCIV (A) GENDER EQUALITY AND FEMALE EMPOWERMENT XCIV (B) ENVIRONMENTAL COMPLIANCE XCV (C) INSTITUTIONAL STRENGTHENING AND LOCAL CAPACITY BUILDING XCV (D) YOUTH (IF APPLICABLE) XCVI (E) DISABILITY (IF APPLICABLE) XCVII (F) SCIENCE, TECHNOLOGY, AND INNOVATION (IF APPLICABLE) XCVII ANNEX VII RESEARCH AND PUBLICATION TRACKER XCVIII ANNEX VIII ENVIRONMENTAL MITIGATION AND MONITORING Y3 & FINAL REPORT CIII USAID.GOV USAID ANNUAL PROGRESS REPORT | II CRONYMS AND ABBREVIATIONS AMELP Activity Monitoring, Evaluation, and Learning Plan AOR Agreement Officer Representative COR Contract Officer Representative IP Implementing Partner M&E Monitoring and Evaluation MEL Monitoring, Evaluation, and Learning USAID United States Agency for International Development CARE: Cooperative for Assistance & Relief Everywhere CBSS: Community-Based Surveillance System C4D: Communication for development DRR: Disaster Risk and Recovery EW: Epidemiological Week EBA: Evidence-Based Analysis (ABE) EMMR: Environmental Mitigation and Monitoring Report EMMP: Environmental Mitigation and Monitoring Plan FY: Fiscal Year HC3: Information, communication, education and health (USAID) KAP: Knowledge, Attitudes and Practices (KAP) MoH: Ministry of Health (MINSA- Peru, MSP – Ecuador) PAHO: Pan-American Health Organization SBCC: Social and behavior change communication SRMH: Sexual, Reproductive and Maternal Health III | USAID ZIKA ANNUAL REPORT USAID.GOV SRH: Sexual and Reproductive Health WHO: World Health Organization UNFPA: United Nations Populations Fund UNICEF: United Nations International Children’s Fund USAID: United States Agency for International Development MC: Monitores comunitarios (community monitors CBSS) ECUADOR DDS: Dirección Distrital de Salud (District Health Department) DDE: Dirección Distrital de Educación (District Education Department) GADM: Gobierno Autónomo Descentralizado Municipal (Decentralized Autonomous Municipal Government) MIES: Ministry of Economic and Social Inclusion MINEDUC: Ministry of Education UTM: Universidad Técnica de Manabí UTMACH: Universidad Técnica de Machala ULEAM: Universidad Laica Eloy Alfaro (Manta) US: Unidad de Salud (Health Unit) MSP: Ministry of Public Health PERU ACS: Agentes Comunitarios de Salud (Community Health Agents) CAD: Ciudadanos al Día (Citizens Informed, Peruvian Non-Governmental Organization) CLAS: Comunidades Locales de Administración en Salud (Local Health Administration Communities) COEL: Centro de Operaciones de Emergencia Local (Local Emergency Operations Center) COER: Centro de Operaciones de Emergencia Regional (Regional Emergency Operations Center) USAID.GOV USAID ANNUAL PROGRESS REPORT | IV C.S: Centro de Salud (Health Center) CUNA MAS: Social program of the Ministry of Development and Social Inclusion DIRESA: Dirección Regional de Salud (Regional Health Department) DISA: Dirección de Salud (Health Department) GERESA: Gerencia Regional de Salud (Regional Health Agency) HCE: Health Care Establishment MIDIS: Ministry of Development and Social Inclusion MIMP: Ministry of Women and Vulnerable Populations MINSA: Ministry of Health PREVAED: Programa Presupuestal Estratégico Reducción de la Vulnerabilidad y Atención de Emergencias por Desastres - PREVAED - 068. (Strategic Budget Program: Vulnerability Reduction and Disaster Response – PREVAED-068) P.S: Puesto de Salud (Health Post) UGEL: Unidad de Gestión Educativa Local (Local Education Management Unit) UPCH: Universidad Peruana Cayetano Heredia V | USAID ZIKA ANNUAL REPORT USAID.GOV ACTIVITY OVERVIEW ZIKA PROGRAM ACTIVITY DETAILS The project contributed to the strengthening of local actors and communities for the prevention and control of Zika, influencing the knowledge, attitudes, and practices of communities, agents, and community health workers. The project recovered best practices and experiences to strengthen and / or develop community monitoring and control mechanisms. It was emphasized on pregnant women, women of reproductive age, and adolescent women. It also proposed to actively involve communities, strengthen or recover the participation of the population in their health care, for which it promoted the generation of alliances with competent agencies of the national government and with the Regional Governments (Peru) and local Municipalities. Objectives to achieve in two phases over three years: 1. Increase community, local and national capacities to deliver efficient and timely response to the Zika virus outbreak and other vector prone diseases through Disaster Risk Reduction (DRR) and Human Rights approaches based on CARE’s experience in SRMH (Sexual, Reproductive and Maternal Health), sustainable community health systems and empowerment to strengthen the direct involvement of communities, by community health agents, in Zika priority areas (prevention, and vector control). 2. To enhance regional and national efforts to help decrease the rates of Zika transmission by sharing findings, impact results and influencing bi-national policy making through a deep and rigorous evidence-based approach of best practices and lessons learned in community mobilization and participation, to allow fast track, gender sensitive implementation strategies in diverse social and cultural contexts, increase coordination and planning capacities, refine an accurate monitoring system and a well-developed communication and dissemination strategy. Geographic Focus: Ecuador: 10 cantons belonging to 3 provinces in the coastal region of the country, two of which suffered from varying degrees of damage from the April 2016 earthquake: Esmeraldas (1), Manabi (6) and El Oro (3) Peru: 20 districts in the northern section of the country: Tumbes (4); Piura (11); Lambayeque (3) and Cajamarca (2) USAID.GOV USAID ANNUAL PROGRESS REPORT | VI Graphic No. 1: Provinces and regions of project Zika response in Ecuador and Peru. Beneficiaries: The following chart shows the number of beneficiaries, admitted to the CARE monitoring platform, who participated directly in project actions. Country Total project Reached Y3 Reached Y1-Y2-Y3 % Women Men Total Women Men Total Ecuador 128944 35663 20762 56440 58465 35710 94175 73 Peru 263009 82658 63727 146385 98333 80874 179207 68 Total 391953 118321 84489 202825 156798 116584 273382 70 Source: CARE Monitoring Platform. September 2019. Additionally, by means of communications disseminated through mass and digital media, 320,000 people have been reached in Peru and more than 600,000 people in Ecuador, in the project's intervention cantons in each country. VII | USAID ZIKA ANNUAL REPORT USAID.GOV ANNUAL HIGHLIGHTS/EXECUTIVE SUMMARY Highlights The Project worked to influence knowledge and behavioral change in men and women (with emphasis on pregnant, childbearing-age, and adolescent women), especially in schools. Reports of indicators and KAP studies developed in the 3 years show the evolution of knowledge and practices. In pregnant and childbearing-age women, an increase in knowledge of 23% and 21.6%, respectively, was achieved in Peru and Ecuador. (Indicator I.25). In Peru, 73.05%, and in Ecuador, 59%, carry out the implementation of prevention practices (Indicator I.26). The adolescents who apply Zika prevention and care practices reached, in Peru, 95%; and, in Ecuador, 55.31%. (I.29). The strengthening of community participation in Zika prevention and Aedes aegypti control was carried out through the community-based surveillance system, whose main actors were community health monitors and / or agents. This system had its specific development in each country, within the framework of the health competencies of local governments and the Ministry of Health. In Peru, the system was implemented in selected areas of 13 districts out of a total of 20 intervened districts, and in 3 additional districts. In Ecuador, the system was implemented in selected areas of 6 cantons, out of 10 intervention cantons. Studies of the experiences show the positive impact on the population of the intervention areas. The project
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