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Year 4 Annual Project Results CARE Global Health Year 4 Annual Project Results Reporting Period: April 1, 2020—March 31, 2021 Region/Country: Tabora, Tanzania Submitted by CARE Canada May 15th, 2021 Tabora Maternal & Newborn Health Initiative (TAMANI): Project Number #D-003063, PO 7063009 Submitted by CARE Canada Contact Information: Rebecca Davidson, Head of Global Health Email: [email protected] Total Project Budget: $12,821,518.00 Contribution Agreement start date: January 6, 2017 Contribution Agreement End Date: December 31, 2021 Contents List of Abbreviations ....................................................................................................................................................... 3 Executive Summary ........................................................................................................................................................ 5 Project Description & Context ........................................................................................................................................ 5 Reach – Beneficiaries & Intermediaries ..................................................................................................................... 7 Operations & Outcomes to Date .................................................................................................................................... 8 Update on Context & Rationale ................................................................................................................................. 8 Project Operations ..................................................................................................................................................... 9 COVID-19 Response Activities............................................................................................................................. 9 Endline Data Collection ........................................................................................................................................ 15 Progress on Implementation: Outputs & Activities .................................................................................................. 15 Management Issues & Adjustments ............................................................................................................................ 43 Changes to Risks & Analysis .................................................................................................................................. 44 Changes to Theory of Change, LM and PMF .......................................................................................................... 44 Environmental Sustainability .................................................................................................................................... 55 Good Governance & Human Rights ......................................................................................................................... 56 Financial Report .......................................................................................................................................................... 57 Progress Towards Outcomes ....................................................................................................................................... 58 Sustainability ............................................................................................................................................................... 77 Lessons Learned and Next Steps ................................................................................................................................. 79 Annex A - Risk Register .............................................................................................................................................. 80 Annex B – Performance Measurement Framework ..................................................................................................... 82 Appendix C – Gender Equality Measurement Framework .......................................................................................... 88 Annex D - Communications Annex............................................................................................................................. 93 Annex E – List of Partners........................................................................................................................................... 94 Annex F – SOGC/AGOTA Policy Brief ..................................................................................................................... 96 Annex G – SOGC/AGOTA Partnership Paper ............................................................................................................ 97 2 List of Abbreviations ASRH – Adolescent Sexual and Reproductive Health AGOTA – Association of Obstetricians and Gynecologists of Tanzania ANC – Antenatal Care BCC – Behaviour Change Communication BEmONC – Basic Emergency Obstetric Maternal Neonatal Care CBHPC - Community Based Health Promotion Coordinators CCHP – Comprehensive Council Health Plan CHWCo – Community Health Worker Coordinator CEmONC – Comprehensive Emergency Obstetric Maternal & Neonatal Care CHMT – Council Health Management Team CHW – Community Health Worker CSC – Community Score Card CSIH – Canadian Society for International Health DHIS – District Health Information System DMO – District Medical Officer DQA – Data Quality Assessment DRCHco – District Reproductive Child Health Coordinator ESIA – Environmental & Social Impact Assessment GII – Gender Inequality Index GoT – Government of Tanzania HF – Health Facility HMIS – Health Management Information System (MTUHA) IDSR - Integrated Disease Surveillance and Response IHI - Ifakara Health Institute MDR – Maternal Death Review MMR – Maternal Mortality Ratio MNCH – Maternal, Newborn & Child Health MoHCDGEC - Ministry of Health, Community Development, Gender, Elderly and Children MPDSR - Maternal Perinatal Death Surveillance & Response NMR – Newborn Mortality Ratio OSCE - Observed Structured Clinical Examination OPD – Out Patient Department PIP – Program Implementation Plan PO-RALG - Prime Minister's Office - Regional Administration and Local Government PSC – Program Steering Committee RAS - Regional Administrative Secretary RBF – Results Based Financing RMC – Respectful Maternity Care RHMT – Regional Health Management Team RMNH – Reproductive Maternal Newborn Health RMNCH – Reproductive Maternal Newborn Child Health RMO – Regional Medical Officer SAA – Social Analysis & Action 3 SBCC – Social Behaviour Change Communication SOGC – Society of Obstetricians & Gynaecologists of Canada SRH – Sexual Reproductive Health TAMANI – Tabora Maternal Newborn Health Initiative TNA – Training Needs Assessment WDC – Ward Development Committee 4 Executive Summary The Tabora Maternal and Newborn Health Initiative (TAMANI) is a five-year project led by CARE in partnership with the Government of Tanzania’s Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) and the Prime Minister’s Office for Regional and Local Government (PO-RALG). Implementing partners include the Society of Obstetricians and Gynecologists of Canada (SOGC), the Association of Gynecologists and Obstetricians of Tanzania (AGOTA), the Canadian Society for International Health (CSIH), McGill University’s Institute for Health & Social Policy, and Ifakara Health Institute (IHI). The project is financially supported by the Government of Canada and is closely aligned to Government of Tanzania (GoT) health polices, strategies and guidelines. The Annual Report covers the period of April 1, 2020, to March 31, 2021.The report provides an analysis on operations to date against the Year Four Annual Work Plan. This report also highlights how the project pivoted to respond to the COVID-19 global pandemic and includes reporting on COVID response programming as approved by GAC in March 2020. Key Activities Completed Against the Year Four AWP: Implemented COVID-19 Response Activities Adapted and delivered R/CHMTs on-the-job Supporting Supervision Program Completed training on for Health Facility Staff on HMIS, DHIS2, Data Analysis/Utilization ASRH Training Completed for Health Care Workers Completed Remaining Health Facility Rehabilitation Project Completed Coaching & Mentoring visits Implemented Community Based CSC and SAA dialogues Completed Endline Data Collection The last full year of project implementation has been an exceptional one in Tabora. The TAMANI team has successfully implemented the TAMANI project against a continually evolving and difficult context. Overall implementation has continued with limited changes to planned activities, while pivoting quickly to implement COVID-19 response programming. Project Description & Context Global Affairs Canada established the Ultimate Outcome and Intermediate Outcomes in the call for proposals, which are presented below as part of the TAMANI logic model. The project addresses issues both on the supply side (1100) as well as the demand side (1200) in contributing to reduced maternal and newborn mortality in Tabora, Tanzania. The logic model remains unchanged from the PIP aside from one slight edit changing reference to MDR to MPDSR to align with the GoT policy. 5 Project outputs under 1100 (SUPPLY): Project outputs under 1200 (DEMAND): 1111 - Regional and district health authorities trained and 1211 - CHW program for reproductive, maternal mentored in gender sensitive supportive supervision for and newborn health and family planning
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