(HFA) Population Services International (PSI) RFA-654-16-000004 Cooperative Agreement No.: AID-654-A-17-00003

Health for All (HFA) Population Services International (PSI) RFA-654-16-000004 Cooperative Agreement No.: AID-654-A-17-00003

Quarterly Report 3: April 1st to June 30th, 2017

1 HEALTH FOR ALL In January 2017, the Population Services International-led Consortium was awarded RFA-654- 16-000004 to implement the project Health for All (HFA), from FY17-FY21. HFA’s program goal is to have USAID Angola partnerships transformed to strengthen the effective use of Angola's resources to meet the country’s development needs. HFA includes three health areas: malaria, HIV and family planning. This Quarterly Report refers to activities implemented between April and June 2017 (Q3): Result 1: LLIN Access and Use Increased by at least 30%. Key Results Expected ● Distribution of 2.9 million mosquito nets in 5 provinces ● LLIN related Social Behavior Change Communication strategy updated and adopted by NMCP and HFA ● 4,000 “activitas” or community agents trained in communication during distribution USAID/PMI supports a pillar of the National Malaria Control Program’s (NMCP) strategic plan: LLIN distribution for universal coverage in Angola. NMCP updated its approach to LLIN distribution and now aims to achieve universal coverage through a national distribution campaign to provide LLIN for all provinces within a year. LLIN Distribution HFA led a national Mass Distribution of LLINS (long lasting insecticide treated nets) during FY 17 in the following provinces (phase 1): • Cuanza Sul • Cuanza Norte • Zaire • Malanje • Uige (Quitexe, Cangola, Sanza Pompo, Puri, Buengas and Mucapa municipalities) This quarter was marked by the implementation of LLIN Distribution activities in all municipalities, following the novel distribution strategy adopted by NMCP. It was not possible to conclude the campaign in all municipalities of the 5 provinces (phase 1) as foreseen due to several local and structural unexpected events in the field, such as: • Delay in delivery of materials to the provinces (not enough time for procurement and delivery of goods to provinces). • Agenda conflicts between the activities of the LLIN distribution campaign and electoral campaign. This implied in restructuring of the calendar of activities in some provinces. • Difficult access to some communities causing delays in registration and distribution activities. • Restructuring of the Malanje team with the engagement of a new provincial coordinator caused delay in the calendar of activities. • Difficulty in transportation due to poor road conditions and long distances between municipalities. However, the campaign activities were officially closed in the provinces of Cuanza Norte and Cuanza Sul by the end of June as previously planned. There was a need to restructure the schedule of activities in the provinces of Malanje, Uige and Zaire. The conclusion of the campaign has been set for mid-July 2017.

Key results achieved during LLIN Distribution Phase 1: • 2.442.370 ITNs distributed • 4.360.602 beneficiaries received ITNs • 108.838 pregnant women reached • 690.992 children below 5 years of age reached • 4,764 activists trained in communication, registration and LLIN distribution • 90 trainers of trainers (ToT) formed for training of activists

Table#1: summary of results of LLIN Distribution – phase 1 # PROVINCE ITNs BENEFICIARIES PREGNANT CHILDREN DISTRIBUTED COVERED WOMEN > 5 YEARS 1 Cuanza Norte 285,252 509,109 12,618 79,161 2 Cuanza Sul 990,944 1,720,325 41,786 262,066 3 Malanje 649,659 1,186,158 31,168 197,845 4 Uíge 186,350 334,670 9,297 60,835 5 Zaire 330,165 610,340 13,969 91,085

TOTAL 2,442,370 4,360,602 108,838 690,992

Table#2: summary of ITNs received, distributed and remaining per province – phase 1 # PROVINCE # ITNs # ITNs # ITNs REMAINING IN RECEIVED DISTRIBUTED PROVINCE 1 Cuanza Norte 293,450 285,252 8,198 2 Malanje 652,850 649,659 3,191 3 Uige 194,900 186,350 8,550 4 Cuanza Sul 1,242,700 990,944 251,756 5 Zaire 393,500 330,165 63,335 6 TOTAL 2,777,400 2,442,370 335,030 PLANNING STAGE 1. Microplanning In early April PSI and its partner Mentor completed the microplanning process in the 6 provinces. The microplanning exercise was carried out jointly with provincial supervisors of the Malaria Program, Malaria Focal Points and Municipal Health Departments to complete the planning process to guide the implementation of activities. The information gathered included: number of villages, number of population, road accessibility, distribution points, etc. The municipalities worked simultaneously in two groups, except for Uige where all municipalities were simultaneously contemplated. The table below indicates the groups of municipalities per province: Table #3: group of municipalities per province MALANGE CUANZA NORTE CUANZA SUL ZAIRE UÍGE GROUP I Malange sede Ambaca Amboim (Gabela) Cuimba Puri Kunda dia Base Banga Quilenda Mbanza Quitexe Kalandula Bolongongo Conda Congo Sanza Pombo Lukembo Quiculungo Seles Nóqui Cahombo Samba Cajú Sumbe Kwamba Nzoji Porto Amboim Kangandala

2. Training of trainers (for CHWs training) GROUP II MALANGE CUANZA NORTE CUANZA SUL ZAIRE Cacuso Cazengo Cassongue Nzeto Buengas Cambundi- Cambambe Ebo Soyo Cangola (Alto Catembo Golungo Cela Tomboco Cauale) Marimba Ngonguembo Libolo Mucaba Massango Lucala Munssende Mucari Quibala Quela Quirima

By 21st April PSI completed the ToT program to build trainer’s capacity to train the activists in the field on malaria prevention counselling and usage of the tools to fulfill community related activities promoted by NMCP with funds from USAID/PMI. For trainers, PSI selected candidates from distribution provinces/municipalities with experience in the areas of training, education and/or communication. The first three ToT sessions were held in Luanda by the PSI team jointly with the NMCP communication officer. Training sessions were also conducted locally in Malanje, Cuanza Sul, Uige and Zaire to complete the number of 90 trainers needed for the training of activists, as detailed in the table below. Table #4: Total number of trainers per province: # PROVINCE # OF PEOPLE # WOMEN # MEN TRAINED 1 CUANZA NORTE 14 2 12 2 CUANZA SUL 30 3 27 3 MALANGE 24 6 18 4 UIGE 10 0 7 5 ZAIRE 12 2 10 6 TOTAL 90 13 74 During the training sessions in Luanda, PSI received a visit from a VectorWorks logistics consultant. It was an opportunity to exchange experiences and reinforce the campaign objectives. IMPLEMENTATION STAGE 1. Training of the warehouse supervisor, logistics and administrative assistants To support the working teams at provincial/municipal level and ensure proper coordination of the campaign operations, the following personnel were recruited and trained: Table#5: Administrative and logistic support team # Position Responsibility # of personnel trained 1 Logistics Coordinate logistics operations at the provincial 5 Assistant level, including rental of vehicles for (1 per province) transportation, control of the provincial warehouse, distribution of campaign materials.

2 Warehouse Control of products entry/exits in municipal 48 Supervisor warehouses (1 per municipality) 3 Administrative Support provincial coordinators in administrative 3 Assistant control and management, including human (Cuanza Norte, Cuanza resources and finance. Sul and Malanje)

2. Training of activists In the provinces, the trainers started the training of communication and registration activists on May 8th -12th. The training of distribution activists was conducted later following the arrival of mosquito nets in each the province. The trainings took 2-4 days in every province. The campaign in the 5 provinces mobilized a total of 4,764 activists, including communication, registration and distribution activists. The table below summarizes the number of activists trained per province: Table#6: Number of CHWs trained PROVINCE CHW TRAINED

Total # men # women 1 Cuanza Norte 529 415 114 2 Cuanza Sul 1,974 734 1,240 3 Malanje 1,382 1,064 318 4 Zaire 489 377 112 5 Uíge 390 327 63 TOTAL 4,764 2,917 1,847 Note: all activists who qualified for the training were subjected to written examinations in addition to fulfilling other criteria like: national identity cards, bank account details and security clearance from local leaders prior to successful recruitment. In Uige and Zaire, the field teams used the group of registration activist for LLIN distribution, which was an advantage that increased efficiency during the distribution phase. The training program for activists was completed in June. 3. ITNs pre-positioning in the provinces The process of pre-positioning of mosquito nets in the provinces started in May, led by the PSM's operational team. In total, PSI received 2,777,400 ITNs. Table #2 has more details on the number of nets received and distributed by province. 4. Pre-communication and household registration Communication and registration activities in the field began on May 18th. Prior to registration, the activists led pre-communication visits in the community to inform the public about the campaign and the importance of having the head of the household present during the registration period. The registration exercise took approximately 14-20 days in all municipalities of the 5 provinces. The activists were distributed by zones and each group of 10-15 activists had a supervisor to guide the activities in the community. During the registration period, the activists worked in pairs (1 for communication and 1 for registration), and on average 40 to 80 households were registered per day, depending on distances and road access. Each registered household received a card indicating the number of mosquito nets to be received, place and date of distribution.

5. Official launching of the LLIN Distribution - 1st phase of national mass campaign

The official launching of the campaign at national level took place in Malanje May 16th, led by PSI in coordination with DPS and NMCP. Two events were combined in a single place: 1) official presentation of the HFA project in a closed tend attended by DPS, USAID/PMI, and other HFA partners and 2) a symbolic LLIN distributions to the public that presented their LLIN vouchers, following all procedures.

Picture#1. Launching event in Malanje In the other 4 provinces, the field teams organized symbolic events, with the participation of provincial malaria partners, DPS and other local authorities. 6. Distribution of ITNs By June 10th and 19th the campaign activities were officially closed in the provinces of Cuanza Norte and Cuanza Sul respectively. Malanje, Uige and Zaire continued to actively distribute the nets, with completion scheduled for July 15th, 2017. For the municipalities where the campaign activities were completed - in consultation with the DPS and RMS - 4-5 bales (about 200-500 mosquito nets) were left to reach people who were unable to be present at the period of distribution. Following all the procedures, ITNs vouchers and registration sheets were also left to be filled out and forwarded to PSI by the end of July. 7. Participation in the MOP From May 29th to June 2nd, PSI team participated in MOP activities led by NMCP and USAID in partnership with World Learning, VectorWorks, The Global Fund and World Vision. It was an opportunity for PSI to present the first results and share some lesson learners from the early stage of the campaign. It was also important to learn from other partners with experience in ITN distribution such as WL. From June 1st-2nd, PSI organized a site visit to Malanje where the MOP team had the opportunity to accompany field activities in the commune of Lombe, in Cacuso municipality. PHASE 1 CAMPAIGN EVALUATION BY VECTORWORKS (preliminary findings) USAID/PMI used the VectorWorks mechanism to mobilize technical support for the national campaign preparation in 2016-2017. VectorWorks provided technical assistance to NMCP to develop a national distribution strategy with quantification of nets and during this quarter conducted process evaluation of the campaign. Draft report was provided that included the following findings: 1. Registration of Households • the general feedback from provincial and municipal interviews was that registration went well, with sufficient numbers of volunteers and supervisors. Some challenges experienced caused delays to registration and some households were missed, however these were responded to and registration took place within the allocated timeframe. • Preliminary findings from household surveys suggest that registration levels were good with all four sampled villages showing strong evidence that registration rates were >75% and 3/4 at least 85%.

2. Distribution process • the distributions observed were well organized with efficient processes though some experienced some issues related to unshaded waiting areas (rural distribution points (DPs), some waste management issues (rural), and demonstration nets not consistently in place. • Preliminary findings from the household surveys suggest that there was a problem with large households not receiving enough nets with none of the four villages passing the threshold of “at least 75% of households received sufficient ITN for all members” and only 3/4 passing the 60% threshold. 3. Logistics of nets • There was sufficient warehousing and security, although some access issues caused delays with getting nets to DPs in Malanje. Nets were at municipal warehouses within sufficient time prior to distribution – no stock out problems were reported, with daily deliveries to DPs and daily warehouse records kept. • The main challenge was transport – type and quantity (additional vehicles required and motorbikes for areas with poor road access). 4. Mobilization and behavior change communication • There is an opportunity to revisit this area in terms of formalizing the communications plan, schedule and budget aligned with the agreed strategy – this area was significantly impacted by insufficient time to plan. • It is reported stronger messages are required in terms of use of nets (what for, how to use, what not to use for, etc.). • Job aides for communications activists and specific communications activities targeting sobas could improve community receptivity of campaign activists and post-distribution SBCC. Post-campaign follow-up should be included. 5. Coordination, planning, training, supervision and reporting • While there was a guiding schedule in place, an implementation plan with schedule of activities at provincial and municipal level would aid coordination. • Minimal planning and coordination tools were used to aid management of the campaign, including regular undocumented meetings – this constrained coordination, communication and clarity for all involved on what was happening and when. • Coordination and communication activities through macro/micro-planning with the province provides an opportunity to improve engagement and embed key messages to increase the effectiveness and efficiency of the campaign. • Fully functioning, agile national, provincial and municipal level committees would aid coordination, improve sharing of information and support issue resolution. • While the NMCP has reportedly been more involved in this campaign than previously, there remains a significant opportunity for more engagement and involvement. • Activists and supervisors had daily briefings during registration and distribution which aided issue resolution throughout the process. • Clear contingency plans are needed for households that are missed, including a process for later distribution. A strategy for surplus nets is also required. • Clarity around the role and engagement of the provincial malaria partners forum is required (where it exists) – this could have been an important support structure during the process, especially in Zaire (where police reportedly refused to support with crowd control problems). • Consideration and clarity around who is involved in supervision is required. The DPS in Malanje would potentially be more engaged / involved through supervision, however no per diems are provided through the campaign and there are no resources within DPS to support supervision activities.

To better respond to the challenges, and prepare for phase 2 of the Distribution campaign, PSI implemented a reflection workshop, described below. Workshop for reflection on results achieved and lessons learned during phase 1:

In the week of June 13th-16th, PSI conveyed a workshop in Luanda with the LLIN team (management and implementation staff) for reflection and evaluation of results and sharing of experiences/lessons learned during phase 1 of the distribution campaign in the 5 provinces. On June 16th, the workshop was also attended by members from NMCP and USAID/PMI, when a summary of results and lesson learned was presented for discussion.

Picture#2. Staff reflection workshop Key lesson learned/recommendations: • Although challenging, the flow of activities proved that the simultaneous distribution strategy is sustainable. Realization of the campaign in 3 months is also feasible. • The information gathered in macro and microplanning is redundant. They can be combined in a single planning exercise. This will free up more time for planning and aligning of the responsibilities of partners at provincial and municipal levels. • Training plans should be reviewed to include a practical session in the community to enable trainers and activists to have direct contact with the reality of their work. • Activists should have a job aid to guide their activities when they are in the field. • In areas of difficult access, registration and distribution activities should be combined to facilitate logistical operations and optimization of time. • Transport should be rented directly in the municipalities where they will work to reduce the number of dropouts and reduce consequent costs. • PSI should work with NMCP to define a clear Communication Strategy for the distribution campaign. The strategy must be shared in advance to ensure consistency of information and implementation of different communication dynamics for better engagement. • Distribution materials should be pre-positioned at least a week before distribution starts. • PSI should work with NMCP officials to develop a monitoring and evaluation plan with clear objectives for supervision visits to avoid overloading of activities in the field. • After the supervision visits, feedback with recommendations should be given to the field team.

Picture#3: transportation of ITNs to a distribution point PLANNING FOR THE NEXT QUARTER: • Completion of distribution activities in the provinces of Uige, Malanje and Zaire; • Validation of final distribution data, including treatment of remaining mosquito nets in each province; • Confirmation of the provinces for phase 2 of the distribution campaign; • Participation of PSI, NMCP and UNITEL in the 4th Meeting of the Communication Working Group organized by Roll Back Malaria in Tanzania; • Development of the workplan for phase 2 of the distribution campaign; • Support the NMCP Communication Committee to finalize the Communication Strategy, including the review of messages and communication materials; • Start micro-planning activities in the provinces to be covered by phase 2.

Result 2: Malaria Services throughout Targeted Municipalities Improved In partnership with the National Malaria Control Program (NMCP), PSI/A carried out 4 consecutive training of trainers (ToT) in Luanda (Hotel Rosa Valls), aiming at developing a cadre of specialized health professionals able to replicate trainings at provincial level on Malaria Case Management, including malaria in pregnancy (MiP/IPTp), use of rapid diagnostic testing (RDT) and microscopy. Health professionals were selected by the NMCP and the Provincial Health Directors (DPS), coming from the following provinces: central level (Luanda), Malanje, Uige, Zaire, Cuanza Norte, Lunda Norte and Lunda Sul. Objectives of the ToT 1. Update health professionals with new Malaria Treatment Protocols with ACT (Artemether + Lumefantrine, Artesunate + Amodiaquine, Dihydroartemisinine + Piperaquine). 2. Train ToT on using Rapid Diagnostic Test (RDT) kits; 3. Standardize knowledge of Intermittent Preventive Treatment in Pregnancy (IPTp) methodology for use in ante-natal clinics (ANC) with Sulfamedoxine + Pirimetamine. Participants Physicians, licensed nurses, nurse technicians working in ANCs. Two participants were invited from each province and 6 from Luanda (from main public hospitals and health clinics). The opening sessions were presided over by a representative of the NMCP and PSI/A, with the participation of certified national malaria facilitators.

The following trainings were carried out: First Training Date: 22 to 27 May 2017 This first ToT had the participation of 18 physicians (6 women), 6 from the central level (Luanda), and 2 from each of the target provinces of Malanje, Uige, Zaire, Cuanza Norte, Lunda Norte and Lunda Sul. Methodology • PPT presentations in plenary • Groups of work • RDT practice Facilitators ➢ Dr. Filomeno Fortes: Certified Trainer by NMCP ➢ Dra Marilia Afonso: Certified Trainer by NMCP ➢ Dra Florinda Victor: Certified Trainer by NMCP ➢ Dr. João Bernardo: Certified Trainer by NMCP ➢ Dr. Elisa Miguel: Certified Trainer by NMCP ➢ Dr. Francisco Telles: Certified Trainer by NMCP – PSI/A Content of Training ➢ Epidemiology of malaria, biological cycle of the parasite, pathogenesis, physiology and laboratory diagnosis (rapid diagnostic test). ➢ General and specific aspects of a) mild malaria, b) severe malaria, c) malaria in children (below 5 years of age), d) malaria in pregnancy, and e) differential diagnose. ➢ What qualifies a good trainer of trainers. Results Out of the 18 participating physicians, 11 (9 men and 2 women) reached 70% and over in the pre and post-tests, having been certified as ToT. Second Training Date: 29 May to 03 June 2017 This second ToT had the participation of 19 licensed nurses (9 women), 7 from the central level (Luanda), and 2 from each of the target provinces of Malanje, Uige, Zaire, Cuanza Norte, Lunda Norte and Lunda Sul. Methodology • PPT presentations in plenary • Groups of work • RDT practice Facilitators ➢ Dra Marilia Afonso: Certified Trainer by NMCP ➢ Dra Elisa Miguel: Certified Trainer by NMCP ➢ Dra Delfina Tinta: Certified Trainer by NMCP ➢ Dr. João Bernardo: Certified Trainer by NMCP ➢ Dra Florinda Victor: Certified Trainer by NMCP ➢ Dr. Francisco Telles: Certified Trainer by NMCP - PSI/A

Content of Training ➢ Epidemiology of malaria, biological cycle of the parasite, pathogenesis, physiology and laboratory diagnosis (rapid diagnostic test).

➢ General and specific aspects of a) mild malaria, b) severe malaria, c) malaria in children (below 5 years of age), d) malaria in pregnancy, and e) differential diagnose. ➢ What qualifies a good trainer of trainers. Results Out of the 19 participating nurses, 10 (6 men and 4 women) reached 70% and over in the pre and post-tests, having been certified as ToT. Third Training Date: 05 to 16 June 2017 This third ToT focused on malaria in pregnancy (MiP) and was given in 2 weeks because additional subjects were included in the training, such as Sexual Health and Adult Training Pedagogy. It had the participation of 19 nurse technicians (all women) that work in Health Units that provide ante-natal assistance (ANC), 7 of which came from the central level (Luanda), and 2 from each of the target provinces of Malanje, Uige, Zaire, Cuanza Norte, Lunda Norte and Lunda Sul. One nurse technician presently working with PSI/A was also trained. Methodology • PPT presentations in plenary • Groups of work • RDT practice • Presentation of individual work (prepared during group work) Facilitators ➢ Head Nurse Filomena Costa: Certified Trainer by NMCP ➢ Dra. Marilia Afonso: Certified Trainer by NMCP ➢ Dra. Elisa Miguel: Certified Trainer by NMCP ➢ Dra. Florinda Victor: Certified Trainer by NMCP ➢ Dr. Cardoso Antonio: Certified Trainer by NMCP ➢ Dr. João Bernardo: Certified Trainer by NMCP ➢ Dr. Francisco Telles: Certified Trainer by NMCP - PSI/A Content of Training ➢ Sexual and Reproductive Health ➢ Humanization of health assistance for pregnant women ➢ Biosafety measures ➢ How to calculate length of pregnancy ➢ Epidemiology of malaria, biological cycle of the parasite, pathogenesis, physiology and laboratory diagnosis (rapid diagnostic test). ➢ General and specific aspects of a) mild malaria, b) severe malaria, c) malaria in children (below 5 years of age), d) malaria in pregnancy, and e) differential diagnose. ➢ Prevention of malaria in pregnancy: IEC/BCC, use of ITNs, IPTp ➢ What qualifies a good trainer of trainers. Results Out of the 20 participating nurses, 16 reached 70% and over in the pre and post-tests, having been certified as ToT. Fourth Training Date: 19 to 23 June 2017 This fourth ToT focused on refreshing knowledge of previously trained 18 ToTs, all physicians coming mostly from Luanda, and a few from the target provinces.

Methodology • PPT presentations in plenary • Groups of work • RDT practice • Presentation of individual work (prepared during group work) Facilitators ➢ Dr. Filomeno Fortes: Certified Trainer by NMCP ➢ Dra. Fernanda Dias: Certified Trainer by NMCP ➢ Dra. Marilia Afonso: Certified Trainer by NMCP ➢ Dr. Rafael Ndimbu: Certified Trainer by NMCP ➢ Dr. Maurício Caetano: Certified Trainer by NMCP ➢ Dra. Elisa Miguel: Certified Trainer by NMCP ➢ Dr. Francisco Telles: Certified Trainer by NMCP - PSI/A Content of Training ➢ Epidemiology of malaria, biological cycle of the parasite, pathogenesis, physiology and laboratory diagnosis (rapid diagnostic test). ➢ General and specific aspects of a) mild malaria, b) severe malaria, c) malaria in children (below 5 years of age), d) malaria in pregnancy, and e) differential diagnose. ➢ What qualifies a good trainer of trainers. Results Out of the 18 participating physicians, only 9 (8 men and 1 woman) reached 70% and over in the pre and post-tests, having their previous certification been confirmed as ToT. Final Recommendations after the 4 Training of Trainers (ToT: ➢ With the newly certified cadre of trainers of trainers (ToT), we can immediately start replicating the trainings at provincial level for local prescribers and other health assistants (e.g. ANC). ➢ Immediately after trainings take place in the provinces and municipalities, start providing monitoring and supervision to trained staff, to guarantee quality of services. ➢ Reinforce social mobilization activities at community level, so as to increase motivation and promote active participation of target populations (especially young women) in malaria prevention and appropriate treatment. Result 3: Sustainable model for providing high-quality HIV/AIDS services established. This component is under the responsibility of MSH, a partner of the HFA Consortium and holder of a Subagreement with PSI. Testing Improvement at the Health Facilities and COC In April, HFA began to provide technical assistance to having rapid testing kits availability and information on a weekly basis from the entire project’s testing points. • HFA continued to ensure the implementation of HIV testing activities inside the designated nine PEPFAR facilities in Luanda and linking HIV positive individuals with appropriate care and the initial consult. • HFA, in April, began to provide technical assistance to ensure the availability of rapid testing kits and of information on a weekly basis from all 47 project testing points. HFA maximized coordination between the different stakeholders within the Health Units and personnel through our Case Managers Staff.

MONITORING & EVALUATION The following Graphics show the entire PEPFAR Targets Results from the Q3 April 1st to June 30th 2017 found in the PEPFAR selected Health Units in Luanda.

The yellow column shows the Target and the green the patients tested during Q3 of FY1.

Index case testing (contact tracing) In June HFA reinitiate the Index Case Testing & Tracing (ICTT) Strategy. This is an important strategy (WHO 2015) to achieving USAID Angola’s targets that must be continuously implemented and scaled-up moving forward. HFA started the ICTT in 3 Health Units: Viana Health Center, Divina Providencia Hospital and Rangel Health Center. In addition to the standard HIV Testing Services (HTS), HFA implemented this strategy as a new approach to improve the coverage of tracing, identification, and testing of partners and children. Testing the partners, children, relatives, and persons in close contact with the Index Case aims to increase the early identification of undiagnosed HIV infections and, if appropriate, refer newly diagnosed PLHIV for HIV care and treatment services. Key to the success of this strategy is that the counselor/health care provider presents to the client the advantages of revealing his or her serologic status to the partner and supports his or her decision making. HFA hired 10 Community Counselors (CCs) with substantial experience in ICTT and has conducted intensive training in the three Health Units mentioned. These CCs coordinate all the activities with the Health Unit through the PAFs and Case Managers to ensure continued counseling and access to Care Services. We divided the CCs into three groups, one per each Health Unit. Each CC group received 60 Index Cases from each Health Unit. They are now working in the different communities to find their partners, children, and relatives for counseling, testing, and linkages to care services. Supervision HFA through our Senior HIV Advisor, the Surveillance Officer and the Responsible of the ICTT are conducting permanent supervision of the seven HFs. They are also holding weekly meetings with Case Managers, monthly meetings with the PAFs and weekly CCs supervisions through direct observation in each Health Unit of their activities. The goal of the supervision is mainly to evaluate activities, coordination amongst them and results achieved. Assessments HFA staff has been involved in 3 operational assessments: 1) Quality Evaluation in Testing Points: The objective of the assessment was to evaluate the quality of the 47 Testing Points distributed in the 9 Health Units in the different Health Services of them. The assessment was done in collaboration among AFENET (African Field Epidemiology Network) and HFA, to evaluate the Lab and Clinical Medical areas through 2 mixed teams (From AFENET and HFA) following the Questionnaire Guidelines of Verification of PMG-TR (Quality Improvement Process Guidelines of Rapid Test) provided by AFENET. The areas evaluated were: • Staff Training and Certification. • Physical Facilities • Security • Pre-Testing Phase • Testing Phase • Post-Testing, Documentation and Register • External Audit

Quality Results of Testing Points in the 9 HFs

60 % (level 1) of the Testing Points need to improve in specific areas; 34 % (level 2) are partially eligible for national certificate. Fortunately, with the exception of 6% (level 0), the rest could improve and cover the needs. Quality Results of Testing Points by Health Unit and with levels

2) Origin of clients who requested testing in the Lab and Health Testing Services (HTS): HFA has done this assessment to know the origin of the clients who requested Testing in the Lab and HTS because we normally collect that information in the other Testing Points (Emergency, Pediatric, Vaccine program, etc.). The Case Managers have done this assessment through observation and requesting directly to the clients in these two testing services (Lab and HTS) with an established questionnaire over the course of two weeks. • 44% come on their own initiative (external) • 40% come from internal health services in the same Health Unit • 16% come from external units (another Health Services outside the Health Unit)

3) Human Resources working in HIV/AIDS Services of the Health Units: HFA has done this assessment with the objective of knowing the quantity and quality of human resources working fulltime in the HIV/AIDS health services.

With the information provided by the three assessments, in the next quarter (Q4) HFA will visit the 9 Health Units to present and discuss the results with responsible staff of the HIV/AIDS services in order to improve the quality of the HTS in each Health Unit, according to their weaknesses. This is the main objective of the assessments performed. PEPFAR Angola-Revised COP16 Implementation Guidance to implementing Partners- Division of responsibilities between CDC/ICAP and USAID/HFA To accelerate the COP17 approved strategy (beginning October 1st, 2017), PEPFAR Angola has decided to expedite an immediate change from the current COP16 site support strategy. Going forward, ICAP (Columbia University), which currently provides technical assistance (TA) on Care & Treatment to all nine PEPFAR-supported sites, and HFA, which currently provides TA on Testing and Linkage to Care and Treatment to all nine PEPFAR-supported sites, will transition the COP17 approved strategy. PEPFAR Angola will guide both Implementing Partners (IPs) to the early adoption of the COP 17 approved strategy. This transition process will begin in June 2017. Specifically during this transition process, provision of comprehensive HIV Testing, Care, and Treatment services in the nine PEPFAR-supported sites in Luanda will be split (2:7) between both IPs as follows: • ICAP will support two PEPFAR sites - Cajueiros and Sanatório with the entire CoC. • HFA will support seven PEPFAR sites - Esperança, Dispensário, Divina Providência, Kilamba-Kiaxi, Pediátrico, Rangel, and Viana with the entire Coc. • In addition, during the transition process ICAP will be responsible for provision of above-site national TA to the Angolan National AIDS Institute (INLS). • ICAP will continue until September with TB/HIV Co-infection activities in all 9 HFs. • ICAP will continue with the Viral Load Pilot until September in 4 HFs (Sanatorio, Esperanza, Divina Providencia and Pediatrico). • HFA will provide Index Case Testing and Tracing in 3 HFs (Rangel, Viana and D. Providencia).

• COP16/FY17 targets will remain unchanged and must be reported on by both partners in DATIM. • ICAP/CDC and PSI-MSH/USAID received the official approved split notification from PEPFAR on June 4th.2017. Stakeholder Participation and Involvement • Established permanent coordination with the Procurement and Supply Management Project (PSM) staff to tracking the availability of HIV test and ARV at health center level. • Participated in technical analysis and discussions to reach consensus with CDC-ICAP on the key issues to inform PEPFAR on proposal for the division of responsibilities within the Health Units. After the split (June 5th), together with ICAP, MSH/HFA started a transition period until September 30th working at the shadow of the other to learn about the different activities. • Provided technical assistance in the AFENET quality of testing assessment: analysis of the information collecting tool, collection of information, data processing, discussion and analysis of the information, and provision of inputs for the final report of the assessment performed. • Established a collaborative and proper communication with the INLS (National Institute of Fight against HIV/AIDS) to understand its priorities and create a participative framework to build a sustainable and scalable Continuum of Care (COC) model for HIV/AIDS services. • Established a collaborative relationship with the Provincial Health Cabinet of Luanda (GPSL), the highest authority of the Health Services in Luanda Province. Lessons Learned Adhesion and Retention (COC): the experience of the Counseling Package provided by the PAFs in Counseling and Testing will be relevant for patient retention. After the split, MSH/HFA is responsible for the entire COC in the 7 HFs assigned and the PAFs are playing a very important role in the follow-up of the HIV+ patients by telephone and rescheduling missed appointments when they start to miss consultations or when they abandon TARV, by doing active search of such patients in coordination with PAFs from other Health Units. Relevant role of the Community Counselors (CCs): The CCs are essential for Index Case Testing and Tracing (ICTT) strategy. The lessons learned during the past experience with Jhpiego were positive and built a very important experience in all the CCs working at present with HFA. Challenges • Maintaining coordination, collaboration and strong relationship with all USAID partners (CDC, AFENET, PSM), our Prime (PSI), INLS, GPSL, and the Ministry of Health. • Guaranteeing quality of data collection from the HFs. • Frequently facing shortages in HIV tests. For instance, national stocks will expire in July and UNIGOLD has experienced stock-outs in recent weeks. • Frequent lack of health service forms, such as prescription pads and test-results forms. • Frequent lack of periodic replacement materials, including gloves, cotton, alcohol, and masks. • Frequent lack of key testing materials and reagents. Next Quarter Main Planned Activities Implementation of the entire Cascade of Care in 7 Facilities After receiving formal notification from PEPFAR, MSH/HFA is providing support to 7 of the PEPFAR health facilities for the implementation of the entire cascade of continuum of HIV care, from testing to ART retention and adherence. This includes screening and testing HIV+ patients for TB, as well as linking them to care, as TB is the leading cause of death among PLHIV.

Continuous Monitoring of the Implementation and Data Collection Plan To ensure that FY1 Q2/Q3 data is collected and reported in a timely and accurate manner, MSH recruited a Surveillance Officer and is currently facilitating the coordination with ICAP on the data collection process supporting the M&E team from PSI. MSH/HFA team will give technical advice on data collection, revision and analysis in the 7 assigned Health Units. Continuous Improvement of the Index Case Testing and Tracing To improve the Index Case in three HFs (Viana HC, Rangel HC and Divina Providência Hospital) by ensuring permanent monitoring and evaluation of activities and results, training on technical issues of Testing, linking to Care Treatment and maintaining permanent coordination with the PAFs and Case Managers in the HFs. Continuous proper supervision Develop Guidelines for proper supervision and registration of evolution of results achieved within the 7 HFs on the activities of CMs, PAFs and CC. Result 4: Strengthened, expanded and integrated FP/RH services at provincial, municipal levels. Main Activities during Q3: HFA held several meetings with RMA to better understand their capacity and needs to manage implementation of activities related to community interventions in Luanda and two other provinces. Two visits to Huambo province took place in April and June. The first visit in April was done by representatives from HFA and USAID with the objective of better understanding the situation of the public health units that had been trained by the previous SASH program. A total of 8 health units from 8 different municipalities were supervised in both visits. These visits helped the team understand the overall picture of health units, which is summarized below: ➢ Constant stock out of family planning methods at provincial level; ➢ Insufficient number of methods distributed in the province, which conditions the delivery of methods to users; ➢ Lack of data collection material (book of record, user registration forms, registration cards, lack of daily and monthly reporting model). A full-time quality assurance officer was hired to supervise the public health units that offer family planning services and identify their needs in terms of family planning provisions. This quality assurance coordinator has a high experience from the previous program SASH (Força Saúde). A new Family Planning Specialist manager was also recruited as a full-time employee to oversee family planning activities in Luanda and Huambo. HFA also made supervision visits to Luanda province, covering 14 public health units in 4 municipalities. The main problems identified were: ➢ Lack of training on Sayana Press, and ➢ stock out of some methods (e.g. Depo-provera). In Huambo, the problem was more severe since the stock out of contraceptive methods is much more frequent than in Luanda. Huambo urgently needs a refresher training on FP methods including insertion and removal of IUDs and Implants. Co-diagnosis The mapping process of public health families in Huambo and Luanda is in progress. List of the public health units of these provinces were acquired from the Provincial department.

A second and more complete list of health units from GEPE was also acquired. This list has GPS coordination which will help the mapping process and facilitate a better supervision of the health Units. Contraceptive Security Plan HFA is participating in a monthly contraceptive security meeting with partners. These meetings unite partners that work on sexual and reproductive health (SRH) and partners that supply contraceptives and other SRH related medicines to the MoH. In total, 4 contraceptive security meetings were attended. During these meetings partners discuss issues around family planning such as: (1) the Inclusion of the Family Planning in the curriculum of nursing and medicine school; (2) development of a national Strategic Plan for Reproductive Health products; (3) review of the annual contraceptive forecast tool. Private Sector Engagement In order to engage pharmacists to offer new contraceptives to their clients, 4 training sessions were conducted at wholesalers for a group of private pharmacists. Sessions included information on dosage, ways of administration, side effects and contraindication and other relevant information on 3rd generation OC pills. Besides, these sessions also served to clarify doubts and demystify the use of contraceptives in general. Result 5: Capacity of Municipal and Provincial Governments to Plan, Fund, Monitor, and Supervise Health Programs Improved DHIS-2 (PSI/A) Staffing During Q3, HFA invested in recruiting key personnel such as: ➢ Dr. Yava Ricardo, as M&E Advisor in Malaria, who worked before at Global Fund. In this position, Ricardo is being seconded to the NMCP, where he has been providing support in the development of the new National Malaria Strategic Plan (PENM) and in a Concept Note for the Global Fund. He attended several national and international meetings in support of the NMCP; ➢ Nilton Sebastiao, as HMIS Specialist. Nilton worked before at Forca Saude helping in the development of DHIS2 as a pilot project in Huambo. Under HFA, Nilton will continue supporting the implementation/extension of DHIS2 as part of the program health management information system. During Q3, Nilton concentrated his efforts in collecting PEPFAR indicators in 9 HIV Clinics in Luanda to report into DATIM (USAID reporting system). Strategic Meetings During Q3, HFA jointed the regular meetings of the national DHIS2 Technical Working group. The meetings are held by GEPE- GTI with other partners to develop the national roadmap for DHIS2, which will facilitate the full implementation of DHIS2 as a national HMIS. During those meetings, the Terms of Reference for the Technical Working Group were defined by all partners. Additionally, HFA submitted an itemized budget and chronogram to GEPE-GTI for the development of DHIS2, hoping that other partners do the same and speed up the finalization of the DHIS2 roadmap. Under advice from USAID, PSI also discussed with ICAP their own plans to develop DHIS2 to avoid overlapping of activities and to plan for complementarity.

Therapeutic Efficacy Study (TES Study) During Q3, HFA (PSI and MENTOR) provided logistic support to the TES study in the provinces of Benguela, Lunda Sul and Zaire. The study was designed by CDC/NMCP/PMI and aimed at monitoring the efficacy of 3 antimalarials. Overall, the training and start dates for the fieldwork followed the planned chronogram. Time extension for the finalization of the study has been granted due to difficulties in finding participants that meet the inclusion criteria. Nevertheless, the study is expected to be finalized by the beginning of August. The initial estimated budget increased from 300,000 USD to over 350,000 USD, given the need to buy materials not originally planned (e.g. generators for some venue sites or additional laboratory materials to smooth the study development). Per request of CDC, HFA also provided financial support to 3 medical students traveling to these provinces to supervise laboratory fieldwork, while their respective funding arrived to their school own from AFENET (African Field Epidemiology Network), the funding source. By the end of Q3, a total of 593 children under 5 years had been enrolled into the study in all three provinces (out of 600 needed), of which 389 had finished the study. See table below. Zaire blood samples for the lumefantrine component of the study were sent to the University of Cape Town for bioanalysis. Results will be ready from the UCT in Q4. During the months of July and first week of August, the fieldwork will continue to allow the last enrolled participants to finalize the study. Afterwards, there will be a closing out event in each of the three provinces, where CDC will present preliminary results. Table: Fieldwork Progress for the TES Study (End of June 2017) Province Antimalarial # CU5 checked # CU5 # CU5 Tested for inclusion enrolled finalized the criteria study

Benguela DP 489 100 88 ASAQ 414 105 53 Zaire AL 326 100 90 ASAQ 278 83 33 Lunda Sul AL 676 105 84 DP 348 100 41 All Total 2531 593 389

LLIN Distribution (Monitoring Component) To strengthen the monitoring component of the first phase of LLIN Distribution Campaign in 6 provinces, HFA developed databases for data collection of key programmatic indicators. Between 2 to 3 persons were trained per province to verify and register data coming from the field (comunas, municipalities) into the municipal sede of each province. By installing the databases in Google Drive, HFA was able to monitor the daily progress of database entry in each province, despite some internet connection problems. Additionally, fieldwork trips were conducted by members of the NMCP and HFA to observe the registration phase and the distribution phase of the campaign. Each province was visited by a team of 2 members at least twice and reports were shared with the program in each province and in Luanda, to correct problems. Reports from the monitoring trips were also shared with external evaluators (VectorWorks) through Google Drive to use as inputs in their work. Databases have also been share with the monitoring subcommittee of the NMCP and with external evaluator.

HIV (Monitoring Component) During April, May and the first 3 weeks of June, HFA continued data collection on HIV testing and linkage to care in 9 facilities in Luanda. After the new division of work between PSI/MSH and ICAP (working the full HIV cascade in 7 versus 2 clinics, respectively), PSI/MSH and ICAP worked collaboratively to collect the remaining information for PEPFAR indicators: TX_NEW and TX_CURR for the entire trimester, and the HCT_TST for the last week of June. In that period, ICAP and PSI/MSH shared methodologies and learned from each other their own experiences in data collection. Analytic results will be ready the last week of July and inserted into DATIM. Costing Plans (MSH) PSI/MSH will carry out costing plans in 24 selected municipalities in coordination with the implementation of the HMIS for data integration into the M&E and surveillance system of the National Malaria Control Program (NCMP). In addition to municipal interventions, HFA is expected to implement interventions that strengthen capacities of the NMCP for national coordination and use of data for decision-making. Main Activities A key step during this Q3 was the fact that USAID identified an Activity Manager for IR5, Lungi Okoko, who is also Malaria Officer. As a result, it was possible for HFA to start the negotiation of USAID expectations on MSH’s interventions under IR5. After extensive discussions, it was clarified that USAID expectations are mainly related on topics to be prioritized and on geographical areas of interest. In regard to the topics to be prioritized, the following were defined as areas of interest to be supported by MSH: ➢ Strengthen municipal capacities in annual planning and budgeting. ➢ Strengthen capacities of the NMCP in annual planning, budgeting, creating job descriptions, financing management, assessment/diagnosis of NMCP interventions, institutional NMCP assessment (using MOST). ➢ Strengthen capacities for costing iCCM (Integrated Community Case Management) interventions (initially malaria, followed by diarrhea and at a later stage pneumonia). The provinces selected to be supported by HFA IR5 are: Zaire, Uíge, Malanje, Lunda Norte, Lunda Sul and Cuanza Norte. During the past quarter, USAID had selected 24 municipalities as targets, but the implementation of activities was delayed due to some pending issues that need clarification with the MoH. One identified constraint was that the MOH demands implementation in all municipalities of a target province, and not just doing partial strengthening of some areas in each priority municipality. MoH is trying to guarantee integral interventions and institutional solutions and not just pilot interventions. One initial agreement with USAID was to start interventions in 2 provinces (Zaire and Lunda Sul) in planning, budgeting and M&E, covering 10 municipalities. Finally, with all the new inputs shared with USAID and PSI, it was possible to carry out a HFA-IR5 work plan for PY2. Implementation Challenges The main challenges to be faced in next quarter are: a) the still pending negotiations between the NMCP and USAID to start the implementation in Zaire and Lunda Sul; b) the sufficient amount of resources needed to mobilize technical teams to Zaire and Lunda Sul Provinces; and c) the possibility of hiring two national junior staff to provide technical assistance in those two provinces.

Consultative Meetings and Workshops ➢ Participation in the Workshop: Revision of the V National Strategic Plan (PEN 2015/18) implemented by INLS, ONUSIDA and the MoH during June 14th and 15th, 2017. ➢ Participation in the First Meeting of the ONGs National and International in the Province of Luanda, implemented by the Provincial Health Cabinet of Luanda (GPSL) June 20th.2017. ➢ Participation in the Workshop: Sub Recipient Management Training, implemented by PSI with the participation of Mentor Initiative, Angola Women Net (RMA) and MSH Angola, during June 29th and 30th 2017. ➢ Participation in the Workshop: IIMS (Assessment of Multiplies Indicators of Health) 2015/2016 Presentation, implemented by National Institute of Statistic (INE), MoH and the Ministry of Planning and Territorial Developing (MPDT) with the technical assistance and collaboration of UNICEF, WHO, World Bank, PEPFAR, USAID, CDC and the GoA. Next Quarter Main Planned Activities For the next quarter (Q4), HFA-R5 staff will start the process of landscaping for planning, budgeting and monitoring interventions with Lunda Sul and Zaire’s provincial and municipal health authorities. In addition, MSH will start conversations with NMCP authorities through leadership of USAID/PSI to make a quick assessment of feasible interventions for next PY2.

MANAGEMENT PLAN Meetings of the HFA Management Committee The first meeting of the HFA Management Committee took place on June 20th, with the participation of all 5 component coordinators, the Director of Finance Department, and members of HFA partners: MSH, MENTOR and RMA. This first meeting was for a formal presentation of each HFA component and of HFA partners, followed by some admin and finance information especially for external HFA partners. The AOR and PMI officials also took part in this first meeting. Sub-Award Management During Q3, and based on HFA priorities, PSI Global completed the sub award agreement with The MENTOR Initiative (MENTOR), and begun the process to formalize a local partnership with Rede Mulher Angola (RMA). Subagreement Management Workshop PSI Global organized and carried out a Subagreement Training Workshop for HFA staff in Luanda from June 26 to 28th and with participation of HFA partners (MENTOR, MSH and RMA) from 29th to 30th of June.

The facilitator was Karen Conley, Director of the Contracts and Grants Department – PSI/DC, with the following objectives: HFA staff (26-28th) • Review the Matrix and the Numerous Steps in the Lifecycle • Understand Where the 6 Required Tools come into the Process • Identify staff member who is responsible for each step in the subagreement management cycle • Identify staff who participates in completion of each step in the cycle • Understand the Phases of the Subagreement Lifecycle • Review of PSI’s Six Required Management Tools • Understand Updates in USG Uniform Guidance Related to SR Management HFA staff and partners (29-30th) • Understand the Phases of the Subagreement Lifecycle • Review of PSI’s Six Required Management Tools • Understand Updates in USG Uniform Guidance Related to SR Management • Understand Subagreement Terms and Conditions • Discussion/Guidance to Help Ensure Compliance Next Quarter Activities • Development and approval of FY2 workplan and budget • Completion of distribution of ITNs in Malanje and Zaire • Plan for phase 2 of ITN distribution in 6 provinces • Complete Subagreement with RMA

This is the Q3 Report. Luanda, 31 of July, 2017.

ATTACHMENTS

1. Performance Monitoring Plan 2. Environment Mitigation and Monitoring Plan

ENVIRONMENTAL MITIGATION & MONITORING PLAN This Environmental mitigation and monitoring plan (EMMP) addresses the activities to be implemented by the Health For All project. The table below summarizes the intervention categories and activities to be implemented in the y1 of the Health For All project. The activities in the table follow the order of the workplan.

Activity Adverse Mitigation Monitor Report Responsible Party Impact Measure Indicators Schedule / Criteria

Result 1 – LLIN access and use increase

Distribution of LLIN to achieve universal Positive Through interpersonal communication workers # of quarterly Municipal LLIN coverage determination (IPC) during and after LLIN distribution, PSI households coordinators, National LLIN instructs the end-users about the proper use of received Coordinator nets. PSI instructs not to use nets for fishing or LLIN use other purposes outside protection against messages mosquitoes. PSI currently does not have activities regarding the disposal or recycling of the used nets.

Development of LLIN related distribution Categorical N/A N/A N/A N/A and Social Behavior Change Exclusion Communication strategy

Training of community workers (activistas) Negative During the training of activists, the proper use of # of quarterly PSI trainers, PSI BCC on communication determination LLIN is addressed. It is emphasized that the nets activists manager should not be used for fishing or agricultural trained on purposes correct messages

Result 2: Malaria Services Through Targeted Municipalities Improved

Facility/laboratory assessment Negative Facility/laboratory assessment will include # of Annually Malaria manager MENTOR determination assessment on biosafety/waste management facilities in Initiative (Including handling, labeling, storage, disposal) compliance with waste Malaria Technical Director manageme PSI nt standards

TOT for national laboratory training Negative The training will include a section on lab waste # of ToTs Annually Malaria Technical Director determination management (Including handling, labeling, trained on PSI storage, disposal). For SOPs, the following lab waste guidelines will be consulted: USAID Sector manageme Environmental Guidance for Health care waste nt and WHO’s Safe Management for Wastes from Health Care Activities.

Dissemination of three training manuals for Categorical Training manuals were printed by another IP. N/A N/A N/A laboratories including the trainer’s manual, exclusion HFA will only disseminate it to the facilities quality service improvement, laboratory agreed with PMI and NMCP service provider training manual

Training and supervision plan development Categorical Training plan will be developed and shared with N/A N/A N/A for participating municipalities exclusion all stake holders as part of capacity building and information sharing

Training of health workers in malaria case Negative Training will include the appropriate information # of health quarterly Mentor Initiative Malaria management determination and MOH SOP on waste management of workers manager with condition biological and hazardous materials including trained in storage, labeling, treatment and disposal. For waste Malaria Technical Director SOPs, the following guidelines will be consulted: manageme PSI USAID Sector Environmental Guidance for

Health care waste and WHO’s Safe Management nt for Wastes from Health Care Activities.

Training and supervision of ADECOS to Negative Training will include the appropriate information # of quarterly IMCI supervisor PSI implement ICCM determination and MOH SOP on waste management of ADECOS with condition biological and hazardous materials including trained in Malaria Technical Director storage, labeling, treatment and disposal waste PSI specifically adapted for ADECOS. ADECOS will manageme be provided with mini bio waste boxes to nt dispose sharps and biowaste during community visits. ADECOS will be linked with the health facility for biowaste disposal. For SOPs, the following guidelines will be consulted: USAID Sector Environmental Guidance for Health care waste and WHO’s Safe Management for Wastes from Health Care Activities.

Technical working group on ICCM and Categorical N/A N/A N/A N/A Malaria Forum support exclusion

Capacity building and strengthening of Categorical N/A N/A N/A N/A NMCP and provincial personnel in exclusion improving Malaria in Pregnancy activities

Result 5. Capacity of Municipal and Provincial Governments to Plan, Fund, Monitor, and Supervise Health Programs Improved.

Capacity building of health officials in Categorical N/A N/A N/A N/A budgeting and budget monitoring exclusion (municipal costing plans) and using data for decision making

Supporting NMCP in the developing, Categorical N/A N/A N/A N/A managing and using data for the decision

3 making through DHIS-2 for HMIS exclusion

Providing logistical support to CDC Negative Study personnel (lab technicians, supervisors) # of TES daily Study supervisors (PSI, therapeutic efficacy study (TES) determination will use MOH SOPs in managing biological and personnel CDC, MOH) with hazardous waste at the provincial health using the conditions facilities where study activities will take place. procedures correctly

Result 3: Sustainable model for providing high-quality HIV/AIDS services established.

Supporting INLS in the policy revision and Categorical N/A N/A N/A N/A HMIS development exclusion

Improving standards of care for HIV care Negative For revised/newly developed SOPs WHO Number of quarterly HIV program manager MSH and treatment services in 9 PEPFAR determination standards will be used, which includes codes of SOPs facilities. This also includes SOPs in supply with condition practice, equipment, health surveillance, chain management at the facility level and training and waste management. For SOPs, the waste management following guidelines will be consulted: USAID Sector Environmental Guidance for Health care waste and WHO’s Safe Management for Wastes from Health Care Activities.

Clinical mentoring and supportive Negative MOH and WHO SOPs will be used and Number of quarterly Clinical Mentors MSH supervision of 9 targeted PEPFAR facilities determination reinforced in the clinics. Where needed, new facility in improving quality of services including with condition SOP will be developed which will follow WHO staffed HIV program manager MSH testing, linking to care. standards trained and M&E manger MSH and PSI supervises on the use of SOPs

Improved delivery of HIV testing and care Negative It is understood that HFA does not have a direct # of monthly Clinical Mentors MSH services in 9 PEPFAR supported facilities determination control of public facilities. However, PSI and services MSH will proactively address safety standards that meet HIV program manager MSH

with condition and SOPs in the supportive supervision and standards M&E manger MSH and PSI recommendations to the facilities of care requireme nts

Index testing (contact tracing) in the three Categorical No community testing will be conducted in Y1. N/A N/A N/A PEPFAR supported facilities exclusion The activity includes partner(s) notification and family testing (linking to testing at the facility)

Supporting INLS in improving data for Categorical N/A N/A N/A N/A decision making including DHIS-2 for HMIS exclusion

Public-Private Partnership with Unitel to Categorical N/A N/A N/A N/A provide free air time for health personnel exclusion

Result 4: Strengthened, expanded and integrated FP/RH services at provincial, municipal levels.

Supporting RH/SRH department of DNSP in Categorical N/A N/A N/A N/A the revision and dissemination of the exclusion policies

Communication campaign using mass and Categorical N/A N/A N/A N/A mid media to increase demand for family exclusion planning

Performance Monitoring Plan

USAID Health for All RFA-654-16-000004

Performance Monitoring Plan - Results 1

National level Indicator Reporting Performance Indicator Definition and Unit of Measure Disaggregation Source Level Frequency Baseline Values Y1 Value Y2 Value Y3 Value Y4 Value Y5 Value

Long-term Result 1: Malaria deaths and cases reduced As available Number of deaths caused by malaria per 100,000 DHS, MIS, MoH vital L1.1 Malaria mortality reduced through national 2014 101 2017 / 2018 / 2019 / 2020 / 2021 TBD Every 2 years persons per year statistics Number of children under 5 who tested positive for Assurveys available DHS, MIS, MoH vital L1.2 Malaria prevalence in children under five reduced malaria / Total number of children under 5 tested for through national 2015-2016 13.5% 2017 / 2018 / 2019 / 2020 / 2021 TBD Every 2 years statistics malaria per 100 surveys Objective 1: Access to and use of insecticide treated nets (ITNs) increased Number of HH with at least 1 ITN for every two As available Proportion of HH with at least 1 ITN for every two people DHS, MIS, MoH vital I1.1 people who slept at home the previous night / Total through national 2015-2016 11.0% 2017 / 2018 / 2019 80.0% 2020 / 2021 100.0% Every 2 years. (universal coverage) statistics Numbernumber ofof HHCU5 surveyed who slept under an ITN the previous Assurveys available Proportion of children under 5 years who slept under an ITN DHS, MIS, MoH vital I1.2 night/Total number of CU5 who slept in surveyed through national 2015-2016 21.7% 2017 / 2018 / 2019 55.0% 2020 / 2021 75.0% Every 2 years the previous night statistics NumberHHs the ofprevious pregnant night women who slept under an ITN Assurveys available Proportion of pregnant women who slept under an ITN the DHS, MIS, MoH vital I1.3 the previous night/Total number of pregnant women through national 2015-2016 23.0% 2017 / 2018 / 2019 55.0% 2020 / 2021 75.0% Every 2 years previus night statistics who slept in surveyed HHs the previous night surveys Activity Number of insecticide treated nets (ITNs) that were Number of ITNs distributed during the universal A1.1. By province 2015 1,739,431* 2017 2,900,000** 2018 1,500,000* 2019 TBD 2020 TBD 2021 TBD Routine data Quarterly distributed in this reported fiscal year coverage campaing in each reported fiscal year Number of community HWs trained in counseling on ITN Number of CHWs trained during the universal A1.2 By province 2015 399 2017 250 2018 TBD 2019 / 2020 / 2021 / Routine data Quarterly use coverage campaign for counseling on ITN Number of households that own at 1 ITN for every A1.3 Number of HHs with at least one ITN for every two people By province 2015-16 654,251 2017 1,837,850 2018 / 2019 2,599,700 2020 / 2021 4,137,032 DHS. MIS Every 2 years two people Number of CU5 years old who slept under an ITN the Number of children under 5 years old who slept A1.4 By province 2015-16 1,150,650 2017 2,293,877 2018 / 2019 3,186,823 2020 / 2021 4,610,319 DHS. MIS Every 2 years previous night under an ITN the previous night Number of pregnant women who slept under an ITN the Number of pregnant women who slept under an ITN A1.5 By province 2015-16 280,698 2017 527,956 2018 / 2019 733,475 2020 / 2021 1,061,105 DHS. MIS Every 2 years previous night the previous night * USAID data; ** Estimated based on the population size of the six provinces where distribution will take place in 2017; Performance Monitoring Plan - Results 2

National Indicator Performance Indicator Definition and Unit of Measure Disaggregation Source Reporting Frequency Level Baseline Value Y1 Value Y2 Value Y3 Value Y4 Value Y5 Value

Long-term Result 2: Maternal and Child Mortality Reduced As available Number of female deaths in a given year per 100,000 live WHO, DHS, MIS, L2.1 Maternal mortality reduced through national 2014 460 2017 / 2018 / 2019 / 2020 / 2021 TBD Baseline and Endline births MoH vital statistics Assurveys available Number of deaths of infants under one year old per 1,000 DHS, MIS, MoH vital L2.1 Infant mortality reduced through national 2015-16 44 2017 / 2018 / 2019 / 2020 / 2021 YBD Baseline and Endline live births statistics, WHO surveys Objective 2: Malaria services throughout targeted municipalities improved National Proportion of children under five years with fever in the last two weeks Number of children under five who had a fever in the two As available DHS, MIS, MoH vital I2.1 who received treatment with an ACTwithin 24 hours of onset of feveror weeks prior to a survey who received an antimalarial through national 2015-16 9.0% 2017 / 2018 / 2019 30.0% 2020 / 2021 70.0% Every 2 years statistics day after Numberaccording of to women national who policy received at the two time or of more survey doses for of Assurveys available Proportion of women who receive two or more doses of IPTp during DHS, MIS, MoH vital I2.2 IPTp during ANC visits during their last pregnancy in the through national 2015-16 36.8% 2017 / 2018 / 2019 45.0% 2020 / 2021 60.0% Every 2 years ANC visits in the last two years statistics last 2 years/Total number of women surveyed who surveys Activity Estimated Values in 24 Selected Municipalities in Lunda Sul, Lunda Norte, Malange, Kwanza Norte, Uige and Zaire Number of health workers trained in intermittent preventive treatment in By province and A2.1 Number of HWs trained in IPTp with USG funds / N/A 2017 300 2018 TBD 2019 TBD 2020 TBD 2021 TBD Routine data Quarterly pregnancy (IPTp) with USG Funds sex Number of of health workers trained in malaria diagnostics (rapid Number of HWs trained in RDT or microscopy test with By province and A2.2 / N/A 2017 350 2018 TBD 2019 TBD 2020 TBD 2021 TBD Routine data Quarterly diagnostic test (RDTs or microscopy) with USG funds in last year USG funds sex Number of health workers trained in case management with artemisinin- Number of HWs trained in malaria case management with By province and A2.3 / N/A 2017 1000 2018 TBD 2019 TBD 2020 TBD 2021 TBD Routine data Quarterly based combination therapy (ACTs) with USG funds ACTs supported by USG funds sex Number of health workers who received formative supervision on By province and A2.4 Number of HWs supervised on malaria diagnostic / N/A 2017 124 2018 TBD 2019 TBD 2020 TBD 2021 TBD Routine data Quarterly malaria diagnostic in last year sex Number of health workers who received formative supervision in ACT By province and A2.5 Number of HWs supervised on malaria treatment (ACTs) / N/A 2017 124 2018 TBD 2019 TBD 2020 TBD 2021 TBD Routine data Quarterly use sex Performance Monitoring Plan

USAID Health for All RFA-654-16-000004

Performance Monitoring Plan - Results 3 Indicator Luanda Level Performance Indicator Definition and Unit of Measure Disaggregation Source Reporting Frequency Baseline Values Y1 Value Y2 Value Y3 Value Y4 Value Y5 Value

Long-term Result 3: HIV/AIDS deaths and cases reduced Estimated number of persons newly infected with HIV As available DHS, MOH, National L3.1 HIV incidence during a specified time period by the number of persons through national 2014 0.28% 2017 / 2018 / 2019 / 2020 / 2021 TBD Baseline and Endline Surveys at risk for HIV infection Assurveys available DHS, MOH, National L3.2 HIV mortality (AIDS deaths) Number of AIDS per 100,000 people per year through national 2014 46 2017 / 2018 / 2019 / 2020 / 2021 TBD Baseline and Endline Surveys surveys Objective 3: Sustainable models for providing high-quality HIV/AIDS services, through the prevention and care & treatment continuum, demonstrated and institutionalized by the Government of the Republic of Angola (GRA) and civil society organizations Number of population getting tested for HIV and As available Proportion of population getting tested for HIV in the last 12 DHS, MOH, National I3.1 receiving their resulst in the last 12 months / total through national 2015-16 27.6% 2017 40.0% 2018 / 2019 50.0 2020 / 2021 60.0 Every 2 years months & received their results Surveys population size Assurveys available Proportion of HIV positive populations on Anti-Retroviral Number of people living with HIV/AIDS who is taking DHS, MOH, National I3.2 through national 2014 45.0% 2017 50.0% 2018 / 2019 60.0 2020 / 2021 70.0 Every 2 years Therapy (ART) ART over total number of people living with HIV/AIDS Surveys surveys Activity HTS_TST: The numerator captures the number of By province, Number of individuals who received HIV/AIDS Testing and 2016 Q1- A3.1 individuals who received HIV Testing Services (HTS) age, sex, service 43,539 2017 49,372 2018 50,606 2019 51,841 2020 53,075 2021 54,309 Routine data Quarterly Counseling services for HIV/AIDS and received their test results Q2 and received their test results At a minimum this means Bydelivery province, point Number of adults and children currently receiving antiretroviral TX_CURR: Number of adults and children currently 2016 Q1- A3.2 age, sex, key- 15,990 2017 25,417 2018 29,230 2019 33,614 2020 38,656 2021 44,454 Routine data Quarterly therapy (ART) receiving antiretroviral therapy (ART). Q2 Bypop province, TX_NEW: Number of adults and children newly enrolled 2016 Q1- A3.3 Number of adults and children newly enrolled on ART age, sex, 1,666 2017 5,818 2018 6,400 2019 7,040 2020 7,744 2021 8,518 Routine data Quarterly on antiretroviral therapy (ART). Q2 TX_RET: Number of adults and children who are still on Bypregnancy province, Percentage of adults and children known to be on treatment 12 A3.4 treatment at 12 months after initiating ART / Total age, sex, / N/A * 2017 80.0% 2018 TBD 2019 TBD 2020 TBD 2021 TBD Routine data Quarterly months after initiation of antiretroviral therapy (+) TX_PVLS:number of adultsNumber and of childrenadult and who pediatric initiated patients ART in on the pregnant at ART Percentage of ART patients with a viral load result documented ART with suppressed viral load results (<1,000 in the medical record and/or laboratory information system (LIS) A3.5 copies/ml) documented in the medical records and or By province / N/A * 2017 85.0% 2018 TBD 2019 TBD 2020 TBD 2021 TBD Routine data Yearly within the past 12 months with a suppressed firal load (<1000 supporting laboratory results within the past 12 months / copies/ml) (+) Number of adult and pediatric ART patients with a viral * Baseline figures to be established with USAID

^ Targets will be disaggregated by HEALTH UNIT where relevant; + absolute values for numerator and denominator will be provided Performance Monitoring Plan - Results 4

Huambo & Luanda Indicator Performance Indicator Definition and Unit of Measure Disaggregation Source Reporting Frequency Level Baseline Values Y1 Value Y2 Value Y3 Value Y4 Value Y5 Value

Long-term Result 4: to be agreed with USAID upon release of HSS M&E Guidance Manual

Objective 4: Strengthened, expanded and integrated FP/RH services at provincial and municipal levels Number of WRA married or in union Proportion of women in reproductive age (15-49) who use (or their sexual partner) a H:5.4% H:10.4% H:15.4% H:20.4% I4.1 who are using (or sexual partner is By province 2015-16 2017 2018 / 2019 2020 / 2021 DHS Every 2 years modern contraceptive method L:23.2% L:42.5% L:47.5% L:52.5% using) a modern contraceptive method Proportion fo women in reprodutive age (15-49) who receive FP counselling from a health Number of WRA reporting to receive H:TBD H:TBD H:TBD H:TBD I4.2 By province 2012 2017 2018 / 2019 2020 / 2021 DHS Every 2 years provider FP counselling / total number of WRA L:23.0% L:25.0% L:30% L:35.0% Activity Number of USG/assisted SDPs By province, Estimates based on Percentage of USG-assisted service delivery points (SDPs) offering FP/RH counseling or A4.1 offering FP/RH services / Total number service delivery 2016 50.0 2017 TBD 2018 TBD 2019 TBD 2020 TBD 2021 TBD MOH data & Retail Every 2 years services (+) of USG assisted SPDs point rural/urban Audit 2015 Percent of USG-assisted service delivery points that experience a stock out at any time Percentage of facilities stocked out of By province, A4.2 during the reporting period of a contrceiptive method that the SDP is expectd to provide each type of contraceptive offered, on service delivery 2016 10% 2017 TBD 2018 TBD 2019 TBD 2020 TBD 2021 TBD MIS data Quarterly (+) the day of assessment point CYP provided by services performed A4.3 Couple years protection in USG supported programs Rural/Urban 2016 41,318 2017 TBD 2018 TBD 2019 TBD 2020 TBD 2021 TBD service statistics Monthly and products distributed Number of health facilities whose Percent of health facilities whose providers reported a Quality of Care score >= 80% for A4.4 providers' QoC score for FP servicest By province N/A * / 2017 TBD 2018 70% 2019 80% 2020 80% 2021 80% Routine data Quarterly management of FP services (+) Numberis >= 80%/Total of health number care providers of health who A4.5 Number of health care workers who successfully completed an in/service training program completed an FP/RH training By province 2016 100 2017 TBD 2018 TBD 2019 TBD 2020 TBD 2021 TBD Routine data Quarterly Numbersupported of by FP/RH USG protocols aiming at A4.6 Number of protocols finalized and approved improving access and quality of service By province 2016 2 2017 TBD 2018 TBD 2019 TBD 2020 TBD 2021 TBD Routine data Quarterly supported with USG funds Number of people trained with USG A4.7 Number of people trained with USG funds By province 2016 100 2017 TBD 2018 TBD 2019 TBD 2020 TBD 2021 TBD Routine data Quarterly funds * Baseline figure not available. Baseline to be established during Y1 or on available data from DHS/MOH estimates

^ Targets will be disaggregated by administrative level where relevant; ; + absolute values for numerator and denominator will be provided Performance Monitoring Plan - Results 5

National Indicator Definition and Unit of Performance Indicator Disaggregation Source Reporting Frequency Level Measure Baseline Values Y1 Value Y2 Value Y3 Value Y4 Value Y5 Value

Long-term result 5: Public Management Strengthened Number of provincial Proportion of provincial authorities who demonstrated use of HMIS for planning and By province and I5.1 authorities with / N/A* 2017 0 2018 / 2019 40.0% 2020 / 2021 80.0% Routine data Every 2 years budgeting by health area demonstrated use of Activity

Objective 5: Capacity of national, municipal and provincial governments to plan, fund, monitor and supervise improved health programs Number of GRA (health) Number of GRA (health) officials trained on budget formulation or execution of best By province, A5.1 officials trained on / N/A* 2017 12 2018 24 2019 48 2020 60 2021 72 Routine data Quarterly practices health area, sex budgetNumber formulation of or By province, A5.2 Number of municipalities with costed health budgets (PMDS cost-out) municipalities with / N/A* 2017 6 2018 8 2019 12 2020 18 2021 24 Routine data Quarterly health area costedNumber health of municipal budgets By province, A5.3 Number of municipal health budgets (PMDS cost-out) accessible to the public health budgets (PMDS / N/A* 2017 6 2018 8 2019 12 2020 18 2021 24 Routine data Quarterly health area costPercent out) of accessible municipal to By province, A5.4 Percent of municipal HMIS reports submitted on time and complete (+) HMIS reports submitted / N/A* 2017 60.0% 2018 70.0% 2019 80.0% 2020 90.0% 2021 100.0% Routine data Monthly health area Numberon time and of provincial complete Number of provincial authorities meeting monthly for at least 3 consecutive months to By province, A5.5 authorities meeting / N/A* 2017 TBD 2018 TBD 2019 TBD 2020 TBD 2021 TBD Routine data Quarterly review HMIS data and incorporate feedback in monthly reports health area Numbermonthly forof bestat least 3 Number of best practices and lessons learned built into the national medium-term data By province, A5.6 practices and lessons / N/A* 2017 8 2018 10 2019 20 2020 24 2021 30 Routine data Quarterly use and planning. health area Numberlearned built of laws, into the Number of laws, policies, regulations, and best practices institutionalized with USG By province, A5.7 policies, regulations, 2016 1 2017 1 2018 TBD 2019 TBD 2020 TBD 2021 TBD Routine data Quarterly assistance health area Numberand best ofpractices MOH By province, A5.8 Number of DHIS2 users trained within MOH with USG assistance personnel trained use / N/A* 2017 TBD 2018 TBD 2019 TBD 2020 TBD 2021 TBD Routine data Quarterly health area DHIS2 with USG funds * Baseline figure not available. Baseline available on Y1 or on available data from DHS/MOH estimates

^ Targets will be disaggregated by administrative level where relevan; ; + absolute values for numerator and denominator will be provided