MCSP Annual Report FY 2018 October 1, 2017– September 30, 2018 Submission Date: November 6th, 2018 Cooperative Agreement No. AID-OAA-A-14-00028 Activity Start Date and End Date: October 2016 – April 2019 Activity Manager: Pavani Ram AOR: Nahed Matta Submitted by: Adhish Dhungana, Manager- Maternal & Child Survival Program Save the Children| Airport Gate Area, Shambhu Marg Kathmandu, Nepal GPO Box: 3394 Telephone: +977-1-4468130/4464803 Email: [email protected] This document was produced for review by the United States Agency for International Development (USAID). Acronyms BEmONC Basic Emergency Obstetric and Neonatal Care CHD Child Health Division CMA Community Medical Assistant CRS Contraceptive Retail Sales CSD Curative Service Division DDA Department of Drug Administration DHO District Health Office DoHS Department of Health Services DIP Detail Implementation Plan ENAP Every Newborn Action Plan FB IMNCI Facility Based Integrated Management of Neonatal and Childhood Illness FHD Family Health Division GoN Government of Nepal IMNCI Integrated Management of Neonatal and Childhood Illness MCSP Maternal and Child Survival Program M&E Monitoring and Evaluation MEL Monitoring, Evaluation, and Learning MNH Maternal and Newborn Health MNHI Maternal and Newborn Health Integration MoHP Ministry of Health and Population NCDA Nepal Chemist and Druggist Association NHRC Nepal Health Research Council NYI Newborns and Young Infants PI Principle Investigator PSBI Possible Severe Bacterial Infection PSD Partner for Social Development Nepal SBA Skilled Birth Attendant SCI Save the Children International SDG Sustainable Development Goal SNL Saving the Newborn Lives TAG Technical Advisory Group ToR Terms of Reference USAID United States Agency for International Development WHO World Health Organization WIRB Western Institutional Review Board Contents Acronyms 2 FINANCIAL INFORMATION Error! Bookmark not defined. INTRODUCTION 4 KEY ACHIEVEMENTS 4 SECTION 1: PSBI Survey and PSBI Pilot 6 I. Background 6 II. OBJECTIVES 6 III. Summary of Major Accomplishments 6 IV. Detail of Accomplishments 8 V. Monitoring, Evaluation, and Learning 13 VI. Challenges/ Lessons Learned and Recommendations 17 VII. Major Activities Planned for Next Quarter 17 VIII. Success Story 18 SECTION 2: Situation Analysis of Inpatient Care of Newborns and Young Infants 20 I. Background 20 II. Summary of Major Accomplishments 20 III. Detail of Accomplishments 20 IV. Challenges/ Lessons Learned and Recommendations 20 V. Major Activities Planned for Next Quarter 21 SECTION 3: Integrated Maternal and Newborn Health Training Study 22 I. Background 22 II. Summary of Major Accomplishments 22 III. Detail of Accomplishments 22 IV. Challenges/ Lessons Learned and Recommendations 23 V. Major Activities Planned for Next Quarter 23 Annex 1: Monitoring visits 24 Annex 2: Monitoring/Supervision Checklist 26 Annex 3: Interview Guideline for Client 28 Annex 4: MEL Plan 30 Annex 5: Report – National Dissemination of PSBI Survey Findings 33 Annex 6: Notes from CRS & Save the Children Nepal Meetings 38 INTRODUCTION The Maternal and Child Survival Program (MCSP) in Nepal implements through three separate activity streams: a field-funded pilot on management of possible severe bacterial infection (PSBI) among private providers, based on results from an MCSP-supported nationally representative survey; and two MCSP Core-funded newborn health activities that were added to the MCSP Nepal workplan in January 2018. To adequately reflect progress against all three activities, a brief summary of key achievements across the portfolio has been included at the beginning. The remainder of the annual progress report is divided into three sections, each one dedicated to one of the discrete activity streams included in the workplan. The annual progress report reflects a summary of key achievements on program activities during the reporting year as well as a summary of key updates during the fourth quarter of the reporting year. KEY ACHIEVEMENTS From October 2017 through September 2018 (Project Year 4; PY4), MCSP Nepal accomplished several notable achievements: Possible Severe Bacterial Infection (PSBI): In quarter 4 of project year 3, a nationally representative survey looking at the management of PSBI among private providers was completed in Nepal. The survey was conducted in June and July 2017 in 25 of the country’s 75 districts. In PY4, MCSP analyzed data from that survey, summarized the key findings, and then collaborated closely with in-country and global stakeholders to identify implications and agree on recommendations from that survey. In doing so, a full report of all findings and a technical brief of key findings were developed and disseminated in several events, including a vetting workshop in Kathmandu and a global webinar organized at MCSP in Washington, DC. In addition, MCSP Nepal worked closely with representatives of the Ministry of Health and Population (MoHP) and USAID to distill key survey findings and used the evidence to design a pilot study aimed at improving the quality of care provided by private providers when managing PSBI symptoms among young infants. A Technical Advisory Group (TAG) was formed to adapt the national IMCNI protocols and develop a training curriculum for this intervention. Private outlets, including drug shops and pharmacies, were mapped in consultation with the district health office and the district chapter of NCDA, and Contraceptive Retails Sales Company (CRS) was contracted by MCSP to support with implementation in Kavre district. Meetings were also held with referral hospitals within the district to build referral networks and linkages with private providers. As of the end of PY4, providers from 45 outlets had received training on PSBI management, and a total of 55 outlets had received a startup kit, which include a thermometer, respiratory timer and pan scale, as well as updated registers and referral slips. Training and implementation began in June, and is expected to continue for nine months, through March 2019. As of August, a total of 46 sick young infant cases had been registered, of which 24 cases were diagnosed with PSBI, the details of which are illustrated in below sections. Situation Analysis of Inpatient Care of Newborns and Young Infants (Core funded): MCSP undertook all the preparatory work for supporting the MoHP to conduct a situation analysis of in-patient care for newborns and young infants (small and sick newborn assessment, or “SSNA”). This included drafting protocols and the implementation plan, receiving US IRB approval and submitting for in-country approval, forming an operations team and a Technical Advisory Group (TAG), and adapting all the necessary tools. Once approval is received from the Nepal Health Research Council, the project will begin data collection. The Maternal and Newborn Health Training Study (MNHI) (Core funded) was completed in Nepal during project year 4. This two-phase study was intended to evaluate the effectiveness of integrated versus standalone training programs to improve knowledge, skills and practices for essential care during labor, childbirth and newborn care in Ethiopia and Nepal. The aim of the study was to generate evidence to inform MNH training programs and to assist the ministries of health to use the evidence to strengthen national training policies. During the project year, the project team conducted six key informant interviews and three focus group discussions with trainers, doctors, and nurses, and then vetted all preliminary results in a validation workshop with stakeholders under the leadership of the MoHP. The key finding was that integrated training, while essential, has resulted in a diluted effect. The newborn components have suffered due to: time limits, which lead to decreased time spent on these components; and, a lack of clinical mentors who practice essential newborn care and newborn resuscitation. The study highlighted that integrated training is definitely the way forward, but more emphasis is needed now to strengthen training materials so as to ensure better attention to quality and time allocations for both the newborn and maternal components, including competent mentors. Findings from this study should be shared and utilized for future provincial-level MNCH training programs. A draft report with recommendations was developed from this workshop and a manuscript will now be developed to capture and disseminate study findings. SECTION 1: PSBI Survey and PSBI Pilot I. Background USAID requested the Maternal and Child Survival Program (MCSP) to build the knowledge base on care for small and sick newborns aged 0-2 months in the private sector in Nepal by conducting a large, nationally representative survey of PSBI care in medicine shops and private clinics. This survey was conducted from June to July 2017 in 25 purposefully selected districts throughout the country. It was designed to build on findings from an earlier study conducted by the Child Health Division (CHD) of the Department of Health Services (DoHS) with support from Save the Children’s Saving the Newborn Lives (SNL) program that illuminated key findings on the quality of PSBI care but had a limited sample. Findings from the survey informed a pilot in Kavre district where private medicine shops and clinics are engaged in delivering quality PSBI management service. II. OBJECTIVES The goal of the MCSP Nepal program is to support the Government of Nepal to reduce newborn and young infant deaths from PSBI by documenting