FORM #3 Grants Solicitation and Management Quarterly Progress Report Grantee Name: Maternal and Child Survival Program Grant Number: # AID-OAA-A-14- 00028 Primary contact person regarding this report: Mira Thompson ([email protected]) Reporting for the quarter Period: Year 2, Quarter 4 (July to September 2018) 1. Briefly describe any significant highlights/accomplishments that took place during this reporting period. Please limit your comments to a maximum of 4 to 6 sentences. • Following the gaps that were identified during the routine TA visits to the districts in the first and second quarters, MCSP engaged the districts in the supported provinces in revising their 2018 annual workplans and budgets based on the data (scorecards) and service quality assessment (SQA) findings. Using these tools, MCSP influenced the inclusion of appropriate high-impact interventions (HIIs) to respond to identified gaps in the revised workplans and recommended the allocation of resources in an equitable manner. Consequently, Districts revised the 2018 CoC plans to incorporate these recommendations and identified interventions that would be included in the 2019 plans in all provinces. Additional details are provided in the provincial report annexes. • MCSP provided technical assistance (TA) during the provincial integrated management meeting (PIM) across all of the four target provinces. These meetings provided an opportunity for MCSP to identify areas requiring TA in a context-specific and responsive manner to the needs of each district. MCSP contributed to discussions in those meetings by making on-the-spot recommendations for improving specific indicators. For example, using a very brief role play, MCSP graphically showed districts a simple way of estimating the number of new FP acceptors. By sharing in those meetings how certain districts had used SQA for planning on how to respond to poorly performing indicators, districts that had not incorporated this in their plans saw the need to and requested orientation by MCSP. Most evidently, MCSP saw an opportunity to provide capacity building of districts teams in using MOH Quality Assurance (QA) tools such as Quality Improvement (QI) projects in addition to the Mentorship and Service Quality Assessment Tools (SQA), processes that MCSP was already providing TA on. MCSP provided TA during the CoC pre-planning and planning cycle. During the TA, 1 MCSP used HMIS data and bottleneck analyses to decide on the inclusion of the following high impact interventions: o Renovation/construction of outreach posts/shelters in 9 Districts in Muchinga and 37 in Eastern Province o Procurement of tents in 6 districts in Muchinga o RED strategy training in 6 Districts in Muchinga, 5 Districts in Luapula o ETAT, IMCI, iCCM and RED strategy training and/or mentorship o Procurement of case management job aids such as IMCI booklet charts • Using the SQA findings, MCSP influenced two Districts in Luapula Province (Chipili and Mwense Districts) to design quality improvement projects. Chipili’s project is looking at case management titled Improving IMCI Services at Chipili Rural Health Centre while that of Mwense aims at improving EPI services in that district. • MCSP worked closely with Mansa District Health Office (DHO) during the measles outbreak along the Zambia-Democratic Republic of Congo boarder. The TA provided by MCSP resulted in the Provincial team extending the Supplementary Immunization Activities (SIA) to other catchment areas where Zambians easily mingle with Congolese. • MCSP has been facilitating formation of mentorship teams in the provinces and has strengthened the district mentorship teams across 43 districts in the four provinces. During the period under review, MCSP supported 3 districts (Kanchibiya, Lavushimanda Mpika) in Muchinga and orientated them in development of mentorship dashboards, which should inform mentorship rounds. The technical assistance has resulted in formation of teams in 8 districts (out of the nine) in Muchinga Province and are using MOH mentorship tools. A number of districts now have functional mentorship teams that are using the revised MOH mentorship tools. For example, in Eastern Province, all districts have made their mentorship teams functional and are being oriented on mentorship dashboards that have already begun being used in that province. • MCSP obtained ethical approval for the General Nursing Council of Zambia to conduct a study to find out the feasibility of decentralizing its continuous professional development (CPD) program. Additional details are provided on page 18 (objective 2). • MCSP completed instructional design workshops for the development of four e-learning modules in antenatal care (ANC), HIV, integrated management of acute malnutrition (IMAM) and in maternal, infant and young child nutrition (MIYCN) courses. Additional details are given on page 16 (objective 3). • MCSP completed the first round of qualitative data collection for its learning question study on the MCSP/Zambia technical assistance model. This study aims to understand the success of the TA model, especially the acceptability of TA without direct funding, the ability of the project to influence technical direction of activities implemented with G2G funds, the extent to which project objectives are achieved and the major factors that have affected the achievement of results positively or negatively. The study through these objectives will effectively document the best practices and lessons learned from implementing this TA approach. 2 2. Briefly describe any unforeseen obstacles or challenges that are having a negative impact on the implementation of the grant activity. For any mentioned, please describe your possible strategy for resolution. • Some DHOs did not adhere to the agreed action points during the pre-planning, such that for the final planning they brought in activities that were outside what had been identified during bottleneck analysis in their districts. TA in this has been ongoing to make the DHOs prioritize context-specific interventions that would appropriately respond to the needs of each district. • Delayed authorization of expenditure of the COC budgets by the national level resulted in delayed implementation of activities by districts and disrupted the opportunities for provision of TA by MCSP. These delays have been discussed at the national level COC coordination meetings and it is expected that they will reduce in future. • Generally, there is a lack of IEC materials and job aids in the facilities across the four provinces. TA in IMCI faced a lot of challenges due to lack of job aids such as IMCI chart booklets, IMCI wallcharts and ARI timers. MCSP continued to advocate to districts to budget for the job aids through the G2G grants and MOH resources. • Districts did not fully understand ETAT training (Emergency Triage & Treatment), making provinces fail to prioritize it. There are no TOTs in any of the four provinces thereby requiring trainers from the national level MOH for any training. With no one trained at Provincial level, the Province has no capacity to promote ETAT in a way the Districts can appreciate it. MCSP has been lobbying for Provincial TOTs to be established. This has not yet been done considering the competing priorities for the same money. MCSP continued to recommend the inclusion of training through the G2G grants. • Inadequate transport hampering follow up visits to districts. With the procurement of vehicles and motorcycles through the G2G grants, this is likely to improve in the near future. 3. Please describe activities to monitor field activities and ensure compliance with USAID family planning and commodity regulations as described in Appendix 2. Activities may include staff training, supervision visits, observation, monitoring of reports, etc. Please indicate whether there are any concerns or questions. • All MCSP staff at the national and provincial levels have been trained and certified in FP compliance as required by USAID. The certificates are on file with the MCSP Zambia Program Officer. MCSP continues to ensure that all staff are oriented to FP compliance and are trained and certified so that they are able to prevent and look out for any violations. • MCSP has continued to repeatedly emphasize to MOH at all levels on the need for compliance with FP rules and regulations. This TA has also included recommendation for MOH personnel to take the appropriate online courses on Global Health eLearning Center 3 4. Briefly comment on the status of the activity as compared with the agreed-to work plan. Mention whether you are behind, consistent with, or ahead of the work plan. Objective 1: Provide demand-driven technical assistance for sustainable scale up of RMNCAH&N intervention across the four focus provinces of Zambia. MCSP is on track under Objective 1. In the reporting period, MCSP worked closely with all districts in the four supported provinces to make recommendations for the most appropriate high impact interventions that are responsive to the needs of each district based on their performance as gathered and displayed using MOH tools of service quality assessments and dashboards, mentorship dashboards and district scorecards. Multiple avenues were used to provide technical support, including provincial and district integrated meetings, maternal and perinatal death surveillance and response meetings, planning meetings and other opportunities as they arose. Please find below an abbreviated list of activities that occurred