MaMoni Health Systems Strengthening Project

Quarterly Report

FY14 Quarter 1: September 24 - December 31, 2013

Submitted

January 31 , 2014

MaMoni Health Systems Strengthening Project Quarterly Progress Report

MaMoni Health Systems Strengthening Activity, : Year One Workplan Narrative Page 1

Acronyms and Abbreviations

AMTSL Active Management of the Third Stage of Labor BCC Behavior Change Communication BSMMU Bangabandhu Sheikh Mujib Medical University CSBA Community Skilled Birth Attendants CV Community Volunteer DCOP Deputy Chief of Party DGFP Directorate General Family Planning DGHS Directorate General Health Services DHSS District Health Systems Strengthening EOI Expression of Interest GoB Government of Bangladesh HBB Helping Babies Breathe HMIS Health Management Information System HPNSDP Health, Population and Nutrition Sector Development Program HRCI Health Research Challenge for Impact HSS Health System Strengthening IEE Initial Environment Examination IR Intermediate Result JHU/IIP Johns Hopkins University, Institute for International Programs JSI John Snow, Inc. LAPM Long Acting and Permanent Method LLP Local Level Planning LMIS Logistics Management Information System LMR Leading and Managing for Results MAMA Mobile Alliance for Maternal Action MCHIP Maternal and Child Health Integrated Program M&E Monitoring and Evaluation MNCH/FP/N Maternal, Newborn and Child health, Family Planning and Nutrition MOH&FW Ministry of Health and Family Welfare MOU Memorandum of Understanding NSV Non-scalpel Vasectomy OR Operations Research PNGO Partner nongovernmental organization PPH Postpartum Hemorrhage PPIUCD Postpartum Intra-uterine Contraceptive Device QA Quality Assurance QPRM Quarterly Performance Review Meeting SC Save the Children SIAPS Systems for Improved Access to Pharmaceuticals and Services SMT Senior Management Team SOP Standard operating procedure SOW Scope of Work USAID U.S Agency for International Development

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Project Summary

Project Name: MaMoni Health Systems Strengthening (MaMoni HSS) Project

Reporting Period: FY 2014- Quarter 1: September 24, 2013 – December 31, 2013

Obligation Funding Amount: USD

Project Duration: Four years

Project Goal: Improved utilization of integrated maternal, newborn, child health, family planning and nutrition services

Project Objective: Increased availability and quality of high impact interventions through strengthening district level local management and health systems

Intermediate Results:

 Improved service readiness through critical gap management  Strengthened health systems at district level and below  Enabling environment promoted to strengthen district-level health systems  Barriers to health service accessibility identified and reduced Geographic Focus: , , Noakhali, Lakhsmipur, Bhola, Jhalokathi, Pirozepur and districts

Introduction This will include a brief overview of the health situation and MaMoni HSS’ role in Bangladesh. It should include the approximate date that activities started and briefly describe the problems we are addressing and the geographic scope of our work. It may also include a map and key indicators, if these help in understanding MaMoni HSS’ work.

Over the past decade, Bangladesh has made significant progress in lowering maternal and child mortality. The maternal mortality ratio has declined 40% from 322 per 100,000 live births in 2001 to 194 in 2010. Between 2007 and 2011, the under-five mortality declined from 65 to 53 per 1000 live births. Skilled attendance at birth nearly doubled between 2004 and 2011 to 32%, with much of this due to increased facility deliveries. Notably, the contraceptive prevalence rate reached 61% for all methods and the total fertility rate declined to 2.3 nationally.

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While Bangladeshi women and children benefit from these improvements for their health, considerable gaps remain. Building on the strong work and success of the MaMoni Project and Maternal and Child Health Integrated Program (MCHIP), the MaMoni Health Systems Strengthening (MaMoni HSS) Project will focus on strengthening the systems and standards for maternal, newborn and child health, family planning, and nutrition (MNCH/FP/N) that will result in further declines in maternal, newborn and child mortality.

MaMoni HSS is an Associate Award under MCHIP, with a period of performance from September 24, 2013 to September 23, 2017. MaMoni HSS is primed by Jhpiego in partnership with Save the Children (SC), John Snow, Inc. (JSI), and Johns Hopkins University (JHU)/Institute of International Programs (IIP), with national partners, icddr,b, Dnet, and Bangabandhu Sheikh Mujib Medical University (BSMMU).

SC serves as the functional operational lead partner for this award in Bangladesh and leads on overall technical areas, oversees the management of project offices and administers all local activity costs. SC provides managerial and financial oversight for all local partners and sub grantees. SC ensures strong and cohesive leadership, rapid expansion/start-up in new districts, and strategic engagement at the national level, particularly with the Ministry of Health and Family Welfare (MOH&FW). Jhpiego is the primary point of contact for this award. In addition to its responsibilities as the prime, Jhpiego also plays a global coordination role among MCHIP partners to ensure effective provision of technical assistance to MaMoni HSS. Jhpiego provides direct assistance in the areas of quality assurance, supporting management decision-making based on data from quality assurance processes, capacity building, clinical expertise in maternal health and family planning, use of human resource modeling to determine health workforce planning and monitoring and evaluation (M&E) support. Jhpiego also manages the subagreement to DNet for implementation of Mobile Alliance for Maternal Action (MAMA) activities. JSI provides technical assistance in health systems strengthening with a specific focus on logistics management. JHU/IIP provides technical assistance for the estimation and analysis of maternal, newborn and child lives saved through Lives Saved Tool (LiST).

MaMoni HSS implementation is supported by a group of local nongovernmental organizations (NGOs) that are strategically placed in local communities, and are channels for scale-up and sustainability.

MaMoni HSS supports the MOH&FW to strengthen health systems in seven districts – Habiganj, Noakhali, Lakhsmipur, Bhola, Pirozepur, Jhalokathi and Brahmanbaria. In addition, receives support during the first year of implementation for targeted newborn care interventions. Implementation in is planned to start in the second year. Habiganj, Noakhali

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and Lakhsmipur districts have received substantial support under the previous efforts of MCHIP, which will continue under MaMoni HSS project.

The following MCHIP components, planned to transition into MaMoni HSS, will continue implementation during the reporting period:  The MaMoni – Integrated Safe Motherhood, Newborn Care and Family Planning Project received a three-month, no-cost extension with a focus on maintaining gains and completing activities previously initiated in Sylhet and Habiganj districts. These districts also started preparations for the transition to MaMoni HSS by the end of this quarter.  MCHIP field-support funded Aponjon activities of MAMA continued implementation of mobile phone-based communication of MNH messages. Aponjon activities will fully transition into MaMoni HSS at the end of third quarter.  MCHIP field-support funded Helping Babies Breathe (HBB) scale up continued to train public and private sector providers, provide refresher trainings, and carry out system modifications and HBB surveillance. HBB activities will transition into MaMoni HSS in March 2014  MCHIP field-support funded District Health Systems Strengthening (DHSS) continued to implementation in Noakhali and Lakhsmipur districts and began preparatory activities for rapid transition to MaMoni HSS at the end of this quarter.

1. Program Objectives and Key Activities This section should state the objectives that have been laid out in the country workplan and provide a quick review of the activities being implemented and planned to achieve each one.

 Results for the Quarter - This section should provide a quick summary of results during the past quarter (bulleted format) and narrative when achievements require additional detail.  Bullets summarizing Major Accomplishments: These summary bullets should reflect the most important achievements over the last quarter and be phrased as results--not as a list of the activities completed but what these activities resulted in or will result in. You must answer the “So what?” question. For example, if a workshop was held, we would like to know the outcomes of the workshop. If trainings were held, we would like to know the larger purpose to which they contribute, not just the number of people trained. LENGTH: Ideally, you should include 4-6 BULLETS ONLY for the entire program, but if there is more than one major program objective or component, 2-3 bullets per component should be your limit.  Short Narrative providing additional details about Major Accomplishments: The narrative should elaborate on the bullet points listed above as well as any other important accomplishments, or reasons expected results were not achieved. The

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narrative should also place the results in context, explaining why they are important and the larger result or outcome to which they are expected to contribute. The narrative should present results for the past quarter by program objective. Past achievements could also be pulled into results narrative by starting each statement about what we did during a quarter with a quick sentence about past work on this particular topic. Graphs, charts and tables should be used to present results when appropriate. Photos are welcome. LENGTH: The narrative portion of the report should not exceed 3 pages.

(i) Results for the Quarter

During the reporting period, the overall focus for MaMoni HSS was on ensuring a rapid start up of implementation and a smooth transition from the ongoing MCHIP- supported projects to the new award. Project implementation built on the platform created by past and ongoing efforts at national and district levels through earlier MCHIP projects- MaMoni, DHSS, HBB Scale Up, MAMA and other complementary initiatives.

During the current start-up quarter, programmatic results are organized by four categories including: start-up activities, human resources, district operations management and consultations with partners and stakeholders. In future quarterly reports, as activities transition from start-up to intermediate result activities, results will be organized by intermediate result.

A. MaMoni HSS Start-up Activities

Activities Planned Activities Accomplished

 Develop MaMoni HSS MaMoni HSS drafted the first year workplan and Year One Workplan shared it with the USAID mission on November 11, 2013 for feedback. Key features of the workplan were also presented to the USAID team on December 3, 2013. A revised workplan was re-submitted on December 25, 2013 incorporating feedback from USAID. A final revision based on inputs from USAID was submitted in January and approved on January 22, 2014.  Develop MaMoni HSS The first draft of the project’s M&E plan was shared M&E Plan with USAID for feedback. Further revisions in the M&E plan will be required in-line with the revisions made to the Year One workplan.

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 Develop MaMoni HSS MaMoni HSS developed and submitted the project’s Branding Plan branding and marking plan which was approved by USAID.  Finalize partner sub- Jhpiego drafted and shared partner sub-agreements agreements with MCHIP consortium partners. The sub- agreements will be finalized during the next quarter.  Procure operational Procurement of project equipment, computers, materials and equipment printers/copiers and other operational equipment has begun and is ongoing.  Prepare for the national Initially, the national project launch was scheduled launch of the project for December 2013. Due to the political situation in Bangladesh during this time period and in consultation with the AOTR, MaMoni HSS decided to postpone the national launch to the second quarter. A suitable date for the event will be determined after the political situation becomes more stable.  Develop SOW and There has been a delay in recruiting the consultant identify a consultant for for supporting initial MaMoni HSS environmental environmental compliance activities. A draft SOW has been compliance activities developed and two potential candidates, one national and one international, have been identified. The SOW and curriculum vitae of the shortlisted candidates will be shared with USAID for review and approval.  Develop SOW for MaMoni HSS developed detailed SOWs for its national level partners national partners- icddr,b, DNet and BSMMU. The SOWs for these partners were included in the Year One Workplan submitted to USAID for approval.  Identify operations MaMoni HSS organized a consultation meeting with research priorities icddr,b and to identify priority areas for conducting operations research in the first year. The outputs from this consultation meeting will be used for a wider consultation meeting with USAID and external stakeholders/experts to be conducted in January 2014. During the consultation, it was agreed that the primary purpose of OR is to inform implementation at the district level, to answer implementation questions identified by the program managers. Thus, all OR must be completed within a six months timeframe so that the findings can be incorporated into the program implementation. In addition, MaMoni HSS will continue to work with the TRAction project implemented by icddr,b to identify

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and implement larger OR questions that are of relevance at the national level. Several potential areas for OR were proposed at the consultation meeting. Icddr,b will synthesize the discussions and propose the final list of OR studies for the first year by the end of quarter 2

B. Human Resources

Activities Planned Activities Accomplished

 Recruit key personnel The hiring processes for all four Key Personnel – Chief of Party, Deputy Chief of Party/ Senior Leadership and Management Advisor, Senior Communication and Advocacy Advisor and Senior Clinical and Quality Assurance Advisor – have been completed. All four key personnel are on board as of the first week of January 2014.  Recruit other MaMoni Detailed job descriptions were developed for all HSS country office staff national and district level positions. The recruitment process for all national level positions started during the first quarter. Out of 37 positions, 23 positions were filled during the first quarter. In addition, recruitment was completed for eight positions during this quarter and the process is in progress for the remaining six positions.  Recruit district level All district level positions were filled in Habiganj, staff Noakhali and districts. Recruitment in the new districts of Bhola, Jhalokathi and Pirozepur has been initiated. The selection process of district level staff will be completed before the end of the second quarter so that the new staff will be in place to start implementation by April 2014 as planned in Bhola, Jhalokathi and Pirozepur.  Deliver short-term Pat Daly of Save the Children visited the MaMoni technical assistance HSS project from November 10-15, 2013, to support the project start-up. Pat met with the project team, key MOH&FW officials and other partners. She also held a debriefing meeting with USAID.

C. District Operations Management

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Activities Planned Activities Accomplished

 Orient district staff and A three-day workshop was held with district level develop district staff and PNGO staff in Habiganj district to provide workplans orientation on the MaMoni HSS design and operational strategies. A total of 11 participants attended this workshop. At the end of the workshop, district teams developed an annual workplan for the district. Teams also drafted SOWs for the local PNGOs.  Develop SOW for PNGOs Detailed SOWs and budgets were developed for the six NGOs in Habiganj, Noakhali and Laksmipur. The process of developing the SOWs helped to build a common understanding between MaMoni HSS staff and partner NGOs on the implementation processes at district level and below and the roles and responsibilities of partners. SOWs and budgets are currently being reviewed by MaMoni HSS for approval.  Select partner NGOs MaMoni HSS initiated the selection of new partners in Bhola, Jhalokathi and Pirozepur districts. MaMoni HSS invited expressions of interest (EOI) from potential partners through an open announcement in local newspapers. Thirty-four NGOs submitted EOI. Using rigorous assessment criteria, nine NGOs were shortlisted for face-to-face presentations. Based on the results of the initial assessment process, four potential partners have been identified for the second stage of assessment, which focuses on financial and management capacity. The selection process will be completed by the end of the second quarter and subgrant agreements with PNGOs will be signed before implementation starts in the new districts in April 2014.  Collaborate with BRAC MaMoni HSS held discussions with BRAC to explore options for collaboration in district level implementation. The two teams agreed to work together in Pirozepur district, where BRAC will support MaMoni HSS carry out community level activities facilitation conducted by PNGOs. During the next quarter, a formal letter of agreement will be signed between the two parties to formalize this arrangement.

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 Set up district level District level offices were established in Habiganj, offices Noakhali and Lakshmipur districts under the previous initiatives. MaMoni HSS initiated office set up in new districts with office space finalized in Jhalokathi and underway in the other new districts.  Prepare activities for MaMoni HSS began preparatory work for facilitating district level district level implementation. This included implementation development of guidelines and tools for conducting district level rapid situational analysis and guidelines for conducting rapid household surveys to inform the development of bottom-up MNCH/FP/N plans. Several operational guidelines and tools were developed during implementation of MaMoni and DHSS projects. MaMoni HSS intends to modify and adapt these tools. These include processes such as community microplanning, community mobilization through Community Volunteers (CVs) and Community Action Groups (CAG), district level Quarterly Performance Review Meetings (QPRM), Union Follow Up meetings, Facilitated Referral Systems etc. During the first quarter, process has been initiated to compile the tools as well as implementation experiences from Habiganj district to consolidate these as standardized processes to guide the implementation in the new districts. A comprehensive District Operations Manual will be completed for orienting project staff and partners during the second quarter.

D. Consultations with partners and stakeholders

Activities Planned Activities Accomplished

 Conduct introductory MaMoni HSS organized introductory meetings with key meetings with officials of the Directorate General Health Services MOH&FW at the (DGHS) and Directorate General Family Planning national level (DGFP). The purpose of these meetings was to introduce key officials to the project  Hold consultation MaMoni HSS held consultation meetings with meetings with other MSH/SIAPS to explore areas of collaboration to USAID cooperating strengthen the logistics management systems of key partners and projects MNCH/FP/N commodities. Both programs agreed to

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work together in Lakshmipur district to extend the current LMIS to all service delivery points. The two projects will also collaborate to identify tracer commodities and explore the feasibility of linking LMIS with the routine health management information system. MaMoni HSS conducted consultation meetings with Mayer Hashi/EngenderHealth to identify potential areas of collaboration. The two projects agreed to advocate together nationally on areas of common interest including pre-eclampsia/eclampsia prevention and management, promotion of progesterone-only pills through DGFP, development and promotion of Minimum Operating Standards for non-scalpel vasectomy (NSV) and tubectomy, and strengthening of the oxytocin cold chain. Mayer Hashi also offered to provide national level trainers for various maternal health/ family planning training (including active management of the third stage of labor (AMTSL), postpartum intra-uterine contraceptive device (PPIUCD), infection prevention, and misoprostol for postpartum hemorrhage (PPH) prevention).

(ii) Challenges, Solutions and Action Taken

Nation-wide protests and pre-poll violence all across the country during much of the first quarter had a major impact on the pace of implementation at the national and district level. The unavailability of senior level officials of MOH&FW also delayed some national level introductory meetings and consultations. At the district level, movement of staff to project sites was grossly restricted. The project focused mainly on completion of national level preparatory activities.

2. The Way Forward: Major Activities Planned for the Second Quarter

This final section should briefly state what major activities are planned for the next quarter. It should also consider any challenges faced during the previous quarter and describe the ways that these will be overcome in the coming months. It should also address any issues that have been raised as needing attention or having priority.

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With national elections planned for January, MaMoni HSS anticipates a more favorable political climate to speed up project implementation at all levels. Below is a summary of major activities planned for the second quarter.

Start-up Activities:

• Project orientation meetings: MaMoni HSS will conduct a series of orientation meetings with senior level MOH&FW officials at the national level. Similar orientation meetings will be conducted at the district and levels, including the new districts of Bhola, Jhalokathi and Pirozepur. The project will seek to form a national Project Steering Committee and identify focal points from the MOH&FW for national level coordination. • National level project launch: MaMoni HSS will collaborate with the MOH&FW and USAID to organize a national level launch of the project. The event is tentatively scheduled for the last week of March 2014. • Complete recruitment, orientation and deployment of staff at national and district levels: Recruitment for all positions will be completed in the second quarter. All staff will be oriented to the project design, operational strategies and job descriptions. This will be done through staff orientation and team-building workshops conducted in the second quarter. • Finalize all subgrant agreements with implementing PNGOs: MaMoni HSS will finalize the SOWs and budgets for all national and district level partners and subgrant agreements will be signed with local partners identified in Bhola, Jhalokathi and Pirozepur districts. MaMoni HSS will also finalize the SOW for collaboration with BRAC for sub-district level implementation in Pirozepur district. • Initiate district level activities in Jhalokathi and Pirozepur by the end of the second quarter: Initial activities include district level orientation meetings and consultations with partners and collaborators. • Develop project operating guidelines and manuals: MaMoni HSS will finalize the quality assurance (QA) strategy and tools, workforce planning guidelines, and district-level guidelines for developing behavior change communication plans. • Complete project M&E plan, including setting performance targets: In line with the project M&E plan, MaMoni HSS will develop a project management information system, including guidelines and protocols for collection, reporting and analysis of routine project information at all levels, including PNGO and project staff. • Develop SOW for gender analysis. • Recruit consultant to develop USAID environmental compliance guidelines and protocols.

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Intermediate Results Activities:

• Facilitate district level bottom-up planning: The district level comprehensive planning process will start in Habiganj, Noakhali and Lakhsmipur districts. The planning process will be begin at the union level, followed by upazila and district levels and will be completed by the end of April. To inform the planning process, rapid household surveys and situational analyses will be conducted in each union. MaMoni HSS will use local level data and a consultative approach during the planning process. • Conduct infrastructure mapping and assessment to identify facilities for infrastructure renovations in the first year of implementation in Habiganj, Noakhali and Lakhsmipur districts. • Roll-out national training plan: Implementation of the national training plan will begin in quarter two with a focus on building the skills and competencies of service providers at all levels. Training in quarter two will include MNCH/FP/N technical areas, training of trainers, national level training on misoprostol, training of community skilled birth attendants for the continued roll out of HBB, and training of PNGO staff and community level facilitators including community volunteers (CVs). MaMoni HSS will carry out training of newly recruited CVs in Habiganj, Noakhali and Lakhsmipur districts and recruit and train new CVs to replace the drop-outs. • Develop the national advocacy plan using a consultative process and form national level advocacy networks. • Hold stakeholder consultations to identify health system strengthening gaps and potential solutions. • Coordinate with the Health Research Challenge for Impact (HRCI) project and BSMMU to develop/modify the curriculum and tools for leadership and management development for district and upazila level managers: The project will continue to follow up with district and upazila level managers in Noakhali and Lakhsmipur implementing action plans developed during the initial training under DHSS. MaMoni HSS will develop case studies and practical management scenarios for the training of upazila level managers. • Initiate community microplanning system in Noakhali and Lakhsmipur districts.

Annexes

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Use the annexes to provide copies of products that were finished during the quarter, success stories, newspaper articles, presentations, etc.

No communications products were finalized during the first quarter.

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