Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham- Pende and Nana-Gribizi, Central African Republic (720FDA18GR00202)

INTERNATIONAL RESCUE COMMITTEE CENTRAL AFRICA REPUBLIC

SEMIANNUAL REPORT

INTEGRATED HEALTH CARE, PROTECTION AND WATER, SANITATION, AND HYGIENE (WASH) INTERVENTIONS FOR CONFLICT AFFECTED POPULATIONS IN OUHAM-PENDE AND NANA-GRIBIZI, CENTRAL AFRICAN REPUBLIC

AGREEMENT NO: 720FDA18GR00202

REPORTING PERIOD: OCTOBER 1, 2018- MARCH 31, 2019

PRESENTED TO:

THE USAID OFFICE OF FOREIGN DISASTER ASSISTANCE

Collaborating Partner: Agency Headquarters: International Rescue Committee/CAR International Rescue Committee c/o Mohammed Chikhaoui, Country Director c/o Erika Pearl, Program Officer Tel: +236 72136704 Tel : +1 212 377 4019 E-mail: [email protected] E-mail: [email protected]

SUBMITTED: MAY 16, 2019

Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham- Pende and Nana-Gribizi, Central African Republic (720FDA18GR00202)

I. Executive Summary

a) PROGRAM TITLE: Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham-Pende and Nana-Gribizi, Central African Republic

PROJECT NO: 720FDA18GR00202

AGENCY: International Rescue Committee

COUNTRY: Central African Republic

CAUSE: Health and Protection

PROJECT PERIOD: 12 months (October 1, 2018 – September 30, 2019)

b) OBJECTIVE: Improve access to and quality of local health care system and protection services for the affected populations in the prefectures of Nana Gribizi and Ouham Pende

BENEFICIARIES: Total number of beneficiaries targeted: 89,753 direct beneficiaries, including 27,109 IDPs Total number of beneficiaries reached to date: 75,379, including 22,613 IDPs

LOCATION: Central African Republic, Ouham Pende and Nana Gribizi Prefectures

 Bocaranga: Zaguindi Health Post, Koui Health Center, Sangami Health Post, Mbotoga Health Center, Bocaranga District Hospital (Ouham Pende)  Ngaoudaye: Kosse Health Post, Boko Health Post, Kollo Health Post, Nzakoune Health Post, Kowone Health Post, Ngaoundaye Hospital (Ouham Pende)  Kaga-Bandoro: Kaga-Bandoro Health Center and MINUSCA and Lazare IDP sites (Nana Gribizi Prefecture)

1 Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham- Pende and Nana-Gribizi, Central African Republic (720FDA18GR00202)

Introduction

The security situation has improved in Bocaranga sub-prefecture since the deployment of Central African Armed force in the city of Bocaranga in January 2019. In Koui and Ngaoundaye sub-prefectures, the security situation is relatively calm despite the presence of rebel groups in the area. No major incidents have been reported against humanitarian partners in these sub-prefectures since the beginning of this project in October 2018. As a result of this improvement in the security situation, some Central African refugees are starting to return from Chad and Cameroon to their villages. According to the OCHA report of March 19, 2019,1 532 households returned between October 2018 and March 2019 to Bezere in Bocaranga sub-prefecture. IRC programs were suspended for a two- week period in early March 2019 on the Koui-Sangrelim axis. As a matter of fact, General Sidiki, the leader of the 3R armed group, restricted access from Makounzi Wali to Koui (Bocaranga Prefecture) to all members of the government, MINUSCA and NGOs beginning March 4, 2019. As a consequence, all humanitarian actors active in Koui suspended their activities pending political discussions between 3R and the government. During this time, the humanitarian community (represented by OCHA) and local authorities were also advocating for access to Koui. On March 12, a meeting was organized between General Sidiki and the humanitarian community; General Sidiki consequently granted NGOs access to the Koui-Sangrelim area.

In Kaga-Bandoro city, tensions continue to be exacerbated between the ex Seleka armed group, located north of the bridge over the Nana River, and the auto defense groups (GAD), located south of the bridge. Several robberies of civilians and humanitarian by armed groups, especially on the axis from and to Kaga-Bandoro city, were regularly reported. Along with other INGOs in the area, the IRC occasionally timed its field movements to those of MINUSCA patrols to gather information on the security situation and thus to ensure the staff’s safety, to regularly monitor security incidents and to comply with the IRC’s rigorous security procedures. This did not impact the IRC’s activities.

In October 2018, a Hepatitis E outbreak was declared in Ouham Pende prefecture. 140 cases were confirmed and 2 deaths reported. Under the coordination of the WHO, partners were mobilized to provide support to the districts affected by the outbreak in terms of treatment, community mobilization, logistics and WASH support. The IRC supported the health districts of Ngaoundaye and Bocaranga by providing health staff for pediatric services and assisted community health workers in conducting community mobilization sessions to prevent the spread of the outbreak and promote best hygiene practices.

On February 7, 2019, a fire broke out at the MINUSCA IDP Camp not far from the IRC mobile clinic. The IRC mobile clinic in the MINUSCA Camp was partially burned, although not structurally damaged and plastic sheeting melted due to the heat. The fire was due to a bush fire near the IDP Camp and nearby shelters burned very quickly due to the dry season. Luckily, there were no serious casualties (or burns). The mobile clinic was closed on February 8, 2019 and service provision resumed the next day.

II. Summary of Activities

A. Health

Number of beneficiaries targeted: 89,753 beneficiaries, including 27,109 IDPs Number of beneficiaries reached: 75,379, including 22,613 IDPs

From October 2018 to March 2019, the IRC has supported 12 Ministry of Health (MoH) heath facilities, including five in Bocaranga/Koui, six in Ngaoundaye, and one health facility and two mobile clinic sites in Kaga-Bandoro. The IRC provided basic health services, including curative consultations, reproductive health, health education, hygiene promotion, the expanded program of immunization, provision of essential drugs and capacity building to MoH health staff through formal and on the job training to enhance quality of care.

With 75,379 direct beneficiaries reached thus far, the IRC has reached 84% of its expected beneficiaries over a six month period, meaning it is well on track to meeting its target. Of those reached, 15,850 were children under 5 years old, representing 21% of total beneficiaries reached.

1 OCHA, Rapport de visite de suivi de la situation humanitaire au village Bezere, 19 March 2019

2 Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham- Pende and Nana-Gribizi, Central African Republic (720FDA18GR00202)

Sub-Sector 1: Health Systems and Clinical Support

As mentioned above, the IRC contributed to addressing the most urgent primary health care gaps in the 12 MoH health facilities and two IRC mobile clinic sites. IRC health staff reinforced health facility staff capacity through monthly technical support and direct supervision to ensure that consultations were carried out according to WHO / MoH protocols Technical supervision focused on the provision of quality basic emergency services such as outpatient consultations, life-saving emergency referrals, antenatal and post-natal care, immunization activities and community mobilization. The IRC health staff provided refresher training for 54 health staff on BEmONC (Basic Emergency Obstetric and New Born care) and treatment protocols for malaria, diarrhea, and respiratory tract infections. The table below shows the number of health workers who participated in the training.

Training topics Male Female Total Treatment protocols for malaria, diarrhea, respiratory tract infection 12 health 12 (4 24 workers midwives and 8 matrons) BEmONC 19 health 11 (4 30 workers midwives et 7 matrons) Total 31 23 54

Curative consultations: During this reporting period, 28,989 outpatient consultations were performed. This represents approximately 40.3% progress rate on the IRC’s total target of 71,804 expected outpatient consultations annually. As explained in the “Challenges” section below, some activities were delayed due to the late signature of the MoU between the Health District (in Ouham Pende) and the IRC.

During the reporting period, the IRC-supported health facilities saw 12,491 consultations in Ouham Pende prefecture, 16,498 consultations in Nana Gribizi prefecture and 46.5% of them concerned IDPs. 13,336 consultations concerned children under 5 years old representing 46% of total consultations.

Progress against target in Progress against target in Nana Gribizi Ouham Pende 4500 6000 4000 5000 3500 3950 3724 3724 3724 3724 3724 3724 3000 3603 3545 4000 2259 2500 2259 2259 2259 2259 2259 3000 2000 2968 2100 1500 2000 2432 2655 1700 1000 1600 1940 1000 1489 500 1007 0 0 Oct Nov Dec Jan Feb March Oct Nov Dec Jan Feb March

Targets reached Targets reached

The number of consultations in Nana Gribizi was below the target for the first three months before it picked up from January through March 2019, which may be related to the low availability of pharmaceuticals in all facilities for the

3 Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham- Pende and Nana-Gribizi, Central African Republic (720FDA18GR00202) first three months of the project (October to December 2018). In Kaga-Bandoro, the IRC signed the protocol with the Health District in November 2018. Therefore, the pharmaceuticals were distributed in December 2018 in Kaga- Bandoro. In Ouham Pende, the protocols with the Health Districts (Bocaranga and Ngaoundaye) were signed in January 2019. Pharmaceuticals were delivered in February 2019, which also explains the difference between what was reached and what was expected for all six months.

Referrals: Health staff in the 12 IRC-supported health facilities and two mobile clinics referred 320 patients with medical complications to Ngaoundaye, Bocaranga and Kaga-Bandoro hospitals. Nearly 60% of these referrals were patients over 5 years old. The main reasons for referrals included complications resulting from acute respiratory tract infections, complications due to incomplete abortions performed at non-IRC supported health facilities, severe anaemias, and severe acute malnutrition with medical complications.

Mobile clinic consultation in Kaga-Bandoro, 15 February Supervision visit in Bocaranga outpatient department (OPD), 2019 25 March 2019

Joint supervision and coordination meeting: During the reporting period, the IRC, in collaboration with health district staff in Bocaranga, Ngaoundaye and Kaga-Bandoro conducted five joint supervision missions from January 2019 to March 2019, including one each in Koui, Ngaoundaye, and Bocaranga and two in Kaga-Bandoro. Such joint supervisions have enabled the IRC to engage regional and district health authorities in IRC health activities as well as in supervision of activities conducted by health facilities they oversee. During these visits, the IRC and authorities reinforced the need for timely reporting (weekly and monthly reports) and introduced a tool to track drug consumption. Health facility staff expressed appreciation for these regular supervision visits. Since then, the IRC has noticed an improvement in reporting and data quality, and a greater willingness to share information, which altogether help the IRC teams and regional and district health authorities better understand the needs in the project’s intervention areas. The setup of monitoring tools also helped better organize the health center’s work and ensure it is responsive to communities’ needs. IRC staff participated in national and district level meetings, such as health and nutrition coordination meetings and quarterly meetings with health district authorities.

Sub-Sector 2: Communicable Diseases

Communicable diseases: During the reporting period, IRC-supported health facilities and mobile clinics conducted 25,161 consultations for communicable diseases (10,296 in Ouham Pende and 14,865 in Nana Gribizi). The top five morbidities were: malaria (representing 41% of total consultations), acute respiratory infection (20%), diarrhea (6%), sexual transmitted diseases (4%) and severe acute malnutrition (4%).

Mortality: Fourteen (14) deaths were recorded from October 2018 to March 2019, including four children who died either from acute respiratory infection, severe anemia or severe acute malnutrition. Nine (9) women died after delivery (3 within the community and 6 at the hospital) and one man died in Bocaranga Hospital due to severe malaria. All of these deaths were recorded 24 hours after they were admitted, which may be explained by the fact that they arrived to the hospital too late. In other words, their complications could have been treated had they come

4 Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham- Pende and Nana-Gribizi, Central African Republic (720FDA18GR00202)

earlier. The IRC will continue outreach activities and awareness raising to encourage people to attend health facilities before it has become too serious for proper treatment.

Expanded program of immunization (EPI): In an effort to prevent epidemic-prone diseases among children, the IRC supported immunization in the 12 health structures (11 in Bocaranga and one in Kaga-Bandoro) and one mobile clinic that serves two IDP sites by providing:  40 liters of fuel per facility per month to maintain the cold chain for vaccine storage ;  Financial incentives to community health workers for community-based outreach activities and incentives to MoH health staff involved in immunization activities; and  Procurement of supplies, cold chain equipment and vaccines, as well as commodities from UNICEF through the health district.

From October 2018 to March 2019, 2,514 children between 0 and 12 months received various types of vaccines in IRC-supported health facilities and two sites served by the IRC mobile clinic. The graph below shows the number of children vaccinated according to the national vaccination protocol. Children vaccinated

Reached 506 s

Target 1990 Measle Reached 973

nta 3 nta Target 1990 PCV/Pe Reached 1035

BCG Target 1057

0 500 1000 1500 2000 2500

SIA in MINUSCA mobile clinic Kagabandoro, March 19, 2019 There is a significant gap in the number of vaccinations carried out against the number expected for measles and Penta 3 as a result of low turnout and occasional lack of vaccine stocks. The vaccination pharmaceuticals are provided and managed by the Ministry of Health. The IRC will continue awareness raising activities to encourage more women to bring their children for EPI services and will help health facilities to monitor the drug stock to order vaccines in advance.

Sub-Sector 3: Reproductive Health

Antenatal and post-natal consultations: Throughout the IRC-support health facilities and mobile clinics, 3,407 pregnant women received antenatal consultations, including 1,704 pregnant women who attended at least two comprehensive antenatal clinics. Through the community health workers, the IRC will continue outreach activities and awareness to encourage more women to attend a second prenatal consultation, to deliver in health facilities and to attend postnatal consultations.

Of those who attended antenatal consultations, 2,266 pregnant women received preventive malaria treatment, 2,687 received the tetanus vaccine, and all 3,407 received preventive treatment against anemia (iron deficiency). 1,850 treated mosquito nets donated by UNICEF were distributed to pregnant women who attended antenatal clinics. During antenatal care consultations, women who consented to rapid diagnosis tests received the following results:

Rapid test Total tested Positive % Malaria 1,844 1,141 61.8 Syphilis 942 22 2.3 HIV 810 28 3.5

5 Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham- Pende and Nana-Gribizi, Central African Republic (720FDA18GR00202)

The malaria rate is high because most people either do not have mosquito nets or do not use them as they feel it is too hot to sleep under a mosquito net. All cases of malaria and syphilis were treated, and all patients with positive HIV results received counseling and started treatment.

Of the 572 postnatal consultations performed at IRC-supported health facilities and mobile clinics, 290 were with newborns who received postnatal care within three days after delivery. This low rate is explained by cultural habits; during sensitizations and home visits, IRC teams learned that after childbirth, the child stays in-house for a month to be protected against evil spirits. The IRC’s plan is to continue raising awareness in the community for behavior change.

Delivery: During the reporting period, 1,057 deliveries were recorded in the catchment areas of 11 health facilities supported by the IRC in Bocaranga, Koui and Ngaoundaye, including 991 deliveries that were assisted by a skilled attendant in health facilities. 66 deliveries were recorded at community level, representing 6.2% of total deliveries. The Kaga-Bandoro hospital’s maternity ward is supported by the ICRC; the IRC therefore does not record the deliveries here.

Family planning: 595 women benefited from family planning services provided by MOH staff in Bocaranga/Koui and Ngaoundaye health facilities, among which 324 were new patients. 4,057 male condoms were also distributed. This low rate compared to IRC target of 9,424 is explained by fear or experience of side-effects; cultural or religious opposition and gender-based barriers; shortage of family planning supplies provided by UNFPA through the health district.

Distribution of FP methods

IMPLANTS 47

MALE CONDONM 4057

INJECTION 364

ORAL 184

0 1000 2000 3000 4000 5000 Antenatal consultation in Bocaranga health center, 28 March 2019

Most women prefer injectable contraception to others methods as the protection is longer-term and they can obtain it without their husbands knowing. The IRC’s plan is to raise awareness among men to allow their wives to use any method of contraception. During the remaining project period, the project will support community health workers in engaging men and women in dialogues around family planning through home visits and focus group discussions.

Sub-Sector 4: Community Health Education/Behavior Change

In collaboration with community leaders, the IRC identified 90 CHWs (29F, 61M)—22 in Kaga-Bandoro sub- prefecture, 25 in Bocaranga, 12 in Koui and 31 in Ngaoundaye sub-prefectures. CHWs were selected based on the population’s size (1 CHW per 500 to 1000 people) and trained on hygiene promotion and health education issues, including sanitation, infant and young child feeding, malaria and diarrhea prevention, and the benefit of ante- and postnatal care, with the purpose of disseminating information and encouraging healthy behaviors among the population, with a special focus on pregnant and lactating women and children under 5. These training sessions took place during the IRC’s supervision visits from November through March (involving the team for about one week per month for all sites). Overall, CHWs are the link between the health facilities and the communities and perform community outreach health activities under the supervision of the IRC community mobilization officer.

6 Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham- Pende and Nana-Gribizi, Central African Republic (720FDA18GR00202)

CHWs reached 75,379 people through awareness raising (10,834 were in Kaga-Bandoro and 64,545 in Bocaranga, Koui and Ngaoundaye sub-prefectures). The CHWs organized mass awareness raising sessions by gathering people in targeted villages and IDP sites. People were also sensitized by CHWs and health workers during their consultations at the health centers. The table below shows the number of beneficiaries reached by message.

Awareness raising session Male Female Total Hygiene promotion practices 10,789 12,105 22,894 Infant and young child feeding practices 5,050 16,888 21,938 Health education (malaria, diarrhea prevention) 16,234 14,313 30,547 Total 32,073 43,306 75,379

Awareness raising focus group discussion in Bocaranga , 6 Awareness raising session in Kaga-Bandoro, 16 January 2019 February 2019

Sub-Sector 5: Medical Commodities including Pharmaceuticals

The essential basic drugs ordered by the IRC to support MoH health facilities were dispatched in December 2018 in Kaga-Bandoro and in February 2019 in Ouham Pende due to a delay in signing the memorandum of understanding between the IRC and MoH at district level. No stock outs were reported in any of the facilities supported by the IRC after pharmaceuticals were received (drug stocks are only tracked for IRC-purchased supplies). A drug consumption tracking tool was distributed to 11 MoH staff (10 men and 1 woman) and staff were trained on the use of that tool in March 2019.

The IRC also trained 34 MoH staff (22M, 12F) on rational management of essential drugs in March 2019 during IRC’s staff supervision visits.

Drug donation to Koui health center, 15 February 2019 IRC medical storage in Bangui, 9 February 2019

B. WASH Sector

7 Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham- Pende and Nana-Gribizi, Central African Republic (720FDA18GR00202)

Sub-sector 1: Environmental Health During the reporting period, the IRC carried out a needs assessment of WASH infrastructure rehabilitation in 11 of the 12 IRC-supported health facilities and two IDP sites in Kaga-Bandoro served by the IRC’s mobile clinic (see Annex 2) and rehabilitated three hand pumps (one each in Boko, Ngaoundaye Hospital and Zanguindi) and the latrine at Ngaoundaye Hospital, which are all in progress. The delays in implementing WASH activities are also due to the late signature of the protocols between the IRC and Health Districts.

The IRC plans to carry out the following activities in the last six months of the project:  Finalization of the rehabilitation of the Boko (Ngaoundaye) pump;  Finalization of the rehabilitation of the hand pump at Ngaoundaye Hospital;  Finalization of the rehabilitation of the Bogang II pump (Zaguindi);  Rehabilitation of septic tanks in Mbotoga maternity ward;  Rehabilitation of one latrine block and a shower at Ngaoundaye hospital;  Purchase and set up of hand and body wash systems for supported health centers.

Sub-sector 2: Sanitation The collaboration protocols also delayed the implementation of sanitation activities in the Bocaranga, Ngaoundaye and Kaga-Bandoro areas. While protocols were being signed, however, the IRC carried out the aforementioned needs assessment for WASH infrastructure rehabilitation (Annex 2). Before the end of the project, the IRC will:  Rehabilitate waste areas (Incinerator, garbage pits, placenta pits) in the health facilities; and  Carry out awareness sessions on handwashing addressed directly to the health workers of the health facilities.

Sub-sector 3: Hygiene Promotion 22,894 people received direct hygiene promotion education in Lazare and MINUSCA IDP sites (excluding mass media campaign and without double counting) which represents 26% progress rate on the IRC’s target of 89,752 people. The same activity will be implemented in Ouham Pende prefecture for the remaining period of the project in order to reach the target as this intervention area has the highest number of targeted beneficiaries.

Toilet of Ngaoundaye hospital that will be rehabilitated under this project

C. Protection

Number of beneficiaries targeted: 10,000 beneficiaries, 3,000 IDPs Number of beneficiaries reached: 10,592 beneficiaries, 2,917 IDPs

Sub Sector 1: Prevention and Response to Gender-based Violence Training of community volunteers, GBV focal points and community relays: From January 15 to 17 in Kaga- Bandoro, the IRC strengthened the capacities of five community volunteers, three GBV focal points and seven community health relays on fundamental concepts of GBV, the referral system for GBV , as well as outreach and

8 Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham- Pende and Nana-Gribizi, Central African Republic (720FDA18GR00202) community mobilization techniques. The IRC targeted community health volunteers since they are far reaching, firmly based within their communities, and can sustainably continue project activities (awareness raising, referrals) beyond the life of this project. A total of 15 people took part in this training, including 8 men and 7 women.

Training of community leaders: In February 2019, the IRC trained 144 community leaders including 100 men and 44 women in Kaga-Bandoro and Ouham Pende on: key GBV concepts; the referral pathway; available services for GBV survivors; the importance of accessing services within 72 hours for rape survivors; and community leaders’ roles and responsibilities with regards to GBV prevention and referral. Site Date Women Men Total Ouham Pende: Mbotoga (Bocaranga) 12 to 14 February 2019 05 24 29 Ouham Pende: Boukaya (Bocaranga) 12 to 14 February 2019 03 27 30 Ouham Pende: Ngaoundaye 18 to 20 February 2019 19 11 30 Ouham Pende: Ngoutere 18 to 20 February 2019 04 26 30 Kaga-Bandoro: 12 to 14 February 2019 13 12 25 MINUSCA and Lazare sites TOTAL 44 100 144

Training with community leaders in Boukaya, 12 to 14 February 2019

1.3 Training of community based organization (CBO) members From February 20 to 23, 2019, the IRC strengthened the capacities of 30 members of five CBOs (all women) based in Kaga-Bandoro on entrepreneurial skills through the CEFE2 methodology. The IRC has been working with CBOs since 2015 as part of a strategy to reach out to communities and ensure sustainability of project activities and impact. The IRC has CBOs in conducting awareness raising activities and EA$E group discussions (an approach to improve management of household finances between men and women). Since CBOs are officially registered at the local level, are active within the communities already, and already practice some income generating activities (IGAs), the IRC is working to support them in creating longer-term development and strengthening their economic empowerment.

1.4 Awareness raising and outreach activities During the reporting period, the IRC organized 110 awareness raising sessions, reaching 9,727 people (including 2,848 IDPs).

Site/n. of sessions Women Men Girls Boys TOTAL Ouham Pende: 25 sessions (Bocaranga, 2,580 1,032 1,245 741 5,698 Boukaya, Sangami, Ngaounadye, Koui, Ngoutere, Kelle-Clair, Mbotoga) Kaga-Bandoro: 85 sessions (MINUSCA 1,692 896 999 542 4,129 and Lazaret IDP sites and town center, as well as the hospital) TOTAL 4,272 1,928 2,244 1,283 9,727

2 Competency-based Economies, Formation of Enterprise is experiential, hands-on learning for business skills training.

9 Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham- Pende and Nana-Gribizi, Central African Republic (720FDA18GR00202)

The sensitizations were facilitated by IRC staff and community volunteers; also, some sensitizations were performed by GBV focal points at the hospital, targeting pregnant and lactating women, as well as women and girls who attend the health centers for family planning. The sensitization themes were:  Types of GBV;  The impact of GBV on survivors (physical- and health-related, psychological, emotional and social effects);  Available GBV care services;  The importance of accessing care within 72 hours for rape cases;  The differences between: “power over (someone/something)”; “power with” and “power to” and their effects on the community and family life. After this awareness raising, the IRC carried out focus groups to Sensitization session in Kaga-Bandoro, determine how many of the beneficiaries had retained knowledge on MINUSCA IDP site, January 28, 2019 GBV prevention and response. The percentages on the right in the table below illustrate how many people demonstrated their knowledge on GBV, its effects and the referral system.

Assessment on the level of knowledge on GBV % who demonstrate Date Site Men Women Girls Boys GBV knowledge 11 March 2019 Mbotoga 15 15 20 17 64% 14 March 2019 Bocaranga 00 37 35 00 79% 15 March 2019 Yadé 35 40 27 00 73% 15 March 2019 Koui 16 34 13 00 80% 26 March 2019 Bezerè 12 13 11 09 46% Total 78 139 106 26

Assistance and response to GBV survivors: 263 GBV cases, including 233 women and 30 girls (with a total of 69 IDPs) were reported at the IRC’s listening centers in Ouham Pende and Nana Gribizi. The breakdown is the following:  161 rape cases, including 126 in the 72 hour timeframe who received PEP kits. Among the 161 cases, 32 were gang rape cases reported mostly in Nana Gribizi prefecture. While this is occasionally reported, this is the first time such a widespread account has been reported. It has dumbfounded the GBV sub- cluster and will be discussed in further meetings.  12 sexual assault cases  65 physical assault cases  1 early marriage case  19 denial of resources and opportunities cases  5 psychological violence cases

68 survivors received a dignity kit.3 The small number of kits distributed is due to the delays in their delivery in Kaga- Bandoro (March) and Bocaranga (February). 238 survivors received health care services at Kaga-Bandoro hospital and the health facilities in the three sub-prefectures of Bocaranga, Koui and Ngaoundaye. All 263 survivors benefited from psychosocial support in 11 listening centers, including 184 cases in three listening centers in Kaga- Bandoro and 79 cases in eight listening centers in Ouham Pende. The IRC referred three rape cases (girls) to MINUSCA UNPOL for judicial support.

Engaging Men in Accountable Practices (EMAP) Group discussions: In Sangrelim, two group discussions were set up in February 2019; 60 women (30 per group) from CBOs were identified for this activity. These 60 beneficiaries participated in EMAP group discussions meant to give women the opportunity and the space to express and share

3 Each dignity kit is composed of: sanitary napkins; underwear ; bucket; cloth; sandals ; laundry and hand soap; head scarf; toothpaste and toothbrush; lotion; cup; blanket; and a packing bag.

10 Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham- Pende and Nana-Gribizi, Central African Republic (720FDA18GR00202) the violence they have experienced in their homes and communities, as well as to recommend changes that need to happen in their homes and communities to make them feel safer.

Sub-Sector 2: Child Protection

Construction of Safe Healing and Learning Spaces (SHLS): The IRC identified areas for the construction of two SHLSs with the participation of community and religious leaders in Bang (Ngaoundaye) and Bocaranga. Construction and the purchase of recreational material for the spaces will be completed during the second half of the project. SHLSs are part of safe community structures, where children play during crisis situations; community volunteers organize recreational, creative and educational activities and share messages on good practices concerning hygiene, protection and social cohesion. One listening room will be built in each SHLS for children in need of individual care, which will be provided the IRC’s Child Protection Assistants.

2.2 Community sensitization on child protection One mass sensitization on child protection and children’s rights was organized in Bang (Nagoundaye) and Bocaranga targeting local authorities, community and religious leaders, Community Networks for Child Protection (RECOPE), youth clubs and volunteers. The goal was to have community members engaged and participating in the implementation of child protection activities in the intervention areas. Site Women Men Girls Boys TOTAL Bocaranga 96 54 19 17 186 Bang (Ngaoundaye) 43 85 18 26 172 TOTAL 139 139 37 43 358

2.3 Set up of new community mechanisms for child protection (RECOPE, Youth Clubs) In February 2019, the IRC established four child protection community mechanisms, including two RECOPE and two youth clubs, to identify vulnerable and at-risk children and youth in need of support. The strategy of implicating community members in the prevention and response efforts for children needing protection support in emergency situations is based on the fact that certain child protection issues are rooted in cultural practices; thus, trusted members of the community are therefore best placed to lead these activities.

The table underneath indicates RECOPE and youth clubs as community based child protection mechanisms put in place in the sub prefectures of Bocaranga and Ngaoundaye with members desegregated by sex. Site Type of child protection Women Men Girls Boys Total mechanism Bocaranga RECOPE 9 6 0 0 15 Bang RECOPE 4 11 0 0 15 (Ngaoundaye) Bocaranga Youth Club 0 0 6 9 15 Ngaoundaye Youth Club 0 0 7 8 15 Total 13 17 13 17 60

2.4 Profiling and reintegration of vulnerable children The criteria for identifying and selecting vulnerable children will be defined by RECOPE and community members with IRC support. The identified children will benefit from holistic care including school and socio-professional reintegration. After these beneficiaries are identified, IRC teams will work with the children to provide an orientation to the process and help them choose whether they want to continue going to school or start working. Children who wish to continue studying will have their school fees paid; those who wish to attend vocational training (starting with those who are 15 years old or older) will be assisted in choosing an adapted vocational training that responds to market needs.

A list of 180 children formerly associated with armed groups and armed forces in Ouham Pende was shared with the IRC by War Child UK, a non-governmental organization that works to rehabilitate, protect and educate former child soldiers. IRC is carrying out a needs assessment for these children to understand their vulnerability before being reintegrated into school or attending vocational training according to his/her age (starting at 15 years old) and

11 Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham- Pende and Nana-Gribizi, Central African Republic (720FDA18GR00202) wishes. Although it took longer than expected for War Child UK to share the list, the IRC expects to achieve its goal by the end of the project period,

2.5 Strengthening the capacity of caregivers to protect children The IRC established three parent/caregiver groups of 25 individuals each, one group in each of the prefectures. The members were selected on two criteria: the first is that they are willing and able to participate in child protection activities and the second is that they are trusted members of the community. - Bocaranga: 14 men and 11 women - Koui: 13 men and 12 women - Bang (Ngaoundaye): 16 men and 9 women In the coming months, these groups will attend capacity building sessions on child protection and psychosocial care with the goal of improving positive parenting practices and children’s wellbeing in their communities.

2.6 Identification of community volunteers The IRC identified 10 community volunteers, including five in Bocaranga (3M, 2F) and five in Ngaoundaye (3M, 2F), to lead activities in Child Friendly Spaces, centers where children can participate in educative and socio-recreational activities to promote their development and safety. In these centers, community volunteers are also responsible for raising awareness of child protection issues and services with community members.

3. Sub Sector 3: Psychosocial Support Services 3.1 Safety Audits The IRC conducted five security audits in March in Mbotoga (Bocaranga) on 11 March 2019, Bocaranga on 14 March 2019, Koui on 15 March 2019, Yade on 15 March 2019 and Bezere on 26 March 2019. 271 community members, including 83 women, 66 girls, 75 men and 47 boys, took part in these focus group discussions. The safety audits report the following: - Women and girls do not feel safe leaving their homes and walking through their fields. Girls are often raped near the villages; women live in fear because they cannot go to cultivate their fields or to collect water safely. - This is the transhumance period and herds stray throughout the forest. Armed men search for nomadic animals (mainly cows) to steal them. This situation creates tension and there is a risk of reprisal attacks, therefore increasing protection risks, by those who practice transhumant livestock farming). The population is displaced because of fear of being attacked. - As drinking water is not easy to find or access, some women and girls are must sometimes fetch water from far away water points, exposing them to significant risks of sexual violence.

3.2 Construction and rehabilitation of listening centers Prior to this OFDA-funded project, the IRC used office space to serve as a listening center. With its current OFDA funding, the IRC has decided to build a listening center within the Kaga-Bandoro Hospital for greater independence and to ensure the confidentiality and security of survivors. In collaboration with the doctor of the Health District of Nana-Gribizi, a space was identified and construction work is underway.

In Bocaranga, with the same objective of guaranteeing the safety and confidentiality for survivors, a fence around the existing listening center is being built and is almost completed.

Listening Center in Bocaranga: construction of a fence, 19 March 2019

12 Integrated Health Care, Protection and Water, Sanitation, and Hygiene (WASH) Interventions for Conflict Affected Populations in Ouham- Pende and Nana-Gribizi, Central African Republic (720FDA18GR00202)

III. Indicator Tracking Please see Annex 1: Indicator Tracking Table.

IV. Constraints and lessons learned

The delay in the implementation of this project is due to the delays in signing the agreement between the IRC and the health districts of Bocaranga-Koui and Ngaoundaye; this led to delays in dispatching pharmaceuticals until December 2018 in Kaga-Bandoro and February 2019 in Ouham Pende. Health workers in the intervention areas also demanded an increase in financial incentives, putting pressure on health authorities who then in turn refused to sign off on their agreements with the IRC. Thanks to the direct intervention of the Health Ministry, it was possible to sign those protocols in Bocaranga and Ngaoundaye. The lack of drugs (which were ordered abroad) frustrated the community. The very close implication of the district and regional health authorities (through supervisions and follow-up visits) made it possible to integrate them strongly in the follow-up of the activities in the health facilities supported by the IRC.

The insecurity in the areas of project implementation occasionally hindered or caused intermittent suspension of the IRC’s activities as was the case of the Koui sub-prefecture in March 2019 as described in the introduction aboveThe resumption of activities was possible thanks to the advocacy efforts to restore humanitarian access led by NGOs, including the IRC, represented by OCHA.

The various trainings organized for community leaders, CBO members, GBV focal points and volunteers show that they know the importance of referring survivors to care services and thus the importance of this type of training. Out of the 263 cases of referred survivors, 40 cases were self-referred, 31 cases were referred by community leaders, 27 cases by community members and 11 cases by members of the CBOs. To improve access to care, the IRC plans to increase awareness raising on women’s rights to receive assistance, for men and community leaders on the importance of care, and for leaders on their roles and responsibilities in the prevention of GBV.

13 Rev. 27 Mai 2018

USAID/OFDA Monitoring Plan Table Template

Organization International Rescue Committee Program Title Improving access to free and quality healthcare to displaced populations CAR in Ouham Pende, Nana Gribizi and Kemo prefectures Location Ouham Pende,Nana Gribizi and Kemo prefecture Budget $1,900,000 Period of Performance NA

Sector Health Sub-Sector Health Systems and Clinical Support

Data Collection Data Collection Methododology of Data source of Location and timing of Limitations Analysis Observations Indicator Indicator definition Baseline Target Data Collection Method Position Responsible for Collection Source Frequency baseline baseline baseline

Health facility: A place that provides health care; a dispensary, health post, health center, health clinic (fixed or Baseline data is Number of health facilities mobile), or hospital. After the distribution of These are 12 of the same Visiting and taking pictures of Facility Reports, IRC Health Managers and IRC Monitoring and gathered from supported Supported: Having received any type of training, rehabilitation, 12 12 kits, follow up every N/A N/A N/A N/A health centers supported under post and health Monitoring Data Evaluation Officers previous project, AID- supplies and/or staffing with USAID/OFDA funding. For the month AID-OFA-G-17-00256. OFDA-G-17-00256. purposes of this indicator, facilities that are only rehabilitated with USAID/OFDA funding should not be included. Health care staff: People working in or alongside a health facility, working towards a common goal for improving the health status of the surrounding population/catchment area. Includes people formally trained (e.g., doctor, nurse) and informally trained (e.g., traditional birth attendants) as well as No baseline carried any cleaning staff and clerks. Technical narratives must 57 (38 health workers, List of attendants, out as the IRC is Compile data from training IRC Monitoring and Evaluation Officers and Health Number of health care staff trained specify the type of health care worker/staff and trainings to 0 4 midwives, 15 Project database, At the time of trainings planning both new N/A N/A N/A N/A N/A rosters and records Manager be given. matrons) Monthly reports and refresher Trained: The sum total of the individuals who completed all trainings for staff. requirements specified for successful completion of a specific training that may include attendance and/or written, verbal, or hands-on demonstration of knowledge and skills.

Percentage of total weekly Surveillance report: Official documentation as required by the 100% 100% Review of surveillance Surveillance reports Weekly IRC Monitoring and Evaluation Officers surveillance reports submitted on Ministry of Health (MoH), WHO, or coordinating health reports/project records and project reports time by health facilities authority on which timely information is collected on epidemic-prone diseases in order to trigger prompt public health response and appropriate intervention. The surveillance system may be referred to as an Early Warning and Response Network/System (EWARN/S). The diseases to be reported on are determined by the MoH, WHO, and/or coordinating health authority, based on local epidemiology. Baseline data is All 13 health centers submitted On time: Received by health authorities and/or coordination gathered from N/A N/A N/A N/A weekly reports under AID-OFA- body by the established deadline. A standardized reporting previous project, AID- G-17-00256. period of every seven days (weekly) is expected, but a OFDA-G-17-00256. reporting cycle and submission deadlines will be agreed upon by the MoH/WHO/coordinating health authority. This indicator does not refer to more immediate or ad-hoc reporting that may be required for certain conditions or within the context of an outbreak response. Health facility: A place that provides health care; a dispensary, health post, health center, health clinic (fixed or mobile), or hospital. F th f thi i di t i l d l h lth f iliti Outpatient: A non-hospitalized individual. This indicator is not Consultations: A visit by a patient to a health care provider in 17,951 per quarter x 4 Patient registers from the subject of a Compiled data from supported IRC Monitoring and Evaluation Officers and Health This will be measured once Number of outpatient consultations which the patient presents with a problem or issue and the 0 quarters = 71,804 supported health Monthly baseline survey as it N/A N/A N/A N/A outpatient facilities Manager activities begin. health care provider provides medical evaluation, diagnosis, annually facilities is to be measured treatment, and/or referral for that person. once activities begin. Sector Health Sub-Sector Communicable diseases

Communicable disease: An illness caused by an infectious agent or its toxins that occurs through the direct or indirect This indicator is not Compile data from supported transmission of the infectious agent or its products from an 13,284 consultations the subject of a health acilities and supported Patient registers from Number of communicable disease infected individual or via an animal, vector, or the inanimate per quarter x 4 quarters IRC Monitoring and Evaluation Officers and Health baseline survey as it This will be measured once 0 CHW programs to calculate the supported health Monthly N/A N/A N/A N/A consultations environment to a susceptible animal or human host. = 53,136 annual Manager is meant to be activities begin. sum total of consultations for facilities Consultation: A visit by a patient to a health care provider in consultations measured once each disease specified. which the patient presents with a problem or issue and the activities begin. health care provider pro

Sector Health Sub-Sector Reproductive Health

Number and percentage of Attended: Presented to a health service delivery point and Compile data from supported pregnant women who have received services required for antenatal visits. 824 (80%) per quarter x health facilities and supported Patient registers from IRC Monitoring and evaluation Officers and Health attended at least two Comprehensive antenatal clinics: The complete package of 0 4 quarters = 3396 CHW programs to calculate the supported health Monthly Manager comprehensive antenatal clinics antenatal services as prescribed by MoH policy and delivered annually (80%) sum total of consultations for facilities by a trained health care worker. each disease specified.

Received: Attended to or seen by a trained healthcare Compile data from supported Number and percentage of provider at a health facility, at home, or at the community- 425 (80%) per quarter x health acilities and supported Patient registers from newborns that received postnatal level. IRC Monitoring and evaluation Officers and Health 0 4 quarters = 1700 CHW programs to calculate the supported health Monthly care within three days of delivery Postnatal care: The complete package of interventions as Manager annually (80%) sum total of consultations for facilities prescribed by MoH policy delivered by a trained healthcare each disease specified. worker

Assisted by: Present and presiding over labor and delivery for a pregnant woman and trained/available to perform assessment and the seven signal functions of basic These indicators are emergency obstetric and newborn care (BEmONC), including Compile data from supported not the subject of a Number and percentage of management of complications or recommending referral, as 340 (80%) per quarter x health facilities and supported Patient registers from baseline survey as This will be measured once pregnant women who deliver IRC Monitoring and evaluation Officers and Health N/A N/A N/A N/A needed. 0 4 quarters = 1360 CHW programs to calculate the supported health Monthly they are to be activities begin. assisted by a skilled (not Manager Skilled (not traditional) attendant at birth: An accredited health annually (80%) sum total of consultations for facilities measured once traditional) attendant at birth professional who possesses the knowledge and a defined set each disease specified. activities begin. of cognitive and practical skills that enable the individual to provide safe and effective health care during childbirth to Sexualwomen violence:and their Anyinfants in the home health center and • Sexual act • Attempt to obtain a sexual act • Unwanted sexual comments or advances • Acts to traffic, or USAID/OFDA Proposal Guidelines Health pg. 14 • Otherwise directed against a person's sexuality using coercion by any person regardless of their Compile data from supported relationship to the victim. This applies in any setting, including 263 per quarter x 4 health facilities and supported Patient registers from Number of cases of sexual violence IRC Monitoring and evaluation Officers and Health home and work. 0 quarters = 1052 CHW programs to calculate the supported health Monthly treated Manager Treated: Trained healthcare workers annually sum total of consultations for facilities • Take history each disease specified. • Perform physical exam • Collect forensic evidence if necessary • Provide emergency contraception • Treatment of sexually transmitted infections, • Provide post-exposure prophylaxis • Provide wound care • Vaccinate against hepatitis B and tetanus, and • Refer to legal social and psychosocial services Sector Health Sub-Sector Community Health Community health worker (CHW): Members of a community who are chosen by community members or organizations to Number of Community Health provide basic preventive health care through health Workers supported (total within Project records & population Project records & IRC Monitoring and Evaluation Officers and Health information, messaging, and health facility referrals. 73 133 Monthly The 73 community health project area and per 10,000 census data population census data Manager There was no survey Supported: Any training, provision of supplies and/or workers comprise the 51 population) or evaluation needed transport, and incentives provided to CHWs with CHWs in Bocaranga and 22 in to gather baseline USAID/OFDA funding. Kaga Bandoro that were data. Baseline data N/A N/A N/A N/A supported by the IRC under is based on results of Compiled data from supported AID-OFA-G-17-00256. The Number and percentage of Community health worker (CHW): Members of a community health facilities reflecting the AID-OFA-G-17- Health facility records & IRC will aim to add 60 more Community Health Workers who are chosen by community members or organizations to number of CHWs supported Surveillance reports IRC Monitoring and Evaluation Officers and Health 00256. 73; 55% 133 (100%) surveillance reports CHWs under this project. (CHWs) conducting provide basic preventive health care through health through the program and the submitted Manager submitted public health surveillance information, messaging, and health facility referrals number of those CHWs routinely submitting surveillance reports

Community members: People living within the program This indicator is not Number and percentage of catchment area. Knowledge, Attitudes, and 15,707 (70%) per Knowledge, Attitudes, the subject of a community members who can Recall: May include spontaneous mention and/or aided recall. Practice (KAP) survey before IRC Monitoring and Evaluation Officers and Health This will be measured once 0 quarter x 4 quarters = and Practice (KAP) KAP Survey baseline survey as it N/A N/A N/A N/A recall target health education Target health education message: Information specific to the intervention (baseline) and Manager activities begin. 62,828 annually Survey is to be measured messages particular disease prevention/treatment or health seeking after the intervention (endline) once activities begin. behaviors that are provided to the community. Sector Health Sub-Sector Pharmaceuticals and other Medical Commodities

Trained: The sum total of the individuals who completed all requirements specified for successful completion of a specific training that may include attendance and/or written, verbal or hands on demonstration of knowledge and skills. Number of people trained in The IRC will begin Medical Commodities: Pharmaceuticals, medical supplies, Recorded tally from sign-in sheet IRC Monitoring and Evaluation Officers and Health medical commodity supply chain 0 60 Course participant list At each training measuring this once N/A N/A N/A N/A N/A medical equipment. for each day of course Manager management trainings begin. Supply Chain Management: The planning and management of all activities involved in the identification of needed medical commodities and their quantities; sourcing, procurement, delivery, monitoring, and all logistics management activities Health facilities: All primary health care centers, mobile clinics, health posts, and any other health service delivery points As of the end of AID-OFA-G-17- Number of health facilities out of supported with pharmaceuticals and/or other medical 00256 and the beginning of stock of any of the medical This will be commodities with OFDA funding. IRC Monitoring and Evaluation Officers and Health 720FDA18GR00202, no health commodity tracer products, for 0 Under 4 Supply chain monitoring tools Inventory lists Monthly measured throughout N/A N/A N/A N/A Medical Commodities: Pharmaceuticals, medical supplies, Manager facilities had experienced stock longer than one week, seven the life of the project. and/or medical equipment. outs lasting longer than one consecutive days Tracer products: Medical commodities essential to the week. implementation of the proposed plan Sector WASH Sub-Sector Environmental Health People: Individuals whose living environment has been improved through solid waste management, drainage, or vector control activities will typically include the entire 1. Documentation of catchment population within close vicinity of the activity the change or performed. The quality of “service” they receive is further improvement in the “improved” as a result of USAID/OFDA assistance in terms of living environment its ease of accessibility, reliability, and/or affordability. Include 1. A documented measurement 2. Population data Number of people receiving a description of how the “catchment” population was of the improvement to the living sources 3. Where improved service quality from solid 22,438 per quarter x 4 IRC Monitoring and Evaluation Officers and WASH determined for these activities. environment possible, conduct a waste management, drainage, or 0 quarters = 89,752 Monthly Manager Solid waste management: The process of handling and 2. The population of the area direct count of vector control activities (without annually disposal of waste material which can pose public health risks who benefit from the activity beneficiary households double-counting) and have negative impact on the environment if not attended must be calculated. and estimates of to appropriately. the number of people Drainage: The means of removing surplus surface water in or living in those near settlements. households. WASH is a new sector under Vector control: A variety of initiatives used to limit or eradicate These indicators are this project and this indicator disease-carrying agents (e.g., insects, other arthropods, not the subject of a measures the number of people rodents). baseline survey as N/A N/A N/A N/A reached through the they are to be intervention's activities, this will Primary data collected measured once be monitored and measured Number of people receiving direct through registration and activities begin. People: Direct recipients of hygiene promotion who have when WASH activities begin. hygiene promotion (excluding mass 22,438 per quarter x 4 Records of households visited records of participants IRC Monitoring and Evaluation Officers and WASH received hygiene messaging personally through a household At each hygiene media campaigns and without 0 quarters = 89,752 and records of participants at directly receiving Manager visit or through participating in a group session implemented promotion activity double-counting) annually group hygiene sessions messages through with USAID/OFDA funding. hygiene promotion programs

Registration and Average number of community Cleaning activity implemented by the members of community records of participants cleanup/debris removal activities remove accumulated solid waste and other debris that, if left directly removing At each cleanup/debris IRC Monitoring and Evaluation Officers and WASH Records of community conducted per community targeted unattended, can pose public health risks to the affected 0 12 (1 per month) accumulated solid removal activities Manager cleanup/debris removal activities by the environmental health population and may have a negative impact on the waste and other debris (Monthly) program environment. through environmental health programs

Sector WASH Sub-Sector Sanitation An observed decrease in open defecation, People: Individuals counted as benefiting from a sanitation An observed decrease in open observed usage of Number of people directly utilizing program are those who are targeted by the program and who defecation, observed usage of 22 438 per quarter x 4 latrines. IRC Monitoring and Evaluation Officers and WASH improved sanitation services regularly utilize sanitation constructed, rehabilitated, or latrines. 0 quarters = 89,752 The source of Monthly Manager provided with USAID/OFDA maintained either directly by the project, or constructed by The population benefiting from annually population data used funding beneficiaries themselves as a result of program activities to the sanitation program will be will depend on the create a communal demand for sanitation. estimated. context and what is available

This indicator measures the cleanliness and operational status of all excreta disposal facilities built or rehabilitated by the program in targeted health facilities. For this indicator, an excreta disposal facility is defined as • A simple pit latrine; • A VIP latrine; or • A flush latrine (pour-flush or cistern-flush) connected to a pit, septic, or sewer. The functionality of all (100%) For the numerator, Clean is defined as excreta disposal facilities built or records from an Percent of excreta disposal • The absence of feces or used anal cleansing material on the rehabilitated by the program in assessment of all No earlier than three facilities built or rehabilitated in IRC Monitoring and Evaluation Officers and WASH slab and within a health facilities will be assessed excreta disposal months after building or WASH is a new sector under health facilities that are clean and 0 95% Manager These indicators are five-meter radius around the exterior of the excreta disposal by direct observation during a facilities during a health rehabilitating excreta this project and this indicator functional not the subject of a facility; and cross-sectional survey no earlier facility survey. For the disposal facilities measures the number of people baseline survey as • The absence of unreasonably noxious odors and excess flies than three months after building denominator, project N/A N/A N/A N/A reached through the they are to be which may cause or rehabilitating. records. intervention's activities, this will measured once users to avoid the facility. be monitored and measured activities begin. A “functional” excreta disposal facility at a health facility must when WASH activities begin. 1. Be constructed of cleanable material; 2. Be supplied with water if water is required for flushing or anal cleansing; 3. Be lockable from the inside; and 4. Have a handwashing This indicator measures the operational status of all hand washing stations built or rehabilitated by the program in targeted health facilities. Handwashing facilities are generally associated with either a latrine or common area accessible to staff, patients, and caregivers. For the numerator, The functionality of all (100%) A “functional” handwashing station associated with a latrine records from an hand washing stations built or must assessment of all rehabilitated by the program in Percent of hand washing stations 1. Be located no more than 10 meters from the latrine; handwashing stations No earlier than three IRC Monitoring and Evaluation Officers and WASH health facilities will be assessed built or rehabilitated in health 2. Have both soap and water present; and 0% 95% during a health facility months after building or Manager by direct observation during a facilities that are functional 3. Appropriately manage gray water. survey. For the rehabilitating cross-sectional survey no earlier A “functional” handwashing station associated with other denominator, project than three months after building common areas accessible to staff, patients, and caregivers records. or rehabilitating must 1. Be in a location which makes hand washing convenient to patients, caregivers, and staff; 2. Have both soap and water present; and 3 Appropriately manage gray water Sector WASH Sub-Sector Hygiene Promotion

Primary data collected Number of people receiving direct through registration and People: Direct recipients of hygiene promotion who have hygiene promotion (excluding mass 22,438 per quarter x 4 Records of households visited records of participants IRC Monitoring and Evaluation Officers and WASH received hygiene messaging personally through a household At each hygiene media campaigns and without 0 quarters = 89,752 and records of participants at directly receiving Manager visit or through participating in a group session implemented promotion activity double-counting) annually group hygiene sessions messages through with USAID/OFDA funding. hygiene promotion programs

Knowledge of the critical times This indicator measures individuals’ knowledge of the hand to wash hands is measured washing practices which are most effective at preventing the WASH is a new sector under through a quantitative, These indicators are spread of pathogens along the fecal-oral cycle. The five this project and this indicator Percent of people targeted by the representative, population-based not the subject of a critical times to wash hands are defined as IRC Monitoring and Evaluation Officers and WASH measures the number of people hygiene promotion program who (household) survey. Questions Beginning and end of baseline survey as 1. After defecation/using the toilet; 0 70% Household survey Manager N/A N/A N/A N/A reached through the know at least three (3) of the five exploring handwashing project they are to be 2. Before eating; intervention's activities, this will (5) critical times to wash hands knowledge must be open-ended, measured once 3. After changing diapers or cleaning a child’s bottom; be monitored and measured e.g., “Please state for me all of activities begin. 4. Before preparing food; and when WASH activities begin. the occasions when it is most 5. Before feeding an infant. important to wash one’s hands.” This indicator measures the effectiveness of hygiene promotion efforts to encourage people to use latrines when defecating. Use of this indicator generally assumes that The practice of using a latrine Percent of people targeted by the household or communal latrines are accessible to the the last time defecating is IRC Monitoring and Evaluation Officers and WASH hygiene promotion program who population. measured through interviews Beginning and end of 0 50% Household survey Manager report using a latrine the last time For this indicator, a latrine is defined as during a quantitative, project they defecated • A simple pit latrine; representative, population-based • A VIP latrine; or (household) survey. • A flush latrine (pour-flush or cistern-flush) connected to a pit, septic, or sewer. Sector Protection Sub-Sector Prevention and Response to Gender-based Violence (GBV) This indicator will be reliant on program Accessing GBV response activities involves individuals utilizing records, women’s services including service centers, action planning, group- and girls’ space based support activities, outreach, case management, or any attendance and activity other service that is responding to a need. These activities records, and program can be accessible to and relevant for any individual. This Aggregate data from various supervision records. Number of individuals accessing Women Protection and Empowerement (WPE) includes but is not limited to survivors of GBV. This can also 0 10,000 data sources related to GBV This Monthly GBV response services officers include those at risk of GBV, but who have not been exposed response activities data can be to any incident of GBV. Activities should be designed around consolidated into semi- an articulated objective and participation defined per activity annual and final These indicators are to reflect the anticipated exposure intended to lead to the reports. This indicator not the subject of a baseline survey as This will be measured once desired program results. will be reliant on N/A N/A N/A N/A program records, such they are to be activities begin. as GBVIMS measured once activities begin.

This indicator should provide details on the specific amount of funding allocated to the GBV sub-sector intervention. This is a Aggregate data from program Number of dollars allocated for required indicator, but is recognized by USAID/OFDA as one Program records, BVA 0 364,380 data sources such as Quarterly WPE Manager GBV programming that will not monitor programmatic activities. reports, finance reports BVA/finance report Numerator: Dollar amount of funds expended on GBV programming.

This data will be collected among the community members, who have attended the awareness raising campaigns and training sessions on prevention and response to VBG, GBVIMS data, Baseline data is Percentage of community Pre-test and post-test evaluation including the people who have already benefitted from the activities reports, Community Mobilisation Program Officers and based on results of members who can correctly say 100% 7,500; 75% during training, FGDs with Daily, monthly N/A N/A N/A N/A available services. This includes the CBOs, the service participants presence /Psychosocial Officers and Assistants AID-OFA-G-17- where to locate GBV services community focal persons providers, the community volunteers, community leaders, local sheet 00256. authorities, the GBV survivors, who had already access to the services.

Sector Protection Sub-Sector Child Protection Child protection services: The full range of individual and community-based child protection services designed to reduce and minimize the risk that children and adolescents have to exploitation and abuse during an Semi-annual reporting will be emergency. limited to the number This indicator will be Child protection issues can vary depending on the context, but participating in a particular reliant on program in general refer to protection from any forms of abuse, Number of individuals participating period. Final reports will report records, activity neglect, exploitation, and violence affecting 0 300 Monthly Child Protection officers in child protection services the total number records, attendance children. Participating in child protection activities involves of participants who participated sheets, and program more than one-time casual exposure activities designed to during the program’s supervision records improve the protective environment for children. implementation. Activities should be designed around an articulated objective and participation defined per activity to reflect the anticipated exposure intended to lead to the desired program results.

This indicator will provide details on the specific amount of funding allocated to the child protection sub-sector Aggregate data from program Number of dollars allocated for Program records, BVA intervention. This is a required indicator but is recognized by 0 199477 data sources such as Quarterly Child Protection Manager child protection programming reports, finance reports USAID/OFDA as one that will not monitor programmatic BVA/finance report activities. As the IRC is intervening in new These indicators are sites, data from the previous not the subject of a A sense of safety or well-being project would not accurately baseline survey as will be measured through indirect N/A N/A N/A N/A reflect the situation in all of this they are to be questions designed to elicit project's sites. These indicators measured once responses that can be quantified will be measured once activities activities begin. on scales such as 1-5 or 1-7. begin. This will be measured with 1. Psychometric scales, validated within the local culture, Sense of safety: A reasonable age- and circumstance- that measure, for example, appropriate level of comfort and a lack of fear in surroundings improvement in well-being; Percentage of targeted children (i.e., places or individuals in an environment). 2. Observations of child’s play or Primary sources reporting an improvement in their Baseline and endlihne Sense of well-being: A general sense of comfort, trust, health, 0 70% interaction with peers or adults include beneficiary Child Protection officers sense of safety and well-being at survey mental/psychosocial stability and functionality, and freedom that provide quantifiable populations the close of the program from abuse, neglect, exploitation, or violence. measures of, for example, The definition of well-being should be locally validated. abnormal reluctance to pursue usual activities or an expressed fear of seemingly ordinary things; and 3. Children’s narratives that explain their feelings compared to the pre-intervention time period.

Sector Protection Sub-Sector Psychosocial Support Services Participating in psychosocial activities involves more than one- time casual exposure activities designed to improve the This indicator will be psychosocial well-being. Activities will be reliant on program designed around an articulated objective and participation records, a safe defined per activity to reflect the anticipated exposure information intended to lead to the desired program results. management system Number of individuals participating Psychosocial support: Programs and activities that builds a Aggregate data from program Women Protection and Empowerement (WPE) 0 400 (GBV / IMS ) which Monthly in psychosocial support services community’s social and psychological resiliency to data sources officers can ensure • Survive extreme shock and exposure to traumatic events, confidentiality of As the IRC is intervening in new • Overcome its impact, and These indicators are survivors, and an sites, data from the previous • Strengthen competencies in dealing with recurring events. not the subject of a effective referral project would not accurately Activities will support strengthening positive coping strategies baseline survey as pathway in place. N/A N/A N/A N/A reflect the situation in all of this which become critically they are to be project's sites. These indicators important when dealing with the loss of life, losing family measured once will be measured once activities activities begin. begin.

Referral cases: Cases accessing services through an Number of GBV referral cases that effective referral pathway in place Aggregate data from partner Aggregate data from benefited from response by 0 50 Monthly WPE Manager reports partner reports partners Partners: IRC's local implementing partners Semiannual Report 1 Semiannual Report 2 Final Target (October 2018 - March 2019) (April - September 2019) (October 2018 - September 2019) Health WASH Protection Health WASH Protection Health WASH Protection Total IDP Total IDP Total IDP Total IDP Total IDP Total IDP Total IDP Total IDP Total IDP Total IDP Award Level Beneficiaries (Cumulative) 189,506 57,218 Health 89,753 27,109 WASH 89,753 27,109 Protection 10,000 3,000 Reporting Period Reached: Total: 75,379; IDPs: 22,613 Total: XXX; IDPs: YYY Health 75,379 22,613 WASH 22,894 20,000 Protection 10,592 2,917

Cumulative Period Reached: Total: 75,379; IDPs: 22,613 Total: XXX; IDPs: YYY Health 75,379 22,613 WASH 22,894 20,000 Protection 10,592 2,917 Semiannual Report 1 Semiannual Report 2 Baseline Target Final Indicator (October 2018 - March 2019) (April - September 2019) M F Total M F Total M F Total M F Total M F Total % of target met Number of health facilities OFDA 12 12 13 supported Number of health care staff 0 57 31 23 54 trained OFDA Health workers 38 38 31 0 31 Midwives 4 4 0 8 8 Matrons 15 15 0 15 15 Percentage of total weekly surveillance reports submitted on OFDA 100% 100% 75% time by health facilities Number of outpatient OFDA 0 71,804 (17,951 per quarter) 28,989 consultations <5 13,336 >5 15,653 Semiannual Report 1 Semiannual Report 2 Baseline Target Final Indicator (October 2018 - March 2019) (April - September 2019) M F Total M F Total M F Total M F Total M F Total % of target met Number of communicable disease OFDA 0 53,136 (13,284 per quarter) 25,161 [1] consultations Malaria <5 2,224 2,522 4,746 Malaria >5 2,199 3,372 5,571 ARI <5 2,058 1,659 3,717 ARI >5 814 502 1,316 Diarrhea <5 501 614 1,115 Diarrhea >5 163 232 395

[1] The IRC-supported health facilities saw 25,161 consultations for communicable diseases during the reporting period. The number of consultations for the top three most seen diseases comprise 16,860 of those consultations. Semiannual Report 1 Semiannual Report 2 Baseline Target Final Indicator (October 2018 - March 2019) (April - September 2019) M F Total M F Total M F Total M F Total M F Total % of target met # and % of pregnant women who have attended at least two 824 per quarter comprehensive antenatal OFDA clinics # 0 3,396 1,704 % 0% 80% 50%

# and % of newborns that received postnatal care within 425 per quarter OFDA three days after delivery # 0 1,700 290 % 0.0% 80% 51% Number and percentage of births assisted by a skilled 340 per quarter OFDA attendant at birth # 0 1360 991 % 0.0% 80% 94% Number of cases of sexual OFDA 0 1052 (263 per quarter) 0 238 238 violence treated Semiannual Report 1 Semiannual Report 2 Baseline Target Final Indicator (October 2018 - March 2019) (April - September 2019) M F Total M F Total M F Total M F Total M F Total % of target met # of CHWs trained and supported (total and per OFDA 133 90 10,000 population within project area) Total 73 133 64 26 90 per 10,000 pop. 1 # and % of CHWs specifically engaged in public health OFDA surveillance # 73 133 64 26 90 % 55% 100% 100%

# and % of community members who can recall target 15,707 per quarter OFDA health education messages # 0 62,829 0 0 0 % 0% 0% Semiannual Report 1 Semiannual Report 2 Baseline Target Final Indicator (October 2018 - March 2019) (April - September 2019) M F Total M F Total M F Total M F Total M F Total % of target met # of people trained in medical OFDA commodity supply chain 0 60 22 12 34 management

# of health facilities out of stock of any of the medical OFDA commodity tracer products, 0 <4 0 for longer than one week, seven consecutive days Semi-Annual 1 Semi-Annual 2 Final Indicator Baseline Target (Oct 18 - March 19) (Apr - Sept 19) Total % of target met Number of people receiving improved service quality from solid waste 89,752 (22,438 OFDA management, drainage, or vector 0 0 per quarter) control activities (without double- counting)

Average # of community cleanup/debris removal activities OFDA 0 12 (1 per month) 0 conducted per community targeted by the environmental health program Semi-Annual 1 Semi-Annual 2 Final Indicator Baseline Target (Oct 18 - March 19) (Apr - Sept 19) Total % of target met Number of people directly utilizing 89,752 (22,438 OFDA improved sanitation services provided 0 0 per quarter) with OFDA funding % of excreta disposal facilities built or OFDA rehabilitated in health facilities that are 0 95% 0 clean and functional % of hand washing stations built or OFDA rehabilitated in health facilities that are 0% 95% 0 functional Semi-Annual 1 Semi-Annual 2 Final Indicator Baseline Target (Oct 18 - March 19) (Apr - Sept 19) Total % of target met Number of people receiving direct hygiene promotion OFDA (excluding mass media 0 89,752 22,894 campaigns and without double- counting) Percent of people targeted by the hygiene promotion IRC program who know at least 0 80% 0 three (3) of the five (5) critical times to wash hands Percent of people targeted by the hygiene promotion IRC program who report using a 0 50% 0 latrine the last time they defecated Semiannual Report 1 Semiannual Report 2 Baseline Target Final Indicator (October 2018 - March 2019) (April - September 2019) M F Total M F Total M F Total M F Total M F Total % of target met Number of individuals OFDA accessing GBV response 0 10,000 3211 6779 9990 services Number of dollars allocated for OFDA $0 $364,380 $74,756 GBV programming Percentage of community members who can correctly OFDA 100% 75% 68% say where to locate GBV services Semiannual Report 1 Semiannual Report 2 Baseline Target Final Indicator (October 2018 - March 2019) (April - September 2019) M F Total M F Total M F Total M F Total M F Total % of target met Number of individuals OFDA participating in child 0 300 341 261 602 protection services

Number of dollars allocated for OFDA $0 $199,477 $12,663.43 child protection programming

Percentage of targeted children reporting an OFDA improvement in their sense of 0% 70% 0 safety and well-being at the close of the program Semiannual Report 1 Semiannual Report 2 Baseline Target Final Indicator (October 2018 - March 2019) (April - September 2019) M F Total M F Total M F Total M F Total M F Total % of target met Number of individuals OFDA participating in psychosocial 0 400 122 412 534 134% support services

Number of GBV referral cases IRC that benefited from response 0 50 3 by partners REPUBLIQUE CENTRAFRICAINE

RAPPORT GLOBAL MISSION D’EVALUATION DES BESOINS EN REHABILITATION DANS LES SOUS-PREFECTURES DE BOCARANGA-KOUI et NGAOUNDAYE (15 Janvier au 29 Mars 2019) Par DABY Malachie, Officier WASH/IRC

I.INTRODUCTION

En réponse à cette crise humanitaire, IRC un projet d’améliorer l’accès et la quantité du système de sante local des populations touchées dans les préfectures de Nana Gribizi et d’Ouham Pende du 1er octobre 2018 au 30 septembre 2019, financé par OFDA. L’objectif est de réduire les impacts négatifs des urgences en fournissant des services de base en eau, hygiène et assainissement (WASH) et en améliorer les conditions d’hygiène de l’environnement dans les trois (3) sous-préfectures d’Ouham Pende (Bocaranga-Koui et Ngaoundaye) dont : L’hôpital de district de Ngaoundaye et de Bocaranga, les postes de santé de Kossé, Kollo, Kowone, Boko, Nzakoun, Zaguindi et Sangami ; en plus les Centres de Santé de Koui et Mbotoga ; pour le projet GO380. II.OBJECTIFS

II.1 OBJECTIF GENERAL

Contribuer à l’amélioration des besoins en réhabilitation des infrastructures eau, hygiène et assainissement dans les 11 FOSA appuyées par ce projet

II.2 OBJECTIFS SPECIFIQUES

 Identifier les besoins en réhabilitation dans chaque FOSA,  Faire l’état de lieu de toutes les infrastructures eau hygiène et assainissement dans toutes les FOSA appuyées ;  Proposer un devis par rapport aux besoins prioritaires.

III. METHODOLOGIE

 Descente sur le terrain pour chaque FOSA  Discussion avec la communauté et les responsables des FOSA pour recueillir les besoins

IV. CONSTATS ET RESULTATS

Les besoins sont rétablis en détail par FOSA pour chaque sous-préfecture, nous appuyons onze (11) FOSA pour ce projet GO380

IV.1. SOUS-PREFECTURE DE BOCARANGA Nous avons trois (3) formations sanitaires appuyées par ce projet il s’agit de :  Hôpital district de Bocaranga-Koui  Centre de santé de Mbotoga  Poste de santé de Sangami

IV.1.A.Du point de vue eau

N. FOSA Type de Fonctionnelle (F) Type de Etat de Comite de Proposition pour Proposition pour la pompe Dis fonctionnelle panne margelle Gestion des la pompe margelle (DF) Points d’Eau Panne (P) (CGPE)

Hôpital Vergnet district de HPV 60 F RAS Bon Oui RAS RAS Bocaranga 1 (BCG) Château alimenté F RAS - ? RAS - par Source de captage Nettoyage de la pompe et 2 Centre de India désinfection de RAS santé de mark II F RAS Bon Oui l’eau Mbotoga 50m 3 Poste de Vergnet santé de HPV 60 F RAS Bon Oui RAS RAS Sangami +150m

IV.1.B. Du point de vue Hygiène

N FOSA INFRASTRUCTURES ETAT BESOIN 1 Hôpital de district de Dispositifs de lavage des Insignifiant Renforcer par les dispositifs de lavage des mains Bocaranga mains 2 centre de santé de Dispositifs de lavage des Insignifiant Renforcer par les dispositifs de lavage des mains Mbotoga mains 3 Poste de santé de Dispositifs de lavage des Insignifiant Renforcer par les dispositifs de lavage des mains Sangami mains

IV.1.C. Du point de vue Assainissement

N FOSA INFRASTRUCTURES ETAT BESOIN COMENTAIRES Latrine VIP Bon RAS Gestion et utilisation

Fosse a placenta Bon RAS Construite par GO354 1 Hôpital district de Fosse a ordure mauvais Supprimer les anciennes et Presque pleine Bocaranga Douche Manque Construction Une douche d’urgence construite en bâche par Fosse a aiguille Bon Construction MSF Bac a ordure Insignifiant Confection et implantation Incinerateur/cendrier Bon RAS Construit par GO354 Latrine VIP/Douche Bon RAS Construire une nouvelle latrine de renfort (projet 2 Centre de santé de prochain) Mbotoga Fosse a placenta Bon RAS L’utilisation et la gestion Cendrier Bon RAS de ces ouvrages Bac à ordure Insignifiant Confection et implantation Incinerateur Bon RAS Puit perdu de la maternité Manque Construction Bâtiment du poste de Un peu mauvais Réhabilitation La toiture suinte et la Sante présence des fissures sur les murs 3 Poste de santé de Latrine VIP/Douche Bon RAS Sangami Fosse a placenta Bon RAS L’utilisation et la gestion Cendrier Bon RAS de ces ouvrages Bac à ordure Mauvais Confection et implantation Incinerateur Mauvais Réhabilitation Grillage + portillons gâtées

IV.2.SOUS-PREFECTURE DE KOUI

Pour cette sous-préfecture nous appuyons deux (2) FOSA qui sont :  Centre de santé de Koui  Poste de santé de Zaguindi

IV.2.A.Du point de vue eau

N. FOSA Type de Fonctionnelle (F) Type de Etat de Comite de Proposition pour Proposition pour la pompe Dis fonctionnelle panne margelle Gestion des la pompe margelle (DF) Points d’Eau Panne (P) (CGPE)

1 Centre santé India De Koui mark II F - - Oui RAS RAS

60m

Acheter les pièces Construire la clôture Manque de comme :(Raccord de protection, et 2 Poste de Vergnet clôture autour Huot, siège du revoir la margelle santé de HPV 60 DF de la pompe Oui clapet Zaguindi +200m pour sa d’aspiration, protection ; poche de joint, Bague de guidage, Piston et segment)

IV.2.B. Du point de vue Hygiène

N FOSA INFRASTRUCTURES ETAT BESOIN 1 Centre de santé de Dispositifs de lavage des Insignifiant Renforcer par les dispositifs de lavage des mains Koui mains 2 Poste de santé de Dispositifs de lavage des Insignifiant Renforcer par les dispositifs de lavage des mains Zaguindi mains

IV.2.C. Du point de vue Assainissement

N FOSA INFRASTRUCTURES ETAT BESOIN COMENTAIRES Latrine VIP/douche Bon RAS Nouvelle latrine de renfort construite par Cordaid Incinerateur/cendrier Mauvais Réhabilitation 1 Centre santé de Fosse a placenta Manque Construction Koui Bac a ordure Insignifiant Renforcer Fosse a ordure Mauvais Construction Bâtiment SMI Mauvais Réhabilitation Ce bâtiment constitue aussi la pharmacie de gratuité Puit perdu de la Manque construction maternité Latrine VIP Bon RAS Nouvelle latrine construite par Cordaid 2 Poste de santé de Zaguindi Fosse a placenta Bon RAS Bâtiment du poste de Bon RAS Exécuté par GO354 Sante Incinerateur/cendrier Bon RAS Bac à ordure Manque Confection et implantation

IV.3.SOUS PREFECTURE DE NGAOUNDAYE

Pour cette sous-préfecture nous appuyons six (6) FOSA qui sont :  Hôpital district de Ngaoundaye  Poste de santé de Boko  Poste de santé de Kosse  Poste de santé de Nzakoun  Poste de santé de Kollo  Poste de santé de Kowone

IV.3.A.Du point de vue eau

N. FOSA Type de Fonctionnelle (F) Type de Etat de Comite de Proposition pour Proposition pour la pompe Dis fonctionnelle panne margelle Gestion des la pompe margelle (DF) Points d’Eau Panne (P) (CGPE) L’eau ne Manque de Changer quelques  Construire la Hôpital India sort clôture Oui pièces d’usures clôture ; district de mark II difficilement autour de la (cylindre, le pvc et  Revoir la Ngaoundaye avec un pompe pour le tringle) margelle 1 DF débit trop sa faible protection ;

Il y a eu Acheter les pièces casse d’un Manque de comme :( 2 Poste de India PVC lie clôture autour Cylindre, pvc, santé de mark II P avec le de la pompe Oui trigle, chaine et de IDEM Boko 90m cylindre et pour sa graisse) cela s’est protection ; détaches des autres pour se diriger vers le bas du forage et d’autres sont en mauvais état 3 Poste de India Manque de santé mark II clôture autour Nzakoun 100m F RAS de la pompe Oui RAS IDEM pour sa protection ; 4 Poste de Manque de santé Kossé India F RAS clôture autour mark II de la pompe Oui RAS IDEM +200m pour sa protection ;

IV.3.B. Du point de vue Hygiène

N FOSA INFRASTRUCTURES ETAT BESOIN 1 Hôpital de district de Dispositifs de lavage des Insignifiant Renforcer par les dispositifs de lavage des mains Ngaoundaye mains 2 Poste de santé de Dispositifs de lavage des Manque Confection et implantation des dispositifs de lavage Boko mains des mains 3 Poste de santé de Dispositifs de lavage des Insignifiant Renforcer par les dispositifs de lavage des mains Nzakoun mains 4 Poste de santé de Dispositifs de lavage des Insignifiant Renforcer par les dispositifs de lavage des mains Kossé mains

IV.3.C. Du point de vue Assainissement

N FOSA INFRASTRUCTURES ETAT BESOIN COMENTAIRES Latrine VIP/ Mauvais et pleine Construire une latrine VIP Seulement des latrine moderne construites par le COGES et Elles sont 1 Hôpital district de Fosse à placenta Manque Construction pleines et dégradées Ngaoundaye (NGD) Fosse à ordure Manque Construction Douche Mauvais Construction Une douche traditionnelle Fosse à aiguille Mauvais Construction de COGES en mauvais état

Bac à ordure Manque Confection et implantation Cendrier Manque Construction Latrine VIP Manque Construction Il y a des latrines modernes construites par le COGES 2 Poste de santé de sans porte Boko Fosse à placenta Manque Construction Cendrier Manque Construction Bâtiment du poste de Mauvais Réhabilitation La toiture suinte et la Sante présence des fissures sur les murs Bac à ordure Manque Confection et implantation Fosse a ordure Mauvais Agrandir la fosse et arranger la clôture Incinérateur Bon RAS Exécuté par GO354 3 Poste de santé de Bac à ordure Manque Confection et implantation Nzakoun Bâtiment du poste de Mauvais Réhabilitation extension du Ce bâtiment est insignifiant Sante bâtiment Fosse a placenta Manque Construction Latrine VIP/Douche Mauvais Réhabilitation de la super Grosses fissures sur les structure murs Incinérateur Bon RAS Exécuté par GO354 4 Poste de santé de Bac à ordure Manque Confection et implantation Kosse Latrine VIP/Douche Bon RAS Fosse a placenta Manque Construction Incinérateur Bon RAS Exécuté par GO354

Difficultés  Contraintes budgétaires qui ne suffisent pas à combler les énormes gaps ;  L’insécurité qui rend d’autres sites inaccessibles (Kollo et Kowone) les activités sont suspendues sur la zone ; NB : 1- La situation est très précaire à Boko suite à l’unique point d’eau qui ravitaille le village est tombe en panne et la population se ravitaille avec l’eau de la source et le puits traditionnelle qui a une profondeur d’1m, non protégé et la qualité n’est pas bonne pour la boisson ; car le constat est que la majorité de la population fait la défécation a l’aire libre ( voir les photos d’annexe)

2-A Ngaoundaye Centre les latrines modernes construites par le COGES sont insignifiantes pour couvrir aux besoins d’assainissement d’un hôpital, elles sont des courtes durées suite à leurs profondeurs de 2m et de diamètre de la fosse 90cm. 3-l’insuffisance des points d’eau a Nzakoun ce qui fait la queue d’attente énorme d’approvisionnement en eau et la population décide d’abandonner le forage pour aller vers la source non protégée. RECOMMANDATIONS  Nos suggestions à la hiérarchie est de prendre en compte les besoins et les gaps s’il y a la possibilité de faire un plaidoyer pour le projet futur.  Compte tenu de la contrainte budgétaire (7000$) est insignifiant à combler tous les gaps, nous avons prévu de faire : - La réhabilitation de la pompe à Boko (Ngaoundaye) ; - La réhabilitation de la pompe à l’hôpital de Ngaoundaye ; - La réhabilitation de la pompe à Bogang II (Zaguindi) ; - La réhabilitation de puit perdu de la maternité à Mbotoga ; - La construction du bloc latrine + douche à l’hôpital de Ngaoundaye ; - La confection des dispositifs de lavage des mains et bac ordure pour le onze (11) FOSA appuyées.

Fait à Bocaranga, le 01 Avril 2019

DABY Malachie /officier Wash

ANNEXE (PHOTOS)

Fig1 : Douche traditionnelle de l’hôpital de NGD Fig. 2 : Fosse a aiguille dégradée Fig. 3 : Dépôt d’ordure à l’hôpital de NGD

Fig. 4 et 5 : Le bloc de latrines dégradé non fonctionnel a NGD

Fig. 6,7 et 8 : La source d’approvisionnement en eau au village BOKO

Fig9 : Petit bâtiment dégradé de PS de Nzakoun Fig10 : La queue autour de la pompe à Nzakoun