Maternal Child Survival Program Quarterly Progress Report

Maternal Child Survival Program

Quarterly Progress Report

Prepared for Juliana Pwamang United States Agency for International Development/Ghana C/O American Embassy No. 19 Fifth Link Road Cantonments Accra, Ghana

Prepared by Jhpiego 1615 Thames Street Baltimore, MD 21231

January 1 – March 31, 2017 Maternal Child Survival Project; FY 2017 Q2 PROGRESS REPORT Cooperative Agreement i No. AID-OAA-A-14-00028

The authors’ views expressed in this report do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

Table of Contents

Contents ACRONYMS AND ABBREVIATIONS ...... 4 I. MATERNAL CHILD SURVIVAL PROGRAM EXECUTIVE SUMMARY ...... 6 II. SUBSEQUENT QUARTER’S WORK PLAN ...... 7 III. PROGRESS NARRATIVE ...... 8 IV. PERFORMANCE MONITORING...…………………………………………………………19 V. LINKS TO OTHER USAID PROGRAMS ...... 20 VI. LINKS WITH GOG AGENCIES ...... 21 VII. USAID FORWARD ...... 21 VIII. SUSTAINABILITY ...... 21 IX. LEVERAGED FUNDING ...... 22 X. PLANNED ACTIVITIES FOR THE NEXT QUARTER ...... 22 XII. PROJECT ADMINISTRATION ...... 22 ANNEX I: PROJECT PERFORMANCE INDICATORS ...... 25 ANNEX II: IPC PERFORMANCE INDICATORS…………………………………………....27 ANNEX III: SUCCESS STORIES ...... 28 ANNEX IV: CHPS FAA MILESTONE DASHBOARD ...... 30 ANNEX V: IPC FAA MILESTONE DASHBOARD…………………………………………36

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Acronyms and Abbreviations ACNM American College of Nurse Midwives BEmONC Basic Emergency Obstetric and Newborn Care CHN Community Health Nurse CHNTS Community Health Nursing Training Schools CHO Community Health Officer CHPS Community-based Health Planning Service CST Country Support Team DACF District Assembly Common Fund DCOF Displaced Children and Orphan Fund DG Director General DHIMS District Health Information Management System E4H Evaluate for Health EBF Exclusive Breastfeeding EMMP Environmental Monitoring and Mitigation Plan ERC Ethical Review Committee EVD Ebola Viral Disease FAA Fixed Amount Award FP Family Planning GAC Ghana AIDS Commission GCNM Ghana College of Nurses and Midwives GGHE General Government Health Expenditure GHS Ghana Health Service GIFEC Ghana Investment Fund for Electronic Communications HRDD Human Resources Development Directorate (GHS) HIV Human Immuno-Deficiency Virus HTI Health Training Institute HQ Headquarters iCCM Integrated Community Case Management ICD Institutional Care Division ICT Information Communication Technology IMNCI Integrated Management of Neonatal and Childhood Illnesses IP Implementing Partners IPC Infection Prevention and Control IPTp Intermittent Preventive Treatment in Pregnancy IT Information Technology TWG Technical Working Group

JHU Johns Hopkins University KNUST Kwame Nkrumah University for Science and Technology LMS Learning Management System MCHIP Maternal and Child Health Integrated Program MCSP Maternal and Child Survival Program M&E Monitoring and Evaluation MER Monitoring, Evaluation and Research MIS Management Information Systems MOH Ministry of Health MOP Malaria Operations MOU Memorandum of Understanding MSF Midwifery Services Framework MTS Midwifery Training School NACP National AIDS/STI Control Programme NITA National Information Technology Agency NMC of G Nurses and Midwives Council of Ghana NMCP National Malaria Control Program NMTC Nursing and Midwifery Training College OSCEs Objective Structured Clinical Examination PMI President’s Malaria Initiative PMTCT Prevention of Mother-to-Child Transmission of HIV PPME Policy, Planning, Monitoring & Evaluation, GHS PPMED Policy, Planning, Monitoring & Evaluation Division, GHS RFP Request for Proposal S4H Systems for Health SBCC Social Behaviour Change Communication SDHT Sub-District Health Team SOP Standard Operating Procedure TA Technical Assistance TAG Technical Advisory Group THE Total Health Expenditure TIWG Technical Implementation Working Group USAID United States Agency for International Development WHO World Health Organization

I. MATERNAL CHILD SURVIVAL PROGRAM EXECUTIVE SUMMARY

The goal of this project is to contribute to the improvement of health outcomes for HIV, malaria, nutrition, family planning and maternal, newborn and child health services. MCSP is working in close collaboration with the Ministry of Health (MOH), Ghana Health Service (GHS) and other United States Agency for International Development (USAID) funded partners (e.g., Systems for Health [S4H], Malaria Care, Evaluate for Health [E4H]), to achieve the following objectives:

Objective 1: A better prepared midwifery and nursing workforce that is equipped with the knowledge and skills to effectively provide HIV, malaria, nutrition, family planning (FP) and maternal, newborn and child health services.

Objective 2: Improved national and regional capacity to implement a harmonized CHPS model which provides high quality HIV, malaria, FP, nutrition, and maternal, newborn and child health services in 5 regions in Ghana.

In FY17 quarter two (Q2), MCSP has completed the following activities: • Organized workshop to create interactive app on HIV 90-90-90 for health care professionals and implementers. • Completed local procurement for medical equipment for the 16 PY3 skills labs. • Participated in site visits with the USAID Mission Director to the Volta and Central regions. • Assisted in the selection of 10 CHPS compounds for adoption as model training sites by four community health nursing schools (CHNTS) and one public health nursing school in collaboration with the principals and tutors, regional and district health directorate. • Submitted the program learning question on urban CHPS to the Johns Hopkins Institutional Review Board for ethical clearance. Received approval and study was determined to be exempt. • Prepared urban CHPS protocol and tools for submission to GHS Ethical Review Committee. Submission to take place in Q3. • Printed and disseminated 200 copies of the national CHPS implementation guidelines in collaboration with Policy, Planning, Monitoring & Evaluation (PPME), GHS. • Completed about 75% of the CHPS FAA milestones in the five MCSP regions. • Participated in the “Institutionalizing Community Health Conference (ICHC)” in Johannesburg, South Africa from 27-30th April, 2017 and made a presentation on the topic “Community Health Practitioner; Evidence To Policy” • Prepared for the upcoming mid-term evaluation visit.

The following activities were achieved for Ebola pillar IV Infection Prevention and Control (IPC): • A total of, 3,799 healthcare workers were trained by the end of March 2017: 2,748 (72%) were clinical staff and 1,051 (27%) non-clinical staff. Average knowledge test scores increased from a baseline of 45% to 70% post training. • Conducted all regional hospital IPC trainings in four regions (Brong Ahafo, Eastern, Upper East and Upper West).

Monitoring and Evaluation Results to date are presented in Annex 1.

Subsequent Quarter’s Work Plan During quarter 3 (April 1 – June 30, 2017), the team will continue to implement activities outlined in the work plan.

For preservice education, the Q3 focus will be on the following major activities: • Distribute equipment and models to 16 schools in order to set up skills labs.

• Submit requisition for both local and overseas purchases in order to set up additional skills labs for the three additional schools under the higher education fund • Set up skills labs in 16 schools and train tutors on the use of the anatomical models in the midwifery and community health nursing schools. • Hold shared lessons learnt meeting with six pilot midwifery schools. • Develop the scope of work and budgets with Nursing and Midwifery Council (NMC) (supervision tool) and Ghana College of Nurses and Midwives (GCNM) (implementation of the midwifery service framework) for their PY3 fixed amount agreements (FAA). • Train eight preceptors each from 12 CHN schools and one public health school on new GCNM preceptor curricula. • Equip CHPS compounds at 12 CHN schools and one public health schools to support clinical practice of students. • Continue to follow up on development of the CHO checklist with the NMC. • Support the midwifery services framework (MSF) multi-stakeholder meeting, in collaboration with GCNM, in first week of May, 2017.

For eLearning, the team will focus on the following activities: 1. Continue with the development of modules by performing the activities below: • Organize workshop for content development for modules on IPC, IMNCI and maternal, newborn and child vaccination • Finalize contract process with the vendor • Develop and review storyboard for modules 2. Commence with the development of interactive app for HIV 90-90-90 by performing the following activities: • Support contract process • Review beta version of Interactive app • Make inputs and changes to the app 3. Award contract for the development of Moodle Plugin and Client Application 4. Support eLearning Secretariat with logistics to visit some of the MCSP supported schools to assess information communication technology (ICT) infrastructure and internet service providers in the schools. 5. Plan and organize additional eLearning module content development in the following specialist areas: infection prevention, 360 degree video of skills labs demonstration, integrated management of neonatal and childhood illnesses (IMNCI), and child health.

For MCSP CHPS, the team will focus on the following activities: 1. Organize national CHPS integrated technical working group (TWG). 2. Pilot the CHPS Planning Tool with GHS. 3. Organize FAA review meeting for five MCSP regions and GHS HQ. 4. Engage consultants to review CHO training materials. 5. Support to carry out learning agenda on urban CHPS. 6. Complete documentation and commence implementation of PPME FAA. 7. Review reports and request for payment for regional FAA. 8. Complete five MCSP regional CHPS FAAs.

For the Ebola Pillar IV Infection Prevention and Control (IPC) activities, MCSP will collaborate with Institutional Care Division (ICD) and Regional Health Directors to continue regional level activities to: • Support regions in the FAA implementation. • Follow up with training coordinators on implementation of the regional FAA by milestone.

• Conduct monitoring and support visits of FAAs in all five regions implementing IPC.

For the Early Child Development (ECD) activities, MCSP has submitted a separate workplan and budget for Phase I activities between March 1, 2017 and Feb 28, 2018.

III. PROGRESS NARRATIVE

a. Implementation Progress

MCSP continues to make progress on the objectives and activities for pre-service education, CHPS and IPC, as outlined in the workplan. Progress is described below by objective, activity, and sub- activity.

Note that MCSP reports on implementation progress for Ebola Pillar IV IPC work plan through a monthly mechanism to the Global Health Ebola Team (GHET); however, some of the broader issues are included in this report. Thus far in FY17, MCSP activities for Ebola Pillar IV IPC carried out include: • Supported the regional health management team (RHMT) on the administration of FAA activities. • Supported regional hospital trainings with their whole site trainings. • Trained a total of 3,799 healthcare workers - 2,748 (72%) clinical staff and 1,051 (27%) non- clinical staff.

Objective 1: A better prepared midwifery and nursing workforce that is equipped with the knowledge and skills to effectively provide HIV, malaria, nutrition, family planning and maternal, newborn and child health services.

Activity 1.1 Improve knowledge of tutors, preceptors, and students on HIV, malaria, maternal and child health, and nutrition

During the PY3 work planning process, the Health Training Institution Secretariat at the MOH and MCSP identified eight midwifery, six community health nursing schools, and one public health nursing school to receive e/mLearning support this year. MCSP has also received additional funding for Higher Education to set up three additional skills labs in three schools. These three schools have been identified in collaboration with MOH as Sampa and Nkawkaw Nurses Training Colleges and the Yamfo Physician Assistant School.

Midwifery Schools Community Health Public Health Nursing Nursing Schools School 1. Offinso (Ashanti Region)**1 1. Esiama (Western 1. Korle Bu (Greater 2. Asanta (Western Region) Region)** Accra Region) 3. LEKMA (Greater Accra 2. Bole (Northern Region) Region) 4. 37 Military (Greater Accra 3. Tanoso (Brong Ahafo Region) Region)** 5. Berekum Drobo (Brong 4. Techiman Krobo Ahafo Region) (Brong Ahafo Region) 6. Kwadaso (Ashanti Region)** 5. Twifo Praso (Central 7. Sunyani (Brong Ahafo Region Region) 6. Krobo Odumase 8. Atibie (Eastern Region) (Eastern)

1 Please note that ** indicates the schools that need to have the new eLearning platform rolled out.

Activity 1.1.1 Develop content for eLearning and mLearning Y3 content: 90-90-90 MCSP organized an eLearning workshop to initiate the process of creating content for the HIV 90- 90-90 interactive app. Twelve Subject Matter Experts (SMEs) were drawn from Ghana Aids Commission, Care Continuum, MICDAK Charity Foundation, National Aids Control Programme, West African Program to Combat AIDS and STIs (WAPCAS) and MCSP. The workshop was facilitated by Leti Arts, a game developer company who created the Hello Nurse app, to develop a multifunctional storyboard of case-based scenarios. Initial draft of the app content was reviewed by the MCSP global HIV subject matter expert. The storyboard will be gamified into an interactive app once MCSP receives workplan approval and the contract is finalized between MCSP and Leti Arts. The joint working group will work on indicators to be incorporated into the app for reporting and performance monitoring purposes.

Y2 content The Helping Babies Breathe learning object has been completed and is currently being reviewed by the American Academy of Pediatrics. The dissemination for this material will happen in Q3.

The remaining task of packaging eLearning modules and objects for the BEmONC modules suffered a setback. A review of the beta version of the packaging completed by the KNUST Department of Communication Design revealed that the quality of the product did not meet MCSP and MOH standards. MCSP will package the modules as learning objects in Q3.

360 Video See details for this activity under IX: Leveraged Funding.

Moodle2 Solution MCSP and MOH are developing a technology solution combining several components to make eLearning accessible on/offline on a range of devices. RFPs were developed for two components of the solution: 1) connect national and school installations and 2) provide offline capability on computers/laptops.

Nine local and foreign companies applied to provide the solutions. All the proposals have been evaluated by the MCSP technical team. A vendor has been selected, and the development of the solution will begin in Q3.

Expanding Access MCSP and MOH, are having ongoing negotiations with Vodafone Ghana for a discount on an internet data package that is affordable for health training schools to improve support for eLearning.

Activity 1.1.3: Support eLearning Secretariat at Health Training Institute Secretariat (HTIS), MOH

The eLearning Secretariat did not organize an eLearning steering committee meeting this quarter and will organize a meeting in Q3.

Activity 1.2: Improve midwifery students’ clinical practice for malaria, FP, maternal and child health, HIV

2 Moodle is a free and open-source software learning management system developed on pedagogical principles to enhance existing learning environments. It is used for blended learning, distance education and eLearning projects in schools, universities, workplaces and other sectors. It can be used on mobile devices. Moodle is already being used in Ghana.

Activity 1.2.1: Improve skills labs at midwifery and community health nursing schools

In the last quarter, earnest preparation was done to set up of skills labs in 16 training institutions (eight MTS, one PHNS, six CHNTS, and Keta MTS). However, MCSP was unable to secure tax exemption letters from the GHS as a result of the transition in government. Training models procured from HQ are ready but have yet to be shipped to Ghana because this paperwork is first needed. This has resulted in a delay in skills lab installation at the schools. MCSP has followed up with the Ministry of Health. Exemptions are now granted on a quarterly basis instead of yearly, so a new application has been submitted. We are hopeful that we will receive the equipment in the 3rd quarter. In the meantime, MCSP procured and delivered skills lab furniture to 16 schools.

Other The PSE team had the opportunity to travel with Andrew Karas, the USAID Mission Director, Ghana, to the Volta and Central regions during the quarter. The Director embarked on a working tour to selected USAID project sites to acquaint himself with MCSP implementation in training institutions to strengthen pre service education Mission Director observes as a pupil is examined

The tour showcased the following MCSP-supported sites: Ho CHNTS, Akome CHPS Compound and Winneba CHNTS. At all locations, the Mission Director interacted with the management, staff and students. The principals in the schools shared information about their school with the team from USAID and students demonstrated their skills. At the CHPS compound, he observed a school health activity. School health service is implemented in schools to improve the health of school children. School children are examined from head to toe to identify any illnesses for further referral. Health talks are also given to school children. During the tour, one such health talk included a demonstration on motor bicycle riding at Winneba.

Demonstration of motor bicycle riding at Winneba Mission Director interacts with tutors at Ho CHNTS.

Other Accomplishments MCSP Ghana participated in the President’s Malaria Initiative malaria operational plans site assessment in the western region prior to the FY18 malaria planning. Areas for the assessment included commodity stock management and pharmacy (drugs), intermittent preventive treatment for malaria in pregnancy (IPTp), long lasting insecticide treated nets, social and behavior change communication (SBCC), malaria activities in basic schools and data and records. Results from the visits were shared in a meeting organized at the National Malaria Control Program.

Higher Education Funds The higher education funds will be used to set up skills labs in three additional schools - Sampa and Yamfo in the Brong Ahafo Region and Nkawkaw in the Eastern Region. Skills lab equipment requisition for both local and overseas procurement will be done in the next quarter. Part of these funds will be used to support the Akome CHPS compound with PMI MOP team visits the labor and delivery of items as well as providing extra fetal skull models Western Region. for the Hohoe MTS. These items were requested during the USAID Mission Director’s visit to these two sites.

Activity 1.2.2: Strengthen clinical coordination and clinical placement processes and rotations MCSP has organized the first planning meeting for the Midwifery Services Framework stakeholder meeting. A list of stakeholders will be finalized at the next meeting in mid-April. Preparations are under way to organize this meeting in first week of May 2017.

Activity 1.2.3 Strengthen schools and NMC to improve quality based on institutional standards and activity NMC has submitted outstanding reports for the FAA activities covering milestones 6, 7 and 8 in Group picture at Akome School with Mission their first award. This quarter, NMC submitted a Director new FAA proposal for NMC regional office supportive supervision visits within their various regions. MCSP is currently reviewing and discussing the proposal with NMC. It is anticipated that the FAA application will be submitted to USAID for approval in Q3.

Activity 1.3: Improve CHN and public health students clinical practice for malaria, FP, maternal and child health, HIV Activity 1.3.2: Improve CHNs student’s practicum at CHPS. MCSP and tutors of five CHN schools in Bole, Oda, Krobo Techiman, Krobo Odumase and Tanoso visited a number of CHPS compounds to select two model CHPS compounds for adoption. Not all schools previously offered field placements before deploying CHNs. These model CHPS compounds will serve as additional sites for CHN student practicums, ensuring they have the opportunity to practice in the field under a trained CHO before being deployed to a site on their own. This strengthens students’ practicums in CHPS and ensures CHNs are ready to work as CHOs upon completion of their courses.

A procurement request was made after assessment and prioritization of needs by the schools and MCSP. All items requested for upgrade for the rest of the five CHNS and one PHNS have been procured and ready for distribution and set up of sites by the schools.

Table 1: CHPS compounds adopted by CHNTS and public health school Name of School CHPS to be adopted and updated Y3 Q2 Y3 Q3 1 Public health nurses Osuwem &Nyigbenya school 2 Navrongo CHNTS Wuru &Pinyoro 3 Tamale CHNTS Kpendua &Young 4 Fomena CHNTS Anwoma & Fumso Ketewaa

5 Winneba CHNTS Ansaful & Nsuekyir 6 Bole CHTS Kakiase &Sonyo 7 Krobo Techiman CHNTS Asubimnya & Ayeasu 8 Tanoso CHNTS Adoe & Boreso 9 Oda CHNTS Kyeremase & Badukrom 10 Odumase Krobo Okweinya CHNTS &Kpong West 11 Twifo Praso CHNTS Kayiriku &Twifo Mampong

Activity 1.4: Support GCNM to implement Midwifery Framework Activity 1.4.1: Provide FAA to GCNM to implement Midwifery Services Framework Preparations are under way to organize a midwifery services framework stakeholder meeting 2 - 4 May 2017. The first planning meeting was held and a draft list of stakeholders was prepared including government, partners, principals, health associations, teaching hospitals, mission health facilities and quasi-government health institutions, among others. The list will be finalized at the next preparatory meeting in April and then stakeholders will be invited.

Activity 1.5: CHN Assessments Activity 1.5.1: Conduct 1 year follow-up assessments of CHN graduating students in 4 schools In order to determine how CHN students are accessing the skills lab and eLearning modules, MCSP conducted a baseline knowledge and skills assessment of CHN students in four CHNTSs in Navrongo, Tamale, Fomena and Winneba. The knowledge and clinical practice (OSCEs) skills of a sample of the graduating class were assessed using a short survey of knowledge questions as well as objective structured clinical exams (OSCEs) for skill evaluation. Data collected from the four schools has been cleaned and analyzed by the research team. The team has developed draft briefers with preliminary results to share with the four schools in early Q3 and will further discuss gaps and challenges in mentorship and skill uptake during pre-service. After feedback from the schools and other stakeholders has been incorporated into the briefers they will be finalized.

The chart below shows the baseline results for the knowledge questions. A total of 120 students participated in the baseline assessment (30 per school). Most students scored below 70% on the knowledge exams and students performed poorly on the OSCE exams, scoring below 60% on the OSCE for correct latching during breastfeeding, 47% on family planning counseling for implants, 50% on malaria rapid diagnostic tests (RDTs) and 25% for cord care. The two figures below illustrate these results. Briefers have been developed and printed and will be shared with the schools during dissemination from the 19 to 21 April 2017.

Figure 1. Results from baseline knowledge assessments in four CHNT schools

Scores across all students on knowledge assessments (n=120 students) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% Student scores on knowledge exams 0% All Schools Navrongo Tamale Fomena Winneba

The baseline assessment reveals that students did not pass the knowledge test and could not safely perform the four OSCE skills included in the study. It is important to look at these skills as general indicators. If students cannot competently perform in these areas it is probable that they would also be unable to demonstrate other required skills. This indicates that there is a critical gap in teaching clinical skills. Causes must be investigated as they are likely to include multiple issues such as staffing, infrastructure, teaching methods, student accountability and study skills.

The median score for OSCE station on exclusive breastfeeding was 50%. Winneba had the lowest median compared to the other 3 three schools.

Figure 2. Results for OSCE station – Exclusive Breastfeeding

The median scores for the OSCE on family planning was 31% across all the four schools. Winneba CHNTS had the lowest median of 27%

Figure 3. Results of OSCE station – Family Planning OSCE Station - Family Planning Scores Across CHNTS (n=120) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% All Schools Navrongo Tamale Fomena Winneba

The median score for the skill station on RDT was 42% across all the four schools. Navrongo and Winneba CHNTS had the lowest median score of 38%.

Figure 4. Results from OSCE station – Malaria Rapid Diagnostic Testing OSCE Station - RDT Scores Across CHNTS (n=120) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% All Schools Navrongo Tamale Fomena Winneba

The skills station for cord care appeared to be the most difficult for the students as reflected in the very low scores. The median score across the schools was 15%. Navrongo had the lowest median score of 8%

This baseline data collection will be followed with qualitative data collection, taking place in the later part of PY3 or the early part of PY4 that will seek to better understand the gaps and challenges faced by the community health nursing training schools and how they can be improved. Quantitative data collection will also take place in PY4. The program will implement the same tools and process as the baseline assessment. This second time point will again assess student knowledge and skills after all four schools have received improved skills labs and are using MCSP e/mLearning materials. The results of this study can be used by stakeholders to help improve pre-service education in

community health nursing schools, thereby advancing provider ability to offer quality services to women and their families.

Activity 2.1 Support national level CHPS technical working group and subcommittees

Activity 2.1.1 & 2.1.2: Support PPME’s national CHPS technical coordination committee and Support CHPS subcommittee on harmonizing the CHPS training package

The Maternal and Child Survival Program (MCSP) in collaboration with PPME of the Ghana Health Service formed a 25 member taskforce/subcommittee to develop and update the national CHPS implementation guidelines. The subcommittee met twice and this was followed up with a series of work to review, edit, and format the draft guidelines by MCSP. The guidelines were launched as part of the national CHPS forum by the Hon. Minister of Health on September 30, 2016. The guidelines were finalized by a team from PPME of GHS and MCSP during the first quarter of PY3. In Q2 of PY4 MCSP has printed and delivered 200 copies of the national CHPS implementation guidelines to PPME. These copies are expected to be distributed to users at all the levels of health service delivery. However, the printing of 300 copies of Making the System Work Part A and B is on hold in order to effect some formatting errors detected. The PPME Director has promised to provide MCSP with the word version for the correction to be made. Printing will be completed in Q3.

The team also discussed the draft terms of reference for the national CHPS implementation technical working group with PPME and the first meeting is scheduled to take place on May 4th, 2017. The terms which include responsibilities, committee composition and committee membership has been accepted by both MCSP and PPME.

Activity 2.1.3: Support CHPS subcommittee on CHPS Training Materials Harmonization

CHPS Training Materials Harmonization Meeting

MCSP, in collaboration with PPME, organized a four day workshop from 14th to 17th February 2017 as a follow up to three previous workshops, held between June and November 2016, aimed to harmonize and standardize tools and materials for CHO training. A 12 member team, mainly composed of the team leaders of the task teams of the previous meetings from the GHS Headquarters Divisions, Regions within the GHS and MCSP Ghana, was brought together for this purpose.

The objectives of the workshop were to: • Review the final CHPS draft training manual using the inputs received from stakeholders; • Develop the pre and post questions for trainees including marking scheme; and,

• Develop a field guide and complete any other work that needed to be done before engaging consultants for final technical review and editing. The next steps after the workshop included: • Giving the reviewed document to consultants for final technical review, synchronization and editing of the volumes and modules and also to trim the sizes of PowerPoint presentations to fit into the number of days allocated to each module. • Holding a two-day validation workshop after the consultants’ review.

Activity 2.3: Support sharing of CHPS best practices Activity 2.3.2 Share CHPS implementation experiences internationally Zacchi Sabogu from MCSP Ghana participated in the Institutionalizing Community Health Conference (ICHC) held in Johannesburg, South Africa from the 27th March to 1st April 2017 and made a presentation on Community Health Practioners; Evidence to Policy as part of WHO community health systems guidelines development as shown in the picture below. The objectives of the conference were: • Sharing state-of-the-art lessons and experience; • Enabling country stakeholders to share progress and identify solutions to persistent challenges; • Informing national policies and plans though evidence, success, and adaptive learning; and • Engaging communities as dynamic resources and agents within national and local systems. The audience included representatives from 45 countries, including 23 official country delegations nearly 400 government officials and health experts. The conference focused on helping Group picture after session 7 presenters on Community-based country delegations develop country- Practitioners: Evidence and Policy. From left is Mariam Sylla specific action plans and learning agendas Diene, UNICEF Niger, Giorgio Cometto, WHO, Temitayo that address priority issues and challenges Ifafore, USAID, US, Kaosar Afsana, Brac, Bangladesh, and to strengthen partnerships with Zacchi Sabogu, MCSP, Ghana communities as resources.

The PPME Director was expected to attend but unfortunately had to cancel his trip due to immigration issues.

Additionally, the CHPS best practices case studies, which were documented in Ashanti region during PY2, were reviewed by the regional CHPS coordinator and approved. After final formatting and editing, the case studies will be uploaded to the GHS website for stakeholder and beneficiary consumption. These best practices case studies can be used by other CHPS compounds as well as national/sub-national CHPS planning committees to improve the services available in CHPS zones.

Activity 2.4 Assist with CHPS planning tool Activity 2.4.1: Continue to refine unit cost to implement CHPS

In Q2, MCSP worked on finalizing the CHPS cost and revenue estimates based on input from MCSP team members and GHS PPME. In addition, MCSP met with JICA and their contractor Deloitte to share the CHPS cost estimates and review the process and methodology for generating them. MCSP provided JICA and Deloitte with technical assistance and input as they develop their CHPS business plan for the MOH. During the same quarter, MCSP continued to work on the Excel-based CHPS Planning Tool.

In the next quarter, MCSP will continue to work with GHS PPME on a dissemination plan for the cost estimate findings. This will include dissemination at the CHPS Technical Working Group meeting in May, and may include a meeting with MOH agencies. MCSP will also continue to provide technical assistance on an as needed basis to JICA and Deloitte. MCSP will work with GHS PPME to finalize cost item quantities in the CHPS Planning Tool, review a Tool user guide outline, and develop plans for disseminating the Tool including providing training. MCSP will also discuss opportunities to develop a broader financial management training for GHS in response to GHS CHPS scale-up needs.

Activity 2.4.2: Develop and implement tools to help national, region, district, and sub- district health management teams cost out their CHPS plans

The beta tool exists as described above. Plans for dissemination are ongoing. The first dissemination will take place at the national CHPS TWG meeting in early May 2017 in Accra.

Activity 2.5: Strengthen CHPS implementation and participation in National Health Insurance Scheme

Activity 2.51: Prepare CHPS and supporting sub-district health teams (SDHT) for working within the capitation payment system This activity is scheduled to begin in PY3 Q4 and continue to PY4 Q1.

Activity 2.6: Roll out harmonized CHO trainings to regions Activity 2.6.1: Conduct two trainings for 50 regional trainers (10 per region) on new CHPS training curricula The trainings will be scheduled for Q1 of PY4 after all the CHPS training materials have been completed, printed and distributed the regions.

Activity 2.7: Continue performance monitoring grants (FAAs) with regions Activity 2.7.1: Provide technical support to regions to implement activities in their FAAs begun in PY 2 (e.g., training) The implementation of the CHPS FAAs for the five MCSP regions started earnestly in the last quarter of PY2 and is expected to be completed by the end of the third quarter of PY3. During the period, some milestones were completed and a joint monitoring visit was conducted to four regions. For further details on the status of the CHPS FAAs, please see Annex V.

Joint monitoring visits A joint monitoring team from MCSP and PPMED conducted monitoring visits to Upper West, Upper East, Eastern and Brong-Ahafo regions during the second quarter. The objectives of the monitoring visits were to assess the level of implementation of the FAAs and to discuss and agree on a feasible

CHPS FAA Monitoring Visit to Nandom District/UWR (left) and DHMT, Nandom District (right)

schedule that could be implemented within the limited timeframe. In total, about 75% of the milestones have been implemented across the five regions.

Apart from the Upper East and West regional health directorates (RHD), the team visited four district health directorates (DHD), four CHPS zones, and one sub-district during the period. During the two visits, the team met the Regional Directors, CHPS coordinators, accountants and other staff to review their implementation plans. At the DHD, the team met with the DDHS, CHPS coordinator and other team members and discussed the contribution of the project in the districts, especially the performance of the CHOs and CHMCs who were trained with funding support from MCSP. The key findings include the following: • Each region revised their implementation plans to ensure that all activities will be carried out on schedule - especially for activities behind schedule. • Discussed and agreed upon reporting and payment schedules. • Discussed and agreed upon strategies to implement some outstanding activities.

Technical Skills Training of CHOs The implementation of the CHPS FAA activities continued in all the five regions. A summary of some of the activities implemented by the regions during the quarter includes: 1. Eastern region organized a bi-annual CHPS review meeting for 26 district CHPS coordinators and key members from the regional health directorate. Participants included public health nurses, disease control officers, health information officers, health promotion officers and nutrition officers who coordinate CHPS activities in the various districts. The objective of the meeting was to review CHPS implementation for the half year ending December, 2016 using data and indicators on CHPS from DHIMS II. 2. Supportive supervision visits to 11 districts in the Upper West Region. The main objective was to provide technical support to all the 11 districts and nine hospitals. The performance of DHMTs were assessed based on these five thematic areas in the supervisory process: i) Managerial area ii) Quality improvement at work place iii) Service delivery iv) Referral and feedback v) Monitoring and supervision system The briefing meetings revealed that 82% of activities in the previous action plans had been implemented. Each district and hospital was given immediate feedback after the supervision visit.

Supervision at the Lawra Hospital Feedback meeting at the DHA (Lawra)

Activity 2.7.3: Share lessons learned for all five regions FAAs The sharing of lessons learnt meeting is the “CHPS/IPC FAA review meeting” scheduled from 16-17th May, 2017. This was postponed from 28-29th March because of the conference in South Africa.

Activity 2.8: Conduct learning activities to inform national CHPS model Activity 2.8.1: Conduct study on CHPS urban model During Q2, the protocol and tools were submitted to the Johns Hopkins Institutional Review Board for review and ethical clearance. The study was determined to be ‘not human subjects research’ (NHSR) and was approved. The MER team has worked extensively on completing the requirements for submission of the study protocol to GHS Ethical Review Committee (ERC), a submission that will take place during Q3. Once ERC approval is received, the study team will begin training data collectors and data collection.

Activity 2.9: Support regional annual integrated plans Activity 2.9.1: Annual regional integrated plans prioritizing CHPS developed This activity was completed in quarter 1 of PY3. MCSP along with other partners and donors supported the regional planning in the five regions where FAAs are being implemented.

Activity 2.10: Encourage usage of the CHPS webpage Activity 2.10.1: Support PPME to improve CHPS webpage This activity will be carried out in Q3

For the Ebola Pillar IV Infection Prevention and Control (IPC) activities, MCSP continued supporting the five regions with regional and district facility trainings. The team is also providing continuous support to the regional health management team on the administration of FAAs. The MER team has instituted a weekly reporting format through which they provide support to coordinators in the regions.

By the end of March 2017, 3,799 healthcare workers have been trained, comprised of 2,748 (72%) clinical staff and 1,051 (27%) non-clinical staff across all the regional and district hospitals from the five regions. Average knowledge test scores increased from a baseline of 45% to 70% post training.

1. Conduct whole-site IPC training at 5 regional hospitals MCSP continued to support the regional hospital trainings in Brong Ahafo, Eastern, Ashanti and Upper East region respectively. Upper West is yet to start their regional training. To date, a total of 1,442 clinical staff and 623 non clinical staff have been trained in all the four regional hospitals.

2. Conduct whole-site IPC training at 51 district hospitals The team continues to support district level trainings. Ashanti has completed four district facility trainings in the Kumasi metropolis. These facilities include Tafo Government Hospital, Suntreso Government Hospital, Maternal and Child Health Hospital (MCHH) and Manhyia Government Hospital. In total, they trained I,213 health workers. Eastern region and Upper East are yet to start with their district level training. Brong Ahafo has completed one district level training where 224 were trained. Upper west has also completed one district level training of 198 participants. Currently, there are some district facility trainings ongoing. These include two district health facility trainings in Ashanti region at Bekwai and Effiduase.

3. Oversight of FAA administration in the five MCSP regions FAA activities in the regions are slower than was anticipated. Ashanti region has completed up to five milestones out of eleven and has submitted reports for reimbursement. These milestones include the signing of the implementation plan, completion of the regional hospital training, purchasing of restock medical items, supportive supervision visits of their regional hospital, Suntreso government hospital, and Manhyia government hospital. They have also completed four district facility trainings in the Kumasi metropolis (Tafo government hospital, Suntreso government hospital, MCHH and Manhyia government hospital). Eastern region has completed three (3) milestones out of nine (9) and has submitted their report. Brong Ahafo completed two (2) milestones and Upper East completed seven (7), both out of eleven (11) and both submitted reports. Lastly, Upper West has completed only one milestone out of nine (9). In response to this delay, MCSP has revised the

payment schedule for Brong Ahafo, requested all outstanding reports and reprogrammed some of the milestones for Upper West, Eastern and Upper East regions. All FAA activities have been scheduled to end by the 31st of July, 2017.

4. Conduct supportive supervision visits at each facility Out of the five MCSP regions, Ashanti regional health team has completed one supportive supervisory visit in the regional hospital as part of their FAA milestones. The other regional health teams will be begin supportive supervision upon completion of the first round of district hospital trainings in Q3.

b. Implementation Challenges

There have been some general delays and challenges during implementation as follows: • PSE skills labs are currently facing the challenge of delayed letters of exemption from the government to allow shipment of models from overseas into the country. This has delayed the setting up of the skills labs for PY3. The project is anticipating these letters to be released soon so the training materials can be shipped. • Three regions, Brong Ahafo, Upper East and Upper West, are having challenges adhering to the milestones schedule, consequently slowing down activities. The MCSP team is following up with the training coordinators to bring activities up to speed. • Some of the activities for CHPS could not be completed by end of PY2 due to initial challenges with GHS PPME Director’s availability.

c. Lessons Learned

Some lessons learned from this quarter include: • Continued visits to schools are needed to monitor utilization of skills labs and provide needed advocacy to ensure administration is supporting the lab’s proper utilization. • Communication to FAA recipients on all means of verification is very important to help them comply with what is required when submitting FAA Activity reports. • Monitoring visits are needed to provide technical and financial assistance to FAA recipients to support the outlined milestones activities as scheduled.

IV. PERFORMANCE MONITORING

IPC Training The MER team supported the program team in the monitoring of IPC training in the five MCSP focus regions. All the regional teams adhered to the training schedules that had been agreed upon in quarter one. The program used the monitoring visits to review participant data and dashboards for training facilitators. Facilitators’ use of training dashboards to monitor student test scores helped increase the post test score average from 65% to 71% at the end of the quarter.

CHPS FAA Monitoring The CHPS team together with staff from GHS PPME conducted FAA activity monitoring visits to some selected districts in Upper East and Upper West regions. During the visit, the team was able to support the regional teams to strategize and complete activities which were behind schedule. Additional monitoring was conducted in Ashanti, Brong Ahafo and Eastern region to support the roll-out of the CHPS FAA.

MECoP Meeting The team also attended the Monitoring and Evaluation Community of Practice (MECoP) meeting which was organized by Evaluate for Health (E4H).

• There was a presentation on challenges with extraction of DHIMS2 data. Evaluate for Health has devised strategies to address this including a memorandum of understanding with GHS- PPME. • The team from E4H also updated members on new maps and created ArcGIS accounts for those without accounts. Part of this presentation was on improving data visualization for reporting and presentations. • Members were also shown a version of the Health Population and Nutrition Office (HPNO) Knowledge Management Portal for IPs which is yet to be completed. this portal allows IPs to know the work being done in each of the regions

Global MER/Digital Health Global Meeting 2017 A member of the MER and a member of the Digital health teams participated in the 2017 Jhpiego Global meeting for MER and digital health which was held in Bangkok in February. The primary focus of the meeting was how to show and improve the impact of program implementation, with participants focusing on the key theme for the meeting: ‘Better Systems, Better Data, Better Decisions.’ Representatives from country offices around the world presented on these themes through demonstrations/discussions around their project work. The meeting gave participants the opportunity to learn from what teams from other offices have done to improve data collection, systems, reporting and data use for decision making. Learning about other systems of data collection will ensure MCSP Ghana is using the right tools to collect the correct information to show the impact of the work MCSP is doing.

There were presentations and hands-on skills training for each of the four objectives. The meeting provided participants with information and knowledge to support MCSP work. The team from Ghana had a poster presentation which shared with participants some digital health and MER innovations in-country, including use of Captricity for data entry and the Hello Nurse! game which is available on the google play store. The lessons learned from the global meeting have been shared with colleagues.

Assessments, Evaluations and Lessons Learned Urban CHPS Study As noted above, the MER team is working to complete the requirements for submission of the study protocol and tools to GHS ERC in the early part of Q3. The study has received approval from the Johns Hopkins IRB. The program has placed a job advertisement for data collectors and data collection is planned for Q3, pending approval from the GHS ERC.

Case Studies The final draft of the case studies was submitted to the leadership of Ashanti region for CHPS team in the region and districts that participated in the cases studies to review the report and provide their input. MCSP is waiting for the Ashanti regional team to provide feedback. This will enable us to finalize the report and publish on the CHPS microsite where other districts can access this learning.

Task Analysis The Task Analysis study assessed the knowledge, skills and competencies of healthcare workers working in CHPS zones. Following the comments received from GHS, the team working on the Task Analysis report met to review the report. The draft report is being updated and will be reviewed further by stakeholders during quarter three. Preliminary results from the study were utilized by the GHS technical team to harmonize CHO training materials. These preliminary results provided important insights into the gaps in healthcare worker training and competencies in CHPS zones. Once the final report is completed we will work with PPME to develop a dissemination plan.

V. LINKS TO OTHER USAID PROGRAMS In this quarter, MCSP continued to collaborate with S4H, E4H and Care Continuum. In PY3, MCSP began collaboration with Care Continuum on the development of the 90-90-90 eLearning content. With S4H, MCSP’s work continues to jointly support the roll-out of IPC trainings. Collaboration with S4H and E4H was seen in this quarter through the joint work on the PMI MOP FY 2018 Planning field visit. MCSP also participates in the COP coordination and knowledge management meetings facilitated by S4H.

VI. LINKS WITH GOG AGENCIES MCSP continues to have a good working relationship with various GOG agencies for preservice education, CHPS and IPC activities. New partnerships will be developed with relevant GOG agencies once the early childhood development work begins implementation.

VII. USAID FORWARD USAID Forward is supported by MCSP through increasing the capacity of the regional health directorates, NMC and GCNM through FAAs to enable them to implement action plans focused on improving their systems, competencies and capacity. This quarter, MCSP started working with PPME on the development of a proposal for FAA activities. This application will be finalized in the next quarter. As described, CHPS and IPC FAAs were approved and implementation of activities have begun.

VIII. SUSTAINABILITY The project continues to design activities through a sustainability lens to ensure that activities started under MCSP will continue after the project ends. This includes establishing well equipped skills labs and training tutors on how to use the labs, strengthening the preceptorship capacity of the midwifery schools and developing the eLearning module content in close collaboration with MOH so they have the capacity to develop and roll out new content after the project. Likewise, for the CHPS work, MCSP works closely with PPME and is using FAAs to enable the regions to identify and implement best practices with technical support from MCSP, which should lead to increased sustainability. For IPC, MCSP is also working closely with the ICD and using FAAs for the regions to implement activities with technical support.

IX. LEVERAGED FUNDING The MCSP Ghana team received funding from Jhpiego to test the use of a 360-degree video for adult learning. A video camera and software has been purchased. Field tests have been conducted both within the US as well as in Ghana to determine the best environment for the actual video shoot. The focus of the video will be to demonstrate how to set up skills labs and therefore filming is planned to take place during the setting up of the skills labs in Q3. The software, Element3D, has also been purchased and prototyping is underway.

A website has been created that showcases the current progress of the project: http://sites.jhpiego.org/360video/. The site includes updates, resources and lessons learned for using this new technology in preservice education.

X. PLANNED ACTIVITIES FOR THE NEXT QUARTER

Over the next quarter, MCSP will continue implementation of PY3 activities:

• 1.1.1: Develop content for eLearning

o Continue with the development of eLearning modules (infection prevention, integrated management of neonatal and childhood illnesses (IMNCI), and maternal/newborn/child vaccination) by performing the activities below: . Organize workshop for content development . Finalize contract process with the vendor . Develop and review storyboard for eLearning modules o Commence with the development of interactive app for HIV 90-90-90 by performing the following activities; . Support contract process . Review beta version of Interactive app . Make inputs and changes to the app o Preparing for 360 video development • 1.1.2: Award contract for the development of Moodle Plugin and Client Application • 1.1.3: Support eLearning Secretariat with logistics to visit some of the MCSP supported schools to assess information communication technology (ICT) infrastructure and internet service providers in the schools. • 1.2.1: Improved skills labs at midwifery and CHN schools o Follow up on exception of all skills labs items to be shipped from overseas. o Distribute all items upon receipt to schools. o Travel to schools to set up skills labs. o Train tutors on use efficient use of skills labs and how to use and care for new models. • 1.2.2: Strengthen preparation of clinical preceptors at midwifery schools o Follow up on preceptor trainings done in Q1 by all the six MTS who received FAA. o Ensure all identified preceptors are trained in clinical and preceptor skills. o Identify all successes, challenges and best practices from these trainings. o Plan and host a 1.5 day meeting to share best practices among the schools. • 1.3.1: Provide needed job aids/support to preceptors o Develop CHO checklist for preceptors • 1.3.2: Improve CHNs students’ practicums at CHPS. o Equip 12 CHPS compounds o Review NMC proposal for FAA and submit application for approval • 1.4.1: Provide FAA to GCNM to implement the Midwifery Services Framework o Midwifery Services Framework stakeholder meeting will be held in the first week of May 2017. • 2.1.1: Support PPME’s National CHPS technical coordination committee (TCC) o Support national CHPS TCC meeting • 2.1.3: Support CHPS subcommittee on harmonizing the CHPS training package o Print 200 copies of training curricula • 2.1.4: Support CHPS subcommittee on CHPS performance monitoring o Provide ongoing technical support to develop and implement dashboard • 2.2.1: Provide a FAA to PPME to conduct supportive supervision and revise the CHPS strategic plan o Administer and monitor FAA • 2.4.3: Number of persons trained in using CHPS costing tool o Disseminate of the tool at the CHPS Technical Working Group meeting in early May • 2.7.2: Monitoring visits to regions to ensure programmatic and financial compliance to FAA terms o Travel to each region with grants compliance officer and program officer • 2.7.4: Develop new FAAs in PY 3 to incorporate rolling out national level materials (guidelines, training materials, performance monitoring) o Meet with regions to develop new SOW and budget • 2.8.1: Conduct study on CHPS urban model

o Implement study based on protocol o Analyze data • 2.10.1 Support PPME to improve CHPS webpage o Quarterly monitoring

IPC Activities: Objective 1: Technical competency and ability of staff at targeted health facilities to routinely practice strong IPC is improved. • Start regional hospital training in Upper West region. • Continue to roll out district hospital trainings across Ashanti, Brong Ahafo, Eastern and Upper East regions. • Conduct supportive supervision and data collection visits to the regions.

XII. PROJECT ADMINISTRATION a. Personnel The Human Resource Manager and Head of Finance and Administration positions assumed work in early April and March 2017, respectively.

The recruitment process is on-going to fill the position of CHPS Technical Advisor and MER Specialist which became vacant in November 2016 as well as to fill the newly created position of Program Officer for CHPS and Digital Health. b. Changes in the Project Additional funds were received under the higher education funding element. These funds will be used to improve the skills labs of three additional schools (two general nurses’ schools and one physician assistant training school).

Contract, Award or Cooperative Agreement Modifications and Amendments Nothing to report during this quarter.

Environmental Monitoring and Mitigation Plan (EMMP) Nothing to report during this quarter. The early childhood development activities will be incorporated into the existing EMMP for monitoring once the workplan is finalized.

Family Planning Compliance The project continues to monitor FP compliance during the setup of skills labs, all trainings, and supportive supervision trips.

KOICA Partnership MCSP is collaborating with KOICA to strengthen education in the Volta Region in both midwifery and CHN schools. In PY3, MCSP continues to provide tutor and preceptor training and support, upgrades to the skills labs, and roll out of eLearning content for supplementary learning. A site visit was carried out in October 2016 to check on the progress of work on the skills lab building by KOICA. Another visit was done in December 2016 on invitation to a site visit meeting from KOICA, Work on building is still in progress. It was originally envisaged that construction would be completed by the end of February 2017 for the skills lab to be set up, but is not yet finished. The program is procuring materials for the skills lab set up and will be ready to implement as soon as the construction is completed.

As at the end of March, KOICA has not yet handed over the structures to the school authority to enable the setting up of the skills lab by MCSP. See below table for status updated for each school:

School District Implementation Status Hohoe Midwifery Training Hohoe Municipal Skills lab and eLearning fully School implemented.

Volta Kete Krachi Midwifery Training Krachi Skills lab set up and eLearning School in process, to be completed in September 2016. Keta Midwifery Training School Keta Under construction, was expected to be ready in February 2017 but not yet completed and no update provided. Ho Community Health Nurses Ho Municipal Skills lab has been set up, Training School eLearning to start in January 2017.

Annexes: I. Project Performance Indicators Table II. IPC Performance Indicator Table III. Success Story IV. Annex IV: CHPS FAA Milestone Dashboard V. Annex V: IPC FAA Dashboard

Annex I: Project Performance Indicators INDICA Y3 Q1 Q2 INDICATOR COMMENTS TOR # TARGET ACTUAL ACTUAL MCSP Ghana SO1: A better prepared midwifery and nursing workforce that is equipped with the knowledge and skills to effectively provide HIV, malaria, nutrition, family planning and maternal, newborn and child health services. 1.1.1 Number of new health workers graduating from 4,505 0 0 Data will be available in schools supported by MCSP Nov, 2017 because of the school calendar. 1.1.2 Number of eLearning modules developed 4 0 0 Time used to identify topic areas and subject matter experts and prepare contracts for vendors. 1.2.1 Number of schools with adequately equipped 19 4 0 The team is still awaiting simulation labs the arrival of models. 1.2.2 Percent of equipped schools having at least one tutor 100% 100% 100% trained on use of novel anatomical models 1.2.3 Percent of schools receiving NMC supportive 75% 0% 0% NMC requested a refresher supervision visit within the year training from MCSP to be able to use the tablets supplied; this has been completed. Supportive supervision visits will be included in the next FAA for NMC. 1.3.1 National CHN school curriculum revised by NMC to N/A N/A N/A Completed during PY2 include CHO training package and ensure adherence to national policy and guidelines 1.3.2 Percent of CHN schools implementing revised 100% 100% 100% national curriculum which includes the CHO training package 1.3.3 Percent of CHN schools offering clinical practice 72% N/A N/A Annual data collection; will experiences in CHPS zones be reported after Q4 MCSP Ghana SO2: The national CHPS strategy, guidelines, training materials, tools, and monitoring systems are standardized and approved. 2.2.1 Performance management system developed and 1 1 1 Dashboard on performance performance table template published on CHPS monitoring published as microsite by PPME with support from MCSP part of GHS indicator dashboards on CHIM website 2.2.2 Number of quarterly regional CHPS performance 10 N/A Biannual data collection; tables published on the CHPS microsite will be reported after Q2 2.4.1 Unit cost data for CHPS basic package and additional N/A N/A N/A Completed during PY2 innovative solutions collected 2.4.2 CHPS costing tool developed N/A N/A N/A Completed during PY2 2.4.3 Number of persons trained using CHPS costing tool 6 0 N/A The training of 2 PPME staff by Cicely is planned as part of Cicely’s visit in May, 2017. 2.4.4 Number of regional five-year CHPS implementation 2 N/A N/A All regions have developed plans developed guided by costing tool five year CHPS roll out

INDICA Y3 Q1 Q2 INDICATOR COMMENTS TOR # TARGET ACTUAL ACTUAL plans but were not guided by the costing tool. The costing tool is yet to be disseminated to the regions 2.5.1 Number of regional health teams trained in 2 2 2 All regional teams have budgeting, planning, and financial management tools been trained in budget (4 for managing capitation officers from each region) but not using the CHPS planning tool 2.6.1 Number of regional trainers developed 10 0 0 Tools and job aids are being finalized. This training is planned for PY4 2.6.2 Number of technically up-to-date tools and job aids 2 0 0 Tools and job aids being harmonized and disseminated reviewed. 2.7.1 Number of awards made directly to local 13 5 N/A 5 CHPS FAA. FAAs for organizations PPME, NMC and GCNM are planned for Q3 and Q4. 2.7.2 Number of civil society organizations (CSOs) N/A N/A N/A receiving USG assistance engaged in health advocacy 2.7.3 Percent of sub-district management teams trained in 20% 6% 6% Eastern region is the only management, including supervision and data use for region to have concluded decision-making this activity which covered 184 sub-districts 2.12.1 Number of regional biannual performance reviews 7 N/A 2 ER-1,and UER-1 using CHPS performance monitoring table

2.12.2 Number of districts with improved annual CHPS 3 3 Several districts, more than performance in at least one key service delivery area 3 2.12.3 Number of districts with a biannual CHPS index 50 N/A Biannual data collection; score of 2 or 3 will be reported after Q2

Annex II: IPC Project Performance Indicators Life of Results Q2 Project through ACTUA INDICA INDICATOR Target Q1 L COMMENTS TOR # (2015- 2017)

150 151 N/A TOT for 151 regional 1.1 Number of trainers trained on IPC trainers was completed in PY2 Q4. 13,975 737 Total number trained from 1.2 Number of facility-level staff trained in IPC 3,799 12 Hospitals Percent of MCSP-supported facilities with over 80% of 100% 0% 9 out of 10 completed 1.3 90% staff trained in IPC facility training Percent of facility-level staff trained in IPC that score at 90% 9% Results for 2,748 clinical 1.4 30% least 85% on the post-test staff trained in Q1&Q2. 56 4 Training has commenced in 1.5 Number of facilities where MCSP supported IPC training 12 12 facilities. 100% 0% 5 out of 10 facilities that have completed the facility Percent of MCSP-supported facilities that received at 1.6 50% IPC training have received least 1 supportive supervision visit at least 1 supportive supervision visit Number of MCSP-supported facilities that received 56 0 0 MCSP is waiting for 1.7 distribution of IPC job aids, posters and other learning Systems for Health to materials finalize the job aides.

ANNEX III: Success Story Community in Ghana Donates Building to Facilitate Community Health Officer’s work

When 30-year old Selina Kuusila started working at Dapoore CHPS zone as Community Health Officer (CHO) barely six months ago, she assumed she would be met with the same lukewarm attitude from community members as she had experienced when she worked at another health center.

The theoretical aspect of community entry that Selina learned in school did not adequately prepare her for the challenges at the facility, “When I came out as a Community Health Nurse, I was just posted to start work without any practical experience” she recalled. “I didn’t know anything like community entry and how to involve community members in your activities”.

Six days a week, Selina wakes very early and walks for 30 minutes to Dapoore, a farming community near Bolgatanga in the Upper East region. She goes very early to ensure she will find community members at home before they go the field to work. Once there, she Selina weighs a year-old baby in her makeshift checks on community members by visiting compound at Dapoore them in their homes and also meets with opinion leaders and chiefs, discussing how to address community health needs.

Her aim is to reduce the incidence of preventable diseases like malaria, counsel mothers about family planning, and detect pregnancy-related problems. Despite this effort Selina often arrives at communities only to find that they are already away from home engaged in farming activities. Because she lives so far from the communities she supports, Selina often felt discouraged to walk such a distance only to be unable to effectively engage with the community.

Then six months ago, Selina got a call from her regional health director to attend a Community Health Officers’ training under the Jhpiego-led USAID flagship Maternal and Child Survival Program (MCSP). The training is meant to equip community health nurses with strategies and tools to support their engagement with communities and the ability to provide quality basic health care services.

Following the training, Selina returned to her facility recommitted to persist in her engagement with the community. Two months later, a community member donated a temporary shelter from where she could offer her services and Selina knew the community entry strategy she was taught at the Community Health Officers training was paying off.

With a new, local place to use as her base, Selina is now able to interact with Dapoore residents more frequently. Selina will not have to rise so early just to meet with community members before they leave for their farms.

“Community entry is very important,” she said. “If you don’t do it very well I don’t think you would be able to do the rest of the work.”

Early every morning, Selina is now visited by volunteer women from the community to help clean her compound and also organize her make-shift workplace after the previous day’s activities in readiness to attend to her clients.

Selina is thrilled at her new relationship with community members. “Because of the Selina sets up her make-shift office before getting to start the community entry technique, I now day’s work know most of the community members and feel supported. The relationship is very nice, actually.”

Annex IV: CHPS FAA Milestone Dashboard Please note that completed activities are indicated by the shaded cells.

Organization Aug- Milestone No. Activity Description Jul-16 16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Ashanti001 Develop SOW and milestone schedule X Ashanti002 Submission of the implementation plan X Organize a planning meeting with all Ashanti003 regional facilitators. X Organizing an 11 day CHO training following the national training curriculum for upgrading the skills for 70 CHNs and Ashanti004 ENs assisted to selected CHPS zones. X

Ashanti Hold community health officer review meetings for 75 CHOs and district CHPS coordinators to review the quarter data, discuss performance updates, and provide technical refresher topics from Ashanti005 the initial CHO training. (30 districts) X Collecting the items procured for the 3 model CHPS compounds from MCSP Ashanti006 office X Establish and launch three pilot model Ashanti007 CHPS compounds for the region X

Organization Aug- Milestone No. Activity Description Jul-16 16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Conduct one-day monitoring and supportive supervision visits to the 15 district health management teams, sub- district health management teams and Ashanti008 CHPS zones Conduct one-day monitoring and supportive supervision visits to the 15 district health management teams, sub- district health management teams and Ashanti009 CHPS zones Hold community health officer review meetings for 150 CHOs to review the quarter data, discuss performance updates, and provide technical refresher Ashanti010 topics from the initial CHO training. Develop and agree to a SOW and

BA001 milestone schedule X Submission of implementation plan

BA002 for activities X Brong Ahafo Strengthen the capacity for the regional and district health management team staff for managing CHPS services (1 day training for 70 BA003 participants) X

Organization Aug- Milestone No. Activity Description Jul-16 16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Organize a materials review meeting to prepare trainers for the regional community health officer trainings. This is a meeting to prepare for the training and agenda items should include: Roles and responsibilities, update modules, assemble dummy,/other materials, discussion of fieldwork plans etc. BA004 X Increase community participation at the district level by training 50 community health management committee members using the CHMC BA005 manual in 3 of the 27 districts X Train 75 community health officers using the community health officer BA006 training manual (10 day training) X Conduct monitoring and supportive supervision visits to 10 districts in the

region and one CHPS zones in each BA007 district X Conduct monitoring and supportive supervision visits to 10 districts in the

region and one CHPS zones in each BA008 district

Organization Aug- Milestone No. Activity Description Jul-16 16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Increase community participation at the district level by training 50 community health management committee members using the CHMC BA009 manual in 23 of the 27 districts Conduct monitoring and supportive supervision visits to 7 districts in the

region and one CHPS zones in each BA010 district Eastern001 Develop SOW and milestone schedule X Eastern002 Submission of the implementation plan X Conduct training and strengthen capacity building for the district health teams in the 26 districts using the community Eastern003 health management committee manuals X Conduct a district level training for sub-district supervisors and community health nurses using the Eastern community health officers training modules and community health management committee manual (one Eastern004 in each district) - 13 districts X Conduct training and strengthen capacity building for the district health teams in the 26 districts using the community health management Eastern005 committee manuals X

Organization Aug- Milestone No. Activity Description Jul-16 16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Conduct a district level training for sub-district supervisors and community health nurses using the community health officers training modules and community health management committee manual (one Eastern006 in each district) - 13 districts X Orientate community health management committees on their roles and contributions towards CHPS with performance indicators identified. (Capacity building for CHMC members by Eastern007 sub-leaders/ CHOs) X Arrange one meeting from the sub-district level to review CHPS implementation and Eastern008 conduct data validation Arrange one meeting from the subdistrict level to review CHPS implementation and Eastern009 conduct data validation X Hold an annual CHPS review meeting for Eastern010 the CHOs Conduct regional monitoring and support visits to district health management teams, sub district health management teams and Eastern011 priority CHPS zones Hold bi-annual CHPS review meeting with Eastern012 the CHPS Coordinators for 26 districts

Organization Aug- Milestone No. Activity Description Jul-16 16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Develop and agree to a SOW and

UE001 milestone schedule X Submission of implementation plan

UE002 for activities X Arrange a training for 35 community

UE003 health nurses in the region X Arrange a training for 35 community

UE004 health nurses in the region X Conduct bi-annual facilitative

UE005 supervision to the 90 sub-districts Organize bi-annual supportive

UE006 supervision visits in 13 districts Upper East Train the 35 newly identified community health management committee members to strengthen community ownership and UE007 participation in CHPS services Convene a bi-annual peer review meeting to strengthen management UE008 coordination with the districts Train the 35 newly identified community health management committee members to strengthen community ownership and UE009 participation in CHPS services

Organization Aug- Milestone No. Activity Description Jul-16 16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Conduct bi-annual facilitative

UE010 supervision to the 90 sub-districts Organize bi-annual supportive

UE011 supervision visits in 13 districts Convene a bi-annual peer review meeting to strengthen management UE012 coordination with the districts Develop and agree to a SOW and

UW001 milestone schedule X Submission of implementation plan

UW002 for activities X Hold preparatory meeting to review materials for the national training package on providing CHPS services and develop finalized training Upper West UW003 materials. X Train 30 community health officers using the national training package on UW004 providing CHPS services X Conduct technical support and facilitative supervision visits to 11 UW005 districts (Quarter 1) X Organize a facilitative suppervision

UW006 review meeting for 30 participants X

Organization Aug- Milestone No. Activity Description Jul-16 16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Orientate 30 community health management committees in the 11 districts on their roles and

responsibilities to foster community participation and involvement in CHPS UW007 services (6 districts) X Organize district facilitative supervision meetings to discuss

district performance and next steps UW008 for improvement (6 districts) Conduct technical support and facilitative supervision visits to 11 UW009 districts (Quarter 2) Arrange a regional CHPS stakeholders meeting to provide an orientation on the revised national CHPS policy (Conduct sensitation workshop for UW010 100 stakeholders on CHPS). Conduct technical support and facilitative supervision visits to 11 UW011 districts (Quarter 3) Organize district facilitative supervision meetings to discuss

district performance and next steps UW012 for improvement (5 districts) Organize a facilitative suppervision

UW013 review meeting for 30 participants

Organization Aug- Milestone No. Activity Description Jul-16 16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Conduct technical support and facilitative supervision visits to 11 UW014 districts (Quarter 4) Orientate 30 community health management committees in the 11 districts on their roles and

responsibilities to foster community participation and involvement in CHPS services (5 districts) UW015

Annex V: IPC FAA Dashboard

Organization Milestone No. Activity Description Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Completion and submission of IPC Implementation Plan form ARIPC01 and Facility Nominal roll form X

ARIPC02 Procurement of Restock medical items for training X

ARIPC03 Completion of Regional Hospital training X

ARIPC04 Completion of Four (4) District hospital trainings.

ARIPC05 Completion of supportive supervisory visit. Ashanti ARIPC06 Completion of Six (6) District hospital trainings.

ARIPC07 Completion of supportive supervisory visit.

ARIPC08 Completion of Five (5) District hospital trainings.

ARIPC09 Completion of supportive supervisory visit.

ARIPC10 Completion of Two (2) District hospital trainings.

ARIPC11 Completion of supportive supervisory visit.

Completion and submission of IPC Implementation Plan form BAIPC01 and Facility Nominal roll form X Brong Ahafo

BAIPC02 Procurement of Restock medical items for training

Organization Milestone No. Activity Description Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 BAIPC03 Completion of Regional Hospital training

BAIPC04 Completion of Three (3) District hospital trainings.

BAIPC05 Completion of supportive supervisory visit.

BAIPC06 Completion of four (4) District hospital trainings.

BAIPC07 Completion of supportive supervisory visit.

BAIPC08 Completion of Five (5) District hospital trainings.

BAIPC09 Completion of supportive supervisory visit.

BAIPC10 Completion of Two (2) District hospital trainings.

BAIPC11 Completion of supportive supervisory visit.

Completion and submission of IPC Implementation Plan form ERIPC01 and Facility Nominal roll form X

ERIPC02 Procurement of Restock medical items for training X ERIPC03 Completion of Regional Hospital training X Eastern ERIPC04 Completion of Four (4) District hospital trainings.

ERIPC05 Completion of supportive supervisory visit. ERIPC06 Completion of four District hospital trainings. ERIPC07 Completion of supportive supervisory visit. ERIPC08 Completion of four District hospital trainings.

Organization Milestone No. Activity Description Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 ERIPC09 Completion of supportive supervisory visit.

Completion and submission of IPC Implementation Plan form UEIPC01 and Facility Nominal roll form X

UEIPC02 Procurement of Restock medical items for training Upper East UEIPC03 Completion of Regional Hospital training X UEIPC04 Completion of District hospital trainings. UEIPC05 Completion of District hospital trainings. UEIPC06 Completion of District hospital trainings. UEIPC07 Supervisory Visit to all 13 Districts

Completion and submission of IPC Implementation Plan form UWIPC01 and Facility Nominal roll form X

UWIPC02 Procurement of Restock medical items for training

Regional Hospital Trainings for Clinical and Administrative UWIPC03 Upper West Staff UWIPC04 Completion of District hospital trainings. UWIPC05 Completion of supportive supervisory visit UWIPC06 Completion of supportive supervisory visit UWIPC07 Completion of District hospital trainings. UWIPC08 Completion of supportive supervisory visit UWIPC09 Completion of supportive supervisory visit