This 8th Quarterly Report was produced for the United States Agency for International Development (USAID) by Medical Care Development International (MCDI), under Cooperative Agreement No. AID - 680- A -11-00001
PMI/ARM3 8TH QUARTERLY REPORT JULY 1 – SEPTEMBER 30, 2013 ______
FISCAL YEAR 2013, QUARTER 4 PROGRAM YEAR 2
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September 30, 2013
PMI/ARM3 Accelerating the Reduction of Malaria Morbidity and Mortality Program
8th Quarterly Report: July1, 2013 to September 30, 2013 Fiscal Year 2013 Program Year 2
Submitted to: Dr. Emile Bongo, Agreement Officer Representative (AOR), USAID/Benin Dr. Milton Amayun, Family Health Team Leader, USAID/Benin
Cover photo: The Minister of Culture and Arts, Mr. Jean Michel ABIMBOLA, visiting ARM3‘s booth during the “Yam Days” Fair in Savalou
PMI/ARM3, Accelerating the Reduction of Malaria Morbidity and Mortality Program (ARM3), is funded by the United States Agency for International Development (USAID), under Cooperative Agreement
AID - 680- A -11-00001. ARM3 is managed by Medical Care Development International (MCDI) as the prime, in collaboration with sub-grantees Africare, Johns Hopkins University – Center for Communications Program (JHU-CCP) and Management Sciences for Health (MSH). The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or of the United States Government.
Contents List of Acronyms ...... 5 Acknowledgements ...... 7 Executive Summary ...... 8 Introduction ...... 12 Result 1: Implementation of malaria prevention interventions in support of the National Malaria Strategy improved ...... 13 Sub-Result 1.1: Implementation of malaria prevention programs in support of the National Malaria Strategy improved 13 Sub-result 1.1a: IPTp uptake increased ...... 13 Achievements ...... 13 Sub-result 1.1.b: Upgrade skills of health workers (public and private sectors) through pre-service and in-service training 14 Achievements ...... 14 Results ...... 15 Sub-Result 1.2: Supply and Use of LLINs Increased ...... 16 Achievements ...... 16 Result 2: Malaria diagnosis and treatment activities in support of the National Malaria Strategy improved ...... 19 Sub-Result 2.1: Diagnostic Capacity and Use of Testing Improved ...... 19 Achievements ...... 19 Results ...... 22 Sub-Result 2.2: Case Management of Uncomplicated and Severe Malaria Improved ...... 22 Sub-result 2.2.a: Upgrade skills of health workers on clinical management ...... 22 Achievements ...... 22 Sub-result 2.2.b: Implementation of the Performance Improvement Approach (PI) in participating health zones and hospitals 24 Achievements ...... 24 Sub-result 2.2.c: Enhance integrated supervision on IPTp, malaria diagnostics and clinical case management of malaria 32 Achievements ...... 32 Results ...... 34 Sub-Result 2.3: integrated Community Case Management (iCCM) improved...... 36 Achievements ...... 36 Result 3: The national health system’s capacity to deliver and manage quality malaria treatment and control interventions strengthened ...... 37 Sub-result 3.1: The NMCP’s technical capacity to plan, design, manage, and coordinate a comprehensive malaria control program enhanced ...... 37 Achievements ...... 37 Results ...... 40 Sub-Result 3.2: Capacity to Collect, Manage and Use Malaria Health Information for M&E and Surveillance Improved .. 40
Achievements ...... 40 Results ...... 47 Sub-Result 3.3: Capacity in Commodities and Supply Chain Management Improved ...... 47 Achievements ...... 47 Results ...... 53 Result 4: Cross Sectional Activities ...... 54 Achievements ...... 54 Results ...... 60 Program Management ...... 61 Field Office ...... 61 Home Office Backstopping and Reporting ...... 61 Short Term Technical Assistance ...... 62 Major activities planned for next quarter (Year 3, Oct-Dec): ...... 63 Financial Summary ...... 65 Annex 1: Cumulative Financial Report ...... 66 Annex 2: SF 424 ...... 67
List of Acronyms
ABD Adjohoun-Bonou-Dangbo ACPB Association of Private Clinics of Benin ACT Artemisinin Combination Therapy AL Artemether + Lumefantrin AMCES Association des Œuvres Médicales Privées Confessionnelles et Sociales ANC Antenatal Care ARM3 Accelerating the Reduction of Malaria Morbidity and Mortality Program (ARM3) BASICS Basic Support for Institutionalizing Child Survival BCC Behavioral Change Communication CAME Centrale d’Achat des Médicaments Essentiels (Central Medical Stores) CCM Clinical Case Management CDC Centers for Disease Control and Prevention CEBAC-STP Coalition des Entreprises Béninoises et Associations Privées Contre le SIDA, la Tuberculose, et le Paludisme CHD Centre Hospitalier Départemental (Departmental Hospital Center) CHW Community Health Workers CIP Interpersonnel communication DDS Direction Départementale de la Santé DHS Demographic Health Survey DPMED Direction de la Pharmacie du Medicament des Exploration Diagnostic DRZ Dépôt Répartiteurs de zone (Health Zone Depots) DSME Direction de la Santé de la Mère et de l’Enfant EEZS Equipe d’encadrement de zone sanitaire ENTASE National School of Senior Technicians in Health and Epidemiological Surveillance ETAT Emergency Triage, Assessment and Treatment EUVS End Use Verification Survey FSS Faculté des Sciences GFATM Global Fund to Fight AIDS, Tuberculosis, and Malaria GOB Government of Benin HMIS Health Management Information System HO Home Office HOMEL Hôpital de la Mère et de l’Enfant de Littoral ICCM Integrated Community Case Management INMES Institut National Médico-Social INSAE Institut National de la Statistique et de l’Analyse Economique IPTp Intermittent Preventive Treatment for Pregnant Women JHU-CCP Johns Hopkins University – Center for Communication Programs LDP Leadership Development Program LLIN Long Lasting Insecticide-Treated Nets LMG Leadership, Management and Governance LMIS Logistical Management Information System MCDI Medical Care Development International MCZS Médicin Coordinateur de Zone Sanitaire (Health Zone Physician Coordinator) M&E Monitoring & Evaluation MEDISTOCK Commodities Management Program MOH Ministry of Health MOU Memorandum of Understanding
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MOP Malaria Operational Plan MSH Management Sciences for Health NGO Non-Government Organization NMCP National Malaria Control Program ODK Open Data Kit OTSS Outreach Training Support and Supervision PAK Pobe-Adja-Ouere-Ketou PAS Porto Novo-Aguégués-Seme-Kpodji PI Performance Improvement PITA Integrated Annual Work Plan PMI President’s Malaria Initiative QAP Quality Assurance Program RBM Roll Back Malaria RDT Rapid Diagnostic Test RMIS Routine Malaria Information System ROBS Réseau des ONG Béninoises de Santé SAKIF Sakete/Ifagni SCM Supply Chain Management SIRP Systeme d’Information de Routine du Paludisme SNIGS Système National d’Information et de Gestion Sanitaire SOP Standard Operating Procedures SP Sulfadoxine-pyrimethamine STTA Short Term Technical Assistance TWG Technical Working Group USAID United Stated Agency for International Development WHO World Health Organization
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Acknowledgements
ARM3 wishes to thank everyone who helped create this document as well as various technical and financial partners for providing constant support to Benin in the fight against malaria, including the National Malaria Control Program as well as our private sector partners: Coalition des Entreprises Béninoises et Associations Privées Contre le SIDA, la Tuberculose, et le Paludisme (CEBAC-STP); Association des Œuvres Médicales Privées Confessionnelles et Sociales (AMCES); Réseau des ONG Beninoises de Santé (ROBS); and Association des Cliniques Privées du Bénin (ACPB). In addition, we would like to acknowledge the USAID Benin Mission for their constant guidance and financial support in the implementation of the ARM3 Project.
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Executive Summary
ARM 3 Results Sub-Results Key Achievements
1. Implementation of Implemented the tracking of pregnant women through CHW home malaria prevention visits in order to ensure completion of IPTp 1st and 2nd dose regimen programs in support in Cotonou of the National Finalized French version of the IPTp Barriers Assessment Report and Malaria Strategy disseminated to MOH, NMCP, WHO and other local partners improved Initiated planning of revised IPTp BCC/IEC materials 1.1 IPTp uptake Signed an MOU with FSS to provide TA in the development of their increased malaria training materials and delivered 12 microscopes to strengthen their pre-service labs Developed and reviewed ToT training manuals on interpersonal communication including the IPTp module Provided refresher training on IPTp to 106 additional health care providers in ANC facilities in 3 Health Zones Initiated actions to address problem of SP stock-outs Concluded private sector Phase 1 LLIN distribution with a total of 44,000 LLINs distributed and 97.5% payment recovery rate achieved Organized Phase 1 post distribution evaluation workshop with 21 CEBAC-STP member companies to reviewed lessons learned Conducted training for 45 participants representing Health Committees from 19 companies as part as Phase 2 distribution of LLINs Developed a protocol for the tracking/monitoring of LLINs distributed in Phase 1 Collected packaging materials for 90% of the 44,000 LLINs 1.2 Supply and use distributed during Phase 1; packaging securely stored awaiting of LLINs increased proper disposal Developed a proposal for the implementation of key program activities with private sector providers Drafted MOUs with private health sector networks, including ROBS, AMCES and ACPB aimed at engaging the private sector in fight against malaria through improved case management, diagnostics and record keeping Initiated discussions with MoH, USAID and other partners in regards to the registration of the private health sector and developed a plan of action 2. Malaria diagnosis 2.1 Diagnostic Provided post-training follow-up of 36 microscopists/technicians from and treatment capacity and use of AL, OP and ZC in malaria microscopy and RDT use activities in support diagnostic testing Supported the development of improved RDT training materials of the national improved malaria strategy Continued implementation of management of severe malaria trough improved the implementation of the ETAT Approach in hospitals. During this 2.2 Case quarter ETAT process indicators were assessed in 12 hospitals management of which revealed marked improvement compared to baseline uncomplicated and Conducted training for 157 health workers in Ouémé/Plateau and severe malaria Borgou/Alibori on case management of uncomplicated malaria improved Conducted training course on IMCI on selected HZs Provided funding to 25 health zones under their MOUs to support integrated supervision of the health facilities
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Conducted quarterly evaluation (April-June) of 18 HZ MOUs in Atlantique/Littoral, Ouémé/Plateau and Zou/Collines, which showed a high implementation rate for almost all HZs and DDSs Implemented Collaborative Improvement sessions in Atlantique/Littoral and Ouémé/Plateau as part of health zone activities implemented under MOUs, with 130 participants from 4 health zones Results of the implementation of the leadership projects of the 14 LDP teams from Atlantique/Littoral and Ouémé/Plateau teams were presented in the 4th LDP workshop: o 64% (9) met the expected target indicator Implemented the first series of learning sessions in Atlantique/Littoral and Ouémé/Plateau with 122 participants from 36 health centers and 159 participants from 48 health centers, respectively Conducted integrated supervision to 401 health facilities Signed an amendment with USAID to continue iCCM activities in the five former BASICS health zones 2.3. Integrated Signed sub-award modification with Africare to implement iCCM and community case conducted the review of the sub-award modification with MSH management Selected and hired iCCM Advisor improved Evaluated the coverage of GSM and GPRS networks in Benin and reviewed alternative platforms to implement the SMS project through the CommCare platform 3. National health Provided support to the NMCP in the organization of the mid-term 3.1 NMCP’s system’s capacity to review of the ‘Plan Intégrée de Travail Annuel’ and drafted an technical capacity to deliver and manage updated PITA for the remainder of the year plan, design, quality malaria Facilitated Technical Working Group meetings: Case Management manage, and treatment and and Supply Chain Management coordinate a control interventions Leadership in Strategic Health Communication course held in Ouidah comprehensive strengthened for 25 BCC local partners malaria control ARM3’s BCC Advisor presented updated BCC Strategy and program enhanced achievements at a PMI-hosted Malaria BCC workshop in Addis Prepared and participated in the implementation of the health facility survey: o Recruitment and training of surveyors o Provided logistical support o Programmed questionnaires into ODK program o Managed data send from the field Facilitated the preparation, publication and distribution of quarterly 3.2 MOH capacity to RMIS Newsletter (Number 11, April-June 2013) collect, manage and Provided technical support to the NMCP to update the following use malaria health databases: LMIS, RMIS, MEDISTOCK, HMIS, PILP GFATM, and information for Palu Alafia (GFATM-funded) monitoring, Organized 3 regional meetings for the validation of RMIS data evaluation and collected from April – June 2013 surveillance Undertook a second RDQA visit to 16 health facilities and 8 health improved zones Carried out nationwide supportive supervision in 41 data collection sites and 11 health zones Updated 34 SNIGS and RMIS databases and provided refresher training to 34 health zone statisticians on LOGISNIGS maintenance procedures Provided technical support to the IRSP for review of sentinel sites
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indicators Conducted emergency procurement to alleviate the stock-out of RDTs and ACTs Trained CAME’s Board of Directors (BoD) on the strategic monitoring of national medical stores Supported NMCP to organize quarterly malaria commodities LMIS 3.3 MOH capacity in supervision in all 34 DRZs, 27 zonal hospitals, and 66 health facilities commodities and Supported the NCMP in the training of users in all 6 health supply chain departments on the MEDISTOCK V4+ software, with a focus on management health workers in Atacora/Donga, Borgou/Alibori, Ouémé/Plateau, improved and Zou/Collines Organized in collaboration with the NMCP, a second LMIS quarterly supervision feedback workshop in Lokossa in September, 2013 Conducted the EUV feedback workshop in Ouémé/Plateau and Porto-Novo Behavioral Change Conducted high level advocacy with the King of Savalou and Communication conveyed the importance of spreading malaria prevention messages (BCC) among his people Partnered with the Savalou Commune and participated in the community health fair “Yam Days” by disseminating malaria messages to the public and national authorities including the Minister Cross Sectional of Culture and Arts Activities Continued mass media campaigns through the addition of 2 local radio stations expanding malaria prevention messages to more people through multiple formats and languages Conducted community dissemination of malaria messages through the women’s theater group ‘Oeil du Septentrion’ (Eye of the North) Trained program managers and facilitators of 6 NGOs in Zou/Collines on malaria prevention, treatment and BCC tools and techniques. Non-Governmental Launched RFA announcement for NGOs in Mono/Couffo, Atacora Organizations and Borgou/Alibori departments in August 2013 Signed sub-agreements with 6 local NGOs in Zou/Collines departments Selected 9 local NGOs in Mono/Couffo, Atacora and Borgou-Allibori Trained 18 NGO staff members on Malaria and BCC approaches Conducted local NGOs supervision visits in Atlantique/Littoral, Ouémé/Plateau and Zou/Collines departments Provided equipment and materials to NGOs in Littoral and Zou/Collines departments Field Office Finalized ARM3 Year 3 work plan and budget Finalized ARM3 Q7performance report Implemented the Health Facility Survey 2013 jointly with the NMCP, PMI and CDC Home Office MCDI: Program backstopping and o Conducted coordination meetings and conferences with Management reporting ARM3 partners Activities o Worked with FO and partners in finalizing the draft work plan for Year 3 and related budget o Supported the preparation of the amendments with ARM3 partners regarding the roll-out of iCCM o Supported FO in the development of the iCCM proposal o Reviewed and tested the CommCare platform for use by the SMS/GPRS (mHealth) component of iCCM
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o Evaluated Phase 1 distribution of LLINs o Worked jointly with CDC, PMI, NMCP and the field team in the implementation of the HFS 2013: . Finalized the review and translation of the protocol and questionnaires in to French . Finalized the Open Data Kit (ODK)-based questionnaires, developed SOP’s and shared them with CDC and the field team . Conducted procurement of equipment and supplies to support the HFS . Provided remote overview during the startup of the survey, managed and consolidated data submitted from the field and sent back to field and CDC. o Reviewed IPTp Barriers Study o Provided final comments for the LLIN and IPTp Literature Review Report compiled by ARM3 partner JHU-CCP Africare: o Developed the iCCM budget and amendment jointly with MCDI o Contributed to the development of Year 3 workplan and budget o Supported the selection of 6 local NGOs in Zou/Collines departments to conduct community-based BCC activities JHU-CCP: o Developed interpersonal communication ToT materials o Provided support for the implementation of community outreach campaigns o Facilitated the implementation of the ‘Strategic Communication and Leadership’ course by providing trainers and course modules o Incorporated activities to address barriers from the IPTp Barrier Assessment into Year 3 work plan o Hired two new staff to provide technical and management support to ARM3 Home Office team o Contributed to the development of Year 3 work plan and budget MSH: o Conducted a review of sub award modifications, SOW roles and responsibilities for the implementation of iCCM o Contributed to the development of Year 3 work plan and budget o Fielded consultants to: . Coach ARM3 and MOH facilitators in the implementation of the fourth LDP workshop, . Evaluate the LDP approach . Assist the supply chain team in the annual review and work plan preparation Human resources Recruited and orientated two accountants for Cotonou and Bohicon project offices and eight Community Assistants for the following departments: Littoral, Ouémé, Zou, Mono, Borgou, Alibori, Donga and Atacora departments Hired iCCM Technical Advisor in August 2013 to provide technical assistance to ARM3 technical team, health zones and NGOs.
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Introduction
Accelerating the Reduction of Malaria Morbidity and Mortality Program (ARM3) in Benin is funded by the United States Agency for International Development (USAID). The ARM3 consortium, led by Medical Care Development International (MCDI) as the prime recipient, includes sub-grantees Africare, Johns Hopkins University – Center for Communication Programs (JHU-CCP), and Management Sciences for Health (MSH). The ARM3 consortium works in partnership with the Benin Ministry of Health’s National Malaria Control Program (NMCP), to implement the five year (October 1, 2011 to September 30, 2016) ARM3 malaria control program. In collaboration with USAID/Benin’s President’s Malaria Initiative (PMI), ARM3 seeks to assist the Government of Benin (GOB) in improving malaria health outcomes in accordance with the NMCP’s guidelines and standards. The primary objective of ARM3 is to help the Government of Benin achieve the PMI target of reducing malaria-associated mortality by 70%, compared to pre-initiative levels in Benin. In support of this PMI objective, the ARM3 program’s specific goal is to increase coverage and use of key life-saving malaria interventions in support of Benin’s NMCP Strategy. ARM3 will also complement and expand the efforts of other donors (for example the Global Fund to Fight AIDS, TB, and Malaria (GFATM), and private sector organizations) to reach the NMCP’s goal of eliminating malaria as a public health problem in Benin by 2030. ARM3’s major results are as follows: Result 1: Implementation of malaria prevention interventions in support of the National Malaria Strategy improved. Result 2: Malaria diagnosis and treatment activities in support of the National Malaria Strategy improved. Result 3: The national health system’s capacity to deliver and manage quality malaria treatment and control interventions strengthened. The project was launched on October 1, 2011, and currently is completing its second year. This ARM3 8th Quarterly Report (July 1, 2013 to September 30, 2013) details the program activities completed and key indicators corresponding to the results and sub-results described in the ARM3 Annual Work Plan and Monitoring and Evaluation Plan. Activities under each sub-result have been aligned to the revised version of the Y2 work plan in order to reflect the progress made by the project. It also presents the key activities planned for the quarter October – December 2013.
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Result 1: Implementation of malaria prevention interventions in support of the National Malaria Strategy improved
ARM3 has been scaling-up prevention efforts through the expansion of intermittent preventative treatment for pregnant women (IPTp) and improved coverage of long-lasting insecticide-treated nets (LLINs) through social marketing of LLINs in the private sector and behavior change communication (BCC/IEC) activities; the two sub-results are: Sub-Result 1 (IPTp increased); and Sub-Result 2 (supply and use of LLINs increased). Sub-Result 1.1: Implementation of malaria prevention programs in support of the National Malaria Strategy improved Results from the 2012 Demographic and Health Survey (DHS) show that only 22.8% of pregnant women had received two doses of Sulfadoxine-Pyrimethamine (SP) in 2011. In support of the President’s Malaria Initiative (PMI) Malaria in Pregnancy (MIP) objectives, ARM3 seeks to improve IPTp uptake. To achieve this result, ARM3 is pursuing interventions that include upgrading the skills of government and private health sector workers both through pre-service curricula modifications at the major training institutions, the National Health Institute (INMES) and the Faculty of Heath Sciences (FSS), and through in-service training. Additionally, ARM3 is working to provide improved supervision and support to health workers to follow case management and prevention guidelines (including IPTp, in the context of focused-antenatal care (ANC), severe malaria, and clinical integrated management of childhood illnesses (IMCI). Finally, ARM3 is continuing the review/implementation of BCC campaigns to promote IPTp, LLIN use and early care seeking behavior in addition to improving skills of government health providers on patient counseling. Sub-result 1.1a: IPTp uptake increased Achievements IPTp implementation activities: Scaling-up use of the IPTp tracking tool with midwives and CHWs Following a workshop organized by Africare with Cotonou midwives to assess the adherence of pregnant women to the 2nd dose IPTp regimen, the midwives organized a meeting with community health workers (CHWs) and staff from NGOs to brief them on the tracking strategy. Midwives shared with CHWs a list of pregnant women who had missed their follow-up visit to ANC clinics. CHWs started tracking pregnant women and referring them to the appropriate ANC clinics to receive IPTp (1st or 2nd dose). Unfortunately, not all the ANC clinics were able to provide IPTp due to the shortage of SP in their health facilities. ARM3 is working with the Central Medical Store (CAME) to make SP available. IPTp barriers assessment The final version of the IPTp barriers study is available in French and the English translation will be submitted to USAID in the next quarter. ARM3 has designed activities around the findings of this assessment and will be incorporated in the Year 3 work plan. This document was distributed to the NMCP and will serve as a basis for revising ARM3 BCC/IEC messages and materials. IPTp Training After completing the formative research on barriers to IPTp use, ARM3 is beginning a campaign entitled “Vector Control Campaign: Make Life Impossible for Mosquitoes”. Messages are designed to target community members and health providers. The former will be educated on the importance of early prenatal care, the role of IPTp as a component of the Malaria in Pregnancy approach, along with LLIN and anemia treatment for pregnant women, and the support needed from husbands to provide
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transportation for their wives to keep their appointments. Providers will be trained to embrace a service- oriented culture in which the clients feel more welcomed, and perceive that they are listened to in addition to receiving appropriate treatment and information. Other messages used in the campaign will promote behaviors related to use and care of LLINs, prompt care of febrile children, the benefits of proper diagnosis to confirm malaria, and appropriate treatment with ACT. Sub-result 1.1.b: Upgrade skills of health workers (public and private sectors) through pre-service and in-service training
Achievements
Support the FSS and INMES in their efforts to incorporate malaria subject matter into pre- service curricula After signing the Memorandum of Understanding (MOU) between INMES, the NMCP and ARM3 on June 25, INMES opened a bank account to receive funding for the procurement of computers and Internet installation. The project will support INMES to access web-based databases (WHO/Hinari) containing the most updated literature on primary health care, mother and child survival, and infectious disease, including malaria; these materials will be used to orient teachers and students towards a culture of information-based decision making. In July, ARM3, the NMCP and the FSS signed an MOU enabling ARM3 to proceed with the delivery of 12 microscopes equipped with light sources and wooden carrying cases to equip pre-service malaria diagnosis laboratories at the FSS. The microscopes and training materials will support the improvement of future health officers’ knowledge and abilities to diagnose and treat malaria to include IPTp uptake and Malaria in Pregnancy (MIP). Once the new academic year commences, training activities will resume at the FSS with practical training on malaria microscopy, quality assurance and equipment maintenance. Collaboration with health schools in Parakou In preparation for expanding ARM3 partnerships with training institutions in Year 3, preliminary discussions were held with the National School of Senior Technicians in Health and Epidemiological Surveillance (ENATSE) and the Faculty of Medicine regarding support for access to NMCP policies and guidelines, training materials, and the above mentioned digital libraries (WHO/Hinari). Action plans for the University of Parakou and ENATSE will be developed and attached to their respective MOUs. Developed curriculum and training materials for TOT in interpersonal communication Trainer and trainee manuals on interpersonal communication were developed and are being reviewed for use in training of trainers and health provider courses at the beginning of first quarter of Year 3. In-service training activities for health professionals As a follow up to the training and supervision of midwives and other health professionals in the promotion of ANC and IPTp use in-service training was conducted in 3 Borgou/Alibori Health Zones namely, Tchaourou, Malanville-Karimama and Nikki-Kalalé-Pèrèrè, in accordance with their MOUs. Three (3) of the 25 health zones implemented IPTp refresher training activities with 106 health providers participating.
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Table 1: Beneficiary characteristics for Year 2 ARM3-supported IPTp Trainings Conducted by Health Zones under their MOUs
Beneficiaries Year 2 Q2 Year 2 Q3 Year 2 Q4 Total year 2 Health Zones 2 20 3 25 Trainees by gender Year 2 Q2 Year 2 Q3 Year 2 Q4 Total year 2 Male 0 30 24 54 Female 34 635 82 751 Total 34 665 106 805 Beneficiaries by profession Medical Medical doctors Medical doctors Medical doctors doctors (0) (11) (10) (21) Nurses (4) Nurses (316) Nurses (57) Nurses (377) Midwives (30) Midwives (275) Midwives (36) Midwives (341) Others (0) Others (63) Others (3) Others (66)
Results Indicator Baseline LOP Target PY2/Q4 Results Source/Comments
Result 1: Implementation of malaria prevention programs in support of the National Strategy improved
Sub-result 1.1: IPTp uptake increased
1) Percentage of women 3.0% Women who receive 22.8% (total) DHS report, May who have completed a two or more doses of 2012 pregnancy in the last two SP during their last years who received two or Source pregnancy within the 24% (Urban) more doses of IPTp during last two years will reach that pregnancy DHS, 85% 21.9% (Rural) 2006 1.a) Proportion of women 28.1% Proportion of women 38.3% RMIS results are from attending antenatal clinics attending antenatal PY2/Q3 who receive IPTp2 under Source clinics who receive (Apr-Jun 2013) direct observation of a RMIS IPTp2 under direct health worker observation by a health 2011 worker will reach 85% 2. Number of health 0 FY13 Target: 476 106 health workers Health zone training workers trained in IPTp health professionals (10 medical reports using USG funds Source from 12 health zones doctors, 57 ARM3 (re) trained in IPTp nurses, 36 Cumulative results Records using USG funds midwives and 3 year 2: 805 health others) retrained in professionals IPTp. (re)trained in IPTp
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Sub-Result 1.2: Supply and Use of LLINs Increased In support of this sub-result, ARM3’s innovative approaches to scaling-up for impact are framed around public-private partnerships. The consortium believes that efforts to scale up malaria control in the public sector are certainly critical and necessary but probably insufficient to achieve the ambitious goals sought by the NMCP and USAID unless access to quality services is increased through the private sector, NGOs and participation of community organizations. ARM3 is using a target subsidy approach that will permit employees of the Beninese Business and Private Association Coalition against AIDS, Tuberculosis, and Malaria (CEBAC-STP) member companies to purchase LLINs at a subsidized price and to do so through an installment payment mechanism that may include deductions from paychecks over time. Proceeds generated from the sale of 100,000 LLINs will permit CEBAC-STP member companies to support complementary activities, including malaria prevention and promotion of specific health behaviors. Achievements All activities proposed in the Year 2 work plan designed to support sub-result 1.2 and associated with Phase 1 distribution of LLINs have been completed. For the current reporting period, ARM3 is providing an update on its activities related to the completion of the Phase 1 LLIN distribution campaign and preparations for the launch of the Phase 2 distribution plan set to begin in Year 3. This update also highlights ARM3’s scale-up activities with private sector health providers and networks, including the Association of Faith-based Medical and Social Work (AMCES), Network of Beninese Health NGOs (ROBS), and Association of Private Clinics of Benin (APBC), through which providers will continue to be trained on malaria diagnostics and treatment, including IPTp as well as new areas such as Health Management Information System (HMIS) and supervision. Additionally, and in coordination with the Ministry of Health (MoH), ARM3 will support the continued registration of private health facilities participating in the abovementioned networks. Results of the Phase 1 Benin Private Sector LLIN Distribution Campaign Before proceeding with the closeout of Phase 1, a final supervisory visit was conducted to 7 companies: CCIB-Aboméy, CBT-Lokossa, UNAPEMAB, CCIB-Atlantique, SCB Lafarge, CDPA Agrisach, Nora Service, Sitab et Lumiere, la SBEEE, Domtraco, Bell Azur and Millenium Popo Beach. Meetings were held with owners and managers of these companies to address bottlenecks whenever possible to ensure compliance with the MOU and review roles and responsibilities. Two companies - CDPA and Nora Service - had problems with the distribution of nets while the rest had difficulties in collecting proceeds from the sale of the bed nets. All undistributed LLINs were eventually distributed by the end of the quarter (i.e. 100% distribution of 44,000 LLINs). The payment recovery rate increased from 75% to 97.5% by the end of the quarter. Evaluation of Phase 1 and Development of Phase 2 Distribution Plans In September 2013, ARM3, the NMCP and its CEBAC-STP partners organized a 2-day workshop to evaluate the Phase 1 Distribution Campaign that grouped together 48 participants representing 21 of the 28 companies involved in the first round distribution scheme. The objective of this workshop was to assess Phase 1 activities, identify lessons learned and use gained experience to develop the Phase 2 distribution Plan.
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Participants identified the following areas of success and difficulties during the review of Phase 1: Areas of success Difficulties The support of high-level authorities (Minister of Complex logistics (transportation and storage). Health and USAID Director) indicates high-level Lack of storage facilities at smaller companies. support for the strategy. Lacked funding to support LLIN promotion Quality LLINs distributed at highly subsidized Limited HR at smaller companies to assist in prices in the private sector can generate a demand distribution. from employees. Conflicting schedules of business leaders Implementation of successful BCC/IEC campaign impacted distribution schedule at some to raise the awareness of employers and enterprises. employees; peer education proved effective. Inability of CEBAC-STP to fully engage in Flexible payment options facilitated employee supervisory visits in remote areas. participation. Private sector capacity to conduct distribution, supervision and BCC/IEC activities has been strengthened. The following recommendations were made for Phase 2: i) Establish health committees in new companies and strengthen existing ones; ii) CEBAC-STP to engage in awareness sessions and supervisory visits; iii) strengthen and increase the awareness of beneficiaries through health committees or CEBAC Secretariat. Successes, difficulties and recommendations were all used to initiate the development of the Phase 2 LLIN distribution plan. Health committee member training for Phase 2 distribution of LLINs Following the recommendations of the workshop on the evaluation of Phase 1, the partners, ARM3, CEBAC-STP and the NMCP, trained members of the health and hygiene committees of the companies that will be receiving nets in Phase 2. A 2-day workshop was held for 45 participants from 19 companies. The objective was to strengthen the capacity of the health committee members on the strategies and tools used for the social marketing and distribution of LLINs through the following activities: i) Present strategy, tools and a timeline for the implementation of Phase 2; ii) train participants on malaria transmission and effective control methods; iii) raise participants awareness about the benefits of the highly subsidized LLIN distribution in the private sector; iv) conduct training sessions for health committee members on the use of tracking tools used in the distribution of LLINs; v) train participants on BCC techniques, social marketing and distribution strategy; vi)develop distribution micro-plans at the company level. Develop survey protocol for the tracking and monitoring of LLINs distributed in Phase 1 A draft survey protocol is being developed to assess the retention, usage and integrity of LLIN distributed to CEBAC-STP employees over the course of Phase 1. The assessment will be conducted based on a sample including companies in major cities (Parakou, Cotonou and Porto-Novo) as areas of study. Develop a proposal for the implementation of activities with private sector providers Training and supervision for private sector health facilities will be integrated into Health Zone MOUs that ARM3 began implementing in Year 2. The Year 3 work plan proposes incorporating a more comprehensive approach for private health sector providers, which include major networks such as AMCES, ROBs, ACPB and CEBAC-STP. The work plan includes the following key activities: i) harmonize intervention approaches between the private sector, the MOH and ARM3 and to discuss the modalities of implementing a national malaria policy; ii) conduct training of private sector health workers in malaria
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diagnosis, case management of uncomplicated and severe malaria, malaria in pregnancy, and information systems and data collection; iii) conduct public-private joint supervision in private sector health facilities; iv) support the private sector reporting in the Routine Malaria Information System (RMIS); and v) facilitate the registration of AMCES-ROBs members, as well as new applicants who have submitted their applications. Draft and validate MOUs for private sector health networks An MOU has been drafted with ROBS, AMCES and ACPB to engage private sector in the fight against malaria. For its part, the private sector is ready to participate in workshops and trainings aimed at aligning their work with MOH policies and guidelines in case management, the sharing and harmonization of databases/statistics with the HMIS/RMIS, supportive supervision, and registration of the private sector health providers. Coordination with MOH and partners to support private sector registration ARM3 met with partners to discuss the support for private health sector, including MSH through its Leadership, Management, and Governance (LMG) project and Abt Associates, which has conducted an assessment of the private sector through the ‘Strengthening the Health Outcomes (SHOPS)’ project in collaboration with private sector organizations and regulatory services of the Ministry of Health. These meetings allowed each partner to present their intervention strategies. ARM3 will support the MoH in identifying bottlenecks in an effort to streamline the registration processes. These interventions will work towards increasing the number of private institutions that are currently waiting to receive authorization for private practice. The USAID-funded LMG project will support institutional reforms that will allow for a better understanding of the private sector at the national level. This implies improving the legal and institutional framework for private practices. It will also support the necessary dialogue between the public and private sectors for better collaboration. Abt Associates, which is implementing the LMG interventions, has convened a workshop to present the SHOPS (Strengthening Health Outcomes through Private Sector) report containing results and recommendations. ARM3 will work closely with LMG to avoid any duplication. Environmental compliance The packaging materials for 90% of the 44,000 LLINs distributed during Phase 1 have been collected as required in the ARM3 IEE (Initial Environmental Examination). ARM3 is conducting a technical review of the World Health Organization (WHO) draft Recommendations on the Sound Management of disposal of packaging for LLINs. Our initial strategy was based on USAID Africa Bureau’s Programmatic Environmental Assessment for insecticide treated materials. ARM3 is looking for alternatives to incineration and will continue to work with the Ministries of Environment and Health to develop more alternative disposal methods for LLIN packaging material. Partnership with Peace Corps A Peace Corp volunteer is actively supporting ARM3 LLIN distribution activities within the private sector by participating in planning, training and BCC activities and in preparations for the Phase 2 distribution scheme. As part of its collaboration with the PMI, the Peace Corps will receive $30,000 from the ARM3 project to support malaria related activities in Benin. These funds will be used to finance training of volunteers and their counterparts and to build their capacity in carrying out effective activities against malaria at the community level.
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Results
Indicator Baseline LOP Target PY2/Q4 Results Source/Comments
Result 1: Implementation of malaria prevention programs in support of the National Strategy improved
Sub-result 1.2: Supply and use of ITNs increased
2) Percent of pregnant 20% Proportion of pregnant 75.5% (total) DHS report, May women who slept under women who slept under 2012 an ITN the previous night Source an ITN the previous night 73.9% (Urban) DHS, in intervention areas will 76.5% (Rural) 2006 reach 85% 3) Percent of children 20% Proportion of children 71% (total) DHS report, May under five who slept under under five who slept 2012 an ITN the previous night Source under an ITN the 70.5% (Urban) DHS, previous night in the 71.3% (Rural) 2006 intervention areas will reach 85% 4) Percent of households 25% Proportion of households 79.8% (total) DHS report, May with a pregnant woman with a pregnant woman 2012 and/or children under five Source and/or children under five 78.2% (Urban) that own at least one ITN DHS, that own at least one ITN 81% (Rural) 2006 will reach more than 90%
4.a) Number of LLINs Distribute 100,000 LLINs Total: 44,000 distributed through social through social marketing LLINs delivered CEBAC-STP reports / marketing among among employees and to employees & ARM3 program employees and dependents of CEBAC- 42,000,000F reports dependents of CEBAC- STP member CFA collected STP member organizations organizations Please note: ARM3 is not directly responsible for mass distribution of LLINs, and consequently has limited control over the LLIN related outcomes
Result 2: Malaria diagnosis and treatment activities in support of the National Malaria Strategy improved ARM3 supports improved case management of both severe and uncomplicated malaria and improved diagnosis of malaria through use of microscopy and RDTs. Result 2 consists of two sub-results: Sub- Result 2.1 (diagnostics capacity and use of testing improved) and Sub-Result 2.2 (case management of uncomplicated and severe malaria improved).
Sub-Result 2.1: Diagnostic Capacity and Use of Testing Improved Achievements Printing and distribution of SOP manuals for laboratory diagnosis of malaria The standard operating procedure (SOP) manuals for laboratory diagnosis were developed and validated last quarter. NMCP has prepared a formal presentation of the SOPs. Printing and dissemination of SOPs is pending official sign-off of the SOPs preface by the Minister of Health. ARM3 also contributed to the development of RDT training materials which are being reviewed and finalized by WHO and NMCP.
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Conduct post-training follow-up supervision and on-site training of microscopists/technicians in the Atlantique/Littoral, Ouémé/Plateau and Zou/Collines Departments In July-August 2013, a post-training follow-up of recently trained laboratory technicians was conducted in 6 departments: Atlantique/Littoral, Ouémé/Plateau, and Zou/Collines. Three (3) teams of two (i.e., 1 supervisor and 1 trainer) evaluated the diagnostic activities of 34 of the 36 microscopists/technicians trained and provided subsequent on-site training over the course of an entire workday. Partial results for 12 out-of the 34 above mentioned technicians (from the Atlantique/Littoral department) are included in the ARM3 Quarter 7 report, but are presented here again to provide an overall sense of performance for this assessment/follow-up exercise. To catalog the supervisory teams’ efforts, an assessment tracking form was developed which included observation checklists and a corresponding score sheet for each diagnostic task performed by the microscopists/technicians. The primary diagnostic activity included in the tracking form was an assessment of microscopists/technicians ability to read a panel of malaria slides of known composition that included 6 slides: 2 negative slides, 2 positive slides for Plasmodium falciparum (of variable density), and 2 positive slides for non-Plasmodium falciparum species. The overall results for all 34 technicians were: i) Sensitivity – 88%; ii) Specificity – 88%; iii) Species Identification – 51%; iv) Parasite Density – 43%. With respect to species identification and parasite density, further efforts will need to be deployed to achieve improved performance. In addition to assessing malaria microscopy skills, the joint supervisor/trainer teams brought malaria rapid diagnostic tests (RDTs) to allow for observations of the technicians administering RDTs and assessed their interpretation through a panel of 10 RDTs. Ninety seven percent (97%) (33/34) of the technicians were able to perform all RDT steps correctly and were also able to accurately interpret the results of all 10 previously administered RDTs.
Technicians/microscopists from the Hospital for Mother and Children - Lagune (HOMEL) being trained to develop malaria slides (including thick and thin blood smears)
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Technicians/microscopists staining, reading slides and administering RDT OTSS Round 13 OTSS Round 13 is scheduled for December/January when the MOUs with the HZs in the Mono/Couffo and Atacora/Donga departments are expected to be finalized. All 118 health facilities involved in the OTSS quality assurance program will be visited during Round 13. Initiated decentralization of OTSS - transfer of supervisory responsibilities to HZs The OTSS decentralization process continues in the health zones where MOUs have already been signed with ARM3. The MOUs, which govern, in part the details of the OTSS program, have been revised through a systematic review of how OTSS methodologies should be implemented within each HZ. The validated and integrated supervision forms will be reproduced and shared with each HZ in order to facilitate the OTSS process. ARM3 intends to sign MOUs with the HZs in Mono/Couffo and Atacora/Donga and to renew the MOUs already in place with the HZs in Atlantique/Littoral, Ouémé/Plateau, Zou/Collines, and Borgou/Alibori during the first quarter of PY3 in time for the start of OTSS Round 13. ARM3 will also continue to strengthen the regional and local supervisory teams in order to facilitate the decentralization. The data entry process will be conducted as it has previously been done under ARM3 but the project will work on the database to streamline the interface, data entry process, and report generation for eventual transfer of responsibilities to health zone staff.
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Results
Indicator Baseline LOP Target PY2/Q4 Results Comments
Result 2: Malaria diagnosis and treatment activities in support of the national malaria strategy improved
Sub-result 2.1: Diagnostic capacity and use of diagnostic testing improved
5) Percent of targeted 95.8% Proportion of health PY2/Q3 results Supervisory visits health centers that have centers with the ability from OTSS Round under the OTSS the following: 1) personnel Source to perform biological 12 QAP were not trained in malaria OTSS diagnostics for malaria 97.7% conducted during diagnostics, 2) no stocks- Round 7 (either microscopy or 1 HF did not meet PY2/Q4 outs affecting malaria rapid diagnostic testing) the indicator diagnostics for 7 or more will be 85% criteria days, 3) a functional due to lack of microscope (non-RDT trained malaria facilities only) diagnostic staff 22) Number of health PY1: On average, at least 1 PY2/Q3 results Supervisory visits workers trained in malaria Average health worker from each from OTSS Round under the OTSS diagnostics (including trainings staff type (lab/clinic) per 12 QAP were not microscopy/RDTs) and Lab: 1.4 facility per supervisory 12 new OTSS conducted during case management with Clinic: 1.3 visit trained in malaria supervisors PY2/Q4 USG funds diagnostics (including trained microscopy/RDTs) and 12 former OTSS Target only includes case management with supervisors re- facilities with labs USG funds trained 117 trainings 41 lab trainings 76 clinical trainings Lab Avg: 0.85 Clinical Avg: 1.58 48 facilities reporting for PY2/Q3
Sub-Result 2.2: Case Management of Uncomplicated and Severe Malaria Improved Sub-result 2.2.a: Upgrade skills of health workers on clinical management Achievements Case Management Training of Uncomplicated Malaria1 During Quarter 8, case management trainings took place in Ouémé/Plateau and Borgou/Alibori where 53 and 104 health workers were trained, respectively, for a total of 157. By the end of Quarter 8, the total number of health workers trained in case management of uncomplicated malaria during Year 2 totaled 907. The following table provides further details regarding trainings conducted during the reporting period.
1 The number of HZs and health professionals retrained in IPTp is mentioned under Sub Result 1.1.b, IPTp training, above.
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Table 2: Beneficiary Characteristics for Year 2 ARM3-supported Case Management Trainings Conducted by Health Zones under their MOUs
Year 2 Q2 Year 2 Q3 Year 2 Q4 Total year 2 Number of Health 2 19 4 25 Zones Trainees by gender Male 2 238 78 318 Female 26 484 79 589 Total 28 722 157 907 Beneficiaries by profession Details by Medical doctors (0) Medical doctors Medical doctors Medical doctors profession Nurses (22) (19) (15) (34) Midwives (6) Nurses (551) Nurses (117) Nurses (690) Others (0) Midwives (110 ) Midwives (17) Midwives (133) Others (42) Others (8) Others (50) Improvement of severe malaria case management As part of its mandate to reduce severe malaria mortality, ARM3 supported the Ministry of Health in the implementation of the Emergency Triage, Assessment and Treatment (ETAT) approach. ETAT approach was conducted in 12 hospitals during Year 2, including three in the Atlantic (Coopérative de Calavi, "La Croix" de Zinvié and Oasis de Ouègbo), 5 in the Ouémé (El Fateh, Coopérative de Ouando, "Le Bon Samaritain", Amour Rédempteur de Dangbo et HZ Adjohoun), 2 in the Plateau (HZ Pobè et HZ Sakété) and 2 in the Mono/Couffo (HZ de Comè et HZ de Klouékanmè) departments. Clinical staff members at these 12 sites were trained along with executives of the DNSP and the NMCP with the support of ARM3. During Quarter 8, all of the hospitals participating in the severe malaria case management implementing the ETAT approach program were monitored through five key indicators, which are listed in the table below. Health workers reinforced their knowledge of ETAT during the review of the indicators. Table 3: ETAT Indicators
September N Indicators Baseline July 2013 August 2013 2013 1 Proportion of children 0-59 months evaluated 3.4% 59% 71.4.3% 78% upon arrival (process Indicator) 2 Adherence Rate to ETAT standards (process 13.3% 56.3% 62.3% 73.5% Indicator) 3 Case fatality rate during the first 24 hours in Not 2 13.8% 14.8% 13.2% emergency (result Indicator) available 4 Ratio of adherence to standards of severe 42.6% 65.3% 66.5% 79.3% malaria case management (process Indicator) 5 Case fatality rate of severe malaria (result 3.6% 4.1% 5.2% 2.6% Indicator) Three process indicators (numbers 1, 2 and 4) increased more than 70% from June to September 2013.The case fatality ratio went from 4.1%% to 2.6% from July to September 2013. It would be premature to infer any causal link based on only three months of data. It should be noted that the majority of smaller zonal hospitals refer their patients to other larger departmental facilities (referral centers).
2 Case fatality rate during the first 24 hours can be influenced by delays in arrival to the hospital, lack of equipment, and lack of skilled health workers
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Training in Integrated Management of Childhood Illness (IMCI)
During the reporting period, ARM3 and the MOH jointly implemented a training course in IMCI for 24 participants, including 15 women from the DAGLA, SAO, Saba and DAA health zones. The goals and objectives of the course were to: i) improve the competence of 24 new providers to enable them to evaluate symptoms and signs of diseases, nutrition, vaccination status, and vitamin A supplementation; ii) appropriately classify diseases; iii) identify treatment for selected classifications; iv) treat childhood illness by administering emergency treatments (pre-referral treatment procedures - the first dose of antibiotics or antimalarial medications like diazepam, quinine and also vitamin A); v) evaluate available medications (i.e., ORS, ATB, ATP) in the HF; vi) teach mothers to continue home care (advise the mother regarding food and nutrition, signs of risk and referral). The methodology is based on theoretical training through readings, written exercises, case studies, algorithms, photos, videos and other teaching aids. Practical training is based on clinical rotations at “St. Infant Jesus of Selome”, CS Bohicon and the Department of Pediatrics of the Departmental Hospital Center (CHD) in Zou/Collines. The total time allocated per person for these training is 100 hours with a breakdown of 68% theoretical and 32% practical exercises. The total number of processed cases was 925 children between the ages of 1 week and 5 years. The average number of cases seen per participant is about 39. The average success rate of the participants was 89%. Four (4) participants performed at a rate of less than 85%. Sub-result 2.2.b: Implementation of the Performance Improvement Approach (PI) in participating health zones and hospitals Achievements Performance Improvement Approach ARM3 seeks to improve the capacities of DDSs and HZs to implement their ARM3-supported MOUs, 3- year strategic plans and annual operational plans. This capacity building initiative has been named the Performance Improvement (PI) approach. By way of instituting the PI approach throughout the implementation and evaluative processes derived from the work plans and MOUs, ARM3 is implementing 2 management approaches: Collaborative Improvement and Leadership Development Program (LDP). The ARM3 PI approach targets health workers and managers through three interventions: LDP training for managers at the health zone level; collaborative approach for health workers at the health facility level; and performance based funding for the health zones to improve the quality of care through training and supervision. At the end of Quarter 8, the PI approach was being implemented in 12 HZs in Atlantique/ Littoral and Ouémé/Plateau. DDS and Health Zone Strategic Operational Plans/Implementation No additional MOUs were signed with the HZs in this quarter; therefore the total number of MOUs at the end of Year 2 is 25/34 for HZs and 4/6 for DDS. In the 12 HZs of Atlantique/Littoral and Ouémé/Plateau 4 major activities are being implemented (i.e. IPTp training, case management training, supervision, and the collaborative approach). In the 13 health zones of the Zou/Collines and Borgou/Alibori only 3 major activities, IPTp training, case management training and supervision, are being implemented. The DDSs are funded to hold quarterly MOU review meetings and to allow the DDS to supervise activities being conducted in the HZs.
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All 25 HZs and four DDSs received an advance of funds. All of the DDS and HZs submitted their requests in time. During Quarter 8, 3 HZs conducted trainings of health personnel in IPTp and 4 conducted trainings in case management. By the end of Quarter 8, the majority of all 25 HZs and 4 DDSs had submitted their final financial reports by the end of the fiscal year but were notified that no amendment or additional advances would be made until all reports were received. Follow-up actions to ensure the submission of financial reports from the remaining HZs will be carried out during the next quarter. Evaluation of MOU with HZs The quarterly evaluation (April to June) of the 18 health zone MOUs in Atlantique/Littoral, Ouémé/Plateau and Zou/Collines showed a high implementation rate for almost all HZs and DDSs. Borgou/Alibori did their HZ evaluations late in the quarter for two consecutive quarters. The assessment covers 8 areas of evaluation (see table below) and includes a review of the financial resources allocated by activity, capacity to address difficulties encountered, and corrective actions taken to improve the HZ and DDS performance. Table 4: Results of the evaluation of Zou/Collines HZ MOU - 1st quarter Evaluation Areas Health Supply Super- Train- Execution Total Performance Zone Admin Finance IEC HMIS chain vision ing rate COZO 0 0 0 3 0 2 1 3 38% Poor ZOBOZA 2 2 0 3 3 3 3 3 79% Satisfactory DAA 3 2 0 3 3 3 3 3 83% Excellent DAGLA 3 2 0 3 3 3 3 3 83% Excellent SAO 3 0 0 3 3 3 3 3 75% Satisfactory SABA 3 2 0 3 3 3 3 3 83% Excellent
In the Atlantique/Littoral department, overall, the results showed an improvement over the previous quarter. In addition, the Atlantique HZs (Abomay-Calaví/So-Ava, Alada/Toffo/Zé and Ouidah/Kpomasse/Tori/Bossito) showed the highest score as illustrated in the graph below. Graph 1: Comparative results of the evaluation scores of Atlantique/Littoral HZs MOUs between Quarters 1 and 2 of Year 2. 100 90 80 70 60 50 40
Percentage 30 20 10 0
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In Ouémé/Plateau, the targeted performance of 80% has not yet been reached by all HZ as shown by the chart below. Graph 2: MOU HZ performance in Ouémé/Plateau following the second assessment
90% 83% 79% 80% 75% 67% 70% 60% 50% 38% 40% 30% 20% 10% 0% PAS 3A ABD Pak SAKIF
Table 5: MOU HZ performance in Borgou/Alibori following their assessment Evaluation Areas Health Supply Super- Train- Execution Total Performance Zone Admin Finance IEC HMIS chain vision ing rate Tchaourou 1 1 3 0 3 3 3 3 71% satisfactory PN 0 3 3 3 3 3 3 3 88% excellent NKP 0 0 0 0 0 3 2 2 29% poor BS 2 2 0 3 3 3 3 3 79% satisfactory KGS 3 2 0 3 3 3 3 3 83% Excellent Baniokara 0 2 0 3 3 3 3 3 71% satisfactory MK 0 2 2 3 0 3 2 3 63% satisfactory
Quality Assurance/Quality Improvement Leadership and Development Program (LDP) Each of the 14 performance management teams participating in the LDP workshops carried out a leadership project in the Atlantique/Littoral and Ouémé/Plateau (EEZS, CHD/OP and HOMEL) departments. The leadership projects are designed to build the leadership capacity of participants and are comprised of 4 workshops (3 devoted to skills development and the final one focusing on sharing of lessons learned and best practices between the management teams) each of which is followed by follow- up coaching visits. As part of the trainings, participants in all teams presented the results of the challenge/health scenario they selected during the training. In July, the coaching teams assessed whether recommendations from the previous quarter had been implemented by the teams, particularly in advance of workshop 4, which included the presentation of the results of each team’s leadership project. Of all the teams assessed, 36% had implemented all the recommendations and were provided with feedback. The level of implementation of action plans varied across the teams from 50% to 100%.
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Graph 3: Level of implementation of LDP Action Plans by HZ AZT, 100% AS, 92% Cotonou 6, 89% ABD, 86% Cotonou 2&3, 83% 3A, 80% OKT, 83% Cotonou 1&4, 78%
SAKIF, 50%
All of the teams are part of the national health system and share the following characteristics: common goals and objectives, common mission and vision, use of LDP to address real challenges in their working environment and limited resources to solve their problems. The leadership projects developed by these teams focused on the improvement of diagnosis, IPTp coverage, health information management (HMIS and Logistics Management Information System [LMIS]), and case fatality ratio due to malaria. The measurable results obtained by each team were presented during the 4th LDP workshop on September 3-5 in Porto-Novo (four of the teams also presented their results at the USAID quarterly review meeting). The results are summarized in the table below. At the end of the process, all 14 teams had demonstrated progress in the implementation of their assigned leadership projects; and based on their presentation had advanced in the execution of their action plans. Sixty-four (64%) percent (9 out of 14), had achieved their projected target by September; 8 out of the 9 teams exceeded their respective targets. Four (4) of the teams were unable to reach their targets. Nonetheless, it is worth noting that there was an improvement in the indicators of these underperforming teams compared with their baseline. ARM3 will monitor these underperforming teams in the next quarter. Table 6: Status of the achievement of projected targeted results by the LDP teams
LDP team Projected Result Baseline Target Actual 1. HZ Cotonou From August 2012 to July 2013, the percentage of 65.4% 99% 100% 1&4 suspected cases of simple malaria tested will increase from 65.4 % to 99% at the four public health centers in Cotonou districts 1 and 4. 2. HZ Cotonou From August 2012 to end July 2013, the proportion of 0% 100% 100% 2&3 LMIS reports correctly filled and transmitted in time by the 6 health centers in the health zones will increase to 100% 3. HZ PAS From August 2012 to July 2013, the proportion of 6.7% 90% 96% children under 5 years who had fever, diagnosed with simple malaria and treated properly with ACT will increase from 6.7% per cent to 90%
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LDP team Projected Result Baseline Target Actual 4. HZ 3A From August 2012 to end July 2013, the proportion of 21% 75% 90% LMIS reports filled in correctly and transmitted on time by the 19 health facilities of Abomey-Calavi - So- Ava would increase from 21% to 75% 5. HZ OKT From August 2012 to end July 2013, the percentage 42% 62% 79.2% of suspected cases of malaria submitted to the biological diagnosis would increase from 42% to 62% 6. HZ 3A From August 2012 to June 2013, the proportion of 45% 60% 69.7% women who gave birth in the health centers having received 2 doses of SP will increase from 45% to 60% 7. HZ ABD From August 2012 to end July 2013, the proportion of 48% 60% 65% women who gave birth in health zone ABD and received two doses of SP under supervision according to the required regimen will increase from 48% to 60% 8. CHD-OP From August 2012 to the end of July 2013, reduce 13% 7% 8.7% the mortality rate for malaria deaths in children under 5 years, from 13% to 7% in CHD-OP
9. HZ Cotonou 6 From August 2012 to end July 2013, the proportion of 21.4% 40% 41.0% women who gave birth in health zone Cotonou 6 and received two doses of SP under supervision according to the required regimen will increase from 21.4% to 40% 10. HZ SAKIF From August 2012 to July 2013, the proportion of 48% 60% 57% women who gave birth at the health centers and received 2 doses SP according to the standards will increase from 48% to 60% 11. HZ Cotonou 5 The percentage of private health facilities that 23.3% 45% 34.2% provided statistical reports (HMIS) no later than the 5th of the month will increase from 23.3% to 45% 12. HZ AZT From August 2012 to the July 30, 2013, the 24% 50% 38% proportion of women who give birth in the health centers of Allada-Toffo-Ze having received their 2 doses of SP following the required interval will increase from 24% to 50% 13. HZ PAK Proportion of pregnant women who have taken the 20% 60% 33% two doses of the SP for the IPTp increases from 20% to 60% by end August 2013 14. HOMEL From August 2012 to end July 2013, the proportion of 0 50% 11.4% pregnant women followed and expectant mothers visiting HOMEL and take 2 supervised doses of SP according to the required regimen will increase to 50% Source: 4th LDP workshop on September 3-5 in Porto Novo It is important to note that in addition to improvements for the abovementioned targeted indicators, the HZ teams improved their management skills as well as their personal attitudes which helped them to facilitate day-to-day activities at the HZs. Collectively, these changes in attitude and the use of information for decision making have benefitted the health zones by motivating and improving the performance of their teams. Some of the success stories are shared in the boxes below.
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The Dual Effect of the LDP and Collaborative
With the Collaborative complementing the LDP, managers and workers have a comprehensive package of methodologies and skills to do their jobs. Bottlenecks are identified and solutions developed through teamwork and coordination.
Ms. Tatiana Aho Glele and Dr. Didier Aggbozognigbe Teamwork
In the past, we used to work as individuals and not as a team. We did not have meetings in my center but now we have them every month. We have objectives; discuss work problems and solve them as a team.
Mrs. Agnes F. Dossou
Improving the work environment through LDP
Before the onset of LDP, relations between the hospital management (Director and Physician Coordinator) were not good. This affected the environment and performance of all the staff. Once LDP was introduced, the work environment improved significantly. Moreover, the Director is more approachable and is engaged.
Dr. Goudjo Fréjus Recognition
SMS recognition to health providers by the HZ physician has significantly improved the morale of Health Workers as they view these actions of their employers as interest in what they do in their work.
Mrs. F. Agnes Dossou Short-term Technical Assistance (STTA) for LDP The roll-out of the 4th LDP workshop and presentation of team results was supported by Dr. Oumar Diakite, MSH Consultant in Leadership Development from Aug 25 to Sep 7, 2013. Collaborative Improvement Collaborative Improvement (CI) complements LDP by providing Health Workers with knowledge and tools to work with their managers, and jointly identify problems and solutions. Deficiencies such as stock-outs of antimalarials, RDTs and other commodities have been identified. To solve these problems, ARM3 is working jointly with the NMCP and appropriate working groups in order to resolve this situation through the procurement of commodities. However, the response to some of the areas identified involves many levels of authority and stakeholders. During Quarter 8, ARM3 continued to implement the CI approach via implementation of the first series of learning sessions in Atlantique/Littoral and Ouémé/Plateau as part of the HZ MOUs. Sessions in Littoral and Atlantique were conducted in July with 28 participants from 7 health centers and 94 participants from 29 health centers, respectively. CI learning sessions in Ouémé and Plateau were conducted in August with 93 participants from 28 health centers and 66 participants from 20 health centers, respectively. The objectives of these learning sessions were: i) to share best practices/lessons learned; ii) monitor the progress through performance indicators; iii) identify obstacles to the implementation of the improvement approach; and iv) to find and share solutions.
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Health workers participating in the Collaborative Learning Sessions The table below summarizes the number of health workers by gender, profession and health zone that participated in the collaborative approach in both Atlantique and Littoral. Table 7: Number of trainees trained on collaborative approach in AL/OP health zones during ARM3 year 2 by gender and profession
Health Zones Year 2 Q2 Year 2 Q3 Year 2 Q4 Total year 2
Number 12 12 4 12 Beneficiaries by gender Male 69 39 54 162 Female 284 309 76 669 Total 353 348 130 831 Beneficiaries by profession Details by Medical doctors (14) Medical doctors (3) Medical doctors (3) Medical doctors (20) profession Nurses (210) Nurses (199) Nurses (61) Nurses (470) Midwives (123) Midwives (145) Midwives (37) Midwives (305) Others (6) Others (1) Others (29) Others (36)
During the collaborative sessions, health personnel identified improvements and obstacles in achieving malaria related indicator targets, i.e., malaria commodities management, case management and prevention of malaria in pregnant women. The graph below was developed by the group from Ouémé/Plateau and shows a reduction in the number of stock outs in Adjohoun-Bonou-Dangbo (ABD) HZ attributable to the efforts of the CI. Graph 4: Evolution of the stock-out rate in the ABD HZ, Ouémé/Plateau
91 91 Collaborative
82 71 73 TauxStock- outde raterupture AL B/6 en in theAL B/6last au month 66 cours du dernier mois 61 64 StockTaux-out de rate rupture AL B/12 en in AL the B/12 last month 43 au cours du dernier mois 41 StockTaux-out de rate rupture AL B/18in en ALthe B/18last
Percentage 34 36 month 31 au cours du dernier mois 27 25 28 23 TauxStock- outde raterupture AL B/24 en in AL the B/24 last 21 21 21 23 21 aumonth cours du dernier mois 13 10 Note: Data for January and February are baseline data for all sites in Group 1 JanuaryJanvier FebruaryFévrier MarchMars AprilAvril MayMai JuneJuin
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The quality assurance teams have been facing stock-outs at the Health Zone Depots (DRZ) of the following malaria supplies: (i) RDTs for diagnostic confirmation, (ii) ACTs (Arthemeter-Lumefantrine) for the treatment of uncomplicated malaria and (iii) of SP for malaria prevention in pregnant women. To overcome the shortage of antimalarials (ACT) and to ensure the continuum of treatment for all age groups, particularly children, available antimalarial adult doses (1x24) are broken up or crushed to making available the doses needed for other ages groups (1x18, 1x12, 1x6)3. Graph 5: Indicators from Porto Novo–Aguégués–Sèmè-Kpodji HZ presented in the first learning session
100 TauxStock de-out rupture rate of enRDT TDR during au 97 coursthe last du month dernier mois 85 82 78 79 71 75 Percentage of children <5 64 Pourcentage d’enfants de 61 with fever tested with RDT
moinsduring de the 5 lastans month avec fièvre à qui le TDR a été réalisé au
40 cours du mois 36 33 Pourcentage de patients de
29 28 Percentage of patients > 5 Percentage 23 27 5presuntive ans et plus malaria, avec suspicion tested dewith paludisme RDT in the à lastqui monthle TDR a 13 9 8 été fait au cours du mois 3 0 0 0 PourcentagePercentage of de patients patients with a negative RDT result treated JanuaryJanvier FebruaryFévrier MarsMarch AvrilApril MaiMay JuneJuin avec TDR/GE négatif, traités auxwith CTA RDT au in coursthe last du month mois
In order to reduce the misuse of ACTs, trained health workers from the PAS HZ increased the use of RDTs to confirm malaria diagnostic before providing treatment incremented. Graph 6: Percentage of children < 5 and patients > 5 with positive RDT results, correctly treated with ACT from the PAS HZ
PourcentagePercentage of children d’enfants < 5 RDT de 86 88 moinspositive, de correctly 5 ans avectreated TDR 84 81 positif,according traités the National 74 73 Guidelines 71 68 correctement selon PCIME
(molécule, posologie,
durée du traitement, conseils, rendez-vous) Percentage of patients >5 years, PourcentageRDT positive, correctly de patients treated de Percentage 5according ans et plus the National avec TDR 16 15 positifGuidelines traités correctement (molécule, posologie, 0 0 durée du traitement, Janvier Février Mars Avril Mai Juin January February March April May June conseils, rendez-vous)
3 However, the solution is only temporary to manage the oversupply of other presentations (ALx18 and AL24) that are at risk of expiring if they are not immediately used.
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The example of PAS HZ shows a marked improvement in the management of malaria cases since the start of collaboration. Health workers strive to improve compliance and document the criteria for proper treatment. However, these indicators taken together at the health zone level may mask some disparities in other health facilities in the area. The recent increase in occurrences of RDT stock-outs since April, that became more evident in June 2013, is resulting in reduced testing rates for febrile patients of all ages. There is a possibility that misuse of ACTs in the treatment of febrile cases may be observed again.
STTA for Collaborative Evaluation of the collaborative implementation in Ouémé/Plateau and Atlantique/Littoral was conducted by Dr. Mahamane Karki, MSH Consultant in Collaborative Approach from September 15th to October 5th, 2013. Sub-result 2.2.c: Enhance integrated supervision on IPTp, malaria diagnostics and clinical case management of malaria Achievements Integrated Supervision As part of its institutional strengthening activities, ARM3 provides funding to health zones under their MOUs, to support integrated supervision at the health facilities in their geographic area. Supervisions started in Cotonou and gradually expanded to other health zones. All 25 health zones conducted at least one supervisory visit to all of the health facilities in their health zone, while only 11 out of the 25 health zones, most of them in Zou/Collines and Borgou/Alibori departments, achieved their goal of conducting 2 supervisory visits in Year 2. An estimated total of 1,035 health workers from 4 HZs were supervised. In Quarter 8th 561 health workers from 401 health facilities in 15 of the 25 health zones were supervised. The percentage of health workers supervised is difficult to calculate as the total number of staff is not always adequately recorded in supervision reports. Several recurring problems were identified during the supervision: i) insufficient malaria commodities, particularly ALx6 (resolved by covering the deficit with overstock of ALx24); ii) the lack of ANC kits and their non-systematic provision to women visiting the ANC clinics; iii) insufficient quantities of SP and RDTs; iv) difficulties with stock management included poor record keeping, lack of inventory control, and poor drug storage; v) non-confirmed malaria cases are still being treated (not necessarily in line with national policy, i.e. use of quinine to treat simple malaria); vi) inadequate staffing- some health facilities rely on “aide soignante”; vii) non-standardized RDTs make it difficult for health workers to adhere to RDTs SOPs; viii) Health workers need to improve their awareness and knowledge on dangers signs for severe malaria in pregnant women. Table 8: Number of Health Facilities and Health Workers Supervised by Department and Health Zone per Quarter*
Jan -March 2013 April-June 2013 Jul -September 2013
Number of Number Number Number Number of Number of Department/ health facilities of health of health of health health health Health Zone workers facilities workers facilities workers
OUEME/PLATEAU
PAK 0 0 0 0 36 36 SAKIF 0 0 0 0 20 20
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ABD 0 0 31 31 31 31 PAS 0 0 27 27 0 0 3A 0 0 20 20 0 0 Total OP 0 0 78 78 87 87 ZOU/COLLINES
SAO 0 0 20 20 0 0 SABA 0 0 23 23 23 23 DAGLA 0 0 29 37 29 29 ZOBOZA 0 0 28 28 28 28 DAA 0 0 25 25 25 25 COZO 0 0 0 0 16 16 Total ZC 0 0 125 133 121 121 ATLANTIQUE/LITTORAL
Cotonou 1&4 8 8 0 0 0 0 Cotonou 2&3 0 0 6 6 6 6 Cotonou 5 0 0 3 14 0 0 Cotonou 6 0 0 5 6 0 0 AS 19 66 0 0 19 19 OKT 0 0 62 62 0 0 AZT 0 0 15 15 0 0 TOTAL AL 27 74 91 103 25 25 BORGOU/ALIBORI
NKP 0 0 0 0 16 27 Parakou Ndali 0 0 0 0 49 135 Tchaorou 0 0 12 12 15 29 Bembereke Sinendé 0 0 27 27 27 27 KGS 0 0 31 33 31 41 Banikoara 0 0 14 14 14 37 Malanville 0 0 0 0 16 32 TOTAL BA 0 0 84 86 168 328 TOTAL PAYS 27 74 378 400 401 561 * This table contains estimated numbers of health workers supervised
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Results
Indicator Baseline LOP Target PY2/Q4 Results Source/Comments
Result 2: Malaria diagnosis and treatment activities in support of the national malaria strategy improved
Sub-result 2.2: Case management of uncomplicated and severe malaria improved
6) Percent of suspected 36.7% (all 90% of suspected 84.8% (all ages) RMIS results are from malaria cases submitted to ages) malaria cases will be PY2/Q3 laboratory testing 17.5% < 5 tested via 86.4% < 5 (April - June 2013) 52.6% ≥ 5 microscopy/RDTs 83.4% ≥ 55
Source RMIS FY11/Q4 7) Percent of patients (all -- ≥ 95% of patients (all 82.4% (all ages) EUVS report, July 2013 ages) who tested positive ages) who tested for malaria (via microscopy positive for malaria (via 70.2% < 5 (Ouémé/Plateau) or RDT) who received an microscopy or RDT) will 91.4% ≥ 5 (based on a sample of anti-malarial receive an effective 15 health facilities) anti-malarial (ACT) Micro – all ages 47% Micro only ≥ 85% RDT – all ages RDT only ≥ 95% 79.3% 8) Percent of patients (all -- < 35% of patients (all 57.6% (all ages) EUVS/LIAT report, April ages) who tested negative ages) who tested 67.2% < 5 2012 for malaria (via microscopy negative for malaria (via 48.6% ≥ 5 or RDT) who received an microscopy or RDT) will (National sample based anti-malarial receive an effective Micro – all ages on 190 health facilities) anti-malarial (ACT) 40.1% RDT – all ages Micro only < 35% 59.5% RDT only < 45% 1.3% (all ages) EUVS report, July 2013 1.1% < 5 1.4% ≥ 5 (Ouémé/Plateau) (based on a sample of Micro – all ages 15 health facilities) 47% RDT – all ages 1.38% 9) Percent of targeted health -- Supervisory visits will 401 Health ARM3 Supervision facilities that received be conducted at 100% Facilities were Reports, July- supervision of targeted health visited in PY2Q4 September 2013 facilities at least once (no OTSS every 6 months supervision was conducted in PY2Q4) 10) Percent of children <1% Percent of children 12.3% DHS report, May 2012 under-five with suspected under-five with malaria (fever) in the last two Source suspected malaria weeks who received DHS, (fever) in the last two treatment with ACTs 2006 weeks who received treatment with ACTs in
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targeted areas will increase to 85% 11) Percent of mothers / <1% ≥ 90% of mothers / 6.7% DHS report, May 2012 caretakers who sought caretakers who sought treatment with the use of Source treatment with the use ACTs for their under-five DHS, of ACTs for their under- children with suspected 2006 five children with malaria (fever) within 24 suspected malaria hours of onset of their (fever) within 24 hours symptoms of onset of their symptoms 12) Number of schools of 0 Develop, review, update 2 (INMES, FSS) MOUs signed with nursing and educational and implement with the INMES, FSS to adopt institutions that have MOH the guidelines and National Malaria updated their malaria training curricula on Guidelines guidelines and curriculum malaria diagnosis and treatment at a total of 4 schools of nursing and educational institutions (2 in PY2; 2 in PY3) 13) Number of newly hired -- Support training in 24 newly hired ARM3 training reports health workers trained in clinical IMCI for 72 health workers clinical IMCI newly hired health trained Total to date: 48 +24 = workers in the public 72 and private sectors to contribute to national scale-up of clinical IMCI 14) Number of hospitals that 21/50 Support refresher 12 During Quarter 8, all of received a refresher training hospitals training and supervision the 12 hospitals that for severe malaria case provided to ensure appropriate received training for severe malaria case management training by management and management through PISAF referral practices for the ETAT Approach severe malaria to the were monitored through remaining 29 hospitals five key performance nationwide indicators. 29 (total) Health workers from the 17 public; 12 private same 12 hospitals reinforced their knowledge of ETAT during the review of the indicators (detailed explanation of the indicators is provided in table 4, ETAT indicators).
ARM3 training reports LOP running total: Cumulative 33 hospitals received training at the national level.
22 Public 19 Private
12 hospitals trained by ARM3 (8 in Quarter 6
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and 4 in Quarter 7), and the 21 hospitals/health centers that have been trained in ETAT by PISAF
Note: the original LOP target was 55 hospitals. This value has been revised down to 29 as PISAF has already provided training for severe malaria case management to 21 hospitals. There are 5 hospitals of the proposed 55 that cannot be identified 23) Number of health FY13 Target: 682 157 health care Cumulative total for workers trained in case health care workers PY2Q4: 907 management with professionals from 19 78 males and 79 Health Zone Training artemisinin-based health zones (re)trained females Report combination therapy (ACTs) in case management 117 nurses, 17 with USG funds with ACTs using USG midwives, 15 funds doctors and 8 others
Sub-Result 2.3: Integrated Community Case Management (iCCM) improved Achievements Signing of amendment with MCDI including iCCM in 5 former BASICS HZs On August 29, 2013, Africare finalized and submitted to MCDI a one-year budget for NGOs implementing iCCM activities in the five former BASICS health zones. Africare signed the updated agreement, complete with requirements for iCCM activities in September 2013. Activities to be implemented by the NGOs include the following: i) Supporting government health facilities to implement training and supervision workshops for CHW networks; ii) strengthening the capacity of CHWs to deliver effective educational messages promoting good health practices; iii) assisting MoH staff to prepare and implement bi-monthly training/supervision meetings with their CHW networks; iv) assisting health zone teams in maintaining community information databases in all villages benefiting from iCCM; v) submitting routine progress reports to ARM3; vi) improving the community-based information system; vii) continuing the SMS/GRPS (mHealth) pilot project in 2 HZs.
Africare’s support for NGOs training and supervision was included in their Year 3 work plan and budget. The iCCM NGO orientation workshop initially was rescheduled. During the reporting period, the iCCM division supported updates to the DNSP database of Community Relays. ARM3 staff initiated an inventory of ongoing iCCM activities in the 5 former BASICS areas to include an inventory of CHWs with cell phones operating in the project zone. Sub-award modification review with MSH for implementation of iCCM activities MCDI Home Office conducted a review of the sub award modification, SOW, respective roles, responsibilities and relations among organizations and the team members. The modification has been signed in early October and will be reported in the next quarterly report.
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Hired the iCCM Technical Advisor ARM3 hired the iCCM Technical Advisor in August 2013 to provide technical assistance in iCCM to the DSME, ARM3 technical team, HZs and NGOs. Dr. Faustin Onikpo has joined ARM3 team. He will be based in Parakou, supporting the implementation of iCCM.
Conducted preparatory activities for the Implementation of SMS/GSM (mHealth) component During the reporting period, ARM3 evaluated the coverage of the GSM and GPRS networks in Benin, reviewed alternative platforms to implement the SMS project. The MCDI HO IT staff identified and programmed an alternative platform using CommCare, and satisfactorily tested it in the US. Based on discussions with the Parakou iCCM coordinator it was concluded that it would be best to diminish dependency on the outside IT consulting firm previously engaged under BASICS. For this reason, a local consultant was hired to conduct the in country feasibility study using the CommCare platform. The assessment, which will include software validation with Java and Android phones, connectivity to the Internet using GSM local networks and acceptability amongst CHWs is scheduled for November, 2013.
Result 3: The national health system’s capacity to deliver and manage quality malaria treatment and control interventions strengthened
Result 3 consists of three sub-results: Sub-Result 3.1: MOH/NMCP capacity to deliver and manage quality malaria treatment and control interventions improved; Sub-Result 3.2: Capacity to collect, manage and use malaria health information for monitoring and evaluation (M&E) and surveillance improved; and Sub-Result 3.3: Capacity in commodities and supply chain management improved. One of the main implementation platforms for the achievement of this result is the support that ARM3 provides to the various technical working groups that advise the NMCP. Sub-result 3.1: The NMCP’s technical capacity to plan, design, manage, and coordinate a comprehensive malaria control program enhanced ARM3 is undertaking activities to reinforce the capacity of the NMCP to manage malaria interventions. One of the primary methods includes the support and promotion of NMCP TWGs (M&E, Supply Chain Management, Communications, and Case Management) to meet regularly and to assist in coordinating with other malaria implementing partners. Achievements NMCP Institutional support ARM3 continued its financial support to the NMCP during the quarter disbursing approximately $45,000 for the publication of the HMIS quarterly bulletin, the PITA review workshop, the TWG and RBM meetings, the purchase of IT equipment and funds for NMCP office operations (i.e. vehicle, generator and photocopy repair and maintenance), and internet connectivity.
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Technical and financial support of the mid-term evaluation of 2013 Integrated Annual Work Plan (PITA) During the reporting period, ARM3 provided financial and technical support to the NMCP to organize the PITA mid-term review. The review was conducted by NMCP staff from the national/department levels and partners (USAID, ARM3, CRS, AIRS, CREC, AFRICARE, and FSS). An updated PITA for the remainder of the year was drafted and validated including proposals for new activities. Major recommendations from the PITA review exercise were: i) the mid-term evaluation must be conducted on time; ii) partners must send their report of activities at least one week before the Workshop starts; iii) the 2014 workplan must be Reviewers of the PITA 2013 drafted before December 2013.
Table 9: Results of the Mid-term Assessment of ARM3-implemented PITA activities
Activities % N Scheduled activities 100 84 Activities launched 83 70 Activities finished 64 45
Malaria Technical Working Groups (TWG) Meetings Case Management TWG The Case Management TWG meeting was held on July 11, 2013. Following a presentation on new malaria case management policy, participating partners presented an update of their training activities (i.e. malaria case management, focused ANC, IPTp, and collaborative approach for simple malaria). The NMCP presented: i) a new action plan action for a more consistent implementation of the free treatment policy; ii) the development of an operational manual on free treatment, including mechanisms to fund treatment, financial management procedures, monitoring, evaluation and reimbursement mechanisms; iii) the results of a mass treatment campaign carried out in selected areas of the country during which all confirmed cases of malaria were treated with ACT and anemic patients were given iron supplements; iv) and mechanisms to improve IPTp coverage through the improvement of interpersonal communication (IC) at both health facilities and the community level, supported by pamphlets on key elements of IC for clients at ANC clinics. The IC sessions emphasized the involvement of husbands and family members in monitoring pregnancies and promoting visits to ANC clinics to receive IPTp.
Supply Chain Management TWG During the meeting, the SCM TWG discussed SP stock-outs at different levels of the health care system. USAID and the NMCP requested ARM3 to work with CAME in order to facilitate local procurement of SP. ARM3 took the lead on this activity through use of a local/regional manufacturer which presented its proposal to the NMCP. Also covered during the meeting was the presentation of Ouémé/Plateau end use verification study (EUVS) results to technical working group members and updates on implementing partner malaria commodities shipping plans.
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BCC TWG The BCC TWG did not meet during Quarter 8, however various members of the working group participated in the ‘Leadership in Strategic Health Communications’ workshop convened in Ouidah as described below.
M&E TWG The M&E TWG did not meet during Quarter 8; the focus of the membership was on the implementation of key activities agreed to in the meeting which occurred in the previous quarter that included: i) asses the level of compliance of RMIS forms with the HMIS M&E forms; validation of the RDQU (Routine Data Quality Assessment) methodology and tool; and ii) discussion of potential solutions for improving the reporting of community-based malaria data. Leadership in Strategic Health Communication Course ARM3 implemented a 2-week course on Leadership in Strategic Health Communication in Ouidah from July 22-August 2, 2013, to build the capacity of 25 BCC local partners, including NMCP staff at the central, departmental and peripheral levels. Participants included program health managers from the Ministry of Health and NGOs. During the training course participants learned methodologies and approaches on strategic communication, innovations in Participants at the Leadership in Strategic Health communication, leadership, advocacy and Communication Course partnership building. At the end of the workshop participants developed action plans to strengthen malaria communications regarding SP intake and prompt care of febrile children. Some groups prioritized plans to address other perceived priorities, such as hygiene and HIV/AIDS. A collaborative network was created among the participants, which ARM3 will support as part of its BCC campaigns. A closing ceremony was held with the participation of MOH representatives and USAID/PMI. ARM3 BCC Manager participated in a BCC workshop in Ethiopia ARM3 BCC Manager participated in a 5 days RBM BCC workshop in Addis Adaba, Ethiopia, with the participation of BCC experts of RBM countries. The workshop included time to present the ARM3 BCC Strategy (developed jointly between JHU-CCP and MCDI) and approach being implemented in Benin and provided participants with tools and resources in communications and monitoring and evaluation.
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Results
Indicator Baseline LOP Target PY2/Q4 Results Source/Comments Result 3: The national health system’s capacity to deliver and manage quality malaria treatment and control interventions strengthened Sub-result 3.1: NMCP’s technical capacity to plan, design, manage and coordinate a comprehensive malaria control program enhanced 15) The number of meetings -- The 4 NMCP technical Case Mgmt – 1 ARM3 program reports held by the NMCP technical working groups BCC – 0 working groups (monitoring (monitoring and SCM – 1 Meetings in PY2: and evaluation, supply chain, evaluation, supply M&E - 0 M&E -3 communications, and case chain, communications, SCM –6 management) and case management) BCC – 2 are meeting regularly as CM-1 planned (twice per year) Sub-Result 3.2: Capacity to Collect, Manage and Use Malaria Health Information for M&E and Surveillance Improved Successful program management requires timely and accurate data to make rational and informed decisions on policy and interventions. ARM3 is evaluating and strengthening each of the major information systems including the HMIS/RMIS (LogiSnigs & LogiHops), LMIS (Medistock), IRSP sentinel surveillance, OTSS, EUVS and other malaria-related systems. The objective is to ensure that each system is providing high quality and timely data for decision-making and to address barriers in information collection, management, and utilization. Achievements Health Facility Survey As detailed in the FY 2013 MOP for Benin, ARM3 began preparations for the Health Facility Survey (HFS) in collaboration with the NMCP, the Centers for Disease Control and Prevention (CDC), PMI/ USAID. A detailed report of the HFS 2013 will be included in the next quarter. HFS Preparation During Quarter 8, ARM3 participated in coordinating conference calls with the above-mentioned partners and executed actions necessary for the implementation of the survey. The MCDI HO supported PMI and CDC in the estimation of the sample size, the programming of the HFS questionnaire in the ODK program language compatible with tablets, and training CDC personnel in the use of the tablets. The HO also facilitated the transfer of the tablets, training materials and supplies required for the survey (i.e., scales, thermometers, reagents, RDTs, and ACTs). Additionally, ARM3 ensured the availability of LLINs, rented vehicles and provided support to surveyors and supervisors. In collaboration with the MOH, PMI and CDC, ARM3 also conducted training of surveyors and supervisors as described below. Surveyor/Supervisor Training A training session for surveyors was held from October 24-28, 2013, in Bohicon. Twenty (20) participants (14 male, 6 female; 10 medical doctors, 3 nurses, 3 midwives and 4 laboratory technicians) were trained over the course of 5 days on the following areas: contents of and requirements prescribed in the HFS protocol, procedures for administering questionnaires, and the use of tablets for data collection. Surveyors tested the survey tools over a 2-day period in 5 different health facilities and provided their feedback at the end of each day. At the end of the training session all surveyors were deemed proficient. Fifteen (15) of the 20 surveyors were assigned to one of 3 data collection teams: North, Center and South
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teams. The remaining 5 surveyors were trained as alternates in the event that assigned surveyors were not able to complete their work.
PMI Advisor, Dr. Emile Bongo, with team supervisor during Surveyors during HFS training pretest at CHD Zou/Collines CDC and PMI Support CDC provided the support of one technical expert, Suzanne Powell, in addition to CDC Resident Advisor, Peter Thomas and Dr. Emile Bongo as PMI Advisor. Both participated as part of the supervision teams. Supervision of surveyor teams during data collection period ARM3 staff members, Drs. Dagnon, Onikpo, and Thior, participated in the supervision of the surveyors and assured the coordinated communication for each survey team. Each day of the HFS, the communications coordinator called each of the 3 teams to provide feedback to the members of the survey team regarding any identified difficulties and to ensure compliance with HFS protocol requirements. Role of MCDI HO in Data Management Data collected on tablets was transmitted to the MCDI HO IT support team via the Internet on a routine basis. The IT team reviewed the data for quality and completeness and forwarded the consolidated database to the CDC team. CDC will support ARM3 to prepare a final survey report during the next quarter. Table 10: Planning of the HFS teams supervision
North Center South S1 (30 Sep – 04 Oct) ARM3 & CDC ARM3 & CDC ARM3 & NMCP S2 (7-11 Oct) ARM3 NMCP & CDC ARM3 & CDC S3 (14-18 Oct) ARM3 ARM3 MOH S4 (21-25 Oct) ARM3 & NMCP MOH ARM3 S5 (28 Oct -1 Nov) MOH NMCP ARM3
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Surveyor receiving instruction on tablets Lab technician performing a diagnosis during the survey
National supervisor with Centre data collection team
Update 34 SNIGS and RMIS databases and provide refresher training to 34 health zone statisticians on LOGISNIGS maintenance procedures Certain activities within the malaria M&E system and routine epidemiological surveillance-strengthening plan call for reinforcing the capacities of key staff in data management and analysis. In order to transfer competencies to Benin health system stakeholders, ARM3, in collaboration with the DDS and the NMCP, conducts semi-annual operational reviews and maintenance activities focusing on the LOGISNIGS software. The ARM3 statistician in collaboration with the M&E advisor and the MOH/NMCP technical staff routinely updates the RMIS and SNIGS databases throughout all 34 health zones. The overall objective is to improve software and database functionality to enhance optimal utilization of the RMIS. Specifically during the quarter, operational updates of the RMIS required the addition of a new executable file, cleaning of the database to remove extraneous elements. Statisticians from the 34 HZs were provided with refresher training on the RMIS and SNIGS operational/maintenance procedures.
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Table 11: Summary of problems encountered during maintenance activities and proposed solutions Problems Solutions Databases are mishandled by statisticians Training and retraining in the relevant software Inappropriate manipulation of systems files, table Repositioning of files and sensitization and refresher structures and relocation of some files generated training on the manipulation of those files software malfunctions Software malfunctions due to poor performance of old Adhere to protocol of compressing files until computers and outdated computers and to non-compression of files are upgraded as recommended
Update NMCP central data platform ARM3 continued to provide technical support to update the NMCP’s databases: RMIS, MEDISTOCK, LMIS, HMIS, the Palu-Alafia GFATM database and the EUV survey database. Data from different regions of the country were merged and analyzed to detect outliers and errors within databases. Technical support to the IRSP for review of sentinel sites indicators During the current reporting period, the IRSP organized the first session to review indicators for the 5 sentinel sites. ARM3 staff participated in this 2-day workshop held in Bohicon by providing technical support in the analysis of the relevant indicators and in proposing solutions to resolve problems related to monitoring sentinel site activities. ARM3 also provided the IRSP with technical support related to improving dissemination of sentinel site data by way of ensuring these data are made accessible for decision-making. Routine Data Quality Assessment (RDQA) and Verification Process In collaboration with the NMCP M&E team, the ARM3 M&E team conducted the second RDQA with the participation of 3 health department statisticians and 8 HZ statisticians. The sampling framework was designed using 3 stages of random selection. Half of the country or six of the twelve departments were selected. From each department a sub-sample of half of the HZs was selected (8 out of 18), and 2 Health Facilities were selected per HZ. The assessment was then conducted within 16 health facilities. The objectives of the RDQA were to assess reporting capacities of facilities and management of malaria data, evaluate the quality of collected data, identify difficulties encountered by all RMIS users, and propose solutions. Recommendations were made to each health facility and HZ in order to improve the system. The chart below summarizes the results of the data management systems assessment. Graph 7: Evaluation of data management system
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RMIS validation workshops for 34 Health Zones During the current reporting period, ARM3, in collaboration with the NMCP, organized 3 regional meetings to validate Health Zone data collected from April to June. Meetings were held in Bohicon from July 22-23, Parakou from July 30-31, and Ouidah from August 22-23. The objectives of these meetings were as follows: i) assess the completeness of collected data; ii) evaluate the quality of collected data; iii) identify errors, outliers, unfilled items, and correct them; iv) identify difficulties encountered during data collection, reporting and management; v) propose solutions to sort out identified problems. Eighty (80) participants (6 DDS statisticians, 34 HZ statisticians, 34 HZ Medical Coordinators (MCHZ), and 2 staff from the NMCP and 4 from ARM3) assessed more than 2,579 reports from 1,058 health facilities. The HMIS reports the number of malaria cases, deaths, and fatality rates at the facility level. Concerns have been raised about accuracy, timeliness and coverage (MOP 2013). Since the beginning of ARM3, one of the project’s focus areas has been to promote RMIS reporting. From Quarter 1 to Quarter 6, RMIS completeness has been consistently increasing. During the reporting period, 157 new HFs reported data using the PNLP1 form and were subsequently integrated into the SNIGS. The number of HFs that reported RMIS data to the SNIGS increased from 901 to 1,058. Due to the addition of these new facilities where no improvements to the RMIS were made, completeness fell from 90.4% to 84.8%. Table 11: Error rate in completing PNLP1 data form elements
Health Department Error rate for PNLP1 data form elements (%)
Oct-Dec 2012 Jan-March 2013 April-June 2013
Atlantique/Littoral 15.1 19.2 36.8 Ouémé/Plateau 22.2 26.8 32.7 Zou/Collines 41.7 19.3 15.3 Mono/Couffo 40.9 11.9 16.1 Atacora/Donga 6.9 4.1 9.2 Borgou/Alibori 6.4 4.1 15.4 22.2 14.2 20.92* National mean Table 12: Error rate for data entry for validated data in 2013
Health Error rate for data entry (%) Department Oct-Dec 2012 Jan-March 2013 April-June 2013
Atlantique/Littoral 30 13 15 Ouémé/Plateau 8 6 13 Zou/Collines 43 4 3 Mono/Couffo 14 7 3 Atacora/Donga 3 3 4 Borgou/Alibori 17 3 4 19.2 6 7 National Mean *This error rate behavior is influenced by the new 157 HFs that have been included during last quarter.
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Graph 8: RMIS completeness by quarter
100 90 before ARM3 80
Q1 70 60 Q2 50 Q3 40 Q4 Percentage ( %) 30 20 Q5 10 0 Q6 before Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q7 ARM3
The graph above shows an increase in RMIS completeness in both public and private sectors. Graph 9: RMIS completeness by type of health facilities (public vs. private)
100 90 80 70 60 50 public 40 private 30 20 10 0 Q3 Q4 Q5 Q6 Q7
Quarterly RMIS (SIRP) supportive supervision of data collection sites in 7 HZs in Borgou/Alibori and 4 HZs in Mono/Couffo The quarterly supervision of data collection sites was conducted in late September 2013by 2 teams covering 4 regions: Borgou, Alibori, Mono and Couffo. Each team was composed of individuals from the NMCP (national and regional offices), health zone statisticians and ARM3 staff. The objectives were to: i) assess the level of knowledge of health workers regarding the use of PNLP1 data form; ii) improve the level of knowledge of those health workers; iii) check coherence among collected data; iv) evaluate the concordance between data on PNLP1 data form and primary data sources; v) formulate recommendations to resolve identified problems in order to improve quality of data. A total of 4 regions, 11 health zones, and 41 health facilities were visited. Forty-one (41) health facility personnel (37% female versus 63% male) were supervised. The methodology consisted of employing the use of a questionnaire, verifying physical documents (registers, stock paper, ACT copy books), and
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providing feedback to health workers on data collection and quality assurance of data. The table below summarizes the results of the quarterly supervision of data collection sites in four regions. Table 13: Excerpt of quarterly supervisions indicators
Indicator Alibori Borgou Couffo Mono All 4 Regions
% of health facility staff trained on RMIS 50.0% 80.0% 40.0% 62.5% 57.5% among those supervised Availability of RMIS user guide 33.3% 0.0% 10.0% 0.0% 12.5% Availability of PNLP1 data form 91.7% 70.0% 80.0% 100.0% 85.0% Availability of PNLP2 data form 25.0% 30.0% 20.0% 25.0% 25.0% Level of knowledge of community data 25.0% 40.0% 0.0% 12.5% 20.0% collection Level of knowledge of outpatient data 83.3% 50.0% 20.0% 50.0% 52.5% collection Level of knowledge of inpatient data 50.0% 40.0% 30.0% 25.0% 37.5% collection Level of knowledge of prevention data 100.0% 40.0% 70.0% 50.0% 67.5% collection Level of knowledge of malaria commodities 91.7% 40.0% 60.0% 62.5% 65.0% data collection Level of knowledge of the timeliness of 41.7% 20.0% 50.0% 50.0% 40.0% community level data Level of knowledge of the timeliness of 100.0% 100.0% 40.0% 62.5% 77.5% health facility level data Availability of malaria commodities stock 91.7% 80.0% 90.0% 87.5% 87.5% register book Availability of REMECAR 91.7% 80.0% 80.0% 87.5% 85.0% Availability of ACT register book 83.3% 60.0% 40.0% 25.0% 55.0% The following constraints have been identified by RMIS users in the field: i) data collection forms are poorly filed at health facilities; ii) lack of knowledge/comprehension of PNLP policies and guidelines; iii) RMIS Guide not available; iv) weak usage of monthly collected data; and v) large number of forms to fill out every month. As a result of these findings, ARM3 suggests the following recommendations are adopted: i) ensure better record keeping and filing of RMIS data collection forms; ii) train the RMIS users on how to collect data and how to implement the NMCP malaria policies; iii) disseminate an updated version of RMIS guidelines; and iv) pursue quarterly supervision of data collection sites. Publish quarterly newsletters ARM3 assisted the NMCP in the preparation of its quarterly RMIS newsletter, Palu-Info. The primary purpose of these newsletters is to keep stakeholders abreast of the current malaria epidemiological situation and malaria prevention activities. The 11th quarterly RMIS newsletter, covering the period April- June 2013, has been developed and distributed.
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Results
Indicator Baseline LOP Target PY2/Q4 Results Source/Comments
Result 3: The national health system’s capacity to deliver and manage quality malaria treatment and control interventions strengthened Sub-result 3.2: MoH capacity to collect, manage and use malaria health information for monitoring, evaluation and surveillance improved 16) Percent of targeted 37.8% ≥ 95% of targeted PY2/Q4 Results RMIS results are facilities reporting through the facilities reporting 81.19% from PY2/Q3 Routine Malaria Information Source through the RMIS PY2/Q3 (Apr-Jun 2013) System and sentinel RMIS and sentinel RMIS: (859 HFs surveillance sites are (FY11/Q4) surveillance sites reported providing complete are providing out of 1058 facilities) information on a regular and complete timely basis for decision information on a IRSP Sentinel making regular and timely Surveillance: 100% basis for decision (5 of 5) making Sub-Result 3.3: Capacity in Commodities and Supply Chain Management Improved The continuous availability of high quality malaria commodities is crucial to reduce malaria related morbidity and mortality in Benin. The main objective of ARM3’s supply chain management (SCM) component is to strengthen Benin’s SCM activities, including building the capacity and improving the performance of Benin’s Central Medical Store (CAME). ARM3 intends to work with CAME to improve governance practices, warehousing of drugs, and financial information systems. ARM3 is supporting the NMCP and CAME in designing and implementing a well-designed Malaria Logistics Management Information System (LMIS) in order to reduce stock-outs and overstocking. Achievements Participated in CAME’s business development plan workshop ARM3 was invited by CAME to participate in its business development plan workshop. A major point of discussion during this workshop was that CAME has started building its new administration office in Cotonou. This office is adjacent to the new CAME warehouses currently under construction. CAME requested ARM3’s support in developing a more efficient storage system design for their warehouses. The feasibility of the request will be discussed with ARM3, CAME and PMI. Conducted training for CAME’s new Board of Directors (BoD) on strategic performance monitoring In April 2012, ARM3 trained CAME’s BoD on strategic monitoring of national medical stores and trained them on performance dashboard. ARM3 will continue to support the BoD in monitoring the dashboard performance indicators. CAME experienced a delay in the election of the new BoD, which prevented ARM3 from following-up on the strategic monitoring of the CAME dashboard of indicators during in the first quarter of 2013. The entire CAME BoD was replaced, except for the President who updated the new BoD members on the strategic monitoring of the performance of CAME’s indicator dashboard which will be implemented next quarter.
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Monitored malaria commodities via LMIS, including MEDISTOCK ARM3 supported the NMCP to organize quarterly LMIS/malaria commodity supervision visits to all 34 DRZs, 27 Zonal Hospitals (ZH), 6 Departmental Hospitals (DH), and 66 health facilities in August, 2013. The supervision teams were composed of two staff from the NMCP along with all NMCP departmental focal points, 6 DRZ managers with good malaria commodities and LMIS management skills and 2 staff from CAME. There were 8 teams of 3 people to supervise the selected health structures. This supervision was the second quarterly supervision of LMIS/malaria commodities. All health zone DRZs, ZHs and DHs were visited by these teams. This supervision helped the NMCP and the ARM3 supply chain team to appreciate the LMIS/malaria commodities reporting rate for health facilities of each health department. One hundred percent (100%) of the DRZs submitted their LMIS/malaria commodities report on time to the central level. The supervision results make it possible for Health Zone Medical Directors (MCZS) to appreciate improvements in reporting rates. The malaria commodities reporting rate increased from 47% in the first quarter of 2013 to 85% as of the second quarter of 2013. Graph 10: LMIS/Malaria commodities reporting rate in first quarter and second quarter of 2013
96% 100% 86% 84% 85% 90% 80% 80% 76% 80% 73% 70% 61% 60% 47% 50% 43% 41% 41% 1rst quarter2013 40% 29% 2nd quarter 2013 30% 20% 10% 0% Borgou Atacora Zou Mono At-litt Oueme Total Alibori donga collines couffo plt
ARM3 supported the NMCP to organize an LMIS/malaria commodities feedback workshop following the supervision rounds. It was agreed the supervision makes it possible for the MCZS to ensure that their DRZs and health facilities are submitting malaria commodities reports on time and to evaluate storage conditions at the DRZ level.
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Graph 11: Improvement of storage conditions at DRZ level from first to second quarter 2013
100% 100% 100% 100% 100% 88% 80% 75% 90% 75% 80% 70% 57% 60% 44% 50% 40% 33% 40% 29% 29% 30% 20% 10% 0%
1rst quarter2013 2nd quarter 2013
DRZ managers have improved storage conditions and no longer store commodities directly on the ground. Four (4) health departments exhibited improved storage conditions in their DRZs. Borgou/Alibori and Mono/Couffo still require improvements. Pallets to store drugs off the floor and thermometers to allow DRZs to monitor storage conditions are required. ARM3 reinforced storage conditions by renovating a number of DRZs. This is the main reason that explains the increase of improved storage conditions from 44% of DRZ to 88% of DRZ. In addition to the LMIS/malaria commodities supervision, MEDISTOCK V4+, that now includes an LMIS/malaria commodities report, was monitored and its users benefited from formative supervision were supervised. MEDISTOCK is used by 100% of DRZ managers to manage malaria commodities while ZH and DH are not as willing to use the software. The main reason is that they want a dedicated computer for MEDISTOCK V4+. The supervisory visits make it possible to confirm the quality of logistics data collected by DRZ managers through evaluation of certain elements in the malaria commodities quarterly report such as: (1) stock on hand at the DRZs, (2) quantities issued from the DRZs to health facilities and (3) lost and replenished drug stores at the DRZ level. The quality of the consumption data coming from health facilities need to be monitored and improved. Summary findings of the latest supervision round included: (1) lack of funding of some facilities which negatively impacts the continued availability of malaria drugs and commodities, (2) lack of quality of the monthly LMIS/malaria commodities report submitted by health facilities to the DRZs, (3) Departments and HZs that are still not using MEDISTOCK V4+ as recommended, and (4) non-reporting of LMIS/malaria commodities information from health facilities (target is 100%). Supported NMCP to coach MEDISTOCK V4+ users in four health departments ARM3 has trained users in all 6 health departments on the MEDISTOCK V4+ software. For the current reporting period, 4 health department were targeted, namely Atacora/Donga, Borgou/Alibori, Ouémé/Plateau and Zou/Collines. The coaching team was composed of NMCP departmental level personnel and the ARM3 supply chain management team. The coaching team visited 44 health structures (23 DRZ and 21 hospitals) and met 88 data managers.
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MEDISTOCK V4+ helps to collect LMIS/malaria commodities reports and logistics data. MEDISTOCK V4+ is the last version of the LMIS/malaria commodities software available and updated in such a way as to have a logistics database available for DRZ and hospitals (ZH and DH). These data are used for malaria commodities quantification and SCM planning. The coaching team ensured that the MEDISTOCK V4+ was available and functional in all health facilities visited. It focused on 4 main points: (1) checking of MEDISTOCK V4+ functionality, (2) update of the MEDISTOCK V4+ database, (3) exportation of MEDISTOCK V4+ database from DRZ and hospitals to NMCP and to health departments and (4) updating the online logistics database called MEDISTOCKWEB. Table 14: Percentage of health structures that have received training on MEDISTOCK V4+ and that received coaching visit during the quarter Jul-Sept. 2013
Health Department Number of health Number of health Number of staff Number staff structures with structures visited trained trained and staff trained on (%) coached (%) MEDISTOCK ATLANTIQUE/LITTORAL 12 12 (100%) 37 24 (65%) MONO/COUFFO 9 9 (100%) 25 22 (88%) OUEME/PLATEAU 8 8 (100%) 23 16 (70%) ATACORA/DONGA2 11 11 (100%) 34 22 (65%) BORGOU/ALIBORI2 15 15 (100%) 44 30 (68%) ZOU/COLLINES2 11 11 (100%) 30 22 (73%) Total 66 66 193 136 (71%) Two (2) out of 3 MEDISTOCK V4+ managers (69%; 90/131) who were trained have been coached as well. Table 15: Percentage of health structures coached that mastered MEDISTOCK SOP
% MEDISTOCK V4+ % MEDISTOCK % of MEDISTOCK managers that master database database exported to MEDISTOCK V4+ updated NMCP at departmental level ATLANTIQUE/LITTORAL 86% 71% 0% MONO/COUFFO 100% 100% 0% OUEME/PLATEAU* 100% 100% 71% ATACORA/DONGA* 100% 100% 71% BORGOU/ALIBORI* 100% 100% 71% ZOU/COLLINES* 100% 100% 33% Average 98% 95% 41%
All visited health facilities have MEDISTOCK available and functional. The data bases are not sent to the NMCP and to the health departments which is a major issue deterring evidence-based decision making. Training of partners (CRS and others) in MEDISTOCK v4 As part of capacity building for M&E staff of CRS PALU ALAFIA partners, a 2-day training session on MEDISTOCK software, funded by the Global Fund, was organized in Cotonou. ARM3 only provided the principle trainer supported by the DRZ managers from Bantè-Savalou health zone. Eight (8) staff members from CRS Caritas, PLAN/Benin and MCDI also participated in the training. Participants mastered the following: i) procedures for ordering and receiving commodities, ii) procedures for
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management of various commodities, iii ) the techniques for monitoring distribution at all levels (CBO facilitators and sub-recipients), and iv) warehouse inventory procedures. Support DPMED to develop common software (MEDISTOCK and PharMeg) for drug management In response to questions from the DPMEP as to the progress and feasibility of merging the two drug management software programs, Pharmeg and MEDISTOCK, the following points need to be taken into consideration: The software currently adopted and recommended by the Ministry of Health is MEDISTOCK Considerable investment has been made by USAID in the development and deployment of this software There are issues specific to each software; i.e. Difference in the platform upon which each has been developed; intellectual property issues, problem of source codes; which must be taken into account for the project to begin and to assure an equitable solution The terms of reference of the current MEDISTOCK staff do not include the time needed to further develop the software to this degree Inherent in this type of operation are unpredictable technical difficulties that can delay the delivery of the final product Implications in terms of policy management of drugs in Benin to take into account need to be resolved early in the process
Therefore it is suggested that: The program look at an improvement rather than merge the two software’s different features addressing users concerns in the management of essential drugs. A greater involvement of the Ministry of Health programs in steering the development of the functionality for the daily management of essential drugs, in this case, the NMCP, DSME, PNT, and PNLS. A multi-stakeholder meeting be held with members of the NMCP, DSME, PNT, PNLS, CAME, the Direction de la Pharmacie du Medicament des Exploration Diagnostic (DPMED), the Minister's Office, NGO partners, and technical and financial partners to better define the terms of reference for improving MEDISTOCK software and a timeline for obtaining these advancements.
Supported NMCP to organize the second national LMIS/malaria commodities supervision feedback workshop ARM3, in conjunction with the NMCP, organized the second national LMIS/malaria commodities quarterly supervision feedback workshop in Lokossa from September 23-24, 2013. The purpose of this workshop was to discuss the findings of the supervision. The workshop was attended by the 6 departmental health directors, 6 departmental pharmacy managers, 34 DRZ managers, 34 MCZS, 27 directors of the HZ pharmacies and representatives from CAME, DPMED, AFRICARE and CRS. Health zones and DRZ managers with good practices identified during the supervision shared their experience with their colleagues. Dr. Seydou Doumbia from MSH headquarters supported ARM3 and NMCP in the preparation of the workshop and presented the importance of quality information for decision making.
The workshop was visited by the Ministry of Health who came on the last day to listen to the recommendations and encourage workshop participants. The MCZS were congratulated for their implication in the resolution of issues identified during the previous supervision and especially in helping
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the LMIS/malaria commodities reporting rate reach 85% during the reporting period when it was 47% in the previous quarter.
Workshop participants were divided into 4 working groups depending on their level of responsibility: i) Group 1 was composed of all Health department directors and all MCZS and was tasked to help resolve issues surrounding the availability of malaria commodities in health facilities; ii) group 2 was composed of departmental and HZ pharmacy directors and managers and was tasked with identifying reasons related to the unavailability of MEDISTOCK V4+ in departmental and HZ levels to suggest solutions to solve this issue; iii) group3 was composed of departmental and zonal health statisticians and was tasked with finding ways to improve LMIS/malaria commodities data quality at the zonal and departmental level, iv) group 4 was composed of DRZ managers and was tasked with finding solutions to improve the reporting rate at the zonal level.
The main recommendations of the working groups were as follows: i) Allow DRZ managers to participate in health zone technical meetings to present the stock status of malaria commodities in the health zone, ii) MCZS should initiate refresher training and coaching on LMIS/malaria commodities for health facility managers; iii) MCZS should initiate bimonthly supervisions of health facility pharmacy managers; iv) Departmental Director should ensure that MEDISTOCK V4+ is implemented and functional in all ZH/DH; v) NMCP should advocate to have computers available where needed in order to allow MEDISTOCK V4+ to be functional; vi) MCZS should ensure that health facilities with financial issues have access to malaria commodities in order to avoid stock-outs; and vii) MCZS should build proper warehouses for health zones where needed.
EUV Ouémé Plateau feedback workshop The EUV in Ouémé/Plateau was conducted in 20 health structures in June 2013. ARM3 and the NMCP presented the results of EUV to the head of the health department, the chief medical officer of the health zone, and the directors of the visited health facilities during a workshop in Porto-Novo. The presentation was followed by discussions on strength and weakness identified during the EUV. The recommendations of EUV were presented to the health department team follow by the development of action plan for resolution of bottlenecks identified. EUV Borgou/Alibori The EUV programmed for the Borgou/Alibori this quarter was postponed at the request of USAID in order to hold the feedback workshop for Ouémé/Plateau before proceeding with the next survey. The EUV will be re-programmed for October-December. Supported NMCP to update the Procurement Planning and Monitoring Report for malaria (PPMRm) database The PPMRm provides data on central-level stock availability for critical malaria drugs and commodities: ACTs, SP for intermittent preventive treatment during pregnancy, and RDTs for accurate malaria diagnosis. ARM3 supported the NMCP to provide information for the PPMRm during the previous quarter which was shared with PMI Washington. Discussed malaria commodities quantification exercise planning with NMCP and stakeholders Continued availability of well managed malaria commodities can only be possible with a proper quantification exercise. During a visit from the ARM3 supply chain team backstop from MSH, ARM3 met with in-country stakeholders including the NMCP, World Health Organization (WHO), UNICEF, AFRICARE, and CRS to engage them in this important activity.
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All partners agreed on the importance of a quantification exercise and promised to provide full support. The agreed upon ideal time to train key NMCP staff and main stakeholders on the quantification manual is the third week of January 2014. To this end, the NMCP and its partners will make available the data needed. This training will be done with the internationally validated malaria commodities forecasting manual. Development of the Year 3 Work plan With the support of Dr. Seydou Doumbia, the SCM team identified key activities to be included in ARM Year 3 work plan. The main objective will be to strengthen the NMCP, CAME and the DPMED’s capacity to forecast needs in malaria commodities and in supply planning. ARM3 will continue to support NMCP, CAME and health zones in the management of malaria drugs and commodities and with the regular implementation of the EUV. Results
Indicator Baseline LOP Target PY2/Q4 Source/Comments Results Result 3: The national health system’s capacity to deliver and manage quality malaria treatment and control interventions strengthened Sub-result 3.3: MoH capacity in commodities and supply chain management improved 17) Number of quarterly and -- The national malaria Quarterly Available LMIS annual reports generated by commodity supply reports from : reports the LMIS per year chain is functioning 34 DRZ All 34 DRZ have with an LMIS that reported but not all regularly provides Annual DRZ reports cover all quarterly and annual reports: 0 of the health facilities reports (4 quarterly under their and 1 annual supervision. Only reports) 85% of HF reported. 18) Percent of government 80.3% ≥85% of government 87.6% EUVS June, 2013 health facilities with ACTs health facilities have available for treatment of Source ACTs available for Sample size is limited uncomplicated malaria RMIS treatment of to scope of EUVS (FY11/Q4) uncomplicated malaria for patients of any age at any point in time covered by project-supported EUV surveys 18.a) Percent of health 77.3% ≥85% of health 69.7% RMIS results are from facilities reporting no stock- Source facilities report no PY2/Q2 outs of ACTs RMIS stock-outs of ACTs (April- June 2013) (FY11/Q4) 19) Percent of facilities in 0% Complete (100%) 0% ARM3 program compliance with CAME implementation of reports reforms reforms initiated in NB: Indicator CAME so as to reformulated to reflect improved governance reforms implemented and transparency of within CAME in lieu of its operations CAME reforms implemented by other facilities.
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Indicator Baseline LOP Target PY2/Q4 Source/Comments Results 20) Percent of facilities that Results pending Results from the 0% ARM3 program submit an action plan in EUVS report EUVS are analyzed reports response to the End-Use and used to identify Restitution to the Verification Survey management and health zones has yet operational issues in to occur the commodity supply chain system
Result 4: Cross Sectional Activities Mass Media During the reporting period, ARM3 BCC initiatives supported the dissemination of information on the following focus areas: (1) proper use of LLINs, (2) IPTp utilization, (3) prompt care seeking and (4) adherence to treatment protocols. Key messages were disseminated regarding the use of LLINs, the importance of women attending antenatal care visits and the benefit of IPTp, the importance of confirming diagnosis before treatment with ACTs. In order to increase knowledge, change attitudes and stimulate behavioral change. ARM3 relied on several channels to reach and mobilize its audiences. Mr. Achille Dossou, the Head of the Health Center being interviewed at Radio Kpasse
Achievements
Radio Programs The addition of two more radio stations to the existing eight stations has expanded the geographical coverage of the program allowing more people to have access to malaria information in multiple formats and languages. The programs are hosted by knowledgeable health providers who are selected and supported by the health zones. These health providers engage listeners by offering opportunities to call in, ask questions, and/or share their stories. Over the past quarter, the radio programs reached an estimated one million women of reproductive age.
Table 16: Local Radio Stations
Radio Targeted health Content/format delivered Number of radio stations zones programs aired Radio La Allada, Ze, So Ava, - Case management of severe malaria 10 in French and 20 Voix de Toffo, Tori, Calavi, - Consequences of malaria for a pregnant in Fon Lama Mono, Zou and woman and fetus Spot was broadcast Oueme (part) - Home-based care of a child with fever 52 times - Prevention of malaria: net, IPTp, case management
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Radio Allada, Ze, So Ava, - Malaria and transmission 10 in French and 14 Immaculee Toffo, Tori, Calavi, - Free care for malaria cases among in Fon & Cotonou, Atlantique, pregnant women and children under five; Spot was broadcast Conception Zou, Mono, Oueme, - Prevention of malaria: bed net use and 120 times Plateau Couffo, IPTp Borgou. Partially Alibori, Atacora and Donga
Radio Dassa-Glazoue, - Malaria diagnostic options 8 in Mahi and 7 in Collines FM Aklahonkpa, Glazoue - Severe case of malaria among children Idaasha de Glazoue - Importance of LLINs Spot was broadcast - LLINs use and keep up 30 times
Radio Pobe-Adja, Ouere, - Diagnostic and treatment 6 in French and 5 in Royale Ketou; Djidja- - Severe case management of malaria Fon. d’Abomey Abomey- among children Spot was broadcast Agbangnizoun - LLIN importance 44 times - LLIN use and keep up
Radio Ouidah, Tori, - Consequences of malaria on pregnant 9 in French and 11 Kpasse Kpomassse, Allada, women and fetus in Fon. Calavi, Come, Grand - LLIN use and keep up Spot was broadcast Popo - Malaria prevention and care 20 times
Radio Parakou, N’Dali, - Malaria case management for children 17 in Bariba and 17 Deema Perere, Nikki (part), - Malaria consequences in Peuhl Tchaourou (part) - Malaria home care for children - LLIN use and keep up - Role of community health worker Radio de Banikoara, Kerou - Malaria case management for children 16 in Bariba and 16 Banikoara (part), Kandi (part) - Malaria consequences on pregnancy and in Peulh fetus - Care of febrile patients - LLIN use and keep up - Role of community health worker Radio Kandi, Gogounou - Malaria case management in children 20 in Dendi and 20 Kandi (part), Segbana - Consequences of malaria on pregnancy in Bariba (part), Banikoara and fetus (part), Malanville - Malaria home care management (part) - LLIN use and keep up - Role of community health worker Radio Adja Ketou, AdjaOuere, - Malaria 20 in Nago, 12 in Ouere Pobe - Prevention of malaria among pregnant Fon and 6 in Goun women - Simple malaria/Severe malaria - Testing for malaria - Managing malaria among children - Consequences of malaria on pregnant women and fetus - Managing suspected malaria case at home Radio La Adjohoun, Bonou, - Malaria 10 in French and 14 Voix de la Dangbo, Agnegnes, - Preventing malaria among pregnant in Weme
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Vallee Ze, Zinvie, Allada, women Akpro-Misserete, - Simple malaria/Severe malaria Porto Novo, Seme- - Testing malaria Kpodji, Avrankou, - Malaria case management Adjarra - Consequences of malaria on pregnant women - Malaria home-based care - Use of LLIN in preventing malaria - LLIN use and keep up The reality radio shows are appealing to women because they enjoy interacting with their peers and enjoy messages that are both entertaining and educational. Moreover, health workers have an opportunity to reach a larger audience compared to the much smaller number of patients at the health centers. ARM3 has developed guidelines detailing its six-step approach for successfully implementing a radio- based reality show. The six steps are: 1. Guess: A few questions are raised and participants are asked to guess the responses; 2. Respond: Respond to questions regarding malaria prevention and case management; 3. Share: Share your history; 4. Listen: Listen to the experience of health workers in your zone; 5. Listen: Listen to your opinion leaders; 6. Commit: Commit to share the messages of malaria prevention (including the use of IPTp) and prompt care seeking at home with friends and neighbors.
Preliminary field testing of the Six-Step Approach by ARM3´s BCC Advisor shows the effectiveness of this approach in changing behaviors. Table 17: Estimated audience of radio reality programs
Radio Name Site where radio Date Estimated number reality program took of people attending place the session
Voix de Lama Agbanou July 3, 2013 310
Tado FM So Ava July 11, 2013 600
Royal FM Abomey Sagon August 23, 2013 600
Radio Collines FM Kere September 5, 2013 700
Voix de Lama Sey September 11, 2013 300
Radio Deema Parakou September 17, 2013 700
Radio de Toura September 18 2013 500 Banikoara
Radio de Kandi Gah Donwari September 20, 2013 450
Radio Immaculee Attognon September 24, 2013 250 Conception Radio Immaculle Lissegazoun September 25, 2013 230 Conception
Radio Kpasse Tokpa Dome September 26, 2013 200
Total 4,480
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Women from the ‘Tokpa Domein Kopmasse’ community surprised Mrs. Kintossou, a midwife working at the local health center by their knowledge of IPTp The radio host of one of the reality shows asked women to provide the name of the treatment consisting of three pills and provided to pregnant women by midwives under supervision. When Mrs. Kintossou heard the question, she thought that no woman would be able to provide the correct answer because she had never provided the name of the pills during prenatal visits. The midwife was very happy to hear several women responding correctly to the question using information they had heard from ARM3 radio sponsored programs.
BCC Materials ARM3 offices in Cotonou, Abomey and Parakou continued to distribute written materials to health centers, partners and the community during community outreach events. Flyers made up the bulk of the distributed materials as they are easy to carry, serve as message reminders for beneficiaries and reinforce malaria messages disseminated by other channels. Table 18: Distribution of BCC material during the 8th quarter
Quantity of ARM3 Office distributed flyers Parakou 20,600 Cotonou 39,750 Abomey 9,000 Total 69,350
Community events ARM3 works with partners to extend the reach of its messages on malaria prevention to the largest number of beneficiaries possible. For example, ARM3 partnered with one local organization based in Parakou to conduct outreach activities and disseminate malaria messages and informational materials during the “Yam Day” (August 15 to 18). Partnering with the ‘Oeil du Septentrion’ (Eye of the North) in Parakou
Oeil du Septentrion is a women theatre group that has received ARM3 assistance in scenario development and the development of malaria awareness and prevention messages. This group is part of the Parakou Health Zone training team and works under their supervision.
The group performed 10 times in different neighborhoods including Tourou, Yara-Kinnin, Dakpararou, Kobe, Banikani, Kpassa Gambou, Gah, Albarika, and Bapkerou, where they were able to reach approximately 2,500 people.ARM3 plans to disseminate this experience and to promote the involvement of more community-based organizations to conduct similar activities. Participants during the presentation of the “Oeil de Septentrion” theater group in Parakou
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Partnership with Savalou commune and participation in the community health fair ARM3 participated in the “Yam Days” community fair with a multidisciplinary and multilingual team composed of the HZ medical doctor, the BCC manager, the BCC officers and Zou/Collines community- based field assistants. The team organized an information booth to educate fair participants about malaria. This booth was visited by a diverse audience of people from different communities, ethnicities, ranks and social levels, from the Minister of Culture and Arts to members of marginalized ethnic groups. An estimated 3,000 visits were registered at the ARM3 booth stand.
High Level Advocacy Visit with the King of Savalou During the last day of the fair, the ARM3 team led by the health zone medical doctor met with his Excellency Dadah Tossoh Gbaguidi XIII, King of Savalou and invited him to become a malaria champion ARM3 team meeting the King of Savalou and sharing partner. malaria informational materials
Assisting local NGOs in implementing community engagement activities
Trained selected local NGOs in Zou/Collines on malaria and BCC approach ARM3 trained 18 people (12 from NGOs and 6 health workers) in a workshop conducted in Dassa in July 2013. The NGO participants were program managers and project facilitators from the 6 selected NGOs in Zou/Collines. The health workers, who were designated by their Health Zone coordinators, attended the workshop in order to meet their NGO counterparts. The focus of the training was malaria prevention, treatment and BCC and was facilitated by a local consultant. Sub-contracting with local NGOs in Zou/Collines departments The six local NGOs selected in Zou/Collines departments signed their sub-agreements with ARM3 in August 2013, and received a first disbursement of $5,213 per NGO to support startup-activities. The terms of reference for the NGOs include the following activities: i) Selection of 15 villages for implementation of activities in their respective health zone; ii) Selection of two CHWs per village; iii) Training of selected CHWs during a 3-day session; iv) Supervision of CHW activities; and v) Grouped supervision meeting with the CHWs for data collection, refresher training and payment of incentives to outstanding performers. Local NGO supervision ARM3 partners and regional NMCP and HZ representatives conducted supervisory visits to NGOs:
- The first joint supervision of NGO-implemented activities in Atlantique and Ouémé/Plateau was held from July 8-10, 2013, with the participation of representatives from Africare and the departmental divisions of the NMCP; focus was placed on quality control of data registries compiled by CHWs; - The second joint supervision of NGO-implemented activities in Atlantique/Littoral, Ouémé/Plateau and Zou/Collines was held from August 26-30, 2013, by Africare, MCDI and RCC project staff. During this visit, local NGOs in Littoral received equipment.
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- The third joint supervision visit was conducted by Africare, MCDI and HZs on a training of CHWs implemented by local NGOs from September 19-26, 2013. During this visit, communication materials such as image boxes, flyers on IPTp, LLINs and ACT were distributed.
Member of the ARM3 partnership (left) reviewing the financial ARM3 partners distributing materials to documents of NGO CERPADEC in Ouidah NGOs in Cotonou
Selection of local NGOs in Mono/Couffo, Atacora and Borgou/Alibori departments The Request for Applications (RFA) for the recruitment of NGOs in Mono/Couffo, Atacora and Borgou/Alibori departments was launched by ARM3 through its partner Africare in August 2013. Forty-two (42) applications were received and reviewed by a committee composed of ARM3 partners, the NMCP, DSME and DNSP representatives. Seventeen (17) NGOs were shortlisted for the on-site visit and pre- award evaluation. At the end of this process 9 local NGOs (one per health zone) were selected. Table 19: NGOs selected in Mono/Couffo, Atacora and Borgou/Alibori departments
Department Health zones Selected NGOs ATACORA Natitingou ADEC Tanguieta EQUI-FILLES Kouande ACDD BORGOU Bembereke ASMA ALOBORI Malanville MILLENIUM ALTITUDE ONG MONO Lokossa APRETECTRA Come FNDH COUFO Aplahoue GRAIB Klouekanme IFAD
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Results
Indicator PY2/Q4Target PY2/Q4 Source/Comments Results Cross sectional – BCC Number of NGOs/CBOs implementing 18 18 Signed agreements community-based BCC activities Number of CHWs implementing 774 774 Reports from Africare supervisions community-based BCC activities Number of CHW trained on malaria and Reports from 11 out of the 18 active 420 420 BCC approach NGOs Number of pregnant women referred to the Reports from 11 out of the 18 active 1,416 1,101 health facilities for IPTp NGOs Reports from 11 out of the 18 active Number of LLINs in households 7,140 11,865 NGOs Reports from 11 out of 18 active Number of LLINs used in households 7,140 9,883 NGOs Number of people who know ACT as the Reports from 11 out of 18 active 10,380 9,289 appropriate treatment for malaria NGOs Number of children <5 referred to health Reports from 11 out of 18 active 372 327 facilities for severe cases of malaria NGOs Reports from 11 out of 18 active Number of home visits done by CHWs 7,140 7,273 NGOs Number of mothers or caretakers who Reports from 11 out of 18 active have children < 5 and pregnant women 2,670 11,373 NGOs educated through home visits Total number of people educated through Reports from 11 out of 18 active 14,280 27,630 home visits NGOs Number of education session performed by Reports from 11 out of 18 active 372 548 community health workers NGOs Number of mothers or caretakers who Reports from 11 out of 18 active have children < 5 and pregnant women 1,860 7,992 NGOs educated through groups sessions Total number of people educated through 3,570 13,393 Reports from 11 out of 18 active group sessions NGOs Number of mobilization campaign Reports from 2 out of 4 active NGOs 2 2 organized by the NGOs in Littoral
Number of people reached by mobilization Reports from 2 out of 4 active NGOs 120 216 campaign organized by the NGOs in Littoral
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Program Management Field Office ARM3 Y3 Work plan: During Quarter 8, the ARM3 team conducted a review of the status of the Year 2 work plan, reviewed guidance documents including the FY 2011, 2012 and 2013 Malaria Operational Plans (MOPs), and the Benin National Malaria Strategic Plan, discussed with the USAID Mission, PMI, PNLP, DSME, DNSP, DDS and ARM3 partners; and developed the first draft of the ARM3 Year3 Work plan. Health Facility Survey: The FO supported the preparation and implementation of the Health Facility Survey that was implemented jointly with the NMCP, PMI and CDC. Preparation of the iCCM proposal: The Chief of Party, the Technical Coordinator and the Parakou Team Leader/iCCM Coordinator, held meetings and conferences with the DSME, PNLP, the DDS Borgou/Alibori and the 5 health zones where the iCCM component will be implemented, and developed a preliminary work plan for Year 1 implementation.. Recruitment of ARM3 Staff: Africare recruited 2 accountants one each for the Cotonou and Bohicon offices and 8 community assistants assigned to the Littoral, Ouémé, Zou, Mono, Borgou, Alibori, Donga and Atacora departments to follow up and support the local NGOs in the implementation of community- based activities. A 1-day orientation session was organized for the accountants and community assistants, respectively, in July and they took up their duties between July and August 2013. Replacement of the Financial and Administrative Manager: During Quarter 8, Mr. Eric Pliya, ARM3 Financial and Administration Manager resigned for personal reasons. Mr. Fructeaux Rodriguez, the ARM3 Parakou office Financial Officer was promoted to the ARM3 FAM position. He will move to Cotonou as soon as the recruitment and training of his replacement in Parakou is completed. The process of selection of the Parakou FAO will commence in October. Training on Innovative Approach for Strategic Communication and Leadership ARM3 personnel, including the JHU BCC Advisor, BCC Officer, the Africare’s liaison officer/GFATM Manager, and the two Africare BCC and Community activities Coordinators from the Abomey and Parakou offices participated in this training (described under Sub-result 3.1). Home Office Backstopping and Reporting MCDI Home Office: Technical/financial support and coordination Home Office (HO) support to Cooperative Agreement Modification: MCDI received the Cooperative Agreement modification from USAID on July 11, 2013, and submitted a fully executed version of the modification to the Contract Officer (Office of Acquisition and Assistance). This modification authorizes ARM3 to conduct the iCCM component in 5 HZs in the North of Benin. iCCM Preparation: i) HO finalized a revised iCCM proposal in a workplan format in collaboration with the field team; ii) finalized the Africare Sub-Award amendment as well as the SOW related to iCCM; iii) reviewed the amendment with Africare and signed the modification on September 16; iv) initiated the Amendment process with MSH to support its participation; iv) identified and programmed a new digital platform (CommCare) for the SMS pilot that will utilize cellphones to permit CHWs transmit monthly reports to the DHZs; a local IT consultant previously working with the BASICS project will test the new platform in October; based on these results a decision will be made to replace the previous SMS platform considered too dependent on external technical assistance. ARM3 Y3 Work plan: MCDI HO provided technical and financial assistance to the field team and supported the coordination with partners in the development of the Year 3 work plan.
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Health Facility Survey: MCDI HO worked jointly with CDC and the field team in finalizing the review and translation of the protocol and questionnaires in to French, developed an SOP for the use of Open Data Kit (ODK) software and tablets in English and French, finalized the tablet ODK based questionnaires and transferred to CDC and field team, conducted procurement of equipment and supplies to support the survey, supported the transference of responsibilities to field team, adjusted the ODK questionnaires as requested by CDC, provided remote overview during the startup of the survey, managed and consolidated data submitted from the field and sent back to field and CDC. Private sector training and registry: MCDI HO supported field team in the development of a plan for the implementation of the private sector registration and training activities. This plan is being reviewed by field team. LLIN Phase 1 close-out and Phase 2 startup: HO provided overview to the finalization of Phase 1 distribution and is in communication with FO to prepare for Phase 2 distribution. Africare Home Office Year 3 work plan and budget: Supported the development of the Year 3 work plan and budget. iCCM: Conducted the review of the iCCM budget and agreement, and signed the amendment to ARM3 agreement, Selection of NGO: Supported the selection and contracting of the partner NGOs. JHU-CCP Home Office Year 3 work plan and budget: JHU-CCP HO contributed in the process of the development of the Year 3 work plan and budget. IPTp Barriers Study: Finalized the report and started the translation into English. Leadership in Strategic Communication course: Coordinated with field office and provided short-term TA to implement the course. Interpersonal communications materials: Reviewed and enhanced the documentation provided by the BCC Advisor. MSH Home Office Year 3 work plan and budget: contributed in the process of the development of the Year 3 work plan and budged iCCM: Started the review of the iCCM budget, the amendment to the agreement, and SOW for the iCCM Advisor. Short Term Technical Assistance Short-term TA was provided for the following:
- The roll-out of the 4th LDP workshop and presentation of team results from Aug 25 to Sep 7, 2013, Dr. Oumar Diakite, MSH Consultant in Leadership Development Program. - Evaluation of the Collaborative’s implementation of uncomplicated malaria in Ouémé/Plateau and the Atlantic Coast from Sep 15 to Oct 5, 2013, Dr. Mahamane Karki, MSH Consultant in Collaborative Approach. - Case Management, Dr. Victor DOSSOU. - Technical guidance to the ARM3 Supply Chain Management from September 14 to 28, 2013, Dr. Seydou Doumbia, MSH Technical Advisor.
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- Implementation of the Leadership in Strategic Health Communication course, July 22 to August 2, 2013, through: Ms. Claudia Vondrasek, a Johns Hopkins University-Center for Communication Programs Senior Staff and Director of Malaria VOICES Project, co-facilitator of the course; and Dr. Stella Babalola, Johns Hopkins University Associate Professor and Senior Researcher at the JHU-CCP Major activities planned for next quarter (Year 3, Oct-Dec):
RESULT 1: Implementation of malaria preventions in support of the National Malaria Strategy improved Monitor the implementation of the activities included in the action plan in the MOU for the FSS Monitor the implementation of the activities included in the action plan in the MOU for INMES Organize briefing for INMES teachers on the national malaria control policy and associated guidelines Supervise INMES teachers on briefing newly graduated health officers national malaria control policy and associated guidelines Sign an MOU with the vocational training schools of the University of Parakou Monitor the implementation of the activities included in the action plan in the MOU for the University of Parakou Plan and implement the second phase of LLIN distribution Follow up on the durability of LLINs of the first phase Contract for LLIN transport Supervision of the LLIN distribution Support LLIN BCC campaigns Finalize agreements for incineration of LLIN bags with Lafarge Completion of procedures for authorization of incineration at the Ministry of the Environment Validates MOU sent to other private sector networks for amendment and acceptance Support each network in the integration of the activities of ARM3 in their work plan Organize a workshop for private sector registration
RESULT 2: Malaria Diagnosis and Treatment activities in support of the National Malaria Strategy improved
Print and distribute training manuals for the malaria case management, IPTp, and MIP in all health zones Deliver emergency equipment to hospitals trained in ETAT Conduct monthly validation of indicators in 12 hospitals involved in ETAT Organize the first learning session of the 12 hospitals involved in ETAT Assess hospitals for enrollment in the next phase of ETAT (human, material and technical) Conduct orientation workshop for officials and their staff on ETAT for newly identified hospitals Train new hospital providers on ETAT Review MOU content and other management tools made available to ZS and DDS Conduct an assessment of the implementation of activities under the MOUs in place in the AL, OP, ZC, and BA departments Sign MOU amendments with the 25 existing HZ Organize a workshop to develop action plans with the signing of the MOU and ZS DDS on behalf of each department
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Organize the signing of MOUs with the remaining 9 health zones of Dongo-Atacora and Mono- Coffou Support for HZ validation indicators sites of the first group for the period from July to September 2013 for departments and OP AL Support the organization of learning sessions (SA 2 Group 1 and Group 2 SA1) Ouémé- Plateau and the Atlantic Coast Support the DDS and ZS for training personnel from the remaining health facilities for the third collaborative group (coaching techniques ) Support the calculation of basic indicators for the third group sites Organize a joint integrated supervision with the SCM department Conduct iCCM NGOs orientation session. Sign sub agreements with the selected NGOs in BASICS former health zones Conduct selected NGOs training/refresher training on iCCM Start iCCM implementation RESULT 3: The national health system’s capacity to deliver and manage quality malaria treatment and control Workshop to review strategies and tools for ARM3 M&E Quarterly Data Validation of HMIS Updating the database of community volunteers for the implementation of IMCI in areas such basics Support organization of the 2013 PITA Train hospital statisticians in LOGISNIGS Train agents on filling in the HMIS NMCP form 1 Development of the third quarter HMIS bulletin number Organize an EUV in Borgou/Alibori Organize an LMIS/malaria commodities supervision Support the NMCP to prepare January 2014 forecasting exercise by collecting necessary data Conduct coaching visits to DRZ and health facilities managers Support CAME to redesign Cotonou and Parakou warehouses and to design the new warehouse of Cotonou Implement a pilot phase of MEDISTOCK V4+ in CAME’s offices in Cotonou, Parakou and Natitingou RESULT 4: CROSS SECTIONAL- BCC In Mono/Couffo, Atacora/Donga and Borgou/Alibori departments Conduct NGOs orientation session on Malaria Community BCC activities Sign sub-agreements with the 14 selected NGOs Conduct the training of NGO members on malaria and BCC approaches Implement community BCC in selected communities Realign the campaign and focus on net use, SP, fever prompt care seeking Disseminate messages through TVs and radio Training of trainers in interpersonal communication Reproduce NMCP music-video on malaria prevention and management Support to private sector to launch the second phase of the project Distribute BCC flyers in the health centers Air TV spots on LLINs
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Workshop with radio managers to discuss achievements and challenges during their contract with ARM3
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