Mapping of RMNCH & Nutrition Programs
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July 2015 Mapping of RMNCH & Nutrition Programs/Projects in Lusaka and Copperbelt Provinces Author: Angel Mondoloka MDGi Program for Accelerating Progress Towards Maternal, Neonatal & Child Morbidity and Mortality Reduction in Zambia Millennium Development Goal Initiative Accelerating the Reduction of Maternal, Neonatal and Child Mortality European Union MDGi: A Joint Programme of the Government of the Republic of Zambia – European Union – United Nations This publication has been produced with the assistance of the European Union. The contents of this publication are the sole responsibility of the Government of the Republic of Zambia and United Nations and can in no way be taken to reflect the views of the European Union A study to map and analyse Reproductive, Maternal, Newborn and Child Health & Nutrition (RMNCH&N ) programs and projects in Zambia with regard to outcomes and lessons learnt and to, hence, inform the design of MDGi with specific respect to program coordination and its potential catalytic role for system strengthening through convergence, integration, scale-up, and sustainability Copyright: Government of the Republic of Zambia/2015 Table of Contents LIST OF TABLES i LIST OF FIGURES i LIST OF BOXES i ACRONYMS ii ACKNOWLEDGEMENTS iv PROLOGUE v EXECUTIVE SUMMARY vi 1. INTRODUCTION 1 2. BACKGROUND 3 3. OBJECTIVES, SCOPE AND DELIVERABLES OF THE STUDY 10 3.1 Specific Objectives of the Study 11 3.2 Scope of the Study 11 3.3 Deliverables of the Study 11 4. METHODOLOGY 12 4.1 Targeting of Respondents 14 4.2 Selection of RMNCH&N Projects and Programs 14 4.3 Interview Questionnaires 14 5. LIMITATIONS OF THE STUDY 15 6. SOURCES OF CRITERIA FOR BEST PRACTICES 17 6.1 The Global Strategy for Women’s and Children’s Health 18 6.2 The Global Investment Framework 18 6.3 The Integration Imperative 21 6.4 The Three Delays Model 22 6.5 Other Sources 22 7. FINDINGS OF THE STUDY 25 7.1 Major recently Completed, On-going or Up-Coming RMNCH&N Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces and Program and Projects 28 7.2 Lessons Learnt 29 7.2.1 Achievements 30 7.2.2 Implementation Challenges 36 7.2.3 Sustainability Issues Noted 39 7.3 Innovations and Good Practices in RMNCH&N 40 7.3.1 Innovations 40 7.3.2 Good Practices 40 7.4 Synergies through Geographic and Programmatic Convergence 41 8. CONCLUSIONS AND RECOMMENDATIONS 45 BIBLIOGRAPHY 47 APPENDICES 51 Appendix 1 Terms of Reference 52 Appendix 2 List of Interviewees 57 Appendix 3 Key Information Questionnaire – District Health Office 63 Appendix 4 Key Information Questionnaire – District Health Facility 67 Appendix 5 Focus Group Discussion Questionnaire 70 Appendix 6 District-level mapping of RMNCH programs and projects by Key Topic 73 Appendix 7 District-level mapping of RMNCH programs and projects by Program/Project 76 Appendix 8 Count of Projects Cross-Classified by RMNCH&N Component Addressed 79 Appendix 9 Percentage of Projects Cross-Classified by RMNCH&N Component Addressed 79 Appendix 10 Count of Projects Addressing Malaria, WASH, GBV and Systems Strengthening 80 Appendix 11 Percentage of Projects Addressing Malaria, WASH, GBV and Systems Strengthening 80 Appendix 12 National Health Planning Cycles and Context 81 Appendix 13 Synergies for Women’s and Children’s Health between the MDGs 82 Appendix 14 Strategic Elements of the Immunisation Vision and Strategy Framework 83 Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces LIST OF TABLES Table 1 Trends in maternal and child health 7 Table 2 Selected health status and utilization indicators 7 Table 3 Interview strategy 12 Table 4 Count of Respondents by Type of Organisation 13 Table 5 Count of RMNCH&N programs and projects by size category 28 Table 6 Key elements of the BHOMA project approach 46 LIST OF FIGURES Figure 1 Demographics 5 Figure 2 Maternal and Newborn Health 5 Figure 3 Equity; Child Health 6 Figure 4 Distribution of Stunting in Zambia 7 Figure 5 A delineation of the deliverables for the mapping study 12 Figure 6 Sample diagram of Zambian national health system 14 Figure 7 The Continuum of Care 19 Figure 8 Places of care giving in the Continuum 19 Figure 9 The global consensus for Maternal, newborn and child health 19 Figure 10 The Conceptual Framework 20 Figure 11 Clarifying the difference between critical enablers and development synergies 21 Figure 12 Priority linkages between SRH and HIV 21 Figure 13 Countdown Countries: Coverage of essential RMNCH interventions along the Continuum of Care 23 Figure 14 Conceptual framework for the BHOMA project 24 Figure 15 The ECD program’s holistic approach 24 Figure 16 Mapping of sex work hot spots in Chipata 21 Figure 17 MNCH pillars and cross-cutting issues 42 LIST OF BOXES Box 1 Grant to Demonstrate the Possibility of Eliminating all New Infant HIV Infections 26 Box 2 Example of a PPP Around Reproductive Health 29 Box 3 Principles of the 2005 Paris Declaration on AID Effectiveness 40 Mapping of RMNCH & Nutrition Programs/ i Projects in Lusaka and Copperbelt Provinces ACRONYMS AAR Japan Association for Aid and Relief, Japan AED Academy for Education Development AFP Acute Flaccid Paralysis AGEP Adolescent Girls Empowerment Programme AIDS Acquired Immune Deficiency Syndrome AMACSI African Member Association Country Sustainability Initiative ANC Antenatal Care ARK Absolute Return for Kids ART Anti-Retroviral Therapy ARV Anti-Retroviral ATC Advanced Treatment Centre AYFS Adolescent & Youth-Friendly Services BCP Behaviour Centred Programming BTL Bilateral Tubal Ligation CAC Comprehensive Abortion Care CBD Community-Based Distributor CBO Community-Based Organization CBV Community-Based Volunteers CCP Comprehensive Condom Programming CD4 Cluster of Differentiation 4 CDC Centres for Disease Control CDI Child Development Index CEDAW Convention on the Elimination of All Forms of Discrimination against Women CEMG Cardno Emerging Markets Group CHAMP Comprehensive HIV/AIDS Management Program CHAs Community Health Associations CHWs Community Health Workers CMMB Catholic Medical Mission Board CNGs Community Nutrition Groups COMPACT Community Mobilization for Preventive Action CP Cooperating Partners CRC Convention on the Rights of the Child CS Caesarean Section CSE Comprehensive Sexuality Education CSS Community System Strengthening CT Counselling and Testing CTC Community-Based Therapeutic Care CVCT Couples Voluntary Counselling and Testing DACA District AIDS Coordinating Advisor DANIDA Danish International Development Agency DATF District AIDS Task Force DBS Dried Blood Spot ii Mapping of RMNCH & Nutrition Programs/ Projects in Lusaka and Copperbelt Provinces DCHO District Community Health Office DCMO District Community Medical Officer DFID Department for International Development DHAPP US Department of Defense HIV/AIDS Prevention Program DHIO District Health Information Officer DHMT District Health Management Team DHO District Health Office DMO District Medical Officer DOTS Directly Observed Treatment, Short-Course EBF Exclusive Breastfeeding ECD Early Childhood Development EDF European Development Fund EGPAF Elizabeth Glaser Pediatric AIDS Foundation EIB European Investment Bank EID Early Infant Diagnosis EMTCT Elimination of Mother to Child Transmission E-MTTS Emergency Medical Treatment and Triage System ENC Essential Newborn Care EU European Union FBO Faith Based Organization GBV Gender-Based Violence HBB Helping Babies Breathe HBC Home-Based Care HCCs Health Centre Committees HCT HIV Counselling and Testing HII High Impact Interventions HIV Human Immuno-deficiency Syndrome HMIS Health Management Information System HTC HIV Testing and Counselling IDRF International Development and Relief Foundation IEC Information Education and Communication IMAM Integrated Management of Acute Malnutrition IMSAM Integrated Management of Severe Acute Malnutrition iNGO International NGO INH Isoniazid IPAS International Pregnancy Advisory Services IRS Indoor Residual Spraying ITNs Insecticide Treated Nets IYCF Infant and Young Child Feeding KMC Kangaroo Mother Care LARC Long-Acting Reversible Contraception LCS Labour Caesarean Section M&E Monitoring & Evaluation MARPs Most at Risk Populations MC Male Circumcision Mapping of RMNCH & Nutrition Programs/ iii Projects in Lusaka and Copperbelt Provinces MCH Maternal and Child Health MDG Millennium Development Goal MTCT Mother to Child Transmission NAC National HIV/AIDS/STI/TB Council NACS Nutrition Assessment, Counselling and Support NASF National AIDS Strategic Framework NFNC National Food and Nutrition Commission NFNSP National Food and Nutrition Strategic Plan NHC Neighbourhood Health Committee NMCC National Malaria Control Centre NPA-WGHA National Plan of Action on Women, Girls and HIV/AIDS NZP+ Network of Zambian People Living with HIV/AIDS OVC Orphans and other Vulnerable Children PACA Provincial AIDS Coordination Adviser PACF Positive Action for Children Fund PATF Provincial AIDS Task Force PATH Program for Appropriate Technology in Health PCOE Paediatric Centre of Excellence PHC Primary Health Care PHO Provincial Health Office PLHIV People Living with HIV PM&E Participatory Monitoring & Evaluation PMO Provincial Medical Officer PopART Population Effects of Antiretroviral Therapy to Reduce HIV PPP Public Private Partnership PSAF PANOS Institute of Southern Africa PVO Private Volunteer Organisation RFSU Swedish Association for Sexuality Education RHCC Reproductive Health Change Communications RPR Rapid Plasma Reagin SAfAIDS Southern Africa HIV and AIDS Information Dissemination Service