HEALTH SERVICES ANNUAL REPORT IMPROVEMENT OCTOBER 1, 2014–
COMPONENT SEPTEMBER 30, 2015
HSI Component Annual Report: October 1, 2014–September 30, 2015 1
Cooperative Agreement No.: AID-685-A-11-00003 Project Dates: October 1, 2011–September 30, 2016 Submitted to USAID/Senegal by: INTRAHEALTH INTERNATIONAL Senegal Country Office Dakar, Senegal Email: [email protected]
The Health Services Improvement project is part of the USAID Health Program and is implemented by IntraHealth International in partnership with Helen Keller International, Medic Mobile, and the Siggil Jigéen Network.
HSI Component Annual Report: October 1, 2014–September 30, 2015 2 TABLE OF CONTENTS
Abbreviations and Acronyms ...... 4 I. Executive summary ...... 6 II. Main achievements ...... 7 Sub-component 1: Increased access to an Integrated Package of Quality Services ...... 7 Sub-component 2: Improved quality of health services in health posts, health centers, and regional hospitals ...... 24 Sub-component 3: Improved human resources management in public sector health facilities ...... 32 Sub-component 4: Development of relationships with private sector health facilities ...... 37 III. Main challenges ...... 56 IV. The way forward and priorities for Year 5 ...... 57 V. Financial report ...... 58 VI. Annexes ...... 0 Annex 1: Performance monitoring plan ...... 0 Annex 2: On-site supervision coverage for SDPs, by package and by health district ...... 10 Annex 3: Summary of IPQS training ...... 14 Annex 4: Integration of FP and vaccination ...... 16 Annex 5: Summary of results of the implementation of integrated advanced strategies ...... 17 Annex 6: Planning tools for ECRs and ECDs ...... 18 Annex 7: Sample sermon ...... 19 Annex 8: mEbola Concept Note ...... 23 Annex 8: Equipment and supply inventory for 31 October 2015 ...... 25
HSI Component Annual Report: October 1, 2014–September 30, 2015 3 Abbreviations and Acronyms Artemisinin-based Combination HC Health Center ACT Therapy HD Health District Marketing and Social ADEMAS HKI Helen Keller International Development Agency HP Health Post Active Management of the Third AMTSL Stage of Labor HSI Health Services Improvement
ANC Antenatal Care ICP Head Nurse Health Workforce Information APL Acceptable Performance Level iHRIS Software AS Advanced Strategies Integrated Management of Adolescent and Youth IMCI AYRH Childhood Illnesses Reproductive Health IPC Interpersonal Communication Health Emergencies Operations COUS Integrated Package of Quality Center IPQS Services CPR Contraceptive Prevalence Rate IPT Intermittent Preventive Therapy Nutritional Recovery and CREN Information System for Education Center ISM Management DAN Division of Food and Nutrition ITN Insecticide-Treated Bednet Directorate General of Health DGS Services IUD Intra Uterine Device Long-Term and Permanent DHIS District Health Information System LTPM Method DRH Department of Human Resources MCD Chief District Medical Officer Department of Reproductive DSR/SE Health and Child Survival MCR Chief Regional Medical Officer Maternal, Newborn, and Child ECD District Medical Team MNCH Health ECR Regional Medical Team Ministry of Health and Social Emergency Obstetric and MSAS EmONC Action Neonatal Care MSI Marie Stopes International ENC Essential Newborn Care NGO Non-Governmental Organization Expanded Program on EPI Immunization ORS Oral Rehydration Salts
EVD Ebola Virus Disease PAQ Quality Improvement Partnership
FP Family Planning PHF Public Health Facility Infection Prevention and GBV Gender-Based Violence PIPE Environmental Protection HAS Hydro-Alcoholic Solution
HSI Component Annual Report: October 1, 2014–September 30, 2015 4 Prevention of Test Technical and PMTCT Mother-to-Child Reach Every TFP Financial RED Transmission District Partners PNC Postnatal Care Cheikh Anta Reproductive UCAD RH Diop University National Malaria Health PNLP Control Program United Nations Regional UNFPA Population Fund Post-Partum RPM Program PP/IUD Intra Uterine Manager United Nations Unicef Device Réseau Siggil Children's Fund RSJ Public-Private Jigéen Nutrition PPP Partnership Situational UREN Recovery and SA Education Unit Regional Analysis PRA Procurement National United States Pharmacy Agency for SAMU Emergency USAID International National Medical Service Development Nosocomial PRONALIN Standard Days Infections SDM World Health Method WHO Control Program Organization Service Delivery SDP USAID Regional Point Coordination RB Automated Data Bureau for the SEDA Exchange Health Program System RDT Rapid Diagnostic
HSI Component Annual Report: October 1, 2014–September 30, 2015 5
I. Executive summary
The Health Services Improvement (HSI) component of the USAID health program is a five- year project that is implemented by IntraHealth International in partnership with Helen Keller International (HKI), Réseau Sigils Jigéen (RSJ), and Medic Mobile though cooperative agreement AID-685-A-11-00003. The goal of the project is to overcome major challenges in the delivery of quality health care services (accessibility, operations, health care staff, and the private sector) to support the Senegalese government’s efforts to achieve the Millennium Development Goals.
The component’s primary objective is to strengthen the delivery of quality health services at health facilities through the following four sub-components:
1) Increased access to an Integrated Package of Quality Services (IPQS) 2) Improved quality of health services in health posts, health centers, and regional hospitals 3) Improved human resources management in public sector health facilities 4) Development of relationships with private sector health facilities
The fourth year of implementation has been a pivotal year, characterized by:
Greater coverage of districts by on-site supervision, with 74% of enrolled service delivery points (SDPs) having received at least one tutor visit
A 73% increase in the number of newly enrolled users of a family planning (FP) method through integrating FP into services and advanced strategies compared to last year
Launching of innovative interventions such as the post-partum IUD (PP/IUD) in Touba health district and the approach to improve postnatal care (PNC-1) in the Sédhiou region
Registration of 12,672 employees from the Ministry of Health and Social Action (MSAS) in the Health Workforce Information Software (iHRIS), which allowed for mapping human resources in health
Scale-up of the Automated Data Exchange System (SEDA), which has now been introduced in 11 regions and 66 health districts
Needs inventory of equipment and training to prepare for the Ebola response in five intervention regions
The signing of Memoranda of Understanding between the TutoratPlus districts and 326 private health facilities
HSI Component Annual Report: October 1, 2014–September 30, 2015 6
II. Main achievements Sub-component 1: Increased access to an Integrated Package of Quality Services
For greater availability of the Integrated Package of Quality Services (IPQS), the component prioritized TutoratPlus implementation and specific interventions in FP, maternal health, child survival, nutrition, and malaria control. Analysis of progress
Expected results for Year 4 Results achieved
The coverage rate for SDPs receiving on-site Tutors conducted 2252 of the planned 2500 supervision increases from 32% to 80%. visits, or an annual performance rate of 90%. The number of SDPs that received at least The number of new users of FP methods is one tutor visit went from 426 in Year 3 to 973, increased with the implementation of at least or 74% of enrolled SDPs. 2249 information sessions and delivery of FP services during vaccination sessions and The total number of new enrolled users for advanced strategies implemented by head the year through integrated services is 30,197 nurses (ICPs) in health huts. compared to 17,417 last year, or a 73% increase compared to the previous year. The skills of at least 327 providers are strengthened in emergency obstetric and 999,189 couple-years of protection (CYP) neonatal care (EmONC) for improved case were generated this year through the management of post-partum hemorrhage, country’s 11 Regional Procurement pre-eclampsia, and eclampsia in mothers and Pharmacies (PRAs), or a 25.74% increase asphyxia in newborns. compared to last year (794,951).
The coverage rate among pregnant women The skills of 123 providers, including 120 for intermittent preventive therapy (IPT2) is women, were strengthened in EmONC in the improved in all districts that have regions of Diourbel, Kaffrine, Kolda, Fatick, implemented the IPT2 improvement and Ziguinchor. approach. 70.16% of pregnant women received two doses of IPT, according to SEDA data (117,374 The skills of at least 225 providers are out of 167,288 initial antenatal care (ANC) strengthened in the management of acute contacts) malnutrition based on the new revised protocols. The skills of 286 health workers (107 men and 179 women) were strengthened in nutrition The vaccination coverage rate among infants applied to the life cycle and essential nutrition age 0–11 months in Penta 3 is improved in and hygiene actions. districts that have implemented the Reach Every District (RED) approach. The vaccination coverage rate for Penta 3 was 95% in August 2015, according to the At least one new vaccine is introduced in the epidemiological bulletin published by the Expanded Program on Immunization (EPI). Department of Medical Prevention.
HSI Component Annual Report: October 1, 2014–September 30, 2015 7
56 health districts receive funding through The component signed sub-contracts with 59 district grants. districts, namely: 13 first-generation, 25 second-generation and 21 third-generation districts.
Description of achievements 1. Introduction and implementation of TutoratPlus
TutoratPlus implementation continued this year with training for new tutors, on-site supervision of providers, and monitoring of TutoratPlus implementation with support teams and the regional level.
Additional tutor training: Following the loss of many tutors in Year 3 (deaths, training, re- assignments, etc.), the component trained 39 new tutors (including 23 women and 16 men) to fill gaps in districts where some packages were no longer available. The training was held in collaboration with the existing trainers of regional tutors and with support from Thiès, Mbour, and Saint Louis health districts, which helped prepare the practical workshops. Training was rolled out in five simultaneous sessions, by package. Tutors from packages 4 and 5 (Services Management and the Information System for Management (ISM)) were grouped into one session. The training had the greatest impact in the Saraya district that was recently enrolled in the IPQS, with four new tutors trained. This improved on-site supervision coverage for the district’s SDPs.
Table 1: Distribution of new trained tutors, by package and by district
Regions Districts Tutors trained, according to package Packag Packag Package Package Package 6: Total Packages: e 1: e 2: FP 3: s 4 & 5: Health Health Matern Disease SDP Communicati Communication al and manage Manage on and and Promotion newbor ment ment Promotion n and ISM health Dakar Guédiawaye 1 1 2 Thiès Mbour 1 1 Popenguine 1 1 2 Thiadiaye 1 1 Meckhé 1 1 Khombole 1 1 2 Kaolack Kaolack 1 1 Nioro 1 1 Saint Louis Pete 1 1 Matam Ranérou 1 1 2 Thilogne 1 1 2 Tambacounda Kidira 1 1
HSI Component Annual Report: October 1, 2014–September 30, 2015 8
Kédougou Kédougou 1 1 2 Saraya 1 1 1 1 4 Kolda Kolda 1 1 2 Fatick Gossas 1 1 2 Fatick 1 1 Passy 1 1 Foundiougne 1 1 2 Kaffrine Kaffrine 1 1 Sédhiou Sédhiou 1 1 Goudomp 1 1 Bounkiling 1 1 2 Ziguinchor Ziguinchor 1 1 Diouloulou 1 1 Diourbel Diourbel 1 1 TOTAL 13 8 9 5 4 39
On-Site Supervision for providers: Tutors conducted 2252 of the planned 2500 visits, or an annual performance rate of 90%. The performance level was affected by the number of SDPs receiving at least one tutor visit, which increased from 426 in Year 3 to 973 this year. This performance is easily explained by the rise in the number of trained tutors and the increased number of visits conducted by tutors, as noted above, especially through greater involvement of chief district medical officers (MCDs), who are increasingly appointing a TutoratPlus focal point within the district medical team (ECD).
Tutors also succeeded in mobilizing partners and health committees to support greater availability of the IPQS through:
Hiring health care staff: 42 midwives, 20 nurses, 7 guards, 18 cleaning staff, 16 community health workers, and 1 driver
A financial contribution of 431,010,177 FCFA, including 215,915,283 FCFA invested by health committees, for support in equipment and infrastructure (rehabilitation and renovation of premises)
The health districts of Popenguine, Joal, Koki, Foundiougne, Passy, Goudomp, Bounkiling, Goudiry, Birkelane, Médina Yoro Foulah, Ziguinchor, and Diamniadio were the highest performing districts, by package (those with a coverage rate greater than or equal to 45%). (See Annex 2.)
Monitoring of implementation of TutoratPlus by ECDs and support teams: During the year, reports sent for the three quarters show that support teams, mainly comprised of the district’s ECDs, made 101 supervision visits to SDPs to assess the quality of supervision provided by tutors at providers’ work sites. The data are underestimated; the figures are
HSI Component Annual Report: October 1, 2014–September 30, 2015 9
lower than the reality because several supervision reports were not sent or sent late by the ECDs to the IntraHealth regional program manager (RPM) or because reports had to be sent back because they were unusable due to poor quality.
Strengths: - Smooth running of on-site supervisions - Tutors’ aptitudes, skills, and dynamism - Mastery of the coaching technique by the vast majority of tutors - Providers’ commitment and enthusiasm for the approach - Supervised providers’ availability and diligence - Acquisition of new skills - Better collaboration between providers and health committee members - Equipment allocated to SDPs through district grants - Health committee’s engagement with significant contributions - Immediate resolution of some equipment gaps - Better organization of services - Improved pacing of tutor visits for some districts - Commitment of the vast majority of tutors to provide high-quality supervision Areas for improvement: - Failure to comply with the maximum time between two rounds of visits, despite improved scheduling of tutor visits - Inadequate equipment: mannequins for active management of the third stage of labor (AMTSL) and scales and measuring sticks for monitoring nutrition to help tutors and providers practice at sites - Low level of involvement among most local officials - Late start of on-site supervision activities, usually after tutor training Recommendations: - Continue advocacy among local officials to instill a greater commitment to the process to solve identified problems in the SDPs - Comply with the set interval between two rounds of on-site training visits - Continue advocacy among health officials, committees, and local elected officials to instill ownership of the activity and ensure its sustainability
Regional reviews of TutoratPlus implementation: Four regional reviews, by priority, were supported in Thiès, Kolda, Kaolack, and Ziguinchor on TutoratPlus implementation outcomes.
One review was organized by the Kolda Regional Bureau (RB) for the three regions that it covers: Kolda, Sédhiou, and Ziguinchor. The meeting presented a brief overview of TutoratPlus and results on the number of trained and community-based providers who were supervised by tutors for the various packages. The meeting also covered the achievements of health committees, local governments, and other partners and improvement reported in the organization of services. Next, the SDP coverage rates for the various packages in each district for the regions covered by the RB were presented.
HSI Component Annual Report: October 1, 2014–September 30, 2015 10
The RB of Thiès organized a review of TutoratPlus implementation for its five coverage regions: Saint Louis, Louga, Diourbel, Thiès, and Dakar. During the review, on-site supervision activities and SDP enrollment were examined, followed by discussions.
In the context of its direct financing, the Kaolack region organized a mid-year review of TutoratPlus, combining the four districts that make up the region. During the review, the main outcomes for the approach’s implementation were shared, including monitoring of private SDP involvement in TutoratPlus, analysis of problems, and identification of corrective measures and recommendations.
Three of the five districts within the Ziguinchor region presented TutoratPlus implementation outcomes during the regional review. Results from the meeting were satisfactory in achieving the district grant deliverables as well as for the level of partner contributions in the districts of Ziguinchor, Thionck-Essyl, and Diouloulou.
However, the SDP coverage rate for Photo1: Meeting to share results for Tutor Package 3 in Niassene health post in Richard Toll on-site supervision of their staff is not satisfactory yet due to failure to comply with the tutor visit schedule. The review also noted inadequate supervision of tutors by ECDs and delays in sending on-site supervision reports and in tutor supervision by ECDs.
2. Improve access to high-quality family planning services
For this year, the component intensified its efforts to increase the number of users of an FP method through continued provider training and FP integration into high-volume services; ensuring the introduction of the PP/IUD; and initiating greater consideration of adolescents’/youths’ needs in the delivery of FP/reproductive health (RH) services.
Introduction of the post-partum IUD: Following the submission of the protocol to introduce the PP/IUD in the district of Diourbel to the MSAS Ethics Committee, the component supported the DSR/SE in developing training, data collection, and supervision tools for the PP/IUD. Next, the tools were finalized and validated by the FP Division of the DSR/SE with members from the Commission on FP Services Delivery within the National FP Technical Committee. Then, in partnership with Diourbel medical region and the Senegalese Association of Gynecologists and Obstetricians (ASGO), the component supported training in PP/IUD for 22 providers, including 19 women from pilot sites (Ndamatou health center and Mahlaboul Faawzeini hospital) in Diourbel. The training lasted six days, with a two-day practical workshop. After the training, 86% of participants had an acceptable knowledge and skill acquisition level (of at least 80%).
HSI Component Annual Report: October 1, 2014–September 30, 2015 11
Following training, 21 FP counselors from 12 SDPs that deliver ANC services were trained for five days on FP counseling, including the PP/IUD, to improve client referrals to SDPs that provide the PP/IUD. After the training, 114 women received counseling and were offered the PP/IUD within 48 hours of having delivered.
Inclusion of FP services in high-volume services delivery: This year saw an actual increase in the number new users of FP methods. For the 1611 information sessions held, 14,697 new users of methods were enrolled, or a 34% increase compared to Fiscal Year 3. The average enrollment rate among the women present is 24%, with variations between regions. Sédhiou region had the highest enrollment rate at 37%, while the regions of Fatick, Ziguinchor, and Kédougou had an enrollment rate below 15%. (See Annex 4.)
Trends indicate that women have a strong preference for injectable, chosen by 55% of them, followed by pills and then implants, as shown in figure below:
Figure 1: Distribution of numbers of new users, by FP method
DIU Methodes 3% naturelles 1% Implants 19%
Pilules Injectables 22% 55%
Implementation of integrated advanced strategies conducted by ICPs in health huts also resulted in the enrollment of 15,499 new users of FP methods. Thus, the total number of new enrolled users for the year through integrated services is 30,197 compared to 17,417 last year, or a 73% increase compared to the previous year.
This performance brings the total number of new users enrolled through this integration strategy to 63,904, or 46% of the 135,000 target set by the National Action Plan for Family Planning for the public sector.
Training for providers in contraceptive technology, focusing on long-term and permanent methods: The Diourbel, Sédhiou, and Ziguinchor medical regions trained 79 providers, including 47 women, in contraceptive technology, focusing on long-term and permanent methods (LTPMs). The training aims to strengthen providers’ capacities to: (1) use World Health Organization (WHO) Medical Eligibility Criteria; (2) deliver contraceptive methods according to standards; (3) provide quality counseling on using contraception
HSI Component Annual Report: October 1, 2014–September 30, 2015 12
methods, particularly long-term methods; (4) manage side effects related to using contraception methods according to standards; (5) apply the necessary infection prevention measures for delivering quality FP services; (6) comply with the principles for logistics management of contraceptives at SDPs; and (7) use the various management tools for FP services (forms, reports, and registers) according to standards.
In Diourbel, training met a need identified during supervision in the region, noting that LTPMs were unavailable in some SDPs because providers had received no training on this. The participants’ average score ranged from 10 out of 25 on the pre-test to 17.41 out 25. Tutors for the FP package began to close participants’ persistent on-site performance gaps.
In the Sédhiou and Ziguinchor medical regions, training covered 8 health centers, 71 health posts (HPs), 3 hospitals, and 10 private and semi-public facilities. In terms of improving skills, participants were supervised according to an observation grid, designed for this purpose. Performance levels for counseling, Jadelle and IUD insertion, and Jadelle removal ranged between 83% and 95%.
Training in FP counseling: The Sédhiou medical region held a training session for each district for head nurses (ICPs) and mid-wives from 50 SDPs (including 3 private SDPs) on FP counseling, including the importance of the Tiahrt amendment. Through three sessions, 60 providers (including 39 women) received training. The number of participants who earned an acceptable performance level (APL) greater than or equal to 80% went from 11 in the pre-test to 42 in the post-test. However, in Bounkiling district, less than half of the trained participants (9 out of 20) scored an APL greater than or equal to 80%. Post-training follow-up will be held at the start of the next quarter to overcome these providers’ gaps in knowledge and skills.
Post-training follow-up for providers: The Sédhiou medical region and Touba district received support to conduct, respectively, post-training follow-up of providers in contraceptive technology and supervision of management of the FP file. The Sédhiou ECDs and regional medical team (ECR) conducted a monitoring visit for trained providers to assess the quality of contraceptive methods supply, with emphasis on long-term and permanent methods. The post-training follow-up, performed with 21 providers from 18 SDPs, highlighted providers’ performance for the implant insertion technique. A persistent lack of interpersonal communication (IPC) between providers and clients was also noted.
Thus, in order to increase the LTPM usage rate, it is essential to improve IPC with clients to ensure a better understanding of the adverse side effects of contraceptive methods. Regular monitoring and application of the applied recommendations will help resolve the issues noted during the supervision.
Supervision of the management of the FP file in Touba district targeted 25 providers from 25 SDPs; including 3 private SDPs. Supervision yielded these findings in the supervised SDPs:
Good availability of contraceptives (no stockouts) The existence of FP files in 60% (15/25) supervised SDPs Good knowledge regarding concepts by the majority of providers
HSI Component Annual Report: October 1, 2014–September 30, 2015 13
Availability of FP management tools in most SDPs Involvement of midwives in the management of the FP file
However, the following was noted:
No training in contraceptive technology for 23 midwives who were newly appointed in the health district A stockout of contraception sheets and stock sheets Failure to master concepts and procedures related to FP data collection Unavailability of quarterly stock registers Poor filing of the FP file Inadequate upkeep and filling-out of management tools for FP data Inadequate interpersonal communication between providers and clients
After the supervision, the following recommendations were made:
For the health district: (1) Plan for on-site supervision of untrained workers on contraceptive technology according to the TutoratPlus approach as soon as possible; (2) Standardize the understanding of FP concepts during the coordination meeting and when filling out management tools; and (3) Order sufficient quantities of management tools for FP. For SDP managers: (1) Fill out quarterly stock registers regularly; (2) Order sufficient quantity of management tools for FP; and (3) Follow instructions for filling out the FP register and management of the FP file.
Support for the AYRH Division of the DSR/SE: Support for the Adolescent and Youth Reproductive Health (AYRH) Division resulted in the supervision of 6 SDPs (including 3 health centers) from the Sédhiou medical region and training for 12 ECR and ECD members from the Kaffrine region (including 5 women) on AYRH standards.
Supervision in the Sédhiou region found there were no designated spaces for adolescents in health centers and no information tools for youth and adolescents on reproductive health.
Training for ECR and ECD members from Kaffrine yielded the following recommendations, which will undergo specific monitoring:
At the SDP level:
- Identify spaces and equipment in SDPs with relevant actors, including adolescents/youth, to set up adolescent spaces - Involve all community actors in the management of AYRH - Create AYRH networks in all areas for SDPs
At the Region/District level:
- Train providers from health posts and other ECD members from all districts on standards - Plan for equipping adolescent spaces in SDPs
HSI Component Annual Report: October 1, 2014–September 30, 2015 14
- Monitor the implementation of the developed action plan - Conduct supportive supervision of providers - Use community radio stations to disseminate information about sexual and reproductive health for adolescents and youth - Organize a national sponsorship day whereby enrolled adolescents mentor out- of-school or drop-out adolescents, to comply with equity issues - Create collaborative frameworks between the various actors working in AYRH - Include AYRH issues in pediatric services At the national level (DSR/SE):
- Advocate among partners to set up adolescent spaces - Support setting up and equipping adolescent spaces - Advocate in favor of mobilizing material and financial resources - Conduct post-training follow-up with partners
Support to implement the Sayana Press introduction plan: The component provided financial support for Path to introduce the Sayana Press in the regions of Fatick, Dakar, Thiès, and Saint Louis, through:
Development of a provider training manual on Sayana Press
Training for 95 trainers who are ECR/ECD members for cascade training for providers on the Sayana Press
Two-day training for 1352 providers on Sayana, including one day of hands-on exercises
Post-training follow-up for 811 providers
Production and provision of job aids on Sayana Press Photo2: Sayana Press injection for a client in the Joal HC
3. Increased availability of quality maternal and neonatal health services
During the year, the component worked with the DSR/SE to improve maternal, newborn, and child health (MNCH) services, emphasizing EmONC and focused ANC, and also by introducing the PNC1 approach at D1–D3 to improve newborn survival. In Year 4, the component reported the following results.
Strengthening providers’ capacities on EmONC: With component support, the regions of Ziguinchor, Kolda, Diourbel, Fatick, Kaffrine, Saint Louis, and Kédougou trained 123 providers (including 120 women), or a performance rate of 32% compared to the annual target. The low performance is due in large part to the budget realignment that decreased the line item for this activity.
HSI Component Annual Report: October 1, 2014–September 30, 2015 15
Training in basic EmONC is more hands-on than theoretical, with the hands-on stage added to the clinical workshops.
Observations dealt with the management of labor using the partograph, AMTSL, newborn resuscitation, post-abortion care, and performing a ventouse delivery and were done through clinical workshops for simulations and a hands-on stage for actual cases. Photo3: Hands-on session with mannequins
Overall, very low knowledge levels in the pre-tests improved by the end of the training, as shown in the figure below.
Figure 2: Average level of EmONC knowledge by region at the pre- and post-test
100
80
60 93 97 87 83 89 40 79 74 78 82 20
0 FATICK KAFFRINE SEDHIOU ZIGUINCHOR KOLDA DIOURBEL KAOLACK KEDOUGOU SAINT LOUIS
PRE-TEST POST-TEST
Similarly, performance improved for all of the regions, with Saint Louis reporting a 92% average performance rate on the post-test.
HSI Component Annual Report: October 1, 2014–September 30, 2015 16
Figure 3: Average performance rates in EmONC training by region
100 96 89 90 83 79 80 68.8 67 70 65 66 60 52 50 40 30 20 10 0 FATICK KAFFRINE SEDHIOU ZIGUINCHOR KOLDA DIOURBEL KAOLACK KEDOUGOU SAINT LOUIS
PRE-TEST POST-TEST
Training for providers in focused ANC: The component continued training for qualified providers in the regions of Dakar, Fatick, and Sédhiou reaching a total of 104 tutors (including 84 women and 20 men). These training sessions covered 69 SDPs, including 5 private SDPs, and addressed shortcomings related to needs expressed by the districts in their annual work plans.
Support for post-training follow-up of providers trained in post-abortion care, EmONC, AMTSL/ENC, and focused ANC: Monitoring sought to assess performance for a sample of trained providers in case management for women during pregnancy and delivery and in post-partum monitoring. The ECRs/ECDs conducted the monitoring with support from the central level and were able to measure providers’ skill acquisition levels.
Kaolack and Thiès regions conducted the supervision on focused ANC in the districts of Nioro, Mbour, Joal, and Popenguine. Overall, 85 providers from 64 SDPs received post- training follow-up. Among the supervised providers, 16 did not achieve an APL of 80%. The least successful points during practical exercises were IPC, applying principles for infection prevention, and performing pelvimetry. The methodology and the pedagogical approach for these themes will be reviewed in the various training guides at the central level to promote greater knowledge acquisition.
The Kolda region supervised emergency obstetric and neonatal care (EmONC) activities and observed eight providers from these facilities: Kolda hospital (3); Kolda health center (3); Vélingara health center (1); and Médina Yoro Foulah health center (1). The supervision observed these six areas: the partograph, infection prevention and environmental protection (PIPE), delivery, AMTSL, essential newborn care (ENC), and newborn resuscitation. Performance ranged from 41% to 87% for ENC, from 54% to 89% for AMTSL, from 58% to 87% for newborn resuscitation, from 56% to 85% for deliveries, from 76% to 100% for the partograph, and from 70% to 85% for PIPE.
HSI Component Annual Report: October 1, 2014–September 30, 2015 17
Some reasons for low performance were lack of heated tables and resuscitation equipment at the Médina Yoro Foulah and Vélingara health centers; and unavailability of Syntocinon, vitamin K, umbilical cord clamps, and antiseptic colllyrium, at some sites.
Also, the component supported supervision in the maternity wards of 10 SDPs (including 2 private SDPs) in Guédiawaye district on AMTSL, the partograph, and newborn care. The supervision’s main recommendations are the implementation of the latest version of the partograph in SDPs, staff training on how to use it, capacity building for providers in Helping Babies Breathe (HBB), and equipment for newborn corners.
4. Strengthening the management of child health and nutrition
The component mainly supported the Division of Food and Nutrition (DAN) and the Division of Child Survival to implement their annual work plan.
Support to extend routine vitamin A supplementation for children in 14 TutoratPlus districts in partnership with HKI and the DSR/SE: Orientation workshops for ECRs/ECDs and micro-planning for routine vitamin A supplementation were carried out in the three regions of Diourbel, Ziguinchor, and Sédhiou. Next, two meetings were held with the DSR/SE to finalize micro-plans for Sédhiou and Ziguinchor.
Support for provider training on nutrition applied to the life cycle and essential nutrition and hygiene actions, focused on negotiation techniques for behavior change: The component continued its efforts in strengthening providers’ skills to better manage nutrition for women and children. During the year, the component supported the regions of Kédougou, Ziguinchor, Thiès, Saint Louis, Louga, Fatick, Dakar, and Diourbel to provide orientation sessions for ECRs/ECDs and provider training. Overall, skills were strengthened for 286 health workers (107 men and 179 women), including providers from 10 private SDPs.
Support for training for ECRs/ECDs and providers on the revised MAM: Efforts to control malnutrition are integral to the component’s priority activities. To address this, the component began coordination and technical support activities to provide guidance to 16 ECR/ECD members, including 10 men, from Saint Louis region. It also supported training for providers from the districts of Podor, Saint Louis, and Guédiawaye on WHO guidelines on child growth assessment and the management of moderate and severe acute malnutrition and acute malnutrition with or without complications. Therefore, skills were strengthened for 187 health workers (80 men and 107 women), including providers from 4 private SDPs.
Training on using the WHO Anthro software (version 3.2.2) to screen and monitor children’s growth: Training targeted ECR and ECD members and tutors from Kaolack region as well as DSR/SE staff and managers of nutrition surveillance sentinel sites. The sessions trained 21 staff (including 8 women).
Alongside the training, the component set up a desktop computer in 50 resuscitation and nutrition education units (URENs), nutrition recovery and education centers (CRENs), and
HSI Component Annual Report: October 1, 2014–September 30, 2015 18
nutrition surveillance sentinel sites where providers have been trained on using the WHO Anthro software.
Support for the DAN/DSR/SE to implement sentinel sites: The Division of Food and Nutrition received technical support from the component to organize a national orientation workshop for ECRs/ECDs on sentinel surveillance of nutritional problems.
Post-training follow-up and supervision of providers on the essential package of nutrition applied to the life cycle, case management of diarrhea with ORS/zinc, the WHO Anthro software, and MAM: Post-training follow-up and supervision activities for providers were carried out in the regions of Ziguinchor, Diourbel, Thiès, Dakar, Kaolack, and Louga. Thus:
220 providers, including 150 women, received post-training follow-up or supervision on nutrition applied to the life cycle, including those from a private SDP 81 providers, including 45 women, on integrated management of childhood illnesses 58 providers on MAM, including 37 women Overall, 359 providers from 64 SDPs received post-training follow-up. The supervision visits helped correct providers’ practices.
Development of job aids for management of severe acute malnutrition without complications: Based on the new protocol, children with grade-1 and -2 bilateral edema (+, ++) with no other complications should be treated at a UREN and not at a CREN. To facilitate the application of this directive, HKI developed a new poster on the management of severe acute malnutrition without complications in URENs. Some 2500 posters were produced and delivered to the medical regions for distribution to SDPs.
5. Malaria control
In Year 4, the component supported the National Malaria Control Program with capacity building for providers; implementation of the IPT2 improvement approach; logistics supervision of essential commodities for malaria control integrated into maternal health and child survival; review, validation, and printing of the flowchart; and completion and printing of training tools for malaria.
Training/Refresher training on malaria prevention and treatment: Training targeted providers from the Louga, Kolda, Sédhiou, and Kaolack regions. This helped strengthen the capacities of 309 providers, including 179 women, out of the 309 target, or an achievement rate of 100%. Training covered 110 SDPs, including 26 private SDPs. Providers were trained in malaria case management according to MSAS standards and protocols that include the new WHO recommendations for intermittent preventive therapy (IPT), seasonal malaria chemoprevention, and chemoprophylaxis for travelers.
Implementation of approaches to improve IPT2 adherence: In Year 4 following implementation in the pilot districts of Touba and Mbao, the approach has been applied in
HSI Component Annual Report: October 1, 2014–September 30, 2015 19
the nine districts of Thiès region and six districts in the Dakar suburbs enrolled in Year 3. In this context, the component supported two districts with the organization of three social mobilizations in the Dakar region. The mobilizations enabled the community to grasp the importance of following the ANC schedule so women can receive timely antimalarial prophylaxis during pregnancy.
In the Thiès region, the component supported six districts to conduct their situational analyses that identified shortcomings in the implementation of the IPT strategy and to fulfill gaps through the development and implementation of an action plan.
Revision, validation, and printing of the flowchart for malaria case management: The component supported the PNLP in the revision and development of the flowchart on the management of uncomplicated malaria. It provided 3000 flowcharts that were distributed to 76 districts and private and semi-public facilities by the National Malaria Control Program (PNLP).
Support for the PNLP to finalize and reproduce training tools on malaria (trainer manual and participant notebook): This activity targeted participants at the central level, drawing from staff at PNLP responsible for malaria prevention and treatment. Participants finalized a strategic document for malaria case management according to the new guidelines. The document included the new WHO recommendations for IPT, seasonal malaria chemoprevention, and chemoprophylaxis for travelers.
End-Use Verification of antimalarial inputs: For Years 2 and 3, this supervision activity consisted of assessing practices in antimalarial inputs management in the health district warehouses in the country’s west, central and eastern areas. In Year 4, upon request of USAID, the component combined the management of life-saving commodities for mothers and children with this supervision through support for the DSR/SE. The tools developed for this purpose were used in a pilot phase, implemented in the Thiès region in the Joal Fadiouth health district.
After the pilot phase of the integrated PNLP/DSR/SE supervision, a Task Force for collaboration and coordination was implemented within the Ministry of Health and Social Action. It is responsible for developing and supervising the national scale-up of the integration strategy for DSR/SE/PNLP logistics supervision.
6. HIV and tuberculosis control
In Year 4, the component supported districts in the Kédougou region in the implementation and national monitoring of plans for elimination of mother-to-child transmission (eMTCT).
Implementation and monitoring of the eMTCT plan: The ECRs/ECDs trained 22 providers (including 17 women) all from the public sector in medical and psycho-social care for adults and adolescents living with HIV, with a component focusing on prevention of mother-to- child transmission (PMTCT): screening and early treatment.
HSI Component Annual Report: October 1, 2014–September 30, 2015 20
National monitoring of the implementation of eMTCT plans in Kédougou districts: In order to monitor the eMTCT plans, two assessments were conducted as scheduled, or a 100% achievement rate for the three districts. These assessments focused on data from 2013 and 2014 and the first quarter of 2015, used to take stock of activity implementation and by the districts to improve PMTCT indicators.
7. Improved vaccination services
The component continued to support training for health workers on the new EPI guide, the implementation of the RED approach, and the introduction of new vaccines.
Training health workers on the new EPI guide: Training targeted 152 providers (including 69 women) out of the target of 77, or an achievement rate of 197%. The objective was greatly exceeded due to the districts’ high demand to strengthen new health workers’ capacities. Training covered 97 SDPs, including 12 private SDPs, in the medical regions of Diourbel, Fatick, and Tambacounda. It upgraded the management of vaccines, the cold chain, injection safety, waste management, integrated disease surveillance, and the response to epidemics, including the management of new vaccines.
Implementing the RED approach in districts: The component continued its support for districts in the Thiès and Dakar regions to implement EPI stimulus plans with the following activities:
Catch-up days were organized alongside social mobilization activities: This activity consists of implementing mobile strategies in neighborhoods to catch children out of compliance with the vaccination schedule with the help of community relais, Bajenu Gox, and neighborhood representatives. They succeeded in vaccinating 13,629 children in the districts of West Dakar, Rufisque, Central Dakar, Guédiawaye, Mbour, Popenguine, Thiès, and Méckhé.
Also, two supportive supervisions were carried out on the management of vaccines and epidemiological surveillance.
Support for the introduction of new vaccines: The component supported holding a preparatory workshop for technical, logistics, communications, and surveillance commissions as part of introducing the injectable polio vaccine. During the meeting, the management tools were finalized and an outline was developed for micro-planning to implement activities at the district level.
8. Institutional support for partners
District grants: As part of the Health Services Improvement (HSI) component, IntraHealth awards sub-grants each year to health districts enrolled in TutoratPlus based on a direct financing model. The sub-grants are used to support improvements in each HSI sub- component, based on pre-established action plans drawn up during the situational analysis. The districts signed a fixed-cost contract with the component enabling them to achieve deliverables such as the purchase of equipment for SDPs, quarter and mid-term reviews of
HSI Component Annual Report: October 1, 2014–September 30, 2015 21
TutoratPlus implementation, meetings for the hand-over from tutors to districts, training for health committees, etc.
Before awarding the sub-grants to the 21 third-generation districts, the component assessed the management capacities of these districts.
The medical teams for the 21 third-generation districts received guidance on the management procedures for the sub-grants.
The component signed sub-contracts with 59 districts, namely: 13 first-generation, 25 second-generation, and 21 third-generation districts. 59 sub-recipient districts signed memoranda of understanding with 158 private health facilities. 9 districts organized the first quarterly review of TutoratPlus implementation, while 12 districts organized the mid-year review. 6 districts held meetings with all actors for the hand-over phase from tutors to ECDs. 7 districts trained 63 health committees on their roles and responsibilities. 20 districts acquired equipment that was delivered to these facilities, totaling an estimated 46,931,404 FCFA.
In addition, the component supported the development of accounting documents and training for 38 managers from the medical regions and the districts of Kédougou, Matam, Saint Louis, and Tambacounda in financial management and materials accounting.
After the training, visits were made to the districts and medical regions of Saint Louis, Matam, Kédougou, and Tambacounda to monitor the use of the tools provided to these managers and to help them overcome any problems in applying the new knowledge learned during training.
The component, in partnership with the MSAS Division of Public-Private Partnership, conducted a mission to evaluate the implementation of the sub-grants awarded to the second-generation TutoratPlus districts. The mission aimed to assess the achievement of deliverables for the 24 second-generation districts enrolled in TutoratPlus.
The assessment made it possible collect the opinions of ECD members, SDP managers, and health committees on the implementation and impact of the sub-grant. Moreover, the assessment determined how effective the partnership between the districts and private health facilities is and how much these facilities are included in TutoratPlus implementation.
The assessment showed that equipment acquired through the sub-grant was available at health centers and health posts. However, most of the actors believe that the funding is insufficient given the districts’ considerable needs. According to the chief medical officers who were interviewed, the sub-grant has had a significant impact on improving the quality of services and working conditions.
HSI Component Annual Report: October 1, 2014–September 30, 2015 22
Contribution to direct financing for the regions: As part of the joint direct financing mechanism between agencies, the component continued its support in six medical regions: Thiès, Kolda, Kaolack, Diourbel, Sédhiou, and Ziguinchor for a total of 72,506,659 FCFA.
Institutional support: The National Program for Quality and the Office of Violence and Trauma Prevention within the Directorate General of Health Services (DGS) received support in IT equipment (two computers). This support is filling equipment gaps for these two services.
HSI Component Annual Report: October 1, 2014–September 30, 2015 23
Sub-component 2: Improved quality of health services in health posts, health centers, and regional hospitals Analysis of progress
Expected results for Year 4 Results achieved
Essential supplies and equipment are always 30 health districts received support in available for IPQS delivery in the SDPs of all equipment for their SDPs through district districts enrolled in TutoratPlus grants and contributions from partners
Key commodities (such as antimalarials and The TutoratPlus evaluation conducted last contraceptives) are available for use in an quarter showed that none of the SDPs in the integrated program sample had a stockout of contraceptives for the three months prior to the survey The referral system between the health posts/health centers/hospitals is operational The decentralization of National Emergency in the regions of Kaolack, Diourbel, Kaffrine, Medical Service (SAMU) certainly helped and Fatick support 117 local governments to have an Health committees and clients provide emergency transportation systems for feedback on services quality and are actively pregnant women. However, following the low engaged in improving the quality of services performance of the decentralized SAMU unit, the activity was stopped to properly evaluate Awareness-raising activities are regularly it and identify bottlenecks. implemented by the SDPs that have a health promotion plan 248 Quality Improvement Partnership (PAQ) teams and committees were implemented in 23 districts. This contributed greatly to IPQS implementation, namely in staff hiring and purchasing ambulances and equipment for SDPs.
Description of achievements 1. Support for equipment and supplies for SDPs
This quarter, the component supported 30 TutoratPlus districts to obtain supplies and equipment through sub-grants. The supplies were purchased based on needs identified during the situational analysis and will help improve the quality of services at the SDP level.
Also, the component supported setting up 50 computers at the URENs, CRENs, and nutrition surveillance sentinel sites, where health workers were trained to use the software to screen and monitor growth.
Also, 86 Jadelle insertion/removal kits and 169 IUD insertion/removal kits were delivered to SDPs in the IPQS regions. As part of the implementation of the PP/IUD, equipment
HSI Component Annual Report: October 1, 2014–September 30, 2015 24
comprising 90 Sims speculums, 30 Kelly forceps, 60 clamps, and 30 cupules were purchased and delivered to the SDP in Touba district.
2. Securing products for contraception, reproductive health, child survival, and malaria
During Year 4, the component continued to support the MSAS to secure products for contraception, reproductive health, child survival, and malaria control through: (i) support for the DSR/SE for contraceptive needs planning, (ii) capacity building in stock management for ICPs and distributors from the Koki district, and (iii) support for districts for logistics supervision of SDPs.
Support for the DSR/SE for contraceptive needs planning: The component supported two mid-year reviews of the preparation of Contraceptive Procurement Tables, with funding from USAID, UNFPA, and the State. The reviews allowed three programs (DSR/SE, Division of AIDS/STI Control, and ADEMAS) to compare ordering and distribution forecasts made in 2014 to deliveries from partners (USAID, UNFPA) and to PRA distributions before beginning procurement planning for 2015, 2016, and 2017. All orders scheduled in 2014 for these three programs were honored at a 96% rate (23/24). For the DSR/SE, annual achievements for 2014 pushed us to decrease orders for 2015 (11), 2016 (13), and 2017 (11).
Training in drug stock management for ICPs and distributors from Koki district: The component continued training in drug stock management for ICPs and distributors from Koki district. Overall, 11 ICPs (6 women and 5 men) and 13 distributors (6 women and 7 men) received training that sought to fill gaps noted in the situational analysis. On the post-test, 82% of ICPs (9/11) and 77% of distributors (10/13) achieved an APL greater than or equal to 80% on the post-test.
Logistics supervision of SDPs: The supportive supervision enabled 223 SDPs to be visited, for an annual target of 200 SDPs, and involved SDPs in the districts of Bambey, Touba, Mbacké, Kaffrine, Birkelane, Koungheul, Malem Hodar, Kaolack, Guinguineo, Fatick, and Kédougou. The supervision found: (i) good availability of tracer medicines in all SDPs (83% availability), (ii) shortcomings in drug management, and (iii) shortcomings in running logistics supervision by ECDs. The supervision made it possible to correct for the noted shortcomings.
3. Strengthening the referral and counter-referral system
Activities implemented this year mainly involved support—first for the SAMU to train health staff in the regions and to restart the SAMU in Thiès, and, secondly, for a Peace Corps volunteer who is overseeing a project to improve emergency management in the same region.
Training for providers on urgent care: In Year 4, the SAMU continued training for health staff on urgent care in the regions of Kaolack, Kaffrine, Kédougou, Tambacounda, Fatick, and Diourbel.
HSI Component Annual Report: October 1, 2014–September 30, 2015 25
Overall, 213 providers (113 men and 100 women) working in urgent care (doctors, pharmacists, midwives, and ICPs) were trained. This brings the number of providers trained as part of the partnership with the SAMU to 407 (222 men and 185 women). Following each training session, several recommendations were made to improve referral/counter-referral in the region. These include, among others:
Take stock of the situation for medicines and supplies needed for urgent care in all service delivery points Provide SDPs with ventilation equipment Provide post-training follow-up by ECRs/ECDs Draw up a procurement plan for commodities and supplies needed to manage emergencies Provide all SDPs with emergency kits Get the newborn corners up and running
Specialists’ tours in the regions: Following each sessions of the urgent care training, the SAMU, with component support, conducted a specialists’ tour at some SDPs in the regions of Kaolack, Kaffrine, Kédougou, Tambacounda, Fatick, and Diourbel. They visited the emergency unit, operating room, maternity ward, pediatrics unit, surgery unit, and radiology unit. The specialists recommended first setting up newborn corners inside the operating room; then, ensuring, to the extent possible, that a pediatrician is present during cesarean sections; and lastly providing emergency kits to pediatrics and the emergency unit.
Decentralization of SAMU in Thiès: The component supported the SAMU to implement a pilot project to decentralize referrals/counter-referrals between districts and health posts in Thiès. Decentralization aims to improve early care for obstetric and pediatric emergencies during mobile team visits into the field.
However, after finding low use of services (38 mobile team visits from May to December 2014) and no involvement of other partners (local governments, medical regions, districts, and other technical and financial partners (TPFs)), the SAMU decided to stop the pilot project in order to analyze problems and find corrective measures so that activities could resume on a solid foundation.
Since SAMU activities were stopped in Thiès, the component and the SAMU Directorate initiated meetings with the Chief Regional Medical Officer (MCR) of Thiès and the Directorate of General Administration and Equipment of the MSAS to identify the ways and means to restart SAMU activities in Thiès. These meetings made it possible to take stock of the problems facing the SAMU in Thiès, which are twofold: the lack of communication and lack of resources to permanently run this service.
HSI Component Annual Report: October 1, 2014–September 30, 2015 26
Therefore, in order to overcome communications challenges, a workshop brought together health educators from nine health districts (HDs), the Thiès ECR, and the SAMU to identify the different opportunities that will address communications.
For challenges related to resources, the component is currently supporting the SAMU and Thiès medical region to prepare a workshop for the various stakeholders involved in the SAMU in Thiès (MSAS cabinet, the DGS, administrative and local officials from the Thiès region, the MCR and MCD, TFPs, and community-based organizations).
Providing post-training follow-up for trained providers: The SAMU conducted post- training follow-up for providers in the Thiès region. Supervisors were from the SAMU team and the Thiès medical region. They visited the ECR; the health districts of Thiès, Tivaouane, and Mbour, visiting health centers and four health posts; public health facilities (PHFs); and the PRA. Monitoring assessed: progress on decentralized training of ICPs at the district level; provision of emergency kits in each SDP; providers’ capacities in urgent care; and emergency commodities availability in the PRA. The following was reported:
Among the strengths: the implementation of a telephone communications network through direct financing to connect those involved in urgent care with each other; good execution of first actions in urgent care; and existing treatment protocols
Among the areas for improvement: no emergency kits in the districts and health posts through a default dedicated budget line; and no orders for some commodities that remained in storage until expiration because staff were unaware of their availability.
Support for the Peace Corps volunteer in Kédougou region: The component provided support for the Peace Corps volunteer who is overseeing a project to improve emergency management in Kédougou region. After developing an urgent care manual that covers recognizing emergencies (especially for women of reproductive age and newborns), how to manage them, and the transportation protocol at the local level, a mission toured nine villages in the Dakatély area to explain the project to communities and to identify volunteers (one man and one woman) selected for each village. The mission comprised the supervisor of primary health care from the medical region, the ICP of Dakatély, the department secretary from the Salémata Red Cross, the Peace Corps volunteer, and the IntraHealth RPM. The mission identified 18 people to train.
After this step, in partnership with the medical region, the Salémata health district, the Red Cross, and the Peace Corps volunteer organized training for 18 emergency volunteers (9 men and 9 women) from the nine villages of Dakatély on the first actions to take in urgent care and on organizing referrals.
HSI Component Annual Report: October 1, 2014–September 30, 2015 27
Photo4: Meetings with communities
Emergency cases especially include pregnant women, mothers, newborns, and trauma. The training methods used during the session are presentations, brainstorming, role plays, films, and hands-on exercises.
Information about the training is also available at the Peace Corps Senegal website at this link: http://peacecorpssenegal.org/2015/06/16/kedougou-health-pcv-uses-his-experience- to-improve-emergency-response-in-rural-villages/
4. Implementation of integrated advanced strategies
This involved having the ICP/State registered midwife (SFE) or a qualified staff member appointed by the health district provide a minimum package of services in health huts in the intervention area covered by the Community Health component. Advanced strategies were held every two months by the health post or health center and were combined with supervision of health huts with the participation of the health hut’s midwife. Some 4739 advanced strategies were conducted by ICPs in health huts. These activities enabled supervision of 3582 health huts and, at the same time, delivery of a broad range of services. Thus:
193,703 children were vaccinated
11,811 long-lasting insecticide-treated bednets were distributed routinely to pregnant women and children
36,716 prenatal consultations were conducted
The table in Annex 5 presents more information on the services delivered through these advanced strategies.
5. Quality improvement partnership for SDP services, including client flow
Implementation of the Quality Improvement Partnerships (PAQ) approach saw several achievements, including continuation of the PAQ tutor visits to SDPs in Year 2; training for tutors and district focal points for Year 3 and the start of tutor visits for Year 3; monitoring of action plans; joint supervision; and the annual assessment workshop.
PAQ implementation in SDPs in partnership with Réseau Siggil Jigéen: Throughout Year 4, the component supported Réseau Siggil Jigéen (RSJ) in the following activities: (i) continuation of PAQ implementation in SDPs; (ii) supervision of activities at the district level; and (iii) monitoring of PAQ implementation.
Réseau Siggil Jigéen set up 248 PAQ teams and committees through PAQ tutors in 23 TutoratPlus districts. The number of enrolled SDPs is 767. Each SDP had to set up a PAQ team and a committee and then develop an action plan. An enrollment percentage of 63.3% was achieved at the end of Year 4 of implementation.
HSI Component Annual Report: October 1, 2014–September 30, 2015 28
Table 2: Summary table of SDP enrollment in PAQs
Description Contract goal Achievements Achievement rate
Number of first-generation SDPs 339 254 74.9
Number of second-generation SDPs 543 265 48.8
Number of third-generation SDPs 329 248 75.3
Total 1211 767 63.3
Monitoring of the action plans revealed the SDPs’ various achievements, including: hiring of qualified staff in the SDPs of Inor in Bounkiling district and Guinaw Rail and Ndiakhou in Khombole district; allocation of an ambulance in the Gossas district; and construction of housing for the midwife at the Thor SDP in the Pout district. Added to these achievements are equipment and human investments on both sides.
The component and the RSJ conducted five supervision missions, including three joint missions, in the districts of Mbour, Joal, Pete, Richard Toll, Vélingara, Médina Yoro Foulah, Diouloulou, Gossas, Mekhé, Khombole, Pout, and Tivaoune. These missions resulted in completion of the visits to Diouloulou, continuation of activities in Pete and Richard Toll, and an assessment of activity implementation in each district.
Also, after three years of implementation, suggestions from stakeholders involved in the PAQ have helped adapt the guidebook to real situations in Senegal. The adaptation process allowed for a review of actors’ roles and responsibilities as well as compliance with the organization of the health pyramid and changes made to territorial administration.
The RSJ focal points produced 80 radio shows and facilitated 45 discussions in 9 coverage regions: Thiès, Kaolack, Dakar, Ziguinchor, Kaffrine, Fatick, Sédhiou, Diourbel, and Saint Louis on the topics of family planning and promotion of the PAQ. The radio shows are part of the efforts to advocate for the PAQ as well as opening prospects for the approach’s sustainability.
The assessment workshop for partners to improve the quality of services was attended by the focal points from Réseau Siggil Jigéen (10 out of 11 regions), the IntraHealth team in charge of monitoring the RSJ project, members of the board of directors, and the RSJ executive team. They were able to determine the annual status of implementation in the regions and discuss the project’s closure activities.
Support for the National Quality Program: During Year 4, the component supported the National Quality Program to develop and distribute activity planning tools for the medical regions and HDs. The tools are for annual planning of critical events and activities at the central level of the MSAS and monthly planning for activities for staff members of the ECRs and ECDs.
HSI Component Annual Report: October 1, 2014–September 30, 2015 29
These tools provide the regions and districts with the schedules of activities for the various directorates and programs so that they may better manage their workflow with monthly and weekly planners charting activities. (See examples of tools in Annex 6.)
However, the challenge is, on the one hand, to obtain more precise periods and dates from programs and directorates, and, on the other hand, to access the National Quality Program availability for the orientation and provision of the tools.
6. Communication and promotion of health services
Key achievements are the production of job aids for providers, religious leaders’ involvement in promoting the IPQS, and support for the MSAS’ and partners’ major events.
Production and diffusion of job aids: The HSI component continues to support the Ministry of Health and Social Action in the development, reproduction, and dissemination of job aids. These tools and job aids facilitate day-to-day work tasks for health providers.
The printing of 1500 copies of each of these posters is underway: Treatment of uncomplicated malaria, treatment of uncomplicated malaria during pregnancy, IPT to prevent malaria during pregnancy, and rubbing hands with hydro-alcoholic solution. The quantities for reproductions correspond to those planned for the year.
Posters on malaria are updated versions that comply with the new guidelines for malaria case management. They should help providers to improve malaria prevention and treatment with the protocols in easy view.
In the context of Ebola virus disease, health providers are a highly exposed target. To support providers in developing the reflex to wash their hands in compliance with standards, 1500 copies of the booklet on infection prevention and environmental protection, 500 copies of the trainers guide, 2000 copies of the provider notebooks were reproduced and distributed. They include technical aspects of the prevention of health care associated infections and take into account providers’ concerns about compliance with best practices in hygiene. These tools help strengthen providers’ skills in infection prevention and environmental protection and should break the chain of disease transmission in SDPs.
The Information Booklet on Family Health for Men in Companies is available, with 5000 copies being distributed. This booklet addresses these topics: family planning, pregnancy, delivery, child health, malaria, and seeking health care services. It aims to ensure men are better informed about the well-being of their families.
The approved job aids are currently being distributed. This activity was well received by the various beneficiaries who find that these tools help overcome the lack of job aids on FP and infection prevention. The new malaria posters help providers to incorporate the new guidelines in the prevention and treatment of this disease. See the table below for the distribution of communications materials by region.
HSI Component Annual Report: October 1, 2014–September 30, 2015 30
Table 3: Distribution of job aids in regions
Uncomplicated IPT Hand Malaria PIPE Stock FP malaria washing among booklet management poster with pregnant guide HAS women Diourbel 100 100 100 100 100 Dakar 242 242 242 242 156 80 242 Kaffrine 75 75 75 75 80 75 Louga 140 140 140 140 140 Thiès 58 58 58 58 58 Kaolack 120 120 120 120 204 97 120 Kédougou 35 35 35 35 35 35 Tambacounda 85 85 85 85 85 Fatick 99 99 99 99 99 30 99
World Malaria Day: For the celebration of World Malaria Day, 2000 adult t-shirts, 400 adult polo shirts, and 1000 children’s t-shirts were produced and delivered to the National Malaria Control Program. The slogan “Investir dans l’avenir : vaincre le paludisme (Invest in the Future: Conquer Malaria)” was kept as the theme and was printed on all the materials. The t-shirts were primarily distributed to students in the 14 regions of Senegal.
IPQS promotion by religious leaders: The approach to involve religious leaders in promoting the use of the IPQS package has entered its active stage. The 14 sermons that were proposed with facilitation from the Imam Ratib from Kaolack were amended and validated during a workshop attended by imams and Arabic professors. The 14 sermons were then translated into French. Training sessions for religious leaders on using these sermons began in September, attended by 51 religious leaders from Ziguinchor who received an orientation on the various areas of the IPQS through sermons. Trained individuals were called upon to promote the IPQS in their communities. The annual goal is to provide orientation for 90 religious leaders. Several constraints became apparent in the implementation process of the approach. Developing the sermons in Arabic took longer than expected due to the considerable amount of research needed, which led to canceling training activities scheduled in Kolda. (See an example of a sermon in Annex 7.)
Imam Amath Kebe, an Arabic teacher at Keur Madiabel high school in Nioro, said: “I believe that the proposed documents are the fruits of very serious research. The content is relevant and drawn from a good source for Muslims, namely Koranic verses and the Hadiths of the Prophet (PBUH).... I’m convinced that if we use these sermons in our communities, we can convince people to take better care of their own health and to turn to health facilities whenever the need arises.”
HSI Component Annual Report: October 1, 2014–September 30, 2015 31
Table 4: Themes and topics in the sermons
Themes Topics addressed
Family planning Birth spacing
Protection during pregnancy and delivery Maternal and newborn health Malaria control Exclusive breastfeeding Seeking health care Preventing violence Gender Male-Female relationships Genital mutilations Child nutrition Child survival Child health care Newborn health Immunization Management of puberty Hand washing Hygiene
Support for SDP health promotion plans: Plans for SDPs to promote health drawn from supervisions conducted by package-6 tutors are being implemented. Financial support was granted to implement activities such as refresher training for community-based staff at SDPs on communications techniques and holding discussions on the IPQS. Sub-component 3: Improved human resources management in public sector health facilities Analysis of progress
Expected results for Year 4 Results achieved
Managers and providers in health posts 76% of SDPs in 61 TutoratPlus districts and health centers routinely use quality have implemented job descriptions for assurance measures to monitor and their staff. improve their own performance in the 18 health districts have assessed the SDPs of 42 TutoratPlus districts. performance of their various SDPs and The performance of clinical staff is have publically recognized SDPs with routinely evaluated with appropriate exceptional performance. rewards or consequences for exceptional iHRIS software has been introduced in 14 or unsatisfactory performance in 42 regions to map human resources. TutoratPlus districts. 12,672 health workers have been listed in Human resources requirements to cover the iHRIS with all information on their the program’s various components are training, career path, marital status,
HSI Component Annual Report: October 1, 2014–September 30, 2015 32
routinely reviewed, and advocacy position held, and where they are posted. activities are undertaken for appropriate 20 midwives and state registered nurses changes in all the regions. have been contracted to support the Mobile phones are used to send health MSAS in the regions of Kolda and data in all regions. Ziguinchor.
972 SDPs in 66 health districts have sent 70 indicators via telephone using the SEDA mobile application.
Description of achievements 1. Strengthening ECR and ECD capacities in human resources management
Development of a regional training plan: In Year 4, the component continued to support the Training Division of the MSAS to develop regional training plans in the regions of Dakar and Kédougou. The MSAS Training Division now has 14 regional training plans.
The MSAS strategy for developing training plans relied on several financial and technical partners who provided support, depending on their intervention area. Therefore, rather than the initially planned 14 regions, the HSI component will support the southern regions (Kolda, Ziguinchor, and Sédhiou), the eastern regions (Tambacounda and Kédougou), and Dakar region.
The training plans take into account critical training needs of the various centers of responsibility for each region, based on the architecture of the National Health Development Plan.
Training for ECDs on improving performance: The component also supported the DRH Training Division under the MSAS to provide orientation on the performance improvement guide for 26 members (13 men and 13 women) of the ECRs, ECDs, and PHFs from Saint Louis region. Training modules dealt with the introduction of performance management, health governance, management, leadership, human resources management, financial resources management, service quality, and monitoring-evaluation.
After the modules were implemented, the orientation workshop continued critical analysis of how objectives have been structured and of the manual’s content, target, and teaching strategy to strengthen health facility managers’ skills in managing performance. Following the training, recommendations were made to correct insufficiencies in the guide and to incorporate practical tools identified by actors in the field before submitting it to an editorial review committee comprised of MSAS directors, MCRs, and MCDs. The Training Division worked on it and submitted the final version for validation. For Year 4, training sessions will be continued in the other regions.
HSI Component Annual Report: October 1, 2014–September 30, 2015 33
2. Support granted to districts to implement a performance improvement system targeting SDPs and providers
Implementation of job descriptions in SDPs: Since this intervention is pegged to TutoratPlus, a booklet on organizing services, including human resources management, was introduced in the training tools. Hence, trained tutors could use this session to help SDP managers implement job descriptions.
Tutors for the “management and organization of services” package continued to implement job descriptions in 73 SDPs (69 public and 4 private SDPs) in 10 regions. This brings the number of SDPs with job descriptions to 987, for both civil servants and community-based employees. Thus, 76% of SDPs enrolled in TutoratPlus have implemented job descriptions for their staff.
Establishment of performance evaluation and recognition systems: The component continued to support health districts to implement a performance evaluation and reward system. Thus, 18 health districts could evaluate the performance of their various SDPs by using a performance evaluation rubric to resolve gaps identified when TutoratPlus was launched. This rubric was used during a rapid SA to assess progress in closing gaps and the availability of previously non-existent services. They also use on-site supervision reports to Photo 5: Awarding the Ngoye private Catholic assess skills acquisition for providing new clinic in Diourbel district services or improving their quality.
After data from the rapid situational analysis were synthesized and analyzed, the six health districts identified the highest performing SDPs in their intervention areas.
These SDPs were recognized during public ceremonies that brought together all SDP managers, providers, administrative and local officials, and health committee members.
For example, data were collected in 23 SDPs (19 public and 2 private) in Diourbel health district to determine to what progress has been made in overcoming gaps and which ones remain. After tabulating results for the collected data, the joint supervision mission identified which SDPs had achieved the highest performance levels. The SDPs of Ngohe (a private Catholic clinic) and Keur Serigne Mbaye Sarr were selected as facilities with the highest number of points.
These two health posts were honored during an official ceremony, attended by the department prefect, the MCR, 8 mayors, 3 ECD members (including the MCD), 23 qualified providers (including 20 ICPs) and 3 partners (Catholic Relief Services, ChildFund, and IntraHealth).
HSI Component Annual Report: October 1, 2014–September 30, 2015 34
3. Support for increased number of staff in SDPs
The main activities achieved this year were the completion of the process to introduce iHRIS software in the 14 regions, continuing to cover the salaries of 20 contracted health workers, and supervision of these staff.
Mapping of health care staff: The component continued to support the DRH of the MSAS to extend the introduction of iHRIS software in the regions of Diourbel, Saint Louis, Matam, Louga, Thiès, and Dakar. Thus, the iHRIS software has now been introduced in 14 regions, including the two pilot regions (Kaolack and Kolda). The approach for extension held the ECRs and ECDs accountable for data collection and entry, under DRH coordination and supervision. The database now lists 12,672 health workers with all information on their training, career path, marital status, position held, and where they are posted.
Support for supervision of the use of iHRIS software: During Year 4, the component supported the DRH to conduct supervision of iHRIS use in the regions of Kolda and Ziguinchor. This mission first assessed the use of iHRIS in six visited facilities in two regions and then strengthened the capacities of MCRs and regional focal points to use the database.
The supervision found good availability of the IT tool in the districts and medical regions and a commitment to using the software among ECRs. However, it was noted that: (i) the MCRs and MCDs have not mastered using the tool, despite attending an orientation on it, (ii) the focal points from the two regions did not update personnel data, (iii) monitoring by the central, regional, and district level was not effective for use of the database, and (iv) few people at the central, regional, and district level are informed about the existence of a tool within the DRH.
Recommendations from the supervision were:
Strengthen the capacities of MCRs and MCDs and the regional focal point, which was done during the mission
Update human resources personnel data for all focal points in the two regions
Strengthen monitoring of database use by the central, regional, and district level
Strengthen communications about the tool between the DRH and the medical regions
Use the software for management purposes
Support for trained staff: In Year 4, the component continued to support the DRH to cover 20 health providers’ salaries (16 SFEs and 4 registered nurses) in partnership with the medical regions of Kolda and Ziguinchor.
These 20 health providers are well integrated in the various health posts and health districts. They receive capacity building through conventional training (focused ANC, ENC, FP, nutrition applied to the life cycle, Information System for Management (ISM), etc.), on-site supervisions for the various TutoratPlus services packages, and technical supervision at the district and regional level and for programs. (See the section on supervision of contracted qualified staff.)
HSI Component Annual Report: October 1, 2014–September 30, 2015 35
Joint supervision of contracted qualified health staff, with the DRH and Kolda and Ziguinchor medical regions: The component supported joint supervision of the contracted qualified health staff, implemented by the DRH and Kolda and Ziguinchor medical regions. The goal of this mission was to conduct an administrative and technical evaluation of the 20 contracted qualified health staff.
During this mission, two evaluation grids (administrative and technical, including key indicators for maternal and newborn health and disease management) were administered by staff and MCDs. Also, providers, ECD and ECR members, and health committee members were interviewed to assess how well these professionals have been integrated into the system, their contribution to their communities’ health, and their barriers.
The supervision found that five health posts are operational due to the contracted staff (in the Diagnon and Dianky HPs in the Ziguinchor region and the Saré Kémo, Kabendou, and Nianing HPs in the Kolda region).
Also, these health providers are well integrated in the various health posts and health districts and have improved performance in their health posts.
These assessments showed a rise in indicators in SDPs where staff was contracted by the component. For example, indicators for RH, FP, child survival, and malaria control in the Dinguiraye HP have improved. A total population of 15,550 people (including 3570 women of reproductive age and 3018 children age 0–5 years) may use its services. This was corroborated by Mr. Ngom, the Treasurer of the Dinguiraye HP (Médina Yoro Foulah HD), who stated: “Before the arrival of the contracted State registered midwife, women in the village of Dinguiraye and the surrounding villages left for The Gambia (15 kilometers away) to get RH services and to vaccinate their children. Today, they don’t go to The Gambia anymore and use the services at the Dinguiraye health post. Even better, the woman from the bordering Gambian villages come to the health post for the midwife’s services.”
The supervision showed the following strengths:
Improvements for RH/CS/FP and malaria indicators in 18 out of 20 SDPs with independent contractors (except Sinthian Koundara and Kabiline where conflicts arose that were resolved through mediation with supervisors).
Good integration of independent contractors within the health posts and communities
IPQS is delivered in all SDPs with independent contractors
All independent contractors received supervision, training, and on-site supervisions
People in the SDPs with independent contractors satisfied
Areas for improvement are:
Inadequate work supplies (especially in health posts in Dinguiraye and Niaming)
HSI Component Annual Report: October 1, 2014–September 30, 2015 36
Existence of maternity wards that are not enclosed (in the health posts of Guiré Yéro Bocar, Kabendou, Niaming, Dinguiraye, Médina Chérif, Mlomp, and Diatock)
Lack of electricity and running water in maternity wards in the health posts of Médina Chérif, Niaming, and Dinguiraye
Lack of staff housing for all ICPs and SFEs, who are currently housed in the community
Recommendations from the supervision call for advocacy among all parties (health district, health committees, and local governments) to improve working conditions for these contracted staff (staff housing, equipment in SDPs, and infrastructure).
4. Use of technology to monitor training and performance
Using ITC has become vital to overcoming the challenges in having quality information for greater visibility and informed decisions. The health sector has been faced with high demands. Therefore, innovative technology-based initiatives have been deployed in this sector in order to bring about cost-effective and high quality solutions used in decision- making processes.
Automated Data Exchange System: During Year 4, 9 out of 14 new regions were enrolled in the SEDA. Thus, SEDA extension is effective in 11 regions and 66 health districts, reporting a coverage rate of 84% of districts, corresponding to 972 SDPs. A new Android version for the SEDA was introduced in the health districts of Kaffrine and Richard Toll, enabling users to update forms remotely with two ways to send them.
Namely, data can be sent using the Web (with WIFI or 3G) or by SMS. Dashboards are being completed so that the SEDA can be used at all levels.
Also, drafts of the SEDA user guide and the supervision grid were developed to Map 1: SEDA coverage of health districts support MSAS entities to monitor the use of the platform.
Sub-component 4: Development of relationships with private sector health facilities Analysis of progress
Expected results for Year 4 Results achieved
Participation of private sector health 326 private SDPs signed a memorandum of providers has increased in IPQS delivery in understanding with health districts as part of districts enrolled in TutoratPlus. TutoratPlus implementation
The TutoratPlus districts hold quarterly 11 health districts met to monitor the
HSI Component Annual Report: October 1, 2014–September 30, 2015 37
discussion meetings with health providers memoranda of understanding with private from the private sector for their intervention sector providers areas. The 322 private SDPs that signed a Routine data from private sector health memorandum of understanding share their providers on the IPQS are available in 70% of data with health districts TutoratPlus districts 123 private sector providers have been Compliance with national IPQS standards and trained in the IPQS, including interpersonal policies is effective for at least 252 private communication sector providers
Description of achievements
1. Including the private sector in the TutoratPlus approach
Enrollment of private SDPs continued this year through the signing of memoranda of understanding with the districts receiving district grants. Thus, the number of private SDPs having signed memoranda of understanding rose to 326 by the end of Year 4. The table below shows the distribution of these private SDPs, by type and by region.
Table 5: Distribution of enrolled private SDPs, by type and by region
Regions Company Semi-public Private Private for- Pharmacy Total medical medical Catholic profit SDP services services clinic
Dakar 5 4 4 87 0 105
Thiès 3 0 17 52 0 72
Fatick 0 0 8 10 2 20
Diourbel 1 0 1 16 0 18
Sédhiou 0 3 2 3 1 10
Tambacounda 0 0 2 6 0 8
Kolda 1 0 6 0 0 7
Kaffrine 0 0 5 1 0 6
Saint Louis 9 9 3 18 1 40
Kédougou 2 1 1 0 3 7
Ziguinchor 1 0 6 6 0 13
HSI Component Annual Report: October 1, 2014–September 30, 2015 38
Kaolack 1 0 4 11 0 16
Matam 0 0 0 4 0 4
Total 326
To improve the monitoring of compliance with signed memoranda of understanding, the component supported the Partnership Division of the MSAS to conduct a mission to assess the effectiveness and compliance with memoranda of understanding at the health district level. Thus, this mission visited 8 medical regions, 11 health districts, and 9 private health facilities in the regions of Kaolack, Kaffrine, Tambacounda, Kédougou, Kolda, Sédhiou, Ziguinchor, and Dakar. This mission revealed that in some districts, collaboration is well underway with private health facilities:
Equipment obtained through the district grants was delivered to private SDPs in an effort to fill gaps
Several private SDPs received supervision visits and participate in sending health data
One area for improvement in compliance with the memoranda of understanding is the private SDPs’ inadequate attendance at coordination meetings.
As part of strengthening relationships with the private sector, the component supported the Partnership Division to set up regional collaborative frameworks on the public-private partnership (PPP) in the medical regions of Kaolack and Thiès. Thus, the regional framework for Public-Private Partnership was created in Kaolack, by order of the governor, and the Thiès regional framework was revitalized with the governor’s commitment. The goal of these frameworks is to revitalize collaboration between all private and public actors in the medical region around the public-private partnership.
2. Strengthening the IPQS as part of the medical services provided by companies
This year, the component supported supportive supervision for private providers from five company medical services in the regions of Saint Louis (four company medical services: CROUSS medical services, CSS, Rectorat, and UGB); and in Ziguinchor (two: SUNEOR, IPRESS). The supportive supervision improved the skills of providers working in company medical services. The supervision focused on maternal and FP services, treatment of malaria with the new guidelines, biomedical waste management, and PIPE. The pool of supervisors was made up of ECDs (SSP supervisor and RH coordinator), ECRs, and the central level of the MSAS.
3. Informing and involving individuals working in large companies in the IPQS with emphasis on RH/FP
Training in interpersonal communications was held in the Dakar medical region. Participants were 11 company paramedical staff, including 5 women. Training focused on strengthening
HSI Component Annual Report: October 1, 2014–September 30, 2015 39
the skills of health workers in company medical services in interpersonal communication for behavior change.
Also, an orientation meeting for company paramedical staff was held on interpersonal communication for using the booklet for men on family health. This meeting helped strengthen the capacities of paramedical staff from seven companies in Dakar on standards for organizing discussions and on presenting the information booklet to men in companies. These activities are part of the “Liggueye te djeummeul njabbot” program that aims to inform male employees about family health. Discussion began in the companies late September; data will be reported in the Quarter 1 report for Year 5.
4. Mobilizing private sector leaders to ensure increased IPQS availability
As part of strengthening the public-private partnership, the component supported the Partnership Division of the MSAS to begin implementing the partnership projects.
For this purpose, the component supported training on the public-private partnership. This capacity building session was for members of the national collaborative framework on the MSAS PPP. There were 33 participants, including 26 men.
Next, the Partnership Division carried out a mission to support the implementation of a PPP project. The first step of this mission was a consensus workshop to select PPP projects. Some 20 members of the MSAS and Ministry of Investment Promotion, Partnerships, and Development of State Teleservices attended the workshop.
Discussions focused on establishing selection criteria to choose the four projects to support in the implementation of PPPs and to develop an identification sheet for each project.
The following criteria were selected:
The project’s compatibility with the national policy for health and social development. The selected project must be in an important strategic area for economic and social development in Senegal and must achieve results to help solve key problems that affect hospitals, medicines, pharmacies, health financing, improving the hospital system, and reducing disparities characterized by a high concentration of infrastructure and equipment in Dakar.
The PPP project’s compatibility with the national health card, compliance with regulations, norms, and procedures specifically for classification; compliance with overall standards, and meeting a need to plan for care delivery to create balance and to optimize the use of resources.
A funding threshold that exceeds one billion to create an enabling environment for public-private partnerships and motivate the private sector to fund the projects in the framework of a PPP contract, which could yield positive results through improved risk assessment practices and better allocation of financial resources.
After the presentations and discussions, these PPP projects were chosen:
HSI Component Annual Report: October 1, 2014–September 30, 2015 40
Setting up and equipping the Sédhiou regional hospital
Relocating the national procurement pharmacy in Diamniadio
The PPP project at Mbour hospital
Installation of PPP projects to renovate technical platforms for all type-1 PHFs
The second step of this mission focused on visiting stakeholders from the various projects in the field. Thus, the PNA, the FONGIP, the Mbour hospital, the Directorate of Private Establishments as well as employers were visited during this period.
The third step established the identification sheets for the different PPP projects that were selected. The committee members, comprised of representatives from the private sector and MSAS divisions and services supported by the Partnership Division and the Ministry of Investment Promotion, developed a framework document for the MSAS, presenting the PPP projects as investment opportunities that will be presented during a coordination meeting with the Minister of Health.
5. Involving pharmacies in delivering quality services
During this year, the component supported supervision of private pharmacies that aims to assess the availability of the IPQS in private pharmacies. The supervision covered private pharmacies enrolled in IPQS training and a few non-enrolled pharmacies to better assess the availability and delivery of advice and services related to the IPQS. The supervision team included the Directorate of Pharmacies, the Order of Pharmacists, and the Private Pharmacists Union.
Overall, 119 pharmacies enrolled in Dakar, Thiès, Fatick, Kaolack, and Diourbel were supervised. Supervision helped to better assess the availability and delivery of services in the IPQS both in the pharmacies enrolled in training and those not enrolled.
The main findings are:
All IPQS services are available in pharmacies, while EPI services are available to a lesser extent.
Regarding drug availability, the full range of contraceptives is available, except for the IUD and implants. Problems with oral rehydration salts (ORS) availability were often noted, with stockouts during the last three months.
There are no inventory management tools specifically dedicated to essential commodities for the IPQS. However, pharmacies have software that allows them to pull up statistics on commodities delivered during a given period, as needed.
There is hardly any collaboration between the TutorasPlus district and the supervised pharmacies. For some pharmacies, information is shared occasionally, but most of the pharmacy owners do not feel involved in the district activities.
HSI Component Annual Report: October 1, 2014–September 30, 2015 41
There is a clear difference regarding the availability of IPQS services delivery between pharmacies enrolled in the training and those not enrolled. Demand for advice exists in all pharmacies, but care differs between pharmacies, depending on whether the owner has been trained or not. In pharmacies that have had training, services delivery is generally based on treatment protocols acquired during training that have been issued by the MSAS.
Also, training for staff in private pharmacies continued with the training of 25 pharmacists in Ziguinchor and Sédhiou on the IPQS.
Lastly, this year saw the collection of consumption data from private pharmacies involving five private pharmaceutical wholesalers. Data was collected on RH, child survival, and FP commodities, especially for all contraceptives and life-saving commodities for maternal and child health. After the data collection, there was a meeting to validate the data with 23 participants, including 13 women. Participants were able to consolidate the data and prepare them for use during the Contraceptive Procurement Tables.
6. Expanding IPQS in the private and semi-public sectors
This year, the component focused on strengthening the capacities of private sector providers through conventional training, post-graduate education, and supportive supervisions.
As part of expanding the IPQS into the private sector, the component supported training for private paramedical staff in Kaolack and Ziguinchor. Training curriculum focused on updates in malaria case management; child survival programs, especially the new standards for treating diarrhea with ORS/zinc; and updates in FP counseling. The training involved 45 participants (28 men and 17 women) in Kaolack and an additional 17 people (8 men and 9 women) in Ziguinchor. It strengthened private providers’ capacities and fostered greater collaboration with the health districts, which had facilitated these sessions.
The component supported the DSR/SE to train private sector pediatricians. This first session brought together 23 members (5 men and 18 women) of the Association of Private Pediatricians. Following a presentation on Ministry of Health priorities for child survival, participants discussed the essential newborn care package and strategies to involve private pediatricians in achieving health objectives for child survival.
This year saw the organization of a training session taught using a post-graduate format in Thiès. There were 38 doctors (including 21 men) from Thiès who participated. The PNLP was able to disseminate these standards and protocols to these doctors from Thiès during this session. Also, the Division of the Health and Social Information System presented the issue of data collection in the private sector with the District Health Information System (DHIS) platform to the doctors.
HSI Component Annual Report: October 1, 2014–September 30, 2015 42
IPC training was provided in the district of Rufisque to 17 participants, including 11 women.
38 providers were trained in the Sayana Press in the Dakar region, namely the Pikine, Guédiawaye, Mbao, Keur Massar, and the South Dakar districts.
In addition, the component supported the MSAS to implement supportive supervision of private-sector providers to strengthen their skills in implementing the national guidelines for various health policies. Private facilities that have signed memoranda of understanding with their TutorasPlus districts were prioritized for the supervision, located in the regions of Dakar, Thiès, Kaolack, Fatick, Ziguinchor, Saint Louis, and Tambacounda. Overall, 84 private health facilities were visited by ECD and ECR members and the central level.
In Touba district, the component supported the HASDET NGO in extension activities for the IPQS. These activities were rolled out in the 90 wilaya community sites, involving promotional activities (discussions and social mobilizations) and services delivery activities (FP and child vaccination). Overall, 1440 discussions took place on the themes of FP, ANC, and vaccinations, reaching 24,067 participants. Alongside these, 15 social mobilizations were held. By the end of the advanced strategies, 6310 women were enrolled for all methods combined, and 11,964 children were vaccinated.
Supervision and monitoring & evaluation
Analysis of progress
Expected results for Year 4 Results achieved
Providers will be supervised regularly 698 SDPs received integrated supervision visits from the district Monitoring will be conducted regularly at the SDP level Support was provided to the CSC to revise monitoring tools Health information will be available in the DHIS2 3820 health huts received a supervision visit from head nurses of health posts Documentation of the component’s key interventions will be available and shared with The intervention to include FP in high-volume the MSAS services was documented, and the final report is available.
TutoratPlus and the IPT2 improvement approach are currently being documented
Description of achievements The intervention’s key priorities for monitoring and evaluation this year are: strengthening supervision systems at the district, SDP, and community level; increased use of health data for
HSI Component Annual Report: October 1, 2014–September 30, 2015 43
decision-making purposes; and documenting and sharing high-impact approaches for IPQS quality.
1. Strengthening supervision systems at the district, SDP, and community level
During the last three months, 88 SDPs were visited as part of the component’s support to resume supervision. Its cumulative results for data from three quarters and data from regions receiving direct financing indicate that a total 698 facilities (46 warehouses, 19 health centers, and 633 health posts) received a supervision visit during the year.
Efforts to improve SDP management were noted during the supervision visits, namely:
Availability of the integrated package of services in SDPs
Medicines are well managed with their prices posted
Inputs (malaria, EPI, PF, nutrition) and equipment are available
Management tools are available and well maintained
Cases (of malaria, diarrhea, malnutrition, etc.) are managed well in compliance with MSAS guidelines
Good availability of essential tracer medicines (at least 80% availability)
Nevertheless, efforts must especially focus on:
Storing medicines in accordance with standards
Providing information on EPI monitoring curves
Applying the formula to calculate ordering quantities for medicines
Lack of newborn corners
Stockouts of essential medicines in some SDPs
However, despite its crucial role in the proper implementation of activities, performance for the supervision activity remains low (41%) due to failure to comply with its periodicity.
In addition, supervision of the component’s interventions implemented this year in 82 public SDPs in seven regions (Diourbel, Fatick, Kaffrine, Kaolack, Kédougou, Sédhiou, and Ziguinchor) showed good availability of ANC registers, while FP registers were only available in 60% of SDPs.
HSI Component Annual Report: October 1, 2014–September 30, 2015 44
Table 6: Availability of ISM tools in private SDPs (N=82)
Number ANC Partograph PNC FP register of SDPs visited
Availability of new 82 PPS 80% 68% 65% 60% versions of management tools
The supervision also showed a high achievement rate for the component’s activities; all of the health posts visited received at least one tutor visit.
The component supported the supervision of community-based facilities, combined with advanced strategies. This year, providers (ICPs and midwives) visited 3582 health huts. Integrated supervision of health huts was genuinely boosted with opportunities provided through direct financing.
2. Increased availability and use of health data for decision-making purposes
Since Year 1, the component has supported the Ministry of Health to increase the availability and use of health data for decision-making purposes by revising and printing management tools and training service providers to use these tools. The component continued its support in this area to cover the regions of Dakar, Fatick, and Ziguinchor this year.
During Year 4, 115 providers (including 68 men and 47 women) were trained in ISM in the regions of Dakar, Fatick, and Ziguinchor, corresponding to 66 public SDPs and 13 private SDPs, or an achievement rate of 47.9%.
The component also supported updating PHF staff on the revised management tools for hospitals through training for 49 staff members (including 25 men and 24 women) from Kaolack and Kaffrine.
As part of improving the component’s internal management, IntraHealth staff from the central level conducted supervision of 11 staff members posted in the field in Kaolack, Kaffrine, Fatick, Diourbel, Louga, Thiès, Tambacounda, Kolda, Sédhiou, Ziguinchor, and Saint Louis.
This supervision found a high level of activity implementation and that RPMs are well integrated into the regional/district medical teams and RB team; supporting documents and office equipment and supplies were also available.
Recommendations sought to make improvements in sending reports on time, the archiving of work documents, and working conditions. The challenge is to carefully monitor their application.
HSI Component Annual Report: October 1, 2014–September 30, 2015 45
3. Documenting and sharing high-impact approaches
The process to document high-impact approaches began this year with the documentation of four approaches, specifically, the integration of FP in vaccination services, TutoratPlus, IPT2 improvement, and the acceptability of the PP/IUD. For the first approach, data have been collected, and the report is undergoing internal validation. For TutoratPlus and the IPT2 improvement approach, data have also been collected, and a consultant is working on writing the preliminary report.
4. Strengthening coordination of interventions to improve service delivery
Frontline staff at the DSR/SE helped improve coordination at the various divisions and offices of the DSR/SE.
Support for the Ebola response
Analysis of progress
Expected results for Year 4 Results achieved
The skills of at least 800 providers from A survey of providers’ skills on the prevention public, private, and semi-public SDPs are and case management of Ebola virus disease strengthened in the prevention and (EVD) was conducted in preparation for their management of Ebola virus disease in the training intervention regions The skills of 447 providers (including 166 At least 250 SDPs are supported with women) were strengthened in the regions of minimum protective equipment Kolda, Sédhiou, Ziguinchor, Tambacounda, and Kédougou Production capacities of 5 hydro-alcoholic solution production units is strengthened The 5 production units received supervision that showed that they are operational. Job aids are available in SDPs to provide However, problems with inputs persist, which information for providers and SDP clients the component will help to resolve. At least 200 providers are informed about Equipment availability was assessed by the Ebola virus disease through ITC component in the SDPs of the intervention regions that identified gaps to fill in this area
Description of achievements The main activities in this plan that were implemented are: capacity building for providers; support for SDPs in equipment and supplies for the prevention and case management of Ebola cases; the use of ITC; health communication and promotion in SDPs; support for supervision; and coordination and communication for Ebola virus disease. The interventions only targeted the regions of Dakar, Kolda, Sédhiou, Ziguinchor, Tambacounda, and Kédougou
HSI Component Annual Report: October 1, 2014–September 30, 2015 46
1. Strengthening providers’ capacities
The component supported efforts to update and share PIPE training modules and tools in the context of Ebola with all technical and financial partners and the various MSAS directorates. This activity’s goals were to share all tools related to PIPE training in a context of Ebola virus disease: training and concept modules, a training plan, and situational analysis tools for training and equipment.
The following proposed modules were selected:
Infection prevention and environmental protection
Organization for health posts, transit centers, and treatment centers
Supplies and equipment for health posts, transit centers, and treatment centers
Identification and management of cases and appropriate hygiene measures
The psycho-social aspects of the disease will be addressed through specific training modules developed by psychiatrists and social anthropologists.
The selected recommendations are:
Present more PowerPoint slides with illustrations and films/photos
Collaborate with the Mobile Health Intervention Team of the Infectious Disease Department
Once the modules were validated, 105 ECR and ECD members, including 88 men and 17 women, from the intervention areas were trained, reaching 33 SDPs, including 4 regional hospitals and 5 PHFs, all of which are public. This activity helped strengthen knowledge among medical teams on PIPE in the Ebola context and to share the situational analysis tools to assess providers’ skills, equipment, and the decentralized training plan. In turn, these teams are responsible for providing training for providers at the health district level.
Before starting provider training on PIPE in the Ebola context, the component surveyed providers’ skills this quarter in a sample of SDPs in the target regions to assess Ebola virus disease prevention and control. It surveyed 65 providers from 59 SDPs in the regions of Tambacounda, Kédougou, Kolda, Sédhiou, and Ziguinchor.
The evaluation addressed:
The status of SDPs covered by the survey
The level of staff training on EVD prevention and treatment and PIPE
Knowledge about biomedical waste management
Knowledge about bio cleaning and maintenance of premises
Knowledge about hand hygiene in health care settings
Knowledge about standard precautions in health care settings
HSI Component Annual Report: October 1, 2014–September 30, 2015 47
Knowledge about prevention measures in Ebola control
The findings were:
90% of SDPs surveyed are health posts and 85% are public
66% of providers are trained in PIPE compared to 83.3% in EVD
50% have acceptable knowledge of biomedical waste management
50% have mastered the principles of bio cleaning, but only 30% know about the products used and risk areas
53.39% have mastered the technique indicated for hand hygiene for a suspected case of Ebola
40.91% fully understand the types of additional precautions to apply for Ebola control
36.35% use the dressing and undressing checklist in the additional precautions
Only 17.67% know the routing requirements for laboratory products
These findings demonstrate that despite training for health workers on EVD, knowledge about preventing and controlling the disease must be strengthened; this explains the need to strengthen workers’ capacities in health care at all levels.
After the survey, the ECRs and ECDs, in turn, trained 342 providers, including 149 women. Only the Dakar region, because of the ECRs’ and ECDs’ availability, were unable to train all providers in the health districts.
2. Support for SDPs in equipment and supplies for Ebola prevention and case management
The goal of this intervention was to identify gaps in equipment and supplies and to help fill noted gaps in the SDPs of the target regions. Equipment survey tools were developed this quarter and then shared and validated by the health emergencies operations center (COUS) and its partners. A checklist was developed based on the COUS standardized list of essential equipment for EVD prevention and case management. Two checklists were developed: one for health posts and another for treatment/transit centers.
Once the tools were developed, the ECRs and ECDs of the regions of Ziguinchor, Kolda, Sédhiou, Tambacounda, and Kédougou began an equipment survey in 314 health posts and treatment centers.
Overall, the findings show that PIPE is still a challenge at peripheral health facilities:
. In every region except Kolda, sanitation around the SDPs is not satisfactory.
. The availability of enclosed trash cans in SDP courtyards is acceptable in all the visited regions.
. The availability of trash cans and posters on hand hygiene is satisfactory in all regions.
HSI Component Annual Report: October 1, 2014–September 30, 2015 48
. In the treatment and delivery rooms, the availability of security boxes, enclosed trash cans, and decontamination products is satisfactory in all regions; however, water points, hydro-alcoholic solution (HAS), and decontamination solution is not sufficiently available, especially in the Kédougou region.
. Biomedical waste management is satisfactory overall in all regions. However, efforts still must be made to ensure the person responsible for biomedical waste management has protection equipment: glasses, protective gloves, apron, etc.
. In terms of standards defined by the COUS, equipment gaps are considerable in the SDPs. The component is committed to fulfilling some of these gaps to improve the EVD response.
The survey also produced information on the number and cadre of health professionals in SDPs:
. Trained staff do not meet WHO standards, given the poor distribution of state registered midwives in the regions of Tambacounda and Ziguinchor.
. There are twice as many untrained staff as trained staff, which in an actual context of EVD will require strengthening the skills of these staff to tackle Ebola prevention and control.
3. Support for the hydro-alcoholic solution production units
The component supported the National Nosocomial Infections Control Program (PRONALIN) this quarter to supervise the hydro-alcoholic solution production units. The Fann, Le Dantec, Touba, Diourbel, and Louga hospitals were visited.
The evaluation addressed:
The functionality of the HAS production units
Production and distribution in Quarter 1 of 2015
A HAS needs assessment
An assessment of tolerance, acceptability, and use of the product
The results are summarized in the table below.
Table 7: Findings from the supervision of HAS production units
Strengths Areas for improvement
Available human resources Failure to follow HAS instructions in hospitals
Available supplies and inputs Ineffective use of the standards for HAS needs assessment Good promotion of HAS use in hospitals through nosocomial infections control Problems using the water distiller in all committees facilities
HSI Component Annual Report: October 1, 2014–September 30, 2015 49
Commitment from actors to achieve Adherence to rubbing with HAS still objectives considered to be low
Support for the sponsor and the partner Durability of distillation equipment
Problems in recycling bottles
Administrative bureaucracy for input turnover
Unavailable human resources for equipment upkeep
Frequent stockouts of inputs for HAS production
Following supervision of the HAS production units, hospitals expressed their needs for inputs and supplies to increase HAS production and for support, which the component will provide them as part of the action plan.
4. Using ITC: This quarter, the component focused its efforts on designing the mEbola platform on EVD. (See mEbola Concept Note in Annex 8.)
Several meetings with the MSAS through the COUS and the IT unit resulted in the platform’s design with collaboration from Unicef and several steps in the implementation stage:
Discussion with headquarters for a crash course on mHero
Sharing the RapidPro platform with Unicef
Validation of job aids:
o Messages to inform providers
o Awareness-raising messages for communities
Platform design based on the Senegalese outline, taking into account:
o The management of sub-groups
o Translation of a few messages into the national language (Wolof)
The start of administrative procedures
At this stage, progress on configuration of RapidPro has reached 92% for rolling out early warning activities and provider training. Alongside this, a request for a short code has been submitted to the Regulatory Authority for Telecommunications and Postal Services (ARTP) for the COUS. The next step will involve training providers to use the platform.
5. Health communication and promotion in SDPs
Training modules and tools were reproduced and disseminated during provider training in infection prevention and environmental protection in the context of Ebola.
HSI Component Annual Report: October 1, 2014–September 30, 2015 50
6. Support for supervision and coordination
The component attended meetings periodically held by the COUS. The meeting addressed topics and recommendations related to mobilization of resources, monitoring of partners’ activities, and information sharing by the COUS.
Coordination of the component’s implementation
In addition to internal-coordination, planning, and report-writing meetings, the component participated in inter-agency coordination meetings, for which some focused on FP and direct financing. At the same time, it continued to work in synergy with the other components, such as:
Community Health Component: To monitor the implementation of identified advanced strategies and RED approaches and to improve IPT2 and the Ebola response, according to the established plan for synergy.
Health Communication and Promotion component: The component continued to activities targeting pharmacies with the Health Communication and Promotion component. Thus, supervision of private pharmacies was done in partnership with ADEMAS.
HIV/AIDS component: To support the Gender Unit and the Office of Violence and Trauma Prevention of the MSAS.
Health System Improvement component: Information sharing on the implementation of advanced strategies and supervision of SDPs in regions receiving direct financing. Mainstreaming gender into component interventions
In Year 4, the component continued to support the MSAS to mainstream gender into interventions and activities through its gender audit of the MSAS. It also strengthened providers’ capacities in the management of gender-based violence (GBV).
Support for the Gender Unit for the gender audit of the MSAS at all levels: The component supported the Gender Unit to conduct the gender audit in the regions of Ziguinchor, Sédhiou, Kolda, Kédougou, and Dakar. Other partners supported this audit: LuxDev in the country’s northern regions, the Belgian Technical Cooperation in the central area, and Catholic Relief Services in Tambacounda and Kédougou through co-financing.
The audit report and the plan to institutionalize gender were shared and validated in the presence of MSAS officials.
The gender audit of the MSAS highlighted positive actions that are taking gender into account in interventions and services delivery at the various levels of the health pyramid. However, some weaknesses were noted at the institutional and programmatic level. Specifically, the audit identified limitations in the understanding and mastery of key concepts, their translation into concrete gender mainstreaming tools when managing the various
HSI Component Annual Report: October 1, 2014–September 30, 2015 51
entities for services delivery, and especially, in the planning, programming, monitoring, and evaluation of programs and projects.
Therefore, based on results from the gender audit of the MSAS, the institutionalization of gender aims to translate into lines of action. Recommendations were made with a view to support effective gender mainstreaming and put it into practice in the ministry’s interventions throughout the health pyramid. Specifically, the plan to institutionalize gender aims to:
Strengthening the involvement and accountability of responsibility centers to promote gender equity and equality at the central and decentralized levels
Accelerating the institutionalization of gender mainstreaming into MSAS organizational instruments and assessment mechanisms
Strengthening capacities in the gender approach and techniques for raising awareness about gender
Supporting behavior change to promote gender issues and to combat stereotypes and GBV
Supporting women in reconciling their multiple family and professional responsibilities
It is structured around these four strategic directions:
Development of a culture of gender equality
Mainstreaming gender into component interventions
Development of technical skills
Promoting decent work
Training for providers on the protocol for managing gender-based violence: The component supported the DGS through the Office of Violence and Trauma Prevention through health staff training on the prevention and case management of trauma due to GBV in the districts of Kolda, Sédhiou, Goudomp, Bounkiling, Ziguinchor, Kédougou, and Pikine (Dakar). For the five initially planned health districts, we were actually able to enroll seven health districts, with Goudomp and Bounkiling requested by health officials.
Thus, the Office of Violence and Trauma Prevention trained 111 participants (72 men and 39 women) in the regions of Kolda, Sédhiou, Ziguinchor, Kédougou, and Dakar (Pikine).
Training involved staff who play an important role in the case management of GBV (physicians, midwives, nurses, and social workers) and actors in the defense and security forces, the legal system, and civil society.
HSI Component Annual Report: October 1, 2014–September 30, 2015 52
For example, in Pikine, the deputy prefect of Dagoudane, the Imam of the Grande Mosque, and the head of the Community Development Department participated in the training alongside providers and partners, such as Médicos del Mundo and AcDev.
The overall goal of this training was to help improve the quality of health services delivery to victims of GBV. These sessions resulted in:
Sharing the draft of the guide on managing trauma due to GBV
Identifying local actors involved in managing care for victims of GBV
Defining a local circuit to manage care for victims of GBV
Lessons learned from these training sessions are:
Persistent problems in obtaining medical certification for victims of violence
The need to create synergy between the various actors for the management of GBV
The importance of a multi-sectoral approach in the complex management of GBV
The existence of many socio-cultural barriers to GBV management that must be addressed through the implementation of a communications plan
The vital role played by health staff in the management of GBV
Compliance with family planning regulations
New trained tutors (39) all received an orientation on FP legislation and regulations.
In addition, monitoring of compliance with US government legislation and regulations for FP was done in 95 SDPs during supervision of the implementation of component activities.
A low percentage of clinical providers are trained on the Tiahrt and other US government legislative regulations and policies regarding FP. Analysis showed that among those supervised, very few were visited by tutors from the FP package; however, all SDPs were in compliance with the legislation, particularly with not setting a quota, not paying bonuses, and providing complete information to beneficiaries.
Table 8: SDP supervision results on compliance with FP legislation (N=95)
Item Percentage
There is a “Tiahrt poster” or an equivalent poster providing full information on FP 70% methods posted on an SDP wall, or equivalent informational materials available in the SDP that describe the benefits, adverse side effects, and health risks of the various FP methods. Providers use the “Tiahrt poster” or equivalent informational materials (flip charts or 95% displays) to provide clients with clear and complete information on the chosen FP method.
HSI Component Annual Report: October 1, 2014–September 30, 2015 53
Item Percentage
Clinical staff are trained on the Tiahrt and other US government legislative 59% regulations and policies regarding FP. Providers provide clear and complete information to clients on the various FP 95% methods without encouraging them to accept a particular method of FP during counseling. Providers provide information to clients on the benefits, health risks, and known 83% adverse side effects of the FP method during specific counseling.
There is a range of FP methods to ensure clients make a free choice from among 97% approved methods. Staff receive a bonus payment for achieving FP targets. 0%
There is a set target or quota for staff for needs other than program planning. 0%
The SDP received equipment purchased by the project for abortion services. 0%
Voluntary sterilization services provided. 0%
A consent form is routinely filled out, signed, and archived for each client. NA
Compliance with regulations for environmental protection
In order to check and track compliance with environmental regulations, the component supervised 93 SDPs, distributed in these 24 districts: Goudomp, Kaolack, Ndoffane, Guinguinéo, Diourbel, Nioro ,Podor, Dagana, Louga, Koki, Saint Louis, Keur Momar Sarr, Saraya, Kédougou, Koungheul, Mbacké, Fatick, Birkilane, Touba, Mbao, Guédiawaye, Diamniadio, West Dakar, and South Dakar.
Supervision checked provider training on PIPE, availability of decontamination supplies and products, and availability of a waste disposal plan.
As shown in the table below, coverage is fairly high for the SDPs that received PIPE training for at least one provider (78%), while SDP coverage for on-site supervision is still low (48%).
Table 9: Summary of results of SDP supervision of compliance with environmental regulations (N=93)
Percentage Item Percentage of SDPs that have at least one staff member trained in PIPE over the last two years 78%
Percentage of SDPs receiving on-site supervision on PIPE 48%
HSI Component Annual Report: October 1, 2014–September 30, 2015 54
Regarding the availability of equipment and consumables for infection prevention in SDPs, there is good availability of decontamination equipment and products (80%) and sterilization equipment (75%). Low availability is noted for waste management equipment (20%) and bio cleaning and maintenance of premises with adapted products and supplies (27%).
The availability of waste disposal plans (67%) and the notebook for the management of adverse events related to commodities and medicines (54%) still needs to be perfected. (See table below.)
HSI Component Annual Report: October 1, 2014–September 30, 2015 55
Table 10: SDP supervision results on the availability and use of PIPE (N=93)
Percentage
Percentage of SDPs that have consumables and equipment for infection prevention 49% in SDPs Percentage of SDPs that have a waste disposal plan 67%
Availability of waste disposal equipment 20%
Percentage of SDPs that have decontamination equipment and products 80%
Percentage of SDPs that have bio cleaning and maintain premises with adapted 27% products and supplies Percentage of SDPs that know there is a reference physician for cases of accidental 61% blood exposure Percentage of SDPs that have sterilization supplies: Poupinel, sterilizer, and 75% autoclave Percentage of SDPs that have a notebook for the management of adverse events 54%
III. Main challenges
Although progress made in the implementation of the action plan is satisfactory, in order to improve performance, the component must:
Improve the on-site supervision coverage rate for SDPs and accelerate the implementation of certain interventions such as the introduction of the PP/IUD, decentralized training of providers on EmONC, newborn care, routine vitamin A distribution, and the management of malnutrition in URENs and nutritional recovery centers
Engage the MSAS in biomedical waste management for EVD in order to stabilize the PI/PE supervision.
Encourage the ECRs and ECDs to improve activity planning for better coordination with the central level by using the job aids developed by the Quality Program and the DGS
Document and share lessons learned and innovative approaches with all stakeholders to promote their appropriation and institutionalization by the MSAS
HSI Component Annual Report: October 1, 2014–September 30, 2015 56
IV. The way forward and priorities for Year 5
For the final year of implementation, the component will focus on:
The transfer and institutionalization of innovative approaches to entities in the Ministry of Health and Social Action (MSAS): specific actions will be undertaken to ensure the sustainability of the Automated Data Exchange System (SEDA), TutoratPlus, and the Health Workforce Information Software (iHRIS). This will be done through sharing documentation results and skills transfer.
Continuing interventions that foster greater access to the IPQS: The IPT2 improvement approach; introduction of the PP/IUD; integration of FP into high- volume services, including the private sector; and supportive supervision and post- training follow-up for providers.
Continuing to support the MSAS in implementing the Ebola response plan through the COUS, the PRONALIN, and the National Hygiene Service
Preparing for the project’s closure according to plans drawn up in accordance with contractual terms
Maintaining a high ethical standard to ensure compliance with USAID and MSAS requirements and expectations in cross-cutting areas such as gender and compliance with environmental regulations and FP requirements
HSI Component Annual Report: October 1, 2014–September 30, 2015 57
V. Financial report
Recipient: IntraHealth International, Inc. Program Name: Health Services Improvement Program Cooperative Agreement Number: AID-685-A-11-00003 Report Name: Budget Tracking Table by Earmark For the Period Ending: 9/30/2015
% allocation Total Amount Total Prior Periods' Current Period Name by Technical Earmarked/Obligated Expenditures To % Expended Expenditures Expenditures Area To Date Date
Malaria 23% $ 6,588,613 $ 4,566,844 $ 291,208 $ 4,858,052 74% Tuberculosis 0% $ 50,000 $ 48,544 $ 324 $ 48,868 98% Nutrition 7% $ 2,117,598 $ 1,720,154 $ 74,303 $ 1,794,457 85% Maternal & Child Health 33% $ 9,355,425 $ 9,460,038 $ 590,512 $ 10,050,551 107% Family Planning & Reproductive $ 9,864,364 $ 412,910 $ 10,737,937 109% Health 35% $ 10,325,027 HIV/AIDS 1% $ 194,000 $ 144,428 $ 7861 $ 152,289 78% EBOLA 1% $ 330,000 $ 31,083 $ 85,548 $ 116,631 35% TOTAL 100% $ 28,500,000 $ 26,296,118 $ 1,462,667 $ 27,758,785 97%
HSI Component Annual Report: October 1, 2014–September 30, 2015 58 VI. Annexes Annex 1: Performance monitoring plan For this fourth year, the component has implemented various strategies to access reliable data from SDPs. Therefore, when reviewing the Performance Monitoring Plan, the component used SEDA data and PRA distribution data for contraceptives, in addition to the conventional use of project activity reports.
Data presented in the SEDA: The SEDA is a platform for sending and analyzing health data through the mobile phone network. Each month, a set number of indicators are sent from the health post by text message to a server via a mobile phone. These data are analyzed automatically, and the results are presented using a Web server. Currently, the SEDA has been introduced in 799 SDPs in 52 districts and 11 regions. The completion rate for disease management reports is 57.6% for malaria, 54.3% for childhood disease, and 58.9% for maternal health. These data are certainly not representative of the entire country, but they identify reported trends for indicators in the districts covered by SEDA. Routine checking helped clean the database of outliers and atypical data. A data-cleanup report is available.
PRA distribution data for contraceptives: To document the indicator for quantities of contraception distribution and the CYP, the component used PRA distribution data for an indirect measurement of the CYP. These data were taken from the computerized management system for contraceptives in regional procurement pharmacies. They were collected from 11 PRAs.
Data generated through the implementation of activities: These data especially provide information on the indicators for the number of persons trained. The Monitoring & Evaluation and Research Department received activity reports with appended attendance sheets listing training participants that were sent by regional program managers and technical advisors. These reports have been checked, synthesized, and archived. An internal double-check verified the quality of the data presented in the Performance Monitoring Plan.
HSI Component Annual Report: October 1, 2014–September 30, 2015
Performance Monitoring Plan: October 1, 2014 – September 30, 2015
FY14 Disaggregated Year-4 # Description of indicators FY15 Achieved Achieved Achieved Achieved Achieved Comments by Achievement Target Q1 Q2 Q3 Q4 Year 4 rate Sub-component 1: Increased access to an Integrated Package of Quality Services
During this quarter, the component Percentage of service continued to provide support to delivery points offering an 1303 SDPs enrolled in TutoratPlus in 1 IPQS in a program Altogether 108% 108% 108% 108% 108% 108% 100% terms of equipment and capacity supported by the United building through on-site supervision States government and conventional supervision.
Number of service delivery The service delivery points enrolled points with family planning in TutoratPlus continued to receive 2 Altogether 1303 1303 1303 1303 1303 1303 100% counseling supported by component support for FP through the US government package 2 and the district grant.
Altogether 173,397 201,471 338,580 258,632 200,506 999,189 576.24% During this fiscal year, 999,189 CYP Pills - 16,794 30,621 24,649 17,397 89,461 - were generated via the country’s 11 Couple-years of protection PRAs. The data are from the PRA 3 Implants - 85,821 162,388 127,160 82,186 457,555 - (CYP) by method distribution statistics. IUD - 26,579 48,949 23,777 42,706 142,011 - This high performance rate is due to Injectable - 63,588 86,267 72,770 50,839 273,464 -
FY14 Disaggregated Year-4 # Description of indicators FY15 Achieved Achieved Achieved Achieved Achieved Comments by Achievement Target Q1 Q2 Q3 Q4 Year 4 rate Condoms - 6458 3481 7874 6636 24,449 - the fact that the target was set using Emergency consumption and other data. In - 168 386 199 170 923 - contraception recent years Senegal has seen a high CycleBeads - 2063 6488 2202 572 11,325 - increase in the contraceptive Altogether 983,900 1,314,357 1,287,859 1,649,740 1,296,664 5,548,620 563.94% prevalence rate, reporting a 25.74% increase compared to last year Pills - 251,904 459,317 369,736 260,952 1,341,909 - (794,951). This increase explains the Implants - 22,683 43,054 33,477 22,928 122,142 - rise in contraceptive prevalence over IUD - 5778 10,641 5169 9284 30,872 - recent years in Senegal. Quantity of contraceptives 4 Injectable - 254,352 345,068 291,080 203,355 1,093,855 - delivered, by method Condoms - 774,914 417,728 944,831 796,360 2,933,833 - Emergency - 3351 7726 3979 3404 18,460 - contraception CycleBeads - 1375 4325 1468 381 7549 - Percentage of pregnant This indicator is defined as the ratio Altogether 72.30% 80.8% 73.20% 59.30% 67.7% 70.16% 97.04% women who received between women who received IPT2 intermittent preventive Urban - 79% - - during their pregnancy during this therapy during their ANC fiscal year compared to the number during their last pregnancy of pregnant women who had an 5 (IPT2) initial ANC contact during the period. Rural - 81.9% - - This year 117,374 pregnant women received two doses of IPT among the 167,288 having had an initial ANC contract (source: SEDA data).
FY14 Disaggregated Year-4 # Description of indicators FY15 Achieved Achieved Achieved Achieved Achieved Comments by Achievement Target Q1 Q2 Q3 Q4 Year 4 rate This indicator is the ratio of the Percentage of women Altogether 90% 96.30% 85.42% 87.30% 97% 97.94% 108% number of women who received receiving active Urban - 95.90% - - AMTSL compared to the number of management of the third 6 assisted deliveries during the same stage of labor through a period. This year, among the 93,753 program supported by the - 96.60% - - Rural assisted births, 91,826 received US government AMTSL (source: SEDA data).
Altogether 358,891 11,484 13,331 12,224 54,787 91,826 25.58% This low level of performance is because the target is set relative to Urban - 4852 - - pregnancies in the 76 districts while Number of women who data are only drawn from the 52 received uterotonic drugs in districts enrolled in the SEDA, which the third stage of labor 7 have a data completeness rate of through a program 58.9%. Preliminary results from the supported by the US Rural - 6632 - - TutoratPlus evaluation show that government AMTSL is delivered in 82% of SDPs, compared to 62% in the situational analysis. Although new SDPs have not been Number of service delivery added to those supported last year, points (type-1 and type-2 the component continued its health centers; and type-1 support for 86 SDPs that provide 8 and type 2 public health 90 86 86 86 86 86 95.5% life-saving maternity care through facilities) funded by the US training for providers from 13 SDPs government providing life- on EmONC, on-site supervision of saving maternal care other SDPs for package 1, and the district grant.
FY14 Disaggregated Year-4 # Description of indicators FY15 Achieved Achieved Achieved Achieved Achieved Comments by Achievement Target Q1 Q2 Q3 Q4 Year 4 rate Use of the partograph to monitor labor is a problem in Senegal. From the TutoratPlus assessment, Percentage of providers although 77.5% of service delivery who comply with standards points use the partograph to and protocols related to the 9 65% 47% 56% 66% 20% 20% 30.7% monitor labor compared to 49.8% in management of labor and the situational analysis, only 20% delivery in facilities funded (n=86) of providers use the by the US government partograph in accordance with standards or use the proper instrument. Altogether 80% 82.4% 87.72% 86.66% 85.36% 85.36% 106% Of the 113,452 live births reported in Percentage of newborns Urban - 76.6% - facilities this year, 96,846 newborns who received a post-natal 10 received a post-natal visit in the 3 visit in the 3 days following days following birth (source: SEDA birth Rural - 86.4% - data).
Altogether 90% 88.7% 85% 87.9% 86.8% 86.8% 96.4% During this year, of the 113,452 live Percentage of newborns births reported in facilities, 98,493 receiving immediate Urban - 92.7% - - - - - newborns received immediate 11 neonatal care through a neonatal care. The assessment data program supported by the show that ENC services are available Rural - 86% - - - - - US government in 83.6% of SDPs compared to 54.2% for the situational analysis. Number of providers Altogether 2706 334 71 22 25 2489 92% This indicator is cumulative. 12 trained in child health and Men 137 34 9 11 1007 Throughout this year, 452 additional
FY14 Disaggregated Year-4 # Description of indicators FY15 Achieved Achieved Achieved Achieved Achieved Comments by Achievement Target Q1 Q2 Q3 Q4 Year 4 rate nutrition through a program providers were trained in child supported by the US health and nutrition. This brings the government number of providers trained in Women 197 37 13 14 1482 nutrition since the start of the program to 2489, with a 92% achievement rate for the indicator. Throughout this year, the 948 SDPs supported by the component that Number of service delivery have an established capacity to treat points assisted by USAID acute malnutrition continued to 13 that have an established 1000 948 52 0 0 948 95% receive component support through capacity to treat acute on-site supervisions. Preliminary malnutrition assessment data showed that 90% of SDPs supported by the component treat acute malnutrition. Data are from the SEDA database, reporting 139,059 cases of diarrhea Number of diarrhea cases for children under 5 years treated among children under 5 with ORS/zinc. The target for this treated with ORS/zinc indicator was set when the case 14 70,000 14,454 32,925 17,865 65,244 139,059 198.6% through a program management of diarrhea with supported by the US ORS/zinc was still a pilot government intervention, while it has now been extended into all SDPs. This might explain the level of performance.
FY14 Disaggregated Year-4 # Description of indicators FY15 Achieved Achieved Achieved Achieved Achieved Comments by Achievement Target Q1 Q2 Q3 Q4 Year 4 rate During this year, 142,264 children Number of children under 5 had pneumonia and were treated years with pneumonia with the recommended antibiotics. receiving antibiotics This strong performance is explained 15 recommended by qualified 86,625 17,794 26,309 21,376 76,785 142,264 164% by the fact that the target was set at health workers as part of a the time when treating pneumonia program supported by the with antibiotics had just been US government mainstreamed (source: SEDA data). 79,590 malaria cases were reported and treated this year. This low level Number of malaria cases of performance is explained by the treated through a program 169,644 16 27,105 5887 2380 44,218 79,590 46.9% fact that malaria cases have supported by USAID (97%) decreased in recent years; also data (general population) completeness is low (source: SEDA data). Number of providers Altogether 309 156 0 124 29 309 100% During this year, the component trained in laboratory supported training for 309 Men - 78 0 41 11 130 diagnosis of malaria additional providers in malaria 17 (microscopy and RDT) diagnosis and treatment. through a program Women - 78 0 83 18 179 supported by the US government
Number of providers Altogether 309 156 0 124 29 309 100% trained in intermittent 18 preventive therapy (IPT) Men - 78 0 41 11 130 through a program Women - 78 0 83 18 179
FY14 Disaggregated Year-4 # Description of indicators FY15 Achieved Achieved Achieved Achieved Achieved Comments by Achievement Target Q1 Q2 Q3 Q4 Year 4 rate supported by the US government Number of providers Altogether 309 156 0 124 29 309 100% trained in malaria case management with ACT 19 Men - 78 0 41 11 130 through a program supported by the US Women - 78 0 83 18 179 government Sub-component 2: Improved quality of health services in health posts, health centers, and regional hospitals Percentage of service The TutoratPlus evaluation delivery points assisted by conducted last quarter showed that USAID that experienced 10% 20 ND 15.6% 0% 0% 0% 110% none of the SDPs in the sample had stockouts of contraceptive (121/1211) a stockout of contraceptives for the products, during the three months prior to the survey. reporting period Integrated supervision continues to Percentage of health be a challenge for the Senegalese facilities that received 1 or 80% 21 28.2% ND 17% 22% 41% 50% health system. During this year, 698 more supervision visits in (1114/1211) service delivery points received an the last 3 months integrated supervision visit. Number of supervision visits During this quarter, 3582 supervision conducted by health facility visits in community health services staff members in sites were made by health facility 22 1576 1277 246 419 1640 3582 234% community health services staff members during advanced sites (health huts and strategies. This brings the home-based care providers) performance to 227%.
FY14 Disaggregated Year-4 # Description of indicators FY15 Achieved Achieved Achieved Achieved Achieved Comments by Achievement Target Q1 Q2 Q3 Q4 Year 4 rate During this year, 4739 advanced strategies were organized for a projected 3000. Number of advanced This high performance rate is, on the strategies conducted by one hand, due to an increase in the 23 3000 1852 246 246 2395 4739 158% public health posts and number of regions receiving direct health centers financing and, on the other hand, because data from the last quarter of FY2014 was delivered to the component at the start of the year. Number of local Following the low performance of governments supported by the decentralized SAMU unit, the US government with an activities were stopped. The 24 148 117 0 0 0 117 79% emergency transport component then organized system for pregnant women stakeholder dialogues to restart the (SAMU) decentralized SAMU. Sub-component 3: Improved human resources management in public sector health facilities This indicator is cumulative. Throughout this fiscal year, 312 additional SDPs have established job descriptions, bringing the total Number of SDPs with job 25 793 81 163 64 4 1055 133.4% number of SDPs with job descriptions for all positions descriptions to 1055. This was the result of work done by tutors. The goal for this year was to implement job descriptions in 50 SDPs.
FY14 Disaggregated Year-4 # Description of indicators FY15 Achieved Achieved Achieved Achieved Achieved Comments by Achievement Target Q1 Q2 Q3 Q4 Year 4 rate Assessment data showed that 93% of SDPs have job descriptions.
Sub-component 4: Development of relationships with private sector health facilities To date, 188 private SDPs were enrolled in TutoratPlus and have signed a Memorandum of Number of private facilities 26 80 188 0 0 0 188 235% Understanding with health districts. enrolled in TutoratPlus They continue to receive component support through on-site supervisions and district grants.
Annex 2: On-site supervision coverage for SDPs, by package and by health district
Pregnancy, Management Managing Health Disease # SDPs enrolled delivery, and Family and commodities communication management Intervention (SA+Action Plan) post-partum Planning (P2) organization of and essential and promotion Medical region (P3) districts (P1) services (P4) medicines (P5) (P6) 2nd 2nd 2nd 2nd 2nd 2nd Public Private Total 1st Visit 1st Visit 1st Visit 1st Visit 1st Visit 1st Visit Visit Visit Visit Visit Visit Visit Darou Mousty 15 0 15 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% Louga Koki 11 0 11 64% 45% 36% 27% 36% 36% 82% 73% 82% 73% 55% 45% Dahra 9 2 11 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% Diamniadio 15 1 16 44% 38% 50% 50% 56% 44% 50% 31% 44% 25% 56% 38% Rufisque 46 0 46 20% 20% 9% 7% 15% 11% 9% 4% 33% 24% 26% 20% Pikine 11 9 20 20% 20% 40% 40% 25% 25% 25% 25% 20% 20% 25% 25% Dakar Keur Massar 12 10 22 36% 32% 36% 36% 32% 32% 27% 18% 32% 32% 36% 36% Mbao 14 7 21 19% 14% 19% 10% 24% 10% 24% 14% 19% 14% 19% 14% Guédiawaye 14 9 23 13% 4% 17% 9% 17% 4% 9% 4% 9% 4% 9% 9% Diourbel 23 0 23 26% 17% 26% 17% 26% 17% 52% 35% 52% 35% 13% 9% Touba 26 9 35 57% 57% 29% 29% 26% 26% 29% 29% 29% 29% 29% 29% Diourbel Bambey 28 0 28 29% 25% 14% 11% 14% 14% 18% 18% 18% 18% 18% 18% Mbacké 21 1 22 14% 14% 18% 14% 14% 14% 32% 27% 32% 27% 0% 0% Foundiougne 10 1 11 45% 27% 45% 36% 36% 27% 82% 64% 73% 64% 55% 36% Passy 9 0 9 78% 67% 89% 67% 78% 67% 89% 67% 78% 67% 78% 67% Fatick Gossas 8 4 12 33% 0% 17% 0% 33% 0% 33% 0% 33% 0% 33% 0% Fatick 27 3 30 20% 10% 33% 3% 13% 13% 17% 17% 17% 17% 30% 3%
Pregnancy, Management Managing Health Disease # SDPs enrolled delivery, and Family and commodities communication management Intervention (SA+Action Plan) post-partum Planning (P2) organization of and essential and promotion Medical region (P3) districts (P1) services (P4) medicines (P5) (P6) 2nd 2nd 2nd 2nd 2nd 2nd Public Private Total 1st Visit 1st Visit 1st Visit 1st Visit 1st Visit 1st Visit Visit Visit Visit Visit Visit Visit Sokone 15 5 20 30% 0% 20% 0% 25% 0% 30% 0% 30% 0% 30% 0% Niakhar 7 1 8 25% 13% 0% 0% 25% 0% 38% 0% 38% 0% 25% 13% Diofior 13 3 16 19% 0% 25% 0% 25% 0% 19% 0% 19% 0% 25% 0% Goudomp 15 1 16 50% 44% 50% 44% 69% 69% 119% 106% 119% 106% 56% 50% Sédhiou Bounkiling 20 0 20 55% 45% 45% 30% 50% 35% 55% 40% 70% 40% 45% 35% Sédhiou 16 0 16 31% 13% 31% 6% 38% 13% 31% 19% 31% 13% 25% 19% Kaolack 34 28 62 35% 21% 37% 23% 29% 24% 35% 29% 35% 29% 32% 23% Ndoffane* 16 6 22 41% 36% 41% 36% 41% 36% 45% 45% 45% 36% 41% 36% Kaolack Guinguineo* 19 1 20 40% 40% 40% 40% 30% 25% 40% 35% 35% 35% 40% 40% Nioro* 31 6 37 32% 24% 38% 32% 35% 30% 16% 14% 19% 11% 16% 14% Kidira 14 2 16 0% 0% 0% 0% 50% 25% 13% 0% 0% 0% 0% 0% Tambacounda Goudiry 12 2 14 0% 0% 0% 0% 71% 71% 0% 0% 0% 0% 0% 0% Koumpentoum 13 1 14 0% 0% 0% 0% 14% 7% 0% 0% 0% 0% 0% 0% Kolda 26 8 34 18% 12% 12% 9% 15% 9% 21% 15% 21% 12% 12% 6% Médina Yoro Kolda 10 0 10 90% 80% 40% 40% 30% 30% 60% 30% 60% 30% 30% 10% Foulah Vélingara 24 0 24 8% 4% 25% 0% 13% 0% 17% 0% 17% 0% 13% 0% Koungheul 17 2 19 37% 26% 32% 26% 26% 21% 32% 26% 32% 26% 37% 21% Malem Hodar 17 0 17 53% 18% 41% 35% 47% 35% 65% 41% 65% 41% 29% 24% Kaffrine Birkilane 14 0 14 57% 50% 71% 43% 50% 21% 71% 50% 71% 50% 64% 43% Kaffrine 21 2 23 17% 4% 17% 4% 17% 9% 30% 22% 30% 22% 17% 4% Matam Matam 11 0 11 36% 36% 0% 0% 55% 45% 0% 0% 0% 0% 0% 0%
Pregnancy, Management Managing Health Disease # SDPs enrolled delivery, and Family and commodities communication management Intervention (SA+Action Plan) post-partum Planning (P2) organization of and essential and promotion Medical region (P3) districts (P1) services (P4) medicines (P5) (P6) 2nd 2nd 2nd 2nd 2nd 2nd Public Private Total 1st Visit 1st Visit 1st Visit 1st Visit 1st Visit 1st Visit Visit Visit Visit Visit Visit Visit Thilogne 10 0 10 0% 0% 10% 0% 40% 30% 0% 0% 0% 0% 0% 0% Ranérou 14 0 14 43% 0% 29% 0% 29% 7% 0% 0% 0% 0% 0% 0% Podor 35 1 36 19% 11% 17% 11% 33% 22% 33% 22% 33% 22% 25% 19% Saint Louis 21 4 25 32% 32% 24% 24% 32% 32% 32% 32% 32% 32% 16% 16% Saint Louis Dagana 14 2 16 19% 19% 19% 19% 19% 19% 19% 19% 19% 19% 13% 13% Pete 26 1 27 22% 4% 11% 4% 22% 7% 22% 7% 22% 7% 4% 4% Richard Toll 22 1 23 9% 4% 17% 9% 9% 4% 17% 9% 17% 9% 9% 4% Saraya 12 0 12 8% 0% 17% 0% 17% 0% 17% 0% 17% 0% 0% 0% Kédougou Kédougou 10 0 10 0% 0% 60% 40% 40% 10% 50% 30% 30% 10% 80% 50% Salémata 8 0 8 38% 13% 38% 13% 50% 13% 38% 13% 38% 13% 38% 13% Thiès 32 24 56 55% 52% 30% 21% 55% 41% 54% 45% 50% 41% 54% 43% Popenguine 8 2 10 90% 90% 80% 80% 80% 70% 80% 80% 60% 90% 90% 90% Joal-Fadiouth 7 3 10 60% 50% 30% 20% 80% 40% 90% 40% 90% 40% 70% 40% Thiadiaye 10 2 12 58% 50% 25% 25% 67% 67% 50% 25% 50% 25% 67% 67% Thiès Mbour 22 12 34 32% 18% 26% 18% 50% 38% 29% 24% 24% 24% 21% 15% Tivaouane 23 0 23 50% 29% 25% 11% 46% 32% 54% 32% 54% 32% 25% 25% Pout 9 0 9 33% 22% 33% 22% 33% 22% 33% 22% 33% 22% 33% 22% Khombole 16 0 16 19% 6% 19% 6% 13% 6% 19% 0% 19% 0% 19% 6% Mékhé 19 0 19 5% 0% 11% 5% 16% 5% 11% 5% 11% 5% 11% 5% Ziguinchor Ziguinchor 22 6 28 54% 32% 54% 46% 39% 32% 61% 54% 61% 54% 54% 46%
Pregnancy, Management Managing Health Disease # SDPs enrolled delivery, and Family and commodities communication management Intervention (SA+Action Plan) post-partum Planning (P2) organization of and essential and promotion Medical region (P3) districts (P1) services (P4) medicines (P5) (P6) 2nd 2nd 2nd 2nd 2nd 2nd Public Private Total 1st Visit 1st Visit 1st Visit 1st Visit 1st Visit 1st Visit Visit Visit Visit Visit Visit Visit Bignona 28 2 30 33% 23% 33% 30% 60% 53% 53% 53% 57% 53% 33% 30% Diouloulou 18 1 19 53% 37% 37% 32% 37% 26% 53% 42% 53% 42% 21% 11% Oussouye 13 2 15 47% 40% 20% 13% 40% 40% 47% 40% 47% 40% 60% 60% Thionck Essyl 14 1 15 27% 7% 33% 13% 20% 20% 33% 33% 27% 27% 27% 20%
Annex 3: Summary of IPQS training
IPQS areas Regions Targets Number of individuals Achieve- Number of SDPs affected for trained ment Year 4 M W Total rate Heath Health Hos- Semi- Total center post pital public and pri- vate Training for providers on FP counseling Sédhiou 60 21 39 60 100% 3 33 1 3 40
Training for providers on LTPM/FP Sédhiou, Diourbel, 140 32 47 79 52% 7 48 2 6 63 Ziguinchor Training for providers on the PP/IUD Diourbel 22 3 19 22 100% 2 0 2 0 4
Training for providers in basic EmONC Diourbel, Kaffrine, Kolda, 384 3 120 123 32% 22 24 11 2 59 Fatick, Ziguinchor Training for trainers on urgent care, Fatick; Tambacounda 150 100 88 188 125% 11 43 2 5 61 emphasizing obstetric and neonatal emergencies Training for providers on focused ANC Dakar, Sédhiou 96 20 84 104 108% 6 57 1 5 69 Fatick Nutrition applied to the life cycle Louga , Diourbel, 438 107 179 286 65% 25 147 3 10 185 Kédougou, Ziguinchor, Saint Louis
IPQS areas Regions Targets Number of individuals Achieve- Number of SDPs affected for trained ment Year 4 M W Total rate Heath Health Hos- Semi- Total center post pital public and pri- vate Training for ECRs/ECDs and providers on Saint Louis, Dakar 225 80 107 187 83% 24 99 1 4 128 revised MAM Training for providers in eMTCT Kédougou 22 4 18 22 100% 2 0 0 0 2
Training for providers on WHO Anthro Kaolack 260 13 8 21 8% 4 11 1 0 16 software Training for providers on malaria case Kaolack, Kolda 309 130 179 309 100% 8 113 2 26 149 management Training for providers on PIPE in a context Dakar, Tambacounda, 800 193 149 342 43% 13 236 1 12 262 of Ebola Kédougou, Kolda, Sédhiou, Ziguinchor Training for providers on the new EPI Diourbel, Tambacounda, 77 83 69 152 197% 8 81 1 13 103 guide Fatick
Annex 4: Integration of FP and vaccination
No. of No. of No. of PNC No. of No. of individuals reached New users of FP methods Enrollment REGION SDPs children consultations sessions rate vaccinated conducted M W T PILL INJECTABLE IMPLANT IUD SDM TOTAL DAKAR 80 107 3149 3256 2253 318 235 451 171 49 112 1018 32%
DIOURBEL 205 15 5168 5183 5743 957 212 522 93 16 3 846 16%
FATICK 111 0 4150 4150 4911 0 54 283 148 5 0 490 12%
KAFFRINE 22 0 654 654 1014 79 43 74 21 3 0 141 22%
KAOLACK 70 0 2702 2702 2448 497 196 382 171 61 17 827 31%
KEDOUGOU 16 0 197 197 0 0 1 16 9 1 0 27 14%
KOLDA 257 1265 12,471 13,736 10,583 1350 169 1378 431 22 0 2000 16%
LOUGA 107 1618 3339 4957 4396 351 284 288 105 31 0 708 21%
SAINT LOUIS 387 0 15,370 15,370 9235 1500 1403 2491 400 99 0 4393 29%
SEDHIOU 104 401 5430 5831 2487 547 148 1043 799 18 3 2011 37%
THIES 190 0 6028 6028 4747 1249 482 1040 358 79 6 1965 33%
ZIGUINCHOR 62 132 2158 2290 2260 368 36 117 99 6 13 271 13%
GRAND TOTAL 1611 3538 60,816 64,354 50,077 7216 3263 8085 2805 390 154 14,697 24%
Annex 5: Summary of results of the implementation of integrated advanced strategies
Number of Children’s health ANC PNC Number of District huts Children Child ITNs ANC ITNs New users AS visits D1–D3 D4–D15 D16–D42 supervised vaccinated vitamin A distributed visits 1–4 distributed DAKAR 39 39 632 326 405 256 37 21 40 21 204 DIOURBEL* 296 185 23,367 2511 1472 1880 0 258 0 0 3214 FATICK 0 0 0 0 0 0 0 0 0 0 0 KAFFRINE 253 240 13,108 3930 284 1372 70 134 192 159 468 KAOLACK* 1141 633 32,249 2570 288 9222 465 1029 1268 1070 2793 KEDOUGOU 5 5 65 3 6 14 3 0 2 1 17 KOLDA* 1172 455 34,009 6526 2067 10,403 306 4331 2560 3487 1567 LOUGA 304 643 3528 1214 301 1471 377 159 245 282 1443 MATAM SAINT LOUIS 88 55 1061 436 3 201 57 16 41 35 209 SEDHIOU* 558 400 14,797 682 1353 7004 173 275 504 389 1605 TAMBA THIES* 951 1065 70,001 42,505 3915 4714 29 933 18 10 3623 ZIGUINCHOR* 110 100 886 251 145 179 55 48 45 16 356
GRAND TOTAL 4917 3820 193,703 60,954 10,239 36,716 1572 7204 4915 5470 15,499 * Direct financing data
Annex 6: Planning tools for ECRs and ECDs
Annex 7: Sample sermon
PROTECTION DURING PREGNANCY AND DELIVERY
First sermon
Praise be to Allah, the most truthful Who says in His Noble Book: “And no female conceives, or lays down (her load), but with His knowledge.” (Surah 35, Verse 11) as He also said, “We cause whom We will to rest in the wombs for an appointed term, then do We bring you out as babes, then (foster you) that ye may reach your age of full strength; and some of you are called to die, and some are sent back to the feeblest old age, so that they know nothing after having known (much).” (Surah 22, Verse 5)
I profess no deity except that of the One Who has no equal, and his kingship and recognition as Holder of absolute power over all things.
I attest that our revered Muhammed is in essence the slave to Allah, and the mission of his messenger is to spread mercy to all creatures. The latter is the Doctor for the spirit, the body, and behaviors; His words do not suffer any passion. It is he who says: “Every one of you is a shepherd and each of you is responsible for his flock.”
May the peace and blessings of Allah be upon Him, upon his family, upon his virtuous companions, and upon all those who follow them in goodness.
I take refuge with Allah against impulses and wrongdoings coming from our spirit, aware that man is only guided without the risk of straying through divine guidance; moreover, He leads astray whom He wills of His righteousness.
In effect,
The period of pregnancy and childbirth in a woman's life is full of dangers, to the point that Allah says, “In pain did his mother bear him, and in pain did she give him birth. The carrying of the (child) to his weaning is (a period of) thirty months.” (Surah 46, Verse 15)
Despite all this, some people do not place enough importance on these dangers. This is the period when the woman needs the most medical and psychological assistance. Therefore, at this precise time she is closer to death than to survival. And they are few who return safely from this journey (childbirth). This is the cause of maternal and newborn death. This is a common phenomenon in the villages of Senegal.
What is the opinion of Islam?
Oh ye Muslims
The goal of Islam is to provide protection to the pregnant woman and the infant. The Prophet (PBUH) has always voiced prayers in support of this. And when childbirth is difficult, He ordered that a few Koranic verses be written down, soaked in water, and given to the woman to drink and placed on her womb. The Koran also gives us the example of the Virgin Mary in these terms: “So she conceived him, and she retired with him to a remote place. And the pains of childbirth drove her to the trunk of a palm-tree: She cried (in her anguish): ‘Ah! Would that I had died before this! Would that I had been a thing forgotten and out of sight!’” (Surah 19, Verse 22, 23)
Had it not been for Allah's protection in these painful moments in a remote place without a doctor, Mary would have died from the severe pain.
This protection for pregnant women and infants began when the Prophet ordered [followers] to choose a chaste spouse in order to produce a healthy child in these terms: “choose a good receptacle for your sperm.”
After marriage, five rights are granted to a pregnant woman and nursing mother:
1- The right of fetus to be protected without transgression. The Prophet has required that all those who jeopardize the fetus through abortion when there are no unavoidable constraints must seek atonement. 2- The right of the pregnant woman to not fast during the month of Ramadan to protect the fetus, the infant, and the nursing mother. And when the pregnant woman and the nursing mother fear for their health and that of their children, they are allowed to not fast during the month of Ramadan. According to Anas ibn Malik, may Allah be satisfied with them, the Prophet said: “Allah has reduced the prayer to half for the traveler, and pregnant and nursing women are spared from fasting.”
In his book “Al-Mughni” ibn Qudamah specifies: “If they fear for their lives, they must break the fast and do it later. And if they fear for their children, they break the fast and do it later with the condition of feeding the needy every day.”
3- The right to delay corporeal punishment that a pregnant woman and the nursing mother who fornicates must endure, for fear of harming the infant or fetus, who has not committed any wrongdoing. Allah said: “And every soul earns not [blame] except against itself” (Surah 6, Verse 164)
Lastly, what Muhaz ibn Jabal said confirms this; according to him, the Prophet says: “When a pregnant woman expressly kills someone, she will only be punished after giving birth and providing proper care to her infant.”
4- The right of the pregnant woman and the nursing mother to be supported financially is an obligation if you believe in Allah: “And if they should be pregnant, then spend on them until they give birth.” (Surah 65, Verse 6)
And expenditures cover all health and food requirements from early pregnancy through the full term. As everyone knows, they have an urgent need for intense health care and nutritional support during this period.
5- The right to inheritance and to will and testament: Al Khurtubi (may Allah be satisfied with him) says: “The ulema agree on the fact that when a man dies while his wife is pregnant, the child living in her womb inherits from him if the child is born healthy, otherwise they say that if the child is not alive at birth, he or she will not receive the father’s inheritance.”
O ye believers
I confirm that this is my intention, “...And those are the limits [set by] Allah And whoever transgresses the limits of Allah has certainly wronged himself.” (Surah 65, Verse 1)
Second sermon
Praise be to Allah Who says in the Holy Koran: “And what is [the matter] with you that you fight not in the cause of Allah and [for] the oppressed among men, women, and children?” (Surah 4, Verse 75)
I profess no deity except that of the One Who has no equal, and his kingship and recognition as Holder of absolute power over all things.
I attest that our revered Muhammed is in essence the slave to Allah, and the mission of his messenger is to spread mercy to all creatures. The latter is the Doctor for the spirits and actions, may Allah reward him constantly, He who says: “Allah will ask each responsible individual about his prerogatives, namely whether he has made good use of them or not. Man will be questioned about his family.”
May the peace and blessings of Allah be upon Him, upon his family, upon his virtuous companions, and upon all those who follow them in goodness.
I beseech you to fear and worship Allah, the two best ways to be closer to Him on the day when a soul will not possess for another soul; for the commandment will be with Allah.
Oh ye Muslims:
Islam is a religion of mercy, therefore Allah, the Almighty, said to his Prophet (PBUH) “And we have not sent you, [O Muhammad], except as a mercy to the World.” (Surah 21, Verse 107)
The way Islam has protected pregnant women and infants never existed in the other religions that came before it. The Prophet Moussa was carried in the womb and brought into this world during a complicated political situation. The Pharaoh, the dictator king, had all the boys who were born slain, yet Allah spared Moussa and his mother the moment he was born. Therefore, we must not neglect the guidance that Islam offers us about protecting women, especially in these specific instances.
I confirm that this is my intention, “The word of thy Lord doth find its fulfilment in truth and in justice. None can change His words.” (Surah 6, Verse 115)
“Our Lord! Grant us what You promised us through Your messengers. And do not disgrace us on the Day of Resurrection. Indeed, You do not fail in [Your] promise." (Surah 3, Verse 194)
“Our Lord! Take us out of this city of oppressive people and appoint for us from Yourself a protector and appoint for us from Yourself a helper.” (Surah 4, Verse 75)
“Our Lord! We have believed, so register us among the witnesses of the truth of the Koran” (Surah 5, Verse 83)
Please rise for the prayer to Allah to forgive you and, of course, all Muslims, wherever they may be.
Annex 8: mEbola Concept Note mEbola is a technological solution to ensure better preparation in the Ebola virus disease (EVD) response. It will replicate mHero, a technological solution used in the sub-region in the EVD response.
What is mHero? mHero is a free communications tool, based on a mobile phone system that uses text messages (SMS) and interactive voice response technologies to connect the Ministry of Health, health care providers, and community health workers on a shared platform. Initially developed to support the global response to EVD, this communications and coordination platform can address the communications challenges that sometimes exist between care providers and the systems that support them. By establishing a real dialogue, mHero allows staff and Ministries of Health to be much more connected than before. In addition, this platform plays a key role in facilitating the effective and efficient implementation of responses in periods of crisis as well as in other contexts.
Strictly speaking, mHero is not a software. Rather, this system unites several existing open source systems that communicate with each other in a coordinated fashion using open standards and leveraging open health information exchange principles. The mHero platform brings together four globally recognized technologies:
RapidPro (www.rapidpro.io), developed by Unicef, is the next generation of the open- source RapidSMS platform that is widely used today. RapidPro is for programming specialists, and not technicians, who want to easily create SMS-based workflows to monitor programs, track activities, or engage with beneficiaries. iHRIS (www.ihris.org) is an open-source human resources information system supported by the CapacityPlus project, which is funded by USAID and directed by IntraHealth. This easy-to-use software is currently implemented in 19 countries giving managers responsible for health worker deployment relevant data on providers and their respective positions. iHRIS gives limited-resource countries the opportunity to optimize their limited health workforce by supporting decision making with high quality data that gathers health worker contact information, information on their deployments, the positions they hold, their cadres, their skills, their qualifications, and more. DHIS2 (www.dhis2.org) is a health information management system adopted by 46 countries and 23 organizations across 4 continents. It helps governments and health organizations to manage their operations more efficiently, to monitor the various processes, and to improve communications. OpenHIE (www.ohie.org) is a global initiative for open-source collaboration dedicated to strengthening health information sharing on a national scale in resource-limited settings.
mHero works by supporting the interoperability of iHRIS and RapidPro through OpenHIE architecture. mHero can immediately use iHRIS data on the health workforce to send specific messages (by health worker cadre, location, or other filters) to health workers whose mobile phone numbers are listed in the iHRIS database and whose establishments are connected to the DHIS2 system. These connections, which can be activated at the central or local level, go well beyond the broadcast messages offered by many technology providers. mHero can easily perform real-time monitoring, complex surveys with multiple objectives, and detailed analyses.
The mEbola platform in Senegal
The mEbola platform operates through the interoperability of iHRIS and RapidPro to inform, alert, and monitor preparations for the MVE response. It targets health workers and communities, especially youths in the Kolda region.
Annex 8: Equipment and supply inventory for 31 October 2015
See electronic file attached to the report.