USAID’s Maternal and Child Survival Program

(MCSP) - Child Health (CH)

Quarterly Progress Report

October1, 2017 to December 31, 2017

Cover photo by Kate Holt, MCSP USAID/Uganda Quarterly Progress Report (Program Year 4)

Project Name: USAID’s Maternal and Child Survival Program (MCSP) Uganda Child Health (CH) Program Reporting Period: October 1, 2017 to December 31, 2017

Obligation Funding Amount:

Project Duration: August 2016 to December 2018

Program Year (PY4): October 1, 2017 to September 30, 2018

Person Responsible for this Report: Dr. Ssekitto Kalule Gerald – Chief of Party, MCSP

Program Goal: To contribute to a reduction in child mortality in the Southwest (SW) and East Central (EC) .

Program Purpose: With USAID Uganda’s Regional Health Integration to Enhance Services (RHITES) partners, identify, implement, and test a package of low cost, high impact, evidence- based CH interventions that can be applied at different levels of the health care system and contribute to a reduction in child mortality.

Program Objectives: 1. Enhance national guidelines and frameworks to support implementation of the essential CH package. 2. Strengthen technical skills, competencies and practices of the RHITES partners and MCSP-supported demonstration districts to implement the essential CH package. 3. Strengthen district level management and planning practices to support the delivery of the essential CH package using adapted REC-QI approaches. 4. Conduct a costing analysis for delivery of the essential CH package. 5. Improve availability of strategic knowledge and tools to scale-up the essential CH package.

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MCSP Uganda–CH PY4 Q1 Report Acronym List

ADHO Assistant District Health Officer AOR Agreement Officer’s Representative CAO Chief Administrative assistant CDSR Child Death Surveillance Response CH Child Health CHC Communication for Healthy Communities CHEW Community Health Extension Worker CHMIS Community Health Management Information Systems CHO Child Health Officer COP Chief of Party CSS National Child and Newborn Survival Strategy DHIS2 District Health Information System 2 DHMT District Health Management Team DHO District Health Officer DHT District Health Team DL Distance Learning DQA Data Quality Audit DQS&I Data Quality Self-Assessment and Improvement EC East Central Region ECD Early Childhood Development EOP End of Program EPCMD Ending Preventable Child and Maternal Deaths EPI Expanded Programme on Immunization FP Family Planning FY Fiscal Year HC Health Centre HF Health Facility HIS Health Information System HMIS Health Management Information System iCCM Integrated Community Case Management IMCI Integrated Management of Childhood Illness IMNCI Integrated Management of Neonatal and Childhood Illness IP Implementing Partners ISS Integrated Support Supervision IYCF Infant and Young Child Feeding JSI John Snow, Inc. LC Local Council LOP Length of Program MCH Maternal and Child Health MCHIP Maternal and Child Health Integrated Program MCSP USAID’s Maternal and Child Survival Program MEL Monitoring, Evaluation, and Learning MNCH Maternal, Newborn and Child Health MOU Memorandum of Understanding MoH Ministry of Health – Uganda MSI Management Systems International OPD Outpatient Department

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MCSP Uganda–CH PY4 Q1 Report ORS Oral Rehydration Salts ORT Oral Rehydration Therapy PEPFAR U.S Presidents Emergency Plan for AIDS Relief PHC Primary Health Care PMTCT Prevention of Mother-to-Child Transmission PMP Performance Monitoring Plan PS Permanent Secretary PY Program Year QI Quality Improvement QoC Quality of Care QRM Quarterly Review Meetings REC-QI Reaching Every Child-Quality Improvement RED Reaching Every District RDC Resident District Commissioner RHITES Regional Health Integration to Enhance Service RMNCH Reproductive, Maternal, Newborn, and Child Health RMNCAH Reproductive, Maternal, Newborn, Child and Adolescent Health SIC Short Interrupted Course SPRING Strengthening Partnerships, Results, and Innovations in Nutrition Globally SS Supportive Supervision SW South West Region U5 Under Five (5) Years of Age UNEPI Uganda National Expanded Programme on Immunization ToT Training of Trainers TOR Terms of Reference TWG Technical Working Group UHVP Uganda Reproductive Health Voucher Program UNICEF United Nations Children’s Fund USAID United States Agency for International Development VHT Village Health Teams WHO World Health Organization WHO AFRO World Health Organization Regional Office for Africa

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MCSP Uganda–CH PY4 Q1 Report I. Introduction

The Maternal and Child Survival Program (MCSP) is a global U.S. Agency for International Development (USAID) cooperative agreement to introduce and support high-impact health interventions in 25 priority countries with the ultimate goal of preventing child and maternal deaths. MCSP is currently implementing two programs in Uganda: the Routine Immunization program (MCSP RI) which works with the Ministry of Health (MOH) and its Uganda National Expanded Programme on Immunization (UNEPI) to operationalize the Reaching Every Child/Community using Quality Improvement Approach (REC-QI) in eleven districts (2014-2019); and the Child Health program (MCSP CH) which is an eighteen-month technical assistance program (e.g., May 2017-October 2018 for in-country implementation, and November-December 2018 for closeout) to provide tailored support in the area of CH to the USAID’s Regional Health Integration to Enhance Services (RHITES) in South West (SW) and East Central (EC) regions. Though the initial Program Description was issued in August 2016, the program scope transitioned from Reproductive, Maternal, Newborn, and Child Health (RMNCH) to exclusively Child Health technical assistance in January 2017 and the concept note was approved on March 14, 2017. Provisional approval for the detailed MCSP CH implementation plan was granted in May 2017, and full approval was provided in August 2017.

USAID’s RHITES projects are working with the Government of Uganda to support implementation of the Uganda Reproductive, Maternal, Newborn, Child, and Adolescent (RMNCAH) Sharpened Plan, which includes a package of low cost, high impact, evidence-based RMNCAH interventions that can be applied at different levels of the health system to reduce mortality. The RHITES projects work directly with the districts they serve and at the central level to assist with national scale up of the package. The expected result of MCSP’s tailored technical assistance for CH is a standardized CH package across the RHITES projects, that determines the costs involved and gathers learning on the feasibility of implementing the package in an integrated way in four demonstration districts (e.g., Luuka, , and Districts), and lessons learned to inform national level CH policy and program updates.

This quarterly report summarizes the progress and achievements of MCSP CH for the period of October 1, 2017 to December 31, 2017.

II. Summary of PY4-Quarter 1 Achievements

Activities Planned Activities Accomplished Objective 1: Enhance national guidelines and frameworks to support implementation of the essential CH package Finalise IMNCI training materials IMNCI materials for the initial phases of training were produced and job aids and printed.

Participation in national monthly Two IMNCI training approaches in the four MCSP level technical working demonstration districts were endorsed by MOH Maternal Child groups/policy review meetings Health (MCH) Cluster for demonstration and documentation on 6 October 6 2017. Participation in the Community MOH confirmed that IPs should continue with village health Health Extension Workers team (VHT)-related activities which are planned for the current National Strategy–Implementing fiscal year. It was clarified that the Community Health Extension Partner’s (IP’s) Breakfast Meeting Workers National Strategy will be operationalized by June 2018.

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MCSP Uganda–CH PY4 Q1 Report Activities Planned Activities Accomplished Objective 2: Strengthen competencies and practices of RHITES IPs and focus districts to implement the Essential CH package IR1: Conduct national and regional Training of Trainers (ToTs) to roll out essential CH package Conduct regional ToTs for IMNCI MCSP CH completed the regional IMNCI ToT facilitation skills for RHITES EC and SW course for the RHITES EC program area, with a total of 12 participants (4M: 8F) trained, out of the 22 participants who attended the regional IMNCI basic course in EC region.

IR2: RHITES supported to train health workers on IMNCI and IMNCI referral component in MCSP demonstration districts Review and adapt mentorship / MCSP CH produced, pre-tested, and finalized integrated CH supportive supervision (SS) mentorship and SS tools and process. tools for district trainings and on- site mentorship Support and participate in district Distance learning: MCSP supported RHITES and Sheema level, blended-learning IMNCI District trainers to conduct 5 sessions of the first phase of the training for health facilities in IMNCI distance learning (DL) module in Sheema. A total of 111 Sheema and Ntungamo Districts in health workers (70F:41M) were trained from 32 of 35 health SW facilities in .

Short interrupted course: MCSP supported RHITES and District trainers to conduct 4 sessions of the first phase of the IMNCI Short Interrupted Course (SIC) in Ntungamo. A total of 97 health workers (61F:36M) were trained from 41 of 44 health facilities in . Support and participate in district DL: MCSP supported RHITES and District trainers to conduct 6 level, blended-learning IMNCI sessions of the first phase of the IMNCI DL module for Kaliro training for health facilities in Kaliro and Kamuli. A total of 124 participants (83F:41M) were trained and Luuka Districts in EC from 20 of 21 health facilities in Kaliro, and 28 of 58 health facilities in .

SIC: MCSP supported RHITES EC and IMNCI trainers to conduct 4 sessions of the first phase of the IMNCI SIC in Luuka. A total of 76 participants (55F:21 M) were trained from 36 of 37 health facilities in Luuka District. Support for on-site post-training MCSP updated and field tested the integrated CH mentorship visits in each of the four districts and SS tools. As part of the field testing MCSP CH in collaboration with MOH and RHITES SW, conducted post- training mentorship and SS for 14 trainees (4F:10M) out of 21 trainees who attended the regional IMNCI basic course in SW region. MCSP collaborated with RHITES EC to conduct training follow up for 65 of the 76 participants who attended the first phase of the IMNCI SIC for Luuka District.

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MCSP Uganda–CH PY4 Q1 Report Activities Planned Activities Accomplished IR3: RHITES and MCSP demonstration districts equipped with job aids, mentorship tools and equipment to implement the essential CH package Update, print and distribute job aids MCSP printed and distributed IMNCI job aids to all trainees and and IEC materials to facilitate health facilities in the four demonstration districts, including implementation of essential CH IMNCI chart booklet, wall charts, counselling cards, and package recording forms. Soft copies of the materials were made available to RHITES EC and SW to enable them to print additional copies. Orient RHITES staff on the use of MCSP supported RHITES EC and SW teams and the district job aids trainers for all four demonstration districts to conduct orientation on the job aids for all health facility workers who participated in the IMNCI trainings. Equip health facilities in The procurement process for basic CH equipment was initiated, demonstration districts with basic and the quantities were reviewed and revised based on MCSP equipment including respiratory CH baseline results. timers, pulse oximeters, and materials for oral rehydration therapy (ORT) corners Objective 3: Strengthened district level management and planning practices using the adapted REC-QI to support the delivery of the essential CH package IR2: RHITES and MCSP district staff trained on introduction and planning for CH REC-QI package Conduct a national level ToT on MCSP in collaboration with the MOH, conducted a national introduction and planning for REC- orientation on the introduction and planning for REC-QI QI implementation implementation for a total of 21 trainers (10F:11M). These included both national trainers for IMNCI and REC-QI to facilitate integration. Provide support during planning MCSP in collaboration with RHITES EC and SW, conducted and implementation of a REC-QI orientations on REC-QI for the four demonstration districts as introduction and planning meeting follows: in each district Luuka and Kaliro: A two-day regional orientation on REC-QI was conducted for the two districts combined. The meeting reached a total of 65 participants (32F:33 M) from Luuka and 42 participants (28 M:14F) from . Participants included the district health team (DHT), health facility-in-charges of all health facilities in districts, CAO, Assistant CAO for Health, Local Council (LC) V chairman, RDC, Secretary for Health, Sub-county chiefs, parish chiefs, district planner and LC III chairmen and RHITES EC staff.

Ntungamo and Sheema: A two-day regional orientation on REC-QI was conducted for the two districts combined. The meeting reached a total of 47 participants (18F:29M) from Sheema District and 58 participants (24F:34M) from Ntungamo District. Participants for the meeting included DHT, HSD-in-

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MCSP Uganda–CH PY4 Q1 Report Activities Planned Activities Accomplished charges, health facility-in-charges, health inspectors, health assistants, and RHITES SW staff. IR3: RHITES and MCSP district staff trained on ISS per REC-QI Orientation on Integrated Support MCSP in collaboration with the MOH, conducted an orientation Supervision (ISS) for RHITES and on ISS as guided by the REC-QI approach for RHITES EC and district staff SW program staff and trainers/mentors from the four demonstration districts. Support RHITES and district health MCSP provided support and tools to RHITES EC and SW to management team (DHMT) to plan for IMNCI training follow up and SS in the four conduct follow up technical demonstration districts. RHITES EC was supported to conduct assistance during SS visits to lower training follow up for the IMNCI SIC participants in Luuka level health facilities District. A total of 65 of the 76 participants who attended the first phase of the IMNCI SIC for Luuka District were covered by the mentorship. IR4: RHITES IPs and MCSP district trained on VHT package Orientation on VHT package and MCSP in collaboration with MOH conducted a one-day conduct training of regional trainers orientation on the roll out of the VHT package for CH as part of at national level the REC-QI national orientation. A total of 21 (10 F:11M) regional trainers for IMNCI and REC-QI attended the orientation, and subsequently supported orientation of the district trainers and RHITES district program officers on the VHT package. Support trainings of district level MCSP in collaboration with RHITES EC and SW, conducted a trainers on VHT package one-day orientation for district level trainers on the VHT package. For the RHITES EC program area, a total of 72 (36F: 36M) participants including health facility-in-charges and DHMT, including the District Planner, underwent the orientation. Of the 72 participants, 47 (28F:19M) were from Luuka and 25 (8F: 17M) were from Kaliro. For the RHITES SW program area, a total of 72 (32F: 40M) participants including health facility-in- charges and the DHMT underwent the orientation. Of the 72 participants, 40 (17F: 23M) were from Ntungamo and 32 (15F: 17M) were from Sheema districts. Provide technical assistance to MCSP supported RHITES EC to conduct district-wide roll out of RHITES and DHMT during the VHT package targeting all health facilities and villages VHT orientation and health reaching a total of 487 (260F: 227M) from all the 8 sub- counties facility micro-mapping in Luuka. MCSP supported RHITES SW to conduct a roll out of the VHT package in 6 out of 15 sub-counties in Ntungamo district, reaching a total of 595 (365F: 230M). Objective 4: Conduct a costing analysis for delivery of the essential CH package. Costing of MCSP technical MCSP began prospective data collection on costs related to assistance MCSP’s support for roll out of the CH package. Data was collected from the start of the program through November 2017.

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MCSP Uganda–CH PY4 Q1 Report Activities Planned Activities Accomplished Costing of district-based partner In November 2017, MCSP met with RHITES SW and RHITES EC technical assistance programmatic and financial staff to develop a process for regular financial data collection related to their support for the roll-out of the CH package. Health financing assessment for As part of the MCSP health systems strengthening core-funded RMNCAH services (core-funded) PY4 workplan, MCSP completed a financing assessment focused on RMNCAH services in October 2017. The purpose of the assessment was to understand the opportunities to better address RMNCAH services through health financing reforms. MCSP shared a draft version of the report with USAID/Uganda and the MOH in December 2017. Objective 5: Improve availability of strategic knowledge and tools to scale-up the essential CH package. IR1: RED (Reaching Every District) Categorization Tool and MNCH Scorecard for monitoring of essential CH package adapted and used Adapt and facilitate use of RED MCSP developed a draft of the CH Scorecard to be used to map Categorization Tool, and MNCH and identify underserved catchment populations and Scorecard for monitoring the interventions with low coverage. essential CH package at all levels IR2: Strengthened capacity of health workers to use CH management information system (HMIS) tools and DHIS2 dashboards Train and mentor health workers MCSP supported orientation on the VHT Register of 72 health on the proper use of the CH HMIS worker and RHITES staff in each of the RHITES EC and SW tools and utilization of data to regions. MCSP in collaboration with RHITES partners supported inform planning the DHT and health facility-in-charges in Luuka and Ntungamo district to orient VHTs on the use of VHT Registers as part of the broader orientation on the VHT package for CH. IR3: Baseline report available and periodic data used for planning, implementation and ongoing progress review Collect baseline and periodic data Reviewed findings from baseline data analysis and developed a on outcomes and impact for CH, first draft of the baseline report. and use it for planning in each of the supported regions IR4: Improved capacity of RHITES and MCSP district staff to monitor timely submission of community and facility HMIS CH data Provide tools and technical support MCSP printed and worked with the RHITES partners in EC and to RHITES and MCSP districts to SW to distribute HMIS tools for collection of routine CH data at ensure submission of facility- and health facilities. community-based HMIS reports for CH

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MCSP Uganda–CH PY4 Q1 Report III. Description of Activities by Objective

Objective 1: Enhance national guidelines and frameworks to support implementation of the essential CH package

 Finalise IMNCI training materials and job aids MCSP completed the review of the latest drafts of the IMNCI training materials and job aids. Copies of the materials to launch the first phase of training were produced and printed. As part of the IMNCI training, MCSP will support the roll out and documentation of learning from the use of these materials. Lessons learned will be incorporated into a final version of the IMNCI training package at the end of the program.

 Participation in national level technical working groups/policy review meetings During the reporting period, MCSP participated in the MOH Maternal Child Health (MCH) Cluster monthly meeting on 6 October 2017 at Hotel Africana in . During the meeting, MCSP shared and received endorsement to proceed with the proposed demonstration and documentation of two IMNCI training approaches in the four MCSP demonstration districts. The two selected models are – 1) the WHO DL model comprising of three one-day, face-to-face sessions with four weeks in between the face-to-face to sessions for self-study and work-based experiential learning; and 2) the SIC, which is an adaptation of Uganda’s six-day abridged course. The two models were developed to improve skills acquisition and translation of knowledge into practice at the workplace, reduce cost for trainings, reduce duration away from service posts and therefore interruption of service delivery; and to facilitate rapid district-wide coverage.

In addition, MCSP participated in the Community Health Extension Workers (CHEWs) National Strategy–IP’s Breakfast Meeting held on 8 December 2017. The meeting aimed to share the CHEWs strategy with the IPs and confirm its operationalization by June 2018. Key outputs from this meeting included clarification on the transition plan for VHTs, and confirmation from MOH for IPs to continue with VHT engagement activities planned for the current fiscal year (eg, FY18). The guidance clarified and provided approval for the child community health activities involving VHTs to proceed as planned for FY18.

Objective 2: Strengthen competencies and practices of RHITES partners and MCSP demonstration districts to implement the essential CH package

 Conduct regional ToTs for IMNCI for RHITES EC and SW MCSP in collaboration with RHITES completed orientation of the IMNCI regional trainers in the RHITES EC region. A four-day facilitation skills course for the regional ToTs for RHITES EC was held from 17 to 20 October 2017 at MUM Resort Hotel in . Participant selection prioritised MCSP demonstration districts and staff who showed enthusiasm to translate what they had learnt into practice. The participants for this training included the MCSP Child Health Officer (CHO) for the RHITES EC region, two RHITES EC Program Officers for prevention of mother-to-child transmission (PMTCT)/RMNCH, and one participant from Kamuli district. Table 1 summarizes the participants in this training, which equipped regional trainers with techniques for delivering the IMNCI training using the materials provided during face-to-face sessions, as well as clinical sessions. Learning was facilitated through “how to” demonstrations conducted by the national trainers and “teach back” sessions by participants, with feedback and support from fellow peers and the national trainers.

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MCSP Uganda–CH PY4 Q1 Report Table 1: Participants for the IMNCI Facilitation Skills Course for the RHITES EC region by District/Place of Work.

Place of work Female Male Kaliro 3 2 Luuka 3 2 Kamuli 1 MCSP 1 TOTAL 8 4

 Provide technical assistance to RHITES and MCSP demonstration districts to implement IMNCI training using DL and SIC models MCSP in collaboration with MOH and RHITES EC and SW began implementing the DL and SIC models for conducting IMNCI trainings for frontline health workers. The trainings were conducted by the recently trained district trainers with support from the RHITES CH Technical Advisors, District Program Officers, MCSP technical staff (CHOs, CH Advisor, and CH Team Lead) and National IMNCI Trainers.

The first phase of training using the DL model was rolled out in the demonstration districts of Kaliro (RHITES EC) and Sheema (RHITES SW). The participants for these trainings in both districts were frontline health workers who spend a significant proportion of their time managing children in outpatient clinics or on the ward. The training in Kaliro District also included participants from Kamuli District because trainings were organised in such a way that only one participant Trainer demonstrating how to check for anaemia to a group of trainees; IMNCI attended from a given health Training Iganga Hospital, 14 November 2017. Photo by A Namagembe. facility per session to minimise disruption of service delivery. Since Kaliro has a small number of sites, it was not possible to raise the minimum number of participants needed per session for three of the six training sessions for Kaliro. Therefore, participants from Kamuli were co-opted for these sessions to obtain minimum numbers of trainees required per session, although RHITES will provide all related technical support to Kamuli in the future. The training in both Kaliro and Sheema comprised of a one-day face-to-face session during which the frontline health workers were introduced to the IMNCI approach for case management of children; job aids for case management using the IMNCI approach; and modules for self-study about managing the main symptoms of common childhood illnesses. In addition, the participants were taken through a clinical session to demonstrate the IMNCI approach in a health facility setting. Participants in

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MCSP Uganda–CH PY4 Q1 Report each session were encouraged to form a study group to share learning across health facilities using social media. The participants will return for the second phase of the training after four weeks.

The training for Kaliro and Kamuli was conducted between 14 to 23 November 2017 for six groups at Hotel Continental in Iganga. The training for Kaliro was conducted outside the district because no suitable training facilities that included clinical training sites were available in the district. In Sheema, the training was conducted between 28 November to 6 December 2017 at Kitagata sub-county hall and Sun Beach Hotel Kabwohe. Table 2: Average number of staff trained per site by level of care, and proportion of participants trained by level of care in Kaliro and Sheema Districts. Kaliro (20 out of 21 health facilities Sheema (32 out of 35 health covered) facilities covered) Level of Care # of participants Average # of # of participants Average # of trained participants trained trained participants per site trained per site Health Centre II 31 3 48 2 Health Centre III 28 3 to 4 26 6 Health Centre IV 6 6 18 9 Hospital n/a n/a 19 19 Note: Trainings achieved expected minimum standard of at least 2 health workers managing children trained in IMNCI at each health facility. The first phase of IMNCI training using the SIC model was rolled out in the demonstration districts of Luuka and Ntungamo. Similar to the DL model, the participants for these trainings in both districts were frontline health workers who spend a significant proportion of their time managing children in outpatient clinics or on the ward. The trainings for both Luuka and Ntungamo Districts were comprised of two and a half-day classroom and clinical sessions. During the training, participants were introduced to the standard IMNCI algorithm (Assess, Classify, Identify treatment, Treat, Counsel and Follow up) of managing a child including key updates on the management and classification of children for danger signs and the four main symptoms (cough, diarrhoea, fever and ear problems), as well as malnutrition and anaemia. In addition, participants were trained on the various IMNCI tools including the chart booklet, the wall charts, and the recording forms. The training for Luuka district was conducted between 20 November and 2 December 2017 for four groups (24 participants per group) at Hotel Continental in Iganga. The training for Luuka, similar to the Kaliro training, was conducted outside of the district because no suitable training facilities that included clinical training sites were available in the district. In Ntungamo, the training was conducted in four sessions between 20 November and 1 December 2017 at Ntungamo Resort Hotel. Table 3: Average number of staff trained per site by level of care; and proportion of participants trained by level of care in Luuka and Ntungamo Districts. Luuka (36 out of 37 health facilities Ntungamo (41 out of 44 health covered) facilities covered) Level of Care # of participants Average # of # of participants Average # of trained participants trained trained participants per site trained per site Health Centre II 41 1-2 49 2 Health Centre III 31 10 30 3 Health Centre IV 4 4 14 3 to 4 Hospital n/a n/a 4 4 Note: Similar to the DL, trainings achieved expected minimum standard of at least 2 health workers managing children trained in IMNCI at each health facility. 12

MCSP Uganda–CH PY4 Q1 Report In the RHITES EC region, Iganga Municipal Health Centre III and Iganga General Hospital were used for clinical sessions; while in the RHITES SW region, Kitagata Hospital and Kabwohe HC IV for Sheema District and for Ntungamo District were used for the clinical sessions.

 Support on-site monthly mentorship post-training visits in each of the four districts MCSP updated and field tested the integrated CH mentorship and SS tools. As part of the field testing, MCSP in collaboration with MOH and RHITES SW conducted post-training mentorship and SS for 14 (4F:10M) trainees, out of 21 who attended the regional IMNCI basic course in SW region from 10 to 13 October 2017. Findings and feedback from field testing were used to finalise the tools.

Using the finalised tools, MCSP in collaboration with RHITES EC conducted training follow up for the IMNCI SIC participants in Luuka District. The onsite mentorship was conducted from 18 to 22 December for Luuka District. The primary target for the mentorship and SS at each of the health facilities were the IMNCI trainees, however, other members of the clinical care team involved in the management of children at the health facility also participated. The mentorship and SS at each health facility was conducted by a team of two persons (district trainer/mentor and a DHT member). Coordination of the teams was done by the Assistant DHO MNCH in collaboration with the National Trainers/Mentors. The following was achieved at each of the health facilities visited: o Orientation of the whole child care team about the CH intervention package, IMNCI approach and the expected changes in child care practices at the health facility o Discussion and agreement with the whole child care team about the roles of the different staff at the facility in supporting case management using the IMNCI approach and increasing coverage for the CH intervention package o Technical support to resolve challenges faced by clinical trainees in translating the knowledge acquired from IMNCI trainings into practice o Support to health facility teams to apply the REC-QI approach (micro mapping, health data review and monitoring, prioritising and targeting underserved communities in their service delivery plans) to improve the health facility performance in terms of increased access and coverage of the CH intervention package o Activation of a Quality Work Improvement Team (QWIT) for CH

 Update, print and distribute job aids and IEC materials to facilitate implementation of essential CH package MCSP printed and distributed IMNCI job aids including chart booklets, wall charts, counselling cards, and recording forms to all trainees and health facilities in the four demonstration districts. Soft copies of the Commented [KO1]: A number would be nice… materials were made available to RHITES EC and SW to enable them to print additional copies. Discussions with USAID’s Communication for Healthy Communities (CHC) were started to support translation of some of the job aids into local languages used in the RHITES EC and SW regions.

 Orient RHITES staff on use of IMNCI job aids MCSP supported the RHITES EC and SW teams, and the district trainers for all four demonstration districts to conduct orientation on the job aids for all health facility workers trained in IMNCI.

 Review and adapt mentorship/SS tools for district trainings and on-site mentorship MCSP developed draft copies of the integrated CH mentorship and SS tools and processes, which were pre-tested on participants from the regional IMNCI basic course for SW. The drafts were revised and reviewed together with RHITES, the DHT and the IMNCI national and regional trainers. Final copies incorporating feedback from the review were produced and will be used to support mentorship and SS

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MCSP Uganda–CH PY4 Q1 Report in all the MCSP CH demonstration districts; and subsequently, components will be adopted into tools used by RHITES for integrated mentorship and SS.

 Equip health facilities in demonstration districts with basic equipment including respiratory timers, pulse oximeters and materials for ORT corners Procurement of equipment for health facilities in the demonstration districts was initiated. Progress has been made in reviewing and revising quantities based on the MCSP CH baseline findings.

Objective 3: Strengthen district level management and planning practices using adapted REC-QI approaches to support delivery of the essential CH package.

 Conduct a national level ToT on introduction and planning for REC-QI adaptation to CH MCSP conducted a one-day meeting at NOB View Hotel, Ntinda on 26 October 2017 to orient stakeholders to the proposed REC-QI adaptation to CH. The meeting participants were national REC- QI trainers, national IMNCI facilitators, and representatives from other REC IPs such as UNICEF, WHO and CHAI. A draft REC Adaptation Guide to CH is under review. The orientation meeting achieved the following outputs: o Gathered feedback from key stakeholders on the REC adaptation process, tools and draft Guide, paving the way for district level orientation. Commented [KO2]: What is the plan for finalization and o National level facilitators were grouped into teams to support district level orientation planned adoption before the orientation next quarter. Considering how long these take, is it feasible to plan for orientation next for next quarter. quester?

 Provide support for planning and implementation of meetings in each district to introduce REC-QI adaptation to CH MCSP, in collaboration with RHITES EC and SW, supported two-day meetings on REC-QI for CH introduction and planning for all four demonstration districts. Combined meetings were held for the two districts in each region as a more pragmatic implementation approach compared to meeting the districts separately. The meetings were facilitated by the national/regional trainers on REC-QI for CH. For RHITES EC, the participants included the DHT; health facility-in-charges of all health facilities in the districts; non-health stakeholders; CAO, Assistant CAO for Health, Local Council (LC) V chairman, RDC, Secretary for Health, sub- county chiefs, parish chiefs, district planner and LC III chairpersons. On the first day of the meeting, the DHT, District Planner and health facility-in-charges reviewed and updated the mapping of communities to the health facilities delivering CH services and the performance of each service delivery unit, and developed action plans to address gaps in coverage of the CH intervention package. On the second day of the meeting, additional CH stakeholders joined Mapping parishes to health facilities by participants from Kaliro District, 2 from the district level. These February 2017. Photo by A. Namagembe

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MCSP Uganda–CH PY4 Q1 Report additional stakeholders were brought for orientation to the package of CH interventions, and discussion of the actions needed at various levels to improve coverage of the interventions. Additionally, the meeting harmonised and built consensus on the health facility catchment areas and action points for improving coverage of CH interventions in their district.

For RHITES SW, the meeting participants included DHT, HSD-in-charges, all health facility-in-charges, health inspectors, health assistants and RHITES SW staff. Unlike the meeting for RHITES EC, in the second day of the RHITES SW meeting they continued with review of the district performance and development of health facility microplans to improve coverage of the CH interventions. Engagement of the other district CH stakeholders will be conducted as a follow on activity at the district level. Key outputs from the meetings in both regions included: o Creation of a common understanding amongst the health facility-in-charges, DHT and other key stakeholders (for Luuka and Kaliro) on the health facility catchment areas and populations for CH service delivery; o Identification of underserved populations and development of action plans to increase service delivery to these populations; o Testing of a CH Scorecard to track coverage of CH interventions by the districts.

 Orientation on ISS for RHITES and district staff MCSP in collaboration with the MOH, conducted an orientation for RHITES EC and SW program staff and trainers/mentors from the four demonstration districts. The two-day orientation meeting was held at Ridar Hotel, Seeta 7 to 8 December 2017. The participants included MOH staff, IMNCI facilitators both from RHITES EC and SW program areas, national REC-QI trainers, national IMNCI trainers, CH technical advisors and district program officers from RHITES SW. Orientation on mentorship was provided and participants reviewed and provided input into the draft mentorship and SS tools and processes, and formed teams and developed plans for conducting IMNCI training follow up mentorship and SS in the four demonstration districts.

 Orientation to VHT package and training of regional trainers at national level MCSP in collaboration with MOH conducted a one-day orientation on the roll out of the VHT package for CH as part of the REC national orientation. A total of 21 (10 F:11M) national trainers for IMNCI and REC-QI attended the orientation, and subsequently supported orientation of the district trainers and RHITES district program officers on the VHT package.

 Support training of district level trainers on VHT package for CH MCSP in collaboration with RHITES EC and SW conducted a one-day orientation for district level trainers on the VHT package facilitated by national and regional trainers. As part of the training, the trainers revisited the basics of facilitation skills; the expected roles of VHTs in promoting CH at the community level; the key family care practices for CH; use of the VHT Register to register all children under five; compiling and using data from the VHT Register to increase coverage of CH interventions; reporting on community health management information systems (CHMIS) by health facilities; and supporting VHTs to promote CH at the community level. In both regions the participants included health facility-in-charges, DHMT, and the District Planner. The district trainers are expected to conduct refresher trainings for VHTs from their respective districts on the package of interventions for CH at the community level, including mapping and registration of households with children under five and identification of children not being reached with CH interventions through review of home-based records.

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MCSP Uganda–CH PY4 Q1 Report  Provide Technical Assistance to RHITES and DHMT during VHT orientation and health facility micro-mapping MCSP supported RHITES EC to conduct district-wide roll out of the VHT package by orienting VHTs on the CH intervention package in Luuka and Ntungamo. In Luuka district, the VHT orientation meetings were held from the 5 to 6 December 2017.

MCSP in collaboration with RHITES SW supported VHT orientation meetings from 6 to 14 December 2017. As part of the VHT orientation in both regions, VHTs were refreshed on their roles in promoting CH at the community level; the key family care practices for CH; mapping of their villages; registration of households with children under five; using home records to identify children missing out on the CH intervention package; and summarising their information for monthly reporting. The Mapping out villages in each parish to VHT members in Luuka District, 7 roll out also included distribution of VHT December 2017. Photo by A.Namagembe Registers to all VHTs and the start of village catchment population registration; identification and referral of children not being reached by the CH package by VHTs; and development of a process to improve reporting on CH as part of the CHMIS.

Objective 4: Conduct a costing analysis for delivery of the essential CH package.

 Develop and implement a system for costing of MCSP CH technical assistance MCSP continued to collect financial information on MCSP’s contributions to the roll-out of the CH package. The data includes direct costs and level of effort data since the beginning of the program.

 Develop and implement a system for costing of district-based partner technical assistance MCSP met with RHITES SW and RHITES EC to develop a data collection strategy for capturing partner’s support to rolling out the CH package in the selected demonstration districts.

 Conduct RMNCH focused health financing assessment (core funded) In October 2017, MCSP completed an RMNCH-focused health financing assessment, which looked at financing challenges related to RMNCH services. The assessment investigated both national and sub- national challenges, including understanding financing-related challenges at the facility level in two selected districts. The draft report was shared with USAID and the MOH for feedback in December 2017.

Objective 5: Improve availability of strategic knowledge and tools to scale-up the essential CH package.  Adapt and facilitate use of RED Categorization Tool, and MNCH Scorecard for monitoring the essential CH package at all levels

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MCSP Uganda–CH PY4 Q1 Report MCSP developed a draft of the CH Scorecard. The Scorecard was used during the district orientation meetings on REC-QI for CH to help district participants identify and map out communities that are under-served and CH interventions with low coverage. Commented [KO3]: I have a problem with the draft scorecard being used as if it is a finished product. We can use a draft in an orientation to test the draft and solicit feedback  Train and mentor health workers on proper use of the CH HMIS tools and utilization of that can then be incorporated back into the draft on its data to inform planning journey toward finalization. Please revise… MCSP conducted orientation of health workers and DHT and RHITES staff in both the RHITES EC and SW regions. The orientations were part of a one-day orientation for district trainers on the VHT package held on the 2 November 2017 at the Source of the Nile Hotel in Jinja for RHITES EC and Acacia Hotel in for the RHITES SW region. In both regions, the health workers were comprised of all health facility-in-charges in the MCSP demonstration districts. In addition, MCSP in collaboration with the RHITES partners supported the health facility-in-charges in Luuka District to conduct orientation for 487 VHTs and 595 VHTs in Ntungamo on how to use the VHT registers. MCSP integrated support for the proper use of CH HMIS tools and utilisation of data during mentorship visits that were conducted in December 2017 in Luuka District.

 Baseline and periodic data on outcomes and impact for CH and use it for planning in each of the supported regions Reviewed findings from baseline data analysis and developed a first draft of the baseline report.

 Provide tools and technical support to RHITES and MCSP districts to ensure submission of facility- and community-based HMIS reports for CH MCSP printed and provided tools for collection of CH data at the health facility level to address gaps that could not be covered by the RHITES partners during last quarter. Provision of the tools ensured that the program would have sources of data to track implementation and expected outputs from the program. Table 4 below shows the tools printed and provided to each of the demonstration districts. The distribution was done in collaboration with the RHITES partners and the DHOs. Table 4: Number of forms/tools printed and provided to each of the demonstration districts. HMIS Item Luuka Kaliro Ntungamo Sheema Total Unit HMIS FORM 073: CHILD REGISTER 155 105 285 220 765 pcs (1 per month for 5 months) HMIS FORM 031: OUTPATIENT REGISTER 155 105 285 220 765 pcs (1 per month for 5 months) HMIS FORM 095: 516 876 1,920 1,218 4,530 pcs VHT/ICCM REGISTER HMIS FORM 032: REFERRAL NOTE 516 876 1,920 1,218 4,530 booklets (In triplicate carbonized) Monthly VHT summary 516 672 1,308 585 3,081 pcs forms MEDICAL FORM 5: (In triplicate, 5 booklets per 775 525 1425 1100 3,825 booklets facility for 5 months) HMIS FORM 054: INPATIENT REGISTER 40 35 80 40 195 pcs (1 per quarter)

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MCSP Uganda–CH PY4 Q1 Report

• Community HMIS (CHMIS) Regional Review Meetings MCSP facilitated the participation of three persons from each of the four demonstration districts in the regional CHMIS review meetings held in Masaka from 9 to 10 November 2017 for SW region, and in Jinja from 23 to 24 November 2017 for EC region. The meetings were organised by the MOH to review and identify solutions to bottlenecks affecting health facility and district submission of CHMIS into the DHIS2. The meetings also aimed to compile suggestions for improvement of existing CHMIS tools and guidelines. The participants of the meetings included DHOs, Biostatisticians and District Health Educators (DHEs) from each of the participating districts.

IV. Challenges, Solutions and Actions Taken

 Doctor’s strike in Uganda in November 2017 The strike of doctors impacted utilization of health facilities and therefore, availability of patients for clinical sessions. Video clips were used to demonstrate and simulate cases that could not be covered due to the shortage of patients at the health facilities.

 Stock out of amoxicillin DT at health facilities The stockout of amoxicillin DT at health facilities remains a major challenge that affects translation of IMNCI training into practice at health facilities, especially in the non-ICCM implementing districts of Luuka and Kaliro. MCSP brought this to the attention of MOH CH Division. A meeting has been proposed with the Diarrhoea Pneumonia Coordinating Committee (DPCC) to look into the issue and devise some potential solutions. MCSP in collaboration with the Uganda Health Supply Chain Project (UHSCP) has been requested to facilitate district participation in this meeting to help understand the causes and also come up with appropriate solutions to meet the district’s needs.

 Planned revisions to the role of VHTs (VHT policy vs. CHEW policy) The two circulars issued by MOH last quarter about the CHEW policy caused hesitation on the side of the DHTs and the RHITES IPs to support implementation of activities involving VHTs. MCSP engaged the MOH Focal Person for VHTs who clarified to individual DHTs and provided concurrence for the planned MCSP/RHITES VHT collaborative activities. MOH in collaboration with Pathfinder International hosted a breakfast meeting where it was shared with partners the final position of the MOH on CHEWs and VHTs, which is to allow VHT activity implementation to proceed for FY18.

 Funding within the RHITES budget to support VHT activities There is no funding in the RHITES budget that is earmarked for critical VHT activities, such as the quarterly review meetings (QRMs) in non-PEPFAR funded districts including Luuka, and no funding available for community activities. MCSP engaged the RHITES IPs to identify funded community activities, especially those designated for tracing HIV patients lost-to-follow-up, that can be used to support the critical VHT activities needed to roll out the CH package. In addition, MCSP in collaboration with RHITES partners are engaging and supporting districts and health facilities to use REC to facilitate efficient allocation of Primary Health Care (PHC) funds, including allocation for VHT activities, to improve coverage of the CH interventions.

 Limitations in time that can be allocated for implementation of/participation in CH activities RHITES are integrated programs implementing nine thematic areas, mostly in a parallel manner targeting the same audience. There is only so much time that can be allocated for CH activities. MCSP has discussed and agreed on a plan with RHITES partners to conduct a targeted IMNCI/REC 18

MCSP Uganda–CH PY4 Q1 Report training/orientation for their respective program officers during the next quarter. This will empower them to integrate and address CH into other thematic areas.

V. Lessons, Best Practices and Recommendations

 Continuous engagement with district leadership: District leadership is critical in ensuring effective implementation of trainings, as well as other program activities. One of MCSP’s initial concerns was the anticipated delay by districts to start training, and the drop out of participants while trainings are taking place. However, continuous engagement with the districts has led to successful mobilization, coordination and training and has ensured that participants come on time and complete the trainings as planned.

 Oral Rehydration Therapy (ORT) corners reestablished using PHC funds allocated to health facilities: During last quarter after the introduction of the IMNCI trainings, several health facilities, especially in the EC region, used local resources to establish and make functional ORT corners. The average cost for ORT corner equipment (5 litre Jerrican; 5 cups; Jug for mixing; Container for cups) purchased by health facilities was UGX 7500-1000 (USD 2-3). Table 5 shows improvements in the proportion of health facilities with functional ORTs.

Table 5. The proportion of health facilities with functional ORTs at baseline compared to January 2018

100.0 90.0

80.0

70.0 58.1 60.0 50.0 40.0 40.0 40.0 27.0 30.0 24.1 16.2 20.0 10.0 10.0 0.0 ORT ORT corners 0.0 Luuka Kaliro Ntungamo Sheema Districts

Proportion Proportion withHFs of Functional Baseline (Aug - September 2017) Round 1 (January 2018)

VI. Success Story

N/A. VII. Management Issues

All planned staff positions were filled with the exception of the MEL Specialist and Knowledge Management Advisor, which was in the final stages of the recruitment process. MCSP received a second

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MCSP Uganda–CH PY4 Q1 Report vehicle from SPRING in November 2017 that is part of the pool available to support program activity implementation.

MCSP held two meetings with the RHITES SW team, and one meeting with the RHITES EC team during the reporting period. The meetings engaged the senior technical leadership for Family Health/RMNCH in the two programs, and where possible, also engaged the senior management at the director level overseeing field operations and the overall technical team. The meetings focused on reviewing progress achieved to date, reviewing and jointly identifying solutions to challenges met, and developing shared work plans for the next month/quarter.

Lastly, MCSP worked with the UHSCP Focal Person for CH to raise the issue of amoxicillin DT stock outs with the relevant MOH divisions. MCSP will collaborate with UHSCP to support the convening of the national DPCC meeting to address this issue jointly with other key stakeholders during next quarter.

VIII. Monitoring and Evaluation

The quarterly collection of program data for the reporting period of October-December 2017 was conducted from 22 to 26 January 2018. However, the number of facilities included in this round of data collection was less than that included in the baseline data collection - only 129 health facilities (see Table 6 below for additional details) were assessed this quarter, compared to 147 health facilities assessed at baseline. The number assessed at baseline included small private for profit clinics; which do not report regularly in DHIS2 and sometimes are not functional. The number of health facilities that MCSP has confirmed as functional with RHITES partners and the respective DHOs for the demonstration districts is 137; and will be the number that MCSP will be able to support throughout the life of the program. The other eight facilities (mostly HC IIs) that were missed during this quarterly data collection, which resulted in 129 health facilities assessed instead of 137 health facilities at baseline, were closed because the health workers were away for training.

Table 6. Number of health facilities assessed this quarter, by district and level of care.

Hospital HC IV HC III HC II TOTAL

Luuka 0 1 9 21 31 Kaliro 0 2 6 13 21 Ntungamo 0 4 9 24 37 Sheema 1 2 7 30 40 TOTAL 1 9 31 88 129

IX. Summary of Quarterly Results

The following table shows the compiled MCSP performance indicators for data available from the four demonstration districts in SW and EC regions where MCSP implemented activities in PY4 Quarter 1.

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MCSP Uganda–CH PY4 Q1 Report

Objective 1: Enhance national guidelines and frameworks for implementation of the essential CH package Previous Current End of Baseline Quarterly Quarterly Program Result Area Indicator Data Source Comments value achievement achievement Target (Jul-Sept 2017) (Oct-Dec 2017) value *National IMNCI training guidelines 1. # of national level including: 1. IMNCI guidelines, tools and chart booklet; 2. manuals, report, briefs IMNCI wall charts; 3. developed or revised National level IMNCI Facilitators IR1,IR2,IR3 for CH with MSCP activity monitoring 0 0 6* 5 Manual (SIC and DL); support (CSS, QoC, form 4. IMNCI desk charts; CDSR, IMNCI) 5. IMNCI Participants disaggregated by topics modules (SIC and DL); and type of products 6.IMNCI Mother’s Counselling Card Objective 2: Strengthen competencies and practices of RHITES partners and MCSP demonstration districts to implement the essential CH package Previous Current End of Baseline Quarterly Quarterly Program Result Area Indicator Data Source Comments value achievement achievement Target (Jul-Sept 2017) (Oct-Dec 2017) value

Health worker = 31 RHITES Partners = 2 RHITES staff made 1. Number of health Health worker = 12 attempts to attend but Health worker workers and RHITES National ToT on were not able to Program records: = 39 staff trained as trainers IMNCI: Regional ToT on complete the trainings IR1,IR2,IR3,IR4 Training tracking 0 for IMNCI using M: 13 F: 9 IMNCI: this quarter. Plans are log RHITES updated guidelines, job EC: 12 participants in place orient RHITES partners = 6 aides and tools (4M: 8F) program staff next quarter. Regional ToT on IMNCI: SW: M: 4 F: 7 EC = 1.79% Baseline for this EC = 1.79% EC = 62.7% 2. Proportion of Health Luuka = 2.78% indicator was collected Luuka = 2.78% Luuka =48.4% Facilities with job aides Kaliro = 0% this quarter. Indicator Quarterly Health Kaliro = 0% Kaliro = 77.3% for case management of focused on job aids IR1,IR3,IR4 Facility Extraction/ 60% childhood illnesses in SW = 12.1% either pinned up on Assessment tool SW = 12.1% SW =36.9% MCSP demonstration Ntungamo = the wall or readily Ntungamo = 11.1% Ntungamo = 48.7% districts 11.1% available at the health Sheema = 13.5% Sheema =25% Sheema = 13.5% facility

EC = 85.9% 3. Proportion of cases EC = 85.9% Luuka = 84.4% EC = 90.5% of children under 5 Luuka = 84.4% Kaliro = 87.4% Luuka = 97.6% years of age with fever Kaliro = 87.4% Health facility Kaliro = 83.4% Baseline for this seeking care at HFs SW = 96.5% IR1,IR2,IR3,IR4 HMIS extraction 85% indicator was collected who received RDT SW = 96.5% Ntungamo = 99.5% tool / DHIS 2 SW =88.3% this quarter. and/or microscopy Ntungamo = Sheema = 94.3% Ntungamo = 86.4% testing for malaria 99.5% Sheema = 90.1% during the last quarter Sheema = 94.3%

4. Proportion of cases EC = 93% EC = 93% Baseline for this of children under 5 Luuka = 99.2% Luuka = 99.2% EC =93.5 % indicator was collected years of age diagnosed Kaliro = 88.1% Kaliro = 88.1% Luuka = 98.3% Health facility this quarter. Possibility with malaria through Kaliro =88.6 % IR1,IR2,IR3,IR4 HMIS extraction 85% of some children RDT or microscopy SW = 98% SW = 98% tool / DHIS 2 getting ACTs without testing who received Ntungamo = Ntungamo = 97.6% SW = 108% malaria or negative ACT treatment during 97.6% Sheema =100% Ntungamo = 101% test. the last quarter1 Sheema =100% Sheema =116%

EC = 29.0% Baseline for this 5. Proportion of cases EC = 29.0% Luuka = 31.4% indicator was collected of children under 5 Luuka = 31.4% EC = 29.7% Kaliro = 26.5% this quarter. Data years of age with Kaliro = 26.5% Luuka = 20.6% Health facility indicated (28 out of 31 pneumonia seeking care Kaliro = 38.9% IR1, IR2,IR3,IR4 HMIS extraction SW = 57.4% 85% health facilities in at HFs who received SW = 57.4% tool / DHIS 2 Ntungamo = Luuka) 90.3% of the appropriate treatment Ntungamo = 76.9% SW = 94.4% 76.9% facilities had with antibiotic during Sheema = 37.8% Ntungamo = 96.3% Sheema = 37.8% experienced a stock the last quarter Sheema = 92.6% out this quarter

1 Data from register shows that some RDT negatexive children aged 5 years were given ACTs for treatment of fever contrary to the treatment guidelines. The South Western region 8% of the cases that received ACTs had a negative RDT/ Microscopy result from the laboratoryr 22

MCSP Uganda–CH PY4 Q1 Report Kaliro is still experiencing significant stock outs of zinc and EC=65.6% ORS. Stock outs in EC=80.3% 6. Proportion of cases Luuka = 72.9% Sheema were lower Luuka = 96.0% of children under 5 Kaliro = 58.2% than baseline. If these Kaliro = 64.7% years of age with Health facility stock outs affected

IR1,IR2,IR3,IR4 diarrhoea seeking care HMIS extraction SW = 85.9% 85% health facilities with a SW = 80.5% at HFs who received tool / DHIS2 Ntungamo = high number of cases, Ntungamo = 93.5% ORS and Zinc (ZN) in 84.4% then it could Sheema = 67.5% the last quarter Sheema = 94.6% contribute to low

coverage overall. Further analysis will be conducted to confirm this.

Objective 3: Strengthen district level management and planning practices using the adapted REC-QI to support delivery of essential CH package Previous Current End of Baseline Quarterly Quarterly Program Result Area Indicator Data Source Comments value achievement achievement Target (Jul-Sept 2017) (Oct-Dec 2017) value

EC: Health *Figure includes Health workers = 1. Number of health workers=72* Health District Biostatistician Program records: 0 workers and RHITES IP RHITES Partner=2 workers =173 and District Planner IRI,IR2, IR3, IR4 Training tracking 0 staff trained on adapted log RHITES partner = REC-QI approach SW: Health RHITES 0 workers=72 partner = 22 RHITES Partner=2 2. Number of health EC = 30 EC = 30 Baseline for this facilities supported2 by Luuka = 30 Luuka = 30 indicator was collected MCSP to conduct Kaliro = 0 Kaliro = 0 this quarter. IR1,IR2,IR3, IR4 Program records 0 137 micro-mapping and planning to improve SW = 22 SW = 22 coverage of CH Ntungamo = 22 Ntungamo = 22

2 MCSP has been conducting integrated training at health facility level to empower VHTs and health workers to use data for planning which also part of the micro planning. Mentorship activities have also been tailored to support the development of micro plans to improve child health indicators and targets. 23

MCSP Uganda–CH PY4 Q1 Report interventions Sheema = 0 Sheema = 0

EC = 37.5% 3. Proportion of health Luuka = 25% EC = 48.2% facilities with catchment Kaliro = 50% Baseline assessment Luuka = 31.8% area micro-map Program records: conducted in this Kaliro = 64.5% IR1,IR2,IR3, IR4 available and displayed Health facility 80% SW = 51.6% quarter showing health assessment form Ntungamo = SW =67.95 % provider assigned for 46.3% Ntungamo = 78.4% every village Sheema = 56.8% Sheema = 57.5%

EC: Kaliro = 126 4. Number of cases of Baseline assessment Kaliro = 258 (VHT registers): Luuka = 332 30% increase children under 5 years conducted in this Luuka =275 IR1,IR2,IR3, IR4 Health facility Ntungamo = 10 from baseline of age referred to HFs quarter assessment form Sheema = 370 to EOP for care by VHTs SW:

Ntungamo =56 Sheema =59

Objective 5: Improve availability of strategic knowledge and tools to scale-up the essential CH package Previous Current End of Baseline Quarterly Quarterly Program Result Area Indicator Data Source Comments value achievement achievement Target (Jul-Sept2017) (Oct-Dec 2017) value

EC: Luuka = 8 137 (100%) 1. Number of health Luuka = 9/31=29% (22.2%) facilities with updated Baseline assessment Kaliro = 11/21=50% Program records: Kaliro = 9 (45%) Ntungamo= 44 IR1,IR2,IR4,IR5, monitoring chart or conducted in this Health facility Ntungamo = 33 Sheema= 35 IR6 REC tool showing quarter SW: assessment form (61.1%) coverage of CH Ntungamo Sheema = 23 Kaliro=21 indicators =23/37=62.2% (62.2%) Luuka=37 Sheema = 19/40=47.5%

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MCSP Uganda–CH PY4 Q1 Report Objective 5: Improve availability of strategic knowledge and tools to scale-up the essential CH package Previous Current End of Baseline Quarterly Quarterly Program Result Area Indicator Data Source Comments value achievement achievement Target (Jul-Sept2017) (Oct-Dec 2017) value

EC: VHTs=487 (260F: 227M) HWS=72 (36F: 2. Number of health 36M) workers and RHITES Program records: RHITES Partner=2 IR1,IR2,IR4,IR5, IPs trained and Training tracking 0 0 (1F: 1M) 350 IR6 mentored on the log proper use of CH HMIS SW: tools VHTs=595(365F:23 0M) HWS=72 (32F:40M) RHITES Partner=2(2M) 3. Number of technical and policy briefs on the Presentation to MCH Program records: IR1,IR2,IR4,IR5, essential CH package Cluster on IMNCI Training/policy 0 0 2 IR6 developed by program Training delivery tracking log to inform the national 1 models scale up Funding for VHT/Community support remains a major challenge 4. Proportion of health EC= 8 (19%) affecting facilities with timely and Luuka = 1 (2.8%) EC= 0(0%) reporting/quarterly complete reports on Kaliro = 7 (35%) Luuka = 0 (0%) review meetings for Baseline assessment community level CH Kaliro = (0%) community activities. IR1,IR2,IR4,IR5, Program records: conducted in this indicators from VHT SW= 31 (34.6%) 85% Late reporting was IR6 DHIS2 quarter registers and CH Ntungamo =17 SW= 20.9% also another issue that

registers entered in (31.5%) Ntungamo =0 (0%) affected several DHIS2 for the previous Sheema = 14 Sheema = 19(47.5%) facilities. This is an quarter (37.8%) area MCSP is working closely with RHITES and other partners to address. Some proposals include 25

MCSP Uganda–CH PY4 Q1 Report Objective 5: Improve availability of strategic knowledge and tools to scale-up the essential CH package Previous Current End of Baseline Quarterly Quarterly Program Result Area Indicator Data Source Comments value achievement achievement Target (Jul-Sept2017) (Oct-Dec 2017) value targeted support at time of HF report compilation

EC =14(26.4 %) EC = 8 (14.3%) Luuka = 5/31=16%

Luuka = 5 Kaliro = 9/22=41%

5. Proportion of Health (13.9%)

facilities that conduct Kaliro = 3 (15%) Baseline assessment SW =43 (55.8%) Program records: IR1,IR2,IR4,IR5, Data quality self- conducted in this Ntungamo = 14 Health facility 100% IR6 assessment and SW = 33(36.3%) quarter (37.8%) assessment form reporting to validate Ntungamo = 21 Sheema =29 CH indicators (38.9%) (72.9%) Sheema =12 (32.4%)

6. Proportion of HFs Malaria

with a deviation Diagnosis = Program records: Baseline assessment Malaria between recorded data 22.4% This indicator is shown IR1,IR2,IR4,IR5, Health facility conducted in this Diagnosis = 20.6% in registers and 0% by illness, not by IR6 assessment form quarter Pneumonia reported data in DHIS Pneumonia district. and DHIS2 diagnosis = 4.3% 2 for selected CH diagnosis = 21.8% Diarrhea indicators diagnosis =3.6% Diarrhea diagnosis =38.8%

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MCSP Uganda–CH PY4 Q1 Report

X. PY4 Quarter 2 Planned Activities

The following are the activities planned for PY4 for the period from January to March 2018:

Objective 1: Enhance national guidelines and frameworks to support implementation of the essential CH package.  Update the national guidelines for the IMNCI referral care package  Support global initiatives to launch WHO Paediatric Quality of Care (QoC) standards and discuss implications for national adaption/implementation

Objective 2: Strengthen competencies and practices of RHITES partners and MCSP demonstration districts to implement the essential CH package.  Provide technical assistance to RHITES and the demonstration districts to conduct onsite mentorship and SS for front-line health workers on CH-post training visits (first and second phase)  Continue technical assistance to RHITES IPs and demonstration districts to roll out IMNCI implementation using the DL and SIC models (second and third face-to-face training sessions)  Continue documenting process and lessons learnt from using the DL and SIC models for IMNCI training  Complete procurement and distribute basic equipment for IMNCI to health facilities in the demonstration districts, including equipment for IMNCI training sites

Objective 3: Strengthen district level management and planning practices using adapted REC-QI approaches to support delivery of the essential CH package.  Train RHITES and MCSP district staff on QRMs  Document process and lessons learnt from adaptation and application of REC concepts to increase coverage of the CH package  Conduct demonstration QRMs in Kaliro, Luuka, Sheema and Ntungamo - 2 day non-residential meetings targeting health facility-in-charges, DHT, civic and political leaders  Support RHITES IPs and demonstration districts to facilitate micro-mapping and planning at health facility level using data to improve coverage, and also roll out and monitor the community CH package using REC. Commented [KO4]: Need to show a process for finalization and adoption of this adapted approach to REC-QI. Objective 4: Complete a costing analysis for delivery of the essential CH package.  Continue to collect financial data from MCSP for their support to the roll-out of the CH package  Collect first round of data from RHITES-SW and RHITES-EC  Develop methodology for facility-level costing for the delivery of the CH package

Objective 5: Improve availability of strategic knowledge and tools to scale-up the essential CH package.  Facilitate knowledge-sharing and scale up of successful CH approaches across the RHITES, and MOH divisions and programs  Provide support to RHITES and MCSP districts to routinely conduct Data Quality Self- Assessment and Improvement (DQS&I) activities for CH data in the districts as part of SS, onsite training and mentorship  Support community reporting systems and integration of REC to develop evidence-based action plans at community level for CH  Dissemination of the baseline results to district and partners for action and quality improvement

Monitoring and evaluation activities  Finalize baseline report  Finalize routine monitoring data collection system including database dashboard  Train and mentor RHITES IPs and demonstration districts on proper use of the CH HMIS tools and utilization of data to inform planning

Program management activities  Hold quarterly update and planning meetings with the RHITES IPs

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MCSP Uganda–CH PY4 Q1 Report

Annex A: EMMR Update Commented [J5]: Kate: Can/should we include the same update that we include in the MCSP Uganda RI Quarterly Report?

Commented [KO6]: We have to update the RI one to include specific environmental issues related to child health – for example, around prescribing or disposal of drugs and injections… Annex B: Photo Gallery

1. ORT Corners in MCSP-supported health facilities

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MCSP Uganda–CH PY4 Q1 Report 2. IMNCI Trainees on Short Interrupted Course in Ntungamo District

3. VHT member and ADHO review of village maps in MCSP-supported health center in

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MCSP Uganda–CH PY4 Q1 Report