Service Delivery and Support for Orphans and Vulnerable Children
Quarterly Report January 1, 2018 - March 31, 2018
Submitted April 30, 2018
Award No. 656-15-00010 FHI 360 Reference No. 102248.001.001.001
Contents
ACRONYMS 4 1 PROJECT OVERVIEW 6 2 HIGHLIGHTS 7 3 SUMMARY OF THE REPORTING PERIOD 7 3.1 CBO Selection, Sub-award Negotiation, Start-up and Close-out 8 3.2 CBO Management 9 3.3 Monitoring and Evaluation Systems 9 4 PROJECT IMPLEMENTATION 11 4.1 IR 1: Increased Utilization of Quality Health, Social and Nutritional Services 11 4.1.1 Mapping existing services 11 4.1.2 Identification of beneficiaries 12 4.1.3 Capacity development for high-quality case management services 13 4.1.4 Case management and service delivery 14 4.1.5 Caseload management 15 4.1.6 Transition assessment and graduation 15 4.1.7 Referrals to HIV and basic health care and other social services 16 4.1.7.1 Linkages and referrals to health providers 16 4.1.7.2 Linkages and referrals with other services 17 4.1.8 Support for adolescents 17 4.1.9 Supportive environment for OVC and healthy life choices 18 4.1.10 Provide structured TA at all levels to support operationalization of guidance and protocols 18 4.2 IR 2: Reduced Economic Vulnerability of OVC Households 19 4.2.1 Meeting basic consumption needs 19 4.2.2 Improve capacity of families to manage money and generate income 19 4.2.3 Transform resources allocation in the household in favor of OVC 20 4.2.4 Technical assistance and supervision 20 4.3 IR 3: Improved Capacity to Provide ECD Services for Vulnerable Children under Age Five 22 4.3.1 Use of quality community child care and development interventions increased 22 4.3.2 Improve parental care and responsiveness for children under five 23 4.3.3 WASH behavior 24 4.3.4 Technical assistance and supervision 25 4.4 IR 4: Capacity of district government and communities to provide essential preventative and protective services to vulnerable families and children 27 4.4.1 Facilitate multi-sectoral coordination meetings to promote collaboration and further the objectives of the project 27 4.4.2 Strengthen capacity of district government and communities to coordinate and respond to OVC needs 27 4.4.3 Develop technical and organizational capacity of CBOs 28 5 EXIT STRATEGY 28 6 PROJECT PERFORMANCE INDICATORS 28 6.1 IR 1: Increased Utilization of Quality Health, Social and Nutritional Services 28
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6.2 IR 2 Reduced Economic Vulnerability of OVC Households 32 6.3 IR 3: Improved Capacity to Provide ECD Services for Vulnerable Children under Age Five 33 6.4 IR 4: Capacity of district government and communities to provide essential preventive and protective services to vulnerable families and children 33 7 PROJECT MANAGEMENT 34 7.1 Approved workplan timeframe 34 7.2 Staffing Changes 34 7.3 Consortium Partner Management 34 7.4 Cost Share 35 7.5 COVida Facebook Page 36 8 MAJOR IMPLEMENTATION ISSUES 36 8.1 Unexpected Spending limitations 36 8.2 Constant Changes 37 8.3 Short timeline for entering beneficiary data 37 8.4 Security in Cabo Delgado 38 8.5 Activista Attrition 35 9 COLLABORATION WITH GOVERNMENT, OTHER DONORS AND STAKEHOLDERS 38 9.1 Collaboration with Mozambican Government 38 9.2 Collaboration with Other Donors and Stakeholders 38 10 UPCOMING PLANS 39 11 EVALUATION/ASSESSMENT UPDATE 40 12 SUCCESS STORIES AND PHOTOS 40 12.1 Success Story 1: “Everything in My Life Changed” 40 12.2 Success Story 2: #ActivistasSãoHerois 41 Success Story 3: Error! Bookmark not defined. 12.3 Savings Groups for Adolescents Error! Bookmark not defined. 12.4 Success Story 3: Siblings gain access to health, education and stability 43 13 FINANCIAL INFORMATION 43
ANNEXES
Annex 1 – Gantt Chart (updated with column indicating status) Annex 2 – Closeout Guidance Annex 3 – List of CBOs and FY18 Targets by District Annex 4 – Collaboration on OVC and HTC referrals Annex 5 - Example of a troubleshooting plan for CBOs with structural problems Annex 6 – Draft findings on adolescents from the baseline survey
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ACRONYMS
ADE Apoio Directo à Escola (Direct School Fund) ADPP Development Aid from People to People AIHA American International Health Alliance AMODEFA Associação Moçambicana para o Desenvolvimento da Família (Mozambique Association for Family Development) APS Annual Program Statement ART Antiretroviral Treatment BCM Basic Case Management CBO Community-Based Organization CCPC Community Child Protection Committee CCS Centro de Colaboração em Saude (Center for Collaboration in Health) CD Community Dialogue CHASS Clinical HIV/AIDS Services Strengthening CIHO Communications for Improved Health Outcomes CMA Comunidade Moçambicana de Ajuda COP Country Operational Plan CP Consortium Partner CSI Child Status Index DCOP Deputy Chief of Party DPGCAS Direcção Provincial de Género, Criança, e Acção Social (Provincial Directorate of Gender, Child and Social Action DPS Direcção Provincial de Saúde (Provincial Health Directorate) DREAMS Determined, Resilient, Empowered, AIDS-Free, Mentored and Safe ECD Early Childhood Development EGPAF Elizabeth Glaser Pediatric AIDS Foundation FDC Fundação para o Desenvolvimento da Comunidade (Community Development Foundation) FGH Friends in Global Health FY Fiscal Year GAAC Grupo de Apoio à Adesão Comunitário (Community Adherence and Support Group) GBV Gender-based Violence GTCOV Grupo Técnico de COV (OVC Technical Working Group) HES Household Economic Strengthening HF(s) Health Facility(ies) HIV Human Immunodeficiency Virus HTC HIV Testing and Counseling ICAP Columbia University Mailman School of Public Health INAS Instituto Nacional de Acção Social (National Social Action Institute) INEFP Instituto Nacional de Emprego e Formação Profissional (National Professional Training and Employment Institute) IR Intermediate Result MCSP Maternal and Child Survival Program MER Monitoring, Evaluation, and Reporting
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M&E Monitoring and Evaluation MGCAS Ministério de Género, Criança, e Acção Social (Ministry of Gender, Children, and Social Action) MINEDH Ministério de Educação e Desenvolvimento Humano (Ministry of Education and Human Development) MOH Ministry of Health MOU Memorandum of Understanding M-SIP Mozambique Strategic Information Project MUAC Mid-Upper Arm Circumference NSTO National Senior Technical Officer NUMCOV Núcleo Multisectoral para Crianças Orfãs e Vulneráveis (Multi- sectoral Steering Committee for Orphans and Vulnerable Children) OGAC Office of the Global AIDS Coordinator PASSOS Integrated HIV Prevention and Health Services for Key and Priority Populations Project PATH Program for Alternative Technologies in Health PEPFAR President’s Emergency Plan for AIDS Relief PMP Performance Monitoring Plan SAAJ Serviços Amigos aos Adolescentes e Jovens, Youth Friendly Services SAVIX Savings Groups Information Exchange SANTAC Southern Africa Network Against Abuse and Trafficking of Children SBCC Social and Behavior Change Communication SCIP Strengthening Communities through Integrated Programming SDSMAS Serviços Distritais de Saúde, Mulher e Acção Social (District Health and Gender, Children and Social Action Services) SIMS Site Improvement through Monitoring Systems SRH sexual and reproductive health TA Technical Assistance ToR Terms of Reference TOT Training of Trainers UNICEF United Nations Children’s Emergency Fund USAID United States Agency for International Development VSL Village Savings and Loan WASH Water, Sanitation, and Hygiene WHO World Health Organization WV World Vision
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1 PROJECT OVERVIEW
Project name: COVida – Juntos Pelas Crianças (formerly Service Delivery and Support to Orphans and Vulnerable Children (SDS-OVC))
Project duration: Five years
Starting date: June 23, 2016
Award Ceiling and Obligated Amount: $84,380,486 and $28,365,460
Geographic focus: COVida implements activities in 64 districts in Maputo City, Maputo Province, Inhambane, Gaza, Sofala, Manica, Tete, Zambezia, Nampula, Cabo Delgado, and Tete.
Project objectives: The overall objective of COVida is to improve the health, nutritional status and well-being of orphans and vulnerable children (OVC) living in the President’s Emergency Plan for AIDS Relief (PEPFAR) defined priority districts for epidemic control. The project has four Intermediate Results (IRs): IR 1: To increase utilization of quality social, health and nutritional services; IR 2: To reduce economic vulnerability of OVC households; IR 3: To improve early childhood development (ECD) services; and IR 4: To strengthen capacity of district government and communities to provide support to OVC and their families. By strengthening the capacity of the family and community to protect and care for their children, COVida aims to enhance overall community resilience. Project interventions are aligned with the family-centered, integrated approach approved by the Ministry of Gender, Children, and Social Action (MGCAS) and the Ministry of Health (MISAU), and facilitate access to government and other services.
Consortium Partners: The COVida consortium is comprised of six partners with geographic and/or technical responsibilities that provide complementarity of expertise and coverage, as show in Table 1 below. Table 1: COVida Consortium Partner Responsibilities Partner Responsibility Area/Topic Project lead Maputo, Sofala, Manica, Tete, Niassa, Nampula, and Cabo FHI 360 Geographic partner Delgado Provinces, and Maputo City Technical lead Case Management, HIV, Organizational Development
Geographic partner Inhambane Province CARE Technical lead Household Economic Strengthening
World Vision Geographic partner Gaza and Zambezia Provinces
PATH Technical lead Early Childhood Development
N’weti Technical lead Social Behavior Change Communication
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Palladium Technical lead Research and Monitoring, Evaluating, and Reporting
2 HIGHLIGHTS
Quarter 2 (Q2) of FY18 was an intensive one for refresher training of community-based organization (CBO) activistas, activistas chefes and supervisors. Through this training, COVida introduced changes in guidance for year two implementation and strengthened activistas’ capacity in case management and contributions in HIV testing and adherence and retention. During this quarter, CBOs continued to serve beneficiaries, all the while adapting to new forms, an updated database, and new guidance (i.e. graduation criteria). We are already seeing progress on the priorities of improving linkages with health facilities, graduating beneficiaries, and ensuring beneficiaries know their status.
The project has shown significant progress on the priorities for FY18: ● Facilitated Training of Trainers (ToT) in all provinces for 85 CBO supervisors and 60 District Health and Gender, Children and Social Action Services (SDSMAS) focal points; ● Facilitated refresher trainings in case management and early childhood development (ECD) for 3650 activistas in all CBOs (except CBOs that had started in the past few months); ● Initiated supervision and mentoring training for activista chefes and supervisors in all provinces; ● 213,789 beneficiaries currently active or graduated, or 63 percent of the FY18 annual OVC_SERV target; ● 51 percent of new beneficiaries identified through health facilities (HFs), an increased from 21 percent in Q1; ● 6,979 referrals were made to HIV services, of which 68% were complete; ● The HIV status of 43,026 or 44 percent of children was known to their caregivers. 35,742 or 26% disclosed HIV Status to activistas. ● 26,658 beneficiaries graduated; ● All CBOs used the electronic Child Status Index (eCSI) tool to enter data on a routine basis, and continual improvements were made; ● 205 new savings groups created, bringing the cumulative project total to 649; the percentage of beneficiary households in savings groups increased to 9%; ● The Minister of Gender Children and Social Action (MGCAS) approved the national Community Preschool Activity Manual and Implementation Guide for pretesting; and ● Mozambique Strategic Information Project (M-SIP) conducted an external Data Quality Assessment (DQA) in Milange and Mocuba. The presentation is scheduled for May.
3 SUMMARY OF THE REPORTING PERIOD
This section reports on the status of the implementation plan at the end of Q2 of FY18 (January 1 - March 31, 2018). In addition to continuing to provide services to beneficiaries, the focus of this quarter was facilitating refresher trainings for activistas, which included updates in case management and graduation protocols and forms, and introduced new or strengthened content on HIV, disclosure, stigma and discrimination, adolescents, and ECD.
COVida’s FY18 work plan was approved by USAID in early December 2017. In March, COVida was informed by USAID that we should not use funds carried over from the prior fiscal year. This required a reduction in the work plan budget by $1.9 million. COVida submitted a revised work plan to USAID on April 2, 2018. While awaiting approval, COVida took steps to reduce costs, including
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suspending the award of new grants, trainings associated with these grants, playgroups, and some debate sessions. These measures will be referenced throughout this report. The situation is more fully described in the Section 8. Major Implementation Issues.
Further details of activity implementation are included in Annex 1 - Gantt Chart, which provides the status of each activity.
3.1 CBO Selection, Sub-award Negotiation, Start-up and Close-out
New awards: COVida had planned to finalize subawards this quarter with 11 CBOs that had been selected through a competitive process to work in 10 new districts in Inhambane, Niassa, Sofala and Maputo Provinces, with the expectation that theses CBOs would start in March and April of 2018. In addition, two CBOs had been selected to replace AMODEFA in Boane and Matola districts. Given the concerns regarding using carryover funds from FY 17 in the current fiscal year, COVida suspended the development of these subawards. This has been disruptive and discouraging for the CBOs who were preparing themselves for a rapid start-up. In most cases, COVida carried out grant development workshops with the CBOs, expending time and travel costs. Some of these CBOs had also identified activistas, and community and government expectations were raised. Per the revised FY18 work plan submitted to USAID, these new CBOs will have awards finalized in Quarter 4 of FY18, with activities starting on October 1, 2018.
COVida concluded one new award with Southern Africa Network Against Abuse and Trafficking of Children (SANTAC), which is assuming AMODEFA’s activities in Boane. This award will be submitted to USAID early next quarter, and the aim is for activistas and beneficiaries to feel minimal disruption when AMODEFA’s award ends on April 30, 2018. SANTAC was identified through a competitive process and will be taking on many of the staff and activistas from AMODEFA. Though Associação Comunitária Para O Desenvolvimento da Mulher de Tsalala (AMTSALA) had been selected to take over AMODEFA’s activities in Matola, their weak financial capacity coupled with the FY18 funding restrictions led COVida to focus on graduating and transferring AMODEFA Matola’s beneficiaries.
Phase out: COVida developed technical guidance for CBOs phasing out this year (see Annex 2), which includes orientation on stopping new beneficiary identification, graduation and case closure, transfer, informing beneficiaries and local government, and recognizing activistas’ work. CBOs in phase out phase this quarter were AMASI in Monapo and Mecuburi (Nampula province, FHI 360 grantees), and Associação Mulher Joven (AMJ) in Mabalane (Gaza province, WV grantee). The phase out in Mabalane was accelerated because of the budget cuts, as there was no possibility to keep AMJ going for longer. AMASI’s phase out was later “reversed” when Monapo was confirmed by USAID to be a FY19 priority district. As noted previously, COVida began the phaseout with AMODEFA, due to USAID’s PLGHA provision.
Closeout: FHI 360 closed out the award to AAVEDOS this quarter.
As Table 2 below illustrates, COVida has 57 CBOs implementing grants in 60 districts. Annex 3 lists the CBOs and their FY18 targets.
Table 2: CBO awards Status of CBO selection and awards March 31, 2018 # of CBOs with fully executed sub-awards 57 # of CBOs with awards that have ended 2 Total number of CBOs 59
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FHI 360 has grants with Progresso in Niassa and Cabo Delgado provinces, and to date the financial performance has been poor, despite intensive technical assistance (TA) efforts from COVida staff at all levels. In the next quarter, FHI 360 will work on an improvement plan to see if Progresso manages to turn the situation around. If the organization does not demonstrate improvement, FHI 360 suspend or terminate the awards.
3.2 CBO Management FHI 360 completed 26 modifications to CBO subawards during this reporting period. The primary purpose of these modifications was to extend the period of performance, obligate funds and, where appropriate, add new activities such as community debates and play groups to allow them to implement FY 18 activities. There were a few cases where we completed modifications with other purposes: - Modify AMASI’s award to assume activities in the areas where AAVEDOS worked. - Extend the period of performance for two weeks for AMODEFA to enable seamless transition of beneficiaries to SANTAC. - Correct an administrative error on a modification executed to Niiwanane.
In addition, FHI 360 terminated AAVEDOS’s grant for non-performance, as described in the prior report.
FHI 360 continues to monitor special award conditions and substantial involvement clauses. FHI 360 has also outlined a process to support, and hold accountable, grantees that have issues impeding their performance. In this period, this support was extended to two more CBOs, increasing the overall number to five CBOs that are currently being supported through this process. This is further described in IR 4.
During this reporting period, WV concluded modifications to extend the period of performance and increase the budget ceiling for partner CBOs in Zambezia and Gaza provinces.
3.3 Monitoring and Evaluation Systems In the prior reporting period, COVida ensured that all data of existing beneficiaries was entered into the database. During this reporting period, the remaining provinces began using eCSI as the sole database for reporting and capturing case management information. As with any significant change and most new databases, the adaptation process has not been without its growing pains.
The database has both a data entry module and a reporting module, both of which have been developed in parallel. The reporting functions are important for us to be able to analyze the data at all levels and catch problems ourselves. However, if these functions are not working, we can still use the raw data to produce the reports centrally and send them to geographic partners (GPs) and CBOs. This slows down the process, but that is less of a concern than not having the data at all – or it being wrong. For this reason, we prioritized the finalization of the data entry module, and will properly address issues with reporting next quarter.
Issues Action steps The software used was heavy and slow, causing The subcontractor developed new modules delays in data entry and producing the reports. using “lighter” and more agile software that will be rolled out in Q3. Version control issues due to multiple small We decided to accumulate changes and roll changes in a short time period. them out after testing twice a year. Back-ups take a long time and use up internet We are considering options of backing up
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credit when the volume of beneficiaries/data is only new data or less frequently. high. Connectivity issues due to power cuts and poor Patience. All CBOs have funds to have internet at CBOs. multiple cellular data providers. Lack of knowledge at some CBOs to address basic Subcontractor provides remote TA, but technological issues (version control, date format, geographic partners often need to physically linking two computers to use one database). visit the CBO to address the issues. At some CBOs, M&E staff are not sufficiently GPs are working with CBOs to address these computer savvy to work effectively with issues and identify qualified staff when databases. current staff are not appropriate. Poor organization of files at some CBOs, leading Ongoing TA to organize files according to them to miss data. protocol. Some CBOs entered data after the deadline due to TA to help CBOs improve planning and poor planning or high volumes of data and a short problem-solve to enter data on time. We are time frame. analyzing scale of problem and decide if adjustments to timelines are necessary. Errors in data entry that affect final numbers (e.g. TA in improving data entry. Intensive data forgetting to enter the name of the activista leads cleaning immediately after deadline. to loss of data, entering each individual as a separate household leads to inaccurate data). Data summaries produced at central level do not A new reporting module has been developed match reporting module at CBO level. and will be rolled out next quarter. CBOs have been informed that data produced with the current module is inaccurate. All technical and M&E staff will learn to use this module, thus expanding the number of people able to support the CBO. CBOs claim they entered data that then Site level visits with CBOs comparing forms to “disappears”. database. While there may be new issues that emerge, to date, these visits have shown that the database was accurate. Even so, Data summaries produced at central level do not these visits have been helpful in building match CBOs’ perception of their own progress. confidence in the database, increasing understanding of how it works, and helping the CBO recognize issues.
The process was made more complicated by changes to indicators, aggregations, and forms such as:
• The OVC_SERV indicator definition now only allows COVida to count beneficiaries that received a service in the last three months. • The OVC_SERV indicator definition now only allows COVida to count beneficiaries who are active or graduated, when before we were able to count those who were transferred or exited. • The CSI tool was changed to include ECD and HIV status. • The follow-up form was changed to include HIV status. • The maintenance phase was eliminated, and new graduation process was introduced. • The graduation process was changed to graduate the family, not individuals, which meant changing the adult module, which is separate from the child module.
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Despite the challenges, the database is progressing well. We knew this process of adapting would take a while, and still have much work to do, but with the collaboration of both technical and M&E staff at all levels, we are making good progress with improvements.
M-SIP conducted an external Data Quality Assessment (DQA) in Milange and Mocuba (both in Zambezia province) and Buzi (Sofala province). We expect the final report at the start of the next reporting period.
4 PROJECT IMPLEMENTATION
As mentioned above, project implementation for most of this quarter closely followed the FY18 work plan, with some caveats – play groups, debates, trainings on SAVIX and new subaward finalization – due to the budget restrictions mentioned above.
From January to February, five-day provincial ToTs were rolled out in each province for CBO supervisors and SDSMAS focal points, who in turn conducted 4-day refresher trainings for groups of activistas at the CBO level in February and March. Subsequently, trainings of activista chefes and supervisors to strengthen their role in ensuring quality case management began.
Efforts to improve linkages with health facilities and other services continued at all levels, culminating with a national level inter-ministerial meeting. All CBOs mobilized beneficiaries to start savings groups. ECD was integrated into household visits through the trainings mentioned above, and COVida prepared to launch the playgroup strategy.
4.1 IR 1: Increased Utilization of Quality Health, Social and Nutritional Services In this reporting period, COVida continued to provide services to new and existing beneficiaries, assessed readiness for graduation and graduated 10% of beneficiaries reached in Q1, increased the percentage of new beneficiaries referred from the health system to 51%, and continued to build upon linkages to increase access to services for OVC with 68% of HIV referrals complete and caregivers knowing and disclosing the status of 26% of child beneficiaries. FHI 360 also laid the groundwork to improve case management by providing refresher training of activistas and mentoring and supervision training for CBO staff. Finally, COVida began implementing new procedures to update the HIV status of beneficiaries.
4.1.1 Mapping existing services COVida continued to encourage CBO partners to expand and update the mapping process, establish partnerships and advocate with the identified stakeholders, mobilize resources for OVC families, and link the beneficiaries to different services available in the community. CBOs have mobilized food baskets for families, clothing, school materials and uniforms for children, referred youth to vocational training, and caregivers to employment with public works. These are just a few examples of how other resources are being mobilized to support OVCs. Other referrals are discussed below in the section on referrals to other services.
As CBOs refer beneficiaries to services, they find that services are not always provided as intended. For example, some Chefes de Bairro are charging 200 MT to issues a poverty certificate, some school directors indicate that ADE funds to help students with school costs are already allocated and not available, the ambulance that is supposed to take patients from the health unit to the district hospital for free requests gas money, beneficiaries referred to National Social Action Institute (INAS) for a basic food package are told that no more are available. As COVida becomes aware of these issues, we raise them at the provincial and, in some cases, national level. The inter-ministerial
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meeting described below under Section 9. Collaboration with Government, Donors, and Other Stakeholders, is an example of the steps taken to address these barriers to services.
4.1.2 Identification of beneficiaries COVida continued to identify vulnerable children through the channels outlined in the FY18 work plan, prioritizing identification through clinical partners’ CBOs and HFs. In this quarter, COVida enrolled and provided at least one service to 24,467 new beneficiaries. To increase referrals from HFs, COVida continued to support partner CBOs to hold regular meetings with HFs to raise awareness of the services COVida can provide to vulnerable children. COVida GPs met with Provincial Health Directorate (DPS) and provincial offices of clinical and other implementing partners in several provinces, such as Tete, Inhambane, Nampula, Maputo, and Niassa, where a common topic was improving coordination for referrals and completed referrals. COVida also printed a poster to help clinical staff understand the OVC identification criteria and provide guidance on when and how to make referrals to COVida, which was distributed to all HFs and clinical partners. As result of this effort, the percentage of beneficiaries identified through HFs or clinical partners increased from 21 percent in Q1 to 51 percent this quarter, as shown in Table 3 below.
Table 3: Origin of OVC Referrals in the Last Three Quarters
FY17 Q4 FY18 Q1 FY18 Q2 Q1 % Q4 % # of # of Q1 % Referred Province Referred by # of families Referred by families families by HF/Clinical HF/Clinical identified HF/Clinical identified identified Partner Partner Partner Cabo Delgado 248 47% 389 34% 570 60% Gaza 2,384 3% 2 0% 0 0% Inhambane 205 13% 87 42% 171 86% Manica 629 65% 122 65% 845 66% Maputo 1,935 2% 1,055 7% Province 54 71% Maputo City 310 9% 299 0% 1813 25% Nampula 2,166 1% 8 20% 94 96% Sofala 325 17% 96 19% 238 49% Tete 169 53% 156 88% 197 29% Zambezia 6,565 0% 114 0% 569 92% Niassa 0 0% 0 0% 2 0% Grand Total 14,936 6% 2,328 21% 4551 51%
In this reporting period, the number of beneficiaries identified through HFs or clinical partners increased significantly in nearly all provinces. After presenting the COVida poster, we noticed that HFs and clinical partners were more inclined to accept the work COVida activistas do to navigate beneficiaries through the health system and enroll HF-referred patients in COVida. In Maputo province, Maputo City and Nampula, the collaboration with clinical partners improved dramatically. In these locations COVida CBOs prioritized identification through HFs, participation in Antiretroviral Treatment (ART) meetings; also, field supervisors provided more intense support to activistas placed in HFs at the beginning of collaboration. In these provinces, senior COVida staff also accompanied CBOs in visits to HFs to explain the project and advocate for more referrals. This has made a significant difference. In Inhambane, where 86% of the 171 new beneficiary household were identified via HFs, Center for Collaboration in Health (CCS) invited CARE to present COVida at a
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Community Engagement meeting in February and to define collaboration strategies. This improved linkages and will be replicated at the community level (between CCS and COVida activistas). In Sofala, the increase was due to having CBO focal points in health facilities, better coordination of health facility staff (including having a health technician from Bandua co-facilitate one of the refresher trainings for activistas), and better understanding of the project by health staff.
As reported in the previous report, in Gaza and Zambezia, the activistas focused on serving existing beneficiaries, rather than enrolling new ones; WV CBOs registered only seven new beneficiaries this quarter. WV has signed a Memorandum of Understanding (MoU) with Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) and is working to finalize MoUs with Clinical HIV/AIDS Services Strengthening (CHASS) and Friends in Global Health (FGH) which they expect will increase referrals from health facilities. Although WV CBOs has activistas chefes allocated at health facilities, they are not clear about their role. WV will focus on helping the CBOs define coordination mechanisms to have health facilitates refer HIV-positive adults with children, and HIV-positive children to COVida
CBOs have also identified HIV-positive beneficiaries in the community (e.g. through community leaders, community testing partners like ABEVAMO, etc.); thus, HFs are the biggest but not the only source of referrals of new HIV-positive beneficiaries. Due to stigma, many beneficiaries (e.g. in Massinga district), go to health centers far from their homes, but CBOs are employing coordination skills to ensure these beneficiaries are registered in the program and receive services even if they were found outside their community. The use of false names was also found as a constraint in Inhambane.
COVida continued to receive very few referrals from Integrated HIV Prevention and Health Services for Key and Priority Populations Project (PASSOS), due stigma and discrimination towards sex worker families in the community, lack of understanding of COVida support to sex workers’ children and limited geographic overlap. This quarter, PASSOS’s partner CBOs in Maputo referred 8 families to COVida CBOs, but only 5 of them live in COVida catchment areas. PASSOS also referred 15 children of homeless sex workers living in Maputo streets, but COVida activistas are not prepared to provide support for this specific target group, and the children were referred to SDSMAS officers. To improve referrals from PASSOS, COVida included a session on stigma and discrimination in the activista refresher trainings and distributed the COVida poster to PASSOS CBO partners.
Provincial teams have met with Hyalisa to discuss the flow of referrals. These are expected to start in the next reporting period.
4.1.3 Capacity development for high-quality case management services COVida provided pre-service training in basic case management (BCM) to an additional 79 activistas from Lichinga, the last district added in FY17, bringing the total trained since project initiation to 4,021 activistas and 573 activistas chefes. For these trainings, COVida mobilized its accredited trainers from SDSMAS from Nampula and Cabo Delgado.
From January to February, COVida Technical Officers conducted provincial level TOTs for 145 trainers (85 CBOs supervisors and 60 SDSMAS technicians), preparing them for subsequent refresher training of activistas, covering new approaches and important areas of focus for the project, including: improved quality of case management and revised forms (CSI, family action plan, etc.); ECD; community screening tool for HIV testing; linkages with HFs for beneficiary identification, testing, referral and adherence to treatment; disclosure support, stigma and discrimination; services for adolescents; sub-populations and differentiated services; and beneficiary graduation. After these TOTs, the CBO supervisors and SDSMAS technicians provided a four-day refresher training to 3650
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activistas at the CBO level, covering most CBOs. The remaining activistas (of CBOs that had started in the last six months) will receive refresher training in the next quarter.
Activistas said that this refresher training was crucial to clear up doubts that were reoccurring in the last year. The fact that most CBOs experienced activista turnover in the past year (some quite high), and new activistas were recruited but no funds existed for pre-service training, meant that these activistas were trained on the job informally. CBOs explained that this was not effective enough to master case management and thus greatly appreciated the four-day training. Many thought it could have been longer, as the agenda was very full and interesting discussions had to be cut off.
CBOs with a large number of activistas took several weeks to finish training all their activistas, since each class size was limited to 25 people to maintain quality. This meant that supervisors were involved in trainings instead of supporting activistas to serve beneficiaries for several weeks. In addition, some activistas were only trained in the new tools and approaches later in the quarter.
COVida Technical Officers conducted a two-day training on mentoring and supervision, equipping CBO supervisors and activistas chefes with knowledge and tools to provide supportive supervision using the mentoring and supervision tool (annexed to the Q1 quarterly report), facilitate weekly meetings to coach activistas on managing their caseloads and planning household visits to meet goals in each family care plan. This quarter, COVida trained 128 supervisors and activistas chefes in Tete, Niassa, Manica and Inhambane, or about 25% of total supervisors and activita chefes. The trainings are ongoing and the remaining provinces and will be covered in the next quarter.
4.1.4 Case management and service delivery In this reporting period, COVida activistas continued to provide priority services to families as outlined in the annual workplan, prioritizing services to beneficiaries carried forward from FY17 to address priority needs and support them to graduate. COVida provided services to 72% percent of its beneficiaries overall. Nampula, Maputo City, Inhambane and Gaza were able to serve 83%, 84%, 90%, and 97%, of their beneficiaries, respectively . In other areas, the high caseload activistas carried was a challenge as it was difficult to reach everyone. CBOs with high targets and large numbers of activistas struggled more than small CBOs to manage and track service provision to their beneficiaries. In Maputo province, the larger districts struggled the most. For example, AMODEFA and CMA have large targets in Boane district and struggled to provided services to all beneficiaries.
The mentoring and supervision trainings introduced in March indicate that most of activistas don’t know the total number of their beneficiaries, especially those activistas with high caseloads. These trainings were a good opportunity to train CBO supervisors and activistas chefes to organize and facilitate weekly meetings where activistas are coached on managing their cases and planning household visits to reach all their enrolled beneficiaries and meet goals in each family care plan. Also, COVida will continue to support CBOs by preparing lists of beneficiaries who had not yet been served, beneficiaries with unknown HIV status and beneficiaries ready for graduation readiness assessment. These lists will be shared at the end of every monthly reporting period and will be the basis to guide weekly meetings between CBO supervisors, activistas chefes and their activistas.
In many CBOs, activistas served beneficiaries and registered the services on the forms, but the forms were not entered into the database. The most common reason was a lack of time (only five days from when the activista chefes hand in the forms to the time when COVida needs to start cleaning data), which means CBOs simply do not enter data even though services were provided. Other constraints included distance (activistas in rural areas have a hard time handing in forms), CBO capacity to use eCSI, and data entry errors (e.g. some activistas provide a referral to testing but don’t mark “health” under services provided, which creates errors in eCSI; different spellings of names lead to people being double-counted; changes or non-entry of activistas in eCSI led to errors),
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which take time to correct. In other cases, activistas provided services but did not register the services on the forms. COVida continues to give TA to CBOs to correctly fill out the forms, but the more complex and numerous the forms become, and the more changes are introduced, the more complicated it is for the activistas.
Exits without graduation were 27% of the beneficiaries reached by end of Q1. These were due to different reasons, for example beneficiaries might have moved (i.e. children moving to try to continue studies in higher grades), they might not be home when home visits take place and therefore do not receive services, and/or activista attrition (especially in Maputo Province with the phaseout of AMODEFA). CBO staff turnover was also a problem in some CBOs. In some Zambezia districts, WV has seen a correlation between distance and poorer performing CBOs, such as those in Chinde and Inhassunge, as TA was impeded by the condition of the roads, which worsened over the rainy season.
4.1.5 Caseload management COVida continued to provide ongoing TA to CBOs to achieve a more manageable caseload, which affects the quality of services provided and the ability of activistas to track all their beneficiaries. As anticipated, the discontinuation of the maintenance phase as an intermediary step before graduation and the revision of graduation criteria had a significant impact in caseload. With these changes, many beneficiaries previously transitioned to maintenance phase were re-assessed applying the new criteria for graduation, since the criteria had changed and become more complex. For example, in anticipation of upcoming guidance on graduation, COVida established a criteria that all members of a household must know their HIV status and any family member on ART needs to have been retained on ART for at least six months. Also, the Minimum Global OVC Case Plan Achievement/Graduation Benchmarks states that families graduate, not individuals, meaning that all members in the family must have all priority needs met to graduate. Similarly, several outcomes in the Stable and Healthy domains must be met for the caregiver, which is applicable to all family members (e.g. able to meet emergency expenses, all family members know status). In cases where these beneficiaries were re-assessed, many were not ready to graduate, which increased the caseload of activistas. Across all COVida CBOs, the average caseload is currently 70 beneficiaries per activista, increasing from 55 at the end of the prior quarter. We expect that with all activistas, activistas chefes, and supervisors trained by the end of next quarter, most of the beneficiaries with 6 or more months in care, will be assessed for graduation. We also expect the number graduated to increase, which will result in a more manageable caseload for activistas. We are evaluating how caseload is calculated and in discussion with technical advisors and USAID on this point.
4.1.6 Transition assessment and graduation This reporting period, COVida introduced the new graduation criteria during the provincial TOTs and activista refresher trainings. Some CBOs began applying the new protocol for assessment for graduations in February; others only in March, due to training on it cascading down in the same quarter. Graduation assessments will continue in the coming quarters. In total, 26,658 beneficiaries graduated. CBOs that were trained first in Maputo City, Tete, Inhambane and Gaza had the highest proportion of graduates, as they had time to apply the new protocol after training. In districts that started implementation later (e.g. Cabo Delgado and Niassa), it was too early to expect that any beneficiaries would graduate. We expect to see more progress in the next quarter. We are also discussing how to accelerate the training of all activistas so changes are implemented more quickly in the next workplan year.
The new graduation criteria were difficult for some CBOs to grasp, and time was needed to explain the entire process again. Furthermore, a new criterion requires that all family members know their HIV status. Since it takes time to convince all members to be tested and for the CBO to learn how to
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record the change in HIV status correctly in the form and database (both new changes introduced this quarter), this has affected graduation numbers.
Activistas also had to prioritize their limited time, as they had considerable caseloads of beneficiaries who all needed to be visited and provided with services, and graduation assessments that take time; thus, our analysis shows that CBOs generally performed well in only one area: serving most beneficiaries, graduation, or updating HIV status, but not all three. Ongoing refresher training and new guidance in all these areas also complicated their work. We will work in this through technical assistance in the remainder of the year.
4.1.7 Referrals to HIV and basic health care and other social services 4.1.7.1 Linkages and referrals to health providers COVida continues to strengthen linkages with clinical partners and HFs, as well with other HIV community programs, through formal and informal meetings at national, provincial and district levels. This reporting period, COVida focalized its efforts to improve linkages with HFs in Maputo City, Maputo Province and Nampula, as these had shown difficulties. In these provinces, COVida’s technical officers supported CBOs to meet with HF directors to explain COVida’s support for HIV care and treatment and to distribute the poster about identification criteria and when and how to refer OVC families to COVida. Table 4 provides the results of completed referrals over the last two quarters.
Table 4: Q2 Linkages and Referrals Achievements Province REFERRALS TO HIV SERVICES REFERRALS TO OTHER SERVICES Q2 FY18 Q2 FY18 Referrals Made % Complete Referrals Made % Complete Referrals Referrals Cabo Delgado 235 76% 172 75% Gaza 77 78% 122 47% Inhambane 379 199% 60 95% Manica 605 71% 286 19% Maputo Cidade 155 126% 61 175% Maputo Province 1035 23% 318 19% Nampula 2697 72% 1409 7% Niassa 43 23% 21 0% Sofala 329 23% 21 200% Tete 384 50% 71 28% Zambezia 1040 62% 190 71% TOTAL 6979 68% 2731 28%
During this reporting period, COVida made 6,979 referrals for HIV-related services, of which 68% were completed. In the prior reporting period, 46% were complete. For overall services, 28% were complete. In the prior reporting period, 26% were complete. While in both cases, the percentage increased, the overall volumes were less than in the prior period. This could be due to the fact that there was not sufficient time to enter all the data into eCSI. We will analyze this recent data further and develop a strategy.
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A common constraint mentioned by beneficiaries, especially in rural areas, is lack of transport to the health facility. Involving clinical and community partners that test in the community is key to address this constraint. COVida staff also noted that some activistas sensitize the beneficiaries about a needed referral (e.g. HIV testing), without completing the referral form. The practice of recording a referral only when the beneficiary accepts to be tested is still happening in some places, although we are addressing this through TA.
To implement the pilot on community HIV testing criteria for 2-17 years OVCs, COVida trained 210 activistas in four districts (Milange, Maganja da Costa, Mopeia and Mocuba) overlapping with Communications for Improved Health Outcomes (CIHO) in Zambézia province. The activistas carried out HTC screening and referred eligible children for HIV testing. The data is being collected and will be analyzed in the next quarter. Please refer to Annex 4– Collaboration on OVC and HTC Referrals, for more detailed information on collaborative arrangements with clinical partners and HFs that are involved in community-based HTC and OVC referrals.
4.1.7.2 Linkages and referrals with other services COVida CBOs continued to strengthen linkages with other government services and the private sector,. The most common non-health completed referrals were for birth certificates and school enrolment. For example, Manica CBOs enrolled 1761 children in school and in Cabo Delgado, 473 children received birth certificates.
However, there is a notable lack of response by government and other local partners to referrals for social protection and other support. The most common challenges are difficulties in obtaining poverty certificates (especially in Maputo, where beneficiaries are being charged up to 200 meticais; in Manica community leaders lack A4 paper, which could be remedied by the CBO), birth certificates, basic social assistance and direct social support from INAS, and school supplies through ADE, as the government services often cite a lack of funds. For example, birth certificates are easier for families living close to the district capital; those who live further away usually lack money for transport. Another constraint is that one or both of the parents also lacks necessary documentation.
At the local level, our CBOs coordinate with registry and notary services to register beneficiaries during campaigns. One good practice between Tsinela and the district Notary Registry Service was an agreement to register at least ten children weekly; this coordination was encouraged from a visit of the office of the Provincial Governor’s wife to Tsinela, in conjunction with the Administrator’s wife’s office and SDSMAS. As described below in Section 8. Collaboration with Government, Donors, and Other Stakeholders, COVida brought many of these issues to light during the central level inter- ministerial field visit and meeting in March, and will continue to follow up in Q3.
4.1.8 Support for adolescents To help activistas provide differentiated services for adolescents, COVida included a session in the activista refresher training curriculum rolled out this quarter. The session includes information on adolescent development, how caregivers can effectively communicate with adolescents, tips to engage with adolescents and parents of adolescents, and adolescent-specific HIV and sexual reproductive health (SRH) information. However, it was widely acknowledged by COVida staff and CBOs that a single session was not adequate for this topic.
Following the training, activistas increased their focus on sensitizing adolescents (during household visits) about adolescent and youth-friendly SRH services (i.e. Serviços Amigos aos Adolescentes e Jovens, SAAJ), making referrals and providing information on the free SMS BIZ counseling service. In Nampula, COVida and its CBOs had meetings with nurses of all the SAAJs to understand how we
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could coordinate. The SAAJs were very receptive, which we hope will start to result in completed referrals to SAAJ next quarter.
Using materials from previous FHI 360 adolescent projects, COVida compiled a toolkit for CBOs to implement group activities for adolescents: adolescent clubs, study groups and debate sessions. While the adolescent debate manual is still in development, some CBOs trained by previous programs started to implement the toolkit. In Maputo Province, Kindlimuka created two study groups. In Manica, COVida CBOs created and supported three adolescent clubs. We will continue to share the toolkit and encourage experienced CBOs to pilot the integration of these activities on a small scale, as COVida has no funds in FY18 to support this activity on a large scale. If it proves valuable, we will gradually work with other CBOs to scale up the approach.
Using the results of the mapping, COVida successfully integrated adolescent OVCs in livelihood activities, such as mechanics, carpentry sewing and metalwork apprenticeships in Tete, Maputo Province, Inhambane and Niassa. In Manica, COVida partner CBO, Centro Aberto de Barue, signed a MoU with a local Recycling Organization to provide training for OVC adolescents.
4.1.9 Supportive environment for OVC and healthy life choices In Nampula and Cabo Delgado, N’weti trained nine debate facilitators, six CBO staff, COVida staff and SDSMAS technicians on the debate manual for debate sessions with savings groups. Other debate trainings scheduled for this quarter were put on hold due to the FY18 funding situation. Debate facilitators started activities only in Cabo Delgado, and 26 debates have been held with four savings groups on HIV prevention and transmission, early marriage, and violence. The topic of violence was hotly debated in all groups, particularly participants’ affirmation that denunciation doesn’t work because the police don’t resolve cases, thus it is better to deal with violence in the family and the community.
COVida has strengthened collaboration with the Hlayisa project in Maputo Province, Gaza and Inhambane. Referral mechanisms agreed between the two projects include:
• COVida will refer to Hlayisa people between the ages of 15 and 29 who are living with HIV but have not yet talked about their HIV status with their families, as Hyalisa provides support for disclosure in the context of index case testing. • COVida will refer adolescent and young people between the ages of 15-29 and who are sexually active to Hyalisa community dialogues. COVida CBOs in Inhambane already referred 30 beneficiaries to Hlayisa community dialogues. • COVida savings groups will be a platform to create Hyalisa’s community dialogue groups. • Hyalisa will refer to COVida its beneficiaries under 18 who are infected or affected by HIV. • In cases where Hlayisa and COVida work with the same CBOs, we are taking steps to ensure there are synergies.
4.1.10 Provide structured TA at all levels to support operationalization of guidance and protocols Per COVida’s TA protocol, CBOs receive one TA visit per month from their COVida technical officer, and regional level M&E and national level technical officers visit each province every quarter. This quarter, the TOT and refresher trainings caused some constraints, with fewer TA visits than normal. However, the TOTs and refresher trainings were key to address capacity gaps. TA was also carried out by email and phone. TA this quarter focused on adapting to the new OVC_SERV indicator definition and forms, using eCSI, graduation, and following up with referrals. After the roll-out of the mentoring and supervision training, in almost all TA visits it was noted that the activistas chefes and supervisors are using the tool appropriately and providing feedback to activistas. CBOs have standardized the weekly meetings between activistas chefes and their activistas to discuss progress, challenges, and plan for the week ahead.
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It was noted that CBO higher level staff need to provide TA to activistas and activistas chefes who struggle with difficult cases, such as child protection issues and child-headed households. COVida provided TA to CBO management staff to follow-up difficult cases and advocate with local leaders and government.
FHI 360 also provided TA visits to Gaza, Inhambane and Zambezia, particularly to support the first TOTs and refreshers.
4.2 IR 2: Reduced Economic Vulnerability of OVC Households 4.2.1 Meeting basic consumption needs During this quarter, COVida provided basic household supplies to 414 destitute families, delivered through local leaders and SDSMAS in Inhambane, Maputo Province, Tete, Nampula and Sofala. The kits mainly included dishes, buckets, plastic sheeting and mats to sleep on. COVida continued to refer vulnerable families to INAS to receive social protection support and mobilized other sources of support, such as a small number of household kits from KPMG in Tete and 210 buckets from the CARE Cyclone Dineo project.
4.2.2 Improve capacity of families to manage money and generate income During this reporting period, 205 new groups initiated savings, bringing the total number of active savings groups to 649. These groups have a total of 13,250 members, of whom 4,830 are COVida beneficiaries (4,000 caregivers, 830 OVC). This represents roughly 9% of beneficiary households that are participating in savings groups. At the end of FY 17, the percentage was.3.2 percent; in Q1, 5%. The steady increase reflects project efforts to increase the percentage of beneficiaries who are benefitting from savings groups.
The majority (80%) of the savings group members are female. The 649 groups have saved from the start of the project a total of MZN 12,916,503, or an average savings of about MZN 975 per participant. Since the start of the project, MZN 6,120,720 has been used in the form of loans to its members, representing a utilization rate of 47% and an accumulation of liquid interest in the amount of MZN 850,304.
Table 5: Savings Group Data # of % of Female # of % of Province # of Groups Members Members Caregivers Caregivers Inhambane 105 2352 84% 494 22% Maputo City and Province 158 3198 84% 866 27% Cabo Delgado 8 135 69% 35 26% Gaza 23 563 92% 229 41% Sofala 25 522 70% 118 23% Manica 54 1110 75% 206 19% Tete 74 1,380 76% 546 40% Nampula 92 2,100 80% 621 30% Zambezia 104 1,792 69% 841 47% Niassa 6 98 86 44 45% Total 649 13,250 79% 4000 30%
Most CBOs have hired household economic strengthening (HES) supervisors to strengthen the implementation of savings groups and improve data quality and collection. HES supervisors also have the responsibility to create and support up to five savings groups, in addition to supervising HES facilitators. CBOs have increased efforts to ensure the majority of savings group members are
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COVida beneficiaries; however, a difficulty that some CBOs mention is that many beneficiaries do not have, or feel that they do not have, enough resources to get started. COVida continues to give TA to CBOs to ensure they know how to lower share amounts, explain to caregivers that very little is needed to get started, and show them ways they could come up with the amount, (e.g. through selling some of their crops).
Participant feedback from the groups is positive, indicating that the groups provide an opportunity not just to save, but to discuss social issues and strengthen relationships and social capital.
4.2.3 Transform resources allocation in the household in favor of OVC HES supervisors and facilitators have continued to sensitize saving group members about the importance to use resources from the savings group in the favor of OVC and the overall family. Activistas are reinforcing this message during household visits (e.g. when they speak about ways the caregivers can overcome challenges with regards to identity documents, school materials, clothes, and food). Several CBOs had savings groups reach the end of their first savings cycle, enabling the distribution of funds to the members, who prioritized paying school costs, improving their businesses (e.g. selling vegetables, which also contributed to improve household nutrition), and improving their homes. Groups established by Tsinela and Mahlahle stood out for their charitable actions, using the remaining social fund, equivalent to about $600 to buy school uniforms and materials for 129 children and identity cards for 14 children. In other locations, savings groups are not clear on how to use the social fund, and sensitization about the need to use savings for OVCs needs to be strengthened.
More adolescent OVCs have started to participate in savings groups, particularly in Sofala and Maputo Provinces. AMODEFA’s team in Boane created two savings groups with 50 OVC members. These adolescents do small jobs in the community and use the money earned to save.
4.2.4 Technical assistance and supervision In March, CARE carried out one training in the Village Saving and Loan (VSL) methodology, followed by one training in Savings Groups Information Exchange (SAVIX). These trainings benefited new CBOs and COVida staff from Maputo City, Maputo Province, and Tete, with participation from 15 CBOs and staff from both FHI 360 and CARE, for a total of 42 participants. The trainings took place in Maputo and were co-facilitated by CARE and FHI 360 staff as well as an international consultant, Andreas Peham.1 During January and February, the Consortium partners were focused on TOTs and activista trainings, thus there was no TA on HES. With the above-mentioned budget cuts, trainings on SAVIX were also suspended in March 2018, pending a cost benefit analysis of using SAVIX. Given CARE’s commitment to the IR2 component and strong belief that SAVIX is the most effective way to collect and analyze data is used for TA decision-making, CARE has offered to financially support the SAVIX trainings using their unrestricted funds to train in Nampula., Cabo Delgado, Niassa and Gaza provinces. CARE is preparing a document outlining the advantages of SAVIX beyond reporting indicators, as a tool to ensure the integrity of savings groups, as an early warning system to identify problems and misuse of funds in time to address them. The consortium will analyze these aspects of SAVIX as part of the workplan process for FY 19.
VSL Methodology Training The five-day methodology training targeted HES supervisors to enable them to successfully form savings groups in their communities and provide support to the groups and HES facilitators. The training also included tools that will help the HES supervisors plan and coordinate HES activities at
1 The cost of Andreas’ consultancy will be included as part of Care’s cost share contribution to COVida. The value will not be reported in the Q2 report because Andreas will also be providing methodology training for Nampula in April. This cost is valued around $10,000 and will be included in Care’s Q3 financial report.
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the CBO level. The training included a session that allowed participants to brainstorm ideas to target and ensure inclusion of COVida beneficiaries (OVCs and their caregivers). After the brainstorming session, the participants were presented with ways in which they can ensure COVida beneficiaries can be included in savings groups. For example, the training facilitators stressed the importance of activistas being part of a savings group so they can understand the benefits and encourage COVida beneficiaries to participate. Additionally, there were sessions on how to introduce the activity at the community level to promote the benefits offered to beneficiaries and community members, information about the election process for the group leaders, and the different phases (preparatory, intensive phase, development phase, and maturity) of the methodology throughout the nine-month cycle and how the groups should be managed throughout these phases.
The training included various group simulations in order to ensure the participants understood how to implement the methodology so they can successfully support the HES facilitators and ensure quality at the community level. As of this quarter, most CBOs have been trained in VSL methodology. The HES Technical Advisor will provide intensive TA to the remaining CBOs in Zambezia.
SAVIX Training. The four-day SAVIX training followed the methodology training, and included information on the M&E tools used at the consortium level to monitor savings groups and capture key performance indicators relevant to COVida using the management platform SAVIX.
Participants in the SAVIX training included 13 CBO HES supervisors that had already formed savings groups, and the learning for them focused on how to best support the HES Facilitators and the savings groups themselves in addition to collecting and documenting data on the groups. Other HES supervisors from three newer CBOs had not started forming groups.
At the end of the SAVIX training a post-test was facilitated to evaluate the level of the participants’ understanding of the information provided during the training. Participants passed the exam with satisfactory marks. The GPs will need to keep in mind the following with regards to SAVIX and the HES supervisors at the CBOs:
• HES supervisors need to travel to remote areas to support and monitor savings groups, necessitating good planning within the CBO. • CBOs that have been recently trained and do not yet have savings groups will need extra support with the utilization of SAVIX given that more time will pass before they put their knowledge of SAVIX into practice. • Some CBOs only have one computer, which is primarily used by the M&E officer. The supervisors will also need a computer or an Android smart phone to input data into the SAVIX database, though budget cuts this year did not allow for including this in CBO budgets.
SAVIX trainings have been put on hold partly due to recent budget cuts, and also to review the costs/benefits of the SAVIX model. The CBOs that have not received SAVIX training include five organization in Gaza, and nine from Nampula, Sofala, Cabo Delgado and Niassa. These CBOs continue to gather data on the groups using Microsoft Excel.
Technical Assistance to CBOs in Maputo City and Province In the streamlined technical assistance model adopted this fiscal year, it is expected that technical advisors will visit a limited number of CBOs in each province in the company of the Provincial Technical Officer (PTO). The PTO then reinforces the recommendations and disseminates them with the remaining CBOs. During this reporting period, the PTOs were heavily involved in the trainings of
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field cadres linked to IRs 1 and 3. This greatly limited their availability for IR2, which in turn limited the TA visits that CARE was able to do. This will change during Q3 and Q4, as trainings are mostly completed and the focus will be on TA.
The CARE IR2 technical staff did conduct a week-long TA visit in Maputo, accompanied by one FHI 360 NSTO. Seven CBOs in Maputo City and Maputo province received TA on the savings group methodology and its correct implementation as well as the usage of SAVIX. The TA focused on harmonizing the methodology being used across the Consortium, the correct usage of the IR2 tools, and effective data collection and data analysis using SAVIX.
Some of the challenges identified during the TA visit to the Maputo CBOs were: 1) The slow progress in some CBOs with regards to forming groups. 2) In one CBO, 4 HES facilitators left within a short period and the CBO was unable to provide sufficient support to the groups. 3) Insufficient understanding of the VSL methodology, linked to the level of capacity of the facilitators and lack of supervisory support. 4) Problems with properly registering loans. 5) Lack of updated data in the SAVIX platform linked to a poor understanding on how to collect all of data requested. CARE provided FHI 360 with feedback and action points with regards to each CBO visited.
The overall recommendations for the FHI 360 and the Maputo CBOs are: 1) Groups should not start to save money unless they have the minimum number of members (10) needed to start saving, to reduce risk. 2) Ensure savings groups have the proper materials (metal box, locks, stamps, bowls, bags, booklets) before they start. 3) Ensure the savings groups are receiving TA from the HES supervisor at the CBO level according to the calendar in the Facilitator Guidebook. 4) Ensure the GP PTO follows-up on these recommendations and shares the recommendations with all other CBO HES staff in the province. 5) Ideally, the savings groups would be formed in areas where the HES facilitators/supervisors can provide frequent TA. CARE also recommended additional support for CBOs on using SAVIX; however, COVida has suspended the use of SAVIX for any CBOs not already using it effectively. In the coming months, COVida will assess the cost benefit of using SAVIX. Excel spreadsheets are able to capture the data necessary for reporting; however, CARE indicates that SAVIX is also an important tool for ensuring quality of savings groups and protecting funds from fraud and embezzlement.
Overall, in Maputo City and Maputo province there is clear need for more intensive supervision from both FHI 360 and CARE. We expect that the presence of trained HES supervisors, recruited during this reporting period, will improve the results in HES.
4.3 IR 3: Improved Capacity to Provide ECD Services for Vulnerable Children under Age Five 4.3.1 Use of quality community child care and development interventions increased In this reporting period, PATH completed the design of the national Community Preschool Activity Manual and Implementation Guide, following the final recommendations from the Technical and Consultative Council of Ministry of Gender, Children, and Social Action (MGCAS). The last changes centered on revision of selected stories and illustrations, and on making the materials more internally consistent in language and formatting. At the Consultative Council meeting in early February, the Minister approved the manual for pretesting, with a request to generate initial lessons by August 2018.
As next steps, PATH—with inputs from GPs, CBOs, and ECD partners—has designed a process for selecting playgroup facilitators and rolling out community playgroups in a gradual and sustainable manner. Three pilot CBOs in Nampula and four pilot CBOs in Maputo City and Province engaged in facilitator selection, which included consultations with the community, a visit to a candidate’s home,
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and a practical test where the candidate was asked to conduct an activity (tell a story or do a game) with preschool-age children. Additionally, a six-day, step-by-step training guide for community playgroup facilitators was designed. In response to the MGCAS request, COVida extended the invitation to several strategic ECD partners—such as UNICEF in Nampula, and Wona Sanana and Essor in Maputo—to be trained as trainers and help MGCAS roll out and pretest the new community preschool tools.
The implementation of the playgroup pilot is currently on hold due to budget restructuring. COVida’s revised FY18 workplan, which is pending USAID approval, reduced the number of playgroups to only four in Maputo City/Province. These would be very low cost, as the training and TA would be facilitated by the close distance and play group facilitator subsidies are minimal. On the other hand, it is a priority for MGCAS and much effort and resources have been put into the development.
4.3.2 Improve parental care and responsiveness for children under five
Training of trainers in case management and ECD PATH worked in coordination with FHI 360 to design the most feasible strategy—within the financial and human resource limitations of the project—to provide ECD-specific training to all CBO activistas. This training had been previously postponed several times due to project constraints. As a result, ECD was integrated into case management trainings that began in January 2018. The provincial TOTs had a dedicated focus on ECD, specifically to developmental monitoring, stimulation, and child safety. PATH provided technical support to these TOTs by designing and producing a training package, facilitating ECD content, demonstrating the methodology to be used during the replication trainings, and coaching trainers during facilitation sessions. As most of these trainings happened simultaneously, PATH’s direct participation and facilitation was not possible in all provinces. PATH and FHI 360 identified priority provinces for direct training in ECD, and as a result, the PATH team supported facilitation in six provincial TOTs—namely, in Nampula, Zambezia, Gaza, Maputo Province (two TOTs) and Maputo City. TOT participants included CBO coordinators and supervisors, SDSMAS technicians, program officers and HIV/AIDS focal points.
It was expected that through these trainings, SDSMAS, CBO supervisors, and other key local project staff would be able to prepare CBO activistas and activistas chefes to better integrate ECD in home visits—including monitoring developmental and nutritional status of HIV-positive and exposed children, counseling caregivers on age-appropriate stimulation and nutrition, and referrals in case of suspected developmental delays and malnutrition, using the referral guide for health facilities.
During the training, it was observed that most of the trainees already had some skills as trainers and basic knowledge about stimulation and nutrition. However, some difficulties persisted as to what should be done during the home visit to ensure that the family received ECD services. The trainers were advised to prepare for the replication trainings by 1) studying the training manual; 2) preparing necessary materials for the training, with special focus on toys and home visit cards; 3) asking GP trainers and regional ECD specialists for support whenever necessary.
Training of and activistas and activistas chefes in case management and ECD This quarter, PATH provided technical assistance to the CBO trainers and SDSMAS supervisors in the replication training of activistas and activistas chefes on ECD in case management. One day of the four-day refresher training was dedicated to ECD. The Regional ECD Specialists (RECDS) supported the implementation of 22 refresher trainings, distributed as follows:
Region Province District/Area CBO Participants Cabo Kaeria Activistas and activistas North Pemba city Delgado (1 group) chefes
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ASAS (1 group) and Angoche and Activistas and activistas Nampula Niwanane (2 training Nampula city chefes groups) Maganja da Activistas, activistas chefes, Caritas (5 training groups) Costa supervisors Centre Zambezia Activistas and activistas Pebane Assodeli (5 groups) chefes, CBO supervisors AJUCOM (2 training Activistas, activistas chefes Manhiça groups) and ACIDECO (2 and M&E officers training groups) Activistas and activistas Maputo Matola ACODEMU (1) South chefes province AMODEFA (2 training Activistas, activistas chefes Boane groups) and M&E officers Activistas and activistas Ka Mubucuane Hixikanwe (1) chefes
In general, the trainings were interactive and ECD was integrated according to the planned agenda. The activistas chefes and activistas had opportunities to discuss their doubts and concerns regarding ECD in home visits. However, some activistas still had difficulties in delivering the content and selecting necessary support materials, such as toys according to the age of the child. Based on the gaps verified in the training sessions, recommendations were made to the CBO and SDSMAS trainers and supervisors with regard to their technical support to activistas chefes, so that these in turn provide systematic support to other activists in ECD. Some CBOs report that some caregivers are too busy to play with their children. Activistas screened under-five children for acute malnutrition and referred cases to health facilities. CBOs counselled caregivers on nutrition, specifically the importance of varying the diet and how to use locally available nutritious foods. In Manica, 80 cooking demonstrations were carried out, along with 115 sessions of nutritional education.
Mentoring and supervision training In this reporting quarter, the RECDS based in the central zone collaborated with FHI 360 in supporting integration of ECD in a two-day training on mentoring and supervision held in Buzi District, Sofala Province. The training targeted Kuphedzana CBO supervisors, activista chefes, CBO M&E officers, and SDSMAS supervisors. Participants had the opportunity to analyze and discuss all aspects of mentoring records and how to effectively integrate ECD with a special focus on using home visit cards to monitor child development and to counsel on stimulation, nutrition and child safety. Although the training participants demonstrated knowledge of the mentoring tools, it became clear that these were not always completed at supervision visits. Recommendations were made to the training team to continuously support the activista chefes in completing the mentoring tools and including ECD in case management discussions.
4.3.3 WASH behavior Activistas sensitized caregivers about the importance of keeping houses and yards clean to prevent illnesses, including showing them how to sweep their yards and get rid of stagnant water. Awareness on the need to wash hands, boil or treat water, build and use latrines, and sleep under mosquito nets were also key messages this rainy season. Activistas also counselled caregivers on the rational use of water, given water restrictions in many parts of the country. With support from community members, 130 latrines were built in Cabo Delgado, and 48 in Manica. In Nampula, 117 families gained access to a latrine this quarter, despite very strong cultural barriers especially along the
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coast, where open defecation is practiced. In Maputo Province, seven families that had latrines too close to their houses, were able to close them up and build new latrines following environmental guidelines, along with Tippy Taps; these families used loans from their savings group participation.
In Maputo City, following lethal collapse of the Hulene landfill in February, which affected several COVida beneficiaries, CBOs supported affected families to re-establish their homes in safer areas, and COVida provided emergency items.
4.3.4 Technical assistance and supervision In mid-January 2018, PATH recruited two RECDS for the northern and central regions of Mozambique, respectively based in Nampula and Quelimane cities, who joined the existing RECDS for the southern region based in Maputo. After the initial induction period, all three RECDS dedicated their attention to supporting the ECD rollout process through provincial TOTs and replication trainings in case management, as described above. Once this process was concluded, the southern and northern region RECDS focused their efforts on identifying and preparing CBOs to implement the playgroup component, an intervention that unfortunately has been suspended.
As per annual and quarterly plans, RECDS are supposed to conduct one quarterly TA visit to each province. Due to other priorities for this quarter as described above, the total number of TA visits conducted by RECDS this quarter has been limited, with only 12 TA visits carried out. Nevertheless, six different provinces have received TA, which includes five provinces (Sofala, Tete, Manica, Nampula, Niassa) that received TA in ECD for the first time in project life.
TA visits allowed RECDS to work with technical provincial teams, CBO supervisors, and activistas chefes with the aim of enhancing their technical skills to ensure effective integration of ECD into home visits and case management activities. The table below summarizes provinces and partners visited, and main findings and recommendations from each TA visit. Table 7: A Selection of Findings and Recommendations from ECD TA Visits Location and CBO Recommendations Lichinga, Niassa Main Findings Associação Progresso • Activistas do not always use home visit visual cards. • Supervisors/activistas chefes do not use mentoring forms during follow-up visits. • Activistas do not have toys in their kit of materials.
Recommendations (Person responsible) • Use weekly sharing and planning meeting of activistas as platform for in-service training in 1) the use of home visit cards and 2) making and using toys during home visits (CBO supervisors). • Ensure regular and adequate use of mentoring form by supervisors and activista chefes (GP technical staff). Nampula City, Main Findings Nampula • Activistas chefes trained in case management and ECD integration. Niwanane • Activistas chefes support activists in integrating ECD.
Recommendations • Continue to provide technical support to activistas chefes so that they can better support the activistas. Marracuene, Maputo Main Findings Province • Provincial technical officers with capacity to support ECD integration activities during CONFHIC home visits and assessment of the nutritional status of children. • Activistas do not integrate ECD during home visits; activistas take the toys with them in
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their bags but do not use them to demonstrate in families.
Recommendations (Person Responsible) • Organize hands-on refresher for activistas on how to do ECD component and how to use toys in home visits; use weekly activista meetings and mentoring visits to reinforce ECD integration (CBO supervisors and activistas chefes). Matola, Maputo Main Findings Province • Supervisors with good capacity to support activistas. ACODEMU • Activistas with all materials needed to do home visits including toys. • Some activistas use toys not suitable for the age group. • Difficulties in the use of the Mid-Upper Arm Circumference (MUAC) tape.
Recommendations (Person Responsible) • Provide support to the activistas to identify toys appropriate for child’s age (CBO supervisors and activistas chefes). • Re-train activistas on use of the MUAC tape (CBO supervisors and activistas chefes). Tete City, Tete Main Findings Kuthandizana Kutchira • Supervisors and activistas chefes know and use mentoring tools. • Activistas record ECD integration in the follow-up sheet. • Activistas do not use home visit cards during home visits. • Activistas do not have enough toys necessary for ECD integration during visits, and do not encourage caregivers to produce toys and play with children (it is the activistas themselves who do it). • Activistas do not monitor child development and consequently they do not refer children suspected with development delays. • Activistas do not refer preschool-age children to community preschools (where they are accessible).
Recommendations (person responsible) • Encourage activistas to always use the home visit cards to demonstrate stimulation activities and nutritional practices appropriate for the age of the child (supervisors and activistas chefes). • Encourage activistas to support caregivers to produce age-appropriate toys and to play with children (activistas chefes). • Reinforce with activistas chefes and other activistas the need to monitor child development in accordance with developmental milestones and refer to health facility in case of developmental delays; reinforce how to use referral guides (CBO supervisors). • Reinforce referrals of preschool-age children to community preschools, where they are accessible (CBO supervisors).
In general, the CBO TA visits conducted by RECDS jointly with CP provincial technical officers showed some improvement in the integration of ECD when compared with previous quarters. This result is attributed to the ECD rollout trainings that were conducted in this quarter. At the CBO level, the supervisors and activistas chefes have begun to integrate ECD routinely into the case management services provided at home visits. However, ECD is still an incipient field of activity for most of the CBOs, and in many cases, they share similar challenges that have been identified throughout support visits and that require project attention:
• Need to ensure regularly and consistent utilization of home visit cards by the activistas to support counseling on ECD specifically and in general. • Adequate monitoring of nutritional status and developmental milestones and referrals to health facility in cases of suspected delays/malnutrition.
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• Toy production and use during home visits; building caregiver skills to make toys and to play with their children. • Consistent use of mentoring form by the CBO supervisors and activistas chefes.
RECDS will be following up with the GPs and CBOs on these and other recommendations made during TA visits.
4.4 IR 4: Capacity of district government and communities to provide essential preventative and protective services to vulnerable families and children 4.4.1 Facilitate multi-sectoral coordination meetings to promote collaboration and further the objectives of the project On 26 March, COVida organized a joint supervision visit to its CBO in Marracuene, CONFHIC. The visit included participants from MGCAS, MISAU, Ministry of Interior (MI), Ministry of Youth and Sports (MJD), Ministry of Justice, Constitution and Religious Matters (MJCR), Ministry of Education and Human Development (MINEDH), INAS, National AIDS Council (CNCS), DPGCAS, DPS, and the district Administrator’s office. This large group split up to visit different beneficiary households and a savings group. The visit was an eye-opener for many Ministry representatives, who were surprised to hear that poor beneficiaries were being charged for poverty certificates, that a girl who had failed in school simply needed glasses but her family did not have resources to make that happen (and supporting this girl required the intervention of five ministries), and that many referrals to government services were not completed.
On March 29th, COVida organized a half-day inter-sectoral meeting with the same ministries and entities, which was held at the Ministry of Youth and Sports, to present progress of the project, findings of the site visit, and debate on main challenges: poverty certificates, direct support for schools, usurpation of inheritance, and birth certificates. The meeting proved useful to raise awareness at a high level about challenges in the field, as many ministry staff were not aware of the realities on the ground, since the policies are often adequate, but are not operationalized as designed. In Q3, COVida will follow up with meetings with key ministries to seek ways to address for persistent challenges.
COVida participated in OVC Technical Working Groups (GTCOVs) and other multi-sectoral and coordination meetings. In two GTCOVs in Manica, where FHI 360 was one of three NGOs present, along with various government institutions, issues relevant to COVida were discussed, such as the free civil registration campaign. In Maputo, COVida participate in GTCOVs to prepare the upcoming mobile brigade for child registration, which culminated in the registration of 116 COVida OVCs. CBOs were actively involved in organizing and holding meeting of Technical Support Groups for OVC (NUMCOV) in all implementation districts. Topics discussed included involving men, delay in follow- up with referrals, birth registration and district agriculture (Serviços Distritais de Actividades Económicas) services.
4.4.2 Strengthen capacity of district government and communities to coordinate and respond to OVC needs COVida trained SDSMAS trainers in about 60 districts to provide refresher training to activistas. The SDSMAS participants indicated that the training was very valuable for their work, as the training used tools and approaches from the MGCAS, and they deepened their understanding of how to coordinate with COVida and facilitate services for beneficiaries. Health facility staff also participated in the CBO refresher trainings, for example, for the session on tuberculosis.
COVida continued to conduct joint supervision visits to CBO activities and beneficiaries, involving both provincial and district government representatives. Social action, health, education and notary
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from district and provincial level were the most frequent participants. Government representatives witnessed the situation of vulnerability faced by OVC families, such as lack of birth registration, lack of clean drinking water, lack of decent food and housing. These visits transmitted a sensitivity to these government technicians, which we hope will increase completed referrals. Community leaders have also been involved in supervision visits and meetings. Their involvement facilitates obtaining statements for various documents needed. Local leaders also mobilize resources in the community.
4.4.3 Develop technical and organizational capacity of CBOs During this reporting period, COVida trained four Gaza province CBOs, namely Activa, AESP, Reencontro and Udeba, on USAID rules and regulations. This training also covered Internal Governance, Policies and Procedures and Internal Controls and was prepared based on Standard Provisions for Non-U.S. Nongovernmental Organizations and the 2 CFR Chapter I, Chapter II, Part 200 et al. (Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards). The Internal Governance part of the training was based on the Mozambican legislation. At the end of the training all CBOs produced actions plans for greater compliance with USAID rules.
As a follow-up of a similar training provided last quarter in Maxixe, COVida paid a visit to six Inhambane CBOs and provided further TA to meet special award conditions in their subawards. In general, the CBOs are complying with many of the actions planned, but further follow-up is needed.
COVida provided structural TA using its Troubleshoot Model to two Maputo province CBOs (ASSEDUCO and CMA), to address their organizational problems and guarantee a smooth implementation of the project. At the end of each visit, an action plan was agreed upon with the CBO (see Annex 5 for the ASSEDUCO action plan).
During this quarter, a template for an electronic backup policy was released to CBOs, with the TA for putting the backup system in place planned for Q3. Once implemented, the backup policy will reduce the risk of electronic data losses, in case of computer malfunction or loss. 5 EXIT STRATEGY
COVida is implementing the exit strategy as outlined in the FY18 work plan. One aspect of COVida’s approach is to identify existing services and strengthen relationships at community and district levels to increase access of OVC to government and other resources. Examples of this collaboration are provided in Section 4.1.7. 6 PROJECT PERFORMANCE INDICATORS
In Q2, COVida continued to build upon progress toward its annual targets. This section shows where we are in achieving the targets set for the year, outlined on the approved work plan and Performance Monitoring Plan (PMP).
6.1 IR 1: Increased Utilization of Quality Health, Social and Nutritional Services Table 8 below illustrates the targets and progress made in IR 1 (increased utilization of quality social, health and nutrition services) in Q2 (and also presents results from Q1).
Table 8: Achievements Against Targets for COVida IR 1, October 1, 2017 to March 31, 2018 Annual Q1 % Q2 % Indicator Target Results Achieved Results Achieved
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Q1 Q2
OVC_SERV Number of active beneficiaries served by PEPFAR OVC programs for 338,023 268,335 79% 213,789 63% children and families affected by HIV OVC_HIVSTAT Percentage of orphans and vulnerable children (<18 years old) with HIV 98,330 2,4972 2.5% 43,026 44% status reported to implementing partner (cumulative) Number of referrals made to health or 169,012 46,289 27% 9,710 33% social services Number of referrals to health or social 85,858 16,964 20% 5,468 26% services known to be completed OVC_ACC Number of active beneficiaries receiving support from PEPFAR OVC 40,131 32,770 82% 6,979 99% programs to access HIV services SS.HRH.02 Number of community health and social workers (CHW) who successfully 1,287 93 7% 75 13% completed a pre-service training program
By end of Q2 FY18, a total of 294,865 beneficiaries were reached through COVida. The majority of these beneficiaries were carried forward from FY17, plus 34,209 new beneficiaries enrolled during the first semester FY18. In March, we were informed that the indicator definition changed for OVC_SERV. In Q1, it included the active, transferred, graduated and exited without graduation beneficiaries, while in Q2, we were required to only count the active and graduated beneficiaries. This excluded any transferred beneficiaries, as well as those that exited from the program without graduation for many reasons, including deceased, lost to follow-up, or even those not served during the quarter. The visible reduction in beneficiaries is due to a change in definition.
During Q2 (see Table 9 below), we provided a minimum of 1 service to 72 percent of our beneficiaries, or 213,789 (including new beneficiaries). 26,658 graduated during the quarter. COVida did not record services to the remaining beneficiaries; preliminary inquiry provides the following reasons: beneficiary not present during household visit (working, at school, in the fields or other reasons), unable to locate household, difficulty managing high caseloads, forms registering services submitted late, so not captured; volume of data too high, so CBO was not able to complete all of data entry before the deadline. COVida is taking the following steps to address the situation: provide guidance to alter visit schedule to catch all family members at least once during the reporting period, continue TA on managing caseloads, submission timelines, and data entry. In addition, COVida will consider altering deadlines to allow more time for data entry.
Table 9: Active and Graduated Beneficiaries
Received Minimum 1 Exits Without Graduation Total Number Graduated service in Q2 Province of % (of total % (to received Number % (of total Beneficiaries Number Number beneficiaries) 1 service) beneficiaries) Cabo Delgado 8260 5247 64% 1394 27% 3013 36% Gaza 24208 23540 97% 3466 15% 668 3%
2 In Q1, the reported figures were only for the new enrollments, while in Q2 we started tracking the total number of beneficiaries
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Inhambane 25302 22694 90% 2009 9% 2608 10% Manica 20362 10766 53% 1468 14% 9596 47% Maputo City 14308 11973 84% 5988 50% 2335 16% Maputo Province 71735 43338 60% 4213 10% 28397 40% Nampula 30304 25060 83% 723 3% 5244 17% Niassa 2262 1991 88% 0 0% 271 12% Sofala 12795 9283 73% 1176 13% 3512 27% Tete 25950 14693 57% 5518 38% 11257 43% Zambezia 59379 45204 76% 703 2% 14175 24% Total 294865 213789 72% 26658 12% 81076 27%
Children under 18 constituted 65% of beneficiaries and 35% adults. COVida registered multiple adults in the household as they often contribute to household income and were part of the family system. We are shifting orientations to a beneficiary population that is 80% children. COVida will consider the best strategy for clarifying with activistas the difference between guidance to graduate entire families, and the need to graduate adults that are no longer receiving services.
As mentioned previously, 72 percent of beneficiaries were provided with at least one service during the quarter. As shown on Table 9 above, the provinces with best performance in providing services to the existing beneficiaries are Gaza (97 percent), Inhambane (90 percent), Niassa (88 percent), Maputo City (84 percent), and Nampula (83 percent), while, the provinces facing challenges in ensuring provision of services are Manica (53 percent), Tete (57 percent), and Maputo Province (60 percent). Assessment of the reasons behind the poor performance indicates that incomplete data entered has been a problem in those CBOs, due to the limited time provided for data management at the CBO level. The CBOs have a total of 7 days to collect all the forms, verify, clean, and enter data, which is not possible to do considering the low capacity at the CBOs and distances (to ensure forms are collected from and corrected by the activistas on time). Other challenges include, attrition among volunteers, leading to difficulties in identifying the families of the resigned volunteers. Despite the strategies put in place to ensure that families are known by more than 1 volunteer, this continues to pose some challenges. Finally some CBOs, are still learning to manage large numbers of activistas. COVida will continue to support CBOs and field staff to improve transition when activistas leave, and to put in place systems to manage activistas. We will also roll out a new reporting tool with eCSI that will help CBOs to do this; it will take some time to train CBOs to use this
In relation to graduation, a total of 12% of all the beneficiaries provided with a minimum of one service were assessed for graduation, and found to have critical needs resolved (both adults and children). The provinces with the highest proportion of beneficiaries assessed and graduated were Maputo City (50 percent of their beneficiaries under OVC_SERV), Tete (38 percent), and Cabo Delgado (27 percent). Gaza (15 percent) and Manica (14 percent). For the remaining provinces, at the end of the quarter some of the CBOs completed training late in the quarter and only began assessing and documenting graduation for the eligible beneficiaries at the end of the period. Other CBOs just recently started project implementation, and it was too early to assess beneficiaries for graduation (including two CBOs in Niassa, two CBOs from six districts in Cabo Delgado, and four CBOs in Maputo, where the majority of beneficiaries have been in the program for under six months).
Regarding referrals made, 9,710 referrals for social and health services were made during the quarter, which takes the cumulative achievement from 27 percent in Q1, to 33 percent in Q2. Since
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most of the beneficiaries served in this quarter were carried forward from past reporting periods, the majority of the needy beneficiaries might have been referred in previous quarters. In Q1, there were a lot of referrals for school and birth registration to prepare for the start of the new school year. FHI 360 will continue to work with CBOs to make sure all important referrals are being made.
Completed referrals reached 5,468 in Q2, taking the total achievement against the annual target from 20 percent in Q1 to 26 percent in Q2. Compared to referrals made, the complete referrals are equivalent to 56 percent of the referrals made, which is above what was projected at the beginning of the year, 50 percent.
Among the referrals made, 71 percent were for HIV services (in a total of 6,979 referrals made), the majority being for HIV counseling and testing services (98 percent of the referrals made for HIV services), and 2 percent was for ART. Compared to the annual target for the number of referrals made for HIV services, this corresponds to an achievement of 99 percent. This is higher than the target because the team has prioritized HIV services.
In knowledge of HIV status of children by their caregivers, we made a change in our approach to track OVC_HIVSTAT indicator in this quarter. While in the previous quarters we were tracking knowledge and disclosure of HIV status among OVCs only for new enrollments, this quarter we brought the complete picture among all the existing beneficiaries (i.e. not only new enrollments). This is in response to the recent focus of the analysis of the HIV status of OVCs by PEPFAR. Figure 1 below presents the picture among those active and graduated beneficiaries (i.e. OVC_SERV), which is the denominator for OVC_HIVSTAT indicator. The illustration shows that among the 213,789 beneficiaries, 137,755 were under the age of 18 years (64 percent of total number under OVC_SERV). Caregivers of 42 percent of the children knew the HIV status of their children, and among these 62 percent disclosed the status (26% of all children), of which 13 percent reported HIV+ status, 70 percent of these already in ART. Among the 66 percent of those with unknown status, 8 percent were referred to HIV counseling and testing services, and 66 percent were tested. This may be due to the fact that we are not yet using the risk screening tool. COVida will work with CBOs to increase referrals of children.
The number of beneficiaries with known status is under-reported this quarter. Between February and March 2018, during the refresher trainings for activistas, we also included sessions related to collecting and documenting updates in HIV status knowledge during the home visits, and instructed how to record this in the forms. Activistas have only started applying this new process towards the end of the reporting period, so we expect to see an increase in the coming reporting periods. It is also important to mention that COVida is not yet using the HIV risk screening tool, recently piloted in Zambézia, on a large scale. Rollout of the tool is expected to take place in Q3, and a more complete picture will be presented at that time.
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Figure 1: OVC HIV Cascade, as of March 31, 2018
Finally, regarding trainings for volunteers, 75 volunteers were trained (70 activistas and 5 HES facilitators) in Q2. These were trained in Niassa, where a new CBO (Progresso) initiated project implementation with training of activistas, and the HES facilitators trained were in Hankoni in Cuamba, where the VSL activities started during the quarter. With these results, we almost doubled the results achieved by the end of Q1, and total achievement of the annual target was increased from 7 percent in Q1, to 13 percent in Q2. As mentioned above, COVida has postponed starting in 11 new districts until the next fiscal year, so there will be no additional trainings this year.
6.2 IR 2 Reduced Economic Vulnerability of OVC Households By end of Q1, we were supporting a total of 444 savings and loans groups. In Q2, 205 new groups were created and started saving during the reporting period, bringing the total number of groups to 649. As shown in Table 10, the new groups increased the overall achievement of the annual target from 35 percent by the end of Q1, to 50 percent at the end of Q2. The number of direct participants in these groups also increased by 6,064, thus increasing the achievement of the annual target from 35 percent at end of Q1, to 56 percent by end of Q2. Table 10: Achievements Against Targets for COVida IR 2, October 1, 2017, to March 31, 2018 % % Annual Q1 Indicator Achieved Q2 Results Achieved Target Results Q1 Q2 Number of savings and loans groups 1,302 444 34% 205 50% formed and saving money Number of direct participants in savings 26,040 8,499 35% 4,751 51% and loan groups supported by COVida Number of OVCs benefiting from parents/caregivers participating in 34,998 9,252 26% 4,175 38% savings and loans groups supported by PEPFAR Value of total savings for COVida - 7,779,269 N/A 12,916,503 N/A supported savings groups
The majority (80 percent) of the group members are women, and 30 percent are caregivers. The 4,830 project beneficiaries who are direct participants in these groups (cumulative number) have a
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total of 13,427 children under their care, who indirectly benefit from this intervention. Estimates indicate that, in total, 9 percent of our beneficiary households participate in the savings groups supported by COVida. This represents a slight increase over the 80 percent in the prior period. We expect this percentage increase during the year as the team improve their ability to motivate beneficiaries to participate.
The groups saved a total of MZN 12,916,503, which is an increase by 66 percent of the cumulative savings by end of Q1, FY18. The average savings per beneficiary is MZN 975.
6.3 IR 3: Improved Capacity to Provide ECD Services for Vulnerable Children under Age Five ECD support was provided to a total of 21,402 children aged 0-5 years. This is more than 4 times the results from Q1, and increased overall achievement of the annual target from 11 percent in Q1, to 56 percent in Q2. In terms of coverage of the eligible children, during this quarter, 34,163 active children were provided with different services, meaning that ECD was provided to 63 percent of the eligible children, which although below the target (100 percent of the eligible children provided with ECD), is higher than the achievement in Q1, when only 11 percent of the eligible children were covered.
In nutrition support, 24,297 children were screened for acute malnutrition, which is 71 percent of the eligible children (aged 6 to 59 months), and increased the achievement of the annual target from 17 percent in Q1, to 68 percent by end of Q2. Among the children screened, 1039 were detected with acute malnutrition, which is 4 percent of the total number of children screened (and consistent with the results in previous quarters), and raising the achievement of the annual target, from 10 percent in Q1, to 41 percent in Q2.
Table 11: Achievements Against Targets for COVida IR 3, October 1, 2017 to March 31, 2018 % Annual Q1 Q2 % Achieved Indicator Achieved Target Results Results Q2 Q1 Number of children 0-5 benefiting from 21,402 56% 47,326 5,320 11% ECD support provided by the project Number of children 0-5 years screened 24,297 68% for acute malnutrition at community 47,326 7,962 17% level Number of children with acute 1039 41% malnutrition detected at community 3,313 319 10% level
6.4 IR 4: Capacity of district government and communities to provide essential preventive and protective services to vulnerable families and children Table 12: Achievements Against Targets For COVida IR 4, January 1 To March 31, 2018 % Annual Q2 Indicator Achieved Target Results Q2 Number of CBO representatives trained 48 201 419% Number of government officials trained 65 60 92% Number of technical coordination 136 168 124% meetings held
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For IR 4, in Q2 there was a general overachievement due to the concentration of trainings for the year in this quarter. In each CBO, staff training in case management and/or mentoring and supervision included M&E officers, supervisors, and coordinators; the target was calculated based on training the staff of CBOs in organizational development and did not include other trainings; we will adjust this next year. The number of technical coordination meetings increased, as CBOs meet frequently with government and other stakeholders throughout the quarter, in addition to other provincial level meetings; thus, this annual target was also set low. 7 PROJECT MANAGEMENT
This section covers those issues that are management in nature, as opposed to technical, and those which affect project outcomes.
7.1 Approved workplan timeframe The due date for the annual workplan is September 30, the last day of the fiscal year. After some back and forth, the workplan was approved on December 5. While we did much preparatory work in November, many activities could only start after the workplan was approved, and in some cases, after sub-partner agreements were modified. As such, trainings of field cadres in the new activities and shifts only began in Q2, and implementation of new activities after that. This means that changes resulting from activities are only starting to appear at the time reports are due. We understand that USAID is considering changing the timeline so workplans are due at the end of May for approval by July/August. If funding is also available during this timeframe, this would allow us to complete the preparatory work of modifying sub-agreements, so that new activities can began the start of the new fiscal year. COVida is also considering strategies to accelerate the training of 4000 activistas.
7.2 Staffing Changes FHI 360’s Finance and Operations Director, Tom Owaga, accepted a position within the FHI 360 country office. FHI 360 requested and received approval in January for Luis Suarez to assume the responsibilities of this position. Luis started in February. It has been a smooth transition.
World Vision has announced that James Mateyo, the Project Manager for COVida with World Vision is not renewing his contract. Recruitment for this role has commenced and WV intends to have a new Project Manager commence by June 1, 2018
FHI 360 has postponed filling a few open positions until FY 19, because of recent information regarding further budget cuts.
Two RECDS were hired during this period. The two new RECDS are based in Zambezia and Nampula Provinces, serving the central and northern regions of the country respectively, and join the already existing RECDS in the southern region. As a result, TA in ECD (stimulation and nutrition) was initiated in the northern and central areas of the country for the first time during COVida project.
7.3 Consortium Partner Management FHI 360 approved workplans for Consortium Partners during this reporting period.
All Consortium Partners are struggling to reduce spending so COVida does not use the carryover funds that USAID has instructed us not to spend. This is described in further detail under Section 8. Major Implementation Issues. As half of COVida’s budget is under the Subaward budget line, the reduction of over 12% half-way through the fiscal year affects all Partners. CARE and FHI 360 are
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particularly affected as these partners had new districts that will now start only in FY 19. Some partners are having to shift staff to other projects or consider laying them off.
In the prior report, we mentioned some issues with WV, particularly regarding their management of sub-awards, data management and communication. As mentioned above, WV is recruiting a new Program Manager. The latest modifications to sub-awards have been signed. WV continues to struggle with data in Zambezia, more so than any other province. In the next reporting period, sernior FHI 360 M&E staff will go to Zambezia with senior WV staff to work together to identify the root causes for this struggle and develop solutions.
7.4 Activista Attrition Activista attrition was about 6% this quarter, as 256 activistas left the project in search of better opportunities. A large proportion of these come from AMODEFA’s project in Matola; the activistas have not been motivated to stay until the end of the project. COVida cannot do much to mitigate the situation although it has provided TA to AMODEFA to produce and implement a closeout plan with the remaining activistas and staff. Although the attrition rate is not very high, it causes disruption, as new activistas have to be trained on the job and are not as effective.
Table 13: Activista Attrition in Q2 Activistas Province Comment lost Cabo Delgado 6 Gaza 16 Inhambane 2 Manica 11 HES facilitators, activistas. To search for work; work with FDC; continue studies Maputo City 2 Maputo 171 156 activistas, 11 activistas chefes, 4 HES facilitators. 3 staff. 72 of these were from Province AMODEFA; activistas were not motivated to stay until the end. The others are from other CBOs, who generally left for other jobs and opportunities. Nampula 28 In search of better opportunities Niassa 10 Sofala 6 Tete 2 Zambezia 2 Total 256
7.5 Cost Share FHI 360 has postponed negotiations with Books for Africa so that half of the costs will fall in FY 19.
CARE’s cost-share contributions include sending its VSL specialist and national coordinator to a regional learning event in Dar es Salaam, Tanzania, hosted by CARE’s regional Access Africa office on “Savings-Led Financial Inclusion.” The knowledge CARE staff acquired in this workshop will contribute to strengthening the HES component under COVida at all levels. CARE also received an in- kind donation in the form of 340 books in Portuguese from Resources Aimed at the Prevention of Child Abuse and Neglect, based in South Africa. The books include illustrative information about child rights and will be distributed to CBOs and activistas for use at household levels. Glynis Clacherty, PhD from the University of Witwatersrand in South Africa, will train activistas on the use of the books. Glynis has worked considerably in the area of ECD with CARE in Inhambane; her time spent on this activity will be an in-kind donation to COVida.
WV used significant private funding to fill gaps for TA visits, as the budget cuts have affected the funds available for travel.
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To encourage CBOs to access local resources in their communities, FHI 360 developed a cost-share workshop for CBOs that included resource mobilization and how to document these contributions for cost share. The workshop has been delivered in Cabo Delgado, Maputo and Nampula provinces and COVida staff have been trained to deliver the training to the remaining CBO, which will be rolled out in Q3.
7.6 COVida Facebook Page COVida partners have been posting stories and sharing successes on the project Facebook page. This exposure will increase in coming months and provides a means to disseminate information about COVida, generate support, and celebrate the achievements of families and contributions of activistas. During this reporting period, there was a particular focus on activistas as heroes, highlighted the contributions activistas make to the project. 8 MAJOR IMPLEMENTATION ISSUES
8.1 Unexpected Spending limitations Early in March 2018, COVida leadership was instructed by USAID to only spend the $12,638,488 that was allocated to COVida in Country Operational Plan (COP) 17, a 13% reduction from the $14,490,846 in the approved workplan budget. To respond, the team submitted a revised workplan that included the following adjustments:
• Postponed signing CBO grant agreements and starting in new districts until next fiscal year. • Scaled down early in districts with lower targets next year. • Froze hiring of any new staff and replace people who leave only when critical for service delivery at all levels, including activistas. • Reduced playgroup activity to demonstration activity in 1 district. • Froze roll-out of savings group debates. Only continued in those districts where facilitators have already been trained. • Froze roll-out of SAVIX system. Only continue in those districts where it is already working successfully. • Postponed importing Books for Africa cost share contribution until next fiscal year. • Reduced regional coordination and in-service training meetings for COVida staff. • Cancelled the annual workplan meeting.
Even with these adjustments, the budget reaches a little over $13 million. The reduction in number of districts served represents a corresponding reduction of 45,217 in targets. We will do our best to compensate for the reduction by supporting CBOs in other districts to overachieve. We will strive to reach the 338,023 beneficiaries in the target USAID provided before the start of the fiscal year. Based on first quarter data, we are on the path to achieving that target, but the OVC _SERV indicator disaggregations have changes, which will impact the number we can reach. Similarly, there is a reduction in the number of savings groups from 1302 to 1035. Without the new districts, there is neither the time nor resources to make up these targets in other districts. While our aim this year was to improve the quality of services, our progress will less than initially expected. Similarly, our progress in rolling out the case management aspects of the eCSI will be limited, as we are unable to mobilize the human resources necessary for this.
The revised workplan was submitted on April 2. COVida is awaiting approval. The mid-year change is extremely disruptive. For example, we are instructing CBOs to let go of people they recruited to
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facilitate debate sessions and playgroups. This has implications for their credibility within the communities, and, in turn, their ability to serve beneficiaries. CBOs and district authorities who were expecting services to start in Q3 are disappointed to learn that there will be further delays, if they are served at all. We have cancelled all SAVIX trainings, which has negative implications for quality control and the mitigation of the misuse of funds in savings groups.
8.2 Constant Changes In the last six months, there have been several changes to indicators described above. COVida has changed its graduation process and criteria to better align with OGAC priorities. Since the ministry has approved the revised CSI that includes HIV Status, HIV Prevention and ECD, we have also rolled out these changes, as well as several other forms at the end of FY 17. We understand that OGAC is now designing graduation benchmarks and has asked 4Children to develop case management tools. Recognizing that even small changes require planning, training and follow-up TA, and that even small changes can be very disruptive, COVida decided to make changes to field-level tools, materials and forms only once a year.
We respectfully request that changes to indicators and definitions from PEPFAR/USAID also be made once a year. If these changes are agreed upon and disseminated by July, we can implement them at the start of the next workplan cycle. At the beginning of each year, we have in-service trainings to roll out changes, and follow-up TA to ensure they are implemented. We also program any adjustments to tools and databases. These costs are already built in. This will reduce the costs and disruptions of interim changes, which can reduce the programmatic and data quality that we are working so hard to achieve.
8.3 Short timeline for entering beneficiary data COVida has less about three weeks between the end of the service delivery period and submission of data reports to USAID. During this time, CBOS need to enter the data; provincial, GP and central staff need to clean, review, and question the data; CBOs respond and update data; and finally GP and FHI 360 aggregate, analyze and submit to USAID. CBOs have been struggling to enter the beneficiary data on time. They only have five to seven days to enter data for household visits from thousands of beneficiaries for the month; many of the CBOS with larger caseloads in particular are struggling. The table below illustrates how data changed when we provided the CBOS additional time to enter data.
Table 14: data that would have been lost without data entry extension Based on data received in With extension timeframe OVC Served 195,995 213,789 # graduated 15,906 26,658 HIV_STAT 35,742 43,026 % received at least one 65% 72% service
COVida is monitoring the situation, making changes to the eCSI so it is more agile, providing TA to CBOs in better managing the flow of paperwork, and finding solutions that allow them to enter the data during the month. We considered increasing personnel entering data at the end of the month, but there are not enough computers or the budget to acquire them. COVida had developed a partnership with MSTAR to develop and initiate a mobile system for gathering routine data, but the budget available for MSTAR used carryover funds and was suddenly unavailable. We will continue to work with CBOs on strategies to enter data on time during the next reporting period, before
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considering shifting timelines. USAID has expressed its interest in having data as close to the end of the quarter as possible to capture any improvements put in place due to analysis from data in the previous period; we need to balance this interest with the consequences of losing large volumes of data because the timeline is too short.
8.4 Security in Cabo Delgado In the prior reporting period, there were armed attacks in Mocimboa de Praia district of Cabo Delgado. These attacks were in January spreading to other districts and COVida restricted travel to affected areas as a precaution. However, since then, there has not been a repeat and staff have resumed normal travel in Cabo Delgado. We continue to monitor the situation.
9 COLLABORATION WITH GOVERNMENT, OTHER DONORS AND STAKEHOLDERS
9.1 Collaboration with Mozambican Government Specific key events to advance collaboration with Mozambican Government were explained in IR4 above. At provincial and district levels, we collaborated with local government in joint supervision visits and coordination meetings. As a result of this collaboration, the project succeeded in:
• Improved acceptance of CBO activistas at the health centers and communication with health staff (Tete). • Having a separate file dedicated to COVida referrals in health centers (Maputo province, Niassa, Manica). • Completed referrals for birth registration (Inhambane, Cabo Delgado, Tete). This includes 43 children that COVida had referred but that were stuck because of inability to pay; a joint supervision visit with government convinced the notary services to emit the documents. • SDAE provision of crop seeds and extension training to OVC families (Maputo, Tete). SDAE also provided a piece of land in Khongolote to open community farms for the poorest beneficiaries, especially child- and elderly-headed households. • Reduction in the waiting period for poverty certificates and provision of basic food basket by INAS and INGC (Tete) • In Matola, the local government contacted a program called Moçambique em Concerto to help with the psychomotor development and prostheses to help a six-year old boy walk. • In Cabo Delgado, joint supervision to Chiure.
In addition to the above-mentioned results, the relevant government offices better understand the COVida project and are more open to cooperate. Finally, more government offices are joining the provincial meetings, including Instituto Nacional de Emprego e Formação Profissional (INEFP) and Municipal Councils.
Challenges remain, especially in health units where the directors move and the new directors don´t understand the presence of the activista. The shortage of funds for coordination meetings and supervision visits is another challenge.
9.2 Collaboration with Other Donors and Stakeholders COVida and its CBOs continued coordination with clinical partners at provincial and district levels. CBOs participated in ART committees in various sites. Coordination with CIHO and Hyalisa were decribed above. COVida also coordinated with other partners such as CIHO, Ophavela, World
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Education, VISTA (International Potato Center), Associação Ecuménica Vocacionada na Alfabetização e Educação de Adultos, Strengthening Communities through Integrated Programming (SCIP), SDAE, and Parlamento Infantil. At provincial and central levels, COVida participated in several multi- sectoral meetings, such as a meeting with the National Coordinating Committee for the Prevention of Early Marriage.
Six COVida CBOs in Nampula, Tete and Zambezia helped facilitate the UNICEF study on Knowledge, Attitudes and Practices related to theiInteractions between caregivers and children 0-2 years, which was led by KPMG. The CBOs organized focus group discussions with beneficiaries, household observation and interviews. KPMG and UNICEF were very appreciative of COVida’s role. We will share a copy of the report when it is ready.
COVida met with Peace Corps and mapped all the districts where COVida overlaps with health or education Peace Corps Volunteers (PCV). COVida has shared information with its staff and CBOs about the benefits that PCV can bring to the project and how to get in touch with the PCV in their community. Two PCV participated in the Inhambane activista trainings, which is the province with the greatest number of PCV already allocated to COVida CBOs. A meeting between Peace Corps and COVida also happened in Tete to deepened linkages; a PCV already works with ADELT in COVida.
COVida has begun discussions with Population Services International (PSI) about referring female beneficiaries over 13 to Tem Mais, a project providing SRH/Family Planning (FP) services through a variety of mechanisms. This quarter, COVida participated in the Sofala Portfolio Review, which provided relevant information on other projects in the province and how to improve synergies. 10 UPCOMING PLANS
The following activities are planned for the next quarter:
1. Conduct joint M&E and technical visits to understand challenges with data entry and make any necessary adjustment to the M&E system. 2. Receive Program and Technical Quality Assistance visit from FHI 360 Headquarters and Regional office in May. 3. Prepare and submit the FY19 work plan by end May. 4. Continue intensive monitoring of CSI application, care plan development, and the integration of ECD activities in household visits. 5. Intensify TA on new forms, graduation process and HIV status. 6. Participate in a two-day workshop on adolescent disclosure, facilitated by American International Health Alliance (AIHA) and AMODEFA. 7. Roll out community debates with savings groups and community leaders in Nampula and Cabo Delgado. 8. Continue strengthening linkages with clinical services, particularly in the provinces in which collaboration has not yet resulted in increased referrals from HFs. 9. Provide TA to support CBOs to initiate savings groups ensuring beneficiary participation, and ensure that CBOs can use SAVIX (those already trained on the system). 10. Provide technical support on ECD through regional ECD specialist’s field visits to project provinces and districts. 11. Continue implementing the community screening tool for HIV testing, in collaboration with CIHO. 12. Address findings from site improvement through monitoring system (SIMS) visits, data quality analysis, and the baseline study in field activities. 13. Post updates on COVida’s Facebook page.
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11 EVALUATION/ASSESSMENT UPDATE
During this quarter, the Palladium/COWI team completed the analysis of the quantitative and qualitative baseline data and drafted the “key findings” and “youth” reports. See Annex 6 for a draft report of key findings, which was shared with USAID to inform COP planning. Findings were shared with the Government of Mozambique during the Interministerial Meeting held in Maputo on March 19th. A brief on the Monitoring, Evaluation, and Reporting (MER) essential survey indicator findings was developed with support from MEASURE Evaluation.
12 SUCCESS STORIES AND PHOTOS
12.1 Success Story 1: “Everything in My Life Changed”
Fatima lives with her twelve-year-old son Fernando in Bandua, Sofala Province. Fernando has a physical disability and a contagious smile. He has never walked or gone to school. With support from Madalena, an activista working with COVida’s local partner Kuphedzana, Fernando received a wheelchair from the NGO Light for the World. Madalena helped enroll Fernando in school and he had his first day the day before our visit. When asked about how it went, he beams with joy.
Fatima is HIV-positive. She had decided to stop her HIV treatment and was very sick when Madalena started working with her. With support from Madalena, she is adhering to her treatment again. “It’s hard to stay on treatment because the health facility is far,” says Fatima. Although she can’t measure time in numbers, her hardships are clearer when she adds, “To go to the health facility to pick up my medicines, I leave home early in the morning, and return when the sun is high in the sky.”
Fatima makes a little money working on other people’s farms to complement the maize she grows in her garden. Although this family is poor by any definition, Fatima and Fernando are more stable than just a few months ago. Says Fatima, “Everything in my life changed thanks to this project, especially because Fernando has a wheelchair. My life had stopped – I couldn’t go to the market or to church. I
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would carry him on my back and he’s gotten so heavy. We can both do more now. And my health has improved.”
12.2 Success Story 2: Turning Dreams into Reality 13 Adélia Feliciano is a thirty-year old woman living with five young children in Bungane, Chibuto district, in Gaza district. Her situation is difficult – Adelia lives with HIV, the father of her children left three years ago. Her children help with household chores and with farming their small plot of land. Her eldest son, José, was forced to drop out of school and help his mother. He does odd jobs and has taken on the role of “father” in the family at the age of nine. Even with this sacrifice, the family can often only eat one meal a day, and Adélia had abandoned her HIV treatment. 14 World Vision’s partner in Gaza, REENCONTRO, is working in Chibuto district. REENCONTRO’s activista, Ana Nhanombe, visited Adélia and her family to assess their situation. 15 “On my first visit, I noticed that the mother had abandoned HIV treatment, the children did not know their HIV status. José had left school, they struggled day and night to feed themselves, and their house was tiny and very precarious. After much conversation, Adélia accepted to resume ART. I referred the children to Bungane health center to get HIV testing.” Fortunately, José, Cátia, Ilda and Justino had negative HIV tests, but Feliciano, the youngest, is still waiting for confirmation of his HIV status. 16 With encouragement from Ana, the family built an improved house, which is bigger and where they can live more comfortably. They also built a latrine. They also received mosquito nets. Ana helped José return to school. 17 With beaming eyes, Adélia says, “My health is good and I can now take care of my children. I’d like them to forget the suffering that the abandonment of their father caused them.”
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World Vision’s partner in Gaza, REENCONTRO, is working in Chibuto district. REENCONTRO’s activista, Ana Nhanombe, visited Adélia and her family to assess their situation.
“On my first visit, I noticed that the mother had abandoned HIV treatment, the children did not know their HIV status. José had left school, they struggled day and night to feed themselves, and their house was tiny and very precarious. After much conversation, Adélia accepted to resume ART. I referred the children to Bungane health center to get HIV testing.” Fortunately, José, Cátia, Ilda and Justino had negative HIV tests, but Feliciano, the youngest, is still waiting for confirmation of his HIV status.
With encouragement from Ana, the family built an improved house, which is bigger and where they can live more comfortably. They also built a latrine. They also received mosquito nets. Ana helped José return to school.
With beaming eyes, Adélia says, “My health is good and I can now take care of my children. I’d like them to forget the suffering that the abandonment of their father caused them.”
ends and the members receive their payout, Benilde plans to use her savings to buy her school uniforms. Gabriela will use her savings to buy school supplies and a backpack for school. In adolescent savings groups, adolescents learn to develop small money-making activities to enable them to get a loan. They learn about the value of saving money from a young age, nurture a spirit of entrepreneurship, and enjoy having a safe space to play and socialize. The adolescent savings groups use the social fund to acquire school materials. While COVida has adolescents integrated in savings groups composed mainly of adults, Benilde and Gabriela belong to adolescent savings groups made up mainly of their peers, especially girls. To ensure adequate support, there are a few adult members, who also provide support help discuss relevant topics such as HIV prevention and early marriage. This innovative approach helps target vulnerable adolescent girls with interventions that enhance their economic stability in the present and future.
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17.1 Success Story 3: Siblings gain access to health, education and stability Jorge is a thirteen-year old orphan who lives in the Massane neighborhood of Buzi district in Sofala Province with his 23-year old sister Maria and their uncle. Jorge has a physical disability and was in ninth grade, but due to health problems, he dropped out of school. COVida’s local partner organization, Kuphedzana identified this needy family. Kuphedzana activista Teresa Manuel assessed the family’s needs and referred Jorge for HIV testing at the health facility. He was diagnosed with HIV and started treatment. Jorge’s health improved and Teresa encouraged him to go back to school. Kuphedzana coordinated his re-enrollment with Education authorities and ensured access to school materials and crutches from Social Action officials so that he could move around. As Jorge’s sister Maria works on a small farm, Kuphedzana’s Household Economic Strengthening facilitator advised her to sell some of her crops so that she could start participating in a savings group. Maria is now active in a savings group and this small family is more stable.
18 FINANCIAL INFORMATION
COVida’s financial report up to the end of this reporting period is summarized as follows: Table 13: COVida Financial Summary for October 1 – December 31, 2017 Item US $ Total Expenses (October 1, 2017 – December 31, 2017 $2,962,762 Cumulative Expenses (LOP) $17,235,623 Projected Expenditures, January 1, 2018 – March 31, 2018: $3,709,946
Projected expenditures do not include obligations that will be outstanding to partners as of December 31, 2017, only expenditures. The contractual line commitments through December 31, 2017 accounts for $ 3,517,832.
Award AID-656-A-16-00010 FHI 360 – COVida 43 | Page Quarterly Report for period January 1 – March 31, 2018, Submitted April 30, 2018 Implementation Activity Domain Lead IR Q1 Q2 Q3 Q4 status 3/31/18 O N D J F M A M J J A S Selection of CBOs in new districts Grants Geo partners IR1 Completed Grant development workshop and conclude agreements with Grants Geo partners IR1 Suspended until Q4 new CBOS Start-up - post award conference, recruitment and hiring of Grants Geo partners IR1 Rescheduled to FY19 Q1 staff and activistas, communication with local authorities Train CBO staff, activistas, SDSMAS representatives in basic Tech Geo partners IR1 Rescheduled to FY19 Q1 case management in 12 new districts Develop training materials for in-service training on case Tech FHI IR1 Completed management, 90-90-90 Refresher TOT for accredited trainers and new potential Tech Geo partners IR1 Completed trainers In-service training for existing activistas, CBO staff and SDSMAS Tech Geo partners IR1 Completed representatives on BCM - three days Training for supervisors and activista chefs on BCM, focus on Tech Geo partner IR1 Will be completed in Q3 transitioning, HIV, action oriented support and supportive supervision Produce an attractive handout for health facilities to post to Tech FHI IR1 Completed remind them of who should be referred to COVida for support. Also tools for activistas (Guia de referencia, forms) Identify beneficiaries through health facilities, USG partners and Tech Geo partners IR1 On-going communities, conduct CSI, delevop care plan Provide age appropriate services and referrals as outlined in Tech Geo partners IR1 On-going workplan and MGCAS guidelines, assess for graduation Referrals for HIV testing Tech Geo partners IR1 On-going
Referrals for ART Tech Geo partners IR1 On-going Training of point person at new CBOs and conducting mapping Tech N'weti IR1 Rescheduled to FY19
Conduct mapping (new CBOs) Tech Geo partners IR1 Rescheduled to FY19
Finalized debate session manual and curriculum Tech N'weti IR1 Completed Train debate session facilitators, CBO staff and SDSMAS in CBOs Tech N'weti IR1 Completed in 2 in 8 provinces provinces; suspended in others Conduct debates with savings groups and community leaders Tech Geo partners IR1 Was delayed due to budget uncertainties, will roll out in Q3 in 2 provinces Translation, printing, shipping and distribution of 300,000 Fin/Procure FHI IR1 On schedule childrens books contributed by Books for Africa ment Training CBOs in mobilizing additional resources for families Grants/Fin FHI IR1 Completed and documenting them for cost share Systematize a structured TA protocol for use in all visits Tech FHI IR1 Completed
Supervisors hold weekly meetings and visits with activistas and Tech Geo partners IR1 On-going chefes Provincial technical staff visit CBOs monthly to support in Tech Geo partners IR1 On-going implementing BCM and paperwork (10x/year) National and Regional technical advisors visit provinces Tech Geo partners, IR1 On-going quarterly to support provincial technical staff (3x/year) Technical partners Joint supervision visits with government officials at distrital Tech Geo partners IR1 On-going level Periodic regional technical meeting Tech and FHI IR1 One completed in Q2, M&E only one more foreseen in FY18 due to budget CBO supervisors accompany activistas Tech Geo partners IR1 On-going CBOs provide material support following guidance and based Tech Geo partners IR2 On-going on CSI and action plan Train savings group facilitators and supervisors for new CBOs on Tech CARE IR2 Rescheduled for FY19 savings groups Sensibilize activistas on importance of savings groups Tech Geo partners IR2 On-going
Support families to form new savings groups to promote Tech CARE, Geo IR2 On-going beneficiary participation partners Train HES supervisors to use SAVIX for HES data Tech CARE IR2 One training completed in Q2; others suspended due to budget Sensibilize savings group members to use savings in favor of Tech Geo partners IR2 On-going children Supervisors visit facilitators weekly to monitor groups Tech Geo partners IR2 On-going development and data collection Provincial technical staff visit CBOs monthly to support in Tech Geo partners IR2 On-going implementing savings groups Regional technical advisors visit provinces periodically to Tech CARE IR2 On-going support provincial technical staff in implementing strategy One-day ECD Training for all activistas, activista chefes, Tech PATH, Geo IR3 Completed supervisors, CBO project officers and SDSMAS reps partners Activistas provide basic ECD services to families with children Tech Geo partners IR3 On-going under five in household visits
Design of community preschool /play groups manual and Tech PATH IR3 Completed implementation guide
Design step-by-step initial six-day training module for Tech PATH IR3 Completed playgroups (completed FY 17) Printing of playgroups manuals Tech PATH IR3 Suspended Playgroups training for CBO facilitators and GP technical Tech PATH IR3 Suspended officers Creation and operation of playgroups Tech Geo IR3 Suspended partners/PATH Technical support / supervision visits to provincial GP staff Tech PATH IR3 On-going Provide monthly TA for playgroups facilitators and supervisors Tech PATH, FHI IR3 Suspended
Technical assistance to MGCAS for integration of ECD as a Tech PATH IR3 On-going priority programmatic area Provide household-level WASH support Tech Geo partner IR3 On-going
Organize one multi-sectoral meeting in a year at national level Coordinatio FHI IR4 Completed n Organize one multi-sectoral meeting in a year at provincial level Coordinatio Geo partners IR4 Completed in each province (may be active participation/ presentation in n existing meeting) Organize two multi-sectoral meetings at district level Coordinatio Geo partners IR4 Completed n Provide training and technical assistance to support partner Tech Geo partners IR4 On-going CBOs to meet project technical standards Provide training and TA to support partner CBOs to comply with Grants Geo partners IR4 On-going terms of agreement and operate smoothly: workshop on ICS, governance, and policies and procedures; follow up TA Provincial Finance Staff monitor and provide TA on Grants/Fin Geo partners IR4 On-going development and application of policies and procedures, use of timesheets, separation of duties, etc. Annex 2 Estratégia de Retirada e Fecho das Actividades
Fevereiro, 2018 Objectivo da Estratégia • Orientar as OCBs sobre os passos a seguir para o fecho das actividades; • Garantir que os activistas focalizam a intervenção na prestação de serviços por forma a graduar o maior número possível de beneficiários/famílias antes da retirada; • Assegurar que os beneficiários não graduados, são transferidos para outros programas e instituições aquando da cessação das actividades; • Preparar as famílias para a retirada das actividades do projecto. • Informar as autoridades locais (comunitárias e governo) • Este apresentação não inclui os processos administrativos que são tratadas separadamente. 2 PASSOS A SEGUIR 1. Notificar a OCB com uma carta, logo que tomar o conhecimento da necessidade de fecho das actividades no distrito 2. Ajudar a OCB a elaborar um plano de retirada, que inclui: ➢Informar as instituições locais, actores chaves, lideranças comunitárias, colaboradores e activistas do projecto; ➢Graduação/Fecho de casos ou transferência para outros programas; ➢Despedir e preparar as famílias para a retirada; ➢Elaboração e submissão de documentos contratuais do projecto (relatórios, inventário, etc.) 3. Monitorar a implementação do plano de retirada do projecto 4. Apoiar a OCB na finalização dos processos necessários para o fecho do projecto 5. Apoiar a OCB a comunicar as autoridades locais e parceiros governamentais chave (Distrito, SDSMAS, Educação, Escolas,…)
6. Incentivar a OCB a reconhecer o trabalho dos colaboradores e activistas 3 (certificados) Graduação e Fecho de Casos
I. Informar a OCB para parar de identificar novos beneficiários (com tempo ideal de 12 meses antes da cessação); II. Orientar a intervenção dos activistas na prestação de serviços para satisfação das necessidades críticas constantes no plano de acompanhamento da família; III. Avaliar a prontidão para graduação dos beneficiários com mais de 6 meses de acompanhamento (de forma rotineira e constante nos últimos 6 meses); IV. Graduar o maior número possível de beneficiários elegíveis; V. Realizar visitas trimestrais de fecho dos casos aos graduados: dependendo do tempo remanescente, as duas visitas de fecho podem ser semanais ou mensais; VI. Actualizar o estágio destes benefícios para GRADUADO no eMAC Reportar a informação no relatório mensal, trimestral e final do projecto. 4 Transferência de beneficiários para outros programas 1. Elaborar uma lista de beneficiários não graduados em função das necessidades pendentes (registo, matrícula…). Nota: Não colocar a informação do seroestado na lista! Exemplo de lista a ser partilhada com Conservatória e Acção social
2. Ajudar a OCB a elaborar uma mensagem comum que será passada aos beneficiários (crianças e cuidadores) sobre as razões da saída/retirada do projecto, para evitar mensagens deturpadas que podem fazer os beneficiários pensarem que estão a ser excluídos do programa (Ex. “Durante a implementação do projecto COVida, o nosso doador identifica novos distritos/comunidades que precisam de apoio e outros onde o projecto já trabalhou e pode sair, deixando alguma capacidade instalada nas famílias e instituições locais para continuar a cuidar das suas crianças”.) 3. Orientar os supervisores para realizarem visitas conjuntas com os activistas para informar as famílias (crianças e cuidadores) sobre o fecho do projecto (no mínimo 3 meses antes do fim das actividades). 5 Transferência cont… 4. Informar ao cuidador que existe a possibilidade de serem transferidos para outros programas, desde que elas consintam que seus nomes e necessidades sejam comunicadas a outras instituições. 5. Pedir o consentimento escrito para a transferência. Se consentem com a partilha do seu seroestado (ex. com unidade sanitária, para poder dar seguimento a necessidades de testagem, tratamento, etc.). 6. Realizar encontros com cada instituição local (acção social, escolas, conservatória…) e lideres comunitários para informar sobre o fecho do projecto e que fizemos o possível e conseguimos graduar XX beneficiários, mas continuamos com alguns com estas necessidades pendentes. 6 Transferência Cont….
7. Partilhar a lista das famílias que deram consentimento para a transferência, com as respectivas instituições e lideres comunitários para que possam considerar estes beneficiários em oportunidades futuras (novos projectos, campanhas de provisão de serviços). 8. Usar o mapeamento feito, para transferir os beneficiários para outras ONGs, igrejas e outras fontes de apoio na comunidade. 9. Se possível, assinar um MdE com a instituição que recebe os casos. 10. Actualizar o estágio destes beneficiários para TRANSFERIDO no eMAC e reportar a informação no relatório mensal, trimestral e final do projecto. 11. Para o caso de transferencia de beneficiários para outro programa de COVs/ONG/OCB, se possível, os activistas ou seus supervisores devem apresentar / acompanhar os beneficiários para facilitar a transferência e fazer a integração dos outros actores da nova organização. Nota: Não partilhar a informação do seroestado sem ter consentimento!
7 Necessidades a priorizar para casos não graduados Caso não seja possivel graduar todos beneficiarios, orientar os activistas para priorizar as necessidades urgentes e/ou relacionadas ao HIV: • Crianças com maior em risco de associação ao HIV, mas ainda não testadas, devem ser testadas e ajudadas a iniciar TARV, caso sejam positivas; • As crianças e adultos HIV+ que ainda não estão em TARV, devem ser ajudadas a iniciar TARV; • As mulheres grávidas que ainda não conhecem o seu estado de HIV devem ser testadas; • Mulheres HIV+ que estejam grávidas ou em pós-parto, devem receber aconselhamento e acompanhamento intensivo para reforço da aderência; • Adolescentes HIV+ devem ser integrados num grupo de apoio, sempre que possível; • Mulheres HIV + gravidas e novas mães devem ser integradas no grupo de Mae para Mae (MpM) ou a uma Mãe Mentora sempre que possível. • Crianças com desnutrição aguda ou que sofrem de abuso devem receber atenção imediata 8 Reconhecer o Trabalho dos Activistas pela OCB • Entregar certificados de reconhecimento/apreciação do trabalho dos activistas e outros voluntários (sempre que possível); • Elaborar a lista de activistas no activo, especificando as formações recebidas e partilhar com instituições e parceiros locais (SDSMAS, Acção Social, ONGs, etc.), para que possam considerá-los em projectos futuros; • Fazer a entrega definitiva de bicicletas e materiais de trabalho (pasta, IEC…) aos activistas, assinando os termos de entrega definitivos.
9 Annex 3 - FY18 CBOs and Targets by District List includes active CBOs. Does not include those new districts postponed to FY 19. Final FY18 Target - Province District CBO OVC Served Total Ancuabe Wiwanane 879 Chiure Wiwanane 1287 Cidade de Pemba Kaeria 3379 Macomia Progresso 1221 Cabo Delgado Montepuez Wiwanane 1167 Mueda Progresso 1867 Muidumbe Progresso 1200 11000 Kamavota Reencontro 3795 Kamaxakeni Moz Hope 2942 Maputo City Kamubukwana Hixikanwe 4075 Nlhamankulu PACO 4200 15012 Bilene UDEBA 7288 Chibuto Reencontro 6383 Guija AESP 4143 Gaza Mabalane AMJ (will phase out in FY18) 900 Mandlakaze ACTIVA 4329 23043 Inharrime Rede Pastoral de Inharrime 3496 Tsinela 4320 Massinga Mahlahle 4323 Inhambane Maxixe Liwoningo 5980 Vilankulo AIPDC 2994 Zavala AKKV 2749 23862 Barue CA Barue 4010 Machaze ANDA 3987 Manica Mossurize Kuzvipira 2624 Sussundenga ANDA 2239 12860 Angoche ASAS 3768 Niiwanane 7680 Nampula City AMASI 3200 Overelalana 4000 Nampula District Overelalana 2200 Rapale UATAF 3100 Nampula Malema UATAF 3400 Moma Ekumi 4000 Nacala AJN 5169 Muecate AEXEMAC 3400 Monapo AMASI 3200 Mecuburi AMASI (district will phase out in FY18) 3200 46317 Cuamba Hankoni 5212 Niassa Lichinga City Progresso 6241 11453 Buzi Kuphedzana 5291 Sofala Morromeu CCM-Sofala 4278 9569 Changara ADELT 4278 Tete City Kuthandizanana Kuchira 8041 Tete Tete Moatize Kupulumussana 4851 Mutarara Caritas Tete 5189 22359 AMODEFA (will be SANTAC) 4000 Boane CMA 12616 Kindlimuka 9600 AMODEFA (will phase out) 4000 Matola ACODEMU 7600 AJPJ 4822 Maputo Magude AMDEC 2458 Province ACIDECO 9600 Manhiça AJUCOM 2384 Marracuene CONFHIC 5982 Matutuine Tiyane 2629 Moamba Caritas 3651 Namaacha ASSEDUCO 1846 71188 Alto Molocue NANA 4471 Chinde UNIDOS 2658 Gile AMME 3473 Inhassunge NAFEZA 3257 Maganja da Costa Caritas 8420 Zambezia Milange ESPANOR 5107 Mocuba NANA 7600 Mopeia Caritas 2714 Morrumbala AMME 7486 Pebane Assodeli 9106 54292 GRAND TOTAL 300955 Annex 4 – Collaboration on OVC referrals and HTC
Province/District Clinical OVC referrals to COVida HIV testing in community and Partners clinics Tete Cidade de Tete HF/CHASS Good collaboration. Good collaboration. Activista chefes in health facilities HFs test all OVC beneficiaries. continue to manage referrals. CHASS only tests index case family CBOs continue to participate in members at the community level Moatize HF/CHASS periodic clinic-based co- Good collaboration. and FDC management meetings. HFs test all OVC beneficiaries. CHASS only tests index case family members at the community level. FDC tests all OVC beneficiaries at the community level. Mutarara HF/CHASS Good collaboration. HFs test all OVC beneficiaries. CHASS only tests index case family members at the community level Changara HF/CHASS Good collaboration. and FDC HFs test all OVC beneficiaries. CHASS only tests index case family members at the community level. FDCs test all OVC beneficiaries at the community level. Cabo Delgado Pemba HF/Ariel Good collaboration. Good collaboration. Montepuez Activista chefes in health facilities HFs test all OVC beneficiaries. Chiure continue to manage referrals. Ariel tests index case family Ancuabe CBOs continue to participate in members at the community level. Mueda periodic clinic-based co- Muidumbe management meetings. Macomia Sofala Buzi HF/CHASS Good collaboration. Good collaboration. CBO Supervisor in health facilities HFs test all OVC beneficiaries continue to manage referrals. CHASS only tests index case family Marromeu CBOs continue to participate in members at the community level periodic clinic-based co- management meetings. Manica Barue HF/CHASS Good collaboration. Good collaboration. Activista chefes in health facilities HFs test all OVC beneficiaries. Machaze continue to manage referrals. CHASS only tests index case family CBO continue to participate in members at the community level. Sussundenga periodic clinic-based co- management meetings. Mossurize Nampula Moma HF/ICAP The relationship with ICAP and HFs Good collaboration with Ophavela. Angoche and improved significantly this quarter. to test index case family members Nampula City Ophavela CBOs Supervisors and activistas at the community level. Monapo were positioned in HIV services at Muecate HFs to help clinical staff to identify HFs test all OVC beneficiaries. Malema and refer OVC beneficiaries to Nampula district COVida. COVida – Quarterly Report – January – March 2018
Rapale CBO supervisors participated in Nacala Porto HF/ICAP weekly clinic-based co-management Mecuburi meetings, to share data of beneficiaries identified at HFs and completed referrals. As result, 97% of 360 families were identified in HFs and 64% of HTC referrals were completed. Maputo City Chamanculo HF/CCS Coordination with HFs and CCS is Collaboration is improving. Kamukukwane improving. HFs requested COVida’s HFs test all OVC beneficiaries. Kamavota CBOs to place more activista in HIV Kamaxaquene entry points health facilities to identify and refer OVC beneficiaries to COVida. This quarter, 61% of 150 enrolled families identified in HFs.
Maputo Province Matola HF/ Ariel Collaboration is improving. The ratio Collaboration is improving. Boane of OVC families referred to COVida HFs test all OVC beneficiaries. Marracuene by HFs, increased from 7% in Q1 to Ariel only tests index case family Manhiça 25% this quarter. members at the community level. ADPP does not test children in the community. Inhambane Inhambane CCS Good collaboration. Good collaboration. CCS Counselor in HF link COVida activistas refer beneficiaries tuberculosis (TB) and HIV patients to to community-based HTC the COVida activista in their conducted by CCS counselors. community. CBOs participate in periodic clinic- based ART meetings. Gaza Gaza HF/EGPAF . No beneficiary identified this Collaboration is improving with HFs quarter, due high caseload of and EGPAF. activistas. HFs test OVC beneficiaries. Zambezia Zambezia ICAP, FGH, No beneficiary identified this Good collaboration. SCIP, quarter, due high caseload of ICAP counselors are testing all CHASS, activistas. COVida beneficiaries in the HF. CIHO SCIP is conducting HTC at the community but only for families of index cases. CIHO is conducting HTC for 2-17- year-old COVida beneficiaries referred using the community screening tool. Niassa Cuamba CHASS Good collaboration with CHASS and Good collaboration. Lichinga HFs. HFs test all OVC beneficiaries. COVida placed activistas in health CHASS only tests index case family facilities to work together with members at the community level. CHASS’s case managers. CBO supervisors participate in weekly clinic-based co-management meetings COVida – Quarterly Report – January – March 2018
Annex 5 - Notas da visita à ASSEDUCO (Troubleshoot model)
Goba, 07 de Fevereiro 2018
Participantes:
ASSEDUCO: Armando Elias Comé - Presidente do CD Mário Geremias Comé – Vice PCD Fátima - Tesoureira Cacilda da Assunção Joaquim – Secretária do CD Dinis Manhice – Coordenador Ravido Cumbane - Contabilista
FHI360/COVida: Omar Mangeira – Assessor para o Desenvolvimento de Capacidades
Assuntos discutidos e recomendações para seguimento
1- A ASSEDUCO foi fundada em 2003 e neste momento conta com 23 membros. COVida é o único projecto neste momento. Em Janeiro de 2018 realizou a sua AG ordinária, referente ao ano de 2017 onde foram eleitos novos titulares dos Órgãos Sociais (OS), para substituir os que optaram por ficar no Executivo1. Passo seguintes: a) ASSEDUCO vai induzir os recém eleitos, para conhecerem os seus papéis e responsabilidades, com base nos Estatutos da ASSEDUCO e no modelo de ROSME2; b) ASSEDUCO vai definir estratégias de aumentar o nr de membros e assegurar que todos pagam quotas regularmente; c) Procurar fundos próprios3 para providenciar incentivos aos titulares dos OS.
2- Tem havido alguns atrasos na entrega de relatório e também no cumprimento de metas, especialmente de referências. Os participantes consideram que os activistas ainda não entenderam devidamente a natureza do COVida, devido a projectos anteriores e ao mesmo tempo, as unidades sanitárias (US) afirmam que não podem dar os nomes das PVHS, porque tal significaria quebra de sigilo. Há falta de colaboração com a fundação ARIEL, porque os únicos contactáveis são os seus activistas colocados nas US que não têm nenhum poder de decisão. Por outro lado, o Coordenador tem um plano de visitas ao campo, mas precisa que as suas visitas se traduzam no melhoramento do desempenho da ASSEDUCO. A ASSEDUCO marcou um encontro para esta Sexta-feira, 9 de Fevereiro com os representantes das US e Ariel, mas não sabe ainda quem virá. Passos seguintes:
1 Na sequência do acordo com o COVida a ASSEDUCO teve de separar os papéis da Governação Interna com os do Executivo, tendo algumas pessoas optado por ficar no Executivo. 2 Regulamento dos Órgãos Sociais em Membros. 3 Realizar actividades de geração de renda. Por exemplo, alugar o pavilhão de criação de aves; elaborar projectos e procurar financiadores. a) Avaliar a atmosfera do encontro da próxima Sexta-feira, dia 9; b) Solicitar o apoio da FHI360 (Ana Paula Ndapassoa e Celeste Nobela) para conversar com ARIEL, sobre colaboração nas US de Goba, Maelane e Namaacha.
3- Fraco desempenho do oficial de M&A/ supervisor O oficial acumula os dois cargos e o seu desempenho ainda não é satisfatório. Neste momento solicitou uma dispensa de 2 semanas para concluir a sua tese de licenciatura4. Passos seguintes: a) O CD da ASSEDUCO e o Coordenador devem analisar o problema do oficial, se é falta de treinamento adequado ou outra razão e se necessário pedir o apoio da FHI360. Se for falta de vontade deve-se tomar a decisão considerada acertada e manter a madrinha informada. A ASSEDUCO é soberana na sua decisão, com base na lei moçambicana. Segundos o acordo assinado com FHI360, a contratação de nova pessoa chave carece de autorização. Esta avaliação deveria decorrer nas próximas semanas. b) O Coordenador deve prestar mais atenção (ajuda) à equipa técnica.
4 Após o encontro, o Coordenador circulou uma carta de pedido de demissão do oficial de monitoria. Annex 6 Situation analysis of COVida’s youth
Partners’ Data Review Meeting April 16th, 2018 Research questions
What is the status of COVida beneficiaries, with respect to various measures of wellbeing? • What are youth’s attitudes about education, early marriage and HIV? • What do youth know about preventing HIV, and the related services available? • To what extent are youth accessing HIV prevention and family planning services and what are the barriers to accessing services? • Where and from whom do youth seek help, support and information? • How and to what extent are youth preparing for the financial demands of adulthood? • How and to what extent are youth civically engaged? • How can COVida interventions be best designed to meet needs, to support youth to engage in their communities, and to become productive adults? 2 Methodology • Household survey of youth in households registered to receive services (N=1440) • Trained data collectors administered standardized questionnaire directly to all youth aged 12-17 years in selected household • 9 focus groups of youth aged 15-17 years in Buzi, Matola and Mocuba • Female single • Female married and/or with children • Male single
3 Youth characteristics • N=1,115 aged 12-17 years (from 716 households) • 48% female • 1.3% married • 52% literate (able to read entire sentence)
4 Measures of wellbeing (youth survey)
5 Education indicators are inadequate • 73% enrolled • 12-14 year olds more likely to be enrolled: 81% vs. 62% • Most common reason for non-enrollment was lack of money for materials, transport (55%) • 60% regularly attending (no missed school days in last week) • 12-14 year olds more likely to be enrolled: 66% vs. 51% • Most common reason for missing school was “too sick” (39%: 45% among females, 33% among males, 46% among 12-14 year olds, 25% among 15-17 year olds) 6 Sexual behavior and pregnancy • One in four report previous sex (half of older youth) • Sexual debut at age 13 • Median lifetime partners=1.2 or 0.8 in last 12 months • About one-third of youth used a condom at first sex, last sex (more common among older youth: 28% vs. 42%) • 2% of females were pregnant at time of survey (5% of older youth)
7 Hopefulness and Perceived Support
• Youth hopeful per Hope Scale (3 out of 4) • Nine in ten youth feel that their guardians respect their opinions, tell them when they are doing a good job, and care about their future • Three-quarters have an adult that they look up to, that can help guide them
8 Attitudes about education & early marriage
9 Youth think schooling is important
• Almost 100% of youth expressed in survey and focus groups that it is important for both boys and girls to attend both primary and secondary school
“Even to farm a plot we must go to school.” (boy, Buzi)
“The family also has to contribute, support, say that they can not give it up. Even at the time when our parents studied, they only went to school barefoot, they had no slippers, they had no notebooks, but they went to school.” (married girl, Matola) 10 Challenges to attending, completing school
• 26% said it is difficult for girls to complete secondary school; 36% said it is difficult for boys to complete secondary school • Most common challenges: • Poverty (mentioned by all FGD participants) • Pregnancy and early marriage (Buzi, Mocuba)
11 Poverty
"(…) there are families who are very vulnerable, buying a notebook is a problem for them. This also leads the youth to drop out of school, in order to get a job to help their mother or father with the household expenses.“ (married girl, Matola)
12 Pregnancy & early marriage “Girls abandon school because (…) they get pregnant, imitating their friends. When girls get pregnant, nothing can be done to get back into school.” (single girl, Buzi) “In some communities there are parents who forbid their daughters to go to school, saying that the woman must cook and marry, some parents treat their daughters like an asset, they even tell their sons to control their sisters so that they do not go to school.” (boy, Buzi) "Our mothers see their daughters as a source of income to help meet the needs of the house, so they force us to marry very early to get relief.” (married girl, Mocuba) 13 Youth do not support early marriage • Over 85% of youth expressed that they do not agree with early childhood marriage (under 18), but ultimately have little control:
“Decisions about marriage, lobolo or traditional ceremonies are made by the elders…” (married girl, Buzi)
• Preferred age of marriage was 20-22 for females and 25 for males (to ensure responsibility)
14 HIV prevention knowledge and services
15 Youth have a lot to learn about HIV • 85% of youth have heard of HIV • Two-thirds have accurate HIV prevention knowledge • Three-quarters reject major misconceptions about HIV transmission • Just over one half have accurate knowledge about mother to child transmission • HIV knowledge is better among older youth • In focus groups, few were able to discuss HIV prevention methods. Single girls and boys in Mocuba noted the importance of initiating ART early and adhering. 16 Access to HIV prevention and family planning services
17 HIV testing uptake • 40% of youth have tested for HIV • 34% of 10-14 year olds, 47% of 15-17 year olds (57% of females, 39% of males) • Barriers: Fear of result, stigma/discrimination, confidentiality, quality of healthcare, poor knowledge: testing only if symptomatic • 72% of youth know where to get tested • 64% of 10-14 year olds vs. 84% of 15-17 year olds • Most common place reported by FGD participants was the hospital; youth open to mobile testing
18 Uptake of family planning services • One-quarter of sexually active females are using birth control: 7% of 10-14 year olds, 30% of 15-17 year olds • Only 42% of females think they have the skills and information to avoid unplanned pregnancy • 37% say the know a place where they can obtain a modern contraceptive method: huge age differential: 24% vs. 59% • Health facility most commonly mentioned (94%) • 27% say the could begin a family planning regimen if they wanted to: age differential: 15% vs. 47%
19 Sources of help, support, information
20 Sources of help and support • When facing a problem at school, home, or a question about sex or their future, one-third did not ask for help • For problems at school, home, about the future, youth talk to adult household members, generally their mothers • For questions about sex, youth talk to their friends • FGD participants talked about engaging the police, community leaders to help them with legal problems • FGD participants in Buzi talked about the role of elders in guiding them: “There are elders in the community who give good counselling….Many youth seek their services, education about marriage, how to care for your husband, how to treat your guests, how care for your house…” (single girl, Buzi) 21 Information channels for HIV • Most common information sources: radio (53%), friends/siblings (37%), TV (35%), teachers (32%) • 24% had talked to a guardian, 20% a health worker, 10% a community worker, 10% a sex partner • For all sources, older children (15-17 years) were more likely to report exposure • Among FGD participants, most common source of information on HIV (testing) was debates at school, activistas, peers • Youth’s most trusted information source on HIV is their guardians (58%), health workers (16%) • Youth’s least trusted information source on HIV are their friends (37%), community leaders (14%) 22 Information channels for family planning • Most common information sources on FP were radio (24%), friends and siblings (19%), TV (18%) • 15% had talked to a guardian, 12% a health worker, 5% a community worker, 7% a sex partner • For all sources, females and older children (15-17 years) were more likely to report exposure
23 Preparations for financial demands of adulthood
24 Few youth are working outside the house • 15% reported working outside the household • Boys more likely than girls to report this: 21% vs. 8% • Older youth more likely to report this: 20% vs. 11% • On average, working youth spent 3 hours working on weekdays • Most commonly cited jobs: household chores for other families (33%) and construction work (19%) • 23% reported having ever received training for work • FGD participants similarly reported unsteady, part-time work, but in the future, want a skilled
profession 25 Youth are concerned about earning money • 65% of youth think it is hard to find work to earn money now, and 50% think that it will be hard to find work as an adult • Older youth are more likely to express concern • FGD participants concerned over work opportunities • Girls expressed more pressure to find work – especially single mothers • FGD participants noted few skills building opportunities (exception: boys in Mocuba & Matola) “There are no opportunities to learn new skills, but rather to do business – sell peanuts, bananas, popsicles.” (single girl, Buzi) 26 Youth are beginning to save • 93% of those who were working, were earning money • 29% of these youth gave the money directly to their caregivers (there is a trend that youth retain more responsibility for their earnings as they age) • 27% have money saved
27 Civic engagement
28 Participation • One-quarter of youth participate in groups (23% in school groups, 25% church groups) • 86% think that it is important to contribute to the community and 66% think they can make a difference in their community (positively contribute) • Most contributions cited by FGD participants were community, school debates related to health (not decision making)
29 Challenges to civic engagement • Support of adults • Half agree that adults care what they have to say, that adults make them feel important (older youth are more likely to agree) • FGD participants generally felt that adults discounted their ability to contribute "(…) the elders do not allow our [youth] participation in decision-making, because they think we are children (…) They [elders] think that the youth does not have the capacity to bring ideas for the society." (single boy, Buzi) • Time, Interest 30 Improving COVida interventions
Input from FGD participants
31 Youth Groups • Interested to learn new things, meet new people, speak up “Yes (we want to participate in youth groups). Because we can share our experiences and ideas, because together we can learn and grow; we can get to know other youth and discuss our problems." (single girl, Buzi) • Barriers to attendance: lack of interest, would rather be doing “adult things”, shy (f, Matola), lack of time (f, Matola), fear of being offended (f, Buzi), prohibition by husbands (f, Buzi), • Preference for groups to be led by an adult (to learn from life experience) 32 Youth-oriented Savings Groups • Interested, have seen success among adult members of their communities “Yes, (we would like to participate) because this will give us an idea of what we can do with our money. Because when you spend without a plan, later you regret that your money is gone and you didn’t know how to keep it.” (single girl, Mocuba) • Barriers: time, lack of money to save, fear of losing money, fear of going into debt • Preference for groups to be led by an adult • Preference for mixed sex groups (except for girls from Buzi) 33 Linha Fala Criança • No knowledge of this cited by FGD participants • Interested in idea • Reasons they might use the hotline: early marriage; forced marriage; sexual violence and mistreatment in the home (physical/emotional); physical abuse; rape; parent abandonment • Suggestions on how to get the word out: • Pamphlets, public events, information sharing at school, at meetings between youth and local govt, going door to door to spread the word
34 Wish list • Education: financial support: school materials and uniforms, support for single mothers who wish to return to school, IT rooms, vocational training, scholarships for higher education, study groups • Livelihood support: employment for parents, youth employment • Health: more family planning and HIV information, more activistas/counselling services (from whom youth could seek support) • Social services: rehabilitation of school infrastructure, open water boreholes and health centres
• Leisure sites 35