Save the Children in Partnership with SNV Projet USAID Nutrition Et

Save the Children in partnership with SNV

Projet USAID Nutrition et Hygiène à Sikasso Cooperative Agreement No. AID-688-A-13-00004

Quarterly Report October 1, 2015-December 31, 2015

Contact Information for this report: Maurice Gerald Zafimanjaka, MSc, MPH Project Director, Projet USAID Nutrition et Hygiène Email: [email protected]

1 Contents

Acronyms ...... 3

Introduction: ...... 4

Context and Project Objectives: ...... 4

Planned activities for the reporting period (Y3Q1): ...... 4

Achievements during Y3 Q1: ...... 6

Success Stories ...... 26

Challenges and Constraints ...... 28

Lessons Learned ...... 29

Gender Integration Achievements ...... 29

Major Activities Planned for Year 3, Quarter 2 (Y3Q2) ...... 30

Indicator Reporting Table ...... 33

Report in Progress ...... 33

Environmental compliance ...... 37

Conclusions ...... 388

Annexes……………………………………………………………………………………………………………………………………………………..38

2 Acronyms ASC Agent de Santé Communautaire AEA Agriculture Extension Agents ASACO Associations de Santé Communautaire ASDAP L’Association pour le Soutien du Développement des Activités de Population ATPC Assainissement Total Piloté par la Communauté or CLTS BDS Business Development Services CAP Community Action Plans CLAN Community Leaders for Action on Nutrition CLTS Community Led Total Sanitation or ATPC CM Community Mobilization CMAM Community-Based Management of Acute Malnutrition CSCOM Centre de Santé Communautaire DRS Direction Régionale de la Santé DRACPN Direction Régionale de l’assainissement et du Contrôle des Pollutions et des Nuisances ENA Essential Nutrition Actions FARN Foyer d ’Apprentissage et de Réhabilitation Nutritionnelle FFMSy Family Farming Management Systems FFS Farm Field Schools FSL Food Security and Livelihoods FP Family Planning GOM Government of Mali HKI Helen Keller International ICRISAT International Crops Research Institute for the Semi-Arid Tropics IER Rural Economy Institute IPC Interpersonal Communication IYCF Infant and Young Child Feeding MAM Moderate Acute Malnutrition MLA Maman Leader Animatrice MUAC Mid-Upper Arm Circumference NG Neighborhood Groups ODF Open Defecation Free OHADA Organisation pour l’Harmonisation du Droit des Affaires en Afrique OTP Outpatient Therapeutic Feeding Program PLW Pregnant and Lactating Women RUTF Ready-to-Use Therapeutic Foods SACCN Senior Advisors for Client Counseling and Negotiation SAM Severe Acute Malnutrition SBC Social and Behavior Change SBCC Social and Behavior Change Communication SIS Système d'Information Sanitaire SFP Supplementary Feeding Program SOW Scope of Work TA Technical Assistance TOR Terms of Reference ToT Training of Trainers USG United States Government VCA Value Chain Analysis VSLA Village Savings and Loans Association WASH Water, Sanitation and Hygiene

3 Introduction: Projet USAID Nutrition et Hygiène (Project) is in its third year of implementation and the reporting period October 1 through December 31, 2015 signals the completion of its ninth quarter of implementation. The Project is active in six health districts, 86 health facilities and 236 villages. 1,960 village community coordination committee (CCC) members, 2, 568 mother leader animatrices (MLAs), 2,078 mother-in-laws, 2,058 husband leaders, 444 relais communautaires, and 200 farmers are conducting social behavior change communication (SBCC) in nutrition, WASH, and Agriculture in the full package communities. In addition, Ms. Meghan Pollak was recruited during the quarter to fill the international WASH and Nutrition Specialist position. She will support the Sikasso team in rolling out the SBCC strategy, which is under development.

Context and Project Objectives: Save the Children leads the implementation of the Project, in partnership with SNV. The Project’s goal is to improve the nutritional status of pregnant and lactating women and children under two years of age in six health districts (Bougouni, Nièna, Sikasso, Koutiala, Kignan, and Kadiolo) of Sikasso Region. Sikasso Region is considered Mali’s breadbasket. It is agriculturally productive and a trade center. It is also one of the most densely populated regions of Mali and host to high rates of malnutrition, particularly chronic malnutrition. The Project’s three strategic objectives are: - SO1: To increase the adoption of optimal behaviors to supports nutrition, health, hygiene and sanitation - SO2: To increase the production and accessibility of nutrient-rich foods - SO3: To improve the delivery of nutrition services to address acute malnutrition

The Project’s approach is grounded in community mobilization and social and behavior change. It works through community structures to facilitate change and promote specific behaviors, engaging community members in Community Led Total Sanitation (CLTS), Care Groups, Women Farmers, Farmer Field Schools (FFS), and Family Farmer Management Systems (FFMSy). The Project also supports the Malian Ministry of Health and ASACO in addressing acute malnutrition through Community-Based Management of Acute Malnutrition (CMAM) and encouraging interpersonal communication (IPC) through client-patient exchanges as a means of prompting the adoption of recommended behaviors. Over the course of five years, the Project will reach at least 13,000 pregnant and lactating women (PLW) and 53,000 children under 2 years of age in six health districts in the Sikasso Region with its complete package of interventions.

Planned activities for the reporting period (Y3Q1):

Crosscutting activities to Operationalize SBC Strategy • Operationalization of SBC strategy: • Capacity building for Village CCCs in community mobilization, coordination, supervision, M&E and negotiation  Contributions to International and local events (International days for Latrines and Handwashing)

SO1: To increase the adoption of optimal behaviors to support nutrition, health, sanitation and hygiene

IR1.1: Households and caregivers have adopted recommended behaviors to support health and nutrition

 Thematic training of SBC Assistants on Lactational Amenorrhea Method as Family Planning (FP) method; 4  Training of Trainers (ToT) for Mother Leaders in communication techniques, Roles &Responsibilities and Monitoring by SBC Assistants at municipality level;  Thematic ToT of MLA by SBC Assistants at village level;  Organize meetings of Neighborhood Groups (households serviced by MLA);  Conduct home visits (full package area).

IR1.2: Households and communities undertake actions to support optimal hygiene and sanitation

Community-Led Total Sanitation (CLTS)

 Pre-Trigger communities (CLTS village assessment);  Conduct workshop with DRACPN to validate list of communities to be triggered;  Trigger communities in CLTS;  Monitor communities post-triggering;  Evaluate and certify communities for open defecation free (ODF) status.

Post-Certification Interventions

 Train SBC assistants, municipality representatives and technical services on post-ODF activities focused on sanitation marketing;  Train SBC agents, municipality representatives, masons and technical services on Slabs Sanplat manufacturing and water points maintenance;  Train SBC agents, municipalities representatives and technical services to promote sanicenters and sanitation shops (links between slabs, Sanplats production center, vendors of sanitation and water materials);  Train SBC agents, municipality representatives, technical services, and sanicenter managers to develop business plans to promote sanplats slabs for households;  Assessment of water points to be rehabilitated.

SO2: To increase production and accessibility of nutrient -rich foods

IR2.1: Producer groups are strengthened

• Workshop to assess local implementing partners; • Organizational and financial capacity building activities; • Organizational and institutional capacity building of farmer groups.

IR2.2: Improved farm management techniques adopted

• Provide technical support to farmer beneficiaries from peer farmers on FFMSy activities, including nutritional value of promoted crops and yield distribution oriented to HH consumption; • Install signs at FFS; • Support women at common gardens; • Support women in individual gardening; • Educate women practicing gardening through food preparation demonstration.

IR2.3: Smallholders’ access to agricultural inputs is strengthened

• Train extension agents on village savings and loans association (VSLA);

5 • Train peer farmers on VSLA; • Implement VSLA in communities; • Conduct nutrition and hygiene SBC activities for members of VSLA.

SO 3: To improve the delivery of nutrition services to address acute malnutrition

IR3.1: Management structure capacity to support CMAM is improved

• Health district focal points work sessions; • Joint field activity supervision.

IR3.2: Health workers have heightened capacity in management of acute malnutrition

• Survey and assess all CSCOM or health facilities; • Home-visit follow-ups and counseling; • Field activity monitoring by CMAM Officer; • Supervise CSCOM (by CMAM Supervisors); • Community-based screening and referrals.

IR3.3: Health workers have heightened capacity to counsel and negotiate with clients

• Conduct counseling and behavior change negotiation; • Organize quarterly meetings of Senior Advisors for Client Counseling and Negotiation (SACCN); • Conduct field supervision of SACCN activities.

Achievements during Y3 Q1:

Cross-cutting activities:

Operationalization of SBC Strategy A draft SBC strategy was developed in Y2 with the support of the SC/US nutrition Advisor. To make the document more sensitive to local culture and context, a national consultant, Mr. Yaya Coulibaly was recruited to provide technical assistance in refining the SBC strategy. In December 2015, the consultant submitted his report. In addition, the Project conducted an internal workshop with its staff to gather their perspectives on the strategy which will be finalized next quarter.

Village Community Coordination Committee (CCC) capacity building Community mobilization through the community action cycle (CAC) is being adopted in 2361 villages where the Project is implementing all three of the strategic objectives. In Y2, all of the 236 villages developed and implemented their one-year community action plans (CAP) under the leadership of their village CCCs. Some of them reviewed their CAP after a year of implementation.

The participatory approach used by SBC assistants to facilitate the CAC process serves as a capacity building

1 Initially, the Project, planned to target 251 villages to implement all its strategic objectives. When introduced in areas of interventions, Project staff noticed only 236 administrative villages. The 15 communities are only hamlets attached to administrative villages. 6 mechanism for community leaders and members of village CCCs. In October 2015, 13 village CACs out of the 50 planned received capacity building when reviewing their CAP. 251 village CCC members (120 men and 131 women) out of the 880 planned received capacity building in planning, supervision, coordination, monitoring and evaluation. In Y3Q1, SBC assistants were busy catching up on MLA trainings and will integrate the 37 remaining informal meetings into their program plans for Y3Q2 to reinforce the capacity of CCCs in monitoring, evaluation and negotiation.

USG indicators: - In Y3, Q1, 251 people (120 men and 131 women) out of the 880 planned were trained in child health and nutrition through USG supported programs - In Y3Q1, 131 women reached with education on exclusive breastfeeding (EBF)

Cheickné Koné, Village Advisor, supported by Souleymane Koné, Kadiatou Koné, MLA, during nutrition working group at community WASH Committee President, presenting the reviewed CAP during validation meeting, Bougoula Village, Zantiébougou health Area, community validation meeting, Bougoula Village, Zantiébougou Bougouni Health District, October, 6 2015. health Area, Bougouni Health District, October, 6 2015.

Contributions to International and local events (International days for Latrines and Handwashing)

Global Handwashing Day In the Sikasso Region, the Project supported the global handwashing day (October 15, 2015) celebration in collaboration with other USAID-funded Projects in the same zone and other technical partners under the leadership of DRS. The official celebration with local authorities took place in Blendio village, Blendio health area, Niéna Health District. In addition, the Project supported village CCC, MLAs and ASACO to celebrate this event in 22 villages mobilizing 1,459 participants (592 men and 867 women) for SBC messaging around handwashing practices at critical moments. Organized activities included: mass sensitizations with question and answer sessions, games related to when and how to wash hands with soap and water, advantages of handwashing, tippy-taps construction and installation at schools, and utilizations of ashes in the absence of soap.

Global handwashing day celebration in Blendio, Niéna Health District, Special Guest during Global handwashing day celebration in October 15, 2015 Blendio, Niéna Health District, October 15, 2015

Role plays on the advantages of handwashing facilitated by ASACO member WASH committee member, Ms Sali Diamouténé and Yacou dit and CSCOM in Pimperna, October 30, 2015 (Ms Oumar Diamoutene) Jacob Diamouténé demonstrating handwashing techniques with soap to participants, October 24, 2015. Global Latrine Day The Project supported the regional authority, Direction Régionale de l’Assainissement, de Contrôle de Pollution et des Nuisances (DRACPN), on Global Latrine Day in November 19th, 2015. The Project supported 23 village CCCs to mobilize 652 villagers (187 men and 465 women) for SBC messaging around latrine construction and use. Village CCCs, in collaboration with community hygiene committee members and MLAs, organized sensitization sessions on the advantages of using hygienic latrines as well as the consequences of open defecation.

Mr. M’Pere Diamouténé, Chief of Zérélaba village committed to Global Latrine Day celebration in Sikasso, November 19, 2015 build his latrine and encouraged households to follow his example and build their own. Zérélaba, November 19, 2015 8 SO1: To increase the adoption of optimal behaviors to support nutrition, health, sanitation and hygiene

Full package of interventions (all strategic objectives) are being implemented by the Project team in 236 villages within fifteen (15) health areas (CSCOM). Women of reproductive age (WRA) are organized into neighborhood groups (NGs) of 10-15 that identify from their members, mothers leaders to be targeted by the Project. Mother leaders are organized into care groups to receive monthly informal nutrition and hygiene education from SBC Assistants (Project staff). The Project is reaching husbands/fathers, mothers-in-laws, and community leaders as they play significant roles in influencing MIYCF and other key behaviors.

IR1.1 Households and caregivers have adopted recommended behaviors to support health and nutrition

The Project is adopting mainly the Care Group approach to promote behavior change among women and children beneficiaries. This approach includes cascade training to strengthen actor capacities to cascade SBC messages. SBC Assistants receive initial ToT on health and nutrition topics, then they train community volunteers (MLAs, mother-in-laws and husbands) to promote health and nutrition behaviors to beneficiaries.

Thematic training of SBC Assistants In Y3Q1, three-day ToT was conducted by SBC officers to train 20 SBC assistants (11men and 9 women) on Lactational Amenorrhea Method. SBC Assistants will cascade this training to WRA through MLAs.

USG indicator: - In Y3Q1, 20 people (11 men and 9 women) were trained in child health and nutrition through USG supported programs; - In Y3Q1, 20 people (11 men and 9 women) were trained in LAM FP; - In Y3Q1, 9 women reached with education on EBF.

ToT of Mother Leaders in communication techniques, Roles &Responsibilities, and Monitoring) by SBC Assistants at municipality level

The Project planned to train 586 MLA members of 78 CG and 70 relais communautaires at municipality level during Y3Q1. 1,790 MLA, 431 relais communautaires (223 men and 208 women), received ToT training on counseling, community visiting and screening of acute malnutrition. The Project decided to accelerate trainings for all MLAs and relais communautaires to put them at the same level and move with the same topics on monthly basis. Additionally, 503 mother in-laws and 521 husband leaders received the same ToT training. Not planned to participate to these trainings, they were included to participants to accelerate their trainings and put all community actors at the same level. These sessions were opportunities for SBC assistants to reinforce education on EBF to participants.

Ms.Mamou Koné, MLA practicing visual aids use during their training in Lamissa Diabaté, Husband leader participating to Banko- Zanfina village, Koumatou Health Area, Bougouni Health MLAtraining,in Katiorni, October 30, 2015 District November28,2015.

USG indicator: - In Y3, Q1, 3,245 people (744 men and 2501 women) were trained in child health and nutrition through USG supported programs -In Y3Q1, 2,501 women (1,790 MLA; 503 mother-in-laws and 208 relais communautaires) reached with education on exclusive breastfeeding

Thematic ToT of MLA by SBC Assistants at village level

MLAs and relais communautaires are expected to receive informal monthly training with SBC Assistants to learn and adopt improved health and nutritional behaviors. In Y3Q1, 212 Care Groups (CG) were intendedto meet with SBC assistants once a month (637 meetings). Due to the decision of putting all community actors (MLAs, mother- in-laws and husband leaders) at the same level (cf. previous section), CGs and Relais communautaires met with SBC Assistants once during Y3Q1. 211 Care Groups consisting of 2,266 MLAs and 211 relais communautaires (164 men and 47 women), 552 mother-in-laws and 522 husband leaders received informal training during these meetings. Topics at these meetings included: handwashing with soap and water, early breastfeeding, EBF, and infant and maternal feeding.

Mahamane Maiga, SBC Assistant, facilitating care group training in Kemasso, Fama Health Area, Sikasso Health District, December, 7 2015

USG indicator: - In Y3Q1, 3,551 people (686 men and 2,865 women) were trained in child health and nutrition through USG- supported programs -In Y3Q1, 2,865 women (2,266 MLA; 552 mother-in-laws and 47 relais communautaires) reached with education on exclusive breastfeeding

Conduct Neighborhood Group (households serviced by MLA) meetings After receiving monthly informal training with SBC Assistants, MLAs return to their neighborhood group (NG) to share and discuss behaviors for adoption during a monthly NG meeting. The Project expected 1,768 NGs to meet every month in 236 villages during the reporting period. However, 915 NG meetings were held by 236 NGs. They succeeded to meet once during the quarter, due to the cascade effect of the MLA training delay. These NG meetings reached 20,799 people (18,632 WRA, 1044 mother-in-laws and 1123 husband leaders).

The thematic lessons for each month are scheduled as in the table below: Période Jan. Feb. March Apr. May June July Aug. Sept. Oct. Nov. Dec.

Complementary feeding Maternal feeding

LAM

ILLNs use

Diarrhea

Early Breastfeeding

Handwashing

MAMA

Another NG activity included nutrition demonstrations. There were 107 nutrition demonstration sessions in 22 communities. 1,372 people (244 men and 1148 women) participated. 686 children (335 boys and 351 girls) were reached by these nutrition demonstrations.

MLA faciltating NG meeting in Mamabougou village, Finkolo AC NG meeting inà Kouroumasso village, Health Area Fama, Sikasso Health Area, Health, Sikasso Health District, November 19, 2015 Health District 11

Cooking demonstration in Pimperna, December 15, 2015 USG indicator: - In Y3, Q1, 19,676 women (18,632 WRA; 1,044 mother-in-laws) were reached with education on EBF.

Conduct home visits Each MLA is expected to conduct once a month one home visit to PLW and children under her supervision. This is an opportunity for her to assess their nutrition status (screenings) and environment (does child eat on clean dishes, does child use pot for defecation, does child receive exclusive breastfeeding, does child older than six months receive complementary feeding etc.) and provide appropriate counseling. 1,635 MLA out of 1,768 conducted 2,938 home visits in 211 communities. They reached 3,214 children and 5,459 women of reproductive age. The mother-in-laws managed home visits within 124 communities and reached 1,011women while husband leaders reached 1,081 in 149 communities. During these home visits, 323 children were screened (175 boys and 148 girls) for malnutrition. The reason only 323 children were screened is due to the fact that not all MLAs had Mid-Upper Arm Circumference MUAC tape. There were 52 (28 boys and 24 girls) cases of moderate acute malnutrition and 8 cases (4 boys and 4 girls) of severe acute malnutrition who were referred to ASCs and CSComs respectively.

USAID Indicators: -During the reporting period, 3,214 children under five reached by USG-supported nutrition programs -5,459 women reached with education on exclusive breastfeeding

Kadiato Traoré, a MLA conducting a home visit and assessing nutrition status of the child before a counseling session. Kalsadiassa village, Finkolo A/C Health Area, Sikasso DistrictNovember 11, 2015 12 IR1.2 Households and communities undertake actions to support optimal hygiene and sanitation

Hygiene and sanitation SBC activities are built around CLTS and sanitation marketing approaches.

Community Led Total Sanitation (CLTS)

CLTS process is divided into four stages (pre-triggering, triggering, post-triggering monitoring, and open defecation-free evaluation and certification.

Pre-Trigger communities (CLTS village assessment): Fundamental data (water points, number of latrines, the number of masons, the community population etc.) were collected in 120 communities. In collaboration with DRACPN, the Project conducted pre-triggering assessments in 120 villages not yet triggered in the Project intervention zone.

Conduct workshop with DRACPN to validate list of communities to be triggered From November 25th to December 4th, DRACPN held a workshop in Sikasso to select and approve the list of 91 villages (45 in Sikasso District and 46 in Bougouni District) to enter CLTS process during Y3.

Trigger communities in Community Led Total Sanitation (CLTS) sessions: During Y3Q1, 30 out of the 91 communities should have been triggered. These communities were not triggered due to agenda conflicts at DRACPN level. The communities are scheduled to be triggered in Y3Q2.

Post-triggering monitoring During the post-triggering stage, communities implement their WASH action plans and receive door-to-door hygiene practice messaging from WASH committees. Post-trigger monitoring sessions are conducted at three/four levels. At the community level, WASH committees, supported by field agents, conduct weekly monitoring sessions which are combined with WASH door-to-door sensitization. At the municipality level, CSCOM and municipality hygiene agents, supported by the Project conduct monitoring sessions at least once a month at selected communities to involve and make them aware of their responsibilities in the WASH CLTS process. The cercle level and eventually regional level are also involved and are supported by the Project at least once during the post-triggering stage to monitor CAP progress at the community level.

During Y3Q1, monitoring took place in 14 villages which were triggered during FY2 in Koumantou municipality. Additionally, from December 23rd to December 30th, monitoring at the Cercle level was realized under the direction of the local sanitation department, Service d’Assainissement, de Contrôle de Polution et des Nuisances (SACPN). 921 households (a total population of 6,117 of 3,054 men and 3,063 women) were sensitized on WASH practices within 14 villages, particularly on latrines, handwashing station use and critical moments for handwashing. In total, 209 new latrines were constructed, 139 existing latrines rehabilitated and 722 handwashing stations with soap and water constructed.

USG indicator: - During the reporting period, 340 people (168 males and 172 females) gained access to an improved sanitation facility in USG-supported programs. - 722 households with soap and water at a handwashing station used by family members in USG-supported programs.

Joint evaluation and ODF certification

13 During the reporting period, 19 villages were evaluated for ODF status and 13 were declared eligible for certification by DRACPN. The certification concerned the communities triggered in Y2 in the municipalities of Kapolondougou and Farakala in the Sikasso Health District.

Eligible villages were not certified due to agenda conflicts of DRACPN and its inability to justify previous advances from the Project. According to SC procedure, DRACPN is not allowed to receive a new program advance while a previous one is not yet justified. It was also noticed that it was difficult to certify some villages declared ODF in municipalities like Kapolodougou due to harvesting period.

One latrine observed by evaluators during evaluation ODF status, One latrine observed by evaluators during evaluation ODF status, Kandiadougou village, Farakala Health Area, Sikasso District, Molasso village, Farakala Health Area, Sikasso District, December 9, December 9, 2015 2015

Post-Certification Interventions Train SBC assistants, municipality representatives and technical services on post ODF activities focused on Sanitation marketing An initial WASH marketing and post-certification workshop was held in Bougouni in November 2015 for SBC assistants, SBC officers and WASH technical advisors and technical service agents (DRACPN, CSRef, SACPN etc.). 31 people trained (24 men; 11 women).

Participants at post ODF activity training, November 2-7, 2015, Training participants conducting self-assessment facilitation in Bougouni Tonfa village, Zantiébougou health area, Bougouni health –District, November, 3 2015 USAID indicator

- During the reporting period, 35 people (24 men; 11 women) trained in child health and nutrition through USG- supported programs; - During the reporting period, 35 people (24 men; 11 women) trained to implement improved sanitation methods.

Train SBC agents, municipality representatives and technical services to promote sanicenters and sanitation shops (links between slabs Sanplats production center, vendors of sanitation and water materials)

These activities were not realized due to agenda conflicts. SBC assistants were not available due to the finalization of MLA formations, lesson revision workshops, and the internal validation of the SBC Strategy. The activities will be implemented in the next quarter.

Train SBC agents, municipality representatives and technical services in Centers managers in business plan to promote sanplats slabs for households

Train SBC agents, municipality representatives, masons and technical services on Slabs Sanplat manufacturing and water point maintenance

Water Point Assessment for Rehabilitation The Project plans to rehabilitate 15 water points in Sikasso and Bougouni during Y3. The process will be divided into three phases: assessment, rehabilitation and monitoring post rehabilitation. The Project scheduled the assessment stage during Y3Q1. The Project hired short term technical assistance to conduct the assessment of 45 (21 in Bougouni and 24 in Sikasso) preselected broken-down water points by the Project team with communities, municipality technicians and DRACPN. In December 2015, the consultant conducted his work and the draft report will be submitted in January 2016. Rehabilitation will be done before the rainy season.

Water point visited during assessment in Pouna village, Water point visited during assessment in Sirakoro village, Bandiéresso Health Area, Sikasso Health District, December Zantiébougou Health Area, Bougouni Health District, 22, 2015 December 28, 2015

SO2: Increase production and accessibility of nutrient-rich foods

IR 2.1. Producer Groups Are Strengthened

Assessment Workshop of Local Implementing Partners (LIP): The Project planned to conduct annual assessment of local implementing partners (LIP): FAAMUYASO and YIRIWA SIRA. This workshop was held on November 24th, 2015 where four (4) staff members representing the two local capacity building providers attended. The assessment revealed the need for improving the accounting and management handouts.

Organizational and Financial Capacity Building Activities for the Implementing Partners: The Project carried out a two-day training in August 2015 for six (6) staff from FAAMUYASO and YIRIWA SIRA, which covered the proper procedures for drafting bills and invoicing with the correct support documentation such as attendance sheets for workshop participants. SNV will be recruiting a consultant to conduct participatory diagnosis with SNV staff and the two implementing partners. This diagnosis will cover administrative, managerial, financial and accounting practices, identifying gaps and areas that need for improvement, preparing the competency tables for different management functions, drafting the management manual and facilitating a validation workshop with the partners before finalizing the manual.

Organizational and Institutional Capacity Building of Farmer Groups The Project team facilitated the identification of 40 women’s groups for the implementation of the village savings and loans association, (VSLA) as scheduled. See full list in Annex 1. Capacity building was not yet launched during Y3Q1. From Y3Q2, the Project team will work with these women’s groups to help them establish basic management and organizational practices for the VSLAs such as the formation of an executive committee, a constitution and internal governance regulations.

IR 2.2. Improved Farm Management Techniques Adopted

In its approach, the Project uses cascade training to transfer improved agriculture techniques and to increase locally-produced food utilization. The eight agriculture extension agents (AEA) receive training and supervision from the Project staff (SNV). They train in turns two hundred peer farmers to provide technical support to two thousand women producers.

In Y3Q1, all eight (8) AEAs (7 men and 1 woman), four SBC agents (3 men and 1 woman), one (1man and no woman) staff from the Ministry of Agriculture and two members of the (LIP) received a two-day training session from November 25th-27th, 2015 to strengthen their capacity to carry out better nutritionally sensitive agricultural practices in both individual and collective sites. The training focused on the basic concepts of food security and good nutrition; types of locally available nutrient rich food recommended for household consumption; the difference between for profit and nutritionally sensitive gardening, selection of nutritionally dense crops and vegetables and best agricultural practices to increase yields.

USAID Indicators: Thirteen people (11 men and 2 women) were trained in child health and nutrition through USG-supported programs

Provide Technical Support to Farmer Beneficiaries from Peer-Farmers on FFMSy Activities, including the Nutritional Value of Promoted Crops and Yield Distribution for Household Consumption: Each peer farmer is expected to meet twice a month ten women producers at their fields to discuss improved agriculture practices for adoption. During Y3Q1, a total of 2000 women producers received technical support from 200 peer farmers about harvesting and storage techniques of cowpeas, soya beans and groundnuts. 17 Emphasis was placed on best practices in drying techniques and storage in order to conserve the nutritional value of the target crops.

These women farmers signed MoUs with their village CCC about the distribution of yield for utilization: 70% for household consumption; 5% for seeds during next campaign; 5% for recipe demonstrations for community activities with mother leaders; 15% to be reimbursed to the women groups; and 5% for the market. In December 2015, a workshop was conducted by Project staff including AEAs on how to support village CCC and women farmers to collect and store yield proportion for community work and make sure households consume part of their production, not sell it.

Install Signs at the Farmer Field School Sites: A total of 35 signs have been installed on farm field school sites (FFS) before the FFS activities start in Y3Q2. The Project will also install signs in Y3 Q2 for five additional FFS and in Y3Q3 for vegetable gardens.

Support Women at Common Gardens:

Through AEA and peer farmers, the Project mobilizes women producers from vulnerable groups to discuss and apply new gardening techniques and nutrition behaviors. Twenty-nine community gardens with an estimated area of 14.5 hectares were established in the Project area. They involve 29 women’s groups composed of 435 women receiving technical support about how to plan garden activities, choose quality vegetable seeds, and plant vegetables. The crops that were covered include yellow potato, Moringa, Baobab, Okra, and Amaranth. These crops have been chosen because of their high nutritional value combined with seedling/seeds access within the target community areas. Farmers are already familiar with Amaranth, Okra and Baobob. The Project introduced Moringa and Yellow Potato.

22 12 2015 : village of Solo. M Ousmane Doumbia Peer farmer with 22 12 2015 : village of Solo. M Ousmane Doumbia, Peer farmer looking for how to improve gardening of women group farmers of Ms Maiga Kadiatou Sanogo extension agent on the community Solo village. garden. They are looking for how to improve gardening.

Support Women for Individual Gardening:

Women participating in community garden activities are sensitized to have their own individual gardens at home and apply gardening for household consumption and needs. Forty-four individual gardens with an estimated area of 1.5 hectare are established at household level by women farmers. They receive regular technical support from

18 peer farmers. The Project anticipates that more individual garden sites will be installed by women farmers in the coming months.

The Project tries to promote bag/sack gardening, a new gardening practice to solve low access to land for women and water shortfall. After experimentation of bag gardening at the Project office, the Project team started training demonstrations with AEAs so that they can promote this technique which is not very popular in Mali while it presents the advantages of water and land saving.

AEAs participating to training demonstration of bag gardening, November, 27 2015

Educate Women Practicing Gardening through Food Demonstration:

This activity was supposed to start in Y3Q1. It will wait for when gardening activities can produce. AEAs received trainings in food demonstration in November 2016. In collaboration with SBC Assistants AEAs will support peer farmers to conduct food demonstration with women farmers.

IR 2.3. Smallholders Access to Agricultural Inputs Strengthened

Train Extension Agents on VSLA: As planned, the SNV Project team conducted a two-day training workshop on October 12th and 13th for eight (8) extension agents to develop the strategy and approach on how to engage with the VLSAs. The workshop covered the process to establish self-managed savings and credit groups and the necessary tools and methods to operate self-managed savings and credit groups.

Agriculture Extension agent participating to the training workshop on VSLA (village saving loan association), October 12, 2015 – Sikasso.

USAID Indicators: Eight people (7 men and 1 woman) were trained in child health and nutrition through USG supported programs

Train Peer-Farmers on VSLA: As scheduled, the SNV Project team conducted a four-day training session from November 9th to 12th 2015 for 40 peer farmers to strengthen their capacities in self-managed savings and loans groups which in turn will support investments in nutritionally sensitive farming. The training focused on basic management practices in establishing savings and loan groups and the different processes and tools associated with managing savings and the issuance of loans. A total of 40 villages have already been chosen for starting the VLSAs. The selection criteria included the motivation of women beneficiaries for the agricultural activities; the availability of peer farmers; the good organization of the village in general; the lack of any conflicts; the cohesion or agreement at the village level; and the existence of a similar savings activity among women. See full list of the villages in Annex 2.

USAID Indicator: Forty (40) people (38 men and 2 women) were trained in child health and nutrition through USG supported programs

Implement VSLA in the Communities: This Y2Q1 planned activity is ongoing. During the reporting period, forty groups were identified, eight AEAs and forty peer farmers trained. VSLA will be functional in Y3Q2.

SO3: Improve the delivery of nutrition services to address acute malnutrition

The Project is strengthening the health system not only to provide high quality CMAM service delivery to treat acute malnutrition cases, but to also systematically integrate nutritional counseling to accompanying caregivers of malnourished children admitted to CMAM program to reduce relapses.

IR 3.1: Management structure capacity to support CMAM is improved

CMAM Project staff is building the capacity of management structure (DRS, health districts, and ASACO) as well as stakeholders so that there is no shortage of CMAM inputs; timely and accurate reporting system is in place, and data used to inform decision-making process.

Health district focal points work sessions

Health district is supposed to convene CSCOMs to monthly meetings at health district level to discuss activity report by subsector, make decisions for improvement and make new plans. These meetings were a great opportunity to discuss and make decisions on nutrition subsector in the past. Unfortunately, due to lack of funding, these meetings do not happen on regular basis. To better support health districts on management of CMAM services, the Project staff works with nutrition focal points on a monthly basis to compile and analyze CSCOM nutrition activity reports and to identify key recommendations for health district officer for decision making.

During the reporting period, 13 out of 12 work sessions with the district nutrition focal points were realized. In the health district of Kadiolo one extra meeting was realized during the same month. 17 support sessions with focal point persons were reinforced to improve the collection and analysis of CMAM data.

After the preliminary analysis with the district nutrition focal points, results and recommendations are discussed with the Health District medical Officer for decision making. 7 out of 12 work sessions took place with the health district medical officers. Due to the very busy schedules of the health district medical officers, which included a great deal of unexpected work tasks, agenda conflicts ensued making it difficult to meet with all district chiefs during Y3Q1.

Joint field activity supervision The Project team regularly organizes joint field supervision with the DRS and health district management team to assess the quality of nutrition service delivery at CSCOMs and ASCs. This supervision covers all aspects of nutrition services (staff skills, nutrition inputs management and storage, health information system, etc.) and uses a Quality Verification Check List (QIVC) as a supervision tool.

During the reporting period, the two planned joint field supervision sessions took place in the Districts of Sikasso and Nièna. Ten CSCOMS received supervision visits and 38 health agents (22 men and 16 women) supervised. 79% of health agents scored at least 75% on QIVC.

Main constraints observed during joint supervisions are low interest of ASACO members in nutrition activities and a very limited number of staff at CSCOM. The Project will work closely with USAID/SSGI to mobilize ASACO for better planning and coordination of CSCOM’s basic health service package, particularly nutrition activities. Municipalities, FERASCOM and health districts will be mobilized to overcome these constraints.

Joint supervision restitution to Blendio CSCOM in presence of Arama Coulibaly, CSCOM Nutrition focal point receiving Joint DRS, Health District, health agents and ASACO, Nov 11, 2015 Supervision by Dr Koné (Health District Focal Point and Dr Talil CMAM Officer), N’kourala CSCOM, Sikasso, Nov 21, 2015 21

IR 3.2: Health workers have heightened capacity in the management of acute malnutrition

The Project provides supports to health agents and ASCs to heighten their capacities to deliver high quality services and manage nutrition inputs and information.

Survey and assess all CSCOMs or health facilities Before working with a CSCOM, Project staff assesses its capacities to identify priority needs. During the reporting period, 14 out of 19 CSCOMs were assessed in 4 Health Districts. The 5 CSCOMs in Koutiala health district were not assessed due to agenda conflicts with the health district. They will be evaluated in the next quarter.

As per the Malian CMAM protocol, passive and active nutritional screenings are conducted respectively by health agents at CSCOM and ASCs, and relais communautaires at community level. Moderate cases of malnutrition are referred to ASCs (in area with SEC program) or to CSCOMs for treatment while severe cases are referred to CSCOM directly. Severe cases with complications are admitted inpatients at stabilization care at CSRef. Community volunteers conduct home visit follow-ups to outpatients until they exit the CMAM program.

Community-based screening and referrals

540 villages of 62 CSCOM reported conducting community-based nutritional screening in Y3Q1. The Project initially planned to reach 9 867children aged of 6 – 59 months for Y3Q1 and reached 150,932 (72,603 boys; 78,029 girls). This high number achieved was facilitated by the seasonal malaria chemoprevention campaign in some Project areas where health personnel screened all children for malnutrition. In addition, 2,314 out of planned 2,105 pregnant and lactating women (PLW) were screened during the reporting period. The screening allowed for the identification of 3,639 children (1,703 boys; 1,936 girls) suspected cases of moderate acute malnutrition and 681 (309 boys; 372 girls) suspected cases of severe acute malnutrition. 189 moderate cases were detected among PLW. They were referred to ASCs and CSCOM for further assessment and treatment. There are two key challenges: i) low motivation of community health volunteers in some villages, particularly in areas where the Project does not have community anchor; ii) and shortage of inputs to treat these cases at the facility level. This year CPS campaigns were combined with screenings of acute malnutrition.

The Project still notices the lack of motivation of relais communautaires in conducting nutrition activities. The involvement of MLAs in community nutrition, including screening and home visit follow-ups is expected to improve the situation.

Based on partnership between the Project, UNICEF and Health Districts of Bougouni and Sikasso, the Project received from UNICEF 4,000 MUAC tapes (2000 for Children screening; 2000 for Women) that were distributed to MLAs to equip them during community nutritional screening.

In terms of admission to the CMAM program, 4,684 children under five years of age and 1,336 PLW were admitted. The table below details CMAM admission.

% planned Vs INDICATORS Target Achieved achieved # children admitted in TFC for SAM without complication 71 1434 5% Number of boys 35 650 5% Number of girls 36 784 5% # children admitted in SFP for MAM without complication 671 3250 21% Number of boys 329 1460 23% Number of girls 342 1783 19% # PLW admitted in SFP for MAM 84 1336 6%

USG indicator:

During the reporting period, 150,932 (72603 boys; 78,029 girls) under five reached by USG-supported nutrition programs.

Home-visit follow-ups and counseling

ASCs and relais communautaires conducted home visits of malnourished children and PLW admitted as outpatients to the CMAM program to make sure RUTF and RUSF were correctly used and provided personalized counseling. Out of 48 planned home visit follow-ups and counseling, 21 visits were realized. 22 (9 boys and 13 girls) out of planned 45 children with severe acute malnutrition were reached.

All undernourished children did not receive home visits. Only the malnourished children who did not properly follow their treatment plans, or had problems gaining weight were visited. 19 home visit follow-ups and counseling sessions out of 48 took place. These visits reached 19 people (5 men and 14 women).

Supervise CSCOM (by CMAM Supervisors)

As part of their technical support role, CMAM Project staff provide supervision using Quality Improvement verification checklist ( QIVC) tools to health agents and ASC. This type of supervision covers technical skills, information system and input management.

In total, 105 CSCOMs and 414 health agents were scheduled to be supervised. During the reporting period, technical supports were provided to 334/414 of these health agents (137 males; 197 females) through 88/105 CSCOM supervisions within six health districts. In total, 51 out of 82 personalized technical assistance sessions were provided to CSCOM health agents conducted by Project staff in Y3Q1. 79% of supervised health agents scored at least 75% during supervision.

Thirty-five (1 man and 34 women) out of 41 ASCs and thirty-seven (24 men and 13 women) out of 47 relais communautaires received joint supervision sessions. 76% of supervised ASCs scored at least 75% during supervisions. There were agenda conflicts related specifically to different CSRef campaigns. Additionally, CMAM supervisors were unavailable due to work on annual data collection.

USG indicator:

-86 out of 139 Y3 targeted health facilities with established capacity to manage acute malnutrition

Keys indicators Severe norms Comments Moderate norms Comments CMAM U5 # Admission 2189 2885 # Exit 1688 1926 Average length of 6 <4wee Length of stay is longer 10 weeks 8 ASC counseling and behavior stay within the weeks ks compared to the norm due to weeks change negotiation should be program shortage of MAM inputs. reinforced. In addition, Health facility counseling and community agents (relais behavior change negotiation communautaires and mothers should be reinforced. In leaders) should assure home visit addition, community agents follow-up at community level. (relais communautaires and Health District and WFP need to mothers leaders) should work together to ensure CMAM assure home visit follow-up at inputs availability. Community community level. Community based intervention such as based intervention such as PD/Hearth and recipe PD/Hearth and recipe demonstration will be demonstration will be strengthened strengthened 23 Default (Lost to 15.26% <15%; Community agents (relais 12.72% <15%; Community agents (relais follow-up) rate >25 communautaires and mothers >25 communautaires and mothers alarmi leaders) should assure home alarmi leaders) should assure home visit ng visit follow-up at community ng follow-up at community level. level. Recovery rate 77.11% >75% 66.76% >75% The stock-out of supplies at <50% <50% alarm alarm the CSCOM level for the cases ant ant of moderate acute malnutrition. This explains the elevated transfer rate.

Non response (to 1.37% N/A 0.55% N/A standard treatment) rate Case fatality rate 0.14% <10% 0.03% <10% >15% >15% alarmi alarmi ng ng Transfer Rate 5.98% 19.93%

Fatoumata Dembele, Nutrition Focal Point, performing group CSCOM team during a monthly meeting inl Pimperna, October discussion on causes of malnutrition, Fanidiama, Nov 11,2015 30, 2015 (from left to right : Adama Diamouténé-Aide soignant ; Assétou Koné-Matrône ; Rokia Konaté-Chargée Nutrition ; Sindiougo Baba Goro-DTC ; Salimata Bengaly-Agent PEV & SACNN ; Bassary Kaloga-Superviseur CMAM ; Seyba Coulibaly- Gérant dépôt)

IR 3.3 Health workers have heightened capacity to counsel and negotiate with clients Health care providers (CSRéf, CSCom and ASC) are being supported through SACCN to systematically provide accurate effective IYCF messages to accompanying caregivers.

Conduct (SACCN) counseling and behavior change negotiation  14 coaching visits, which reached 12 ASCs (3 men and 9 women).  34 health visits by health agents that reached 42 people (15 men and 27 women).  2964 (959 men and 2005 women) patients in CSCOMs who received counseling and behavior change negotiation sessions.  255 (92 and 163 women) patients who received behavior change negotiation counseling at ASC sites

Maminata Mariko, SACCN providing counseling and negotiation Salimata Bengaly, SACCN providing counseling and negotiation for for breastfeeding to a lactating woman, in Kodialanida FP methods to a lactating woman, October 30, in Pimperna November 11, 2015

25 Success Stories Gouana Community Increased Its Access to Clean Water

Like many other communities in the Sikasso Region, Gouana, one village of Zantiégougou municipality, Mamissa Health Area, Bougouni Health District, did not have access to clean water. Although the NGO Helthyetas constructed two community water pumps in 1984, both were in disrepair forcing women to use the unique wells in the village, where water is not potable water.

Through its community action cycle (CAC), Projet USAID Nutrition Hygiène mobilizes targeted communities to assess their accessibility to quality water and mobilize local resources to build/rehabilitate water points and meet minimum standards. This process is conducted by the community coordination committee (CCC) composed of community leaders facilitated by a Social and Behavior Change (SBC) Assistant, a Project field staff. CCC may be organized according to thematic priorities such as food security, nutrition, and WASH to think and coordinate community actions in these areas.

In Gouana, Sidiki Coulibaly, a SBC Assistant, facilitated the CAC process with the local CCC and WASH committee members to figure out how to improve safe water access and how to repair the two broken-down water pumps to serve 100 households (746 people). He accompanied CCC to present their action plan to Mayor, Adama Doumbia in early December 2015. It was an opportunity for CCC to advocate the repair of the two water pumps. Convinced of the magnitude of the issue, Mayor Doumbia asked Gouana CCC to assess and cost the rehabilitation of the two hand pumps. Under the guidance of Gouana CCC, the relais communautaire supported by a local technician assessed and estimated a budget of 500,000 CFA F for the materials and reparation of the two water pumps. When submitted to the Mayor, he accepted to fund the work and ordered the rehabilitation of the two water pumps. The rehabilitation started in the same month of December 2015 and finished in January 5, 2016.

Community members, particularly women, now have access to potable water, which will not only cut long distance travel for water, but also increase sanitation and minimize risk to water borne disease in Gouana. Bassaran Samake, 42 years-old, one MLA of Gouana village says : « I am happy to have access to potable water again. Now, my family and the whole community can drink and use clean water and I will not have difficulty promoting hygienic behaviors to my peers.”

Success Story Written by: SIDIKI COULIBALY ASSISTANT SBC MAMISSA Le 28/01/2016 Contact: Sidiki: [email protected], +22366974531

26 Diversifying Diets for Better Maternal and Child Nutrition in Tiéwarla

Projet USAID Nutrition Hygiène strives to improve the nutritional status of pregnant and lactating women and children under two by supporting optimal behaviors to support nutrition, health, hygiene and sanitation and increasing the production and accessibility of nutrient-rich foods. Before Project interventions, many communities in the intervention zone knew how to cultivate nutritious crops including soy, groundnuts, and nybé, but did not know how to transform these foods into nutritious recipes. In Y3Q1 Projet USAID Nutrition Hygiène focused on bridging the gap between the production of healthy foods and fortified recipes. In Tiéwarla in the eastern part of Nkourala village in the commune of Kapolondougou, community members are realizing Project goals and objectives through interactive cooking demonstrations at the community level. The majority of Tiéwarla’s 336 inhabitants work in agriculture, market gardening, or small commerce.

USAID Projet Nutrition Hygiène was introduced to Tiéwarla through community mobilization activities, which encouraged collaborative thinking, problem solving and solidarity. With the help of community members, the Project conducted formative research to identify actual health behaviors and sub-behaviors and barriers to the adoption of recommended health behaviors and sub-behaviors.

To increase the production and access to foods rich in nutrients, women farmers in Tiéwarla cultivate soy in their individual plots for consumption. After the harvest, women farmers transform soy into nutritious foods to give to their children under two years of age. In November, 2015, the Deputy Chief of Party, the Nutrition Technical Advisor, and the newly recruited Nutrition and WASH Specialist visited Tiéwarla to discuss Project activities with women farmers. During the discussion, community members talked about the improved nutritional status of children under two and pregnant woman after the introduction of foods rich in micronutrients such as soy. Children now consume nutritious foods such as soy bouille and soy milk thanks to Project cooking demonstrations. Maimouna Ouattara, a Maman Leader and soy enthusiast, even shared some of her soy creations with Project staff during their visit. She has become one of the main leaders in teaching other neighborhood group members how to integrate soy into complementary feeding behaviors and how to create dried soy nuts, soy beignets, and soy bouille.

In 2016, Projet USAID Nutrition Hygiène will continue sensitizing target community members on how to prepare various nutritious recipes by replicating successful activities already taking place in Tiéwarla.

Written by: Keita Abdrahamane, [email protected], +22363288027

27 Challenges and Constraints

Challenges and constraints Actions

The implementation of the SBC strategy A workshop was held from December 14th to 18th to needs someone to concentrate on the development of review the strategy and make recommendations for tools and staff training. better implementation. Efforts are focused on better integration of nutritional, agricultural and WASH activities and stronger involvement of the respective committees, at the community level.

Collaboration and scheduling conflicts at the health The Project and health district partners will plan district level. activities together to alleviate scheduling conflicts and miscommunication issues. Coordination meetings will be held every Friday under leadership of the DRS to better manage planned activities.

Activity delays due to DRACPN: - limited number of DRACPN staff delaying some CLTS activities, particularly ODF status Work closely and provide support to DRACPN on how to evaluation proceed on program advance justification correctly and - DRACPN has not justified on time program on time advance preventing the Project from providing additional program advances according to MoU with DRACPN.

Integration of Project community activities in PMA Presentation of Project community activities during (activities at CSCom level) district health level monthly meetings.

Low motivation of relais communautaires (RECO) - Keep working with RECO; - Reinforce MLA who can reduce the workload of RECO for community work.

Lessons Learned

 Developing an SBC strategy is a complex and time consuming endeavor that requires full-time support. The Project is using MoH counseling cards to promote priority behaviors included in the strategy but will also hire or contract a SBC Advisor to finalize the SBC strategy and operationalize it through Project activities.

 The training and awareness activities provided by the 8 agricultural extension officers and the 200 peer farmers helped the women beneficiaries understand that a balanced diet should be composed of several food groups that are already available at the village or the household level. Women beneficiaries also realized that their main diet is dominated by cereals which are insufficient to cover their nutritional needs. Additionally, the agriculture committees, nutrition and sanitation set up in each village realized that the 2 immediate causes of malnutrition are diseases and inadequate diet.

 Community members are not able to focus only on Project activities during growing season and harvest season (June to December). Therefore, the Project needs to focus efforts from January to June when community members are more readily available.

 Partners should harmonize as much as possible their approach and terms of partnership when supporting local government, communities, and their representatives (administrative and logistics supports, etc.). The latter prioritize partners that meet their personal interests. The Project started to build coalition SC- implemented WASH Projects to harmonize partnership to DRACPN. The Project will build a coalition with other partners to support the regional and district programs of the government. This coalition will define and advocate for more or less harmonized ways of working with the local authorities.

Gender Integration Achievements

The Project staff promotes women’s participation at all levels of decision making and acting. Women are well represented in almost all decision making processes (CCC, WASH committees, mother leaders, etc.). It was challenging to have women in the agriculture sector. However, the Project team made a particular effort to include women. Currently, there is one woman among the eight extension agents, and 4 out of 200 peer farmers. Additionally, community women led nutrition demonstration activities including the collection of supplies and ingredients as well as the preparation of fortified recipes.

Technical Assistance and Visitors Did your organization utilize short-term TA during the fourth quarter?

No/Not Applicable Yes If yes, please list below:

- Natalie Roschnik, Nutrition and ECD Advisor in October 2015 - Adriane Seibert, Nutrition Advisor in November 2015

Travel and Visits Did your organization support international travel during the fourth quarter?

29 No/Not Applicable Yes

-Visit from Natalie Roschnik, Nutrition and ECD Advisor in October 2015 -Visit from Nutrition Advisor in November 2015

Major Activities Planned for Year 3, Quarter 2 (Y3Q2)

Cross-cutting activities:

 SBC Materials Developer/Advisor;  Crosscutting activities;  Operationalize SBC Strategy;  Replication or production of materials used in SBCC;  Community mobilization techniques and zonal action plan training (Community Coordination, Community diagnostic and planning) Village CCC will receive informal training in mobilisation coordination, supervision, M&E, negotiation;  Contribution to International and local events (SIAN, International days for Latrines, Breastfeeding, and Handwashing). SO1: To increase the adoption of optimal behaviors to support nutrition, health, sanitation, and hygiene

IR1.1: Households and caregivers have adopted recommended behaviors to support health and nutrition

 Community mobilization techniques and zonal action plan training: SBC Assistant will receive thematic ToT by SBC Officers;  Community mobilization techniques and zonal action plan training. Maman Leader Animatrices trained (ToT of Mother Leaders in communication techniques, Roles &Responsibilities, and Monitoring) by SBC Assistants at municipality level;  Community mobilization techniques and zonal action plan training: MLA within CG will receive thematic ToT by SBC Assistants at village level;  Conduct Neighborhood Group (households serviced by MLA) meetings;  Conduct home visits (full package area);  Conduct additional SBC activities based on SBC strategy roll-out. IR1.2: Households and communities undertake actions to support optimal hygiene and sanitation

 Trigger communities in CLTS: Community Led Total Sanitation (CLTS) sessions;  Monitor communities post-triggering;  Evaluate communities for ODF status;  Certify communities achieving ODF status: 1st villages out of 15 triggered;  Certify communities achieving ODF status: 14 remaining villages out of the 15 triggered;  Post-Certification Interventions;  Train SBC agents, municipalities representatives and technical services on the development of community planning for WASH;  Facilitate WASH community planning;  Support Municipalities to update their PDESEC integrating WASH community action plans;  WASH SBC conducted by WASH Committees to complement MLA/RECO;  Train WASH Committees on water purification and Essential Hygiene Actions;

30  SBC communication sessions conducted by WASH committees;  Access to sanitation products improved;  Train SBC agents, municipalities representatives, masons and technical services on Slabs Sanplat manufacturing and water points maintenance;  Train masons;  Train SBC agents, municipalities representatives and technical services to promote sanicenters and sanitation shops (links between slabs Sanplats production center, resellers of sanitation and water materials);  Sanitation Shop Implementation;  Train SBC agents, municipalities representatives and technical services in Centers, managers in business plan to promote sanplats slabs for households;  Sanicenters develop their business plans;  Train SBC agents, municipalities’ representatives and technical services on water purifiction/treatment;  Organize fairs to promote sanplat slabs;  Organize water and sanitation fameworks of dialogue.

SO2: To increase production and accessibility of nutrient-rich foods

IR2.1: Producer groups are strengthened

 Organizational and financial capacity building activities;  Organizational and institutional capacity building of farmer groups. IR2.2: Improved farm management techniques adopted

 ToT of extension agents on family farming systems, including nutrition values of promoted crops;  ToT of peer farmers on FFSy, including nutrition value of promoted crops and yield distribution oriented to household consumption;  Provide technical supports to Farmer beneficiaries from peer farmers on FFMSy activities, including nutrition value of promoted crops and yield distribution oriented to HH consumption;  ToT of extension agents on NRM techniques;  Train FFS participants (peer farmers) for intercropping nutrient-dense varieties and nutritional gardens;  Support women at community and individual garden sites;  Educate women practicing gardening through food demonstration.

IR2.3: Smallholders access to agricultural inputs is strengthened

 Implement VSLA in community;  Conduct nutrition and hygiene SBC activities for members;  Field Supervision;  Supervise direct beneficiary farmers.

SO3: To improve the delivery of nutrition services

IR3.1: Management structure capacity to support CMAM is improved

 Health district focal points work sessions;  Joint field activity supervision. IR3.2: Health workers have heightened capacity in management of acute malnutrition

31  Survey and assess all CSCOM or health facilities;  Train health agents on National PCIMA (CMAM) protocol;  Home-visit follow-ups and counseling;  Community level Advocacy;  Field activity monitoring by CMAM Officer;  Supervise CSCOM (by CMAM Supervisors);  Community-based screening and referrals. IR3.3: Health workers have heightened capacity to counsel and negotiate with clients

 Training of Counselors (Counseling and Negotiation);  SACCN (ASCs) coaching;  Conduct (SACCN) counseling and behavior change negotiation;  Quarterly SACCN Meetings ;  Supervision ;  CMAM staff Meetings.

32 Indicator Reporting Table

Target Achievement Comment (please explain why you are above or below target by 10%

MATERNAL AND CHILD HEALTH 1 Number of households with 1 157 722 During Y3Q1, 722 out of observed 921 soap and water at a hand households in 14 CLTS triggered villages washing station used by (communes: Koumantou) had soap and water family members in USG at a hand washing station. supported programs

2 Number of women reached 1 042 30641 Field agents systematically provide with education on exclusive information about exclusive breastfeeding breastfeeding during each meeting with community groups:

3 Number of individuals 187 35 Trainings were provided during post-CLTS trained to implement training improved sanitation methods

Number of Men 72 24 Number of Women 115 11 NUTRITION 4 Number of people trained in 9 191 7163 During Y3, the Project trained 7163 people : child health and nutrition (1641 males; 5522 females), through USG supported programs

Number of Men 6 347 1641 Number of Women 7 679 5522

5 Number of health facilities 14 CSCOM where assessed during Y3Q1 with established capacity to but the Project support have not started 105 86 manage acute under yet. Others 5 CSCOM will be assess during nutrition second quarter Numerator 105 86 Denominator 139 139 6 Number of children under 150, 603 children reached out of 32,321 five reached by USG- planned to be reached. The seasonal malaria supported nutrition 32 321 150 603 chemoprevention campaigns facilitated the programs nutritional screening of high number of children

Number of boys 15 837 72632 Ratio boys/girls from achievement were used Number of Girls to disaggregate by sex for Y3Q1 from Koutiala and Sikasso health district. Sex was not 16 483 78029 distinguished by Health district.

WASH 7 Number of communities 0 0 13 out of 19 communities evaluated ODF in certified as “open defecation Y3Q1 could be certified. These evaluated free” (ODF) as a result of USG villages were triggered during Y2 assistance

8 Number of people gaining 0 0 According to USAID’s new M&E plan, access to an improved implemented funded health Projects, drinking water source this indicator has been changed taking into account the case of two criteria (water source must be funded by US government and accessing water duration from house-water source- home must not be more than 30 minutes). The Project will take these news criteria to collect data after rehabilitated broken down water source at the Y3Q2

Number of Men 0 0

Number of Women 0 0

9 Number of people gaining 0 340 In 113 households, 340 people out of 6117 access to an improved inhabitants within the 921 observed sanitation facility households used improved sanitation facility Number of Men 0 168 168 out of 3054 male inhabitants within the 921 observed households. Number of Women 0 172 172 out of 3063 female inhabitants within the 921 observed households. 34

Report in Progress

Summary Plan of Activities for the quarter Status of implementation Comments STTA/Consultants SBC Materials Developer/Advisor A workshop was held from December 14th to 18th to review the strategy and make recommendations for better implementation. Efforts are focused on better integration of nutritional, agricultural and WASH activities and stronger In Progress involvement of the respective. Water point assessment consultant The evaluation was completed December (engineering company) Achieved 30th, 2015. Crosscutting activities Operationalize SBC Strategy SBC strategy validation/action plan workshop: This workshop was held from December 14- one in Bougouni and one in Sikasso December 18, 2015. SBC Assistants, SBC Coordinators, and the AVAs were present and discussed and revised the SBC Strategy and refined the schedule of activities for Completed 2016. Village CCC capacity building in mobilisation coordination, supervision, M&E, negotiation

This activity is ongoing until Y3Q3. Action plan reviews that were not realized during Ongoing Y2 were completed in Y3Q1. Contribution to International and local events During Y3Q1 the Project participated in (SIAN, International days for Latrines, Global Handwashing Day and Global Latrine Breastfeeding, and Handwashing) Ongoing Day and plans to participate in 2016. SO1: To increase the adoption of optimal behaviors to support nutrition, health, sanitation, and hygiene IR1.1: Households and caregivers have adopted recommended behaviors to support health and nutrition thematic ToT for SBC Assistant by SBC Officers Training on |TOPIC] was held in December Completed 14th -December 18th 2015. ToT of Mother Leaders in communication techniques, Roles &Responsibilities, and Monitoring) by SBC Assistants at municipality level

Completed ToT of MLA by SBC Assistants at village level This activity continues throughout the Ongoing Project. Explain some delays Conduct Neighbourhood Groups (households This activity continues throughout the serviced by MLA) meetings Ongoing Project. Explain some delays 35

Conduct home visits (full package area) This activity continues throughout the Ongoing Project. Explain some delays Conduct additional SBC activities based on SBC Nutrition demonstrations is integrated into strategy roll-out Ongoing SBC activities IR1.2: Households and communities undertake actions to support optimal hygiene and sanitation Pre-Trigger communities (CLTS villages This activity was realized and it allowed assessment) DRACPN to choose which villages are Achieved eligible for triggering. Conduct workshop with DRACPN to validate list The DRACPN realized workshop and chose of communities to be triggered Achieved 91 communities for triggering. Trigger communities in CLTS: Community Led Total Sanitation (CLTS) sessions. Not Started This activity will be realized in Y3Q2. Monitor communities post-triggering: Post- The monitoring of new communities has not declenchement monitoring. been started, but monitoring of villages Ongoing triggered in Y2 continues. Post-Certification Interventions Train SBC assistants, municipality representatives and technical services on post This fundamental training was completed in ODF activities focused on Sanitation marketing. Achieved November 2015. Train SBC agents, municipality representatives and technical services on the development of Agenda conflicts and miscommunication did community planning for WASH Not Started not allow for the realization of this activity. Access to sanitation products Train SBC agents, municipalities representatives, masons and technical services on Slabs Sanplat manufacturing and water Agenda conflicts and miscommunication did points maintenance Not Started not allow for the realization of this activity. Train SBC agents, municipality representatives and technical services to promote sanicenters and sanitation shops (links between slabs Sanplats production center, resellers of Agenda conflicts and miscommunication did sanitation and water materials) Not Started not allow for the realization of this activity. Train SBC agents, municipality representatives and technical services in Centers managers in business plan to promote sanplats slabs for Agenda conflicts and miscommunication did households Not Started not allow for the realization of this activity. SO2: To increase production and accessibility of nutrient-rich foods IR2.1: Producer groups are strengthened Assessment workshop of local implementing One assessment workshop took place in partners Achieved November 2015 Organizational and financial capacity building Ongoing One two day workshop conducted in August activities 2015, followed by coaching and mentoring of staff until early January 2016 Organizational and institutional capacity On going 40 farmers groups are receiving capacity building of farmer groups building activities. IR2.2: Improved farm management techniques adopted

Provide technical supports to Farmer beneficiaries from peer farmers on FFMSy activities, including nutrition value of promoted crops and yield distribution oriented to HH consumption On going Support women for individual gardening On going 41 individual women gardens are receiving technical support Educate women practicing gardening through For Y3Q2 To be completed next quarter after food demonstration receiving the recommendation on the SBS strategy IR2.3: Smallholders access to agricultural inputs is strengthened Train extension agents on VSLA Achieved Training Peer farmers on VSLA Achieved Implement VSLA in community On going 40 villages already identified, activities to commence in the next quarter Conduct nutrition and hygiene SBC activities for On going To be completed next quarter after members receiving the recommendation on the SBS strategy Supervize direct beneficiary farmers On going A monitoring form has been developed for farmers supervision SO3: To improve the delivery of nutrition services IR3.1: Management structure capacity to support CMAM is improved Health district focal points work sessions. Ongoing This work facilitates decision making. Joint field activity supervision. This reinforces the capacity of CSCom Ongoing nutrition staff. IR3.2: Health workers have heightened capacity in management of acute malnutrition Survey and assess all CSCOM or health It allows for the progressive coverage of 139 facilities. Ongoing CSComs in Project activities. Home-visit follow-ups and counseling These visits permit the monitoring of Ongoing instructions given by health agents. Field activity monitoring by CMAM Officer: Not achieved This will be modified to joined supervision Supervise CSCOM (by CMAM Supervisors) Ongoing Community-based screening and referrals Ongoing IR3.3: Health workers have heightened capacity to counsel and negotiate with clients Conduct (SACCN) counseling and behavior To fortify behavior change communications. change negotiation Patients receive counseling about behavior Ongoing change during their treatment. Quarterly SACCN Meetings Ongoing

Environmental compliance The Project took all measures to monitor its environmental compliance during the reporting period and can attest that Project staff, partners, and beneficiaries were compliant. The Project team promoted environment-friendly agricultural techniques to women farmers. All accompanied woman farmers used organic manure and compost as fertilizers when growing cowpeas, groundnuts and soya. They did not use chemicals nor genetically modified organisms. For conservation techniques, the Project promoted the use of ash or bio-conservator like Neem (Azadirachta indica).

Conclusions All Project operational activities are on course. The SBC Strategy is in the process of being modified to reinforce behavior change tools and activities planned for implementation in 2016—cooking demonstrations with soy and groundnuts. The Project focused on fortifying synergy with other USAID funded Projects. Agenda conflicts, especially with DRACPN and DRS, hindered Project activities in Y3Q1. The Project plans to organize scheduling meetings with these organizations to clarify and create a more systematic and realistic schedule.

ANNEXES

Annex 1; List of Women Groups for VSLAs Activities

Bandierso Bandiersso Ngolo Diassa Demdelela Bagayogo Finkolo/AC N'Kourala Tiérouala N'Golopèrèbougou M'Pèdougou Gniriwani Tiérouala FAMA Siramana Naniassoni Kouroumasso DALLE N'Galamanigobougo u KOLOKOBA Nampilyidougou Pimperna Kodialanida Zerbala Diassadéni Wayéré Kapala Sanasso Zantiébougou Falaba Boundjonidjouka Bougoula Zantogola Mamissa Koumantou Berela Tebezana Kokouna Babilena Sedougou N'tjila Sido Solo N'Tingolé Farabougou Dendiala Weyala Bougouni Boundio Niasana Soroni M'Piéna Moyala

Annex 2: List of Selected Villages for the VSLAs Activities

AIRES DE VILLAGES AIRES DE VILLAGES SANTE SANTE Zantiébougou Falaba Bandierso Bandiersso Boundjonidjouka Ngolo Diassa Bougoula Demdelela Zantogola Bagayogo Mamissa Finkolo/AC Koumantou Berela N'Kourala Tiérouala Tebezana N'Golopèrèbougou Kokouna M'Pèdougou Babilena Gniriwani Sedougou N'tjila Tiérouala Sido Solo FAMA Siramana N'Tingolé Naniassoni Farabougou Kouroumasso Dendiala DALLE N'Galamanigobougou Weyala KOLOKOBA Nampilyidougou Bougouni Boundio Pimperna Kodialanida Niasana Zerbala Soroni Diassadéni M'Piéna Wayéré Moyala Kapala Sanasso