Improving Malaria Care Burkina Faso AID‐624‐A‐13‐00010

th Demonstration of proper use of LLIN during the 201S Malaria Day Celebration, May 9 2015

Quarter 3 Report /Project Year 2 Period of Performance: April – June 2015

Submitted July 31st 2015

Table of Content Acronym List ...... 3 1. Summary ...... 5 2. Key Achievements ...... 7 2.1 Strategy 1: Advocacy, Policy Change and Dissemination ...... 7 2.2 Strategy 2: Capacity Building ...... 7 2.3 Strategy 3 : Supportive Supervision ...... 11 2.4 Strategy 4: Performance and Quality Improvement ...... 11 2.5 Strategy 5: Behavior Change Communication ...... 15 3. Other Achievements ...... 18 4 Planned Activities for the Next Quarter (July to September, 2015), by Strategy...... 21 5. Challenges ...... 22 Annex 1: ...... 24 Annex 2: Implementation of Third quarter Activities for Year 2 of the IMC Project ...... 26 Annex 3: 104 CSPS selected in consultation with the Regional Health Directorates for BCC activities ...... 30 Annex 4: Fiche de Pre‐test des Job Aides (Affiche) ...... 32 Annex 5 : Suivi des ateliers de plaidoyer régionaux, questionnaire à l'intention des leaders: gouverneurs, Hauts commissaires, maires, chefs coutumiers, religieux : ...... 33

Acronym List ACT : Artemisinin‐based Combination Therapy ASBC : Community Health Agent BCC : Behavior Change Communication BF1 : Burkina Faso 1 (Television Channel) CAMEG : Central Medical Stores CCM : Country Coordinating Mechanism CHW : Community Health Worker CHU : University Hospital CHW : Community Health Workers CISSE : Centre d’Information Sanitaire et Surveillance Epidemiologique (Center for Health Information and Surveillance) DES : Directorate of MOH in charge of Health infrastructures DGESS : Direction Générale des Etudes et Statistiques Sectorielles DGS : Direction Générale de la Sante DHMT : District Health Management Team DLM : Direction de la Lutte contre la Maladie DPS : Direction de la Promotion de la Santé (Directorate of Health Promotion) DQA : Data Quality Audit DRS : Direction Régionale de la Santé DSF : Direction de la Santé de la Famille (Directorate of Family Health) DMO : District Medical Officer (MCD in French) ECD/DHMT : Equipe Cadre de District /District Health Management Team ENDOS : Entrepos des Donnees Sanitaire (Health Management Information System) ENSP : Ecole Nationale de la Sante Publique (National Public Health School) GF/GFATM : Global Fund for AIDS, TB and Malaria HMIS : Health management information system IEC : Information Education Communication IMC : Improving Malaria Care IMTP : Integrated Malaria Training Package IPC : Interpersonal Communication IPTp (IPT‐SP) : Intermittent preventive treatment in pregnancy IRS : Indoor Residual Spray JEMS : Jhpiego Enterprise Management System JHU : Johns Hopkins University LLIN : Long Lasting Insecticide‐treated Net LNSP : National Public Health Laboratory MER : Monitoring Evaluation and Research MIP : Malaria in Pregnancy MOH : Ministry of Health MOP : Malaria Operational Plan NMCP : National Malaria Control Program NMSC : National Malaria Steering Committee NMSP : National Malaria Strategic Plan PADS : Programme d’Appui au Développement Sanitaire (Program for Health Development) PAMAC : Programme d’Appui au Monde Associatif et Communautaire 3

PIC : Plan Intégré de Communication PMI : President Malaria Initiative PPIUD : Postpartum Intrauterin Device PQI : Performance and Quality Improvement PROMACO : Programme de Marketing Social et de Communication pour la Santé (an Affiliate of PSI, Population Services International) RMA : Rapport Mensuel d’Activites (Monthly activity report) QA : Quality Assurance RBM : Roll Back Malaria SMC : Seasonal Malaria Chemoprevention SNIS : National Health Information System SP : Sufadoxine Pyrimethamine SPIH : Service de Planification et d’Information Hospitalière RDT : Rapid Diagnostic Test ToT : Training of Trainers TRaC : Tracking Results Continuously USAID : United States Agency for International Development

1. Summary

The Improving Malaria Care Project – Burkina Faso was awarded 8 October 2013. This five‐ year project is funded by the United States Agency for International Development (USAID) and is implemented by Jhpiego in collaboration with its partner PROMACO. The goal of this project is to contribute to reducing malaria morbidity and mortality in Burkina Faso by 50% by 2015. At the end of five years, IMC will contribute to improving the quality of prevention, diagnosis and treatment of malaria in 100% of public health facilities.

The intermediate results of the IMC project are:

I) Improved malaria prevention with the proper use of Long‐Lasting Insecticide‐Treated Nets (LLIN) and the systematization of intermittent preventive treatment in pregnancy (IPTp). II) Improved management of malaria through diagnostic confirmation and appropriate case management III) Improved capacity of the National Malaria Control Program (NMCP) to plan, design, manage and coordinate a comprehensive malaria control program

This report covers the period from April to June 2015. Key activities included:

1. Supporting the organization of technical working group meetings, including planning, development of the scope of work and report preparation. In this quarter, the Planning, Monitoring & Evaluation and Research Working Group convened. 2. Completed training of 525 providers in 15 health districts on new malaria case management guidelines; 3. Perfectum Afrique, experts in management training, conducted a capacity building workshop for NMCP staff. 4. Implementing the malaria data quality improvement plan through the orientation of 89 data managers on the revised malaria data collection and reporting tools; 5. Beginning the integration process of the malaria database (BD‐Malaria) to the national health information database (Endos) ; 6. Supporting the organization of World Malaria Day activities; 7. Initiating the implementation of performance and quality improvement activities through the adaptation of performance standards for malaria prevention and treatment with stakeholders; 8. Preparations for the national malariology course in Bobo‐Dioulasso with a workshop chaired by the Course Director, the development of the roadmap, the establishment of a monitoring committee, and several meetings among the four key partners (WHO, Jhpiego, NMCP, INSA); 9. Pre‐testing of revised Job Aids on Malaria diagnosis and case management, Directly observed SP administration for IPTp, uncomplicated and severe malaria case management protocols, and proper use of LLINs in 2 health regions. 10. With technical support from Jhpiego headquarters staff, conducted an analysis of strengths, weaknesses, opportunities and threats in malaria programming and developed a strategic action plan for strengthening the implementation of the IMC project (funded by Jhpiego, not project funds); 5

11. With support from Jhpiego headquarters staff, conducted a technical and programmatic review, as well as internal controls review (financial, materials and human resources), of the Burkina Faso office function and projects management (funded by Jhpiego, not project funds);

The last quarter of the year will be devoted to:  Convening a national MIP stakeholder’s meeting to discuss the WHO updated guidance on early initiation of IPTp  Support meetings of the malaria technical working groups;  Organize monitoring of the use of RDTs at the community level;  Continue implementation of performance and quality improvement activities in the three health regions ;  Post‐training supervision for providers ;  Continue integration of the malaria database (BD‐Malaria) into the national health database (Endos) ;  The national malariology course in Bobo‐Dioulasso will be completed;  Continue BCC activities implementation: duplicate and disseminate job aids, broadcast radio and TV spot on malaria prevention, group discussion at community level  Develop the IMC Year 3 Workplan, pending availability of the revised Malaria Operational Plan;

2. Key Achievements

During the third quarter of Year 2, the following activities were completed, by strategy: 2.1 Strategy 1: Advocacy, Policy Change and Dissemination

The Planning, Monitoring & Evaluation and Research Working Group of the Malaria Steering Committee held a meeting in this quarter. The table below shows discussion points, action items and focal point for follow‐up.

Table 1: Discussion points for the committee on planning, monitoring and evaluation meeting Technical Meeting Discussion Points Action Items Responsible Committee Date 1. Presentation on the decree Transmit comments and points to pertaining to the creation and integrate the coordination of the Participants function of Steering Committee NMCP for consideration in the next and technical committees. modification of the decree. 2. Presentation on the budgeted Exchange with partners to confirm action plan for 2015 for availability of funds to finance Planning, monitoring, evaluation and planned activities in the plan. Monitoring, April 24, research for the NMCP. Evaluation and 2015 NMCP 3. Organization of malaria Write the report and share with Research Monitoring research results dissemination participants. Contact the President and Evaluation days in Burkina Faso. of the Committee to designate the Unit persons who will be in the 7 person scientific committee. Establish the organization committee for results and research dissemination days.

2.2 Strategy 2: Capacity Building

Concerning capacity building, the following activities were carried out in the 3rd quarter.

2.2.1 Partnership with Perfectum Afrique to build NMCP capacity Perfectum initiated its activities with the organization of a workshop for capacity building with all staff of the NMCP from 27 April‐1 May, 2015. This five‐day workshop was followed by an evaluation by each staff. The results of this workshop evaluation will allow Perfectum to complete the first report and to formulate recommendations, which, when implemented, will strengthen the management capacity of the NMCP. Next steps with Perfectum are: ‐ Development of ROD (Results Oriented Document) for each individual in NMCP ‐ Development of RNA (Results Negotiated Agreement) ‐ Development of ROAD (Results Oriented Assessment Documents) ‐ Methodological guidance of NMCP staff for development of a strategic plan

2.2.2 Provider Training on the Integrated Malaria Training Package (IMTP) In this quarter, trainings were completed for 575 providers (184 women) from 15 of the 17 target districts for this project year (see Figure 1 and Table 2 below). Training sessions were 7

led by district trainers with the support of a DRS‐level trainer and a central‐level trainer. 79% of providers trained work in CSPS (n=453), 15% at CMA (n=88), and 3% each from CM and Dispensaries (n=18 and 16 respectively). The distribution of providers by cadre is presented in Table 3 below. These trainings combined theoretical and practical aspects of prevention and case management of malaria.

Table 2: Distribution of providers trained by cadre and sex Cadre Sex Total F M AA‐ Accoucheuse Auxiliaire (Auxilliary Midwife) 53 3 56 AB‐ Accoucheuse Breveté (Certified Midwife) 4 0 4 AIS‐ Agent Itinérant de Sante (Outreach Health Agent) 4 5 9 AS‐ Agent de Sante (Health Agent) 2 10 12 IB‐ Infermière Breveté (Certified Nurse) 37 98 135 IDE‐ Infermiere Diplôme d’Etat (Registered Nurse) 49 238 287 MD‐ Médecin (Doctor) 2 9 11 ME‐ Maïeuticien d’Etat (Male Registered Midwife) 0 26 26 Pharmacien (Pharmacist) 0 1 1 SFE‐ Sage Femme d’Etat (Registered Midwife 33 1 34 Total 184 391 575

IMC has completed training for a total of 625 providers this project year, exceeding the initial target to 600 for the year. While the target has been exceeded…. some districts have not been reached by training such as: the 5 Five urban districts of Ouagadougou, 3 urban districts of Bobo Dioulasso, Koudougou Health District, Ziniaré Health District, Boromo Health District, Kombissiri Health District, Manga Health District.

Map 1: Cartography of districts with trained health providers in 2014 and 2015 by IMC project and other partners 8

Graphic 1: % of people with fever who are tested for malaria in the 38 supported Health Districts

Graphic:2: % of people with confirmed malaria and (3) % of providers trained on new malaria guidelines

Graphic‐3 % of pregnant women who received LLITNs during ANC

Preparation workshop for the National Malariology Workshop in Bobo‐Dioulasso A preparation workshop for the Advanced Malariology Course in Bobo was held from 1‐5 June 2015. This workshop brought together 20 resource people from the central departments of MOH, training and research centers, the NMCP, WHO and Jhpiego, and was chaired by Professor Guiguemdé who will lead the course. This meeting allowed participants to finalize the content of the course, the profile of participants (malaria program mangers) and a roadmap. This course will occur during the period of September 14th to October 23rd. The development of a budget outline and the establishment of a monitoring committee were also products of this workshop. The following modules were selected for the first course in malariology: 1) Introduction to the course 2) Basics of Malaria 3) Malaria Epidemiology and Surveillance 4) The Entomology of Malaria and Vector Control 5) Diagnosis, Treatment and Prevention 6) Communication, Social Mobilization and Advocacy 7) Monitoring, Evaluation and Research 8) Planning for Malaria Control

2.2.4 Orientation of data managers on the revised collection and reporting tools for malaria data After the workshop to revise the malaria data collection and reporting tools held from 20 March to 3 April 2015 in Koudougou, chaired by the Directorate General of Health, three orientation workshops for data managers from the DRS, the CHR, the CHU and the health districts were conducted in Bobo‐Dioulasso, Ouagadougou and Tenkodogo. A total of 89 data managers — 63 district data managers (CISSE), 13 regional data managers, and 13 from Hospital Planning and Information Unit (SPIH)) – were oriented on the revised monthly malaria data collection and reporting tools. During these trainings, the guide for filling the monthly malaria report was presented. New indicators, such as “number of suspected cases of malaria”, “number of pregnant women who receive IPT3”, “number of pregnant women who receive IPT4”, and “number of pregnant women who receive IPT5”were explained to managers so that they could explain to providers.

2.2.5 Integration of the malaria database (BD‐Malaria) into the national health data systems (Endos)

In order to have more reliable data from a national source and to reduce the workload for providers and data managers, IMC suggested after the results of the DQA to support the PNLP and the DGESS to integrate the data from BD‐Malaria into national HMIS (Endos). A second meeting held May 19th between the NMCP, the DGESS/DSS and Jhpiego confirmed the steps in the process, which include, i) the identification and validation of a comprehensive list of indicators related to malaria that will be integrated in the Endos database, ii) the definition of these indicators, iii) the revision of the monthly report form (RMA) to integrate the malaria data, and iv) the development of an implementation plan for the use of the new Endos database with the new malaria data. IMC will continue to provide technical and financial assistance to NMCP and DGESS to complete the integration of malaria indicators into the national HMIS database (ENDOS).

2.3 Strategy 3: Supportive Supervision

During this period, priority was given to training sessions for providers in the health districts. Supervision of providers will be conducted in the next quarter (July‐September 2015).

2.4 Strategy 4: Performance and Quality Improvement

2.4.1 Development of performance and quality standards for prevention and treatment of malaria according to the updated malaria guidelines. IMC proposed to address performance and quality improvement for prevention and treatment interventions for malaria using Jhpiego’s Standards‐Based Management and Recognition (SBM‐R) approach. This process will give NMCP and DHMT and the Ministry of Health a tool to monitor and evaluate the quality of services of malaria control both in the public health facilities and in communities. This approach can be tailored to each service delivery level.

IMC and NMCP, jointly with the Health Facilities Directorate (This Directorate is in charge of the MoH Quality Improvement Process) adapted performance standards to the new malaria prevention and treatment guidelines in Burkina Faso. The initial draft was based on experience implementing SBM‐R for malaria services in other countries. Twenty people from the NMCP (3), DSF (1), DPS (1), DGESS (1), DES (1), ENSP (1), Regional Supervisors (2), District Supervisors (2), Providers (4) and IMC (4) attended this five‐day workshop (4‐8 May 2015). The final document with performance and quality standards developed during this workshop is divided into six areas with 32 performance standards and 216 verification criteria, shown in Table 4 below.

Table 3: Six performance and quality improvement areas were identified during the PQI workshop in May 2015 No Areas Number of Number of performance verification standards criteria 1. Organization of Services 04 31 2. Malaria Case Management 08 62 3. IPT in Pregnant Women 06 33 4. Promotion and Use of LLIN 03 13 5. Community Case Management of Malaria 07 51 6. Infection Prevention 04 26 Total 32 216

Table 4: An example of RDT practice standard

Notation Standard de performance Critères de vérification Commentaires O N N/A Vérifier si le prestataire : 1 Effectue le TDR si le client présente une fièvre ou ATCD de corps chaud 2 Explique la procédure d’utilisation du TDR au client et obtient son autorisation avant de réaliser le test

3 Rassemble tous les éléments du kit selon le contenu et les instructions du fabricant et vérifie que :  le TDR n’est pas périmé  les emballages ne sont pas endommagés  le dessicant a conservé sa couleur blanche

4 Se lave les mains et porte les gants Ecrit la date et le nom ou le code du client sur la 5 cassette 6 Ouvre la lancette sans toucher ni souiller l’aiguille

Le prestataire réalise le test de diagnostic rapide Prend le troisième doigt de la main gauche du du paludisme chez le client 7 client préalablement nettoyé et séché à l’air libre, présentant une fièvre ou et pique pour obtenir une goutte de sang ATCD de corps chaud.

Recueille la goutte de sang avec l’anse de 8 prélèvement et la met dans le trou approprie

Applique le nombre adéquat de gouttes de diluant 9 selon les instructions du fabricant

Trie les déchets en:  mettant la lancette dans le container à aiguilles  mettant les gants, le tampon et l’anse de 10 prélèvement dans la poubelle jaune  conservant la cassette dans un container approprié  mettant le reste des déchets dans la poubelle noire

2.4.2 Workshops to Launch SBM‐R : Improved Performance and Quality of Services in Malaria Prevention and Case Management Following the development of performance and quality standards, Jhpiego collaborated with the DES, the Directorate responsible for the quality of services within the MOH, to launch the SBM‐R approach in three regions: Centre South Region (23 to 27 June), South‐West Region (29 June to 3 July) and Cascades Region (29 June to 3 July). The first workshop was conducted with the support of regional STTA provided by Dr John Agbodjavou, Jhpiego Regional Advisor, who specializes in SBM‐R and in malaria. The other two workshops were then held concurrently. A total of 105 participants from regional and district management teams along with providers from 26 facilities were trained in the SBM‐R approach (see Table 5 below).

The objectives and the results of these workshops were as follows: 1. Introduce the process and principles for implementation of SBM‐R 2. Initiate use of the performance standards and monitoring tools in the hospitals and health centers, including:  Initial measurement of the health facility’s performance  How to fill out the summary form  Calculation of the SBM‐R the score (a percentage)  Identification of rapid interventions that can be implementing in the near term to address gaps in performance  How SBM‐R can be used for self‐assessment within the facility.

Region District Health Center participants Centre South (Manga 4 (Kombissiri, Manga, 8 36 Po et Saponé) South West Gaoua) 5 ( Batie, Dano, 11 44 Diebougou, Gaoua et Kampti) Cascades (Banfora) 3 Banfora, Mangodara 7 25 et Sindou 3 12 26 105 Table 5: Participants to the SBM‐R process initiation

2.5 Strategy 5: Behavior Change Communication

2.5.1. Community Engagement Activities

Following advocacy workshops held in each region in 2014, IMC has supported NMCP to implement community BCC activities on malaria prevention and control. 208 community health workers (CHW, ASBC in French) working with 104 CSPS were selected to strengthen local communications to increase malaria prevention and health service utilization. (See Annex 3 for details on the selected CSPS). The community interventions are focused on four regions of Burkina Faso: Center (Ouagadougou), the Center West (Koudougou), Hauts Bassins (Bobo‐Dioulasso) and South West (Gaoua). The choice of these regions is based on the availability of PROMACO field workers who provide the follow up.

55 group discussions were held bringing together 556 community leaders, including 66 women. The objective of these group discussions is to improve the involvement of the community leaders to support malaria control interventions.

During these information and advocacy meetings for the implementation of outreach activities, the population learned:  The current malaria situation in the health region of their CSPS.  The context and justification of the meeting.  The package of activities that the ASBCs will conduct (home visits, accompany pregnant women to pre‐natal consultations, educational talks and film projection, etc…)

Supportive supervision visits were also conducted to support the advocacy workshop implementation at the CSPS level. A team comprised of IMC project staff and the NMCP were able to follow the progress of 10 of the 55 workshops. During these visits, the team was able to help correct misperceptions related to malaria. Village leaders committed to support the CHWs in their outreach activities.

« We are very happy to have this project initiative which consists of meeting with us to talk to us about malaria.Nous sommes vraiment contents de cette initiative du projet qui consiste à nous rencontrer pour nous parler du paludisme. I was not aware of the gateways for malaria into children less than 5 years. For example, I did not consider “warm body” of my children as the beginning of malaria. It was once they were vomiting and losing consciousness that we were running around. This meeting was very beneficial to me and I thank IMC and USAID. Both ASBCs that are there are ours and we are going to join hands to work on awareness. After this meeting, I can say that the project bodes well for a good beginning and I ask God to accompany us as everything is in his hands.

Kaboré Yamba Saïdou, Responsible for youth in Boulom Nahiri, after the advocacy meeting in his village on May 21, 2015.

Participants from the advocacy workshop in Sourgou, in the Participants in the advocacy workshop held at the CSPS Bouloum Koudougou health region on 20 May 2015 Nahiri, in Koudougou on 21 May, 2015

2.5.2. Pre‐test of communication materials

Following the first pretest for IEC / BCC tools that took place during the second quarter (from 18 to 20 February 2015) in three health facilities in Ouagadougou, it was decided to test the tools in other health districts in Burkina. Thus, from 16 to 19 June 2015, a joint team comprised of representatives from the DSF, the NMCP, and Promaco visited the Hauts‐Bassins and Sahel regions. The pre‐test concerned 12 health facilities (6 in the Hauts Bassins and 6 in the Sahel). In each facility, a group of 2 to 10 providers were given a questionnaire. The results of the second pretest provided useful additional feedback for the revision and finalization of the tools

2.5.3. Radio and Television Broadcasts of Malaria Messages fter taking into account the results of the pretest, broadcasting agreements were signed with public and private television and radio channels. In May and June, 820 communication spots were aired on 15 stations of which 3 were television (see Table 6).

Table 6: Distribution of malaria and prevention and treatment communication spots, May‐June 2015 Number of Zone Type of Media spots aired Television National Territory National 65 Ouagadoudou BF1 25 Ouagadoudou SMTV 25 Radio National Territory National 130 Savane FM 65 Ouagadoudou Ouaga FM 60 Salankoloto 50 Koudougou Palabre 50 Sabou Pengdwende 50 Réo la Voix du Sanguié 50 Marché Central Bobo 100 Bobo Dioulasso OMEGA FM 50 Gaoua RTB2 50 Dano Dano 50 Total 820 Source : Promaco 2015

2.5.4. Monitoring of commitments made at the regional advocacy workshops

From 27‐30 April, 2015, a joint team of PROMACO and PNLP staff were in Koudougou to monitor the implementation of commitments made at the regional advocacy workshop held on 12 february 2015. This group was able to meet individually with targeted leaders including: the Governor of the Central West region, the High Commissioner of the province of Boulkiemdé, an official of the Protestant Community, an official of the Muslim community and a Traditional Leader.

The objective was to collect data on the effects of regional advocacy workshops using a questionnaire developed by IMC Staff (See Annex 6). The team noted that: All leaders confirmed the existence of meetings. They all also said that the issue of malaria was raised during their last meeting. To the question: “Have you taken concrete action against malaria as a result of the advocacy workshops?” We noted the following:

"Our role after the Koudougou advocacy workshop was to bring the information on malaria to our mosques. To do this, we did a tour of the villages upon the renewal of the mandates of the managers of our structures. We realized that in our remote countryside, malaria is still misunderstood. Children are dying of malaria and the communities think it is God who acts to punish because of disobedience to his will. There are even imams who refuse to talk about awareness in mosques. For them, the mosques are made only for prayer. But we are trying to correct this." Mr. Sinare, representing the Muslim community.

"From the first week of May 2015, we will send encouraging to all our pastors so they speak of malaria while preaching in the churches." The representative of the Protestant community.

Furthermore, the High Commissioner said he participated in ceremonies during which he urged the public to protect themselves against malaria.

The representative of the traditional chiefs from Godhin said he organized a day of malaria awareness in Koudougou. Over 60 notable invitees were present. The DRS was also represented with about thirty participants.

3. Other Achievements

3.1 Participation in World Malaria Day Activities in Zorgho

Burkina Faso celebrated World Malaria Day on 9 May, 2015 in Zorgho. This celebration was done conjointly with the World Health and Tuberculosis Control Day. The malaria theme was: "Invest in the future, defeat malaria." The ceremony was chaired by the Minister of Health and included the Resident Representative of WHO in Burkina Faso, USAID Director in Burkina Faso.

The day before the official celebration was marked by a session with the Zorgho general public. It was organized by the NMCP, with technical support and financing of IMC project. This meeting brought together hundreds of participants to share malaria awareness messages including: malaria prevention during pregnancy, appropriate use of LLINs malaria diagnosis and treatment using RDT, early consultation in case of fever c. This was done using games, question and answer forums and theater.

3.2 Malaria Strategic Planning Visit from Jhpiego Headquarters

Jhpiego Burkina received a technical assistance team from Jhpiego Headquarters in Baltimore to conduct strategic planning for the IMC project in order to develop a local capacity building plan for Jhpiego to achieve project results and to contribute to reduce the burden of malaria in Burkina Faso. This was financed by Jhpiego. The objectives included:  Work with IMC team to review existing project efforts, gaps and new opportunities (e.g. SMC, community case management) and determine key steps and actions to move forward;

 Review M&E structure in place (Jhpiego and Ministry of Health) and determine the way forward to allow Jhpiego to monitor and visualize malaria trends with the most complete data available;  Determine technical assistance support required from the region or headquarters;  Develop a team matrix outlining roles and responsibilities moving forward for both in country and regional and/or headquarters staff.

A site visit to Saponé District and CSPS Kounda, along with meetings with NMCP, DPS and USAID helped to better appreciate the effects of the implementation of project activities of IMC.

A number of strategic actions were identified, and a process of prioritizing them is continuing.

th Strategic planning team met with Sapone District DHMT on May 13 2015

3.3 Program, Technical and Internal Controls Review of Jhpiego Burkina Faso office.

Also in late May and early June, teams from Jhpiego headquarters visited the Burkina office to conduct a review of program and technical quality, as well as internal controls for financial, material and human resources management. These reviews are based on performance standards much like the standards we promote in our projects (See Strategy 4 above). The findings will help the country office to improve their operational performance as well as ensure appropriate support from Jhpiego Headquarters.

3.4 Monthly Meetings with USAID

In June, the IMC project team and USAID decided to hold monthly update meetings, which take place the last Tuesday of each month. During this quarter, the meeting took place on June 23, 2015. During this meeting, USAID staff presented the Measure Evaluation team to IMC who are preparing monitoring and evaluation for malaria. USAID reiterated the importance of the need to support national players in their participation of this monitoring and evaluation. Key discussions points include:  USAID holds the Vice‐Presidence of the CCM and would like for Jhpiego to participate in CCM meetings.  USAID also provides an assistance role for the TFP (Technical and Financial Partners) whose leader is UNICEF and would like Jhpiego to attend meetings.  The next MOP visit will be in January 2015 and Jhpiego was invited to identify sites for the PMI team to visit (Saponé and Koudougou were chosen)  USAID would like to see a cartographic representation of the support of malaria activities among IMC and other donors. An initial effort at this is presented above for the IMC supported districts and work is continuing to refine the use of a map for showing what is going on in each district.  Jhpiego needs to further reflect on Infection Prevention and Control (IPC) trainings in the context of Ebola and other infectious diseases (Meningitis, hemorrhagic fever, flu and cholera) which USAID will have Jhpiego manage with additional funds through the IMC project. Jhpiego should anticipate reviewing the IPC training modules and describe the national needs in terms of treatment sites and isolation of cases. During the week of July 20, someone from CDC will visit Burkina for this purpose and a meeting will take place with the DLM, which Jhpiego will attend.  The dates of IMC activity implementation and the PQI training were sent to USAID which asked that training and other field activities be sent to them for potential participation based on their availability.

3.5 Participation in the National Committee on Ebola Virus Disease (EVD) Control meetings. Given the persistence of EVD in West Africa, monitoring remains essential and malaria control activities are carried out in the context of preparedness and response to the outbreak of EVD. IMC staff are involved in technical commissions of the National EVD Response Committee and have participated in many preparatory meetings for a national response to a potential EVD outbreak.

4 Planned Activities for the Next Quarter (July to September, 2015), by Strategy.

Strategy 1: Advocacy, Policy Change and Dissemination  Support the organization of malaria steering committee meeting.  Support the technical groups to organize quarterly meetings.  Support the NMCP to organize periodic partner meetings.  Organize a national MIP stakeholders meeting to discuss the WHO updated guidance on early initiation of IPTp.  Promote and advocate for continuous availability, and improved distribution, of malaria control commodities: LLINs for routine distribution (pregnant women and children), RDTs, ACT, SP, artesunate injectable or injectable arthemeter for the treatment of severe malaria.  Support the NMCP to adapt the pilot experience of the response plan to the high transmission season of malaria (preparation of hospitals for better case management of severe malaria during high transmission season).  Advocate for better use of epidemiologic surveillance of malaria for decision making.  Support the Centre Muraz to complete the study on the effectiveness of ACT and the entomological surveillance of Indoor Residual Spraying.  Support a field visit of the NMCP and the DPS to review the use of RDTs at the community level, and to collect and document lessons learned to better define the roles and responsibilities of CHWs for the diagnosis and treatment of malaria. Provide technical support to NMCP and its partners in the publication of the quarterly journal, Palu Info.

Strategy 2: Capacity Building  Ensure that there are orientation meetings with providers and their trainer colleagues on new malaria guidelines.  Support the NMCP for data validation of malaria at the district level.  Support the NMCP to develop an integrated database which will include BD‐Malaria in the Endos Database software.  Support the NMCP to implement an integrated data quality improvement plan taking into account the results and recommendations from the data quality audit.

Strategy 3: Supportive Supervision  Strengthen integrated supportive supervision of providers by district and regional management teams.  Provide technical support to the NMCP in organizing field visits to strengthen supervision of malaria control activities and share recommendations for integrated supervision.

Strategy 4: Quality and Performance Improvement  Continue the implementation of SBM‐R in three (3) regions.  Conduct an evaluation on the quality and management of malaria cases using WHO tools and guidelines.

Strategy 5: Behavior Change Communication  Reproduce and disseminate communication tools  Conduct an audience study for mass media campaigns (measurement of the level of listening, the understanding of messages and overall audience appreciation of broadcasts).  Develop and publish malaria prevention messages in newspapers  Continue to organize village workshops for advocacy for implementation of community activities.  Complete outreach activities (ASCB and OBC)  Monitor program activities

Other activities for the coming quarter

Complete planning for the IPC training and support to be funded through the IMC Cooperative Agreement Following the request from USAID, Jhpiego will provide training in infection prevention and control (IPC) through the IMC project.

Develop the Year 3 Workplan for IMC The development of the Year 3 workplan for IMC will happen in the next quarter in partnership with the Ministry of Health and USAID. IMC is awaiting the revised MOP to be able to start work planning.

5. Challenges

5.1 Need for additional training of health care providers Despite the reach of IMC to date, and MCHIP before it, there are many healthcare providers that have not received training on malaria management, particularly the latest guidelines. For instance UNICEF, Italian Cooperation and PADS were supposed to cover the remaining district’s providers. Unfortunately, some districts have not been reached by training such as: The 5 Five urban districts of Ouagadougou, 3 urban districts of Bobo Dioulasso, Koudougou Health District, Ziniaré Health District, Boromo Health District, Kombissiri Health District, Manga Health District.

Another challenge lies in the strategy initiated by PMI to train one provider per facility. Since this is most often the Nurse‐in‐charge for the health center, the midwives and auxiliary midwives who provide ANC have only rarely been participants in the trainings. This may have an inadvertent negative affect on IPTp. IMC would like to suggest that once the IPTp guidelines are fully update to include the earlier initiation of IPTp at 13 weeks, which efforts should be devoted to updating ANC providers with a focus on ensuring their skills and confidence to estimate gestational age.

IMC continues to believe that attention is needed at the referral level to ensure that hospital level staff are adequately prepared to manage severe malaria. Hospitals are too often overwhelmed and under prepared to manage the influx of very sick patients during the high transmission leading to otherwise preventable deaths if treatment was better managed.

5.2 Availability of malaria control commodities

Despite the gains made by the commodities for malaria control management monitoring committee, there were stockouts of SP, ACT (for children under 5 years), LLINs, and RDTs in certain health districts. Pending the availability of resources from the Global Fund for the purchase of LLINs, the country is currently facing national stockouts of LLINs for routine distribution at ANC. As mentioned above in Section 4.1, IMC will work to promote and advocate for continuous availability of malaria control commodities as well as provide information from field visits to inform further improvements in monitoring and forecasting particularly for the free products.

5.3 Administrative Delays with USAID

IMC had to slow down activities in April after notifying USAID that remaining funding was limited and requesting a modification to receive Year 2 funding. The new funding was received on April 30th, following extensive follow‐up to receive a response.

5.4 The sociopolitical situation causing many changes in officials. The current situation of political transition in Burkina has been marked by changes among government officials. A number of MoH positions have changed hands, including the NMCP Coordinator, the Director General and the Secretary General. Another change which affects health activitiy is the removal of Arrondissement level mayors, whose budgets were previously intended to support community health activities. Elections scheduled for the coming quarter are expected to cause a slowdown in activities and particularly travel for IMC staff.

ANNEX 1: PROGRESS ON PERFORMANCE INDICATORS

Actual Year 2 (Oct 14 – Sept 15) Rate (%) Year 1 Cumulative of Q4 total Indicators Q1 Q2 Q3 Cumulative results (Jul -Sept Global (Oct - Dec 14) (Jan - Mar 15) (Apr.-Jun15) Total (Y1 +Y2) 15) Target Advocacy, policy change and dissemination Number of policies or directives 00 00 00 00 02 02 N/A developed or updated Number of job aids, IEC, data 08 00 00 08 management, training materials, other 00 08 N/A tools developed Capacity development Number of trainers trained 68 00 60 00 60 128 N/A Number of healthcare providers 939 00 50 525 575 1,514 56.9% trained Number of data mangers trained 58 00 00 00 00 58 69.9% Number CBOs engaged in project 00 00 00 00 00 00 00.0% activities Number of providers receiving mobile mentoring (mMentoring) by SMS or 00 00 00 00 00 00 N/A voice Integrated supportive supervision % of planned integrated supervision 65% 90% 90% 90% 80% 90% 94.7% conducted % of malaria-specific supervision 65% 90% 90% 90% 80% 90% 94.7% visits conducted by NMCP Performance and Quality Improvement

Number of facilities implementing PQI, 00 00 00 26 26 26 49.1% % of facilities achieving 80% of 00 00 00 00 00 00 00.0% established PQI standards Behavior Change Communication Number of behavior change communication (BCC) print materials 00 00 00 00 00 00 N/A distributed/posted Number of radio and TV spots aired 00 00 02 820 822 822 N/A Percentage of target audience who agree with statements pertaining to ND ND ND ND ND 00 NA key communications messages Percentage of target audience who know the cause of, symptoms of, ND ND ND ND ND 00 NA treatment for preventive measures for malaria Number of contacts made with people through project-supported IPC or 332 00 173 556 729 1061 N/A community sessions

Annex 2: Implementation of Third quarter Activities for Year 2 of the IMC Project Status Activity / Task In Comment Completed Postponed Process Advocacy, Policy Change and Dissemination 1. Support for the multi sectorial Malaria X Steering Committee semi‐annual meetings. 2. Support quarterly Technical Working Group X meetings 3. Support NMCP to organize regular malaria X program meetings with partners and donors 4. Advocate for Prevention and Case X management working group to address MIP 5. Update IPTp directives and training materials X and support dissemination 6. Support collaboration between NMCP and DSF and DPS to maintain up to date malaria component of integrated CHW package, x including job‐aids, supervisory support and HMIS reporting 7. Promote and advocate to NMCP and malaria partners for availability of key commodities: LLINs for top‐up at ANC and primary health X services for children; SP at ANC; RDTs and ACTs at all points of care; and arthemeter or artesunate for treatment of severe malaria. 8. Advocacy with DHMTs, FHMTs to make clean water available at facilities for IPTp directly X observed treatment (DOT) 9. Support NMCP to adapt and pilot malaria response plan guidance (preparedness of x hospitals to manage severe malaria during high transmission season) 10. Advocacy with PADS, DRS and NMCP for increased time and resources dedicated to X integrated supervision 11. Advocate for access to and use of epidemiological surveillance data for X monitoring and decision‐making 12. Promote collaboration with malaria research centers for information sharing and X harmonization of activities 13. Support the conduct of an ACT efficacy study MOU has been X by Centre Muraz signed 14. Support a field visit by NMCP and DPS staff to X the pilot sites for CHW use of RDTs to gather 26

Status Activity / Task In Comment Completed Postponed Process lessons learned in order to better inform the development of the CHW profile and their responsibilities related to malaria diagnosis and treatment 15. Support for publication of NMCP quarterly X newsletter (Palu Info)

Capacity Building

1. Update approximately 60 trainers/supervisors X in remaining regions/districts on IMTP 2. Train 600 providers on integrated malaria 50 providers training package, in remaining districts from 2 Health X Districts were trained 3. Support staff to staff orientation based on X IMTP training 4. Conduct orientation sessions on the updated malaria directives for at least 650 health care X providers 5. Promote use of mobile phone technology as a tool to mentor providers for correct X implementation of malaria protocols for prevention and treatment 6. Pre‐service education:

Update ENSP instructors on malaria protocols a. Site visits to follow‐up ETS and mentor X ENSP instructors and preceptors b. Conduct an assessment of the implementation of revised malaria X training curricula in order to inform future support to ENSP 7. NMCP capacity building: Support NMCP to develop and implement X capacity building plans for staff 8. Support NMCP and DGESS to reinforce M&E

quality at all levels a. Support NMCP to develop and implement malaria data quality improvement plan X based on the DQA findings and recommendations b. Support NMCP to develop the integrated database which will include BD Malaria in X ENDOS (national database) c. Support NMCP to conduct malaria data X validation at District level 27

Status Activity / Task In Comment Completed Postponed Process d. Promote mobile technology for data managers to support data recording and X reporting Supportive Supervision

1. Provide TA support to NMCP to organize and conduct site visits to reinforce malaria X supervision and inform recommendations for integrated supervision 2. Reinforce integrated supportive supervision of providers by district and regional management X teams Performance and Quality Improvement 1. Conduct a workshop to adapt performance standards for malaria prevention and X treatment to conform to national policy and directives. 2. Conduct workshops to introduce PQI process X in ten facilities and collect PQI baseline data a. Support NMCP to incorporate the PQI mechanism into its own program X monitoring to strengthen management and leadership b. Support monitoring of standards (links to supervision), address gaps in X implementation 3. Conduct assessment of malaria case X management using WHO protocol and tool Behavior for Change Communication

1. Finalize the baseline BCC report, including key recommendations for communications X channels and messages 2. Support the NMCP Communications Unit and MOH Communications Unit to prioritize communication channels to disseminate key messages, taking into account the recently X revised NMCP Communications Plan, and PMI guidance on BCC and findings from the baseline assessment 3. Update and disseminate job aids to reflect revised directives (e.g., CM, severe malaria, X IPTp, IPTi) for use by providers and CBO animators 4. Develop and disseminate BCC messages via X 28

Status Activity / Task In Comment Completed Postponed Process mass media 5. Develop and pretest TV, radio and print messages to promote bed net use and other X key messages 6. Broadcast TV and Radio spots X 7. Conduct an audience investigation of mass media (measurement of the listening level, X understanding and appreciation) 8. Engage with community based organizations for the conduct of interpersonal X communication activities 9. Develop scope of work and selection criteria for CBO partners in collaboration with NMCP X and DSF and DPS 10. Solicit applications from CBOs, review and X select 11. Train sub‐regional grantees (local CBOs) on BCC, malaria and project management to X conduct communications activities 12. Develop and disseminate BCC messages via X Inter personal communications 13. Organize villagers advocacy workshops X intended for community leaders 14. Conduct sensitization activities by community based organizations (CBO) including theater X forum, care groups, and others 15. Support updating of NMCP webpage on MOH X site

Annex 3: 104 CSPS selected in consultation with the Regional Health Directorates for BCC activities DRS Centre Ouest DRS Hauts Bassins Health District N° Name of the CSPS Health District N° Name of the CSPS 1 1‐ Palogo 1‐ KARANGUASSO 1 1‐ Poya 2 2‐ Niandiala VIGUE 2 2‐ Diosso 3 3‐ Poa 3 1‐ Lena 4 4‐ Godin W 2‐ LENA 4 2‐ Satiri 5 5‐ Bouloum Nayiri 5 3‐ Werou 1‐ KOUDOUGOU 6 6‐ Tanghin Wobdo 6 1‐ Legema 7 7‐ Sakoinsé 3‐ DAFRA 7 2‐ Secteur 24 8 8‐ Sourgou 8 3‐ Kouentou 9 9‐ Bingo 9 1‐ Dodougou 10 10‐ Thyou 10 2‐ Koumi 4‐ DO 11 1‐ Secteur 1 11 3‐ Kouakoualé 12 2‐ Kayero 12 4‐ Nasso

1‐ CSPS urbain de 13 3‐ Saadon 13 Houndé 2‐ LEO 14 4‐ Bourra 14 2‐ Dougoumato 2 5‐ HOUNDE 15 5‐ Koumbo 15 3‐ Founzan 16 6‐ To 16 4‐ Boueré 17 7‐ Tabou 17 5‐ Kari 18 1‐ Seguedin 18 1‐ Faramana 19 2‐ Soaw 19 2‐ Dangounani 3‐ NANORO 20 3‐ Kindi 20 3‐ Soungalodaga 6‐ DANDE 21 4‐ Sigle 21 4‐ Fo 22 1‐ Didyr 22 5‐ Koundougou 23 2‐ Kordie 23 6‐ Siankoro 24 3‐ Tita 24 1‐ Koloko 4‐ REO 25 4‐ Kyon 25 2‐ Kourinion 26 5‐ Tenado 26 3‐ Ndorola 27 6‐ Dassa 27 4‐ Kayan 7‐ ORODARA 28 7‐ Secteur 4 de Reo 28 5‐ Kangala 29 1‐ Tiaré 29 6‐ Kourouma 30 2‐ Basnéré 30 7‐ Samorogouan 5‐ SAPOUY 31 3‐ Sapo 31 8‐ Sindo 32 4‐ Nevry Total CSPS 31

Total CSPS 32

DRS Centre DRS Sud Ouest Health District N° Name of the CSPS Health District N° Name of the CSPS 1 1. CSPS de Polesgo 1 1‐ Batié Nord 2 2. CSPS de Sakoula 2 2‐ Kampti 3 3. SPS de Roumtenga 3 3‐ Djigoué 1‐ NOGR BASSAM 4 4. CSPS de Sogdin 1‐ GAOUA 4 4‐ Malba 5 5. CSPS de 25 5 5‐ Tonkar 6 6. CSPS de 26 6 6‐ Boulera 7 1. Bassinko 7 7‐ Obire 8 2. Bissiguin 8 1 bapla 9 3. Kamboinsin 9 2 ilonioro 2‐ DIEBOUGOU 10 4. Yagma 10 3 bondjigui 11 5. Markoussis 11 4 dankoble 12 6. Pazani 12 1 batié

13 7. Pabré 3‐ BATIE 13 2 legmoin 2‐ SIGNOGHIN 14 8. Sabtinga 14 3 midebdo 15 9. Nedogo 15 1 dano 16 10. Zouma 16 2 dissin 17 11. Gaskaye 17 3 babora 4‐ DANO 18 12. Goupana 18 4 memer 19 13. Kodemtoré 19 5 oronkua 20 14. Zibako 20 6 kolkol 21 15. CMI 21 Total CSPS 20 Total CSPS 21

Annex 4: Fiche de Pre‐test des Job Aides

1. CONTENU DE L’INFORMATION NON OUI EN OUI CRITERES DE REUSSITE PARTIE TOTALEMENT 0 1 2 Les informations sont scientifiquement exactes Le contenu est clair et cohérent L’affiche contient des informations pertinentes en rapport avec les directives nationales de prise en charge des cas la prise en charge du paludisme

Les illustrations sont en adéquation avec le contenu de l’affiche Le texte et l’image sont complémentaires Les logos des différents partenaires sont disposés convenablement

2. LISIBILITÉ DE L’AFFICHE

NON OUI EN OU CRITERES DE REUSSITE PARTIE I 0 1 2

L’affiche est visible à 3 mètres

La présentation est agréable : la mise en page est aérée, claire, équilibrée Le titre a une taille suffisante et est mis en valeur

Le sous-titre a une taille suffisante et est mis en valeur

Les textes ne sont pas trop longs

L’orthographe et la syntaxe sont correctes

Les couleurs utilisées sont attrayantes

NB : Si réponse 0 ou 1 : préciser les raisons

Annex 5 : Suivi des ateliers de plaidoyer régionaux, questionnaire à l'intention des leaders: gouverneurs, Hauts commissaires, maires, chefs coutumiers, religieux :

Année ; période / / T1 ; T2 ; T3 ; T4 Région :_

Province :

Commune de :

Type d’autorité : /_ / 1 gouverneur ; 2 haut‐commissaire ; 3=maire ; 4=Chef coutumier ; 5=autorité religieuse

1‐ Avez‐vous organisé des rencontres statutaires de votre structure / / 1=oui, 2=non Si oui, quel est l’intitulé de la rencontre A quelle date a‐t‐elle eu lieu la dernière rencontre Donner le public

2‐ . Quelle est la fréquence de tenue de ces rencontres /__/ 1 hebdomadaire ; 2 mensuelle ; 3 trimestriel 3‐ Au cours de ces rencontres abordez‐vous des thématiques sur la santé / / 1 oui ; 2 non

Si oui, quels sont les thématiques abordés / /1 VIH/SIDA ; 2 paludisme ; 3 MGF ; 4 PF ; 5violence faite aux femmes ;

4‐ A votre dernière rencontre avez‐vous abordé la thématique sur le paludisme / / 1 oui 2

5‐ Avez‐vous posé des actions dans le cadre de la lutte contre le paludisme / / 1 oui ; 2 non Si oui, Quelle action ? ______

6‐ Si non, quelle action concrète comptez‐vous entreprendre dans ce cadre

7‐ Avez‐vous participé à des cérémonies autres que les rencontres statutaire / / 1 oui ; 2 non

8‐ Si oui, quelle type de cérémonie s’agit‐il : / / 1 fête religieuse ; 2 fête traditionnelle ; autre à préciser ;

9‐ Avez‐vous profité de ces cérémonies pour parler du paludisme au cours de votre intervention / / 1 oui ; 2 non ;

Si oui, quel message avez‐vous fait passer:/ / 1 utilisation MILDA ; 2 CPN2 ; 3 TPI ; 4 consultation précoce ; 5 assainissement.

Financement des activités du paludisme par les collectivités locales : 33

Ce questionnaire veut savoir si les mairies allouent des budgets pour la lutte contre le paludisme

10‐ Existe‐t‐il un budget pour contribuer à la lutte contre le paludisme/ / 1 oui ; 2 non Si oui, quel est le montant / /

11‐ 11 quels sont les rubriques concernées / / 1 achat médicaments ; Achat de médicament ; 3 Sensibilisation ; 4 autres

12‐ Si non, que comptez‐vous faire