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Mayer Hashi-II Family Planning Project in Bangladesh

(MH-II) QUARTERLY REPORT

Reporting Period: October 1–December 31, 2017

Project Year 5, Quarter 1

Submitted to: Office of Population Health, Nutrition and Education United States Agency for International Development USAID/Dhaka

By MH-II Project

Associate Cooperative Agreement No. AID-388-LA-13-00002 Under Leader Award No. GPO-A-00-08-00007-00

Date of Submission January 31, 2018

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TABLE OF CONTENTS

Table of Contents 2 Acronyms 3 Executive Summary 5 1. Major program results and achievements 7 2. Challenges 13 3. Program management 14 4. Next steps 15 Annex 1. Activity description and achievements in Q1 16 Annex 2. Indicator Tracking Table: Target vs. Achievement for PY5 Q1 46

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ACRONYMS

ADCC Assistant Director, Clinical Contraception AFWO Assistant Family Welfare Officer AHI Assistant Health Inspector ANC Antenatal care AUFPO Assistant Upazilla Family Planning Officer BCO Bangladesh Country Office CC Community clinic CCSDP Clinical Contraceptive Services Delivery Program CHCP Community Health Care Provider CYP Couple-years of protection DDFP Deputy Director Family Planning DDM Data for Decision Making DG Director General DGFP Directorate General of Family Planning DGHS Directorate General of Health Services DHIS District Health Information System DQA Data Quality Assessment EPI Expanded Program on Immunization FP Family planning FPCS-QIT Family Planning Clinical Supervision-Quality Improvement Team FPI Family Planning Inspector FPO Family Planning Office FWA Family Welfare Assistant FWC Family Welfare Center FWV Family Welfare Visitor GOB Government of Bangladesh HI Health Inspector ICT Information communication technology ICV Informed consent and voluntarism iDQA Internal data quality assessment IEC Information, education, communication IPC Interpersonal communication IR Intermediate result IUD Intrauterine device KM Knowledge management LARC Long-acting reversible contraception LD Line Director M&E Monitoring and evaluation MaMoni HSS MaMoni Health Systems Strengthening Project

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MCH Maternal and child health MCWC Maternity and Child Welfare Center ME&R Monitoring, evaluation, and research MH-II Mayer Hashi II FP Project in Bangladesh MIS Management information system MO Medical Officer MOHFW Ministry of Health and Family Welfare MOU Memorandum of Understanding NGO Nongovernmental organization NSV No-scalpel vasectomy NXT Implanon NXT OGSB Obstetrics and Gynecological Society of Bangladesh OP Operational Plan PHC Primary health care PM Permanent method (of contraception) PNC Postnatal care PPFP Postpartum FP PSA Professional Services Agreement PY5 Project year 5 Q1 Quarter 1 QA Quality assurance QI Quality improvement QIC Quality Improvement Committees QIS Quality Improvement Secretariat RH Reproductive health RTC Regional Training Center SACMO Sub-Assistant Community Medical Officer SBCC Social and behavior change communication SMS Short messaging system SRHR Sexual and reproductive health and rights TA Technical assistance TOT Training of Trainers UFPO Upazilla Family Planning Officer UH&FPO Upazilla Health and Family Planning Officer UHC Upazilla Health Complex UNFPA United Nations Population Fund USAID United States Agency for International Development YPSA Young People in Social Action

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EXECUTIVE SUMMARY

The Mayer Hashi II Project (MH-II), the family planning (FP) project in Bangladesh, successfully completed its fourth year on September 30, 2017. MH-II was initially a four-year project from October 1, 2013—September 30, 2017 under a Leader with Associate Cooperative Agreement awarded by the United States Agency for International Development (USAID). USAID granted a one-year funded extension to MH-II (October 2017—September 2018) with a different strategic approach in specific, targeted geographic areas1 for systems strengthening, working closely with Ministry of Health and Family Welfare (MOH&FW) and local nongovernmental organizations (NGOs). Overall, in project year 5 (PY5), MH-II, still aims to improve the use of reproductive health (RH) and FP services with an emphasis on informed and voluntary use of long-acting reversible contraception (LARC) and permanent methods (PMs).

This progress report covers the first reporting quarter (Q1) of PY5, from October 1--December 31, 2017. The total couple-years of protection (CYP) achieved during this period is 130,230, which is 22% of the annual project benchmark (588,189). This slight variation of achieving CYP benchmark is due to the preparatory work undertaken by the project in establishing three districts offices, and downsizing the staffs and the Dhaka office. These preparatory activities delayed our interventions at field level. During this period, MH-II supported 657 health facilities, which is 96% of the annual benchmark (687).

The project provided support to the Directorate General of Family Planning (DGFP) in organizing 471 special FP service delivery days by engaging surgeons, mobilizing clients, and providing logistic supports in Q1. The special FP service delivery days served 8,158 LARC and PM clients, which is 14% of the annual benchmark. MH-II projects reaching 60,000 LARC and PM clients through special FP service delivery days over the course of the full PY5.

MH-II developed a training plan based on findings from the mapping of training needs for LARC and PM service providers. During Q1, 308 service providers received training through support from the project, which is 4% of the annual training benchmark (8,795). In Q1, four batches of basic LARC and PM training were conducted in three districts in coordination with DGFP Regional Training Centers (RTCs). A total of 20 newly-recruited doctors received the training. The project conducted three batches of refresher training on intrauterine device (IUD) service provision for 38 Family Welfare Assistants (FWAs), Female Sub-Assistant Community Medical Officers (SACMOs), and doctors. To ensure hands-on practice, both the LARC and PM trainings and IUD refresher trainings were linked with special FP service delivery days. DGFP staff conducted these trainings with support from MH-II. Ninety-eight percent of the providers trained were deemed performing to standard on LARC and PM by the end of the training.

1 Mayer Hashi II’s geographic focus for PY5 is in three districts (Sylhet, Khulna, and Comilla) in 38 Upazillas and 37 hard-to-reach Upazillas, totaling 75.

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To build capacity on training facilitation skills for 14 trainers from the three project-supported districts the project provided a Training of Trainers (TOT) on Training Skills Standardization in Q1. These trainers will facilitate clinical and non-clinical training and orientation on LARC/PMs, rights-based FP counseling, and facilitative supervision. All training will be conducted in project- supported Skills Labs in the three districts. The project provided an additional TOT on rights-based FP counseling for 95 participants (Medical Officers, Maternal and Child Health and Family Planning [MO, MCH-FP], Upazilla Family Planning Officers [UFPOs], and Assistant Upazilla Family Planning Officers [AUFPOs]). The trainers who received this TOT conducted six batches of cascade trainings on rights-based FP counseling for 115 FWAs and FP Inspectors (FPIs) in Sylhet.

According to the project’s PY5 workplan, MH-II will help to establish three “Skills Labs” in the three DGFP RTCs in Comilla, Khulna, and Sylhet that provide all clinical and non-clinical training for these districts. In preparation, the project held several advocacy meetings with the Line Director (LD) of the Clinical Contraceptive Services Delivery Program (CCSDP)/DGFP, and equipped two centers (one didactic and one for clinical practice) for each of the three Skills Labs. MH-II procured the majority of the furniture and equipment for these Skills Labs during Q1. In addition, the project completed the facility mapping, developed a list of required items, and provided TOTs to the trainers from the three Skills Labs on training skills standardization, clinical skills standardization, and rights-based FP counselling.

The vacancy of 20% of DGFP field worker positions inhibited the project’s demand-side work during Q1. Of primary concern was the limited number of field workers available to conduct home visits to provide quality FP information for potential LARC and PM users. To address this issue, MH-II engaged local NGO partners to conduct demand-generation work and refer potential user to facilities for FP special service delivery days. While Sub-award agreements in Comilla and Khulna were completed during Q1 and Memorandums of Understanding (MOU), the agreement and MOU with the local NGO partner in Sylhet district is expected to be completed in Q2.

In Q1, the project revised its monitoring and evaluation (M&E) Plan for PY5, which was submitted to USAID for review. The project also updated its Knowledge Management (KM) Plan to include PY5 activities. To ensure the quality of data collected and reported, MH-II conducted three joint Data Quality Assessments (DQAs) with the DGFP. Based on findings from these DQAs, some client consent forms lack complete data, such as client numbers, phone numbers, and national ID numbers. The project discussed these findings with DGFP local level managers, and advocated for follow-up with the FP service facilities and MH-II district teams followed-up with the providers from respective facilities to ensure the completion of consent forms.

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1. MAJOR PROGRAM RESULTS AND ACHIEVEMENTS

1.1 Utilization of FP services: Benchmark for CYP achieved During Q1 (October 1–December 31, 2017), MH-II achieved 130,230 CYP, which is 22% of the annual projected benchmark (588,189). Out of the total CYP, 5% was contributed by IUDs (32,032), 6% by implants (32,586), 7% by female sterilization (43,446), and 4% by no-scalpel vasectomy (NSV) (22,165). (Annex 2).

1.2 Number of facilities supported During this period, the project supported 657 facilities, which is 96% of the annual benchmark (687). Among these facilities, 579 were from the DGFP, 75 were from the Directorate General of Health Services (DGHS), and three were from NGO-supported facilities.

1.3 Training and orientation provided To assess training needs, a mapping of provider distribution and training status was conducted in Q1 in the three project-supported districts. Data were analyzed, and a final draft report is under development. Based on preliminary findings, a training plan for the year has been developed, and the following training was conducted during this reporting quarter.

1.3.a Basic training on LARC and PM During Q1, the project supported the conduct of four batches of basic LARC and PM training (18 days for each batch) in three districts through DGFP RTCs. DGFP trainers conducted these trainings with support from MH-II. A total of 20 doctors received the training: five each from both Sylhet and Comilla, and ten from Khulna. These trainings were linked to special FP service delivery days to ensure an adequate number of clients for practical training. During their practical Basic Training on LARC & PM, Photo credit: EHB training, Sylhet participants served 103 clients, while Comilla participants served 36 and Khulna participants served 184 (Table 1).

Table 1: Number of providers who received LARC and PM training in Q1 by district Basic LARC/ PM IUD Refresher District Batch # of Participants Batch # of Participants Sylhet 1 5 -- -- Comilla 1 5 1 10 Khulna 2 10 2 28 Total 4 20 3 38

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1.3.b Refresher training on IUD The project supported three batches of IUD refresher trainings conducted by DGFP trainers. A total of 38 Family Welfare Visitors (FWVs), female SACMOs, and two doctors received the refresher—two doctors and eight FWVs from Comilla, and 27 FWVs and one female SACMO from Khulna (Table 1).

1.3.c TOT on training skills standardization A TOT on training skills standardization was held from November 12-16, 2017 at the Mohammadpur Fertility Service and Training Center in Dhaka for trainers (service providers and managers) from the three project-supported districts to enhance their facilitation skills. These trainers are now expected to facilitate quality clinical and non-clinical trainings through the Skills Labs. A total of 14 participants, both from MH-II and the DGFP, participated in the training (five each from Sylhet and Comilla, two from Khulna, one from Jessore, and one from the CCSDP).

1.3.d TOT on rights-based FP counseling

Group attended in the TOT on Right Based FP Counseling; Role-play during training, Photo Credit: EHB Photo Credit: EHB

Four batches of TOTs on rights-based FP counseling skills were organized for all trainers, including MOs (MCH-FP, Clinics), Assistant Director, Clinical Contraception (ADCC), UFPOs, and AUFPOs at the district level to support the cascade training of rights-based FP counseling skills. A total of 95 participants from three districts received the TOT (27 from Sylhet, 28 from Khulna, and 40 from Comilla).

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1.3.e Cascade trainings on rights-based FP counseling The trained trainers already conducted six batches of cascade trainings from December 18—21on rights-based FP counseling for FWAs and FPIs in three Upazillas of Sylhet district. A total of 115 participants (43 from South Surma, 37 from Bishwanath, and 35 from Beanibazar) attended these cascade trainings. Cascade Training on Right Based FP Counseling; Photo Credit: EHB 1.4 Support facilities to organize FP special service delivery days During Q1, MH-II provided support to the DGFP in organizing 471 special FP service delivery days, where 8,158 LARC and PM clients received FP services (6,023implants, 593 IUDs, 32 Jadelle, 958 female sterilizations, and 552NSVs) (Table 2). The project supported the engagement of surgeons where no trained provider was available, and ensured facility readiness with respect to availability of equipment, infection prevention practices, and client privacy during counseling and service provision, availability of information, education, communication (IEC) materials, and community mobilization. MH-II also conducted 13 joint quality assurance (QA)/quality improvement (QI) monitoring visits to ensure quality LARC and PM services on 13 special FP service delivery days. In hard-to-reach Upazillas (30 out of 37), the project engaged 20 surgeons for the provision of LARC and PM services during special FP service delivery days in Q1. 26 advocacy and planning meetings were been conducted by the project with FP managers (DDFP, ADCC, MCH-FP MO, and UFPO) and FPIs in Upazillas and at the district level to organize these days.

Advocacy workshop on LARC & PM: Photo credit, EHB Engagement of District Managers; Photo credit, EHB

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Table 2: Number of clients and special FP days per area in Q1 FP Female Districts Implant Jadelle IUD NSV Total Days Sterilization Comilla 211 2,125 4 259 520 319 3,227

Khulna 88 1,360 0 191 190 60 1,801

Sylhet 93 1,208 0 14 170 74 1,466 Hard-to- 79 1,330 28 129 78 99 1,664 Reach Areas Total 471 6,023 32 593 958 552 8,158

1.5 Strengthen coordination between the DGFP and DGHS for postpartum FP (PPFP) Coordination between DGFP and DGHS regarding Imprest fund issues has been an ongoing challenge. MH-II aims to support the Director Generals (DGs) in overcoming challenges, working locally (with Upazilla administrations) to identify and build upon success stories, and increase coordination and collaboration between DGFP, DGHS, and private sector facilities in order to make Imprest funds available at all facilities. However, a more permanent, systems strengthening solution to the availability of Imprest funds may require higher-level advocacy (at the level of Secretaries or even at the level of Minister) for creating Imprest funds for LARC and PM services in the Operational Plan (OP) of the DGHS. MH-II developed a Concept Note to advocate for Imprest funds at the highest levels, and will carry forward work on this issue to ensure availability of Imprest funds in the OP of the DGHS.

In Comilla, a district-level advocacy meeting was held on December 6, 2017 to strengthen LARC and PM services in the DGHS and private facilities. The Divisional Director, Chittagong (Health) attended as the chief guest; the Civil Surgeon, Comilla as a special guest; and the Deputy Director of Family Planning (DDFP) Comilla presided over the meeting. In Khulna, a local system has been developed through coordination between the DGFP and DGHS and Imprest funds are now available in DGHS and private facilities. MH-II will document and build upon this and similar practices.

1.6 Establish functional Skills Lab for sexual and RH (SRH)/FP training in three project districts MH-II conducted several advocacy meetings with the LD of the CCSDP/DGFP to establish functional Skills Labs in the three DGFP RTCs in Comilla, Khulna, and Sylhet. In consultation with the LD, the project equipped two centers (one didactic and one for clinical practice) for each of the three training centers:  Comilla RTC: Office of the Regional Supervisor (Family Planning Clinical Supervision- Quality Improvement Team [FPCS-QIT]) Comilla for didactic training, and Comilla Maternity and Child Welfare Center (MCWC) for clinical practice.

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 Sylhet RTC: Office of the Regional Supervisor (FPCS-QIT) Sylhet for didactic training (facilities in nearby Upazillas to be used as clinical sites).  Jessore RTC: Although Khulna is a MH-II-supported district, the office of the Regional Supervisor, FPCS-QIT Khulna is located in Jessore. Therefore, the project, in consultation with the CCSDP/DGFP, selected Jessore FPCS-QIT for didactic training and both Jessore MCWC and Khulna MCWC for clinical practice.

The project conducted the following activities in Q1 regarding the establishment of Skills Labs:  Mapping and needs assessment of each of the six facilities completed (listing the items already available and to be purchased)  Coordination with the MaMoni project to ensure the complementarity of procuring the required items for the labs (MaMoni HSS provided some items previously)  List of items for each of the sites developed, and shared with the LD of the CCSDP  Purchase orders given to vendors  Prepare transfer letters for the handing over of equipment to the DGFP training centers in the three districts  Trainers for the three Skills Labs were identified and provided with a TOT (in training skills standardization, clinical skills standardization, and rights-based FP counselling)  Training plans developed, and trained trainers began conducting non-clinical and clinical trainings

1.7 Identify and sign MOUs with local NGOs (sub-awardees) to organize outreach service and refer clients In Q1 of PY5, the project identified and signed MOUs with two local NGOs (Young People in Social Action [YPSA] for Comilla district and Shushilan for Khulna district). The agreement process for Sylhet district is still ongoing. The focus of sub-awardees is to refer potential FP clients to facilities and special FP service delivery days after providing accurate SRH/FP information. Additionally, sub-awardee activities seek to remove demand-side barriers by using their community volunteers in the three districts, as well as Meeting with Youth Group; Photo credit: EHB in hard-to reach Upazillas. This approach will help the project accelerate implementation and achieve its benchmarks in a timely manner.

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1.8 Embed one MH-II staff member in the DGFP During PY5, MH-II identified one senior staff member to be embedded in the DGFP to work and coordinate closely with the CCSDP and Management Information System (MIS) Department of DGFP to provide support for establishing functional Skills Labs, and initiate effective use of the DGFP training MIS. To prepare for this activity, MH-II senior management held several meetings with the LD of the CCSDP of DFGP. Based on the DG’s approval, the CCSDP Unit allotted a new space for a MH-II Senior Technical Advisor.

1.9 Establish three regional offices During Q1, the MH-II project established three regional offices in Sylhet, Comilla, and Khulna to ensure improved coordination and technical support to local health service providers. Each regional office has three EngenderHealth staff to coordinate training and community mobilization efforts, as well as provide technical assistance (TA) and monitoring for related to the organization and coordination of special FP service delivery days. The MH-II field teams work closely with local DGFP and DGHS officials and health facilities, local NGOs, and other partners to strengthen LARC, PM, and other FP services in the three project-supported district.

1.10 Monitoring, evaluation, and research (ME&R) In Q1, MH-II’s ME&R team implemented planned activities according to the workplan, including providing ongoing TA and support to the program team. The team finalized all standard and custom indicators for PY5. The ME&R Plan was revised for PY5 and submitted to USAID on December 31, 2017 for review and comment. The ME&R team routinely collected FP service statistics from the national MIS of the DGFP; MH-II events information, performance during special FP days; and training data, and continuously updated the MH-II database. The data was used to monitor performance against project indicator benchmarks. The ME&R team verified data from the DGFP’s online MIS system by reviewing its accuracy and consistency and provided feedback. The service statistics for LARC and PM were used to calculate CYP and to better understand performance levels and trends.

During Q1, the ME&R team conducted three joint DQAs. A team consisting of the Deputy Director of the DGFP’s MIS Unit and four MH-II ME&R staff visited different levels of government FP facilities in Comilla Sadar, Chandina Upazilla, and Muradnagar Upazilla in Comilla district. The team also visited NGO facilities, including Marie Stopes, Surjer Hashi and Bamaneh clinics. In two Family Welfare Centers (FWCs) visited, consent forms were not filled- in properly (e.g., couple ID number/phone number/national ID numbers were missing). These findings were discussed with facility staff who agreed to record the information properly going forward. After completing the DQA, the ME&R team conducted a debriefing of DQA findings with the DDFP in Comilla districts, who agreed to discuss these issues at their monthly meeting.

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Finally, the MH-II Knowledge Management (KM) Plan was updated to include PY5 activities. A session on gender has also been incorporated into all trainings (which are now longer than two days). In Q1, 17 participants received and orientation to gender in one of the project’s various trainings.

2. CHALLENGES Since the project adopted a modified approach to cover all Upazillas in three districts and in 37 hard-to-reach Upazillas, Q1 served as a kind of start-up period, even though it is PY5 of the project. The project aimed to rapidly lay the groundwork for activity implementation; however, this meant that activities could not start immediately. This is one of the reasons for achieving less CYP than planned (achieved 22% of annual benchmark compared to planned 25%). We had to reorganize the project office, including human resources, relocate staff in three districts, and establish project office in 3 districts. The project experienced some delays in the new agreements with the local NGO partners. Since the preparatory phase is almost over, we will now be able to focus more on the proposed activities in a more intense way, which we are confident will help us to catch up and achieve the expected CYPs in the next quarter.

For improved community mobilization, and to link clients with special service days, reduce demand side barriers, MH II, during the quarter, had signed agreements with two local NGOs, in Comilla with YPSA and in Khulna with Shushilan. The following steps have been taken to organize regular FP special service delivery days in all Upazillas of three districts and 37 hard-to- reach Upazillas.

 Lack of trained service providers (newly recruited doctors, many of whom are in the districts, have only been trained on implant among LARCs and PMs). To address this problem MH-II has supported the engagement of surgeons for conducting FP special service delivery days in 30 of the hard-to-reach Upazillas.  Lack of field workers (in some Upazillas up to 20% of the field worker’s positions are vacant). To overcome this limitation MH-II identified local NGOs and signed agreements for sub-awards to the organizations to use their networks of volunteers for mobilizing clients for FP special service delivery days in the 2 districts and 37 hard-to-reach Upazillas.  Reluctance to perform LARC and PM services among the trained providers. The project is trying to make available alternate providers in these places, while also working with the DGFP and DGHS to identify the reasons for the provider attitudes and try to address them.  Non-functional infrastructure to provide quality FP services. MH-II is considering using the nearest FWC, Community Clinics (CC) and local NGO facilities for providing FP services as alternate facility to organize FP Special Service Delivery days.

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 Perception of non-adoption/non-acceptance of permanent FP methods among the indigenous population in hill districts. More community dialogues and information sharing to address myths and misconceptions, and other demand side activates (LARC and PM leaflet distribution and increased interpersonal communication (IPC) with potential users) will be conducted in the three hill districts.  Reports and data collection from districts is time consuming as the field staff are now in a new geographic area and approach of work. Some of the reporting formats are newly added. To address these challenges, ME&R staff continue to provide hands-on coaching to the field staff on reporting and accurate completion of different forms.

3. PROGRAM MANAGEMENT

Staffing During Q1, 52 national and international staff provided support to MH-II—31 were program staff and 21 were operations staff. MH-II’s expatriate Project Director began working on November 13, 2017. Technical Director, Joan Venghaus, resigned from her position effective October 31, 2017, and Dr. Sanjida Hasan became Acting Technical Director effective November 1, 2017. As per Modification #14: Change Key Personnel: AID-388-LA-13-00002, all four of the project’s key personnel received approval from USAID on November 29, 2017 (Bushra Abbasi, Project Director (began work on November 13, 2017 serving as Acting Project Director); Dr. Sanjida Hasan, Technical Director (began serving as Acting Technical Director effective November 1, 2017); Kamrul Hasan, Director Finance and Administration; Shahana Rahman, Director ME&R. During Q1, nine program staff were relocated to the three district offices (three staff per district) in Khulna, Comilla, and Sylhet.

Finance In Q1, MH-II spent $720,259 against the budget of $866,000. The project achieved/spent 83% of the quarterly budget. The average monthly expenditure rate for the reporting quarter was $240,086. This was lower than planned as a result of the transition into the YR5 extension year, which impacted the rate of activity implementation and related spending. This process included the downsizing and new recruitment of staff, establishment of three new regional offices, the relocation of staff to the district level, and the execution of sub-agreements with local NGOs.

With the close of Q1, the cumulative expenditure of MH-II stood at $20,589,513 against the award ceiling of $23,995,167. There remains $3,405,654 to spend from Q2-Q4 in PY5. The MH-II Project Management team is carefully monitoring spending to ensure that it remains within the ceiling of $23,995,167. By the end of this reporting quarter, the project has completed 51 months of the project cycle with nine months remaining. From the project’s inception to date, MH-II has attained an average monthly burn rate of $403,716. The project received the obligation $23,764,519 from USAID.

14 | Page e-Payment and Mobile Banking MH-II introduced e-payments in executing program activities. Staff payrolls, nearly all vendors, and all sub-awards are now paid through e-payment. Through the introduction of e-banking and mobile banking, MH-II has fulfilled its contractual obligation to institutionalize a cashless financial system.

Cost Share To date, MH-II has collected a cost share of $9.2 million against the target of $2,66 million, which is 346% higher than the total target. Cost share contributions are comprised of FP logistics provided by the DGFP to support FP service performance, the value of the volunteer time provided by government and non-government personnel, and free office space/workshop venues provided by the government and NGOs. MH-II national and international sub-awards also contributed their due cost share contributions.

4. NEXT STEPS

During Q2 of PY5, MH-II will prioritize activities in the following areas:

 Strengthening LARC, PMs, and other FP services through organizing special FP service delivery days at the union level  Initiate rights-based FP counseling at the facility level and community level  Increase PPFP services in private and DGHS facilities  Based on lessons learned from the MaMoni HSS project, engage community members (e.g., community clinic groups, women’s group, and youth groups) in demand-side activities  Partner with local NGOs for the referral of potential FP users by conducting group meetings and routine follow up with pregnant women during ANC and postnatal care, as well as women attending Expanded Program on Immunization (EPI) clinics, satellite clinics, community clinics, and FWCs  Update and/or print and distribute social and behavior change communication (SBCC) and IEC materials in facilities and at the community level  Conduct routine QA/QI visits in high-volume facilities and during special FP service delivery days  Support the conduct of training on rights-based FP counseling for all DGFP clinical providers (FWVs, SACMOs, and doctors), all DGFP field workers (FPIs and FWAs), the DGHS (Health Assistants, Assistant Health Inspectors [AHIs], Health Inspectors, and Community Health Care Providers), and local partner NGO volunteers  Establish functional Skills Labs in the three project-supported districts

The following annexes detail project achievements based on the proposed activities (Annex 1), and achievements against major indicators (Annex 2).

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Annex1: Activity Description and Achievements in PY5 Q1

Sub-IR1 Effective and high-quality FP services delivered in 3 districts and 37 hard-to-reach Upazillas Result 1.1 Capacity of public and private sector service providers to provide LARC and PMs increased

Activity 1.1.1 Strengthen the capacity of service providers on LARC/PM and PPFP Quarterly Achievement Implementation Benchmark Geographic Partners/ Remarks of Activities Time Frame /Deliverables Location Collaboration Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1.1.1a Conduct mapping of DGFP/DGHS/ Final mapping Sylhet, training needs LARC, NGO, report Comilla, X PM, and PPFP Director Khulna Report writing writing ME&R 1.1.1b Conduct LARC/PM DGFP and Training on PMs Sylhet, 38 Upazillas training (as needed and DDFP offices; conducted for 50 Comilla, based on the finding of NGO and doctors trained in 5 Khulna (as the mapping exercise) private sector batches required) Linked with IR2 Activity facilities X X X to address barriers to Training on IUD services within the for 250 providers community to ensure (doctors, FWVs, trainers know the proper female SACMOs,

use of the uterine elevator paramedics)— and tubal hook as Trained in 21 standard practice during batches training conducted mini lap ImplanonNXT Link training with special training (50 doctors FP days to ensure client in 5 batches)

load for hands-on 4 batches on LARC/PM and 3 batches on IUD practice 1.1.1bi Conduct 18-day basic 50 new and LARC/PM training on LARC and untrained doctors training is aligned

PM for 50 new and 15 20 15 trained in with special FP recruited recruited untrained doctors LARC/PM days 20 newly

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Quarterly Achievement Implementation Benchmark Geographic Partners/ Remarks of Activities Time Frame /Deliverables Location Collaboration Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1.1.1bii Conduct 6-day training 250 doctors, female IUD trainings are on IUD for doctors, SACMOs, FWVs, linked with IUD 50 38 female SACMOs, FWVs 100 100 and paramedics special days

and paramedics trained on IUD SACMO 1.1.1biii Conduct 2-day training 50 new and Skills building of on Implanon NXT for untrained doctors this training done

new and untrained 10 20 20 trained in Implanon during special FP doctors NXT days 1.1.1c Strengthen the DGFP, DGHS Imprest funds Central level Total 25 facilities coordination system Medical available in the - DGHS (20) and between the DGFP and College DGHS private sector (5) DGHS for PPFP as MH- Directors, X X X X by the end of PY5 II expands PPFP in the Superintenden with Imprest funds DGHS and private t In progress hospitals 1.1.1d 25 hospitals with PPFP 25 facilities offer services offer 100% X X X PPFP to 100% of N/A counselling clients who deliver 1.1.1e Support conducting 13 DGFP and PPFP trainings Sylhet, Provide support to batches of 3-day PPFP DDFP offices; conducted for 65 Comilla, the 3 RTCs

training for 65 NGO and participants in 13 Khulna (as (DGFP training participants, as identified private sector batches for: required) centers) during joint mapping facilities 25 doctors and responsible for the exercise (DGFP/private nurses, 25 three districts in sector/NGOs) paramedics, and organizing and

15FWVs conducting

counseling and N/A clinical trainings. Trainee and trainers will be on

8 batches for 40 participants 5 batches for 25 participants call to attend deliveries 24/7

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Quarterly Achievement Implementation Benchmark Geographic Partners/ Remarks of Activities Time Frame /Deliverables Location Collaboration Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Quarter-wise Narrative Description of Activity Q1 Task # 1.1.1a: District teams completed data collection for the “mapping on training needs” on LARC, PM, and PPFP in Comilla, Sylhet, and Khulna districts. The ME&R team completed the data analysis. Based on findings from the training needs assessment, LARC, PM, and IUD training have already begun in all three districts. Completion of the final training needs mapping report is forthcoming.

Task # 1.1.1b: Training on LARC and PMs: During Q1, 4 batches of training on LARC and PM were conducted in Comilla, Khulna, and Sylhet districts through Skills Labs with support from MH-II. 20 newly recruited government doctors participated in these trainings, in which 10 days (55% of the total number of hours) were used for simulation and client practices to ensure provider competency. Among these 20 participants, 5 were from Sylhet, 5 were from Comilla, and 10 were from Khulna (Table A1). To ensure adequate hands-on practice, all training was linked with special FP days. Sylhet participants practiced on 103 clients during their hands-on session, while Comilla participants practiced on 36 clients, and Khulna participants practiced on 184 clients.

Table A1: LARC&PM Training Status District Date Batch # of Participants Sylhet December 3-24, 2017 1 5 Comilla December 3-24, 2017 1 5 Khulna November 11-30, 2017 1 5 December 3-24, 2017 1 5 Total 4 20

Training on IUD: In Q1, 3 batches of IUD refresher training were conducted in Khulna and Comilla districts. In Comilla, a refresher training on IUD was held at MCWC Comilla. Two Medical Officers (MOs) and 8 FWVs attended the training from Chouddogram and Brahmanpara Upazillas. The project also conducted two batches of IUD refreshers trainings in Khulna where 27 FWVs and one female SACMO participated (Table A2). To ensure adequate hands-on coaching. Special FP service days were linked with training. 38 participants received IUD refresher training.

Table A2: IUD Training Status District Date Batch # of Participants Sylhet ------Comilla November 26-29, 2017 1 10 Khulna November 13-16, 2017 and 2 28 December 10-13, 2017 Total 3 38

All these training conducted through skills lab with support from the project. Trainers from DGFP training centers conduced all these trainings.

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Quarterly Achievement Implementation Benchmark Geographic Partners/ Remarks of Activities Time Frame /Deliverables Location Collaboration Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Task # 1.1.1c: Coordination between the DGFP and DGHS regarding the Imprest fund issues has been an ongoing challenge for the project. The project has been trying to develop a system to overcome these challenges, working locally (with Upazilla administrations) to increase coordination and collaboration between the DGFP, DGHS, and private sector facilities to ensure that Imprest funds are available at all facilities. However, a permanent resolution to the issue of the availability of Imprest funds requires higher-level advocacy (at the level of Secretaries, or even at the level of Minister may be required to ensure Imprest funds for LARC and PM services in the Operational Plan of the DGHS).

In Comilla, one district-level advocacy meeting was held on December 6, 2017 to strengthen LARC and PM services in DGHS and private facilities. Divisional Director, Chittagong (Health) attended as chief guest; Civil Surgeon, Comilla as special guest; and Deputy Director Family Planning (DDFP) Comilla presided the meeting. In Khulna, local system has been developed through coordination between the DGFP and DGHS and now Imprest funds are available in DGHS and private facilities.

Task # 1.1.1d: Not applicable this quarter

Task # 1.1.1e: Not applicable this quarter

Result 1.2 Training, support, and performance improvement mechanisms institutionalized Activity 1.2.1 Consolidate LARC/PM and PPFP counseling, services, and awareness (In selected high-volume private facilities, as well as with the DGFP, DGHS, and NGOs in urban areas) 1.2.1a Identify facilities (public, 15 new facilities Sylhet, See footnote 2 private, NGO) in urban offering PPFP in Comilla,

5 areas with high number 10 the urban areas Khulna N/A of deliveries and initiate2 PPFP services 1.2.1b Develop/revise/review all # of final tools and Dhaka tools and protocols to be protocols adapted used in follow up to and in use in all ensure facility readiness X X X X facilities

to serve as DGFP RTCs finalized offering training in all Revised and methods

2 Initiate PPFP services: Initiating PPFP services in a 24/7 high birth facility may include the sensitization of local level stakeholders, the training of direct service providers (including doctors, nurses, paramedic, FWVs and all field workers), assurance of the availability of special equipment (e.g., Kelly forceps) and infection prevention, orientation of all facility staff, the establishment of rights- based FP counseling during all ANC and PNC visits, and the removal of demand-side barriers. 19

Quarterly Achievement Implementation Benchmark Geographic Partners/ Remarks of Activities Time Frame /Deliverables Location Collaboration Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1.2.1c Conduct a rapid DGFP; NGO Final rapid analysis Sylhet, assessment of existing and private report (and Comilla, X ed training facility readiness sector presented to Khulna facilities training centers) Conduct 1.2.1d Work with the Line LD of the 3 training centers Sylhet, Director (LD) of the CCSDP and having 3 classroom Comilla, CCSDP and DGFP office DGFP office cum skills-practice Khulna to establish fully- facilities and 3 functioning Skills Labs clinical sites having for SRH/FP training facilities for skills (planning stage) practice fully-  Develop list of items equipped and required and X functioning with purchase equipment up to X X  Develop guidelines date, manual being

for implementation used, X  Identify trainers monitoring plans

developed equipment developed  Review training X X materials needed and adapt update if X necessary  Establish training and

monitoring plans LabSkills location selected and list for logistic and with the DGFP 1.2.1e Conduct monitoring and CCSDP 2 follow ups per Sylhet, Legacy plan follow-up of DGFP center per month Comilla, updated to include Training Center Skills for the 1st 6 months Khulna new interventions Labs ensuring Labs are X X X such as Skills N/A fully equipped, regular Labs trainings organized, and follow-up plans in place

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Quarterly Achievement Implementation Benchmark Geographic Partners/ Remarks of Activities Time Frame /Deliverables Location Collaboration Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1.2.1f Conduct routine QA/QI Deputy Monitoring visit Sylhet, Ensure IP, FP monitoring of service Director report and Action Comilla, counseling, side delivery of trained Family Plan developed Khulna effects and providers in identified Planning and implemented complications high-volume facilities (DDFP), City management, (public [City Corporation Corporation record-keeping, facilities], private, NGO) Medical equipment/supplie N/A in urban areas in Officers s IEC/job aids, collaboration with DGFP (MOs), and ensure ICV Training Center Skills Project compliance Labs Directors from private and 40 QA/QI monitoring visits 40 QA/QI monitoring visits 25 QA/QI monitoring visits NGO facilities 1.2.1g Reprint and distribute USAID’s PPFP materials Sylhet, PPFP pictorial cards (as Social printed and Comilla, needed) to providers and Behavioral distributed as Khulna field workers creating Change needed awareness and counseling Communicatio on PPFP n (SBCC)

project; 1,000 1,500 1,500 1,000 DGFP Information Education Motivations (IEM) Unit 806 pictorial job aid distributed 1.2.1h Conduct generic TOT to DGFP TOTs conducted Sylhet, Share final standardize training Training and final training Comilla, training report techniques and ensure Centers; report developed Khulna with the DGFP trainers use different Trainers from trainers in place

participatory NGO clinics;

20 methodology for training OGSB and not lecturing (UFPOs, MO-MCH/FPs, participants trained and other trainers) 1 TOT conducted, 14 20 total (1 batch)

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Quarterly Achievement Implementation Benchmark Geographic Partners/ Remarks of Activities Time Frame /Deliverables Location Collaboration Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1.2.1i Support conducting DGFP Cascade trainings Sylhet, 60 total (3 batches cascade trainings for 1 Training on going conducted Comilla, of 20 /1 batch per batch/district of Centers; by trainers from the Khulna district) MOs and standardized training Trainers from 3-RTCs and final UFPOs

60 skills (for newly recruited NGO clinics; training reports N/A doctors and other cadres). OGSB developed Follow up and monitor cascade training 1.2.1j Orientation of FWAs on DGFP (local  Orientations Sylhet, 1 batch per sub- proper registration of level) conducted Comilla, district x 38 pregnant women by  Registration lists Khulna Upazillas FWAs using existing developed/shared This will be a half- registers with sub-district a day training HQs, and DGFP along with the 1.5

N/A

1,900 Training Centers days cascade  Registration lists training on rights- used for referral based FP and counseling counseling for PPFP at all training of FWAs levels 1.2.1k Support the CCSDP to CCSDP Supported CCSDP Sylhet, Introduce together ensure proper tracking of in functionalization Comilla, with MIS trained providers using Director computer based Khulna department of computer-based training ME&R training software DGFP to record software (GOB procured by deploying a all trained software with our person and using an providers support) user manual, and a) Develop X X X X linking this with

guidelines the CCSDP CCSDP b) Deploy people training/monitoring Link with the CCSDP MIS system training/ monitoring MIS system

Deployed one person for support to

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Quarterly Achievement Implementation Benchmark Geographic Partners/ Remarks of Activities Time Frame /Deliverables Location Collaboration Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Quarter-wise Narrative Description of Activity Q1 Task # 1.2.1a: N/A for this quarter

Task # 1.2.1b: Facility readiness tool revised, finalized, and used during rapid assessment of existing training facility readiness.

Task # 1.2.1c: With concurrence from the DGFP, MH-II conducted a rapid assessment of the existing training facility readiness of RTCs in three districts. However, a rapid assessment of NGO and private sector facilities has not yet been conducted. Rapid assessments have been conducted in the following centers:  Comilla RTC: Office of the Regional Supervisor (FPCS-QIT) Comilla, and Comilla MCWC  Sylhet RTC: Office of the Regional Supervisor (FPCS-QIT) Sylhet (facilities in different nearby Upazillas to be used as clinical sites)  Jessore RTC: Office of the Regional Supervisor (FPCS-QIT) Jessore, and Jessore MCWC; and Khulna MCWC (replacement of Sylhet MCWC)

Task # 1.2.1d: The project conducted several advocacy meetings with the LD, CCSDP/DGFP to establish functional Skills Lab in the three DGFP RTCs in Comilla, Khulna, and Sylhet. In consultation with the LD, the project equipped two centers (one didactic, and one for clinical practice) in each of the three training centers:  Comilla RTC: Office of the Regional Supervisor (FPCS-QIT) Comilla, and Comilla MCWC  Sylhet RTC: Office of the Regional Supervisor (FPCS-QIT) Sylhet (facilities of different nearby Upazillas to be used as clinical sites)  Jessore RTC: Although Khulna is the Divisional Headquarter, the Office of the Regional Supervisor, FPCS-QIT Khulna is located in Jessore. Therefore, the project selected Jessore FPCS-QIT, and Jessore MCWC; and Khulna MCWC

Rent for the three RTCs will be paid by the DGFP. The premises of the Sylhet RTC still needs to be rented.

The project conducted the following activities related to the establishment of Skills Labs during this quarter:  Mapping of all six facilities completed (listing the items already available and center-wise items to be purchased)  List of items to be procured for each of the sites developed, and shared with the LD, CCSDP  Purchase order given to vendors  Trainers for the three Skills Labs identified and provided TOTs (training skills standardization, clinical skills standardization, rights-based FP counselling)  Training plans developed, and trained trainers began conducting non-clinical and clinical trainings Task # 1.2.1e N/A for this quarter

Task # 1.2.1f: N/A for this quarter

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Quarterly Achievement Implementation Benchmark Geographic Partners/ Remarks of Activities Time Frame /Deliverables Location Collaboration Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Task # 1.2.1g: In Q1, the project distributed 806 PPFP job aids. In addition, the project took the initiative of re-printing the following: i) Leaflet on LARC&PM (740,000), ii) Plastic hand fan with FP information (14,160), and iii) PPFP job aid (3,000). MH-II will distribute FP Flipcharts, FP FAQ booklets (Jante chai), Leaflets on LARC&PM, Plastic hand fan with FP information, and PPFP job aids for removing demand side barriers, as well as for quality FP counseling. The CCSDP Unit of the DGFP has taken the initiative in adapting and printing an FP Flipchart for which MH-II is providing technical assistance. MH-II will collect the FP flipchart from the CCSDP for distribution in the intervention areas. The FP FAQ booklet (Jante chai) will also be distributed. IEC/SBCC materials will be distributed in Q2. Ito date, the project distributed 80,750 IECS/BCC materials in Q1.

Task # 1.2.1h: A TOT on Training Skills Standardization was held from November 12-16, 2017 at the Mohammadpur Fertility Service and Training Center (MFSTC), Dhaka with trainers (service providers and managers) to enhance their training facilitation skills, with the expectation that they would facilitate clinical and non-clinical training through Skills Labs. 14 participants, from the project and DGFP, participated in the training.

Table A3: TOT on Training Skills Standardization Technique Status Districts #of Participants (Organization-based) DDFP CCSDP Comilla 5 0 Khulna 2 0 Sylhet 5 0 Dhaka 0 1 Jessore 1 1 Total 13 1 Total 16

Task # 1.2.1i: N/A for this quarter

Task # 1.2.1j: N/A for this quarter

Task # 1.2.1k: During the PY5 workplan period, the project planned to embed one staff member in the DGFP responsible for working closely with the CCSDP and Management Information System (MIS) Unit to support for functioning Skill Labs, and DGFP training MIS. To functionalize this decision, MH-II senior management had several meetings with the LD, CCSDP/DFGP. Based on our request, the Director General, DGFP provided approval for an office for the Senior Technical Advisor in the CCSDP Unit of DGFP.

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Quarterly Achievement Implementation Benchmark Geographic Partners/ Remarks of Activities Time Frame /Deliverables Location Collaboration Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Activity Expanding LARC/PM services to the All Upazillas in 3 districts and 37 hard-to-reach, low-user Upazillas in 18 districts 1.2.2 1.2.2a Identify local NGOs to NGOs and other 37 Upazillas organize outreach trained providers in 18 service, refer identified and used districts and clients/provide outreach for providing all Upazillas services either by X LARC/PM services in Khulna, available trained NGO Comilla, providers or hired Sylhet providers (where there providing LARC/PM are no service providers) NGOsLocal identified 1.2.2b Issue Professional EH HQ PSAs/Sub- 16 hard-to-

Service Agreements Contracts & agreement signed reach (PSAs)/Sub-award to Compliance districts and 8 8 identified local NGOs Unit (CCU) Khulna, process Comilla, sub-awardees sub-awardees andSylhet signed Agreement with 2 2 with Agreement districts 1.2.2c Support districts to DGFP, local Special FP days 37 hard-to-  Assessed facility organize and set up NGOs conducted reach low readiness for regular routine system of performing conducting for special FP days in all Results shared with Upazillas special FP days Upazillas in 3 districts USAID in quarterly identified by  Use Mobile and 37 hard-to-reach low- report the DGFP Service Delivery user, Upazillas (in non- Teams where intervention districts) Couple-years of Sylhet, needed protection (CYP) Comilla,  Support Upazilla Khulna FP Officers (UFPOs) and MO-MCH/FPs in 471 special FP days organized 300 special FPdays organize 700 Special FP days organized

1,000 special FP days organized 1,000 special FP days organized the development of monthly plans using data

25

Quarterly Achievement Implementation Benchmark Geographic Partners/ Remarks of Activities Time Frame /Deliverables Location Collaboration Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1.2.2d Monitoring of QA/QI of DGFP FPCS- 10% of the total Sylhet, Ensure IP, FP special FP days in 3 QIT number of special Comilla, counseling, districts and 37 hard-to- FP service days Khulna in management of reach Upazillas visited and all Upazillas side- monitored plus 37 effects/complicati special FP days will be hard-to- ons, record- used to train the 70 30

100 100 reach and keeping (service new/unskilled provider so low users documentation that they obtain and reporting), supervised skills practice

equipment/supplie 13 QA/QI monitored on LARCs s, IEC/job aids, ensure ICV compliance 1.2.2e Conduct refresher While conducting training on IP during QA/QI monitoring monitoring of QA/QI of visits at MCWCs, special FP days all clinical staff, staff

300 300 300 including support 54 staff 100 100 staff, from UHCs and FWCs will be involved in IP refresher training 1.2.2f Provide ongoing DGFP Necessary coaching Sylhet, Provide coaching and mentoring and mentoring Comilla, mentorship on to Regional provided on Khulna conducting onsite Supervisors/FPCS-QITs ongoing basis training, how to to build their capacity in provide supportive

facilitative supervision 3 3 3 Regional feedback, hand- N/A and conducting client exit Supervisors/FPCST holding support interviews -QITs facilitative clinical supervision skills training/service observed during provision follow up visits

26

Quarterly Achievement Implementation Benchmark Geographic Partners/ Remarks of Activities Time Frame /Deliverables Location Collaboration Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1.2.2g Support training centers Local level 300 FPIs oriented Sylhet, 5 batches per to conduct training on DGFP staff to facilitative Comilla, district (15 batches facilitative supervision supervision and Khulna each of 20

for FP Inspectors (FPIs) orientation/training participants) yetNot completed 60 FPIs 90 FPIs 90 FPIs 60 FPIs report developed/shared 1.2.2h Assist the quality USAID/QIS MH-II will As requested by improvement secretariat request for 1 work with the QIS and (QIS) of the MOHFW to year support QIS in 13 USAID for 1 year strengthen QA and QI districts- report systems for SRH at the Panchogarh district level (13) Thakurgaon  Facilitating monthly Naogaon Quality Improvement Natore Committees (QICs) Pabna meeting Meherpur  Assisting in Jhenideh developing QIC Magura meeting minutes Manikganj 3 districts 4 districts 3 districts 3 districts  Sending QIC meeting Munnshigan minutes to QIS of the j MOHFW Brahmanbar follow-up done 1 in district.  Following up the iaComilla implementation of & decisions taken in Chandpur QIC meetings  Providing logistical support in QIC 5 QICs meeting held in 5 districts, 1 orientation 1 in district, 1 meetings

27

Quarterly Achievement Implementation Benchmark Geographic Partners/ Remarks of Activities Time Frame /Deliverables Location Collaboration Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 1.2.2.i Develop/adapt and DGFP Job-aid for NSV Dhaka 1,600 service disseminate job-aids for Training developed and delivery sites no-scalpel vasectomy Centers disseminated (nationwide) will (NSV) for providers receive NSV job X X (showing fascial aid (number based N/A interposition) DGFP on the current sites circular will be offering NSV) distributed nationwide Quarter-wise Narrative Description of Activity Q1 Task # 1.2.2.a and 1.2.2.b: In Q1 of PY5, the project identified and completed agreement for sub-awardees with two local NGOs (YPSA for Comilla district and Shushilan for Khulna district). The agreement process for Sylhet district is ongoing. These sub-awardees are expected to help remove demand-side barriers, refer potential FP clients, and organizing special FP service delivery days by using their community volunteers in the three districts, as well as hard-to reach Upazillas. YPSA will provide support in all Upazillas in Comilla district and in 14 hard-to-reach Upazillas. Shushilan will work all Upazillas in Khulna district and in one hard-to-reach Upazilla. During Q1, 20 surgeons have been hired to perform LARC/PM services in 30 hard-to-reach Upazillas. In Sylhet district, two NGOs (Shimantic and SSKS) were identified and now provide clinical-based FP services.

Task # 1.2.2.c: In Q1, a total 26 advocacy and planning meetings were conducted with FP managers and FPIs (DDFP, MO-MCH-FP, UFPO and FPI) at the Upazilla and district level to organize and conduct special FP service delivery days in hard-to-reach Upazillas. In this quarter, Comilla, Khulna, Sylhet, and hard-to-reach Upazillas organized 211, 88, 93, and 79 special FP days, respectively. During special FP days, 13 QA/QI monitoring visits were conducted. Performance of special FP days in Comilla, Khulna, Sylhet, and hard-to-reach districts as listed below:

Table A4. Number of clients and special FP days per area in Q1 PY5 Female Implant Jadelle IUD NSV Total Districts FP days Sterilizati Clients Clients Clients Clients Clients on Clients Comilla 211 2,125 4 259 520 319 3,227 Khulna 88 1,360 0 191 190 60 1,801 Sylhet 93 1,208 0 14 170 74 1,466 Hard-to- 79 1,330 28 129 78 99 1,664 reach Total 471 6,023 32 593 958 552 8,158

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Quarterly Achievement Implementation Benchmark Geographic Partners/ Remarks of Activities Time Frame /Deliverables Location Collaboration Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Task # 1.2.2.d: During Q1, MH-II conducted 13 QA/QI visits in 3 districts and four hard-to reach Upazillas. During QA visits, it was observed that in a few facilities, IP processes were not followed properly. It was also observed that client privacy and confidentiality were not maintained, and counseling was not conducted properly. The QA visit team shared feedback with Upazilla managers and concerned staff.

Table A5: Number of QA/QI visits conducted in Q1 District # of Visit Facilities Covered Upazillas Covered Sylhet 5 5 Sadar, Golapganj, Jaintapurm, Balagonj Khulna 2 2 Digholia, Dumuria Comilla 2 2 Laksam, Sirajganj (hard-to- 1 1 Chowhali reach) Kishorganj (hard-to- 1 1 Mithamoin reach) Bandarban (hard-to- 1 1 Lama reach) Habiganj (hard-to- 1 1 Azmiriganj reach) Total 13 13

Task # 1.2.2.e: In Q1, 54 participants received hands-on coaching for IP in the above mentioned facilities.

Task # 1.2.2.f: N/A for this quarter

Task # 1.2.2.g: Most FPIs are now involved in rights-based FP counseling training. Therefore, in Q1, this activity was not conducted.

Task # 1.2.2.h: During this quarter, an orientation was held on 5S (Sort, Set, Shine, Standardize, and Sustain) for staff at Pabna District Hospital. Random follow up visits were conducted at Natore District Hospital. In both districts’ facilities, QIC models were found to be going well. However, Natore District Hospital requires further logistics support (e.g., bin, coloring, guiding sign, tag [red, green, yellow]), etc. From November to December 2017, 5 QIC meetings were held with the Ward Improvement Team (WIT) leader at facilities in the following districts: Thakurgaon, Panchagarh, Natore, Pabna, and Naogaon. It was observed that all facilities were fully oriented to 5S and well informed about QIS goals.

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Quarterly Achievement Implementation Benchmark Geographic Partners/ Remarks of Activities Time Frame /Deliverables Location Collaboration Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Sub-IR2 Demand for FP services, especially LARCs and PMs, increased Result 2.1 Communication strategies promoting social norms for delaying spacing and limiting births implemented Activity 2.1.1 Increasing information and access to FP including PPFP by removing community barriers and establishing referral linkages 2.1.1a Develop system for PPFP DGFP and  Established PPFP Sylhet, Work with counseling during ANC, DGHS counseling Comilla, immunization PNC, and immunization system Khulna centers and/or visits (at the satellite  Added to facility satellite clinics to clinic and immunization level card and develop/ensure centers), by DGHS Field client ANC cards referral linkages Workers, namely Health  Immunization for PPFP (initial Assistants (HAs) and centers and/or mapping required Assistant Health X X X X satellite clinics of immunization Inspectors (AHIs) and have effective clinics; provision Family Welfare referral linkages of necessary In progress Assistants (FWAs). for PPFP materials; monitoring visit to Develop system of  Formal referral ensure materials effective PPFP referral system stablished used) linkages from the satellite in at least 1

clinic and immunization district centers

30

Quarterly Achievement Implementation Benchmark Geographic Partners/ Remarks of Activities Time Frame /Deliverables Location Collaboration Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2.1.1b Establish referral links Local NGO Referral linkages in Sylhet, between NGO partners; place between Comilla, community volunteers for municipality NGO community Khulna FP services (in urban volunteers and FP areas) in 3 districts: services  Train 300 NGO volunteers on right- based FP counseling,

SRHR and gender, and referral 100 100 100  Provide list of the facilities (public, In progress private sector/NGO) for client referral  Establish referral linkage between NGO community volunteers and FP service delivery facilities

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Quarterly Achievement Implementation Benchmark Geographic Partners/ Remarks of Activities Time Frame /Deliverables Location Collaboration Benchmark/Deliverable

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2.1.1c Based on lessons learned DGFP System for Sylhet, from MaMoni HHS to community-based Comilla, revitalize existing FP communication Khulna community rights-based revitalized FP communication according to annual through (linked activity client segmentation of 2.3.1b) done by FWAs  Domiciliary visits using ICT (# of and group education door-to-door and sessions by FWAs, group education in Has, AHIs, HIs, FPIs, Immunization CHCPs, NGO clinics, Satellites, volunteers and others FWC, and CC in Sylhet, Khulna, during ANC completedNot and Comilla districts increased)  Visit for targeted groups pregnant women during ANC/PNC, newlyweds, high parity women sit immunization centers Quarter-wise Narrative Description of Activity Q1 Task # 2.1.1a: In all three districts, a cascade training plan for rights-based FP counseling was developed to established PPFP counseling for all DGHS and DGFP field workers and service providers. After the training, all field workers and providers provide FP counseling to women during ANC, PNC, and other visits systematically.

Task # 2.1.1b: In Comilla and Khulna districts, two NGOs were identified to establish referral linkage between NGO’s community volunteers and FP facilities for rights- based FP services. The referral system will be developed in Q2. In Sylhet, the NGO selection process is underway.

Task # 2.1.1c: Not yet completed

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Result 2.2 Accurate Knowledge of FP, specially LARCS and PMs, increased among community leaders families and clients Activity 2.2.1 Support the DGFP, DGHS, SBCC working group and UNFPA to strengthen correct knowledge and awareness of LARC and PM services Quarterly Achievement Implementation Partners/ Geographic of Activities Time Frame Deliverables Remarks Collaboration Location Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2.2.1a Adapt experience from DGFP/CCSD Collaborate with Dhaka other USG-funded P Ujjibon/MaMoni programs used in the field HHS to get more (need to obtain X knowledge about DGFP/CCSDP support) their community

engagement completedNot activities 2.2.1b Train Upazilla FP CC members 14 CC members 42 CC group Officers on the and staff trained quarterly in 3 members trained implementation of including union of the 3 to communicate approaches to engaging women/youth districts with different

Community Clinic (CC) groups 14 14 14 groups at the Support Group members community level

and others utilizing completedNot existing community networks 2.2.1c Train community 20 batches x 30 Engage 3 sub- volunteers on rights- participants per awards YPSA,

based FP, SRHR, and 300 300 batch Shushilan, and Not gender (Linked with JASISH 2.1.1b) completed Quarter-wise Narrative Description of Activity Q1 Task # 2.2.1a: Not yet completed

Task # 2.2.1b: Not yet completed

Task # 2.2.1c: Not yet completed, but will provide in next quarter in all three districts. In Khulna, a TOT on rights-based FP, SRHR, and gender will be provided to NGO Supervisors from January 3-4, 2018.

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Result 2.3 Client Identification and referrals increased Activity 2.3.1 Support DGFP trainers in organizing and conducting training/orientation of FWAs and NGO volunteers on rights-based FP counseling, as well as equipping them with job aids and IPC materials Quarterly Achievement Implementation Partners/ Geographic of Activities Time Frame Deliverables Remarks Collaboration Location Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2.3.1a Conduct TOT for rights- DGFP TOTs conducted and Sylhet, (Upazilla FP based FP counseling Training final training report Comilla, Officers skills for all trainers Centers; developed Khulna [UFPOs], Trainers from 75 trainers will Medical-Officers,

NGO clinics; receive TOT. Each Maternal and

75 OGSB; EH Training Center will Child Health/FP HQ train 1 batch of 25 [MO-MCH/FPs], Technical trainers Regional Specialist Supervisors, and other trainers) 95 trainers received TOT 2.3.1b Support 2.5 days cascade DGFP Cascade trainings Sylhet, 20 total (3 trainings for rights-based Training conducted by the Comilla, batches/1 batch FP counseling skills for Centers; three RTCs of Khulna per district) all doctors, FWVs, Trainers from DGFP involving doctors, FWVs,

SACMOs, nurses, NGO clinics; Upazilla-level SACMOs, paramedics, and 1.5 days OGSB trainers nurses, cascade training on right- Technical paramedics, based FP counseling for Specialist FWAs, FPIs, the FWAs, FPIs, Health Health Assistant 100 providers

Assistant [HAs], and 3200 providers 3200 providers [HAs], and Assistant Health Assistant Health Inspector, HIs, CHCPs, Inspector, HIs,

NGO volunteers, and CHCPs, NGO 115 providers trained Sylhetin others (Linked activity of volunteers, and 2.1.1c) others 2.3.1c Support 1.5 day cascade DGHS Cascade trainings Sylhet, training of CHCPs in conducted at Comilla, rights-based FP Upazilla-level by the Khulna

counseling 200 200 three RTCs of N/A DGFP involving Upazilla-level trainers

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Quarterly Achievement Implementation Partners/ Geographic of Activities Time Frame Deliverables Remarks Collaboration Location Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2.3.1d Provide ongoing TA to DGFP Ongoing TA Sylhet, DGFP ensuring quality provided and IEC Comilla, counseling by using job- gaps identified, Khulna X X X X aids/interpersonal filled, and addressed communication materials, Ongoing etc. Quarter-wise Narrative Description of Activity Q1 Task # 2.3.1a: MH-II organized 4 batches of TOTs on rights-based FP counseling for a total of 95 MOs (MCH-FP), UFPOs, and AUFPOs at the district level (27 participants in one batch in Sylhet, 28 participants in one batch in Khulna, and 40 participants in two batches in Comilla).

Table A6: TOT on rights-based FP counseling # of Participants *AD MO (MCH- AFWO District Date Batch (CC)/ Hired UFPO UH&FPO* FP)/ (MCH- AUFPO NGO Total MO Surgeon MO(clinic) FP) (CC) Sylhet December 3-7, 2017 1 4 - 10 1 9 3 -- -- 27 Comilla December 17-21, 2017 and 2 13 - 20 2 04 -- 1 -- 40 December 24-28, 2017 Khulna December 17-21, 2017 1 7 1 9 3 4 2 1 1 28 Total 4 24 1 39 6 17 5 2 1 95 *Upazilla Health and Family Planning Officer (UH&FPO); Assistant Director (AD)

Task # 2.3.1b and 2.3.1c: After receiving the TOT on rights-based FP counseling skills, the trainers of Sylhet conducted 6 batches of 2-day cascade trainings on rights- based FP counseling skills for FWAs and FPIs in South Surma, Bishwanath, and Beanibazar Upazilla from December 18-21, 2017. A total of 115 participants (South Surma-43, Bishwanath-37, and Beanibazar-35) attended the training. DGFP trainers conducted all of the sessions. Comilla and Khulna will start this activity in Q2.

Task# 2.3.1d: To ensure quality counseling, MH-II is supporting the DGFP by providing job-aids/IPC materials, etc.

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Sub-IR3 Supportive enabling environment advances access to LARC/PMs and other FP/RH services Result 3.1 Key policy barriers to LARC and PMs Activity 3.1.1 Strengthening DGFP decentralized planning through evidence-based decision-making policy implementation Quarterly Achievement Implementation Partners/ Geographic of Activities Time Frame Deliverables Remarks Collaboration Location Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 3.1.1a Work with local DGFP DGFP, Policy change being Sylhet, For example, officials to set up an SMS DGHS, and implemented Comilla, during the FP system to update all staff OGSB Khulna special week and on policy changes and Clients Fairs, monitoring MH-II has used implementation at the SMS to inform monthly DGFP Upazilla the providers and level meetings, using X X X X field workers

Facebook to remind about the date doneNot providers online and place of the resources, updates and FP special days schedule activities and CHCPs and FWAs for injection follow up 3.1.1b Provide support to the Regional DGFP staff utilizing Dhaka This support will MIS Unit and CCSDP to Supervisors the checklists be provided at adapt EH’s DDM tool the central level (e.g., checklist for SRH (DGFP) HQ. services) for use by X

DGFP staff (as per DGFP doneNot needs) and orient them on how to use data for decision making

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Quarterly Achievement Implementation Partners/ Geographic of Activities Time Frame Deliverables Remarks Collaboration Location Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

3.1.1c Continue to work with Different Collecting quality Sylhet, Previously. MH- district and MIS Unit levels of the data and analyzing Comilla, II worked with staff to collect quality DGFP and using data for Khulna the MIS Unit of data, interpret and decision making DGFP, analyze data through conducted joint X X X X DQA to make evidence- decisions based based programmatic on data analysis, decisions (DDM) during and made During DQAthe visit, monthly meetings decision for relevant data collected improvement 3.1.1d Conduct follow up and DGFP and Sub-district Sylhet, Sub-district level hands-on coaching for municipalitie managers and staff Comilla, sub-district managers and s (urban using DDM Khulna 0 15 15 15 staff to ensure use of areas), and routinely DDM NGOs (monitored through doneNot follow-up checklist) 3.1.1e Develop Concept Note MOHFW Concept Note Dhaka for operationalizing developed and Imprest Fund into the shared with DGFP, DGHS system in order to X X DGHS, USAID, and expand implementation submitted to Draft concept

of PPFP services in the MOHFW note developed DGHS facilities

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Quarterly Achievement Implementation Partners/ Geographic of Activities Time Frame Deliverables Remarks Collaboration Location Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 3.1.1f Advocacy meetings with MOHFW 2 circulars issued Dhaka the two Secretariats to that 1) allow Imprest allocate Imprest funds funds to flow into the DGHS system, directly to the and ensure availability of DGHS (Senior contraceptives to the Secretary of the DGHS, especially MOHFW), and 2) maternity wards that indicates which X X X X Directors—from Hospitals or doneNot PHCs—are responsible for managing and allocating Imprest funds (Secretary of DGHS) Quarter-wise Narrative Description of Activity Q1 Task # 3.1.1a: Not done

Task # 3.1.1b: Not done

Task # 3.1.1c: During the DQA visit, relevant data collected

Task # 3.1.1d: Not done

Task # 3.1.1e: MH-II will carry forward the work of operationalization of Imprest funds into the DGHS system to ensure the availability of money and commodities to DGHS facilities. The first meeting in this regard was held recently. Based on the meeting, a Concept Paper is being drafted (first draft ready by January 4, 2018). In the concept note, it will be emphasized to have a pot of money in one of the operation plan of the DGHS as Imprest funds for FP services. Once the first draft is ready, it will be reviewed by EHB. The Concept Note will then be shared with the DGFP, DGHS, and USAID and submitted to the MOHFW. During the process of submission to the MOHFW, a higher-level consultant with experience conducting advocacy with Secretaries and Ministers will be hired.

Task # 3.1.1f: This task will be done through the higher-level consultant after development and finalization of the Concept Note. USAID will also be actively involved is activities related to the availability of Imprest funds for FP services.

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Monitoring & Evaluation Quarterly Achievement Implementation Partners/ Geographic of Activities Time Frame Deliverables Remarks Collaboration Location Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Activity 1 Revision of ME&R Plan and projection of USAID standard and custom indicators ME&R team reviews and revises the annual ME&R Plan based on annual workplan along with the projection of standard and custom indicators. 1.1 Review and revise Revised ME&R

ME&R and incorporate Plan approved suggestions from USAID X and send final updated submitted

ME&R Plan to USAID ME&R plan for approval 1.2 Project USAID standard Finalized benchmark and custom indicators and available submit to USAID X d Complete

Quarter-wise Narrative Description of Activity Q1 Task # 1.1: The revised ME&R Plan was submitted to USAID for review and comments on December 31, 2017.

Task # 1.2: USAID standard and custom indicator benchmarks were finalized and submitted to USAID/D. Activity 2 Maintenance of MH-II database and conduct joint DQA This is a regular monthly activity to incorporate MH-II’s accomplishments reported from program staff, MOU partners, and the private sector through an efficient web-based data input and output system. Project data are collected in the standard format prepared by ME&R team.

2.1 Collect and collate DGFP National FP service National national FP service statistics collected

statistics data from X X X X and collated for 10 and collate

national MIS of DGFP months Collected 2.2 Collect and collate FP MH-II FP service statistics Sylhet, service statistics of MH-II partner of sub- Comilla, sub-awardees/ partners NGOs awardee/partners Khulna X X X X

(YPSA, Shushilan, and collected and collate Jashis) collated according to extended contract Collected and

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Quarterly Achievement Implementation Partners/ Geographic of Activities Time Frame Deliverables Remarks Collaboration Location Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2.3 Collect and collate MH-II DGFP and MH-II events Sylhet, events information, ME&R information, trainee Comilla, trainee data, and trainee data, and trainee Khulna and follow-up data X X X X follow-up data 37 Upazillas collected and collate

collated for 10 Collected and months 2.4 Collect and collate ME&R QA & QI Sylhet, QA/QI compliance data compliance data Comilla, collected and Khulna, and X X X X collated for 10 37 hard-to- N/A months reach Upazillas 2.5 Provide support to DGFP and User support to the Sylhet, DGFP/MIS for online ME&R DGFP MIS staff for Comilla, data entry X X X X online data entry Khulna Support provided provided 2.6 Clean and check validity DGFP and Cleaning and National of online data ME&R validity checking of X X X X online data performed Ongoing 2.7 Document event reports, ME&R Event reports, FP Sylhet, special FP day records, Special Days Comilla, trainee records, etc. records, trainee Khulna, 37 records, etc. hard-to- documented reach Upazillas X X X X and Bangladesh On going Country Office (BCO) (Dhaka)

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Quarterly Achievement Implementation Partners/ Geographic of Activities Time Frame Deliverables Remarks Collaboration Location Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2.8 Update quarterly and ME&R Quarterly and annual BCO annual performance data performance data (Dhaka) tracking table X X X X tracking table

updated for 4 Updated quarters 2.9 Process trainee data Trainee data BCO according to TraiNet need X X X X processed for 12 (Dhaka) months Done 2.10 Update trainee data to the TraiNet input system BCO TraiNet online input X X X X updated for 4 (Dhaka) system quarters Done 2.11 Prepare summary training 4 summary reports BCO report from the TraiNet prepared and (Dhaka) X X X X 1 database and submit to submitted y report USAID summar 2.12 Conduct joint DQA with DQA report shared 3 districts the DGFP MIS and with DGFP and the and 6 hard- CCSD unit to ensure data 5 5 5 5 issues addressed to-reach

quality Upazillas 3 DQAs Quarter-wise Narrative Description of Activity Q1 Task # 2.1 to 2.4: The ME&R team collected and collated data from the national FP service statistics from the national MIS of the DGFP, MH-II events information, and trainee training data. This data is used for different types of analysis, service statistics for LARC and PM are calculated for CYP, LARC, and PM trends. Findings are shared with the program team. Data is used to monitor the performance of the indicators.

Task # 2.5: During the DQA visit, the team identified that in the online system, there was one program error of total calculation in Tubectomy service data (MIS from-4). The DQA team shared this information with the DGFP/MIS Unit for their correction.

Task # 2.6: The ME&R team checked and verified MIS data from the DGFP from July to September 2016, including the calculation of the service data and the data consistency.

Task # 2.7: According to the assignment plan of the ME&R team, collect all event reports, special FP day and trainee records, etc., and keep these documents both in hardcopy and soft copy form.

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Quarterly Achievement Implementation Partners/ Geographic of Activities Time Frame Deliverables Remarks Collaboration Location Benchmark/Deliverable

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Task # 2.8: Annual tracking table of PY3 updated and tracking table of Q1 of PY4 updated

Task # 2.9 & 2.10: As a regular monthly activity during this quarter, the ME&R team uploaded training events information from the IR teams 1 and 2 for Q4 of PY4 on the USAID TraiNet online input system and for Q1 of PY5 training information is currently uploading.

Task # 2.11: Q4 of PY4, a summary training report from the TraiNet database was prepared and submitted to USAID. The summary training report will be prepared after the Training the TraiNet information uploading.

Task # 2.12: During Q1, the ME&R team conducted three joint DQAs to review the quality of data (validity and reliability) on the permanent and LARC service statistics at the district, Upazilla, and union level of the government facilities and NGOs facilities. A team consisting of the Deputy Director of the MIS Unit of the DGFP and ME&R staff from MH-II visited different level of government FP facilities in Comilla Sadar, Chandina, and Muradnagar Upazilla in Comilla district. The team visited NGOs facilities, Marie Stopes clinics, Surjer Hashi clinics, and Bamani clinics.

During this visit, the team identified a few transcription and compilation errors in these Upazillas. In all three Upazillas, in some consent forms, no couple number/ phone number/national ID number was recorded. The main reason for this error was that they were using old consent forms with no option of recording this information. This issue was discussed with facility staff who agreed to record this information properly going forward. After completing the DQA, the ME&R team conducted a debriefing on DQA findings with the UFPOs and the DDFP of Comilla districts. The DDFP of Comilla took these issues seriously and agreed to discuss them in the monthly meeting. The ME&R team also shared findings with the DGFP MIS Unit at Dhaka.

Activity 3 Program progress monitoring and iDQA of specific activities 3.1 Conduct performance Director Performance monitoring of PSA ME&R monitoring visits partners, and other X X X X conducted and report

special activities submitted. doneNot 3.2 Conduct iDQA of Director iDQA visits PSA/Sub-awarded ME&R conducted partners, special 2 2 2

activities, etc. doneNot Quarter-wise Narrative Description of Activity Q1 Task# 3.1 and Task # 3.2: As the MOU with sub-awardees were just signed, there were no monitoring activities or iDQAs conducted in Q1. After receiving their performance reports, these activities will begin.

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Quarterly Achievement Implementation Partners/ Geographic of Activities Time Frame Deliverables Remarks Collaboration Location Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Activity 4 EngenderHealth (EH) HQ Updates: Update EH global on organizational indicators annually according to HQ requirements. Prepare semi-annual portfolio review report and quarterly country projects updates. 4.1 Prepare and submit Director Quarterly and semi- quarterly, semi-annual ME&R annual portfolio portfolio, and annual X X X X reports prepared and

reports using program vs. submitted 1 report budget forecasting tools 4.2 Quarterly and annual data M&E Officer Data entered 4 times entry using DHIS2 X X X X using DHIS-2 platform platform Done Quarter-wise Narrative Description of Activity Q1 Task # 4.1 The semi-annual portfolio report for the month of April to September 2017. Report for October to December are underway.

Task # 4.2 For the months of September, October, and November, monthly data was submitted to EH HQ via an online system using the DHIS2 platform as per HQ requirement. Activity 5 KM and the provision of TA for gender sensitive approaches in MH-II The purpose of KM is to gather and share knowledge, evidence, best practices, and experience/lessons learned from project activities in order to improve program performance and ensure a strong project legacy. The gender activity intends to strengthen the integration of gender into all EHB programs and to promote gender equitable staff dynamics and attitudes and strengthen gender mainstreaming at EHB according to EH’s Gender Policy.

5.1 Assist project staff in Director KM documents are documentation and use of ME&R utilized internally KM documents X X X X and externally Ongoing

5.2 Routinely update Director KM pipeline Knowledge Product ME&R products updated Pipeline X X X X Ongoing

5.3 Conduct quarterly Director Quarterly meeting in go X X X X On meeting of KM teams ME&R conducted

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Quarterly Achievement Implementation Partners/ Geographic of Activities Time Frame Deliverables Remarks Collaboration Location Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

5.4 Knowledge product Director Follow-up of KM

development ME&R X X X pipeline product ing updated Ongo 5.5 Organize quarterly TBD Meeting minutes Finalization of all Gender Focal Team X X X X prepared knowledge (GFT) meeting products in Q3 5.6 Monitor gender issues are TBD Training reports included in all trainings include addressing X X X X /orientations gender issues report prepared 5.7 Orientation on basic TBD Training conducted gender issues for new as needed (relevant) staff of MH-II X X X X and PSA partner’s staff and other gender issues next next quarter. related activities Commence in 5.8 Follow-up TBD Follow-up to ensure implementation of that the gender Gender Policy X X X X policy is being

implemented Ongoing Quarter-wise Narrative Description of Activity Q1 Task # 5.1 to 5.4: The KM Plan was revised for the period of 2015 to 2018 and submitted to HQ. There are 10 project briefs in the pipeline. Two briefs were finalized and submitted to EH HQ for final layout. EH HQ requested to hold these briefs until February/March 2018 for the extension of the project. From the next quarter, we will start working on it.

Task # 5.6: A gender session was included in all trainings, longer than two days. In these quarter, 17 participants have received basic gender orientation.

Task # 5.7: A basic orientation on gender for MH-II sub-awardees will be conducted in next quarter.

Task # 5.8: Ongoing

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Quarterly Achievement Implementation Partners/ Geographic of Activities Time Frame Deliverables Remarks Collaboration Location Benchmark/Deliverable Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Activity 6 Prepare quarterly and annual report 6.1 Collection and collation All project data of total project data X X collected and collated Done 6.2 Compile all activity Technical Accomplished accomplishments and Director X X narrative write-up narratives developed Done 6.3 Gather feedback from HQ Technical All feedbacks ne X Do and USAID Director incorporated 6.4 Finalize end of project Technical End of project report report and submit to Director X finalized and USAID submitted Done 6.5 Assist MH-II staff to Technical Assisted in disseminate project Director dissemination and outcomes including X holding of an EOP holding an End of Project seminar Done (EOP) seminar Quarter-wise Narrative Description of Activity Q1 Task # 6.1 to 6.4: During the reporting period, the PY4 annual report was prepared and submitted to USAID. A draft progress report for Q1 of PY5 was in progress, to be send to EH HQ for review, after that the feedback from EH HQ will be incorporated and finalized the report. The final report will be submitted to USAID.

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Annex 2: Indicator Tracking Table: Target vs. Achievement for PY5 Q1

PY5 (FY2017-18) PY5 PY5 Annual Quarter 1, Quarter 2, Quarter 3, Quarter 4, PY5 Total SL # Program Elements/Indicator Achievement Benchmark Oct 1 - Dec Jan 1 - Mar Apr 1 - Jun Jul 1 - Sep Achievement (Oct'17-Sep'18) 31, 2017 31, 2018 30, 2018 30, 2018 (Oct'17-Sep'18) in % Project Objective: Increased use of effective family planning (FP) and reproductive health (RH) services F:3.1.7.1 Couple years protection (CYP) in sites # of Clients CYP - 130,230 130,230 22% supported by MH-II project (CYP) - 98,815 588,189 Method Implant (Implanon) 41,402 103,505 32,032 32,032 31% IUD 31,153 143,304 32,586 32,586 23% Female Sterilization 19,803 257,439 43,446 43,446 17% NSV 6,457 83,941 22,165 22,165 26% F:3.1.7.1- # of USG-assisted service delivery sites 687 657 657 96% 3 providing FP counseling and services Types of sites Public Sector DGFP 580 579 579 100% sites DGHS 75 75 75 100% NGO/Private NGO 15 3 3 20% Sector sites Private Sector 17 0 0 - Result 1.1: Capacity of public and private sector service providers to provide LARC and PMs increased Custom # # of providers receive training/or on-the-job 1 training, orientation, or mentoring with USG 10,695 308 308 3% fund Training/Orientat Training 8,795 308 308 4% ion Orientation 1,900 0 0 - Cadre of trainees Medical & # of Women 769 84 84 11% by sex Para-Medical # of Men 313 41 41 13% Others non- # of Women 6,996 122 122 2% technical # of Men 2,617 61 61 2% Custom # % of MH-II trained service providers who 98% 2 performed at the national standard in the past 90% 98% 98% (56 out of 57) year

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PY5 (FY2017-18) PY5 PY5 Annual Quarter 1, Quarter 2, Quarter 3, Quarter 4, PY5 Total SL # Program Elements/Indicator Achievement Benchmark Oct 1 - Dec Jan 1 - Mar Apr 1 - Jun Jul 1 - Sep Achievement (Oct'17-Sep'18) 31, 2017 31, 2018 30, 2018 30, 2018 (Oct'17-Sep'18) in % Result 1.2: Training, support, and performance improvement mechanisms institutionalized Custom # # of clients who adopted postpartum family 7,455 1819 1819 24% 3 planning (PPFP) methods (within 48 hours) PPFP-Tubectomy 4,600 1267 1267 28% PPFP-IUD 2,655 552 552 21% PPFP-Implant 200 0 0 0% Custom # # of supported sites that received at least one 4 supervisory visit within the past year (QA/QI 105 0 - - monitoring visit) Custom # # of LARC and PMs provided by mobile 5 team/TA in public, NGO and private sectors 60,000 8,158 8,158 14% sites supported by USG fund Method Implant 34,000 6,055 6,055 18% IUD 12,000 593 593 5% Female Sterilization 10,000 958 958 10% NSV 4,000 552 552 14% Local NGO Implant supported IUD outreach services Female Sterilization by methods NSV MH-II facilitated Implant 6,055 6,055 service by IUD 593 593 Methods Female Sterilization 958 958 NSV 552 552 Result 2.1: Communication strategies promoting social norms for delaying, spacing, and limiting implemented program elements/indicators Custom # # of communication materials 5 0 - - 6a developed/updated by MH-II project Custom # # of communication materials distributed by 812,827 80,750 80,750 10% 6b MH-II project

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PY5 (FY2017-18) PY5 PY5 Annual Quarter 1, Quarter 2, Quarter 3, Quarter 4, PY5 Total SL # Program Elements/Indicator Achievement Benchmark Oct 1 - Dec Jan 1 - Mar Apr 1 - Jun Jul 1 - Sep Achievement (Oct'17-Sep'18) 31, 2017 31, 2018 30, 2018 30, 2018 (Oct'17-Sep'18) in % Result 3.1: Key policy barriers to LARC and PMs Custom # of decisions taken by using EH’s Data use for #7 Decision Making (DDM) tools by the DGFP 15 0 - - staff District Khulna 0 - - Comilla 0 - - Sylhet 0 - - Hard-to-reach areas 0 - - Custom # Proportion of service providers who report 8 increased clear understanding on gender 17 17 17 after the USG supported training Sex Number of Women 14 14 14 Number of Men 3 3 3 Clear understanding on gender 88% after the USG supported 90% 88% 88% (15 out of 17) training

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