Quarterly Report July 1, 2020

Amplification de la Santé de la Reproduction et de Planification Familiale

(AmplifyPF)

Quarterly Report

July 1, 2020 – September 30, 2020

Submitted to United States Agency for International Development USAID/West Africa Regional Health Office

By Pathfinder International

Under Cooperative Agreement No. 72062418CA00003

TABLE OF CONTENTS

Table of Contents ...... 2

Acronyms and Abbreviations ...... 3

Section 1: Introduction & Summary ...... 5

Section 2: Description of Activities ...... 6

Section 3: Monitoring, Evaluation & Learning (MEL)...... 20

Section 4: Implementation Challenges ...... 22

Section 5: Compliance ...... 25

Section 6: Upcoming Activities ...... 27

Annexes ...... 29

ACRONYMS AND ABBREVIATIONS

AmplifyPF Amplify Family Planning and Sexual and Reproductive Health project

AOR Agreement Officer Representative AYSRH Adolescent and Youth Sexual and Reproductive Health CHW Community Health Worker CBD Community-Based Distribution CBO Community Based Organization CIP Costed Implementation Plan CLA Collaborating, Learning and Adapting COP Chief of Party COVID Coronavirus disease CRESAC Centre Régional d'Evaluation en Education, Environnement, Santé et Accréditation en Afrique (Regional Center for Evaluation in Education, Environment, and Health and for Accreditation in Africa) CSPS Centre de Santé et de Promotion Sociale (Health and Social Promotion Centre) CSI Centre de Santé Intégré CSU Centre de Santé Urbain (Urban Health Centre) CTAR Comité Technique d’Appui au RIA (Technical Support Committee) CYP Couple-Years of Protection DHIS District Health Information Software DMPA-SC Self-injected subcutaneous DMPA (Depot-medroxyprogesterone acetate) DQA Data Quality Assessment DSF Division for Family Health DSMI/PF Division de la Sante Maternelle et Infantile et de la Planification Familiale (Division of Maternal and Child Health and Family Planning) EAWA Ending AIDS in West Africa E2A Evidence to Action Project FP Family Planning FP/RH Family Planning and Reproductive Health GHSC-TA Global Health Supply Chain Technical Assistance HIPs High Impact Practices HMIS Health Management Information System HP+ Health Policy Plus ILN Integrated Learning Network ISBC Identification Systématique des Besoins de la Cliente (Systematic Identification of the Client Needs) IT Information and Technology IUD Intrauterine Device IBP Implementing Best Practices Initiative JSPF Journées Spéciales de Planification Familiale (Family Planning Special Days) LMIS Logistics Management Information System MCH Maternal Child Health

MCM Modern Contraceptive Method MEL Monitoring, Evaluation and Learning MOH Ministry of Health MSHP Ministère de la Santé et de l’Hygiène Publique (Ministry of Health and Public Hygiene) OP Ouagadougou Partnership PACFP Post-Abortion Care Family Planning PAGE Passage á Grande Echelle (Scale Up) PLGHA Protecting Life in Global Health Assistance PNSME Programme National de Santé de la Mère et de l'Enfant (National Maternal, Newborn and Child Health Program) PP Post-Partum PPFP Post-Partum Family Planning PSM Procurement and Supply Management QA Quality Assurance REDI Rapport building, Exploration, Decision making and Implementing the Decision RH/FP Reproductive Health/Family Planning RHO USAID West Africa Regional Health Office SCC Sahel Collaboration & Communication SRH/FP Sexual Reproductive Health/Family Planning TCI The Challenge Initiative TOR Terms of Reference UNFPA United Nations Population Fund USAID United States Agency for International Development USG United States Government WABA West Africa Breakthrough Action WAHO West African Health Organization

SECTION 1: INTRODUCTION & SUMMARY

This report covers the third quarter (July 1, 2020 to September 30, 2020) of year 2 of the USAID funded Amplify Family Planning and Sexual Reproductive Health (Amplify PF) project. This quarter, activities focused on: the introduction of the ILN model into Zinder district and the integration of FP into nutrition in Zinder National Hospital in Niger; the functionality of ILNs through CTAR meetings; resources mobilization; capacity building of health workers including CHW and municipality agents; demand creation through awareness campaigns with WABA; monitoring ISBC; implementation of JSPF; development of core package and dashboard; acquisition of medical equipment for selected health facilities; development of a concept note on the impact of COVID-19 on FP service delivery; finalization of and orientation of country teams to ILN self-evaluation tools; collaboration and coordination meetings at national and regional levels, including RHO IPs’ fiscal year 2021 work plans joint review; and data collection, reporting and analysis.

During the reporting period, most target countries removed the lockdown/curfew imposed at the onset of the COVID- 19 pandemic as there has been a decrease in new cases. Although the project staff continued to have virtual meetings with some partners, it was possible to organize in-person meetings and training sessions in 3 of the 4 target countries, as well as implement the JSPF under strict observation of barrier measures prescribed by the MOH in all countries. The project has developed a catch-up plan so activities not implemented during the first wave of COVID-10 (April, May June) can be achieved during the July-August-September quarter, despite obstacles due to rainy season.

Key achievements during this reporting period:

• 103,310 FP clients visited the health facilities of the 16 ILNs, among which 24,636 are new users • 84,984 CYP achieved by the health facilities of the 16 ILNs;

Below are achievements obtained through the direct support of AmplifyPF: • 27,291 women received a modern contraceptive method (16,482 through Amplify supported ISBC and 10.809 through JSPF) among whom 16,770 are new users (6,026 through JSPF and 10,744 through ISBC); • 353 health care providers oriented on ISBC (162 in Burkina; 152 in Togo; 24 in Niger and 15 in Cote d’Ivoire); • 338 health workers providers trained in contraceptive technology and counseling (179 in Cote d’Ivoire; 71 in Burkina; 58 in Niger and 30 in Togo); • 435 CHWs participated in JSPF, distributed condoms or were trained in the 4 target countries’ ILNs; • 86 CHW involved in community mobilization during JSPF (44 in Togo; 42 in Cote d’Ivoire); • 77 Health facilities benefited from supportive supervision (32 in Niger; 31 in Togo and 14 in Cote d’Ivoire); • 58 stakeholders of the Zinder district (Niger) oriented on AmplifyPF objectives and ILN model & structures; • 39 stakeholders from Niamey region’s 3 ILNs oriented on community dialogue and site walkthrough approach; • 39 Community activities (17 community dialogue and 22 site walk throughs) carried out with WABA; • 20 CS agents trained on contraceptive technology including implant provision (task shifting) in Niger; • 20 staff from AmplifyPF trained on QA and Collaborative Improvement; • 14 partners/projects representing all four countries met for collaboration and coordination meetings • 12 staffs (7 from the MOH, 4 staffs of AmplifyPF and 1 staff of WABA) trained on DQA. • 07 coordination/collaboration meetings conducted for coordinated action at the regional level

SECTION 2: DESCRIPTION OF ACTIVITIES

The activities implemented during this reporting period (July-September 2020) are highlighted below. OBJECTIVE 1: STRENGTHEN AND INSTITUTIONALIZE A SYSTEM FOR ADAPTATION AND REPLICATION OF KEY FAMILY PLANNING HIGH IMPACT PRACTICES (REPLICATION)

ILN ACTIVITIES

The AmplifyPF team was able to implement an important number of activities in Burkina Faso. • Functionality of the ILN: The completion of 3 statutory meetings of the CTAR of Boromo, Do and Dafra resulted in the development of a work plan and a communication plan with the creation of a WhatsApp group and a Facebook page. These meetings also helped to re-launch resource mobilization efforts with municipal partners.

• Family Planning Special Days (JSPF): During this quarter, and despite the previous challenges faced by the health facilities for the procurement of free contraceptives, the project was able to support 24 health facilities by holding JSPF. In total, 1,667 women accepted contraceptive methods at the JSPF, including 567 new users. A total of 322 CHWs participated in these JSPF with 234 being females and 88 males. .

JSPF in the DS of Boulmiougou: Clients Waiting for FP Care • Monitoring ISBC implementation: AmplifyPF team monitored ISBC implementation in 72 Health facilities (3 facilities through physical visit and 69 through telephone or WhatsApp’s. This gave an opportunity to stock 77 facilities with ISBC reference/ counter reference cards and monitor the implementation of ISBC tools. Data on ISBC were reported by 82 health facilities from the 4 ILNs. The data revealed that a total of 8,511 women were reached from ISBC, among whom 2,272 received a modern contraceptive method, 915 of whom were new users.

JSPF in Dafra: Supervision at the CSPS Guimbi Ouattara • World contraception day: The commemoration of World Contraception Day on September 26, 2020 was an opportunity to officially launch free family planning in Burkina Faso. The launch ceremony took place in Banfora in the Cascade Region under the chairmanship of the Minister of Health and the patronage of the First Lady of Burkina Faso. AmplifyPF’s HIP Officer represented the project and participated in the official launching ceremony.

In Côte d’Ivoire, despite the challenging circumstances due to higher numbers of COVID-19 cases than in the other target countries and election-related insecurity, the team carried out the following activities:

• Functionality of the ILNs: Four out of five ILNs held their quarterly meeting (Abobo Ouest, Port-Bouet-Vridi, Bouake Nord-Ouest and Daloa). The ILN of Yopougon Ouest-Songon was unable to hold a meeting due to conflicting agendas. The meetings allowed the members of each ILN to review the district's activities and make recommendations for improving the indicators and data quality. In addition, workplans and communication plans were developed this quarter for the CTARs and Communes of Abobo Ouest and Daloa. Those of Yopougon Ouest-Songon and Bouaké Nord-Ouest were scheduled for Q1 of Year 3.

Group picture from the 2nd meeting of the Abobo CTAR on September 30th, 2020

• Family Planning Special Days (JSPF): 17 JSPFs of 3 days each (including 7 preceded by community dialogues and site walk-throughs and 7 as part of the World Contraception Day celebration) and 3 JSPFs of 1 day (conducted during a communication campaign in collaboration with WABA) were caried out in the 5 target districts. A total of 3,775 clients, including 2,417 new acceptors, received modern contraceptive methods according to the following distribution : District of Port-Bouet-Vridi: 1,344 clients including 997 new acceptors; Abobo West District: 275 clients including 194 new acceptors; Yopougon West-Songon District: 479 clients including 279 new acceptors; Daloa District: 1028 clients, including 583 new acceptors; Northwest Bouaké District: 649 clients, including 364 new acceptors. Stand held jointly by AmplifyPF and WABA at the official ceremony of WCD in CI

These activities wouldn’t be possible without the support of 42 community health workers • Monitoring ISBC implementation: During this quarter who helped to mobilize the populations. 82 a facilitative supervision was organized in the district of CHWs also played a key role with 197 district Port-Bouët. AmplifyPF provided technical support to the chiefs for the campaign of free distribution of development of the MCH supervision grid (including FP) and financial support (logistics and costs for refreshments 218160 condoms in the 5 target districts. and printing) for this activity.

In Niger most AmplifyPF support was done through conference calls or WhatsApp and was able to achieve the following accomplishments.

• Functionality of the ILNs: During this quarter the ILN of Zinder was implemented. The CTAR members conducted a meeting in order to draft their work and communication plan. This meeting also provided an opportunity to provide an overview of the AmplifyPF project and USG compliance regulations on FP and abortion to five (05) members of the ECD and 53 members of COSAN. All five ILNs conducted meetings with partners for the development of a resource mobilization plan and advocacy documents for resource mobilization.

Orientation workshop at the ILN of Zinder

• Monitoring ISBC implementation: During this quarter, in the 5 ILNs of Niamey and Zinder, 27,449 clients benefited from the ISBC. A total of 3,637 accepted a MCM and among these 2,878 were new users. These results demonstrate the positive continuation of the trend we noticed during the previous quarter and the effectiveness of ISBC despite the COVID-19 pandemic.

ISBC follow-up at the Tsamkaka nursing center in the Mirriah ILN

• Supervision of Health facilities: 32 public health facilities of the Mirriah (21) and Niamey 5 (11) ILNs benefited from supervision from AmplifyPF, through which the project and facilities were able to identify some pain points but also some strengths. The positive aspects are (i) the availability of the entire range of contraceptive products, (ii) the availability of infection prevention materials, and (iii) the availability of personnel trained in CT. The areas for improvement are (i) the delay in the transmission of data on FP and (ii) the insufficiency of IUD insertion and removal equipment. This supervision was also an opportunity to brief the providers who were not trained on ISBC and in the filling and classification of FP forms. Over 100 people including health workers, service recipients, political and religious leaders and CBO members took part in these visits.

• Family Planning Special Days (JSPF): Six (06) JSPF clinics were organized in the ILN of Niamey 5, Niamey 1 and Mirriah, covering eighteen villages. These JSPF resulted in raised awareness of 2,169 clients among whom 650 clients received a modern contraceptive method, including 247 new acceptors. The clients were distributed as follows: Niamey 5 (262 clients, including 74 new acceptors); Niamey 1 (96 clients, including 26 new acceptors); Mirriah (292 clients, including 147 new acceptors).

• Net-Mapping: During this quarter the ILN of Zinder conducted its net-mapping leading to the identification of 57 stakeholders that can serve to mobilize resources within the district to support FP services.

In Togo, the project team continued monitoring the implementation of the ISBC approach and organizing JSPF.

• Functionality of the ILN: During this quarter 2 meetings of CTARs were conducted. The meeting of the Avé CTAR on July 23rd gathered 9 participants and helped to assess the level of implementation of the CTAR action plan and the results of the resource mobilization meetings (follow-up of the commitments). The meeting of the Agoè-Nyivé CTAR was held on August 27th and brought together 17 members. It helped to review the CTAR action plan, to coordinate the preparation of resource mobilization meetings at the municipal level, as well as the organization of the walk-through visits in collaboration with WABA. In the D3 ILN, the planned activities were not carried out due to the COVID-19 pandemic.

• Monitoring ISBC implementation: The public health facilities of the 3 target ILNs have been provided with ISBC cards and reference/counter reference cards as well as with complementary report cards during the monthly follow- ups. 1,967 women benefitted from ISBC, among whom 893 received a modern contraceptive method with 205 new users.

• Family Planning Special Days (JSPF): 22 sessions of JSPF days were organized in the project's 3 intervention ILNs (Avé: 7, D3: 5 and Agoè-Nyivé: 10). 6,528 people (including 1548 men) were reached by the campaigns with the support of 44 CHWs, reaching 1,625 acceptors of an MCM among whom 864 new acceptors.

FP service delivery at Amoutivé Health Center in D3 ILN in Lomé Role-playing phase during the ISBC orientation in the Avé ILN, July 24, 2020

• Supervision of Health facilities: During this quarter, supervision of public and private health facilities as well as CHWs in the 3 ILNs identified the following strengths and weaknesses. Strengths include the availability of personnel able to offer FP services; ISBC ownership by all public facilities; and the availability of FP commodities. Weaknesses include an insufficient number of IUD insertion / removal kit; a poor availability of medical equipment to offer immediate PPFP services and the absence of QA teams in all health facilities. One of the main problems in the public facilities is the lack of information regarding the available FP services as well as the hours these services are offered among the public. Proposed solutions are (i) display the FP services available as well as hours they are offered at the front of each health facility and (ii) train health workers on proper counseling of clients with focus on “how to welcome” a client.

CAPACITY BUILDING In Burkina Faso, the AmplifyPF team conducted the following capacity building activities:

• Training in Contraceptive Technology: A training was conducted to 71 providers (21 from the Boromo district, 25 from the Do health district and 25 from the Dafra health dirstrict) in reversible long-acting family planning methods in the post-partum and post-abortum periods.

• Orientation in DMPA-SC: 30 health providers from the Boulmiougou health district were oriented on self-injection of DMPA-SC. As a result, they will in turn orient beneficiaries who opt for self-injection.

• Orientation in ISBC- Family Planning of 162 health workers (88 providers from Boromo ILN and 74 from Boulmiougou ILN)

• Medical equipment: During the quarter, the AmplifyPF project acquired medical and technical equipment for 92 health facilities identified with lack of medical equipment to deliver FP services during the baseline in the 04 ILNs of AmplifyPF. The delivery of this equipment to the health facilities will be made during the month of October 2020.

In Côte d’Ivoire, AmplifyPF conducted the following capacity building activities:

• Training in contraceptive technology: During this quarter 180 health care providers (172 midwives, 7 nurses and 1 physician) received theoretical and practical training in contraceptive technology with an emphasis on Post-partum and Post-abortum FP. AmplifyPF also provided guidance on how to fill in the complementary tools. More precisely, (i) 41 providers in Abobo Ouest (38 midwives, 2 nurses and 1 physician); (ii) 21 midwives in Port-Bouët-Vridi (iii) 38 midwives in Yopougon Ouest- Songon; (iv) 40 providers in Daloa (36 midwives and 4 nurses) ; (v) 40 providers (39 midwives and 1 nurse) in the municipality of Bouake Nord-Ouest.

Training sessions for health care providers in PPFP and PAFP on an anatomical model in the district of Bouaké NO

• Medical equipment has been procured for 17 HF (3 in Abobo Ouest, 4 in Daloa, 3 in Bouaké Nord-Ouest, 3 in Yopougon Ouest-Songon and 4 in Port-Bouet-Vridi) identified with lack of medical equipment to deliver FP services during the baseline . the total cost of this medical equipment is worth $ 42,000 US and delivery in 5 slots is planned for November 2020.

• Orientation in ISBC- Family Planning: 15 providers (5 midwives, 6 nurses, 3 CHWs and 1 Waitress from the Health District of Daloa received orientation on the Systematic Identification of Client Needs in FP (ISBC/PF).

The Niger AmplifyPF team focused its capacity building interventions and efforts on:

• Community dialogue: This quarter, 39 CTAR members form the 3 ILNs of Niamey were trained, in collaboration with WABA, on community dialogue strategies and walk through visits.

• Post-Partum/Post-Abortion FP: 58 Health Workers (from public health facilities of the ILNs of Niamey 1, Niamey 3 and Niamey 5) were trained on Post-Partum/Post-Abortion FP to reinforce the capacity of ILNs to implement these HIPs.

Practical session of the PPFP/PAFP training at the Niamey5 ILN

• Orientation in ISBC- Family Planning and DMPA-SC: 22 health providers were trained on ISBC and DMPA-SC. This orientation allowed the participants to (i) understand ISBC and DMPA-SC, and (ii) set-up the ISBC cards and chronograms and determine next steps.

• Training in contraceptive technology: 20 CHWs (providers at the CS level) from the Mirriah ILN were trained on contraceptive technology with a focus on Implanon. This training enabled the CHWs to gain a thorough understanding of implant placement and removal.

• Supervision of Health Posts: During the reporting period, the AmplifyPF team supervised 3 Health Posts (Cases de Santé) in the ILNs of Niamey region with a total of ten (10) Community Health workers in order to reinforce their capacity in community-based distribution of contraceptives and data reporting.

• Medical equipment: 76 public health facilities in ILNs of Niamey and Zinder were selected to receive medical equipment from the AmplifyPF project. The procurement process was conducted during this quarter and the handover will be conducted on October 15th. An official ceremony will take place at the ONPC with the presence of the Ambassador of the United States of America in Niger and the Minister of Health of Niger.

In Togo, the following capacity building activities were implemented:

• Orientation in ISBC- Family Planning: 152 providers, including 34 men, were oriented on the ISBC approach. • REDI counseling: During this quarter 30 providers from the 3 ILNs received capacity building training on REDI counseling. • DQA: The team conducted a capacity building training in DQA. Participants included 7 staff from the Ministry of Health and Public Hygiene, 4 staff from the AmplifyPF Project and 1 staff from WABA.

REDI Counseling Training Group photo

COUNTRY LEVEL COLLABORATION & COORDINATION

In Burkina Faso, in addition to its continuous collaboration with the USAID Burkina office, the AmplifyPF coordinated meetings and activities with the following partners: WABA, GHSC-PSM, GHSC-FTO, TCI, and HP+.

1. WABA: The project supported WABA to conduct 08 (eight) site walk-throughs and 04 (four) community dialogues in the health facilities of Do and Dafra ILNs. The two teams collaborated to organize 24 JSPF in the Boulmiougou, Do and Dafra heath facilities. Finally, the teams exchanged on preliminary results from the analysis of existing FP data in the sub-region.

2. GHSC-FTO: Within the framework of improving the quality of logistics data, the Directorate of Healthcare Product Supply Chain Management (DCAPS), in collaboration with GHSC-FTO and AmplifyPF, conducted a joint supervision of logistics data quality from 6th to 12th September 2020 in the 13 regions. Following the audit, a workshop was organized on September 21st, in Ouagadougou, to share results with all the stakeholders. One of the difficulties encountered by all five districts of this region was the failure to carry out supportive supervision during April and May 2020 because of the COVID-19 pandemic. It was decided that the Baskuy district, which has a small number of health facilities to cover for supervision, will come to support the district of Boulmiougou, which needs to supervise 42 health facilities.

3. GHSC-PSM: The AmplifyPF team participated in the workshop for the development of the GHSC-PSM support plan to the Ministry of Health for the period from October 2020 to September 2021. During this workshop, held from 22 to 24 July 2020, our team proposed activities within the framework of collaboration with PSM.

4. USAID Burkina: Participation in the meeting for the presentation of the annual action plans of USAID's regional FP projects held on September 22-23, 2020.

5. TCI: A workshop was organized by the municipality of Bobo with the support of TCI for the development of the Reproductive Health of Adolescents and Youth action plan in the municipality of Bobo (Dô and Dafra ILNs). The implementation of this action plan will complement and strengthen the actions undertaken by AmplifyPF in the implementation of ISBC, the provision of FP services and the mobilization of local resources and from the private sector.

6. HP+: We participated in the monthly meeting of FP and maternal health partners organized by Health Policy Plus (HP+) in collaboration with USAID. The participants discussed the vision, objectives, guidelines, coordination and integration of interventions in mother-child health. From now on this meeting will be extended to partners intervening in maternal and neonatal health, infant, adolescent and nutrition and will be held on the first Thursday of each month.

7. EAWA: The collaboration between the AmplifyPF and the EAWA teams has led to progress in the integration of FP/HIV activities in the joint sites. During this reporting period, the AmplifyPF team collected information and conducted an inventory of the capacities and needs of these health facilities to offer FP services. In total, five (05) of the six (06) health facilities were visited. Each of the health facilities received a Tiahrt leaflet from AmplifyPF. Also, 04 health providers from the 02 common sites of the 02 projects (CM vie positive and CMA of Pissy) in the DS of Boulmiougou were trained on ISBC.

In Côte d’Ivoire, the AmplifyPF team continuously worked with the MSHP and collaborated with WABA.

1. Ministry of Health and Public Hygiene (MSHP): This quarter we participated in a workshop organized by the PNSME regarding the technical review of the policy document for standards and protocols for maternal and child health. The HIPs (PPFP and PAFP, task shifting and ISBC/FP) were integrated into these different documents.

2. WABA: In preparation of the JSPF we conducted 9 community dialogues and site walk throughs in Port- Bouët, Abobo Ouest, Daloa and Bouake. Furthermore, during our campaign for the free distribution of condoms, WABA continued to broadcast radio spots with messages on the importance of using contraception during the COVID-19 pandemic to prevent risks of STI/HIV as well as unwanted pregnancies. In addition, an awareness raising activity was conducted in the framework of the “Merci Mon Héros (MMH)” campaign in the target districts of Abidjan. AmplifyPF provided FP services in a health center for each of Abidjan’s districts. Finally, the AmplifyPF team participated in the regular meetings set following the assessment on Social and Behavior Change of the MSHP leaders and partners organized by WABA in collaboration with the PNSME.

In Niger, the main points of collaboration during this quarter, in addition to the work completed with the MOH, were with WABA, the Ministry of Population, GHSC-FTO, HP+ and local partners. 1. MOH: In Niger, AmplifyPF participated in four meetings: (i) the RMA project tool validation workshop (reaching married adolescent girls) organized by the Directorate of Family Planning; (ii) a workshop to analyze the activities of young people in the FP action plan organized by DFP; (iii) meeting of thematic groups on offer and young adolescents (iv) meeting to set up the technical working group for the review of the Costed Implementation Plan (CIP).

2. WABA: In addition to the JSPF, 3 Community dialogues and 5 walk through visits were organized in collaboration with WABA at the ILNs of Niamey 1, Niamey 3 and Niamey 5.

3. Ministry of Population: The project team participated in a radio and television debate organized by the Ministry of Population on the impact of the COVID-19 pandemic on the demand for and access to health care for mothers and children, and particularly FP. Site walk through at the ILN of Niamey 3 organized in collaboration with WABA 4. GHSC-FTO: AmplifyPF and GHSC-FTO jointly organized the DQA training and conducted DQA surveys. More precisely, AmplifyPF provided technical support for the training of regional level managers on DQA.

5. HP+: the AmplifyPF team in Niger received advocacy support from HP+ during the preparation of the resource mobilization round table.

In Togo, the AmplifyPF team continued its work with the MOH and collaborated with DPS, WABA, GHSC-TA-FTO and Jhpiego through the following activities: 1. DPS: A working session was organized with the Prefectural Director of Health (DPS) of the Gulf following the new administrative reorganization in July 2020. This meeting was an opportunity to present the AmplifyPF project as well as its ongoing activities in the D3 ILN, including the JSPF, monthly activity monitoring, and the orientation of health workers in ISBC.

2. WABA: During this quarter we jointly conducted 2 community dialogues in the Avé and D3 ILNs. In addition, we organized 3 site walk throughs in 2 health facilities in the Avé ILN and 1 health facility in the Agoè- Nyivé. These walk throughs permitted WABA and AmplifyPF to assess the communities and as a result the community of the D3 ILN paid an amount of 1,679,500 out of the 2,229,900 promised CFA funds to repair the USP Katanga. Renovation of the USP Katanga

3. GHSC-TA-FTO: The AmplifyPF Togo team had a teleconference with the staff of the Togo team of the Global Health Supply Chain -Technical Assistance Francophone Task Order (GHSC-TA-FTO). The agenda for this meeting included the following points: (i) presentation of the two projects, (ii) avenues for collaboration and (iii) next steps. A synergy of action for the conduct of facilitative supervision was discussed and will be included in AmplifyPF Year3 action plan

4. Jhpiego: Participation in the workshop to review FP indicators and set up new FP indicators in the DHIS2.

5. EAWA: Organization of monthly monitoring of activities in the common sites.

Objective 2: Engage and leverage domestic donors and West African communities and resources to build sustainability and scale of selected HIPs (Scale & Sustainability )

SCALE & SUSTAINABILITY ACTIVITIES

Under objective 2, several scale and sustainability activities were carried out in each country.

In Burkina Faso: The AmplifyPF team participated in various meetings with partners during this period. • We continued to participate in USAID partners video conference meetings in which two new USAID funded projects (the Palladium project managed by HP+ and PREPARE Burkina Activity managed by Pathfinder International) were presented.

• A discussion was engaged with the Head Doctors of the ILNs, with the Department of Family Health (DSF), the Technical Secretariat for the Acceleration of the Demographic Transition (ST / ATD), the Health Services Quality Department (DQSS) and with the Activity Manager of AmplifyPF at USAID, to discuss national FP priorities and to collect the needs of the health facilities. Among the priorities formulated are (i) coaching women in ILNs for self- injection with DMPA-SC; (ii) training and coaching of health care providers and CHWs to delegate of FP tasks; (iii) providing health facilities with equipment for the practical implementation of HIP / FP; (iv) support to ILNs for the collection and management of FP data.

• Participation in the stakeholders’ orientation workshop on domestic resource mobilization for the procurement of contraceptive products in Burkina Faso, organized by the DSF with UNFPA funding in collaboration with the Ouagadougou Partnership. This workshop enabled the development of an action plan structured around three (3) components which are: advocacy, communication and coordination, monitoring and evaluation. The action plan will be implemented in the country to secure and supply the budget line for contraceptive product procurement.

• AmplifyPF provided technical support to DSF/MOH for the development of a budgeted plan for the continuity of essential services of RH, Maternal, Neonatal and Infant Health to be submitted to WHO for funding. This budgeted plan includes training of Boromo ILN’s frontline staff on contraceptive technology in the context of task shifting of family planning.

• Also, the AmplifyPF team participated in the dissemination of the key results of the study entitled "COVID-19 in Burkina Faso: Knowledge, attitudes and practices of populations, socio-economic impact on households and on access to health services” carried out by the Higher Institute of Public Health in collaboration with JHPIEGO. A sample of 3,524 women selected on the PMA (Performance Monitoring for Action) platform were interviewed by telephone between June 25 and July 10, 2020 regarding the impact of COVID-19 on health facility attendance. 3 out of 10 (31.2%) women declared they were afraid of contracting COVID-19 while going to health facilities; despite this only 5.8% among those who needed consultation attended a health facility. The reasons given for not using FP during this period are: (i) ffinancial barriers (for 14.6% of women surveyed), (ii) husband's opposition (10.9%) and (iii) fear of contacting the virus (6%). AmplifyPF will be able to use the results of this national coverage study for the assessment study on the Impact of the COVID-19 on FP Services in the Intervention districts of the project.

AmplifyPF through its Scale-Up Officer: • Participated in the validation of the research protocol for the implementation of DMPA-SC by self-injection in Burkina Faso. This study will be conducted by the Institute for Research in Health Sciences (IRSS) and will

facilitate a greater impact for the deployment of self-injecting DMPA-SC by exploring the capacities of the health system and the various determinants that can be barriers or facilitating elements.

• We worked closely with UNFPA and DSF to draft and finalize a work plan for AYSRH submitted to the Embassy of the Netherlands for a funding opportunity. This plan covers five regions of Burkina Faso including the Boucle du Mouhoun region which hosts the Boromo ILN. The activities that will be implemented are expected to strengthen the interventions planned by the AmplifyPF project in the ILN, especially regarding the functionality of the youth centers and the coverage of young people through schools. AmplifyPF Scale-Up Officer provided the technical lead for the work.

In Côte d’Ivoire the team conducted advocacy with the PNSME for the establishment of the PAGE committee during the technical review workshops conducted to validate the policy document for standards and protocols for maternal and child health.

Resource mobilization: • Follow-up calls and coaching allowed us to achieve the following : (i) the 5 municipalities have finalized their net- mapping (Daloa, Bouaké, Abobo, Port-Port-Bouet and Yopougon) (ii) the municipality of Daloa has held 2 resource mobilization meetings (1 with the pharmaceutical sector and the other with a group of business stakeholders) and is currently at the monitoring stage. The town halls of Bouaké and Port-Bouët have scheduled the mobilization meetings for November 2020 after the presidential elections (scheduled for October 31st 2020).

Efforts to ensure the sustainability of interventions: • We want to acknowledge the help provided by the municipalities, districts or health facilities for the provision of various meeting rooms during the CTAR meetings or trainings for the providers. In addition, the PNSME provided the project with contraceptive products for the JSPFs.

In Niger, AmplifyPF provided technical support through its Adaptation Officer in the development of a resource mobilization plan to finance the scaling up of interventions using the IMPACT2 model in Dosso. Furthermore, the team provided support to the DFP for the coordination of resource mobilization meetings for the review and development of the FP plan. Finally, we facilitated the organization of meetings with local partners of the Niamey 3 ILN and established a framework for regular meetings.

In Togo, the AmplifyPF country team participated in the national workshop to review FP indicators and set up new FP indicators in the national instance of DHIS2. Three new indicators were retained: (i) the self-injection continuity rate of Sayanna Press, proposed by Jhpiego and (ii) two indicators proposed by AmplifyPF namely (a) the proportion of women who benefited from FP in the post-abortion period and (b) the proportion of women who received FP in the immediate postpartum period. In addition, the Scale-Up Officer provided technical support to the DSMI/PF for the preparation and implementation of activities planned within the framework of the celebration of World Contraception Day in Togo.

OBJECTIVE 3: INSTITUTIONALIZE A SUSTAINABLE AND SELF-REGULATING SYSTEM OF SERVICE QUALITY ASSURANCE AND MONITORING

QUALITY ASSURANCE ACTIVITIES

Four (4) staff of the AmplifyPF Burkina Faso team were oriented by the regional project office on Family Planning Quality Improvement.

In Côte d’Ivoire we did not yet have any quality assurance support activities for the health facilities. Nevertheless, the results of the baseline assessment of the districts selected to become ILNs revealed that: (i) 35% of the 78 public health facilities visited have a Quality Assurance Committee or Team; (ii) 61.5% are without a Quality Assurance Manager and 74.4% are without a Coach (external or internal) on Quality Insurance.

In Niger we conducted DQA in 5 CSIs of the ILNs of Niamey. Furthermore, technical and financial support was provided to conduct a DQA survey in the Niamey ILNs. DHIS2 was also updated in the Niamey 1, Niamey 3, Niamey 5 and Mirriah.

The AmplifyPF Togo staff was oriented on ethics and data collection on July 27, 2020 by the Quality Assurance Officer and other members of the regional office. Furthermore, the staff was oriented on the framework to assess the impact of the COVID-19 pandemic on FP services in the AmplifyPF ILNs and the rapid analysis tools. This orientation led to the achievement of 8 interviews.

At the regional level, the self-assessment tool was finalized on the KoboToolBox platform and is available online and through an application. The Togo and Niger country teams as well as the DSF of the Ministry of Health in Niger were oriented on the 4 modules that comprise the tool.

The results of the baseline survey on quality assurance levels and activities in health facilities were synthesized in briefs (regional and country level). These results allow the monitoring of the implementation of activities related to quality assurance in the ILNs.

ACCREDITATION

The reference document has been significantly improved and is much closer to meeting the requirements of the project. It now incorporates requirements applicable to all ILN stakeholders, ensuring a more realistic assessment of the operation of the ILNs.

Two documents concerning the accreditation of ILNs (the guide and the self-evaluation checklist) have been prepared this quarter, thus allowing us to move towards the final phase of the development process, which should be completed during the regional workshop for the validation of the tools planned for Q1 of year 3.

In addition, a guidance document on the accreditation process (ILN accreditation framework) has been developed.

OBJECTIVE 4: COLLABORATION & COORDINATION: COLLABORATE AND COORDINATE WITH OTHER USAID FP/RH PARTNERS WORKING ON COMMODITY SECURITY, DEMAND CREATION, POLICY, LEARNING, AND RELATED HEALTH SYSTEMS.

REGIONAL LEVEL COLLABORATION & COORDINATION

The project has adjusted to the COVID-19 pandemic and used Visio meeting as a way to stay in touch with other RHO projects for synergies as well as with other partners and stakeholders. At regional level, the following activities have been implemented with partners this quarter: 1. Meetings with GHSC-TA-FTO for synergy in the improvement of FP commodity management in 3 of the four AmplifyPF target countries that GHSC-TA-FTO supports (Burkina Faso, Niger and Togo).

The two RHO projects organized at the regional level four (4) coordination meetings to enable (i) the country teams to share the joint activities planned or implemented and (ii) the regional teams to make recommendations for better synergy between the 2 projects in their support to countries in the implementation of the quality FP services as per RHO takeaway messages from the fiscal year 2020 joint review of work plans. The following coordination and planning recommendations were made prior to the fiscal year 2021 joint review of work plan: (i) hold weekly joint Visio meeting to review the joint monthly action plan at country level; (ii) held a bi-weekly joint Visio meeting to review country teams’ joint achievements and make recommendations at the regional level. The following are the outcomes of these meetings: • Formalize systematic monthly joint meetings to provide updates on the two projects joint achievements and discuss challenges both at country and regional levels; • Undertake joint supportive supervision visits in AmplifyPF ILNs’ health facilities in order to improve facilities’ management of FP commodities and provide quality data on stock-outs; • Each project shares with the other project its 2021 work plan before the joint review of RHO projects; • Prepare a document on joint activities to be presented during the joint review; and • Provide budget for training of health workers on logistics in the 2021 work plan of each project; • Approach WAHO to propose the possibility of sharing good practices for the commodity security in the context of COVID-19 through a webinar; • Propose themes of regional interest that could be subject of webinars during the fiscal year 2021.

Of all the seven points above, only the 2 last points weren’t implemented during this reporting period (July-August- September 2020) and will be addressed during the fiscal year 2021.

2. Meetings with Breakthrough Action/WABA AmplifyPF and WABA are working in close collaboration in the four target countries, as WABA ensures the demand creation technical aspects. Regular update meetings are organized through Visio conference and this quarter a total of three (3) meetings took place. These meetings enabled the two project teams to exchange on the ILN certification criteria, the promotion of certified sites and the collaboration of the two projects in the implementation of Quality Improvement Teams. In addition, the results of a situational analysis on provider behavior in the four target countries of AmplifyPF conducted by WABA and Camber Collective were shared with AmplifyPF country and regional teams. That analysis provided the data necessary to develop a better strategy to respond to provider bias. Through these meetings the 2 projects were able to (i) set up a technical committee to develop a community component of the collaborative improvement of the quality of FP services; (ii) Involve WABA staff in the QA / Collaborative training organized by AmplifyPF during September; and (iii) review jointly the communication tools (leaflets) on FP in the 4 AmplifyPF target countries in collaboration with each country’s MOH. AmplifyPF will ensure the printing of these leaflets in its target districts (ILNs).

3. Preparation for the RHO Implementing Partners joint review of 2021 work plans. AmplifyPF undertook three main activities before participating in the joint review meeting held by RHO via Visio conference. a. Dissemination of the protocol stabling a secretariat to coordinate RHO projects. That protocol was developed by AmplifyPF but was not approved yet. Therefore, AmplifyPF worked with the AOR to have it approved followed by its dissemination to all the RHO projects’ chiefs of Party/Directors (HP+, Breakthrough Action/WABA, GHSC-TA-FTO and EAWA). b. Preparation of the update table of achievements of RHO IPs synergy based on the 2020 work plan review synergy table. The update table informed RHO of what has been achieved in synergy by each thematic group during the course of 2020 work plans implemented by AmplifyPF, HP+, GHSC-TA-FTO, WABA and EAWA. c. Preparation of AmplifyPF presentation based on a format provided by RHO: AmplifyPF prepared the presentation, but was unable to prepare a one-minute video to present its participants as requested due to two issues: (i) its participants were more than 10 as each country teams planned to have at least 2 staff in addition to the 6 regional staff bringing it to 14 participants; (ii) the IT didn’t have the experience to develop such video. It was after the meeting that AmplifyPF video was made and shared with RHO team.

4. Participation in the RHO IPs 2021 work plans joint review meeting (September 22 to 23 ) That meeting lasted two days and involved all the Implementing Partners of RHO (AmplifyPF, WABA, HP+, GHSC-TA- FTO and EAWA) and the West Africa Health Organization, which is a RHO Partner. The following made up the agenda of the two-day meeting: (i) Opening remarks by Director of RHO; (ii) Video introduction of participants; (iii) WAHO highlights and priorities from the annual operation plan; (iv) Presentation of 2021 work plan by each Implementing Partner in the following order AmplifyPF, WABA, EAWA, HP+, GHSC-TA-FTO; (v) Welcome remarks of DG/WAHO with questions; (vi) presentations on FP/HIV integration opportunities and Best Practices; Health System Strengthening Accelerator and Fistula Care Plus project; and (vi) Closing remarks.

After the meeting, RHO shared a “domains lead table” that specifies for each of the following 8 domains, who is the lead and who is contributing actor: HP+ is lead for Policy and Domestic Resource Mobilization; AmplifyPF is lead for Task shifting in FP, Post-Partum FP and Quality Assurance; WABA is lead for Demand Creation; and GHSC-TA-FTO is lead for Commodity Security. All projects will have elements of capacity building as a transversal domain. In addition to the domains, RHO defined for each domain lead closing takeaways that need to be addressed. AmplifyPF has the following ones: • Consider monthly reporting of AmplifyPF results (PEPFARization); • Share quarterly summary report though a partner servlist (apply to all partners); • Clearly include Sayana Press scale-up activities in task shifting; • Discuss/review the purpose of the GIS mapping; • Ensure correct counselling for side effects; • Link quality FP services to increase in uptake (RHO requires more information to better understand the role of CRESAC as lead in accreditation in the region and their collaboration with WAHO); • Clarify activities as secretariat of the coordination of FP partners; • Collaborate closer with GHSC on commodity security; • Review level of effort for activities in Burkina Faso and Niger and prioritize Togo.

AmplifyPF will provide feedback to the RHO through the revised version of its 2021 work plan narrative.

SECTION 3: MONITORING, EVALUATION & LEARNING (MEL)

This section gives an overview of the performance of the ILNs supported by AmplifyPF in terms of FP service utilization and FP commodities stock-out. It also details the activities implemented by the project during the quarter to ensure high-quality data collection and reporting.

ILN Performance in terms of CYP and FP Users

The details of the performance indicators are included in Annex 1 that consists of an Excel tool that includes the performance indicator table, charts and a dashboard to visualize the data in a user-friendly way. Below is a summary of key indicators from this quarter.

Between July and September 2020, 16 ILNs out of the 17 supported by AmplifyPF1 have achieved 84,984 CYPs, recruited 24,636 new FP users and offered an FP method to 103,310 new and continuing clients who visited the facilities. As of the end of this quarter, the project achieved and even surpassed its annual targets in terms of number of CYPs, reflecting a shift toward longer acting methods as compared to the past. The achievement rate is relatively high in terms of new clients (91%) but falls below target for the total number of clients served (71%). A decrease in the use of FP services due to the COVID-19 pandemic may partially explain this low performance. Continuing clients may have chosen other means of resupply or simply may have stopped using their method. The current study on the impact of COVID-19 in FP service utilization that AmplifyPF is conducting will give more insight on these assumptions.

The performance in terms of CYP is a little bit higher, except in Niger, where only 10% of the annual target has been achieved. In the three other countries, higher percentage of the annual was achieved, surpassing the 25% benchmark in Côte d'Ivoire (35%) and just below it in Togo (23%). Burkina ILNs managed to achieve 21% of their annual target only.

There are marked differences between the countries’ performance. Togo performed well against all three indicators, surpassing 100% of targets for the number of CYPs and new users. Burkina Faso also had good performance in terms of number of CYPs and clients served. Niger performed well in terms of recruitment of new clients and number of CYPs. Côte d'Ivoire surpassed targets for CYPs with an achievement rate of 132%. In general, there is still room for improvement for the recruitment of new clients in Burkina Faso and Côte d'Ivoire and the total number of clients served in Niger and Côte d'Ivoire.

The direct contribution of AmplifyPF to those results can be measured through the contribution of the JSPF and ISBC supported by AmplifyPF to this performance. For instance, 8,624 new users of modern contraceptive methods were recruited via these two approaches: 4,529 through IBSC in Burkina, Niger and Togo, while 4,095 were through JSPF in Côte d’Ivoire and Togo.

TABLE 1: SUMMARY OF SELECTED PERFORMANCE INDICATORS IN TERMS OF CYP AND FP USERS Country Achievement during the quarter % of PY2 annual target achieved to date Number of Number of Total Number Number of Number of Total Number CYP achieved New Clients of FP users CYP achieved New Clients of FP users recruited served recruited served Burkina Faso 31,274 6,508 47,663 90% 72% 90% Côte d'Ivoire 33,001 8,095 24,711 132% 79% 74%

1 We do not report data from the Matameye ILN to avoid double account with the on-going USAID-funded project RISE implemented in the same district.

Niger 11,926 5,970 24,274 93% 122% 63% Togo 8,783 4,063 6,662 117% 143% 94% Total 84,984 24,636 103,310 102% 91% 77%

ILN Performance in terms of post-partum and post-abortion care FP uptake (PPFP and PACPF Uptake)

During this quarter, 29,972 deliveries were registered in the facilities of the 16 ILNs in Burkina Faso, Côte d'Ivoire, Niger and Togo among which 10% of the mothers received an FP method before discharge (immediate post-partum). The highest immediate PPFP uptake is recorded in Niger, as usual, (49%) and the lowest one in Cote d’Ivoire (2%). The uptake in Togo and Burkina Faso is similarly low (3%). The PPFP uptake rate is far below the annual target except in Niger, where it even surpasses it, as was the case during the previous quarters.

In contrast, the ILNs performed better in terms of PACFP with nearly 57% of the 1,060 clients who seek PAC services receiving an FP method before leaving the facilities in Burkina Faso, Togo and Côte d'Ivoire (data are not available in Niger). Burkina Faso has achieved the highest performance with 73% and Togo the lowest, just above 28%. In Côte d'Ivoire too, less than half the PAC clients received an FP method.

TABLE 2: SUMMARY OF THE ILNS PERFORMANCE IN TERMS OF PPFP AND PACFP UPTAKE Country Immediate post-partum FP Uptake FP Uptake during FP Uptake # PP Clients # PP clients % PP clients # PAC Clients # PAC Clients % PAC Clients discharged discharged discharged discharged with an FP with an FP with an FP with an FP method method method method Burkina Faso 13,988 452 3.2% 522* 380* 72.8%* Côte d'Ivoire** 8398 181 2.2% 373 173 46.4% Niger 4,475 2179 48.7% Missing Missing Missing Togo 3,111 99 3.2% 165 47 28.5% Total 29,972 2,911 9.7% 1,060 600 56.6% * Data from Boulmiougou ILN are missing ** These are data from 3 ILNs only (Port-Bouet, Daloa and Bouake). Abobo and Yopougon data are missing.

Activities to ensure collection and reporting of relevant and high-quality data

During this quarter, intensive efforts were deployed in all countries to ensure both completeness of the data collection at the facility level, completeness of reporting in DHIS2 and improved data quality as described in the previous section of the report.

In Togo, the regional office trained 12 staff (7 from the MOH, 4 from Togo country team, 1 from WABA) in DQA with theoretical and practical sessions. This helped create a bridge between the project and the person responsible for the national health management information system that will be leveraged to maintain high data quality in Togo.

In all countries, AmplifyPF staff conducted field visits to supervise implementation of project activities during which they discussed data quality issue with the facilities managers and providers. Tools to collect and report additional data not included in the national HMIS were also developed and used in the field to track: PPFP and PACFP, FP commodities stock out, JSPF and ISBC data.

During this quarter, AmplifyPF worked on assessing the impact of COVID-19 on FP service continuity by analyzing data recorded by ILNs’ facilities in the four target countries during the COVID-19 pandemic period and the corresponding period last year. The draft quanitative and qualitative reports on that assessment will be available in October 2020.

SECTION 4: IMPLEMENTATION CHALLENGES

Amidst the many activities implemented this quarter, and the successes and progress accomplished, there were some challenges that the project faced. These challenges are highlighted in the below table, along with their impact and mitigating strategies to overcome them.

TABLE 3: CHALLENGES, IMPACTS AND MITIGATION RESPONSE

Challenge Impact Mitigation Responses Burkina Faso 1 Find an approach to get The mobilization of resources by • Reinforce the coaching of Mayors and municipalities involved and municipalities should enable health General Secretaries of town halls. take leadership in resource training projects to be carried out as mobilization. part of the improvement of FP and health services in general. Côte d’Ivoire 1 Collecting good quality data at Project indicators on PPFP and • Availability of complementary data the health facilities level. PAFP are poorly informed. collection forms (PPFP/PA and ISBC/PF) to the health facilities. • Organize quarterly active data collection visits to the health facilities in the five target districts. • Monthly monitoring of health facilities by districts. 2 Collecting quality data from the The data collected cannot be used. • Support of target districts by providing districts. Failure to complete ISBC data from revised data collection tools to have health facilities of target districts. indicators on PPFP and PAFP and the establishment of a complementary sheet. • Coaching of M&E managers and SME coordinators in target districts. Niger 1 Availability of quality data Delay in data transmission and • Organization of workshops to fill in through time. insufficiency in data quality. the data in the DHIS2 and conduct the DQA in the CSIs that are having difficulties. 2 Overlap with mass campaign Delay in the implementation of • Organization of meetings with the activities. activities. ILNs to define the timing of the mass campaigns and make a schedule. Togo 1 Implementation of activities in Monitoring field activities is hindered • Establish mobile monitoring. this quarter due to COVID-19 by restrictions surrounding COVID- pandemic. 19. 2 Implementation of activities in Difficulty for municipalities to • Periodic monitoring and support to this quarter due to Covid-19 mobilize resources. municipalities for the development of pandemic. health projects.

Regional 1 The effective start of the Late establishment and involvement • Involve all stakeholders, particularly stakeholders' orientation of pre-accreditation teams in the members of the Ministry of Health, in process on the accreditation overall ILN's accreditation process. the process of developing the standard. reference system. 2 The development of the The schedule for validation, pre- • While waiting for the finalization of the electronic version of the self- testing and implementation of the electronic version of the self- assessment tool took longer tool has been affected. assessment tool, we oriented the than expected. As a result, we AmplifyPF country teams as well as were unable to validate the representatives of the Ministry of tool and conduct the pre-test in Health in Côte d'Ivoire (PNSME) and 1 ILN per country as planned. Niger (DSF) on the self-assessment tool. 3 Obtaining resources from local Non-fulfillment of resource • Reorienting resource mobilization and private partners in the mobilization commitments from the meetings to focus on FP or youth- different communes. private sector and municipalities. focused micro-projects. 4 Implementation of activities in Slowdown of activities. • Use teleworking as much as possible; this quarter due to COVID-19 • Use COVID-19 prevention measures pandemic. for all meetings.

SECTION 5: FINANCIAL BRIEF

1: EXPENDITURES

From inception to September 30, 2020, the reported expenditures represent 93% of the obligated amount and 38% of the total budget. The figures are summarized in the table below:

TABLE 4: EXPENDITURES SUMMARY

Cumulative Expenditures (Year to Date) Amount As of July, As of August, As of Remaining Line Item ($ US) 2020 2020 September, Budget 2020

Total Budget $18,499,311 $11,384,226 $6,304,922 $6,708,984 $7,115,085 Obligation $7,639,487 $524,402 % Obligation 83% 88% 93% 7% % Total Budget 34% 36% 38% 62%

The table reveals a total expenditure of $7,115,085 (38%) as September 30, 2020 with a remaining estimated amount of $11,384,226 (62%). Significant efforts were made during the reporting period to scale up activities and increase spending during COVID-19 pandemic. Moreover, the project team is planning to increase project spending during Year 3 workplan implementation to bring the current burn rate up to the targeted burn rate.

2: COST SHARE

Due to COVID-19, planned activities and action plans to be taken pertaining to cost share collection have been delayed, resulting in a setback of the project cost share reporting during the current reporting period. The actual figures are:

TABLE 5: COST SHARE SUMMARY

Line Item Total CS CS reported CS reported as Cost Share Cost Share % of CS reported as of this quarter of September commitment Remaining reported last quarter 30, 2020 (A) (B) (C) (D) (E) = (D)-(C) (F) = (C)/(D) Cost Share $516,648 $307,442 $824,090 $2,400,000 $1,575,910 34% (CS)

Pathfinder is expecting to increase its cost share contribution during Year 3 of the project due to the number of activities to be implemented jointly with one of Pathfinder platform project (IMPACT 2) as a result of the change in the project geographic coverage in Niger since AmplifyPF will be expanding its coverage to Zinder health district.

SECTION 5: COMPLIANCE

During the reporting period, AmplifyPF completed several USG compliance activities as outlined below:

TABLE 6: COMPLIANCE ACTIVITIES UNDERTAKEN DURING THE REPORTING PERIOD

Compliance Area Actions Taken During the Quarter Environment Burkina Faso • The training program for the 71 providers (21 from Boromo District, 25 from Do HD and 25 from Dafra HD) in reversible long-acting family planning methods in the postpartum and postabortion periods included a session on the appropriate disposal of medical waste. In addition, a compliance pamphlet was given to each participant. • 27 CTAR members were oriented on FP and environmental compliance and received the compliance pamphlet. • During the supervision trips to the CSPSs for the JSPFs, the USG environmental regulations were monitored by the teams. There is a lack of incinerators for the disposal of bio-medical waste in some FPs. The Bindougousso incinerator is under construction (waste is in the open air in the CSPS like in Tounouma and Colma). The MAIYA Association has just built an incinerator for the CSPS of Bolomakoté in the HD of Dafra. For the other HFs, AmplifyPF had discussions with the managers of the town halls to find corrective solutions while waiting for the construction of the incinerators. Côte d’Ivoire • During the training provided to the 179 health care providers we raised awareness on the proper disposal of medical waste • The 14 health facilities that hosted the JSPFs this quarter have adequate procedures and capacity to properly handle medical waste. • USG's environmental regulations during the JSPF (hygiene, waste, etc.) were followed. We distributed hand gels, bleach, glove kits and garbage bags to health care providers. Niger • 100 health workers from public and private health facilities were oriented on compliance and USG requirements. • During this quarter 32 health facilities were supervised in the Mirriah et Niamey 5 ILNs. Togo • 30 providers were trained, during REDI counseling trainings, on environmental compliance. • 152 non-FP service providers were oriented on environmental compliance during the ISBC approach orientation. • During the CTAR meeting in Agoe-Nyive and Ave, 31 participants were briefed on USG environmental compliance. • The USG's environmental regulations were followed during the JSPF supervision. • During the JSPFs, the project financially supports the purchase of consumables (single- use syringes, gloves, compresses, etc.). It ensures the proper disposal of waste generated by clinical services.

Family Planning & Burkina Faso Protecting Life in • A total of 263 people were oriented during the trainings (ISBC, on the MLDA and DMPA-SC). Global Health Each participant left with a leaflet on FP compliance. Assistance • The Tiahrt posters were displayed in the joint intervention sites of the EAWA/AmplifyPF project. • 71 health workers trained on PFPP were oriented on FP/PLGHA compliance. • During this quarter, the AmplifyPF project purchased medico-technical equipment for the health facilities in the target ILNs. Steps have been taken to ensure compliance with USG requirements in terms of FP/PLGHA compliance Côte d’Ivoire • 179 providers received an orientation on FP/PLGHA during each of the nine training sessions on PPFP and PAFP (40 in Abobo Ouest, 21 in Port-Bouet-Vridi, 38 in Yopougon Ouest-Songon, 40 in Daloa and 40 in Bouake North West). • During this quarter, the attendance lists of health providers trained in FP compliance, as well as the lists of CTAR members from Abobo-Ouest, Daloa and Bouaké-Nord Ouest who have been trained, have been added to the country file on compliance. • During the supervision of the Port-Bouet-Vridi district we noticed that Tiahrt posters were displayed in the consultation rooms. . Niger • 153 providers were trained on compliance and US FP requirements.

Togo • 30 providers were trained, during REDI counseling trainings, USG’s FP/PLGHA compliance. • 152 non-FP service providers were oriented on FP/PLGHA compliance during the ISBC approach orientation. • During the CTAR meeting in Agoe-Nyive and Ave, 31 participants were briefed on USG FP/PLGHA compliance. • During the JSPF, the providers were trained on the FP/PLGHA compliance requirements • Tiahrt posters were distributed in the 2 regional directorates and the 3 directorates of the intervention districts and all health facilities

Trafficking in Persons • No specific activities beyond regular monitoring by all local compliance officers in each country.

SECTION 6: UPCOMING ACTIVITIES With the reported slowdown in new COVID-19 cases in most AmplifyPF target countries, an “acceleration” plan has been developed for the next quarter in order to address the backlog and implement the postponed activities. The activities are described in the table below.

TABLE 7: PLANNED ACTIVITIES Q1 PY3 (OCTOBER-DECEMBER 2020)

Year3 Fisrt Quarter (Q1) Implementation Table (October to December 2020 Objectives, Intermediate Results and Activities and syub-activities Oct Nov Dec Objective 1: Replication: Strengthen and institutionalize a system for adaptation and replication of key FP High Impact Practices (HIPs) Intermediate Result 1.1: Integrated Learning Networks (ILNs) (17) established in four target countries Set up of new ILNs in Togo Identify new districts in Togo to introduce ILN model Orient new districts staff and stakeholders on the project Support the establishment of Togo's new ILNs Technical Support Committees (CTAR) Conduct the mapping (Net-Map) of stakeholders and their interrelationships and potential resources to support the implementation of HIPs in the new ILNs of Togo with support from the Regional Office Support each Togo new ILNs to develop the various action plans of each ILN (District Plan, CTAR Plan, Municipality Plan and Communication Plan) Support the functioning of ILN Technical Support Committees (CTAR) in the 4 countries Intermediate Result 1.2: ILNs serve as adaptive learning incubators for replicating HIPs Develop capacity of districts selected to be ILNs Provide equipment and IPC materials to selected Health Facilities of the new ILNs in Togo Support the integration of FP-SRMNIA-Nut into Mirriah and Zinder commune ILNs in Niger - Strengthening the skills of providers and CHWs in SRMNIA-Nut-FP - Strengthening nutrition and delivery services in equipment and equipment Support the systematic use of the "Identification Systematique des Besoins de la Cliente (ISBC)" approach through the use of the tool for identifying FP integration opportunities Support the strengthening of provider skills in PPFP and PAFP Support the strengthening of provider skills specific to informed choice counseling and the management of contraceptive side effects Support the strengthening of provider skills in the Youth approach Support the strengthening of provider skills in contraceptive logistics management Support the implementation of the initiative "Young RH / FP champions at ILN level" through young ambassadors of RH / FP, young parliamentarians, national youth organizations and implementing partners as well as other projects in each country - Meeting with young people, identifying and setting up JCSR/PF, and training JCSR/PF and RJASR - Organizing educational talks - Organizing 3 conferences - Organising outreach activities for out-of-school and in school youth - Organizing Digital communication campaign - Providing Free consultations for adolescents and youth in sexual and reproductive health - Monitoring, Coordinating and Documenting the activities of the JCSR/PF initiative Strengthen teen pregnancy prevention programmes in collaboration with municipalities in the 4 countries (Youth Activities) Support the intensification of the FP service delivery through the scaling up of DMPA-SC (Sayana Press) in the ILNs and through ad-hoc and outreach activities - Orient providers on the administration of the product to clients and on coaching clients for self-injection - Orient C HWs on the administration of the product to clients and on coaching clients for self-injection - Organize FP Special Days and World Contraception Day, etc.) - Orgnize community mobilization and Community Based Distribution of FP services (including Sayana Press) through CHWs Strengthening demand creation through collaboration with WABA in the 4 target countries to ensure saturation with complete information Multiply and disseminate communication tools developed in collaboration with WABA for demand creation in FP services at the ILN levels Continue the assessment of the impact of COVID-19 on the continuity of FP services Monitor the implementation of interventions (monthly monitoring of the ISBC, stock-outs, PPFP and PAFP) Follow up closely on project documentation via TEAMS Intermediate Result 1.3: HIP working groups at the country level established to support ILNs' scale-up of HIPs Support the operation/functionning of the HIP Scale Up Committees in project target countries (regular meetings) Support the establishment of HIP Scale Up Committee in Côte d'Ivoire in collaboration with WAHO 27 Intermediate Result 1.4 Establish a system of strategic adaptation in collaboration with key partners to replicate the ILN model outside of project intervention areas Establish memoranda of understanding or other agreements with organizations, projects and networks to formalize collaboration to replicate ILNs outside of project intervention areas Provide targeted technical assistance to districts / organizations wishing to replicate the ILN model as needed Objective 2: Scale & Sustainability: Engage and leverage domestic, donor, and West African communities and resources to build sustainability and scale of selected HIPs Intermediate Result 2.1: Institutionalize activities for country-level scale-up of ILNs Support the revision, multiplication and dissemination of normative documents related to HIPs as needed Intermediate Result 2.2: Institutionalize activities for regional-level scale-up of ILNs Intermediate Result 2.3: Leverage existing networks of programs Intermediate Result 2.4: Leverage and mobilize resources from municipalities and private sector Strengthen the capacity of ILN municipality officials to mobilize internal and external resources to support ILNs and to develop a resource mobilization plan Coach ILN municipalities to develop and implement FP resource mobilization plans Support municipalities to organize meetings for private sector resource mobilization in ILNs Follow-up of the implementation of resource mobilization plans by the municipalities of the ILNs on a bi-annual basis Have the municipalities adopt the accountability charter Objective 3: Quality Assurance: Institutionalize a sustainable and self-regulating system of quality assurance (QA) and monitoring Intermediate Result 3.1: Develop QA tools for ILN-level monitoring of HIP implementation Follow up on DQAs conducted by AmplifyPF country teams Monitor the quality of HIP implementation (including the quality of data through DQA) Intermediate Result 3.2: Establish a national-level QA certifying authority Support set up of Quality Improvement Teams (QITs) in the 4 countries with WABA (1 support per country) - Identifying health facilities eligible to set up QIT - Training of QIT nuclei and QA coaches - Installing Officially the QIT Follow up the functionality of Quality Improvement Teams (QITs) with WABA Validate the quarterly self-assessments of each ILN and provide feedback to CTAR Intermediate Result 3.3: Establish a regional-level QA accreditation body / system Improve with the project regional team inputs, the « draft 1 » of the accreditation rerentiel and the « draft 0 » of the guide and the list of seef-evaluation of the referentiel for ILNs accreditation Present the « draft 2 » (of the referential for ILN accréditation and the « draft 1 » of the guide aand list of self-evaluation to the the project regional team and to the each target country team via visio conference Finalize the referentiel of ILN accreditation and the guide a dn the list of self-evaluation with inputs from participants to the presentation sessions. Objective 4: Collaboration & Coordination: Collaborate and coordinate with other USAID FP / RH partners working on commodity security, demand creation, policy, learning, and related health systems Intermediate Result 4.1: Coordinate support from USG projects to achieve Amplify-FP goals at the national level and in the region Orient new USAID projects on the AmplifyPF project (goal, objectives, approach and expected results) Intermediate Result 4.2: Convene regional FP / RH forums Develop Domain Lead table with Synergy Actions and share with RHO/ USAID Implementing Partners (IPs) Organize quarterly quarterly visio meeting with RHO/USAID Implementing Partners and RHO Organize a regional meeting of RHO/USAID's IPs on a topic of common interest (satelite meeting or stand alone meeting) Participate in regional / international meetings on FP / RH (RAPO, IBP forum, ECOWAS parliamentary meeting on health financing) Intermediate Result 4.3: Develop a GIS-based mapping of HIPs for the region Identify / Map all the projects and partners intervening in the field of FP / RH in each target country using a template agreed with the Ouagadougou Partnership Coordination Unit Complete the Etri Labs online questionnaire by each country team to facilitate the update of the OP site Present the OP website at each wisdespread scale-up (PAGE) Committee meeting by each Scale-Up Officer Year3 Fisrt Quarter (Q1) Implementation Table (October to December 2020 Objectives, Intermediate Results and Activities and syub-activities Oct Nov Dec Objective 1: Replication: Strengthen and institutionalize a system for adaptation and replication of key FP High Impact Practices (HIPs) Intermediate Result 1.1: Integrated Learning Networks (ILNs) (17) established in four target countries Set up of new ILNs in Togo Identify new districts in Togo to introduce ILN model Orient new districts staff and stakeholders on the project Support the establishment of Togo's new ILNs Technical Support Committees (CTAR) Conduct the mapping (Net-Map) of stakeholders and their interrelationships and potential resources to support the implementation of HIPs in the new ILNs of Togo with support from the Regional Office Support each Togo new ILNs to develop the various action plans of each ILN (District Plan, CTAR Plan, Municipality Plan and Communication Plan) Support the functioning of ILN Technical Support Committees (CTAR) in the 4 countries Intermediate Result 1.2: ILNs serve as adaptive learning incubators for replicating HIPs Develop capacity of districts selected to be ILNs Provide equipment and IPC materials to selected Health Facilities of the new ILNs in Togo Support the integration of FP-SRMNIA-Nut into Mirriah and Zinder commune ILNs in Niger - Strengthening the skills of providers and CHWs in SRMNIA-Nut-FP - Strengthening nutrition and delivery services in equipment and equipment Support the systematic use of the "Identification Systematique des Besoins de la Cliente (ISBC)" approach through the use of the tool for identifying FP integration opportunities Support the strengthening of provider skills in PPFP and PAFP Support the strengthening of provider skills specific to informed choice counseling and the management of contraceptive side effects Support the strengthening of provider skills in the Youth approach Support the strengthening of provider skills in contraceptive logistics management Support the implementation of the initiative "Young RH / FP champions at ILN level" through young ambassadors of RH / FP, young parliamentarians, national youth organizations and implementing partners as well as other projects in each country - Meeting with young people, identifying and setting up JCSR/PF, and training JCSR/PF and RJASR - Organizing educational talks - Organizing 3 conferences - Organising outreach activities for out-of-school and in school youth - Organizing Digital communication campaign - Providing Free consultations for adolescents and youth in sexual and reproductive health - Monitoring, Coordinating and Documenting the activities of the JCSR/PF initiative Strengthen teen pregnancy prevention programmes in collaboration with municipalities in the 4 countries (Youth Activities) Support the intensification of the FP service delivery through the scaling up of DMPA-SC (Sayana Press) in the ILNs and through ad-hoc and outreach activities - Orient providers on the administration of the product to clients and on coaching clients for self-injection - Orient C HWs on the administration of the product to clients and on coaching clients for self-injection - Organize FP Special Days and World Contraception Day, etc.) - Orgnize community mobilization and Community Based Distribution of FP services (including Sayana Press) through CHWs Strengthening demand creation through collaboration with WABA in the 4 target countries to ensure saturation with complete information Multiply and disseminate communication tools developed in collaboration with WABA for demand creation in FP services at the ILN levels Continue the assessment of the impact of COVID-19 on the continuity of FP services Monitor the implementation of interventions (monthly monitoring of the ISBC, stock-outs, PPFP and PAFP) Follow up closely on project documentation via TEAMS Intermediate Result 1.3: HIP working groups at the country level established to support ILNs' scale-up of HIPs Support the operation/functionning of the HIP Scale Up Committees in project target countries (regular meetings) Support the establishment of HIP Scale Up Committee in Côte d'Ivoire in collaboration with WAHO Intermediate Result 1.4 Establish a system of strategic adaptation in collaboration with key partners to replicate the ILN model outside of project intervention areas Establish memoranda of understanding or other agreements with organizations, projects and networks to formalize collaboration to replicate ILNs outside of project intervention areas Provide targeted technical assistance to districts / organizations wishing to replicate the ILN model as needed Objective 2: Scale & Sustainability: Engage and leverage domestic, donor, and West African communities and resources to build sustainability and scale of selected HIPs Intermediate Result 2.1: Institutionalize activities for country-level scale-up of ILNs Support the revision, multiplication and dissemination of normative documents related to HIPs as needed Intermediate Result 2.2: Institutionalize activities for regional-level scale-up of ILNs Intermediate Result 2.3: Leverage existing networks of programs Intermediate Result 2.4: Leverage and mobilize resources from municipalities and private sector Strengthen the capacity of ILN municipality officials to mobilize internal and external resources to support ILNs and to develop a resource mobilization plan Coach ILN municipalities to develop and implement FP resource mobilization plans Support municipalities to organize meetings for private sector resource mobilization in ILNs Follow-up of the implementation of resource mobilization plans by the municipalities of the ILNs on a bi-annual basis Have the municipalities adopt the accountability charter Objective 3: Quality Assurance: Institutionalize a sustainable and self-regulating system of quality assurance (QA) and monitoring Intermediate Result 3.1: Develop QA tools for ILN-level monitoring of HIP implementation Follow up on DQAs conducted by AmplifyPF country teams Monitor the quality of HIP implementation (including the quality of data through DQA) Intermediate Result 3.2: Establish a national-level QA certifying authority Support set up of Quality Improvement Teams (QITs) in the 4 countries with WABA (1 support per country) - Identifying health facilities eligible to set up QIT - Training of QIT nuclei and QA coaches - Installing Officially the QIT Follow up the functionality of Quality Improvement Teams (QITs) with WABA Validate the quarterly self-assessments of each ILN and provide feedback to CTAR Intermediate Result 3.3: Establish a regional-level QA accreditation body / system Improve with the project regional team inputs, the « draft 1 » of the accreditation rerentiel and the « draft 0 » of the guide and the list of seef-evaluation of the referentiel for ILNs accreditation Present the « draft 2 » (of the referential for ILN accréditation and the « draft 1 » of the guide aand list of self-evaluation to the the project regional team and to the each target country team via visio conference Finalize the referentiel of ILN accreditation and the guide a dn the list of self-evaluation with inputs from participants to the presentation sessions. Objective 4: Collaboration & Coordination: Collaborate and coordinate with other USAID FP / RH partners working on commodity security, demand creation, policy, learning, and related health systems Intermediate Result 4.1: Coordinate support from USG projects to achieve Amplify-FP goals at the national level and in the region Orient new USAID projects on the AmplifyPF project (goal, objectives, approach and expected results) Intermediate Result 4.2: Convene regional FP / RH forums Develop Domain Lead table with Synergy Actions and share with RHO/ USAID Implementing Partners (IPs) Organize quarterly quarterly visio meeting with RHO/USAID Implementing Partners and RHO Organize a regional meeting of RHO/USAID's IPs on a topic of common interest (satelite meeting or stand alone meeting) Participate in regional / international meetings on FP / RH (RAPO, IBP forum, ECOWAS parliamentary meeting on health financing) Intermediate Result 4.3: Develop a GIS-based mapping of HIPs for the region Identify / Map all the projects and partners intervening in the field of FP / RH in each target country using a template agreed with the Ouagadougou Partnership Coordination Unit Complete the Etri Labs online questionnaire by each country team to facilitate the update of the OP site Present the OP website at each wisdespread scale-up (PAGE) Committee meeting by each Scale-Up Officer

ANNEXES

1. Updated performance indicators table 2. Dashboard 3. AmplifyPF Core Package Contribution