USAID/SENEGAL HEALTH PROGRAM 2016–2021 USAID/NEEMA INTEGRATED SERVICE DELIVERY AND HEALTHY BEHAVIORS
Quarterly Activity Report January 1–March 31, 2019
USAID/Neema Quarter Report - January 1–March 31, 2019
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The “USAID/Neema” Project is an instrument of the USAID Health Program in Senegal for 2016–2021.
Cooperative Agreement No.: AID-685-A-16-00004
Project Dates: September 1, 2016–August 31, 2021
Submitted to USAID/Senegal by: IntraHealth International
Senegal Country Office
Dakar, Senegal
Email: [email protected]
“USAID/Neema” project IntraHealth International/Senegal
Cité Keur Gorgui, Immeuble El Hadji Bara Fall
Dakar, Senegal
Tel.: (221) 33 869 74 94
Fax: (221) 33 825 65 23
This document was prepared with the support of the American people through the United States Agency for International Development (USAID). The contents are the sole responsibility of IntraHealth International/Senegal and do not necessarily reflect the views of USAID or the United States Government.
USAID/Neema Quarter Report - January 1–March 31, 2019
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LIST OF ABBREVIATIONS AND ACRONYMS ACPP CHANGE, PROMOTION, AND ASSESSMENT AGENT
AMTSL ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOR
ANC ANTENATAL CARE ANCS NATIONAL ALLIANCE OF COMMUNITIES FOR HEALTH
AYRH ADOLESCENT AND YOUTH REPRODUCTIVE HEALTH
AYSRH ADOLESCENT AND YOUTH SEXUAL AND REPRODUCTIVE HEALTH
BMWM BIOMEDICAL WASTE MANAGEMENT
BREIPS REGIONAL BUREAU OF HEALTH EDUCATION AND INFORMATION SERVICE
CAC/GBV COMMUNITY ACTION CYCLE ON GENDER-BASED VIOLENCE
CBO COMMUNITY-BASED ORGANIZATION
CCA ADOLESCENT COUNSELING CENTER
CDS HEALTH DEVELOPMENT COMMITTEE
CHA COMMUNITY HEALTH AGENT
CNLS NATIONAL AIDS COUNCIL
COP CHIEF OF PARTY
CREN NUTRITIONAL RECOVERY AND EDUCATION CENTER
CSC COMMUNITY HEALTH UNIT
DHIS-2 DISTRICT HEALTH INFORMATION SYSTEM-2
DLSI DIVISION OF AIDS/STI CONTROL
DRH DEPARTMENT OF HUMAN RESOURCES
DSME DEPARTMENT OF MATERNAL AND CHILD HEALTH
ECD DISTRICT MEDICAL TEAM
ECR REGIONAL MEDICAL TEAM
FP FAMILY PLANNING
GBV GENDER-BASED VIOLENCE
HD HEALTH DISTRICT
HP HEALTH POST
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HSS+ HEALTH SYSTEM IMPROVEMENT PLUS
HWS HAND-WASHING STATION
ICP HEAD NURSE
iCVAC INTEGRATED COMMUNITY WATCH COMMITTEE
IDU INJECTION DRUG USER
IMCI INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES
IMU INTEGRATED MOBILE UNIT
IPT INTERMITTENT PREVENTIVE THERAPY
ISD-HB INTEGRATED SERVICE DELIVERY & HEALTHLY BEHAVIORS
ISM INFORMATION SYSTEM FOR MANAGEMENT
IYCF INFANT AND YOUNG CHILD FEEDING
JHU/CCP JOHNS HOPKINS UNIVERSITY/CENTER FOR COMMUNICATION PROGRAMS
LLITN LONG-LASTING INSECTICIDE-TREATED BEDNET
MCD CHIEF DISTRICT MEDICAL OFFICER
MCR CHIEF REGIONAL MEDICAL OFFICER
MDSR MATERNAL DEATH SURVEILLANCE AND RESPONSE
MNCH MATERNAL, NEWBORN, AND CHILD HEALTH
MR MEDICAL REGION
MSAS MINISTRY OF HEALTH AND SOCIAL ACTION
MSM MEN WHO HAVE SEX WITH MEN
NGO NON-GOVERNMENTAL ORGANIZATION
PIPE INFECTION PREVENTION AND ENVIRONMENTAL PROTECTION
PLHIV PEOPLE LIVING WITH HIV
PMP PERFORMANCE MONITORING PLAN
PNA NATIONAL PROCUREMENT PHARMACY
PNC POSTNATAL CARE
PNLP NATIONAL MALARIA CONTROL PROGRAM
PPFP POST-PARTUM FAMILY PLANNING
PRA REGIONAL PROCUREMENT PHARMACY
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PSNSC NATIONAL COMMUNITY HEALTH STRATEGIC PLAN
PSP POLICIES, STANDARDS, AND PROTOCOLS
RB REGIONAL BUREAU
RH REPRODUCTIVE HEALTH
SAACAJ POST-ABORTION CARE FOR ADOLESCENTS AND YOUTHS
SBCC SOCIAL AND BEHAVIOR CHANGE COMMUNICATION
SDP SERVICE DELIVERY POINT
SFE STATE REGISTERED MIDWIFE
SNEIPS NATIONAL EDUCATION AND HEALTH INFORMATION SERVICE
SW SEX WORKER
TOP TATARSEN OPERATIONAL PLAN
VADI INTEGRATED HOME VISIT
VCT VOLUNTARY HIV COUNSELING AND TESTING
WASH WATER, SANITATION, AND HYGIENE
WISN WORKLOAD INDICATORS OF STAFFING NEED
USAID/Neema Quarter Report - January 1–March 31, 2019
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Table of Contents
List of Abbreviations and Acronyms ...... 3
1. Project Overview ...... 8 1.1. Summary Table ...... 8 1.2. Project Description ...... 9 Introduction ...... 9
Background ...... 9
USAID/Neema project objectives and strategies ...... 10 2. Executive Summary of Quarter Report ...... 10
3. Achievements this quarter ...... 11 3.1. Progress on challenges identified last quarter ...... 11 3.2. Achievements this quarter by sub-component ...... 12 Objective 1: Increased access to and utilization of quality health services and products in the public sector ...... 12 Objective 2: Increased adoption of healthy behaviors ...... 33
Monitoring & Evaluation, Research, and Learning...... 36
Project management and coordination ...... 39 UNPLANNED ACTIVITIES ...... 42 MAIN CHALLENGES AND SOLUTIONS ...... 43 4. Cross-cutting issues ...... 44 Gender mainstreaming ...... 44 Compliance with environmental regulations ...... 44 Compliance with family planning legislation and regulations ...... 45 5. Main activities planned for next quarter ...... 46
6. Annexes ...... 47 Annex 1: Progress on Work Plan/Indicators ...... 48 Annex 2: Financial Report ...... 54 Annex 3: Tutorat 3.0 implementation in intervention health districts and medical regions ...... 55 Annex 4: List of medical equipment and supplies for new health posts ...... 57 Annex 5: Status of community-based AYRH package ...... 58 Annex 6: Status of the VADI approach ...... 58 Annex 7: Summary of results of integrated mobile unit implementation ...... 59 Annex 8: PIPE supplies provided to districts in the 7 concentration regions ...... 60 Annex 9: Summary of the screening campaign ...... 61 USAID/Neema Quarter Report - January 1–March 31, 2019
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Annex 10: Summary of CBO activity ...... 62 Annex 11: Success story ...... 63
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1. PROJECT OVERVIEW
1.1. SUMMARY TABLE
Project name: USAID/Neema
Integrated Service Delivery and Healthy Behaviors (ISD-HB)
Project Dates: September 1, 2016–August 31, 2021
Name of Implementing Partner: IntraHealth International
Cooperative Agreement No.: AID-685-A-16-00004
Name of AOR: Fatou Ndiaye
Name of Subcontractors or Consortium National Alliance of Communities for Health (ANCS) Members: ChildFund Helen Keller International ideas42 Johns Hopkins University/Center for Communication Programs (JHU/CCP) Réseau Siggil Jigéen (RSJ)
Geographic coverage (by regions): USAID Health Program Concentration Regions: Diourbel – Kédougou – Kolda – Matam – Saint Louis – Sédhiou – Tambacounda Additional regions with HIV/AIDS hot spots: Dakar, Mbour, Ziguinchor
Reporting period: January1–March 31, 2019
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1.2. PROJECT DESCRIPTION
INTRODUCTION
The Integrated Service Delivery and Healthy Behaviors (ISD-HB) project, called “USAID/Neema,” supports the efforts of the Government of Senegal to ensure health services are sustainably improved and effectively utilized to reduce maternal, neonatal, and child mortality and morbidity and contribute to an AIDS-free generation.
The project is implemented in the USAID Health Program 2016– 2021 regions of concentration: Diourbel, Kédougou, Kolda, Matam, Saint Louis, Sédhiou, and Tambacounda. In its third year, HIV/AIDS hot spots the project is also supporting implementation of the “Test, Treat, and Retain in Senegal (TATARSEN)” approach in hot spots in Dakar, Mbour, and Ziguinchor.
The ISD-HB project is implemented by IntraHealth in partnership with the National Alliance of Communities for Health (ANCS), Réseau Siggil Jigéen, ChildFund, Helen Keller International (HKI), Johns Hopkins University/Center for Communication Programs (JHU/CCP), and ideas42.
BACKGROUND
Senegal has made notable achievements in health, especially in maternal, newborn, and child health and family planning (MNCH/FP) over the last two decades. It is one of the highest performing countries in reducing mortality for children under 5 years (among infants and children) in Africa, and the prevalence rate for modern contraception has nearly doubled since 2010, increasing from 12%1 to 21%2 in 2015. These efforts are the result of the Senegalese government’s strong commitment to promote health-sector accountability through policies, strategies, and plans committed to reproductive health (RH) and MNCH/FP, HIV and malaria control, and nutrition.
Despite this progress, challenges remain. These include the unequal use of high-impact interventions aimed at reducing maternal and newborn mortality and their extension at the institutional level, ongoing stockouts of essential medicines and commodities, delayed recourse to health care, geographic barriers hindering
1DHS-MICS 2010–2011 2C-DHS 2015 USAID/Neema Quarter Report - January 1–March 31, 2019
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Also, significant disparities persist in terms of gender and at the regional level. The Government of Senegal has an unprecedented opportunity to overcome these challenges and achieve its vision outlined in the Plan for an Emerging Senegal (Plan Sénégal Émergent; PSE) through the USAID/Neema project of the USAID Health Program.
USAID/NEEMA PROJECT OBJECTIVES AND STRATEGIES
The USAID/Neema project’s main objectives by 2021 are:
• Increased access to and utilization of quality health services and products in the public sector • Increased adoption of healthy behaviors
2. EXECUTIVE SUMMARY OF QUARTER REPORT
This report presents key achievements reported for USAID/Neema project implementation from January to March 2019. Achievements mainly revolve around these activities:
- Continued implementation of Tutorat 3.0 - Actual launch of integrated mobile units (IMUs) with visits in all of the 4 selected regions (Diourbel, Kolda, Saint Louis, and Sédhiou) - Celebration of International Women’s Day on March 8 in all intervention regions and at the central level - Support for community groups to prepare and use fortified flour - Installation of hand-washing stations (HWSs) - Adolescent and youth reproductive health (AYRH), specifically focusing on raising awareness about violence in school settings - Implementation of the community action cycle on gender-based violence (CAC/GBV) strategy and enrollment of new community facilities in the service packages - Continuation of communication activities with media spots and awareness-raising sessions led by community-based organizations (CBOs) through group discussions and integrated home visits (VADIs) - Coordination, planning, and management of project interventions
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3. ACHIEVEMENTS THIS QUARTER
3.1. PROGRESS ON CHALLENGES IDENTIFIED LAST QUARTER
Challenges identified last Solutions implemented this Lessons learned and observations quarter quarter
2) Establishment of a central-level working group for institutionalization, incorporating the Directorate General of Social Action, the Private Sector Health Alliance (Alliance du Secteur 1) 3 meetings held with the Privé de la Santé; ASPS), the National Directorate General of Health Procurement Pharmacy (PNA), the Institutionalization of Tutorat Services to share Tutorat 3.0 Global Health Supply Chain/Task Order, documents and results of the the National School of Health and Social various Tutorat stages Development, and National Nosocomial Infections Control Program 3) 4) Utilization of training institutes in the institutionalization process
Standardization of funding to A meeting of various partners helped implement integrated Integration processes and intervention regions and partners community watch committee implementation tools shared with define the enrollment plans and (iCVAC) activities in districts all stakeholders implementation methods by the various partners
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3.2. ACHIEVEMENTS THIS QUARTER BY SUB-COMPONENT
OBJECTIVE 1: INCREASED ACCESS TO AND UTILIZATION OF QUALITY HEALTH SERVICES AND PRODUCTS IN THE PUBLIC SECTOR
SUB-OBJECTIVE 1.1: INCREASED COVERAGE AND UTILIZATION OF EVIDENCE-BASED, SUSTAINABLE, HIGH-IMPACT INTERVENTIONS IN HOUSEHOLDS AND HEALTH FACILITIES
Activities planned for the quarter Achievements: Implementation status Outputs or outcomes achieved
SCALE UP A PACKAGE OF HIGH-IMPACT MATERNAL, NEWBORN, AND CHILD HEALTH PRACTICES IN SERVICE DELIVERY POINTS (SDPS) BASED ON LESSONS LEARNED
The project supported the Ministry of Health - A memorandum establishing a central-level working group to and Social Action (MSAS) to establish the oversee the institutionalization process was proposed. institutionalization process for the Tutorat - Major steps for the institutionalization process were
3.0 approach proposed.
127 (SDPs) were visited by tutors in 18 districts.
1st Visit
All 6 packages were covered in an initial visit, or 97 SDPs visited
and 182 qualified providers (including 92 women) coached
overall. 221 community health agents (CHAs) (including 128 Support on-site coaching of providers by women) were coached. Tutorat 3.0 implementation tutors in the regions of Diourbel, Kédougou, 2nd Visit Kolda, Saint Louis, Sédhiou, and All 6 packages were covered in a second visit, with 30 SDPs Tambacounda visited and 77 qualified providers (including 61 women) coached overall. Also, 18 CHAs were coached. Overall, 198 SDPs (38%) received at least one package for the first on-site coaching visit and 62 SDPs received both visits. (Details in Annex 3)
Support for tutor training in Bambey and 23 new tutors (including 15 women) were trained. Diourbel districts
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116 tutors were monitored. Strengths: District medical team (ECD) and regional medical team (ECR) members’ commitment evident through their active participation; Interest expressed for on-site supervision by providers and other coached actors; Involvement of health-post Support for monitoring and supervision of actors (head nurses (ICPs), health committee members, and tutors in Diourbel, Kédougou, Kolda, Saint representatives of local municipalities) through tutor meetings Louis, and Tambacounda regions to discuss and share outcomes. Areas for improvement: Some shortcomings noted in the activity’s preparatory stage; Frequent stockouts of management tools (attendance sheets, on-site supervision sheets). Recommendations have been drawn up for districts to address these shortcomings.
- Technical support to train 53 trainers in universal coverage/long-lasting insecticide-treated bednets (LLITNs) in Support for malaria control acceleration Diourbel plans in the regions of Diourbel and Saint - Technical support for the quarterly review by priority in Louis districts, medical regions, and the Regional Procurement Pharmacy (PRA) in Diourbel and Saint Louis
- IPT plans were evaluated and updated in the 9 districts in Support for the intermittent preventive Kédougou, Kolda, and Sédhiou regions Support for malaria control therapy (IPT) stimulus plan in Kolda, - 1 supervision visit/documentation of community-based IPT Sédhiou, Kédougou, Matam, and Saint Louis conducted in Médina Yoro Foulah and Goudomp districts regions - 45 IPT buckets distributed in Matam and Saint Louis regions
-20 providers (including 10 women) and 5 distributors from 13 Post-training follow-up for providers from SDPs received post-training follow-up. These findings were Koumpentoum district in Tambacounda reported: medical region (MR) o No posters of the new treatment flowchart in consultation rooms
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o No ministerial memorandum about the new guidelines for the management of malaria in many SDPs o Providers often fail to check if pregnant women have allergies to sulfonamides during antenatal care (ANC) Recommendations were made to address these shortcomings.
- 15 health facilities—including 3 hospitals, 7 health centers, and 5 health posts (HPs)—were visited. - 29 state registered midwives (SFEs) were reached. The following recommendations were made: ❖ Strengthen communication activities at SDP level (group Support for post-training follow-up for discussions and interpersonal communication on PPFP) providers trained in post-partum family ❖ Strengthen equipment in health posts and health centers planning (PPFP) in Diourbel MR through grant deliverables ❖ Steer package-2 tutors toward sites with gaps in PPFP training and managing the FP file ❖ Implement and use the new registers and fill in columns designated for PPFP delivery data
Support to collect data and monitor Family planning implementation of post-abortion care for adolescents and youths (SAACAJ) in 3 pilot - 100% completion rate for January and February in the 3 sites. The sites (Mbacké health center, Ndamatou percentage of post-abortion FP consultations is 62%, or a 46- Hospital (Touba), and Matlaboul Fawzaini percentage-point increase compared to the baseline (16%) National Hospital (Touba))
Support for a mid-term evaluation of the - The evaluation report is being finalized for sharing with the MR SAACAJ intervention at the 3 intervention and the Department of Maternal and Child Health (DSME) sites
Support for a workshop to finalize tools for The following drafts have been produced and are being self-injecting, subcutaneous Depo-Provera validated: at community level - Community-level implementation guide
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- Trainer guide for clients - Aide-mémoire for community actors
Support for the DSME for a meeting to finalize the terms of reference (ToRs) for the ToRs for the consultant to develop the guide on managing consultant who will develop the guide on Maternal and newborn health emergency obstetric care are available. managing emergency obstetric care and to ToRs to complete the EmONC curriculum are available. finalize the emergency obstetric and neonatal care (EmONC) curriculum
5 groups of community agents visited and 30 individuals reached (including 26 women). Mission to monitor and identify community- Overall, 837.5 kg of flour have been produced. agent groups working with fortified flour in 49 children with moderate acute malnutrition, 199 pregnant Koumpentoum health district (HD) women, 130 breastfeeding women, and 104 other individuals received nutritional support from the Koumpentoum group, which produced 287.5 kg of flour. Nutrition
Support the DSME to develop flowcharts on The infographic is being completed. infant and young child feeding (IYCF)
Technical support for the Division of Food and Nutrition to train a pool of trainers on 21 people have received IYCF training. IYCF
45 CREN providers who are trained on PECMAS were Support for provider supervision in nutrition supervised. This activity reached 7 SDPs (4 health centers and 3 recovery and education centers (CRENs) in public health facilities). Overall average performance is 59.28%. Child survival Diourbel MR on the revised management of This supervision was done in synergy with UNICEF. severe acute malnutrition (PECMAS) Results have been shared and recommendations were made during a debriefing meeting.
Support for adolescent counseling centers 32 group discussions on early pregnancy, child marriage, female AYRH (CCAs) and Youth Promotion Project (PPJ) genital cutting, sexual abuse, and STI/AIDS.
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Youth Spaces in Bakel, Matam, Saint Louis, 4 sessions to screen 2 films on: early marriage, “Amina la and Tambacounda to implement activities collégienne,” and excision, “Brisons le silence.” targeting out-of-school youth - 810 adolescents/youths, including 448 girls, were sensitized.
Support for an informational and 44 individuals were reached (including 26 women) comprising introductory workshop on implementing the Academic Inspector (IA) and Education and Training Inspector Neema project’s AYRH component at facility (IEF) staff and HD staff in partnership with the Division of School level in Diourbel and Matam MRs Health Inspection (DCMS).
Support for the Division of School Health Inspection to implement a student - 10 middle schools were supported with substantial teacher information program led by school involvement. mediators in middle schools and high - 232 facilitated group discussion sessions with students on AYRH and violence in school settings sensitized 7963 schools in Kédougou and Tambacounda students, including 4011 boys. MRs
15 providers (including 8 women) trained on the features of Support for a provider training session on adolescent/youth-friendly services and specific concerns for this the “Construire Son Avenir” (“Build Your age group. This will enable them to monitor and supervise AYRH Future” in English) curriculum in Saraya activities led by peer-educators in their areas. district
The 20 providers (10 state registered nurses and 10 SFEs) signed their contracts with the MSAS Department of Human Resources Hiring and assigning qualified providers for (DRH) and began working in the 10 new posts in Tambacounda Support for upgrading health huts into health the new HPs (5) and Kolda (5) regions. posts ECRs/ECDs and providers were introduced to their roles and responsibilities in running the new HPs in Tambacounda and Kolda.
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Medical regions received medical supplies and equipment for Support in equipment for new posts these 10 new HPs and are planning for their delivery to the new facilities. (See Annex 4 for the equipment list)
DELIVERY OF AN INTEGRATED PACKAGE OF HIGH-IMPACT PREVENTION AND CARE SERVICES BY COMMUNITY HEALTH AGENTS
- 33 additional CHAs (including 20 women) from huts that are The project supported CHA training in the already enrolled have been trained on the DIPEC.Com this Complete CHA training on the DIPEC.Com MRs of Matam, Saint Louis, Sédhiou, and quarter. Tambacounda. - Overall, 106 additional CHAs were trained, or a 36% coverage rate for the annual target.
- 16 of the remaining planned 30 huts are enrolled, for a 53% Training for CHAs in health huts in Bambey Complete introduction of contraceptive pills in huts annual coverage. (11) and Vélingara (5) - 28 CHAs are trained, including 21 women.
- 65 huts with community-based access to injectable contraceptives through subcutaneous injection were enrolled Continue community-based delivery of injectable Extended delivery of the injectable method this quarter, or a total of 115 huts offering injectable contraceptives through subcutaneous injection and in Kanel, Kédougou, Kolda, Saraya, and contraceptives (or 84% of huts planned for this year). of Sayana Press, by training CHAs from target Vélingara districts - 112 CHAs (including 63 women) were trained in community- health huts based access to injectable contraceptives through subcutaneous injection
- 93 huts/sites enrolled in the 2nd quarter - 261 huts and sites enrolled overall this year; or 48% of projections (See details in Annex 5) - This quarter, 244 CHAs (including 109 women) have been Implement a community services package adapted Enrollment of huts and sites in Kédougou, trained to deliver the community-based adolescent and youth to adolescents/youths in sites and huts Kolda, and Sédhiou regions. sexual and reproductive health (AYSRH) services package. - Since the start of the year, 590 CHAs (including 260 women) have been trained to deliver the community-based AYSRH services package.
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- Throughout this quarter, 447 additional CHAs (including 237 Fulfill the required number of CHAs to train on the women) from huts and sites that are already enrolled were community-based services package adapted to Support to train CHAs in Kédougou, Kolda, trained in community-level AYRH adolescents and youth in huts and sites enrolled for Saint Louis, and Tambacounda regions - Since the start of the year, 848 additional CHAs (including 515 AYRH services delivery women) were trained in community-level AYRH, or a 50% annual coverage rate (See details in Annex 5)
Support CHAs to organize debates and group Support for CBOs in the districts of Pété, discussions among support groups on the Saint Louis, and Podor to hold debates and 237 group discussions organized, for an annual goal of 4314 or challenges surrounding nutrition and WASH group discussions on issues surrounding a performance rate of 5.5% around huts/sites (60% of huts) nutrition and WASH
- 71 SDPs, and 74 staff were supervised. Strengths: - Motivation of providers, ECDs, and the hygiene brigade - Integration of essential nutrition and hygiene actions into health activities Support districts to improve the quality of growth Areas for improvement: monitoring and promotion activities, screening, Supervision of the nutrition/WASH package - Tools filled out insufficiently or not at all and vitamin-A supplementation at SDP level to was organized in Bounkiling, Koumpentoum, - Lethargy in establishing routines at community level strengthen implementation of essential nutrition and Saraya districts - No incorporation of vitamin-A supplementation or screening and hygiene actions through bimonthly monitoring into community-based activities - No vitamin A at site and hut level - Inadequate organization of services In order to address all noted gaps, an action plan to address gaps was developed with a quarterly monitoring mechanism at district level.
- 14 new huts in Tambacounda (13) and Saint Louis (1) regions. Support ECDs to get new health huts up and Enrollment of new huts in Tambacounda and - 23 newly enrolled huts since the start of the year, or a 96% running in the intervention regions Saint Louis regions increase for the annual target. - 30 CHAs trained this quarter, including 18 women.
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- Overall, 72 CHAs (including 55 women) from new huts have been trained on delivering the basic services package since the start of the year.
Training for health committee members for health huts in Saint Louis and Tambacounda - 51 members (including 13 women) trained on the technical and on the technical and financial management financial management of a health hut. of a health hut.
The following supplies were delivered to the districts: Support for equipment for 31 new health - Management tools (18,850 tools) huts - Cooking demonstration supplies - Infection prevention supplies, including incinerators
- 32 new sites enrolled this quarter in Kédougou (17), Sédhiou (10), and Tambacounda (5) regions. - Overall, 89 new sites planned for this year have been enrolled, or a 66% increase. - This quarter, 156 change, promotion, and assessment agents Enrollment of new sites in Kédougou, (ACPPs), including 96 women, were trained. Sédhiou, and Tambacounda regions - Overall, 383 ACPPs (including 223 women) have been trained on Support health districts to enroll new community the expanded package delivered in sites since the start of the sites in intervention regions year. - Overall, the capacities of 257 health committee members (including 177 women) in Matam and Tambacounda were strengthened to support site management.
The following supplies were delivered to the 29 districts: Support in equipment for 134 new sites - Management tools (18,850 tools) - Cooking demonstration supplies
DELIVERY OF AN INTEGRATED PACKAGE OF HIGH-IMPACT SERVICES AT HOUSEHOLD LEVEL
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- During this quarter, 4762 HWSs are installed in households, Support districts to produce hand-washing stations Continuation of HWS installation activities including 1135 in Sédhiou, 63 in Vélingara, 1014 in (HWSs) and promote their use in vulnerable and sensitization activities on using HWSs at Tambacounda, and 2550 in Diourbel. households the vulnerable household level - Overall, 8600 HWSs have been installed, or a 74% coverage rate.
Training and support for community groups - 79 community actors (including 75 women) trained in Diourbel in Diourbel, Kolda, Sédhiou, and and Mbacké. This activity reached 47 SDPs (including 2 health Tambacounda regions to prepare and use centers and 45 health posts) and produced 572 kg of fortified Support districts so they can support existing fortified flour flour. Community actors from Diourbel district were organized community groups in the preparation and use of into a federation of 4 economic interest groups by the district. fortified flour to treat moderate acute malnutrition - 19 groups from the districts of Bakel, Bounkiling, Goudiry, Médina Yoro Foulah, Saraya, Sédhiou, and Vélingara received support to produce 878.7 kg of flour.
Enrollment of 43 huts and sites in the - Overall, 262 (of the 357 planned) huts and sites have been regions of Saint Louis (11); Sédhiou (10); and enrolled, or 74%. Implement the VADI strategy using the revised Kolda (22) - 216 CHAs, including 100 women, trained. Overall, 772 CHAs methodology and tools in sites and huts (including 449 women) introduced to the revised VADI strategy (See Annex 6)
iCVAC implementation tools shared - The iCVAC integration processes and its implementation tools were shared with all stakeholders: the Community Health Unit (CSC), DSME; Directorate of Disease Control/Neglected Tropical Diseases; Division of the Health and Social Information System; Health Emergencies Operations Center (COUS); MR, district, and Support training for national trainers on the CHA representatives; USAID; Health Systems Strengthening Plus integrated community watch committee (iCVAC) (HSS+); and USAID/Neema. (including printing of implementation tools) - Enrollment plans and implementation methods were defined for each partner’s intervention area.
Introductory meeting held for the pool of - 18 facilitators (including 11 women) were introduced. national facilitators on the iCVAC strategy - Among these trainers, 7 are from the MSAS (Agency for Universal Health Coverage (ACMU), DSME, CSC, and the Directorate of
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Disease Control) and 11 are technical and financial partners (USAID/Neema, ChildFund, Red Cross-Senegal, HSS+, Catholic Relief Services, and World Vision-Senegal)
IMPLEMENT A CROSS-CUTTING, MULTI-SECTOR, GENDER-BASED-VIOLENCE PREVENTION STRATEGY
Communication activities were developed in - 2 awareness-raising caravans on early pregnancy and marriage the 7 concentration regions in collaboration (Diourbel and Sédhiou), 1 social mobilization in Saint Louis, and with MRs, HDs, and local actors; and 1 panel in Tambacounda were held on the topic “Think fairly, CAC/GBV groups were set up build intelligently, innovate for change”; 3 panels held on early Support for the celebration of the 2019 pregnancy and post-partum infections (Kédougou and Sédhiou). International Women’s Rights Day on March 8, - 1612 individuals (including 1343 women) have been directly including the “Quinzaine de la femme,” a two-week affected by these activities. celebration of women Activities providing free consultations for FP, - 50 new users of FP; 18 ANC visits; 42 ultrasounds; and 89 women ANC, and cervical and breast cancer screened for cervical cancer. screenings in Kolda and Goudomp districts
SUB-OBJECTIVE 1.2: LINKAGE BETWEEN COMMUNITY AND FACILITY PLATFORMS IS STRENGTHENED AND SUSTAINED
Activities planned for the quarter Achievements: Implementation status Outputs or outcomes achieved
INTEGRATION OF COMMUNITY HEALTH INTO THE HEALTH SYSTEM
- 37 communities implemented a local referral system for emergencies this quarter. - 38 transportation vehicles (including 3 in Saint-Louis, 6 in Matam, A referral system for emergencies seen in Support communities to organize and implement 6 in Tambacounda, and 23 in Kédougou) are made available. health huts is implemented in Matam, a referral system for urgent cases seen in health - 1,033,350 FCFA was mobilized by the 37 communities to help Saint Louis, and Tambacounda regions huts families cover medical costs at the point-of-contact facility.
- 44 women benefited from this system. - Since the start of the year, 70 of the 439 projected new communities (or 15% of the annual target) have set up a system.
USAID/Neema Quarter Report - January 1–March 31, 2019 21
Hold a harmonization workshop to The community level has been included in the framework incorporate free-access initiatives into documents to incorporate targets for free access initiatives Support the development of management tools mutuelles and to operationalize universal and aids to activate free health care for children (children 0–5 years, pregnant women, and persons over 60 years) health care at community level in February under 5 at community level into the community-based health insurance system (community- 2019 in partnership with the Agency for based mutuelles). Universal Health Coverage, DSME, and CSC
Regional body: 26 participants, including 5 territorial officials, 6 ECR/ECD members, and 15 partners. Departmental body: 25 participants, including 3 administrative 2 meetings were supported at the regional Support holding quarterly meetings for officials, 7 territorial officials, 1 health development committee and Koumpentoum department level community health coordination bodies at all levels (CDS) member, 8 health staff, and 5 partners.
The main recommendation was to involve the Departmental Child Protection Committees (CDPEs), community-support groups, and village committees in the CAC/GBV strategy.
Support an evaluation of the National Community The project supported completion of the The evaluation report is available, and key challenges were Health Strategic Plan (PSNSC) 2014–2018 evaluation report identified.
Strategic priorities have been set. The next steps are: Support the development of the PSNSC 2018– The development process is underway • Organize thematic workshops to draft content for lines of 2022 action • Hire a consultant for consolidation and budgeting • Organize a workshop to validate the PSNSC 2018–2022
EXPANDING THE PACKAGE OF SERVICES OFFERED AT COMMUNITY LEVEL
Support an introduction for ECRs/ECDs 42 people, including 21 women, introduced Support MRs and districts to organize mobile team activities in the regions of Diourbel, Kolda, Support for the IMU launch ceremony 90 participants, including 40 women, at the launch ceremony in Saint Louis, and Sédhiou activities in January 2019 Diourbel
USAID/Neema Quarter Report - January 1–March 31, 2019 22
31 visits made, including 16 in Diourbel, 3 in Saint Louis, 6 in Sédhiou, and 6 in Kolda. During these visits, 771 children 0–23 months were vaccinated, 405 children 0–59 months received vitamin-A supplementation, 643 children 6–59 months where screened for malnutrition, and 292 children 12–59 months were dewormed. Also, 229 pregnant women received their ANC, including 170 who received IPT under DOT and 41 who received an LLITN. 64 women who IMUs made visits in the MRs of Diourbel, delivered received PNC. 155 FP clients were seen, including 57 Kolda, Saint Louis, and Sédhiou new enrollees in the program. For screening, 44 individuals were screened for HIV, 5 for cervical cancer, and 97 for breast cancer; 1691 individuals were reached through social and behavior change communication (SBCC) activities.
Overall performance for IMUs relative to the number of planned visits is 33% for this quarter and 6% for the year. (See details in Annex 7)
19 providers, including 10 women, from 6 SDPs are supervised. Supervision recommendations are: - Improve coordination between the health post and the Supervision of IMU activities at the 4 hut/site scheduled for IMU visits districts in Diourbel region - Involve ACPPs from huts/sites scheduled to receive IMU visits - Guide sensitization on the services package offered by the IMU so that it reaches the intended target
A workshop to finalize tools was organized The draft of the implementation guide was improved and completed. Support finalization and printing of the Note: The MSAS replaced the itinerant The community health trainer guide for providers was initiated implementation guide and tools for the midwives strategy with the “Enhanced to strengthen their capacities, which will ensure better coaching “Enhanced Outreach Strategy” for HP teams Outreach Strategy” for health post teams for CHAs by nurses and midwives. intervention These documents will be validated and shared next quarter.
INTEGRATE GENDER CONSIDERATIONS INTO A PACKAGE OF SERVICES AND LINKAGE ACTIVITIES BETWEEN THE COMMUNITY AND HEALTH FACILITIES
USAID/Neema Quarter Report - January 1–March 31, 2019 23
- 10 CHAs, 3 ICPs, and 3 ECDs participated in the pre-test with support from USAID/Neema project staff. - 3 health huts and 3 health posts have applied the scorecard. Results showed that CHAs and HP managers are able to use the Support the CSC on the pre-test and validation of scorecard at hut and post level; the pre-test report is available at tools to implement the community health Tools were pretested in Touba HD the CSC. scorecard Next steps • Incorporate observations from the pre-test into the implementation document • Submit the implementation document to the MSAS HSS platform for validation
STRENGTHENING COMMUNITY AND LOCAL-MUNICIPALITY PARTICIPATION IN COMMUNITY HEALTH, ESPECIALLY FOR YOUTH
Pools of regional facilitators supported 12 - 267 actors introduced to training community groups in sites, training sessions for trainers of community including: 25 ECD members (including 11 women), 223 groups in the 12 following districts: Touba, Support districts to train trainers at district level on providers (ICPs/SFEs), including 148 women, and 19 Diourbel, Vélingara, Saint Louis, Pété, CAC/GBV implementation USAID/Neema project facilitators (including 3 women). Matam, Bakel, Kidira, Kanel, - Overall, 23 of the 25 district sessions were conducted, or 88% Koumpentoum, Makacoulibantang, and of the annual target. Kédougou
- This quarter, 816 days of visits were carried out by ICPs/SFEs to introduce 57 community groups to the approach in the districts of Bambey, Diourbel, Mbacké, Touba, Saint Louis, Richard Toll, Support ICPs and midwives to train community ICPs and SFEs support training for Dagana, Podor, Matam, Kanel, Thilogne, Ranérou, groups at CAC/GBV-site level CAC/GBV group members in all 7 regions Tambacounda, Koumpentoum, Saraya, Salémata, Kolda, Vélingara, and Médina Yoro Foulah. - A total 938 of the 5438 planned days (or 17%) were devoted to having groups trained by providers in CAC/GBV sites.
Support to train members of 320 - During this quarter, 5048 CAC/GBV group members Support districts to train community groups community groups to implement (including 3798 women) were trained. 73 synergy committees selected for the CAC/GBV CAC/GBV activities in the 7 set up in 73 sites to coordinate group activities.
USAID/Neema Quarter Report - January 1–March 31, 2019 24
concentration regions - Overall, 377 community groups (of the planned 725) were trained, or 52% of the annual target. - 6081 CAC/GBV members from these 377 groups were trained. - 84 synergy committees (of the planned 435) are set up, or an annual progress of 19.3%.
- This quarter, 12 sites received at least one monitoring visit by ECDs in the districts of Tambacounda (1), Richard Toll (2), Matam (1), Ranérou (3), Thilogne (2), Kanel (1), and Podor (2). - 7 sites (4 in Diourbel and 3 in Matam) have at least 1 group Support groups and district monitoring of that has completed the first cycle. ECDs and ICPs monitored the community CAC/GBV strategy implementation in 435 sites - 41 sites (15 in Matam, 12 in Saint Louis, and 14 in Diourbel) groups’ activities and 29 districts have at least 1 group receiving material and/or financial support. - Overall, 16 sites were visited by 8 ECDs, and groups from 57 sites have received material and/or financial support from the project to implement their activities since the start of the year.
Support the CSC to organize a pre-test and The pre-test has been organized for next - The MSAS did the technical validation. validation of introductory tools for local officials - Tools will be submitted for political validation to the MSAS quarter on community health management HSS platform.
The CSC organized a trainer orientation on Organize trainer training and facilitation of procedures and tools used to train local - 19 participants were introduced, including 10 women. training sessions for local officials (including - The next step is to support organization of training sessions officials in community health management printing tools) for local officials. in February 2019
This quarter, government officials 31 visits were made in 25 huts and 6 sites. organized joint monitoring visits of The few reported achievements from the visits include: community-based interventions in 17 local - Installing additional material resources in 2 sites to support Organize joint monitoring visits with local officials municipalities with the participation of cooking demonstration activities local officials, government officials, and - Provision of supplies and 200 LLITNs by a local association to district teams, in the regions of Matam, Grand Mpal health hut Saint Louis, and Sédhiou After the monitoring visits, local officials committed to support:
USAID/Neema Quarter Report - January 1–March 31, 2019 25
- Fencing and water supply for the Ndioupnan health hut - Provision of medicines, renovation work, and support through supplies and equipment for Agnam Godo and Asndé Bala huts (Agnam Civol municipality)
- A plan to address problems related to the low ANC completion rate was developed. Organize community dialogue sessions to identify A dialogue session was held at the Nabadji - The Bajenu Gox committed to organizing VADIs and group barriers related to health services quality Civol HP in Matam district discussions to sensitize people about the importance of ANC and to track down women lost-to-follow-up for ANC.
A show on ANC was organized in Ngoye Organize citizen radio club shows 12 people participated in the show, including 5 women. municipality (Bambey HD)
Renewed commitment from mayors to include a budget line to Support spokespersons’ participation in budget Support for 3 spokespersons at policy finance health in 2019: Ngoye 3,000,000 FCFA (5208 USD), planning debates to include an MNCH/FP budget debates for Ngoye, Nabadji Civol, and Nabadji Civol 2,000,000 FCFA (3472 USD), and Ranérou 500,000 line Ranérou municipalities FCFA (868 USD)
1 disbursement follow-up was conducted A commitment voucher for the Tocky mayor is available at the Mobilize resources from mayors’ commitments for the mayors of Ngoye and Tocky treasury
SUB-OBJECTIVE 1.3: QUALITY SERVICES AT HOUSEHOLD, COMMUNITY, AND SDP LEVELS ARE IMPROVED AND SUSTAINED
Activities planned for the quarter Achievements: Implementation status Outputs or outcomes achieved
DISSEMINATION OF POLICIES, STANDARDS, AND PROTOCOLS
USAID/Neema Quarter Report - January 1–March 31, 2019 26
- 144 providers (including 31 men) from 77 health posts, 11 Dissemination of PSP documents on health centers, and 3 hospitals introduced to the PSP. Support to disseminate the Policies, Standards reproductive, maternal, newborn, child, - 55 sets of PNP were handed out and 144 USB keys were and Protocols (PSP) and guidelines for and adolescent health to providers from distributed. directorates and programs to providers during the districts of Bambey, Diourbel, and - Overall, 193 providers (including 141 women) have been conventional training Touba and hospitals in Diourbel region trained on the PSP since the start of the month, or an annual performance rate of 24%.
Support inclusion of the integrated IMCI content is available on the online portal. management of childhood illnesses (IMCI) content on the e-learning portal Support orientation for providers on using the DSME trainers’ skills were strengthened on using the online online portal Support for a training workshop for IMCI course. national trainers of the integrated IMCI To date, we have 470 sign-ups and 315 active users on the course included in the e-learning portal platform.
6 drafts of job aids have been completed and their branding have been validated. These include: - Case management of post-partum hemorrhage Completion of job aids and validation of Support the distribution of job aids on maternal - Newborn resuscitation the branding by the USAID communication and child health - IMCI approach team - Definition of key FP concepts - FP counseling steps - Accidental diseases and poisoning among children
STRENGTHEN CAPACITIES OF HEALTH WORKERS AT HEALTH CENTERS, HEALTH POSTS, AND HEALTH HUTS TO IMPLEMENT PROCESSES TO IMPROVE SERVICES QUALITY
Support for the DSME to develop ToRs for - ToRs for supervision of the maternal and newborn death Support to conduct maternal death surveillance supervision of the maternal and newborn audits are available and response (MDSR) reviews in Diourbel, death audits and to share MDSR tools - MDSR tools (implementation guide for maternal and Matam, and Saint Louis regions (implementation guide for maternal and newborn death audits) have been shared newborn deaths audits)
USAID/Neema Quarter Report - January 1–March 31, 2019 27
STRENGTHEN CAPACITIES OF THE PUBLIC HEALTH AND LOCAL GOVERNANCE SYSTEMS TO SUPPORT AND MONITOR HEALTH SYSTEM PERFORMAN CE AND QUALITY
Hold a BMWM training session for providers from Bounkiling district (Sédhiou 25 providers, including 10 women, are trained in BMWM. MR) Support MRs to implement regional biomedical HDs and public health facilities in all 7 medical regions received waste management (BMWM) plans a batch of supplies comprising: trash cans, trash-can liners, Support to install BMWM supplies in the 7 durable coveralls, protective goggles, rubber gloves, rubber concentration regions boots, and pairs of gloves. (See distribution table in Annex 8)
- Organization of 10 introductory workshops - 10 MCRs, 29 MCDs, and 39 managers introduced to sub- for chief district medical officers/chief grant management procedures. regional medical officers (MCDs/MCRs) - 34 No.-2 amendments to subaward sub-contracts have been and HD and MR managers on sub-grant signed for 318,195,484 FCFA. management procedures. Validation of budgets for new deliverables and signing of amendments to subaward sub- contracts. Follow up on the contract signing process with ECRs and ECDs - 5 No.-1 amendments to subaward sub-contracts, with no Signing of sub-contract between Matam additional cost, have been signed by 4 MCDs and the MCR of MR and its health districts Matam to extend the sub-contract performance period from - March 1, 2019 to September 30, 2019.
- 2 subaward sub-contracts have been signed with MCRs from Signing of subaward sub-contracts to Tambacounda and Kolda to cover the salaries of 20 providers cover salaries of 20 providers in new HPs in 10 new HPs in Tambacounda and Kolda regions. in Tambacounda and Kolda regions
USAID/Neema Quarter Report - January 1–March 31, 2019 28
Overall, 20 of the 23 districts whose tutors - Overall, 30,873,816 FCFA of the total amount of 318,195,484 Grant subawards to medical regions and have been trained, requested payment for FCFA has been disbursed this quarter to HDs/MRs for the districts to ensure availability of high-impact on-site supervision tutor visits and second sub-contract obligation, or a 9.7% achievement rate. quality services supervision by ECDs of on-site supervision visits
16 MSAS senior staff (including 7 women) received leadership and management training. Support to train MSAS senior staff on This training helped participants: Support capacity building in leadership for leadership and management by the - Identify for themselves factors to improve the work MSAS entities in collaboration with the DRH Organization and Methods Office (BOM) environment to optimize performance and HRH2030 in synergy with HRH2030, GoTAP, and - Strengthen their leadership skills to guide health teams HSS+ toward significantly improving health outcomes - Lead teams so they are able to face challenges
SUB-OBJECTIVE 1.4: KEY POPULATIONS IN TARGET AREAS ARE TESTED, ENROLLED ON ANTIRETROVIRAL THERAPY, AND PROVIDED QUALITY CARE IN ALIGNMENT WITH THE “90-90-90” GOALS
Activities planned for the quarter Achievements: Implementation status Outputs or outcomes achieved
SUPPORT THE DIVISION OF AIDS/STI CONTROL IN THE COORDINATION AND MONITORING-EVALUATION OF THE CARE CASCADE AND TREATMENT OF KEY POPULATIONS AND THEIR PARTNERS
Support for the National AIDS Council 16 partners from civil society and the public sector met to map (CNLS) and the Division of AIDS/STI Develop a mapping exercise of interventions funding. Control (DLSI) to collect data and and partners treating key populations Gaps and indicator achievement levels will be analyzed during information from civil society and public the national workshop to summarize data. sector partners
USAID/Neema Quarter Report - January 1–March 31, 2019 29
These briefings with MCRs/MCDs from selected sites provided an opportunity to discuss project interventions and challenges: Presentation of the HIV component’s new Support ECRs/ECDs in collaboration with the ▪ Key population cascade at each site directions in accordance with PEPFAR DLSI and CNLS to plan, coordinate, and ▪ Mediators’ performance and incorporation of community guidelines to MCRs/MCDs from the monitor TATARSEN Operational Plans (TOPs) data at site level selected sites in Dakar and Mbour ▪ Screening objectives and requirements for follow-up and reporting at each site
Support the reproduction and distribution of Reproduction and distribution of 1000 pens, 3000 two-colored shirts, 300 multi-pocket Sols communication materials to promote communication materials to promote Wild vests, 300 sports water bottles, and 300 tactical solar LED screening and USAID/Neema project branding screening and project branding flashlights with stands were received.
Meeting participants discussed and identified needs and a process for installing a platform in project sites. Identified needs ✓ Including the Mbour site ✓ Inclusion and coding of key populations (men who have sex with men (MSM), sex workers (SWs), and injection drug users (IDUs)) Hold a meeting with Institute for Health ✓ Coding of key populations (MSM, SWs, and IDUs) Support implementation of a unique Research, Epidemiological Surveillance identification code for people living with HIV and Training (IRESSEF) and present an upstream of screening (PLHIV), including those in key populations electronic reporting system for HIV- ✓ Follow-up, care, and treatment (treatment follow-up, positive cases management of comorbidities, monitoring, and reporting viral load) Installation process ✓ Inventory and database, incorporating reporting of key populations receiving follow-up in selected sites in Mbour, Dakar, and Ziguinchor ✓ Training and support through tools and equipment for sites
USAID/Neema Quarter Report - January 1–March 31, 2019 30
STRENGTHEN MSAS CAPACITIES TO PROVIDE QUALITY CARE WHEN SCREENING KEY POPULATIONS AND THEIR PARTNERS
35 applications were collected from candidates. 24 applications were selected, including 8 from SWs, 11 from Support the recruitment of 50 new key- A selection committee to review MSM, and 5 from IDUs. Rejected applications were either population mediators to conduct outreach candidates’ applications to the outreach incomplete or did not comply with the requirements. The activities within hidden key populations mediator positions was organized committee recommended increasing the number of MSM outreach mediators in Dakar.
In Ziguinchor: 28 hot spots, including 19 SW sites, 6 MSM sites, and 4 IDU sites In Kolda: 21 hot spots listed, including 10 SW sites, 7 MSM sites, and 4 IDU sites In Mbour: 63 hot spots listed, including 44 SW sites, 40 MSM meeting points, and 18 IDU sites. Strengths Complete annual mapping of hot spots with Mapping of hot spots and estimated size • Strong presence of the 3 categories of key populations the estimated size of key populations for each of key populations in Ziguinchor, Kolda, (MSM, SWs, and IDUs) in most hot spots in Mbour region and Mbour • Strong involvement of key populations during focus groups Areas for improvement • Low estimation of data for non-association, key populations comprising friendship networks that frequent certain private residences or meet by chance in homes or schools • Poor access to some rental accommodations and private residences
23 outreach mediators’ capacities were strengthened on Organize training workshops for community A training workshop for demedicalized demedicalized screening (11 MSM, 8 SWs, and 4 IDUs, actors on community-based demedicalized screening was organized in Mbour for including 9 women). screening outreach mediators The following recommendations were made:
USAID/Neema Quarter Report - January 1–March 31, 2019 31
• Test mobilization capacity of mediators trained during activities and pair them with site mediators who are already trained • Initiate internships in laboratories for these mediators to help them learn the approach
Hold a meeting with the Youth Promotion It was decided to identify an HIV-activities package during the Strengthen CCAs to implement an activity Project (PPJ) to incorporate HIV and package for youths in key populations next workshop to review an appraisal of the AYRH component target youths in key populations
Overall, 1593 individuals—including 713 MSM, 550 SWs, and 330 IDUs—received demedicalized screening. Implementation of a campaign focusing In this group, 87 cases tested positive and were all referred to on delivering demedicalized screening services to key populations (SWs, MSM, various health facilities of their choosing to confirm their tests. Support mediators to organize 680 and IDUs) and discussion groups to ensure 86 of this group confirmed their tests, and among them, 63 community-based demedicalized screening those PLHIV on antiretroviral therapy who initiated antiretroviral therapy. (See Annex 9 for details) activities with group sponsorship for 10 key- need viral load testing get it. This activity population groups was rolled out simultaneously in the Campaign outcomes revealed a few lessons, including the regions of Dakar, Sédhiou, Ziguinchor, and challenges in mobilizing some key populations to confirm a Kolda as part of the USAID/Neema project. reactive test in health facilities, despite the covered reimbursement of transportation costs.
STRENGTHEN MSAS CAPACITIES TO PROVIDE QUALITY CARE WHEN TREATING KEY POPULATIONS AND THEIR PARTNERS
Support implementation of discussion groups Organization of discussion groups This intervention enabled 77 women and 25 men living with for HIV-positive populations on antiretroviral followed by sampling for viral load HIV on antiretroviral therapy to test their viral load therapy measurement measurement after 6 months of treatment.
COMMUNICATION, ENABLING ENVIRONMENT, LOGISTICS, AND STAFF
Provide support to RNP+ and the National Support for RENAPOC peer educators to Network of Key Population Associations organize guided debates and group 50 MSM screened, including 8 positive cases directed toward (RENAPOC) and other civil society discussions, followed by screening with facilities of their choice
USAID/Neema Quarter Report - January 1–March 31, 2019 32 organizations to strengthen institutional and MSM outside of associations organizational operations and to implement a prevention, care, and follow-up services package for key populations
SUB-OBJECTIVE 1.5: INSTITUTIONAL SUPPORT IS PROVIDED TO MSAS ENTITIES
Activities planned for the quarter Achievements: Implementation Outputs or outcomes achieved status
SUPPORT IN HUMAN RESOURCES
The project supported revision of Support the introduction of Workload Indicators WISN training modules. WISN training modules are available, and the World Health of Staffing Need (WISN) in concentration The MSAS sent a request for Organization has agreed to support the WISN introduction process. regions in partnership with the DRH technical support to the World Health Organization.
Provide institutional support to partners of Financial support for the Directorate General of Health Services to Support provided to the MSAS for MSAS entities for specific events and activities hold a decentralized coordination meeting in Saint Louis. Overall, 83 specific activities (World Days, etc.) people, including 65 men, participated.
OBJECTIVE 2: INCREASED ADOPTION OF HEALTHY BEHAVIORS
SUB-OBJECTIVE 2.1: HIGH-QUALITY, TARGETED SOCIAL AND BEHAVIOR CHANGE COMMUNICATION (SBCC) INTERVENTIONS ARE SCALED UP TO PROMOTE HIGH-IMPACT SERVICES AND HEALTHY BEHAVIORS
Activities planned for the quarter Achievements: Implementation Outputs or outcomes achieved status
USING DATA TO DEFINE APPROACHES AND MESSAGES
USAID/Neema Quarter Report - January 1–March 31, 2019 33
Conduct a mid-term quantitative study on Tools were updated and the protocol - The protocol has been submitted to the National Ethics Committee ideational factors and health-promoting was completed for Research in Health (CNERS). behaviors - The call for tenders is launched in two newspapers, L’Observateur and Le Soleil.
LOCAL PROMOTION OF ESSENTIAL HOUSEHOLD HEALTH BEHAVIORS
The contract has been signed and Headquarters’ approves signing a contract with FyFly to display Conduct a poster and SMS campaign posting will start next month in the 5 signage on the sides of vehicles in 5 concentration regions that have promoting the Jàpp naa cì campaign themes regions TATA buses.
On national TV stations - 119 spots on the Jàpp naa cì national campaign, including 66 targeting communities and 53 for families On national radio stations - 168 spots on the Jàpp naa cì national campaign, including 183 targeting communities and 168 for families on Sud FM, RFM, Zik TV and radio stations broadcast spots FM, and Soxna FM Broadcast radio and TV programs to promote and shows to promote healthy On regional radio stations healthy behaviors in the national campaign behaviors in the national campaign For the MNCH/FP/essential family health practices/AYRH/gender- based violence (GBV) theme, 12,889 spots, 93 shows, 1822 inserted messages, 25 news reports, and 37 sponsorships were broadcast in the regions of Diourbel, Kolda, Matam, Saint Louis, and Sédhiou. As part of promoting the song contest album in Sédhiou and Kolda, partnering radio stations played the ensemble song and the winning song for the region 350 and 250 times, respectively.
CBOs are implementing community- - 560 group discussions covering topics on MNCH, essential family Support districts to implement community- health practices, AYRH, GBV, FP, health mutuelles, and malaria. These based activities in Diourbel, Kolda, based activities with CBOs group discussions reached 15,494 individuals, including 12,827 Sédhiou, and Tambacounda regions women.
USAID/Neema Quarter Report - January 1–March 31, 2019 34
7781 VADIs on several topics: FP, Jàpp naa cì social support, MNCH, GBV, AYRH, essential family health practices, and malaria, which reached 32,747 people, including 22,007 women. (See details in Annex 10)
Overall, 31 groups of people, including 11 women’s groups, 11 Implementation of Nurturing husbands’ groups, and 9 key-populations groups received this training Connections is underway for blocks 1 Support districts to implement the Nurturing in the two blocks, or 620 people were reached (including 298 women) and 2 in Dagana district in 3 HPs Connections (NC) approach in 2 in the 3 HPs. (Mbane, Ndombo, and Diaglé). concentration regions More men (80%) than women (51%) participate in the activities.
Changes in behavior were noted for gendered division of labor and
equitable sharing of and access to food.
IMPLEMENT GENDER-FOCUSED SBCC STRATEGIES
Organize an extensive awareness-raising A service provider was selected A campaign guidance document is available. campaign on gender and the effects of GBV following a call for tenders. on families and youth, based on a diagnosis ToRs for the mission were shared with of the social determinants of GBV the partner.
SUB-OBJECTIVE 2.2: PUBLIC SECTOR CAPACITY TO COORDINATE, DESIGN, AND ADVOCATE FOR BETTER SBCC STRENGTHENED AT THE NATIONAL AND REGIONAL LEVELS
Activities planned for the quarter Achievements: Implementation status Outputs or outcomes achieved
PROVIDE INSTITUTIONAL SUPPORT TO SNEIPS AND BREIPSS
Strengthen public sector capacity to Participation in the Social and Behavior 6 individuals were sponsored to participate in the summit on coordinate, design, and advocate for Change Communication Summit in Abidjan behalf of the Ministry of Health (3 for the National Education
USAID/Neema Quarter Report - January 1–March 31, 2019 35 improved SBCC at the national and regional and Health Information Service (SNEIPS), 1 for the National levels Malaria Control Program, 1 for the CNLS, and 2 for the DSME).
SUPPORT FOR KNOWLEDGE MANAGEMENT IN SOCIAL AND BEHAVIOR CHANGE COMMUNICATION (SBCC)
Share platform content during the SNEIPS Provide maintenance for an electronic review and the technical working group The portal was developed and is kept up to date. portal for knowledge management Validation of the platform by USAID is expected
Adapt and translate communication tools to Communication materials are available on The platform can be accessed on promosante.sn. ensure “the right” tools are available on the the electronic portal Updating is continuous. electronic portal
SUB-OBJECTIVE 2.3: TECHNICAL AND OPERATIONAL CAPACITY OF LOCAL ORGANIZATIONS TO DESIGN, IMPLEMENT, AND EVALUATE SBCC PROGRAMS IMPROVED
Activities planned for the quarter Achievements: Implementation status Outputs or outcomes achieved
DEVELOPMENT OF A TAILORED CAPACITY BUILDING PLAN FOR THE NGO
Support implementation of the Participation in the Social and Behavior 1 individual was sponsored to participate in the summit on nongovernmental organization (NGO) Change Communication Summit in Abidjan behalf of the local NGO. capacity building plan
MONITORING & EVALUATION, RESEARCH, AND LEARNING
Activities planned for the quarter Achievements: Implementation status Outputs or outcomes achieved
USAID/Neema Quarter Report - January 1–March 31, 2019 36
MONITORING OF PROGRAM IMPLEMENTATION
Significant progress in report completion rates was noted. However, a A quality audit of data generated through recommendation aimed at ensuring complete availability of activity program implementation was conducted at reports and attendance sheets for trainees along with archiving them the regional bureaus (RBs) was drawn up.
Organize monitoring missions for 7 health huts visited, 3 in Kolda region and 4 in Sédhiou region project interventions Areas for improvement: A technical support mission for community- - Availability of new collection tools in all visited huts and sites level interventions in the Kolda RB area - Shortcomings in filling out some tools Recommendations were formulated for ECRs to ensure tools are available and to strengthen CHAs’ skills in using them.
STRENGTHENING SUPERVISION SYSTEMS AT DISTRICT, SDP, AND COMMUNITY LEVEL
20 maternity units covered. 21 female providers were supervised. 28 participants (including 24 women) attended the meeting to share results Participants discussed these recommendations for ECDs: Supportive supervision for MNCH followed • Produce heated tables locally using the CDSs Support integrated supervision at all by a meeting to share results in Kanel health • Share supervision results with CDSs during the next HD levels (MR, HD, HP, and health hut) district in Matam medical region coordination meeting • Plan to purchase supplies (aspirators, bags + masks) in district deliverables • Produce aprons for deliveries and protective sheets for delivery tables
INCREASED AVAILABILITY AND USE OF HEALTH DATA FOR DECISION-MAKING PURPOSES AT DISTRICT, SDP, AND COMMUNITY LEVEL
USAID/Neema Quarter Report - January 1–March 31, 2019 37
Support the districts to train providers on using the information system for An ISM training workshop for trainers is 16 trainers, including 8 women, introduced to the ISM modules and management (ISM) tools, including held in Diourbel MR tools. The next step is to train ECRs/ECDs and providers. revised tools for community level
SUPPORT FOR THE DSME TO PLAN, MONITOR, AND EVALUATE ITS PROGRAMS
- An application (ArchiveSoft-2) offering a dedicated management Establishment of a physical archiving system model that can archive, share documents, and monitor indicators for Support to establish a communication for resources and monitoring of DSME the DSME was implemented. channel for DSME data indicators - 13 DSME staff, including 8 women, were trained to use the platform. - A request was drawn up to host the platform on the AIDE server.
Support to develop the performance An initial draft of the DSME PMP is available. Support monitoring missions of DSME monitoring plan (PMP) interventions Support to develop the annual report A consolidated and coherent draft is available.
DOCUMENTING AND SHARING HIGH-IMPACT APPROACHES
Support to document Vitamin-A 3 success stories are available. supplementation for children in Goudomp
USAID/Neema staff training on producing logical and eye-catching documentation, IntraHealth headquarters communication team helped strengthened reporting, and presentation of information 6 staff members’ capacities. Document key project interventions on project impact
Site visits were carried out in Kolda, These interventions were targeted: Tutorat 3.0, involving HIV Ziguinchor, Sédhiou, and Tambacounda mediators, fortified flour, PPFP, IPT for pregnant women, and engaging regions to produce publications on project local municipalities. interventions Drafts of success stories have been prepared.
USAID/Neema Quarter Report - January 1–March 31, 2019 38
PROJECT MANAGEMENT AND COORDINATION
Activities planned for the quarter Achievements: Implementation status Outputs or outcomes achieved
COORDINATION WITHIN THE USAID HEALTH PROGRAM THROUGH GOTAP
Participate in developing an integrated The project participated in developing plan for the USAID Health Program in The draft of the 2019 integrated action plan has been developed. the integrated action plan for 2019 partnership with GoTAP
The meeting was devoted to: • Information on the delay in funding implementation for FY2019 • Synergy to strengthen MSAS leadership capacity Participate in Chief of Party (COP) COP participated in the COP meeting on • Support for Yeksi Naa meetings and inter-agency meetings 11 January 2019 • An exercise on filling out the synergy matrix between the various USAID agencies • Share the HSS+ model • Planning for the next USAID Health Program field mission
COORDINATION AT THE OPERATIONAL LEVEL THROUGH REGIONAL BUREAUS
A review was organized to: Organization of a quarterly review at the Organize a quarterly coordination • Draft the Q2 quarter report and annexes Diourbel Regional Coordination Unit meeting for each RB to review USAID • Develop a quarterly work plan for April–June 2019
Health Program implementation • Update databases
• Conduct an internal data quality audit
2 MRs received support to hold their quarterly coordination meeting. The following points were discussed: • Evaluation of the quarterly work plan Support MR quarterly coordination Support provided to Kolda and Diourbel • Monitoring indicators through the District Health Information System- meetings medical regions 2 (DHIS-2) • Presentation of project results for Q1 Y3 • Presentation of the UMI approach and methodological guide
USAID/Neema Quarter Report - January 1–March 31, 2019 39
Participation in 2 MR coordination meetings and 8 district coordination Participation in regional coordination meetings, leading to: meetings for the MRs of Kolda and • Identification of 4 UMI intervention sites in Médina Yoro Foulah and 4 Participate in district and regional Sédhiou and the HDs of Vélingara, UMI sites in Vélingara coordination meetings Médina Yoro Foulah, Diourbel, Touba, • Scheduling and establishing coordination mechanisms for visits Goudiry, Tambacounda, Saraya, and • Review of malaria data for Touba district Kédougou • Sharing the UMI methodological guide in the 2 districts of Touba and Diourbel
Support to hold an annual planning Draft of the annual action plan incorporating Neema project Organize joint-planning workshops workshop with Kédougou MR and 2 interventions is prepared. with MRs and HDs quarterly workshops with Tambacounda Drafts of quarterly action plans are developed. MR and Salémata district
21 district-level sessions were held in Support ECRs and ECDs to brief SDPs on Matam, Ranerou, Bakel, Goudiry, 615 CDS members are trained, incluidng 472 men. managing CDSs Koumpentoum, Tamba, Kolda, Vélingara, and Médina Yoro Foulah
COORDINATION WITHIN THE CONSORTIUM
The meeting’s main recommendations are to: • Facilitate thematic groups around teams Establish and hold quarterly advisory Meeting to build synergy within the • Revisit regional indicators based on the Continuous DHS and plan committee meetings consortium interventions accordingly • Institute regular coordination and planning meetings at central level • Organize monitoring/supervision visits and discussions with RBs
Workshop participants: Organization of 2 workshops to develop Hold quarterly review and planning • Reviewed quarter performance Q1 and Q2 quarter reports for Year 3 of meetings • Analyzed performance achievement levels the USAID/Neema project • Identified priorities for the next quarter
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PROJECT MANAGEMENT
The mission was able to: • Analyze coordination, planning, and monitoring mechanisms for Conduct quarterly monitoring of project A quarterly mission to monitor project interventions within RBs implementation at the RB and regional implementation by the Deputy Chief of • Analyze the completion rate of action plans unit level Party in Kolda and Tambacounda RBs • Verify compliance of operational procedures with the project’s strategic priorities
BUILDING SYNERGY WITH PROJECTS AND PROGRAMS
Develop and monitor plans to build A plan to build synergy developed Implementation of training for CDSs in synergy with GOLD and HSS+: synergy between projects and between the Neema and HSS+ documentation of the process is underway. programs in each RB components at the Kolda RB level
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UNPLANNED ACTIVITIES
Unplanned activities Outputs or outcomes achieved
Technical support (workshop facilitation and document preparation) to develop the Integrated Communication Drafts of the Integrated Communication Plan for 4 consolidation regions are available Plan for Thiès, Dakar, Kaolack, and Fatick regions, in synergy with HSS+
Technical support for the DSME communication team to A draft of the national FP communication plan is available develop the national FP communication plan
Technical support for the DSME to revise MNCH MNCH communications materials are available communication materials
Support to implement the database for pilot Baseline data collected in Médina Yoro Foulah municipality in synergy with Naatal municipalities in synergy with USAID programs Mbay, GOLD, Kawoolor, and ACCES
Support for the consultant to hold meetings and collect data targeting key populations from the CNLS, MSAS, DLSI; technical and financial partners, and civil society organizations A workshop to develop and validate an advocacy memo focused on: Mission to develop the advocacy document to mobilize • Programming gaps in terms of completeness and coverage of technical and PEPFAR funds financial services delivery • Gaps in human rights regulation and protection • Gaps in the monitoring-evaluation and research system • Identification of targets and priority intervention areas for the project • Identification of priority project interventions based on PEPFAR guidelines
Support for Matam MR for the mass drug distribution Support in human resources provided through bureau staff participating in advanced campaign for neglected tropical diseases deployments
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MAIN CHALLENGES AND SOLUTIONS
Challenges identified this Recommended solutions Going forward quarter
Actual launch of on-site Support quarterly scheduling of Post-training follow-up of tutors by supervision in Kédougou, visits in each district the MR Bambey, and Diourbel districts and Matam MR
Optimize how well mobile Expand services delivery in SDPs Contracts signed for new SDPs health units operate and increase demand for care Reviews organized with medical regions
Get the 4 sites located in Share the intervention strategy Development of action plans by site Dakar, Ziguinchor, and with implementation partners Mbour operational to treat and site managers HIV key populations
Start provider training on Validation training tools for Planning regional sessions gender mainstreaming in trainers SDPs
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4. CROSS-CUTTING ISSUES
GENDER MAINSTREAMING
The key activity this quarter was the celebration of International Women’s Rights Day on March 8, including the “Quinzaine de la femme,” a two-week celebration of women in the program intervention regions. This quarter also saw the continuation of CAC/GBV activities in Diourbel and Tambacounda with district-level training and establishment of community groups. In Saint Louis, implementation of the Nurturing Connections approach continued in Dagana district.
Celebration of International Women’s Rights Day (March 8, 2019)
Various sub-activities were organized, including:
• Free consultations, depending on the area, offering MNCH/FP, breast and cervical cancer screening, and HIV screening (Kolda and Sédhiou). They resulted in enrolling 50 new FP users, screening 89 women for cervical and breast cancer, and delivering 18 ANC consultations. • Major communication efforts through awareness-raising caravans, panels, and community fairs. These activities focused on the general theme of March 8, 2019—“Think fairly, build intelligently, innovate for change”—and specific topics such as early marriage and pregnancy, post-partum infections, women’s decision-making power, and their empowerment. These activities sensitized at least 1612 people, including 1343 women. • Launch of the booklet of health providers’ testimonials on equitable access to care. These 30 testimonials were collected during the week of March 8, 2018 in the program’s seven intervention regions. This collection activity tackled issues beyond clinical aspects of health, focusing also on the highly transformative work done by health providers and community actors.
Continuation of CAC/GBV activities in Diourbel and Tambacounda with district-level training and establishment of community groups
Training sessions for trainers for CAC/GBV implementation held in Diourbel and Tambacounda reached 108 health providers, including 55 women. Also, 69 community groups (fathers, mothers, grandmothers, and adolescents) also received training.
Actual implementation of the Nurturing Connections (NC) approach in Dagana district
Overall, 31 groups of people (women, husbands, and people in key populations), or 620 individuals (298 women and 322 men), received this training at HP level in Mbane, Ndombo, and Diaglé.
COMPLIANCE WITH ENVIRONMENTAL REGULATIONS
BIOMEDICAL WASTE MANAGEMENT
This quarter, biomedical waste management (BMWM) activities were carried out in Sédhiou region, with BMWM training for 25 providers (including 10 women) from Bounkiling health district.
MONITORING OF COMPLIANCE WITH ENVIRONMENTAL REGULATIONS
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Supervisions of infection prevention and environmental protection (PIPE) detected a lack of basic supplies and equipment in some facilities. Therefore, to address these shortcomings, the project set up BMWM supplies in the 29 districts. These equipment batches comprised: step-on trash cans, storage bins (intermediate bulk container; IBC), standard trash cans, yellow trash bags (50L), black trash bags (50L), red trash bags (50L), yellow trash bags (20L), black trash bags (20L), red trash bags (20L), durable coveralls, protective googles, rubber gloves, rubber boots, and pairs of gloves.
COMPLIANCE WITH FAMILY PLANNING LEGISLATION AND REGULATIONS
CAPACITY BUILDING ON FP LEGISLATION AND REGULATIONS
Tutor visits for package 2 (FP) made it possible to coach 42 qualified providers (including 40 women) and 37 CHAs (including 30 women). Also, 6 female tutors for the FP package in Diourbel and Bambey districts were introduced to FP.
SURVEILLANCE OF FP COMPLIANCE
Lack of Tiahrt posters was the main finding noted during the integrated quarterly supervisions. Thus, to make sure this tool is available in SDPs, the project supported the DSME to update and validate the Tiahrt Amendment poster on the various family planning methods. USAID and the DSME validated the content. Printing and distribution of the document is planned for next quarter.
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5. MAIN ACTIVITIES PLANNED FOR NEXT QUARTER
Activities planned for the next quarter Expected outcomes
OBJECTIVE 1: INCREASED ACCESS TO AND UTILIZATION OF QUALITY HEALTH SERVICES AND PRODUCTS IN THE PUBLIC SECTOR
Continue Tutorat 3.0 implementation All trained tutors have conducted on-site supervisions
Continue IMU activities 144 visits conducted
Support training for community groups selected for 150 groups trained the CAC/GBV
Organize community dialogue sessions to identify 3 community dialogue sessions barriers related to health services quality Commitments from 3 new mayors
Support implementation of AYRH activities in CCAs in 18 film screenings, 15 dialogue sessions, and 8 social Diourbel and Mbacké mobilizations are organized
Support supportive supervision of providers in Diourbel MR on the Nutrition/Child Survival package 45 providers are supervised in 4 districts by including actors trained on fortified flour
Support a follow-up mission to health huts in Diankémakha health district that were upgraded to Supervision of 5 health huts upgraded to health posts health posts
Train providers from Diourbel, Saint Louis, and Matam 150 providers are introduced to the PSP on the PSP
Support WISN introduction at regional level in Saint WISN is introduced in the regions of Saint Louis and Louis and Diourbel Diourbel
Support leadership training for MSAS senior staff 50 senior staff are trained in leadership
Plan activities in the 4 treatment sites for key An action plan is available for each site populations
Adapt and revise collection tools in accordance with Tools are updated PEPFAR requirements
Conduct integrated supervision at all levels At least 50% of SDPs are covered in each region
Data for the 7 concentration regions are checked, Conduct a data quality audit in the regions corrected, summarized, and validated
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Train providers and community actors on using ISM Providers and community actors from 7 concentration tools regions are introduced to ISM tools
A tree-based system for the ArchiveSoft-2 platform is Support a workshop to define the DSME archiving defined, and DSME indicators are edited in the policy platform table
OBJECTIVE 2: INCREASED ADOPTION OF HEALTHY BEHAVIORS
Research firm is selected and field activities are Complete the second stage of the longitudinal study started
The contractual package with media outlets is Continue activities with media outlets and CBOs implemented at national and regional level The contractual package with CBOs is implemented
Continue signage displays on billboards and vehicles Signage on vehicles is started this quarter
Support the BREIPS quarterly review and Policy Quarterly reviews are conducted Initiatives Teams
6. ANNEXES Annex 1: Progress on Work Plan/Indicators
Annex 2: Financial Report
Annex 3: Tutorat 3.0 implementation in intervention HDs and MRs
Annex 4: List of medical equipment and supplies for new health posts
Annex 5: Status of the community-based AYRH package
Annex 6: Status of the VADI approach
Annex 7: Summary of results of integrated mobile unit implementation
Annex 8: PIPE supplies provided to districts in the 7 concentration regions
Annex 9: Summary of the screening campaign
Annex 10: Summary of CBO activity
Annex 11: Success Story
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ANNEX 1: PROGRESS ON WORK PLAN/INDICATORS
Data used to prepare the Performance Monitoring Plan for this quarter are from the following sources:
1. DHIS2 platform for services data. The quarterly data completion rates in the DHIS-2, measured on March 29, 2019, are shown in the table below.
Medical region DSR/SE: Monthly report Child nutrition and health
Diourbel 58.7 71.3
Kédougou 67.4 82.9
Kolda 57.2 61.4
Matam 66.3 62.7
Saint Louis 51.8 66.7
Sédhiou 62.6 94.9
Tambacounda 64.7 83.3
Overall rate 61.2 74.7
2. The National Procurement Pharmacy (PNA) database (Yeksi Naa data) for the stockout indicator. Stockouts are calculated in terms of SDP coverage rates, which were 94%. 3. Active data collection done in ECRs and ECDs provided information for the indicators on basic emergency obstetric and neonatal care and FP delivery at health facility level.
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ACHIEVEMENT Progress Comments DESCRIPTION OF SOURCE/COLLECTION REP. DESAG. BASELINE FY19 INDICATORS METHOD FREQ. Q1 Q2 Q3 Q4 FY19 OBJECTIVES Goal: Support the efforts of the Government of Senegal to ensure health services are sustainably improved and effectively utilized to reduce maternal, neonatal, and child mortality and morbidity and contribute to an AIDS-free generation. Objective 1: Increased access to and utilization of quality health services and products in the public sector 1.1.4 Couple-years of Diourbel 31,780 48,633 24,651 PRA data are not available yet protection (CYP) Kédougou 20,883 17,728 2871 for this quarter. through a program Kolda 40,781 34,619 14,434 HL.7.1-1 supported by the US Every 3 Matam 25,408 10,500 296 PRA distribution data government months Saint Louis 69,375 58,892 10,206 Sédhiou 21,960 18,642 7772 Tambacounda 53,700 35,000 7382 TOTAL 26,3887 224,014 67,612 1.1.10 Number of children Diourbel 27,633 18,306 2641 2206 26% under 5 years with Kédougou 5380 3922 591 951 39% pneumonia receiving This quarter, of the 12,806 Kolda 33,085 25,310 1403 2896 17% antibiotics cases of children with 3.1.9.2-3 recommended by Every 3 Matam 7254 3525 12 290 9% pneumonia, 12,029 (94%) DHIS-2 providers and CHAs months Saint Louis 17,148 13,793 551 1854 17% received the recommended trained through a Sédhiou 12,838 7230 1045 894 27% antibiotics, achieving a 23% program supported by Tambacounda 15,528 17,651 2495 2938 31% increase for the annual target. the US government TOTAL 118,866 89,739 8738 12,029 23% 1.1.12 Number of children Diourbel 33,325 36,098 6215 10,181 45% under 5 years with Kédougou 5937 6431 505 1986 39% diarrhea treated This quarter, for the 35,664 HL.6.6-1 Kolda 27,025 29,274 555 3533 14% according to national childhood cases of diarrhea, DHIS-2 Every 3 Matam 17,116 18,540 556 1958 14% guidelines (ORS/zinc) 32,567 (92%) were treated months Saint Louis 32,754 35,479 2364 5104 21% through a program with ORS/zinc, or a 30% supported by the US Sédhiou 12,665 13,719 1534 3523 37% increase for the annual target. government Tambacounda 15,557 16,851 2011 6282 49% TOTAL 144,379 156,392 13,740 32,567 30% 1.1.18 Number of qualified Diourbel 154 216 75 94 78% 168 qualified providers, community Kédougou 48 149 0 2 1% including 87 women, and 218 providers trained in Kolda 44 165 0 12 7% community actors, including HL.9-4 nutrition through a 139 were trained in nutrition, Every 3 Matam 0 119 93 0 78% program supported Project archives achieving a 47% increase for months Saint Louis 372 314 108 24 42% by the US Sédhiou 91 153 0 87 57% the annual target. government Tambacounda 0 318 23 167 60% TOTAL 709 1434 290 386 47% 1.1.19 Diourbel 33% 75%
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ACHIEVEMENT Progress Comments DESCRIPTION OF SOURCE/COLLECTION REP. DESAG. BASELINE FY19 INDICATORS METHOD FREQ. Q1 Q2 Q3 Q4 FY19 OBJECTIVES Percentage of providers Kédougou 44% 75% No data for this quarter who comply with Kolda 33% 55% because supervision was not standards and protocols Situational analysis Matam 29% 75% done this quarter. related to the report for baseline Every 3 3.1-7 Saint Louis 38% 57% management of labor study months Sédhiou 50% 75% and delivery in facilities Supervision Report funded by the US Tambacounda 52% 75% government TOTAL 43% 75% 1.1.20a Number of service Diourbel 60 89 85 96% These data come from active delivery points Kédougou 23 32 22 69% collection conducted by ECRs providing basic life- Kolda 51 60 46 77% and ECDs. Supervisions will be saving maternal care conducted next quarter to Every 3 Matam 58 85 32 38% (basic emergency compare these data. Supervision Report months Saint Louis 89 110 63 57% Custom obstetric and Sédhiou 53 58 15 26% neonatal care) Tambacounda 61 92 18 20% supported by the US government TOTAL 386 525 281 54% 1.1.20b Number of service Diourbel 11 47 10 21% These data come from active delivery points Kédougou 4 16 1 6% collection conducted by ECRs providing vacuum- Kolda 14 33 11 33% and ECDs. The package tutors assisted vaginal Every 3 Matam 8 43 2 5% are being trained to improve delivery supported Supervision Report months Saint Louis 15 56 25 45% performance for this Custom by the US Sédhiou 5 26 4 15% indicator. government Tambacounda 10 48 8 17% TOTAL 67 269 61 23% Diourbel 100% 100% 100% 100% Family planning counseling and/or services are delivered Kédougou 100% 100% 100% 100% Percentage of in all health posts and health 100% service delivery Kolda 100% 100% 100% centers. points offering Supervision Report Every 3 Matam 100% 100% 100% 100% HL.7.1-2 counseling and/or PF months 100% services supported Saint Louis 100% 100% 100% by the US Sédhiou 100% 100% 100% 100% government Tambacounda 100% 100% 100% 100% TOTAL 100% 100% 100% 100% 1.1.24 Percentage of Diourbel 0.17% 3% 3% 10.5% 92% The main reason for service delivery PNA data (Yeksi Naa) Every 3 Kédougou 1.06% 3% 23% 15.0% 88% stockouts is product non- points assisted by months Kolda 0.15% 3% 19% 19.0% 84% delivery in January (contract USAID that Supervision Report Matam 0.28% 3% 7% 20.5% 82% signing) and the late start of
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ACHIEVEMENT Progress Comments DESCRIPTION OF SOURCE/COLLECTION REP. DESAG. BASELINE FY19 INDICATORS METHOD FREQ. Q1 Q2 Q3 Q4 FY19 OBJECTIVES experienced Saint Louis 0.21% 3% 6% 6.5% 96% product deliveries in February stockouts of Sédhiou 0% 3% 13% 10.0% 93% in the 6 World Bank regions. HL.7.1-3 contraceptive Tambacounda 1.06% 3% 3% 25.0% 77% products during the TOTAL 1% 3% 11% 15.5% 87% reporting period HL7.2-1 Percentage of Yearly Diourbel 77% 90% Annual frequency. individuals who Kédougou 51% 70% remember hearing Behavior Surveillance Kolda 65% 83% or seeing a specific Study/Special Matam 65% 82% message on FP/RH, collection/national Saint Louis 86% 90% with support from survey Sédhiou 59% 74% the US government Tambacounda 59% 76% TOTAL 67% 81% HL7.2-2 Number of Yearly Diourbel 794 1356 Annual frequency. community health Kédougou 539 692 workers supported Kolda 1655 1837 by the US Matam 639 1402 government who Mapping of huts and Saint Louis 1153 1503 provide information sites; Project archives Sédhiou 1229 1014 about FP, FP Tambacounda 1976 2738 referrals, and/or FP services during the TOTAL 7985 10,542 year 1.1.28 Number of women Diourbel 39,062 39,062 9519 10,868 52% Of the 23,047 deliveries receiving AMTSL Kédougou 3781 3781 1299 1157 65% performed in facilities, 29,261 through a program Kolda 12,377 12,377 2179 4066 50% (84%) were under AMTSL, supported by the US DHIS-2. DHIS2 Every 3 Matam 10,236 10,236 576 2482 30% achieving a 44% increase for Custom government database extraction months Saint Louis 21,902 21,902 2228 3845 28% the annual target. Sédhiou 7186 12,345 1827 2736 37% Tambacounda 13,469 13,469 2884 4107 52% TOTAL 108,013 113,172 20,512 29,261 44% 1.1.34 Number of children Diourbel 65,779 91,785 14,384 19,395 37% This quarter 65,031 children under 5 years who Kédougou 8037 11,808 3721 3551 62% under 5 years received received a nutrition Kolda 16,353 34,814 4551 5957 30% growth monitoring and Every 3 intervention in a DHIS-2 Matam 25,137 13,694 1694 4445 45% promotion, or a performance months program supported Saint Louis 47,579 66,092 6317 12,403 28% rate of 36% for the annual by the US Sédhiou 9574 42,154 7072 8168 36% target. HL.9-1 government Tambacounda 22,927 42,690 4894 11,112 37%
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ACHIEVEMENT Progress Comments DESCRIPTION OF SOURCE/COLLECTION REP. DESAG. BASELINE FY19 INDICATORS METHOD FREQ. Q1 Q2 Q3 Q4 FY19 OBJECTIVES TOTAL 195,386 303,037 42,633 65,031 36% Number of children Diourbel 48,135 69,359 9006 15,317 35% 50,509 children 0–23 months 1.1.35 0–23 months old Kédougou 6075 9235 2401 2788 56% old received growth who received a Kolda 16,525 24,211 3877 5300 38% monitoring and promotion nutrition Every 3 Matam 15,831 8968 994 3284 48% services, or a 34% increase for DHIS-2 intervention in a months Saint Louis 36,600 52,230 4389 9412 26% the annual target. program supported Sédhiou 23,497 29,604 4251 5640 33% HL.9-2 by the US Tambacounda 20,318 39,249 3481 8768 31% government TOTAL 144,466 232,855 28,399 50,509 34% 1.2.1 Percentage of SDPs Diourbel 48.0% 79% No data for this quarter that have a Kédougou 54.0% 82% because supervision was not functioning Situational analysis Kolda 54.0% 82% done this quarter. referral/counter- report Every 3 Matam 43.0% 77% Custom referral system from Quarterly supervision months Saint Louis 45.0% 78% the community to report Sédhiou 83.0% 93% the health post Tambacounda 67.0% 87% TOTAL 54.5% 82% 1.4.1 Number of Dakar IHS 827 1343 281 305 44% individuals of key Pikine 150 896 105 122 25% Every 3 populations tested Mbour 124 1294 75 212 22% District reports months who receive their Ziguinchor 295 1443 160 455 43% HTS_TST results TOTAL 1396 4975 621 1094 34% 1.4.2 Number of persons Dakar IHS 65 158 23 27 32% (adults and children) Pikine 8 81 19 14 41% Every 3 newly enrolled on District reports Mbour 8 116 8 13 18% months TX_NEW antiretrovirals Ziguinchor 9 130 9 15 18% TOTAL 90 484 59 69 26% 1.4.3 Percentage of Dakar IHS 0% 90% 9% 10% patients on Pikine 15% 90% 15% 17% antiretrovirals with Mbour 24% 90% 28% 31% an undetectable viral District reports Ziguinchor 0% 90% 0% 0% load reported in Every 3
TX_PVLS registers in a months
treatment center or TOTAL 3% 90% 11% 12% laboratory information system in the last 12 months Objective 2: Increased adoption of healthy behaviors
USAID/Neema Quarter Report - January 1–March 31, 2019 52
ACHIEVEMENT Progress Comments DESCRIPTION OF SOURCE/COLLECTION REP. DESAG. BASELINE FY19 INDICATORS METHOD FREQ. Q1 Q2 Q3 Q4 FY19 OBJECTIVES Percentage of Diourbel 43.8% 69% Annual frequency. 2.7 households that Kédougou 52.8% 63% DHS reports have a designated Kolda 46.5% 61% C-DHS space for hand Matam 93.2% 90% Behavior Surveillance Yearly HL.8.2-5 washing with soap Saint Louis 94.9% 90% Study and water that is Sédhiou 47.0% 73% used frequently by Tambacounda 17.2% 57% family members TOTAL 53.9% 72%
USAID/Neema Quarter Report - January 1–March 31, 2019 53
ANNEX 2: FINANCIAL REPORT
Redacted
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ANNEX 3: TUTORAT 3.0 IMPLEMENTATION IN INTERVENTION HEALTH DISTRICTS AND MEDICAL REGIONS
Introduction to Situational Analysis Tutor Training On-Site Coaching Tutorat 3.0 # Enrolled # Com- # SDPs that % SDPs # of persons # Tutors Launch SDPs that Medical of pleted # Avail- # of received at least that District introduced Private/ trained of on- received two region SD ? To- able Tutors one package received Public semi- site packages Ps tal Action select- at least public super- Plans ed one 1st M W T M W vision 1st visit 2nd visit 2nd visit package visit
Diourbel 24 YES 40 13 53 24 0 24 24 12 6 7 NO 0 0%
Touba 27 YES 42 12 54 27 0 27 27 16 9 7 YES 23 22 85% 7 6 Bambey 28 YES 36 22 58 28 0 28 28 13 3 9 NO 0 0% Diourbel Mbacké 24 YES 47 28 75 24 0 24 24 12 5 6 YES 11 8 46%
12 MR Total 103 63 240 103 0 103 103 53 23 29 34 30 33% 7 3 Saraya 18 YES 22 6 28 18 0 18 18 6 3 3 YES 13 72% 2
Kedougou 14 YES 15 13 28 14 0 14 14 6 3 3 NO 0 0% 0
Kédougou Salémata 7 YES 15 11 26 7 0 7 7 7 4 3 YES 7 100% 4
39 52 30 82 39 0 39 39 19 10 9 20 0 51% 6
Kolda YES 18 53 71 27 1 28 28 14 7 7 YES 19 1 68% 1 29 Médina YES 21 26 47 14 0 14 14 7 4 3 YES 6 0 43% 0 Yoro Foulah Kolda 16 Vélingara YES 14 26 40 22 0 22 22 12 6 6 YES 14 9 64% 3 23 10 68 53 158 63 1 64 64 33 17 16 39 10 61% 4 5 Kanel YES 19 76 95 37 0 37 0 0 0 0 NO 45 Matam YES 28 19 47 0 0 0 0 0 0 0 NO 30 Matam Ranerou YES 4 34 38 12 0 12 0 0 0 0 NO 17 Thilogne YES 10 22 32 0 0 0 0 0 0 0 NO 13
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15 105 61 212 49 0 49 0 0 0 0 1 Podor YES 17 36 53 35 2 37 37 16 10 8 YES 15 41% 33 Saint Louis YES 18 25 43 19 6 25 25 10 5 5 YES 7 28% 18 Dagana YES 19 13 32 13 2 15 15 7 4 3 YES 7 47% 12 Saint Louis Pete YES 34 70 104 28 0 28 28 13 7 5 NO 0 0% 28 Richard Toll YES 25 0 25 25 13 3 5 NO 0 0% 24 14 115 88 232 120 10 130 130 59 29 26 29 22% 4 Goudomp YES 15 23 38 15 2 17 17 8 3 5 YES 12 4 71% 3 18 Bounkiling YES 11 47 58 23 0 23 23 12 5 7 YES 11 6 48% 1 24 Sédhiou Sédhiou YES 16 38 54 23 1 24 24 12 5 7 YES 13 10 54% 2 24 10 MR Total 66 42 150 61 3 64 64 32 13 19 36 20 56% 6 8 Bakel 20 YES 39 29 68 20 0 20 20 8 4 4 YES 7
Diankhe 9 YES 23 6 29 9 0 9 9 5 3 3 YES 5 Makha Goudiry 17 YES 36 10 46 17 0 17 17 8 5 3 YES 5
Kidira 17 YES 46 7 53 17 0 17 17 8 4 4 YES 3 2 18% Tambacoun da Koum- 18 YES 43 4 47 18 0 18 18 7 3 4 YES 5 pentoum Maka Couli- 11 YES 27 5 32 11 0 11 11 6 3 3 YES 6 bantang Tamba- 25 YES 41 21 62 25 0 25 25 16 7 8 YES 9 counda 25 MR Total 117 82 337 117 0 117 117 58 29 29 40 2 18% 0 5 67 68 141 TOTAL: 7 REGIONS 613 29 552 14 566 517 254 121 128 9 198 62 38% 23 4 3 1
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ANNEX 4: LIST OF MEDICAL EQUIPMENT AND SUPPLIES FOR NEW HEALTH POSTS
NAME QUANTITY Step-on mucous suction pump 10 Ventilation bag + mask for newborns 10 Plastic basin (6L) 10 Delivery kit 20 Episiotomy kit 10 Bandage kit (7 instruments) 20 Small surgery kit (13 instruments) 10 Gynecological examination kit 20 Metal box for gloves (set of dressing drums) 20 Stainless steel basins (6L) 10 Set of 3 stainless steel rectangular trays (large, medium, and small) 20 Set of 3 vaginal speculums 20 Set of kidney dishes 20 Tape measure (1.50m) 10 Forceps with holder 10 Medium wash bottles 10 Stainless steel obstetric stethoscope 10 Blood pressure monitor with stethoscope 20 Medical thermometer 20 Dressing trolley 20 Step stool 20 Bed frame and mattress 30 Baby and child electronic scale 10 Adult scale with measuring stick 10 Pole hoist with basket 20 Step-on trash can 20 Step-on trash can with lid (50L) 10 Delivery table 10 Gynecological consultation table 10 Height-adjustable stool 10 Portable light 10 Treatment table 10 Desk with drawer 10 FP file 10 Glucometer 10 Penguin aspiration device 10 Implant insertion/removal kit 10 Newborn corner 10 Height-adjustable stool 10 HemoCue device or HemoCue HB 201 hemoglobin analyzer 10 3-panel screen 20
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ANNEX 5: STATUS OF COMMUNITY-BASED AYRH PACKAGE
Saint Region Matam Diourbel Tambacounda Kédougou Kolda Sédhiou Total Louis
Enrollment of huts and sites in AYSRH Y3 forecast 8 109 206 65 156 544 Achieved Q1 8 113 25 22 0 168 Achieved Q2 - - 57 22 14 93 Annual progress 100% 104% 40% 68% 9% 48% Additional CHA training Y3 forecast 343 117 201 365 137 173 363 1699 Achieved Q1 233 120 0 28 20 0 0 401 Achieved Q2 102 - 0 114 94 137 0 447 Annual progress 98% 103% 0% 39% 83% 79% 0% 50%
ANNEX 6: STATUS OF THE VADI APPROACH
Saint Regions Matam Diourbel Tamba Kédougou Kolda Sédhiou Total Louis Y3 forecast 31 8 0 71 89 26 132 357
Achieved Q1 89 8 0 75 25 22 0 219
Achieved Q2 - - - - 57 5 10 72 Annual progress 287% 100% - 106% 92% 104% 8% 82%
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ANNEX 7: SUMMARY OF RESULTS OF INTEGRATED MOBILE UNIT IMPLEMENTATION
Children’s health ANC PNC FP HIV Cancer screening IEC # of # of # of # of # of # of # # OF children children children 6– #of # # of Cervical persons children IPT # of # of users adolescents/youths Breast DISTRICT VISIT 0–23 who 59 months ANC PNC # of new persons cancer reach- 12–59 unde LLITNs of modern 10–24 years who cancer S months received screened visit visit FP users screened screenin ed by months r distributed FP methods received FP screening vaccinate vitamin for s s for HIV g an IEC dewormed DOT services d A malnutrition activity DIOURBEL MEDICAL REGION Diourbel 8 274 163 215 117 58 30 11 19 12 39 12 20 0 0 439 Bambey 3 79 48 79 37 29 26 5 7 9 35 5 0 0 0 189 Mbacké 2 30 33 67 23 14 9 5 1 8 20 5 0 0 0 150 Touba 3 67 13 59 12 19 16 10 18 11 27 6 0 0 0 156 MR Total 16 450 257 420 189 120 81 31 45 40 121 28 20 0 0 934 SAINT LOUIS MEDICAL REGION Podor 3 104 61 106 39 20 16 0 5 4 6 1 12 0 41 252 MR Total 3 104 61 106 39 20 16 0 5 4 6 1 12 0 41 252 SEDHIOU MEDICAL REGION Bounkiling 2 42 18 18 9 10 6 6 0 1 1 0 0 5 8 16 Goudomp 1 0 5 5 5 10 9 3 2 0 0 0 0 0 9 11 Sédhiou 3 0 17 19 13 12 8 1 7 4 8 1 0 0 39 40 MR Total 6 42 40 42 27 32 23 10 9 5 9 1 0 5 56 67 KOLDA MEDICAL REGION Kolda 2 58 12 14 12 17 19 0 2 2 7 13 4 0 0 156 Médina 2 93 35 47 25 25 21 0 2 2 3 2 7 0 0 170 Yoro Foulah Velingara 2 24 0 14 0 15 10 0 1 4 9 1 1 0 0 112 MR Total 6 175 47 75 37 57 50 0 5 8 19 16 12 0 0 438 GRAND 31 771 405 643 292 229 170 41 64 57 155 46 44 5 97 1691 TOTAL
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ANNEX 8: PIPE SUPPLIES PROVIDED TO DISTRICTS IN THE 7 CONCENTRATION REGIONS
REGIONS NAME TOTAL DIOURBEL KEDOUGOU KOLDA MATAM SAINT LOUIS SEDHIOU TAMBACOUNDA Step-on trash cans 175 100 150 65 100 150 100 840 Storage bins (intermediate bulk containers; IBCs) 0 2 2 0 0 2 0 6 Standard trash cans 100 30 100 45 80 50 60 465 Yellow trash bags (50L) 1000 300 700 800 1000 500 800 5100 Black trash bags (50L) 1000 500 700 700 900 700 900 5400 Red trash bags (50L) 500 200 300 200 350 300 400 2250 Yellow trash bags (20L) 1000 300 700 800 900 500 900 5100 Black trash bags (20L) 1000 500 700 700 900 700 900 5400 Red trash bags (20L) 500 200 300 200 350 300 400 2250 Durable coveralls 10 4 6 6 7 5 7 45 Masks 10 4 6 6 7 5 7 45 Protective goggles 10 4 6 6 7 5 7 45 Rubber gloves 10 4 6 6 7 5 7 45 Rubber boots 10 4 6 6 7 5 7 45 Pairs of gloves 10 4 6 6 7 5 7 45
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ANNEX 9: SUMMARY OF THE SCREENING CAMPAIGN
MSM SWs IDUs
SITES
YIELD YIELD YIELD
TX_NEW TX_NEW
HTS_TST HTS_TST
HTS_TST_POS HTS_TST_POS
HTS_TST HTS_TST_POS TX_NEW
DAKAR 100 4 4% 4 72 8 11% 7 80 0 0% 0 MBOUR 100 3 3% 3 100 4 4% 4 100 2 2% 2 ZIGUINCHOR 375 32 9% 10 80 4 5% 4 100 3 3% 3 KOLDA 68 4 6% 4 208 12 6% 12 40 3 8% 3 SEDHIOU 70 2 3% 2 90 4 4% 4 10 1 10% 1 Total 713 45 6% 23 550 32 6% 31 330 9 3% 9
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ANNEX 10: SUMMARY OF CBO ACTIVITY
Regions Activity Number of Number of males Number of females activities reached reached implemented Adults Adolescents Total Adults Adolescents Total Group 135 496 99 595 2220 275 2495 discussion Diourbel Group 33 53 112 165 327 154 481 discussion VADI 722 1149 642 1791 2393 1088 3481 Group 62 217 297 514 946 92 1038 Kolda discussion VADI 1280 1426 684 2110 2436 1082 3518 Group 47 169 265 434 659 265 924 Sédhiou discussion VADI 825 863 557 1420 1186 819 2005 Group 103 94 0 94 2192 416 2608 Saint discussion Louis VADI 3255 957 1362 2319 4786 1823 6609 Group 43 58 0 58 1671 1133 2804 Matam discussion VADI 1266 639 980 1619 3158 289 3447 Group 56 298 109 407 478 233 711 Kédougou discussion VADI 230 605 327 932 748 306 1054 Group 81 272 128 400 1647 119 1766 Tamba- discussion counda VADI 203 341 210 551 1197 696 1893 Group 560 1657 1010 2667 10,140 2687 12,827 Total discussion VADI 7781 5980 4762 10,742 15,904 6103 22,007
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ANNEX 11: SUCCESS STORY
Midwives Are Changing the Story for Women in Rural Senegal
It was late at night during Ramadan when Fatou Mbaye had to make some fast decisions.
A pregnant woman had just stumbled into Tanaf Health Post, where Fatou works as a midwife. It was clear the woman was sick. A quick examination pointed to preeclampsia, a dangerous elevation in blood pressure that can be fatal for both mom and baby.
But what to do? The woman needed more specialized care than the little health post in Senegal’s Goudomp district could provide. She needed the hospital on the other side of the Casamance River, which meant she also needed transport and money, and she didn’t have either.
So Fatou—very pregnant at the time herself—loaded the woman into a narrow wooden boat and took her there.
That was three months ago. Today is not so stressful, Fatou tells us. It’s busy, of course—she sees around 30-40 clients every day. But the sun is shining and there are no emergencies so far. Just the usual cases of diarrhea, malnutrition, sexually transmitted infections, and—most common of all, for Fatou--prenatal visits.
At the moment, she’s conducting a prenatal exam with a client who’s pregnant with her fifth child. When the woman sits up from the examination table, Fatou hands her three tablets of sulfadoxine and pyrimethamine and a cup of water. The client swallows the antimalarial pills and Mbaye makes a note of it in the health post’s register.
All of this seems very routine, but in fact Fatou has just delivered a crucial element of comprehensive maternity care in Senegal. Malaria rates have been dropping in Senegal for the past decade, but it remains endemic in the country. And it’s particularly dangerous for pregnant women. The parasite is known to target the placenta and can cause a pregnant woman to develop anemia, give birth prematurely, or even lose the fetus.
Before the USAID funded Neema project came along, Fatou says, women would come to the post for occasional malaria treatment, but unless they came back on their own, there was no way for health workers to follow up or make sure they were getting all the medications they needed. With Neema’s help, they’ve developed a case-management system that fills their data gaps and improves care at the post.
Take the client Fatou is talking with now, for example. Now that her information is recorded and up-to-date in the register, Fatou will stay in touch with the community relay—a community-based worker who lives in the woman’s village—by phone to ensure the woman keeps taking her preventive medicines and is staying healthy throughout her pregnancy. Because of this upgraded recordkeeping and follow-up, Fatou says, they’ve seen malaria rates among pregnant women at the post drop from 3% in 2016 to 2% in 2018.
Soon after that late-night boat journey, Fatou gave birth to her first child, a healthy baby boy. The woman she had saved was still recovering in the hospital nearby—she had survived, but her baby, sadly, had not. This is a wider problem that Senegal’s policy-makers and frontline health workers alike are now grappling with after infant mortality increased slightly last year.
Before we leave, we ask Fatou, What’s your favorite part of being a midwife?
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“I love helping people,” she says. “Especially women who are vulnerable, who have no job and no money. Seeing them get healthier is what drives me to get up in the morning and come here.”
Fatou Mbaye, midwife at Tanaf Health Post, in Goudomp district, Senegal. Mbaye always wanted to be a midwife. As a child, she spent whole days watching her mother, a hospital matron, as she worked.
Photo by Clement Tardif for IntraHealth International.
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