USAID Health Service Delivery Quarterly Progress Report

April 1, 2020 to June 30, 2020

Submission Date: July 29, 2020

Agreement Number: AID-278-A-16-00002 Agreement Period: March 15, 2016 to March 14, 2021 Agreement Officer’s Representative: Dr. Nagham Abu Shaqra

Submitted by: Dr. Sabry Hamza, Chief of Party Abt Associates 6130 Executive Blvd. Rockville, MD 20852, USA Tel: +1-301-913-0500/Mobile: +962-79-668-4533 Email: [email protected]

This document was produced for review and approval by the United States Agency for International Development/Jordan (USAID/Jordan).

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

TABLE OF CONTENTS

ACRONYMS AND ABBREVIATIONS ...... III GLOSSARY ...... VI 1. ACTIVITY OVERVIEW ...... 1 A. ACTIVITY DETAILS ...... 1 B. VISION ...... 2 C. MISSION ...... 2 D. IMPLEMENTATION APPROACH ...... 2 2. EXECUTIVE SUMMARY ...... 4 A. SUMMARY OF REPORTABLE Q3 INDICATORS ...... 4 B. COVID-19 AND USAID HEALTH SERVICE DELIVERY’S RESPONSE ...... 5 C. RMNCH+ SERVICE DELIVERY IMPROVEMENT ...... 7 D. COMMUNITY ENGAGEMENT ...... 8 E. RMNCH+ COMMUNITY OUTREACH PROGRAM ...... 9 F. INNOVATION GRANTS ...... 9 G. JORDAN’S MATERNAL MORTALITY SURVEILLANCE AND RESPONSE SYSTEM ...... 9 H. STRENGTHENING SELF-RELIANCE ...... 10

3. ACTIVITY IMPLEMENTATION ...... 11

SUMMARY OF FY20 Q3 DELIVERABLES ...... 11 Result 1: Expanded Availability of and Access to Integrated RMNCH+ Services ...... 14 Sub-result 1.1: Increased Uptake of Integrated RMNCH+ Services ...... 14 Sub-result 1.2 Increased community involvement to promote and increase demand for RMNCH+ services ...... 23 Result 2: Improved Quality of Integrated RMNCH+ Services ...... 28 Sub-result 2.1: Improve provider competency and behavior to deliver evidence-based RMNCH+ services ...... 28 Sub-result 2.2 Strengthening management to support delivery of high-quality RMNCH+ services ...... 30 USAID Health Service Delivery Support to the National COVID-19 Preparedness and Response Plan 2020 for Jordan ...... 34 Support the National COVID-19 Preparedness and Response Plan – Pillar 7 (Case Management) ...... 34 Support the National COVID-19 Preparedness and Response Plan – Pillar 8 (Operation Support and Logistics) ...... 38

i USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

Support the National COVID-19 Preparedness and Response Plan – Pillar 2 (Risk Communication and Community Engagement) ...... 40 Support the National COVID-19 Preparedness and Response Plan – Pillar 3 (Surveillance, Rapid Response Teams, and Case Investigation) ...... 41

4. COLLABORATION AND KNOWLEDGE SHARING ...... 42

A. USAID HEALTH SERVICE DELIVERY IMPLEMENTING PARTNERS ...... 42 B. PARTNER ENTITIES IN HOST GOVERNMENT AND OTHER DONOR AGENCIES...... 42

5. PLANNED ACTIVITIES FOR NEXT QUARTER ...... 44

6. BRANDING, COMMUNICATIONS AND DISSEMINATION ...... 45

A. KEY COMMUNICATION ACTIVITIES IN FY20 Q3 ...... 45 B. CALENDAR OF PLANNED OUTREACH AND COMMUNICATION EVENTS FOR FY20 Q4 ..... 45

ii USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

ACRONYMS AND ABBREVIATIONS

ALSO Advance Life Support for Obstetrics AO Agreement Office CDC Centers for Disease Control and Prevention CDD Communicable Diseases Directorate CHWs Community Health Workers CHC Community Health Committee CME Continuing Medical Education COVID-19 Corona Virus Disease 2019 CS Cesarean Section CSC Community Scorecard CSS Client Service Station CYP Couple Years of Protection DAG Directorate Advisory Group EMPHNET Eastern Mediterranean Public Health Network ETITD Electronic Transformation and Information Technology Directorate FBSS Facility-Based Supportive Supervision FGAC Family Guidance and Awareness Center FP Family Planning FPCM Family Planning Compliance Monitoring FY Fiscal Year GBV Gender Based Violence GFA Geographic Focus Area GP General Practitioner HAD Health Affairs Directorates HC Health Center HCC Healthy Community Clinic HCAC Health Care Accreditation Council HCAD Health Communication and Awareness Directorate HCP Health Care Provider HMIS Health Management Information System HPC Higher Population Council HPS Health Promotion Supervisors IDQCD Institutional Development and Quality Control Directorate iii USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

IEC Information, Education and Communication IFH Institute for Family Health ICD International Classification of Diseases ICU Intensive Care Unit IPC Infection Prevention and Control IRC International Rescue Committee ISD Integrated Service Delivery ISDIC Integrated Service Delivery Improvement Collaborative IUD Intrauterine Device IV Intravenous JAFPP Jordanian Association for Family Planning and Protection JMMSR Jordan Maternal Mortality Surveillance and Response JMMSR-IS Jordan Maternal Mortality Surveillance and Response Information System JUH Jordan University Hospital LARC Long Acting Reversible Contraceptive LHSS Local Health Systems Sustainability MCH Maternal and Child Health MOH Ministry of Health MTaPS Medicines Technologies and Pharmaceutical Services MtMBSG Mother-to-Mother Breastfeeding Support Groups NAG National Advisory Group NCDD Non-Communicable Diseases Directorate NGO Non-Governmental Organization NICU Neonatal Intensive Care Unit Ob/Gyn Obstetrics and Gynecology OTJ On-The-Job PHC Primary Health Care Q Quarter RMNCH+ Reproductive, Maternal, Newborn and Child Health including Nutrition, Non-Communicable Diseases and Gender Based Violence RMS Royal Medical Services RHAS Royal Health Awareness Society SBCC Social Behavior Change Communication SDP Service Delivery Point

iv USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

TOT Training of Trainers TWG Technical Working Group TWCS Tafilah Women Charitable Society UNFPA United Nations Population Fund USAID United States Agency for International Development WCH Woman and Child Health WCHD Woman and Child Health Directorate WHO World Health Organization WHO-EMRO WHO Eastern Mediterranean Regional Office

v USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

GLOSSARY

Baseline A method used to assess a current situation to help USAID Health Assessment: Service Delivery identify gaps in delivery of reproductive, maternal, newborn and child health services, and measure progress against the baseline over time.

Change Package: A group of interventions designed to improve the health service delivery process and address gaps indicated in the baseline assessment findings as part of the Integrated Service Delivery Improvement Collaborative (ISDIC).

Client Service A functional triage unit or station established within the health facility Station (CSS): using existing resources with the aim of improving and organizing client flow to ensure receipt of integrated health care services.

Continuum of Public health framework based on integrated service delivery (ISD) Care: throughout the lifecycle (adolescence, pregnancy, childbirth, postnatal period and childhood) and between places of care (including households, communities and clinical care settings).

Collaborative Each ISDIC cycle includes a collaborative session in which several SDP Sessions: teams present their progress and discuss how they overcame challenges. This collaborative approach allows exchange of productive ideas and experiences, facilitating greater improvement for SDPs.

Coronavirus An infectious disease caused by a newly discovered coronavirus in Disease 2019, it spreads primarily through droplets of saliva or discharge from (COVID-19) the nose when an infected person coughs or sneezes. At this time, there are no specific vaccines or treatments for COVID-19. However, there are many ongoing clinical trials evaluating potential treatments.

Data-Driven The use of assessment and research data to improve the delivery and Approach: management of services for reproductive, maternal, newborn and child health, including nutrition, non-communicable diseases and gender- based violence (RMNCH+), by promoting evidence-based decision- making and informed strategic planning.

Decision Support An information system that aggregates and reports on key System: performance indicators in an easy-to-use format for RMNCH+ program managers at all levels.

Facility-based A process of guiding, helping, training and encouraging staff to improve Supportive their performance continuously; it is a group collaboration effort at Supervision the facility level. The FBSS uses open, two-way communication and (FBSS): team-building to facilitate problem-solving, by focusing on monitoring performance through the use of clinical performance checklists for service providers at the facility, according to a supervisory plan.

vi USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

Innovation The Innovation Grants Program supported a wide range of innovative Grants: approaches and activities to improve access to, quality of, and use of RMNCH+. USAID Health Service Delivery defines “Innovations” as service delivery, community interventions, or technology applications that are not currently part of ongoing programs throughout Jordan, and which intend to achieve improved health results.

Integration of From the client's perspective, integration means health care that is Care: seamless, smooth, and easy to navigate. From the provider's perspective, integration means that separate technical services and their management support systems are provided, managed, financed, and evaluated either together or in a closely coordinated way. Evidence-based clinical pathways reinforce compliance with key steps in service delivery. Providers structure interactions with clients based on an initial assessment of client needs. Documentation provides useful information for each client and service. From a community’s perspective, health care responds to priority needs with good access to and quality of care, and more engagement in planning and monitoring of health services. From a health manager’s perspective, information on overall service provision is readily available, aggregated as needed for each level of care. This should lead to prompt identification of gaps or challenges, and better use of resources.

Integrated Service An integrated, preventive, and curative package developed to enhance Delivery Package: access to care, and quality, integration, and consistency of care. This integration is essential to improving the delivery of RMNCH+ services at Service Delivery Points (SDPs) and avoiding missed opportunities for comprehensive service delivery.

Integrated Service USAID Health Service Delivery uses a customized collaborative Delivery approach to introduce and implement the ISD package in selected Improvement SDPs. The ISDIC is a dynamic, data-driven approach that uses a cycle Collaborative: of performance-based monitoring, analysis, and change implementation. Each ISDIC cycle includes a collaborative session, a change package, and an action period that allows SDP teams to implement and monitor progress in improving RMNCH+ services according to results. Jordan Maternal The JMMSR is a national system to quantify the maternal mortality Mortality ratio for Jordan through active surveillance, and to eliminate Surveillance and preventable maternal deaths. Bylaw 10 mandates implementation of Response the JMMSR system for all sectors, and technical steps cover the (JMMSR) System: notification of deaths among women of reproductive age, identification of maternal deaths, review, analysis, response, and dissemination. Service Delivery SDPs are the health facilities (clinics and hospitals) selected by USAID Points (SDPs): Health Service Delivery to implement improvements related to RMNCH+ services.

vii USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

1. ACTIVITY OVERVIEW

A. ACTIVITY DETAILS

Activity Name USAID Health Service Delivery Activity Start/End Date March 15, 2016–March 14, 2021 Name of Prime Implementing Abt Associates Partner Contract/Agreement Number AID-278-A-16-00002

Jordan Health Care Accreditation Council (HCAC), Eastern Mediterranean Public Health Partners Network (EMPHNET), Population Council, American College of Nurse-Midwives Geographic Coverage Nationwide (Governorates/Districts) Fiscal Year 2020 Quarter 3 Reporting Period (April 1, 2020 to June 30, 2020)

The five-year USAID Health Service Delivery is funded by the United States Agency for International Development/Jordan (USAID/Jordan). The objective is to improve health outcomes for women of reproductive age and children under the age of five, including Syrian refugees living in Jordanian host communities. Abt Associates and its partners implement USAID Health Service Delivery.

In partnership with the Government of Jordan and other international and local partner organizations, USAID supports programs that expand access to and availability of integrated health services and improve the quality of essential health services at the national and sub- national levels in Jordan. Multiple initiatives are under way to improve the health of both Jordanian nationals and non-Jordanians living in Jordan. The main guiding frameworks are the Ministry of Health (MOH) Five-Year Strategic Plan, the Jordan Response Plan, and the USAID Country Development Cooperation Strategy. USAID Health Service Delivery supports and reinforces many of the themes and concepts in these strategic documents.

USAID Health Service Delivery directly supports USAID/Jordan’s Results Framework Intermediate Result 3.1 (Health Status Improved), by expanding access to and availability of integrated health services. USAID Health Service Delivery works in the public, nongovernmental, and private sectors in its geographic focus areas to improve the quality of RMNCH+ services.

USAID Health Service Delivery also contributes to improving health-seeking behaviors and practices by increasing health services’ accountability to and engagement of communities. USAID Health Service Delivery helps alleviate impacts of rapid population growth by increasing access to quality health services, and by improving availability and quality of family planning services.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

In collaboration with the MOH Communicable Disease Directorate (CDD), USAID Health Service Delivery, per USAID guidance, developed and implemented new activities to support the National Preparedness and Response Plan for COVID-19 in Jordan. USAID Health Service Delivery activities addressed several pillars from the National Preparedness and Response Plan for COVID-19, Pillar 7 on Case Management, Pillar 8 on Operation Support and Logistics, and Pillar 2 on Risk Communication and Community Engagement.

B. VISION

Women of reproductive age and children under five years of age in Jordan will access and receive comprehensive, integrated quality health services across a continuum of care, resulting in improved health status.

C. MISSION

USAID Health Service Delivery aims to improve health outcomes for women of reproductive age and children under five years of age, including Syrian refugees living in Jordanian host communities. Abt Associates and its partners implement the programs and interventions. The USAID Health Service Delivery approach will stimulate management, clinical, and behavioral changes within Jordan’s public, nongovernmental organizations (NGOs), and private health services that will lead to better RMNCH+ outcomes.

Integrated, efficient, and effective health service delivery is an essential instrument to enhance the health status, health protection, and social welfare of women of reproductive age and children under five years of age.

USAID Health Service Delivery works with Jordanian counterparts at all levels of the health system to ensure that they assume full ownership of all programs. Building capacity to sustain performance improvements is a core component of every level and intervention. By engaging health managers and health teams in improvement processes, USAID Health Service Delivery builds their capacity to engage in continuous improvement cycles.

USAID Health Service Delivery provides clinical training to address identified gaps or weaknesses, and strengthens supportive supervision at each level of the system to sustain clinical and managerial competencies in the future.

D. IMPLEMENTATION APPROACH

USAID Health Service Delivery has two main results under the objective of improving health outcomes for women of reproductive age and children under five years of age, as shown in the results framework below (Figure 1).

Result 1 addresses expanding availability of and access to integrated reproductive, maternal, neonatal, and child health services. USAID Health Service Delivery designs and implements interventions to increase uptake of RMNCH+ services by the targeted population (Sub-result 1.1). The interventions also increase community involvement in raising awareness of RMNCH+ information and services available in the public, non-governmental, and private sectors (Sub-result 1.2).

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

Result 2 addresses improving the quality of integrated reproductive, maternal, neonatal, and child health services. This requires complementary and parallel interventions to improve provider competency in delivering high quality, evidence-based services (Sub-result 2.1), and to strengthen management of RMNCH+ services (Sub-result 2.2).

Objective: Improved health outcomes for women of reproductive age and children under five

Result 1: Expanded availability Result 2: Improved quality of of and access to integrated integrated RMNCH +services RMNCH+ services

Sub-result 1.1 Sub-result 1.2 Sub-result 2.1 Sub-result 2.2 Increased uptake of Increased community Improved providers’ Strengthened integrated involvement to promote, and competency and management to RMNCH+ services increase demand for, quality behavior to deliver support delivery of RMNCH+ services evidence-based high-quality RMNCH+ services RMNCH+ services

Figure 1: USAID Health Service Delivery Results Framework

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

2. EXECUTIVE SUMMARY

A. SUMMARY OF REPORTABLE Q3 INDICATORS

Overall, three out of the six reportable indicators for this quarter (A1, Q7.2 and Q8) were within ±10% of the set target, while the other three indicators (R3, A3, Q7.1) were more than 10% below the target. Annex 1 provides a detailed description of all monitoring indicators.

• During FY20 Q3, 25 NGO clinics representing over 20% of all SDPs at the primary health care (PHC) level did not provide data on R3, A1, and A3 indicators. Three Institute for Family Health (IFH) clinics closed, and the clinics did not resume operations after the government shutdown ended. The International Rescue Committee (IRC) clinics are operating virtually; therefore, the two participating IRC clinics did not receive FP clients during this quarter. Even though the Jordanian Association for Family Planning and Protection (JAFPP) clinics have been operational since the last week of April, the JAFPP headquarters and clinics declined to communicate with USAID Health Service Delivery since April, and accordingly JAFPP did not provide the data on PHC indicators.

• The MOH PHC SDPs and most of the NGO clinics have been fully operational only for the month of June. All PHC SDPs closed during the period from the second half of March until the end of the third week of April. During April and May, due to the government shutdown, SDPs received fewer FP clients.

• In addition, USAID Health Service Delivery added data from the first two weeks of March 2020 that had not been reported from PHC SDPs during Q2 due to the government shutdown.

• The PHC A1, is a percent indicator and will not be affected by the short operational period and absence of data from the 25 NGO clinics. In contrast, the numeric R3 and A3 indicators are largely affected.

• The hospital SDPs continued operation during the government shutdown, yet with reduced numbers of staff.

• About 89% of all PHC facilities were providing five modern family planning methods including intrauterine devices (IUDs) and implants (A1 indicator). The value of this indicator is about 1% below the set annual target of 90%.

• The R3 indicator representing the total Couple Years of Protection (CYP) for PHC and hospital SDPs reached 15,356, which was about 44% below the projected quarterly target of 27,500. Based on FY19 CYP data, USAID Health Service Delivery estimates that the missing data from 25 NGO clinics would have contributed to approximately 37% more CYP. Moreover, the government shutdown and closure of SDPs during April and May likely contributed to the underachievement of this indicator.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

• During this quarter, the PHC facilities managed to achieve 7,279 new family planning visits (A3 indicator), which is about 35% below the projected quarterly target of 11,250. Based on FY19 data, USAID Health Service Delivery estimates that the missing data from the 25 NGO clinics would have contributed to approximately 21% more new family planning visits. Moreover, the government shutdown certainly contributed to the underachievement of this indicator (in addition to the 25 non-reporting clinics).

• The focal points in JMMSR facilities reported about 41% of deaths among women of reproductive age were notified within 24 hours of time of death (Q7.1 indicator). The reported figure was below the target of 60% by more than 10%. The operation of hospitals with reduced number of staff during the government shutdown has played a role in the underachievement of this indicator.

• About 90% of the 126 JMMSR facilities notified deaths among women of reproductive age or submitting zero-reports (Q7.2 indicator). The reported figure was about 5% below the set target of 95%.

• The Health Directorate Advisory Groups (DAGs) reviewed 100% of maternal deaths within one month of completion of household survey (Q8). The value of this indicator is an exact match of the annual target.

B. CORONA VIRUS DISEASE 2019 (COVID-19) AND USAID HEALTH SERVICE DELIVERY’S RESPONSE

On March 19, 2020, Abt Associates received a request from the USAID Agreement Office (AO) to develop new activities within USAID Health Service Delivery’s mandate to support the National Preparedness and Response Plan for COVID-19 in Jordan. USAID Health Service Delivery is working in close collaboration with the MOH Communicable Disease Directorate (CDD) to address the following pillars from the plan: Pillar 7 on Case Management, Pillar 8 on Operation Support and Logistics, and Pillar 2 on Risk Communication and Community Engagement. USAID also requested that USAID Health Service Delivery work on and Pillar Three on Surveillance, Rapid Response Teams, and Case Investigation. However, per USAID guidance, USAID Health Service Delivery put on hold the Pillar 3 planned activities in FY20 Q3. During FY20 Q4, USAID requested that USAID Health Service Delivery terminate this activity. a) Pillar 7: Case Management

During FY20 Q3, under Pilliar 7, USAID Health Service Delivery supported the MOH’s CDD in developing the “Clinical Guidance and Protocols for COVID-19 Case Management”. USAID Health Service Delivery developed this guidance using the most updated evidence from the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC), in addition to the current knowledge emerging from countries with high levels of COVID-19. USAID Health Service Delivery also developed the corresponding “Clinical Guidance and Protocols for COVID-19 Case Management – Training Manual.” Together with the MOH CDD, USAID Health Service Delivery conducted a training of trainers (TOT) workshop to establish a core group of MOH trainers to support subsequent health care provider trainings on the Clinical Guidance and Protocols for COVID-19. Eighty-five participants attended the TOT and 53 passed the training requirements.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

USAID Health Service Delivery conducted nine virtual training workshops for PHC facilities and five virtual training workshops for hospitals, with the MOH’s WCHD (Woman and Child Health Directorate) and CDD selecting trainees. The workshops aim to improve the MOH staff knowledge and ability to screen, triage, and manage suspected and confirmed COVID-19 cases, including for pregnant women and children. USAID Health Service Delivery trained a total of 424 PHC staff and 538 hospital staff on case management. Therefore, in FY20 Q3, USAID Health Service Delivery trained 1047 trainees on Pillar 7, including trainees from the PHC facilities, hospitals, and the TOT participants.

During FY20 Q4, USAID Health Service Delivery will continue to support the MOH in expanding training on COVID-19 Case Management to cover all training modules. Additionally, USAID Health Service Delivery will support LHSS to include select private providers in relevant training modules. b) Pillar 8: Operation Support and Logistics

Under Pillar 8, USAID Health Service Delivery, together with the CDD and the Institutional Development and Quality Control Directorate (IDQCD) of the MOH, adapted and translated the “Public Hospital Readiness Checklist for COVID-19.” The WHO Eastern Mediterranean Regional Office (WHO-EMRO) originally developed this checklist. During FY20 Q3, USAID Health Service Delivery, in collaboration with the MOH CDD and the IDQCD, conducted the assessment in two MOH nominated hospitals (Zarqa New Governmental Hospital and Al-Hussein (Al-Salt) New Hospital). The assessment findings will support the MOH and hospital managers in making informed decisions, developing a roadmap, and creating strategies addressing priority areas in preparation for COVID-19 cases. During FY20 Q4, once USAID Health Service Delivery and the MOH finalize the “Public Hospital Readiness Checklist for COVID-19” refinements, USAID Health Service Delivery, in collaboration with the MOH, will conduct hospital readiness assessments in nine additional MOH hospitals.

In FY20 Q3, USAID Health Service Delivery worked jointly with the MOH’s Electronic Transformation and Information Technology Directorate (ETITD) on another activity in support of Pillar 8. USAID Health Service Delivery with ETITD began designing the enhancement of the existing MOH Mobile Health Map Application by adding functions pertinent to COVID-19 services provided at each facility level. c) Pillar 2: Risk Communication and Community Engagement

Under Pillar 2, USAID Health Service Delivery, in collaboration with the Health Communication and Awareness Directorate (HCAD) of the MOH, updated the health education and awareness messages related to COVID-19. These messages were prepared using WHO and CDC information. USAID Health Service Delivery, in collaboration with the HCAD and the Health Promotion Supervisors (HPS), supported the community health committees (CHCs) to share the newly developed COVID-19 health messages within their communities using their social media platforms, e.g., Facebook and WhatsApp. In Addition, the HCAD uploaded the health education and awareness messages related to COVID-19 on the MOH website.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

C. RMNCH+ SERVICE DELIVERY IMPROVEMENT

During the government lockdown, USAID Health Service Delivery developed and submitted to USAID alternative approaches to sustain access to RMNCH services during the COVID- 19 pandemic. USAID Health Service Delivery designed the alternative approaches to facilitate the identification of RMNCH clients in need of health care services while at home. The approaches included initiating interactive dialogue between health care providers (physicians and / or midwives) and their clients who are at home and have specific RMNCH needs. USAID Health Service Delivery also continued to follow-up virtually with counterparts and worked with CHCs to post health messages on their social media platforms.

USAID Health Service Delivery partners with the MOH, Royal Medical Services (RMS), and NGOs to improve RMNCH+ services through Integrated Service Delivery Improvement Collaborative (ISDIC) cycles that allow staff in hospitals, Health Centers (HCs), and NGO clinics to identify their own performance gaps in RMNCH+ services and develop and implement interventions to resolve them.

USAID Health Service Delivery also engages private sector providers through training and technical support to increase their understanding and use of RMNCH+ best practices. a) Primary Health Care Service Delivery Improvement

Previously, USAID Health Service Delivery led collaborative sessions with key MOH and NGO counterparts. To support the MOH’s journey to self-reliance, in FY20 Q2, USAID Health Service Delivery provided minimal support to the Health Affairs Directorates (HADs) to conduct the collaborative sessions. Due to the government shutdown, Irbid HAD was not able to conduct its collaborative sessions planned for the end of March. Accordingly, on May 31st and June 1st, USAID Health Service Delivery assisted the Irbid HAD to conduct two virtual collaborative sessions with its 17 HCs.

Due to the government shutdown, USAID Health Service Delivery staff were not able to conduct follow-up field visits during April and May. The field visits resumed in mid June. The objectives of HC field visits were to follow up on RMNCH+ progress and COVID-19 HC preparedness.

USAID Health Service Delivery continued supporting the Client Service Station (CSS) implementation at MOH HCs and NGO clinics. The CSS aims to increase clients’ awareness of RMNCH+ services and minimize missed opportunities for women and children to receive the Maternal and Child Health (MCH) services.

During FY20 Q3, HC managers continued to conduct FBSS as soon as the HCs resumed functionality at full capacity, in late May. HC managers sent FBSS reports to HADs for their review and feedback.

In April 2020, to facilitate access to integrated RMNCH+ services during the COVID-19 pandemic, USAID Health Service Delivery with the MOH WCHD initiated a virtual training to enable targeted HCs and NGO clinic staff to provide virtual MCH services and counseling.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

b) Private Sector Providers

USAID Health Service Delivery added topics related to the COVID-19 pandemic to the “Private Sector Training Plan.” During FY20 Q3, USAID Health Service Delivery conducted a “Nutrition during Pregnancy and Infection Prevention and Control (IPC) Measures related to COVID-19” workshop. Thirty-one private physicians from five governorates (Amman, Irbid, Zarqa, Ma’an and Aqaba), in addition to physicians from Al-Amal Hospital, attended the workshop.

USAID Health Service Delivery also conducted “Frequently Asked Questions during COVID- 19 Pandemic related to Pregnancy, Breastfeeding and Child Health” training workshop. Twenty-one private physicians from four governorates (Amman, Irbid, Zarqa, and Aqaba) attended the workshop.

In addition, USAID Health Service Delivery conducted a virtual refresher training on the didactic part of Copper IUD insertion and removal. Twenty-two private physicians attended the three-day virtual training. USAID Health Service Delivery also began conducting the practical part of the IUD training with individual physicians at their private clinics. c) Hospital Service Delivery Improvement

In June, USAID Health Service Delivery conducted 10 quarterly data collection visits. To facilitate timely data collection, health care providers, working in participating hospitals, helped to provide the required FY20 Q3 data samples. USAID Health Service Delivery also followed-up virtually with MOH and RMS hospitals to facilitate preparing and developing comprehensive change packages. This process supports identifying areas for improvement and mitigating any challenges. USAID Health Service Delivery continued to support four HADs to improve the linkages between hospitals and PHCs. The team provided technical assistance to increase the hospitals and PHCs’ uptake of integrated RMNCH+ services.

In FY20 Q3, the Director of the Clinical Pharmaceutical Directorate continued to collaborate with hospital pharmacists to establish a suitable environment to implement the Aseptic Preparation and Administration of IV (Intravenous) Medications and Fluids Guidelines. USAID Health Service Delivery also finalized the National Guideline to Support Vaginal Births and Reduce Unnecessary Primary Cesarean Sections (C/S) based on the latest evidence-based practices. These guidelines target health care providers working in labor departments. The guidelines aim to achieve safe reduction in the existing rate of primary CS deliveries in Jordan, through standardizing health care provider practices.

D. COMMUNITY ENGAGEMENT

During FY20 Q3, USAID Health Service Delivery collaborated with the HCAD of the MOH to strengthen the capacity and performance of 80 active CHCs within MOH HC catchment areas. The teams used the Community Mobilization Manual to train 83 participants from four CHCs. During the COVID-19 pandemic, USAID Health Service Delivery provided technical support to CHCs to activate/reactivate social media platforms (e.g., Facebook pages/groups and WhatsApp groups) to be able to quickly share important health messages in communities.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

The 80 CHCs posted 2239 RMNCH+ health messages on CHC’s Facebook pages/groups and 2895 RMNCH+ health messages on CHCs’ WhatsApp groups. To strengthen community feedback mechanisms, USAID Health Service Delivery worked with the HCAD to strengthen the role of the CHCs in ISDIC sessions to represent community voices. USAID Health Service Delivery supported the HCAD to conduct a quarterly HPS coordination workshop.

E. RMNCH+ COMMUNITY OUTREACH PROGRAM

The RMNCH+ Community Outreach Program has supported health promotion and health education activities through sub-agreements with the IFH and the JAFPP. Under the program, female Community Health Workers (CHWs) visited households to provide information on RMNCH+ topics, and guide women of reproductive age and children under five to relevant health services. On March 16, 2020, based on USAID guidance aimed at limiting the spread of COVID-19, all household visits under the Community Outreach Program were suspended. Soon afterwards, USAID Health Service Delivery terminated the Community Outreach Program per USAID’s direction.

In FY20 Q3, USAID Health Service Delivery worked with IFH and JAFPP on the technical and financial closeout processes. USAID Health Service Delivery completed the technical closeout both for both partners, and will finalize the financial close out during FY20 Q4. Final partner technical reports highlighted achievements, success stories, challenges, and lessons learned.

IFH and JAFPP handed over CHWs’ tools and equipment used during household visits. USAID Health Service Delivery approved both IFH and JAFPP requests to retain Information, Education and Communication (IEC) materials, so they can continue to use these materials in their clinics.

F. INNOVATION GRANTS

In FY20 Q3 USAID Health Service Delivery continued the technical and financial closeout for the Innovation Grants program for the three grantees listed below. Closeout will be completed during Q4.

1. Healthy Community Clinic (HCC) implemented by the Royal Health Awareness Society (RHAS), terminated March 22, 2020 due to COVID-19. 2. Breaking the Wall of Silence implemented by the Tafilah Women Charitable Society (TWCS), terminated March 22, 2020 due to COVID-19. 3. Improve and Expand Existing GBV Services in Zarqa implemented by the Family Guidance and Awareness Center (FGAC), terminated March 22, 2020 due to COVID-19.

G. JORDAN’S MATERNAL MORTALITY SURVEILLANCE AND RESPONSE SYSTEM

USAID Health Service Delivery, in collaboration with the MOH and implementing partner, EMPHNET, held a virtual workshop on May 13-14, 2020 for selected DAG members, nominated by the MOH Non-Communicable Diseases Directorate (NCDD). The objectives of this workshop were to explain the Three Delays conceptual framework, as a comprehensive approach in maternal death review, and to strengthen the capacity of DAG members to identify contributing factors to maternal deaths by applying the Three Delays Model to specific scenarios.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

Due to the government shutdown, USAID Health Service Delivery was unable to conduct field visits to support DAG members and/or focal points during this quarter. However, USAID Health Service Delivery provided virtual support using designated WhatsApp groups and phone calls to ensure the continuity of the JMMSR system implementation. Moreover, in April, USAID Health Service Delivery supported DAG members in the Amman HAD to conduct a virtual DAG meeting to complete the review of the 2019 maternal death cases.

USAID Health Service Delivery supported the National Advisory Group (NAG) to hold a series of virtual NAG meetings, to complete the review of the pending 2019 maternal death cases. In April, the NAG convened five meetings to review 18 maternal death cases. In May, the NAG convened four meetings to review 13 maternal death cases, nine of which were late maternal death cases.

H. STRENGTHENING SELF-RELIANCE

During FY20 Q3, USAID Health Service Delivery continued working with counterparts on RMNCH and COVID-19 self-reliance elements, and supported counterparts to engage their decentralized staff to strengthen their commitment. USAID Health Service Delivery also continued developing handover plans. USAID Health Service Delivery will ensure relevant MOH staff, who are already oriented on and use the materials, receive all relevant technical products. For RMNCH+ service delivery, this includes not only technical training but also TOTs, adaptation of monitoring processes, supervisory functions to maintain quality, and leadership training. For community engagement, this includes fostering CHCs to have a more active role in collaborative sessions, representing community voices. For the JMMSR, this includes high-level ownership and support of the system, well-trained and oriented staff at every level, and a robust but flexible information system (IS).

During FY20 Q3, USAID Health Service Delivery built the capacity of HADs and NGO counterparts in Irbid to conduct collaborative sessions on their own. For COVID-19, piloting and finalizing the refinements of the Hospital Readiness Assessment tool will allow the MOH to ensure public hospitals are able to use a customized tool for Jordan to establish an appropriate roadmap or action plan for COVID-19 based on transmission scenarios. Developing and handing over the clinical protocols, guidance, and the training materials will allow the MOH to continue to ensure their staff have the skills needed to address COVID- 19. By supporting the MOH ETITD to develop new functions for the MOH Mobile Health Map Application, the MOH will have more accurate, real-time data, to support their COVID- 19 preparations and response.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

3. ACTIVITY IMPLEMENTATION

SUMMARY OF FY20 Q3 DELIVERABLES

Table 1 summarizes the status of FY20 Q3 deliverables. USAID Health Service Delivery presents a complete report on indicators in Annex 1: Monitoring and Evaluation Report.

Table 1: Summary of the Main Deliverables/Milestones for FY20 Q3 No. Deliverable Status RMNCH+ Main Deliverables Summary reports on women and child 1) health services comprehensive counseling Completed. training workshops developed Summary reports on long-acting reversible 2) contraception (LARC) training workshops Completed. developed Completed. Community mobilization and health CHC community mobilization and health promotion report on virtual activities 3) promotion reports generated generated. Eighty CHCs posted 2739 RMNCH+ health educational messages on their Facebook pages/groups. Completed. National clinical practice guidelines for 4) Clinical practice guidelines completed, pending reduction of C/S developed His Excellency the Minister of Health’s signature. Training packages for reduction of C/S 5) Completed. based on approved guidelines developed 6) JMMSR IS users training implemented Completed. MOH ETITD staff training on 7) cybersecurity, development, and Completed. networking completed Summary report on PHC collaborative 8) Completed. sessions for each ISDIC cycle developed Ongoing. Summary report for joint collaborative USAID Health Service Delivery finalized the 9) sessions between PHC and hospitals first joint collaborative sessions and related developed reports in FY20 Q2. Initially postponed, the second collaborative sessions will take place in FY20 Q4. Ongoing. USAID Health Service Delivery completed Summary report on hospitals collaborative 10) the first hospital collaborative sessions and sessions for each ISDIC cycle developed the related reports in FY20 Q2. The Second collaborative sessions will take place in FY20 Q4.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

Table 1: Summary of the Main Deliverables/Milestones for FY20 Q3 No. Deliverable Status Selective/restrictive episiotomy practices 11) Completed. protocol developed Mother to mother breastfeeding support 12) Completed. training package disseminated End of grant evaluation report generated 13) Completed. for completed grants Central and HAD supportive supervision 14) Completed. manual updated Outreach implementing partners’ final 15) Completed. reports generated Ongoing. In FY20 Q3, USAID Health Service Delivery Enhanced Health Map Mobile Application hired the contractor for the Enhanced Mobile 16) developed with RMNCH functions Health Map Application. During FY20 Q4, the HMIS team will work with the contractor and the MOH to enhance the existing MOH Mobile Health Map Application. Ongoing. Strengthened capacity of the MOH ETITD In FY20 Q3, USAID Health Service Delivery team to maintain and support the hired the contractor for the Enhanced Mobile 17) implementation of the enhanced Mobile Health Map Application. During FY20 Q4, the Health Map Application developed HMIS team will work with the contractor and the MOH to enhance the existing MOH Mobile Health Map Application. 18) Final grantees’ progress reports generated Completed. Support the National COVID-19 Response Plan Jordanian- relevant COVID-19 training Completed. 19) materials finalized and uploaded on the Relevant materials both Arabic/English MOH website completed. Virtual training on case management protocols for health care providers 20) conducted Completed.

Readiness plans for 11 public sector Ongoing. hospitals developed During FY20 Q3 USAID Health Service Delivery, in collaboration with the MOH, conducted a pilot field assessment for two 21) MOH hospitals (Al Hussain (Salt) New Hospital and Zarqa New Governmental Hospital). In FY20 Q4, USAID Health Service Delivery is planning to scale up the readiness assessment based on the feedback from the pilot field assessment report.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

Table 1: Summary of the Main Deliverables/Milestones for FY20 Q3 No. Deliverable Status Multidisciplinary teams in 14 HADs and 11 Ongoing. public sector hospitals trained Workshop training on the WHO hospital 22) readiness checklist started in FY20 Q3. The training workshops will continue during FY20 Q4. Enhanced/Updated Mobile Health Map Ongoing. Application Module with COVID-19 The HMIS team and the ETITD worked functions together to design and finalize the enhancement features of the Health Map 23) Mobile Application. The HMIS team, with agreement from ETITD, developed an action plan with the contractor to monitor the progress of implementation of the enhanced features. Reports on Mobile application 24) development and management training for Planned for Q4. ETITD staff generated Health education and awareness messages 25) related to COVID-19 developed by Completed. HCAD and shared with CHCs Facilitate access to integrated RMNCH+ services during COVID-19 pandemic Customized counseling checklists and 26) frequently asked questions and answers Completed. developed Summary report on the capacity building 27) Completed. activities developed 28) Operational procedures developed Completed.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

Result 1: Expanded Availability of and Access to Integrated RMNCH+ Services

At the beginning of the government lockdown, USAID Health Service Delivery developed and submitted to USAID alternative approaches to sustain access to RMNCH services during COVID-19 pandemic. The alternative approaches were designed to facilitate the identification of RMNCH client profiles in need of health care services while locked at home. The approachess included initiating interactive dialogue between health care providers (physicians and/or midwives) and their clients who are at home and have specific RMNCH needs. USAID Health Service Delivery also continued to follow-up virtually with counterparts and worked with CHCs to post health messages on CHC social media platforms.

Sub-result 1.1: Increased Uptake of Integrated RMNCH+ Services

Using the integrated service delivery improvement collaborative (ISDIC), USAID Health Service Delivery collaborates with the MOH, the RMS, and NGO counterparts to improve their RMNCH+ services. The ISDIC cycles allow hospital, HC, and NGO clinic staff to identify their own performance gaps, develop and implement a change package, and develop a set of interventions to resolve identified gaps. The change packages make it easier to verify and measure positive changes.

A. Primary Health Care Service Delivery Improvement

a) Integrated Service Delivery Improvement Collaborative (ISDIC)

Previously USAID Health Service Delivery led ISDIC sessions with key MOH and NGO counterparts. To support the MOH’s journey to self-reliance, in FY20 Q2, USAID Health Service Delivery provided minimal support to the HADs to conduct the collaborative sessions. Due to the government shutdown, Irbid HAD was not able to conduct its collaborative sessions planned for the end of March. Accordingly, on May 31st and June 1st, USAID Health Service Delivery assisted the Irbid HAD to conduct two virtual collaborative sessions with its related 17 HCs. This was a new experience for the HAD and HC staff; however, the sessions were successful and informative. The Irbid HAD Woman and Child (WCH) Unit Head and MCH supervisor took the lead in facilitating the two sessions. They enthusiastically and capably guided HC staff and CHC representatives to present virtually their achievements and success stories. The discussions included presentations on the HCs’ performance progress, monitoring indicators, gaps in services, and suggested solutions for improvement. Sixty one participants attended these collaborative sessions.

During these virtual sessions, USAID Health Service Delivery presented on traditional versus modern family planning methods to raise awareness on the high use of traditional methods in Jordan (14.4%), and highlight the high failure rates compared with modern methods. USAID Health Service Delivery also presented on preparedness for pregnancy, and encouraged HC staff to provide preparedness for pregnancy counseling and dispense folic acid to selected clients. HCs will provide these services to clients who want to get pregnant and ask to have their IUD or Implanon NXT removed.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

“Thanks to USAID Health Service Delivery for enabling us to move ahead with use of new technologies for our virtual training instead of traditional ways”.

Dr. Abd-Al-Kareem Daradkeh, Manager of Dair Abi Saied HC, Irbid HAD Virtual Collaborative Session for Irbid HCs in June 1, 2020

USAID Health Service Delivery continued providing support to the PHC SDPs throughout the COVID-19 pandemic, via phone calls and WhatsApp chats. This follow- up was important to motivate staff to maintain continuous communication, and helped to urge the PHC teams to comply and offer a high level of quality for services provided.

Figures 2 and 3 below show the percent improvement of PHC SDPs who provided five modern family planning methods and the percent of postnatal woman who received a modern family planning method from PHC SDPs during FY20 Q1-Q3. The presented data shows that the government shutdown did not have a negative impact on performance, and facilities succeeded in maintaining the progress gained.

86.6% 88.5% 88.7%

FY 20 Q1 FY 20 Q2 FY 20 Q3

Figure 2: Percent of PHC SDPs Providing Five Modern Methods during FY20 Q1- Q3

74.6% 68.4% 69.3%

FY 20 Q1 FY 20 Q2 FY 20 Q3

Figure 3: Percent of Postnatal Woman Received a Modern Family Planning Method from PHC SDPs during FY20 Q1- Q3

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

Due to the government shutdown, USAID Health Service Delivery staff were not able to conduct regular follow-up field visits on RMNCH+ services during April and May of FY20 Q3. Selected field visits were resumed in mid June. The objectives of HC field visits are to follow up on RMNCH+ progress and COVID-19 HC prepardness. Specific objectives included:

1. Follow-up on the readiness of SDPs to deal with suspected COVID-19 cases. 2. Follow-on the implementation of IPC measures related to COVID-19. 3. Provide on-the-job (OJT) training to staff on IPC measures for COVID-19 when needed. 4. Follow-up the implementation of SDPs RMNCH+ change packages. 5. Provide on-site coaching, technical assistance, and monitor SDP staff performance through reviewing clients’ medical records. 6. Support the implementation of the virtual client-provider interaction. For more information about it, please refer to Sub-result 2.1, PHC.

USAID Health Service Delivery conducted 47 field visits for MOH HCs and six field visits for NGO clinics.

b) Client Service Stations

USAID Health Service Delivery continued supporting CSS implementation at MOH HCs and NGO clinics. The CSS aims to increase clients’ awareness of RMNCH+ services and minimize missed opportunities by women and children to receive the MCH services.

During the government shutdown, the MOH HCs temporarily stopped the provision of regular health care services. However, by mid-April, the MOH resumed the provision of selected health care services with a minimum number of staff. The CSS operational status was significantly affected during the government shutdown; however, following the gradual resumption of health care provision in MOH HCs there was improvement observed during June and as per below table.

Table 2: Monthly CSS Operational Status for all SDPs in FY20 Q3 Month Active Partially Active Not Active May 18 4 100 June 43 37 42

c) Facility Based Supportive Supervision (FBSS)

During FY 20 Q3, HC managers continued FBSS as soon as the HCs resumed functionality at full capacity in late May. HC managers sent FBSS reports to HADs for their review and feedback. The HADs responded to the reports and sent feedback to HCs. During FY 20 Q3, 78 HCs conducted FBSS and sent reports to their respective HADs. Thirteen HADs out of 14 sent their FBSS reports to the WCHD. For NGOs, six IFH clinics out of nine sent FBSS reports to their headquarters and received feedback. The IRC clinics are still closed due to COVID-19 pandemic.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

USAID Health Service Delivery continued assisting the Technical Working Group (TWG) that integrates the FBSS training manual and tools within the central supervision manual. During FY20 Q3, the TWG conducted two virtual meetings through which they finalized the manual.

d) HC Leadership Certification Program

USAID Health Service Delivery implemented the HC Leadership Certification Program, through its sub-award to the Health Care Accreditation Council (HCAC). In FY20 Q3, due to the COVID-19 pandemic and the government shutdown, USAID Health Service Delivery terminated some of HCAC sub-award activities including the HC Leadership Certification Program. USAID Health Service Delivery will provide certification of attendance to the 53-trained HC managers who attended this Program.

e) Preconception Care

To facilitate the preparedness for preconception care services, USAID Health Service Delivery, in collaboration with the WCHD, developed and printed a job-aid containing the main pillars of Preparedness for Pregnancy. This simple job-aid will support HC midwives as they provide this service. The job-aid helps midwives to identify the target group, identify the main topics for discussion during counseling, and explain how to do proper documentation. USAID Health Service Delivery supplied printed copies to WCHD for distribution to HCs.

f) Family Planning within Integrated Care

In close collaboration with MOH, USAID Health Service Delivery implemented interventions to increase traditional method users’ uptake of modern family planning services. During FY20 Q2, USAID Health Service Delivery gave a full presentation about traditional versus modern methods at the collaborative sessions, to ensure that HCs and NGO clinics are including relevant activities within their change packages. In FY 20 Q3, USAID Health Service Delivery gave this presentation virtually in a collaborative session conducted with the Irbid HAD. Irbid HCs included change package activities that focus on traditional methods users.

Due to the government shutdown, CHCs paused using the direction slip, developed and used previously by USAID Health Service Delivery to direct beneficiaries to receive family planning services.

USAID Health Service Delivery, in collaboration with WCHD, finalized and printed two family planning pamphlets. “How I Can Help My Wife in Planning Our Family,” targets men and “Family Planning Improves Lives” targets traditional family planning users. WCHD received the printed pamphlets and will distribute them to HCs and CHCs to use during their activities.

USAID Health Service Delivery adopted the USAID job aid “NORMAL” that contains messages on menses changes and will provide it as soft copy to the MOH’s WCHD next quarter.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

g) Breastfeeding Promotion

USAID Health Service Delivery, in collaboration with the HCAD, conducted a virtual meeting with the Mother-to-Mother Breastfeeding Support Groups’ (MtMBSG) facilitators. USAID Health Service Delivery shared the latest global breastfeeding recommendations, in the context of COVID-19. The MtMBSG facilitators developed plans to conduct MtMBSG virtual sessions.

USAID Health Service Delivery supported and supervised the MtMBSGs virtual sessions conducted with pregnant and breastfeeding mothers from six HADs (Capital, Zarqa, Balqa, Ajloun, Jarash, and Mafraq).

USAID Health Service Delivery, in collaboration with the WCHD, continued building the capacity of an additional eight HAD (Capital, Balqa, Karak, Jarash, Ajloun, Mafraq, Irbid and Ramtha) staff to enable them to establish, facilitate, support, and monitor breastfeeding support groups at HCs. The training also covered raising awareness and promoting positive practices related to breastfeeding and child nutrition. USAID Health Service Delivery conducted three virtual training workshops attended by 135 staff members. Staff included WCH Unit Heads, MCH supervisors, and HC midwives and physicians.

“I was surprised with the mothers’ interaction during the virtual breastfeeding sessions. Their passion for gaining and exchanging information helped me to continue conducting the sessions virtually. I shared with mothers the importance of breastfeeding and the necessary precautions during COVID-19 pandemic” Ms. Su’ad Hakawati, CHC Head and Breastfeeding Support Group Facilitator - Princess Basma HC - Amman HAD

h) Gender

During Q3, USAID Health Service Delivery was not able to conduct interactive gender- training workshops for MOH staff, due to the government shutdown. During FY20 Q4, gender trainers will convert the training materials and exercises to meet with virtual training requirements. The upcoming training will target MOH staff members from central directorates, HADs, and HCs, as well as NGO staff.

i) Integrated Service Delivery (ISD) Recognition Program

In FY20 Q3, due to the COVID-19 pandemic and the government shutdown, USAID Health Service Delivery terminated some HCAC sub-award activities including the ISD Recognition Program.

During FY20 Q4, USAID Health Service Delivery will hand-over all related materials including the assessment reports to the MOH WCHD.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

j) Strengthening Self-Reliance

To improve MOH HAD and NGO self-reliance, USAID Health Service Delivery built their capacity to own and lead the collaborative sessions. Irbid HAD WCH Unit staff prepared and conducted the virtual collaborative sessions.

In addition, the Woman and Child Health Services Follow-up Committees from four HADs (Capital, Madaba, Mafraq and Karak) conducted their quarterly meetings in June 2020. These committees are responsible to follow up on the progress of women and child health indicators, assess needs, identify challenges, and implement interventions to improve access and quality of services.

B. Hospital Service Delivery Improvement

a) Integrated Service Delivery Improvement Collaborative (ISDIC)

During the COVID-19 pandemic, the USAID Health Service Delivery hospital team continued to conduct virtual semi-annual data collection and followed-up with 19 MOH and RMS participating hospitals. The hospital working groups showed commitment to maintaining their progress during the COVID-19 pandemic.

In the beginning of FY20 Q3, given COVID-19 circumstances, USAID Health Service Delivery staff were unable to conduct in-person field visits. Therefore, the hospital team followed-up virtually via phone calls, WhatsApp, and email. This follow-up had an important role in motivating hospital staff to maintain the continuity of communication and helped to urge the hospital teams to comply and providing high level of quality of services (see Figure 4 below).

In June, USAID Health Service Delivery conducted ten quarterly data collection visits. To facilitate timely data collection, health care providers, working in participating hospitals, helped to provide the required FY20 Q3 data samples. FY20 Q3 results showed staff compliance to implement the clinical pathways and procedures, despite the challenges that health care providers faced due to the pandemic. For example, both MOH and RMS hospitals showed progress with the breastfeeding indicator.

USAID Health Service Delivery conducted a training workshop related to case management for pregnant women with COVID-19. WHO recommends that mothers, with a suspected or confirmed case of COVID-19, be encouraged to practice skin-to- skin contact and to initiate breastfeeding, because the benefits of breastfeeding outweigh the potential risks of COVID-19 transmission. Midwives and nurses worked on raising the awareness of women who gave birth in this period, encouraging new mothers to continue skin-to-skin contact and breastfeeding.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

100%

99% 98%

FY 20 Q1 FY 20 Q3 Target

Figure 4: Percent of Women Giving Birth who Initiate Breastfeeding within the First Hour of Birth in Hospitals during FY20 Q3

In FY20 Q3, the USAID Health Service Delivery team noticed variations in the C/S indicator results. The indicator results decreased in comparison with the data generated in the previous data collection cycle. In addition, the results varied among different hospitals. The reason for this variation is likely due in large part to the government shutdown leading to a high workload at each hospital, with reduced staff capacity. For example, from March to mid-May hospitals worked with half of their normal HR capacity. To improve this indicator and associated C/S services, USAID Health Service Delivery’s hospital team suggested that each hospital circulate clinical pathway instructions to Ob/Gyn physicians and anesthesiologists. In this way, OB/Gyn physicians and anesthesiologists would ideally maintain their continued compliance to the clinical pathway related to administering antibiotic prophylaxis to women undergoing CS.

In FY20 Q3, USAID Health Service Delivery followed-up virtually with MOH and RMS hospitals to facilitate preparing and developing comprehensive change packages. This process supports hospitals to identify areas for improvement and mitigate any challenges. By the end of July, USAID Health Service Delivery and the hospital working groups will review and finalize the change packages to meet their RMNCH+ related needs.

b) USAID Health Service Delivery Efforts to Improve Linkages between PHCs and Hospitals

In FY20 Q3, USAID Health Service Delivery continued to support four HADs to improve the linkages between hospitals and PHCs. The team provided technical assistance to increase the hospital and PHC uptake of integrated RMNCH+ services. However, given COVID-19, hospital and PHC joint collaborative sessions were unable to take place during FY20 Q3. To enhance collaboration and to support the continuum of care approach, between participating hospitals and PHCs, USAID Health Service Delivery will conduct the next cycle of joint collaborative sessions virtually throughout FY20 Q4.

In FY20 Q3, virtual communication with HADs, 18 HCs and four hospitals continued to enhance the implementation and continuity of RMNCH+ services. USAID Health Service Delivery’s virtual follow-up and communication shed light on women's awareness about

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

family planning. Some women obtained family planning methods from pharmacies, despite pandemic conditions and difficulty reaching the HCs and hospitals. USAID Health Service Delivery documented many instances whereby women obtained family planning methods from pharmacies. USAID Service Delivery also received anecdotal evidence that in the communities served by these facilities, women were seeking hospital care in a timely manner, demonstrating awareness of pregnancy-related warning signs.

In FY20 Q3, participating hospitals continued to provide postpartum counseling and family planning services to mothers prior to their hospital discharge. However, due to early hospital discharge, during evening and night shifts, some new mothers did not receive family planning services.

c) Aseptic Preparation and Administration of Intravenous (IV) Medications and Fluids Guidelines

In FY20 Q3, the Director of the Clinical Pharmaceutical Directorate continued to collaborate with hospital pharmacists to establish a suitable environment to implement the Aseptic Preparation and Administration of IV Medications and Fluids Guidelines. Certain hospitals already commenced establishing a suitable area within their facility to prepare IV medications and fluids according to best evidence-based practices, within the hospitals’ capabilities.

Furthermore, many hospital staff who attended the Aseptic Preparation and Administration for IV Medication and Fluids TOT workshops conducted OJT sessions to enhance and strengthen staff capacity working in the Neonatal Intensive Care Unit (NICU). These training sessions aim to improve safe practices in preparing compounded sterile medications and fluids. Next steps focus on obtaining, His Excellency, the Minister of Health’s approval and signature on the Aseptic Preparation and Administration for Intravenous Fluids Guidelines. Afterwards, USAID Health Service Delivery will disseminate the guidelines to all public hospitals in FY20 Q4.

d) Unnecessary Cesarean Section Reduction

In FY20 Q3, USAID Health Service Delivery finalized the National Guideline to Support Vaginal Births and Reduce Unnecessary Primary Cesarean Section based on the latest evidence-based practices. These guidelines target health care providers working in labor departments. The guidelines aim to achieve safe reduction in the existing rate of primary C/S deliveries in Jordan, through standardizing health care provider practices. They also guide providers to provide pregnant women with consistent quality of care during delivery. Finally, the guidelines better enable providers to make informed decisions.

In FY20 Q2, USAID Health Service Delivery collected baseline data for the Unnecessary Cesarean Section Deliveries Reduction Program in ten selected hospitals. During FY20 Q3, USAID Health Service Delivery’s hospital team analyzed the data. On May 18, 2020, the hospital team conducted a virtual meeting with the C/S Oversight Committee to discuss the baseline data. During this meeting, the committee agreed that the baseline data results support the need to have a national guideline to support clinical decisions, via accurate and up-to-date clinical information. The committee requested to modify the clinical audit tool to capture more relevant information.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

Furthermore, the committee agreed to submit the National Guidelines to Support Vaginal “It is crucial to continue with the Births and Reduce Unnecessary Primary training plan during these times to Cesarean Section to His Excellency, the Minister ensure adherence to the National of Health, and send an official letter to His Guidelines within the agreed-upon Excellency, explaining the objectives of the roadmap.” Unnecessary Cesarean Section Reduction Dr. Mazen Zibdeh, Oversight Program and baseline results. Approval of these Committee’s Chair and Private guidelines is crucial to enforce efforts in Sector Ob/Gyn Consultant improving the C/S practice in Jordan, and to contribute to reducing preventable maternal mortality. In addition, USAID Health Service Delivery finalized the needed material for clinical training and OJT for hospitals enrolled in the Unnecessary Cesarean Section Deliveries Reduction Program. USAID Health Service Delivery’s hospital team planned capacity building and technical support in May 2020 for the Unnecessary Cesarean Section Deliveries Reduction Program. However, the hospital team postponed the capacity building activities due to the government shutdown, and based on the Oversight Committee’s request to wait for His Excellency, the Minister of Health’s endorsement of the guidelines. In FY20 Q4, USAID Health Service Delivery will provide virtual capacity building and technical support training for health service providers in the selected hospitals on using the developed technical materials.

e) Facility-Based Supportive Supervision

During FY20 Q3, USAID Health Service Delivery conducted a virtual workshop on the FBSS for 89 health care providers working in obstetric departments and NICUs from MOH and RMS hospitals. The objectives of the virtual workshop included building the capacity of the senior staff to implement the FBSS in hospital obstetric departments and NICUs, and reflecting two-way communication best practices between a supervisor and the staff undergoing supportive supervision. Additionally, USAID Health Service Delivery updated the FBSS competency checklists in accordance with the 2019 updated maternal and neonatal clinical pathways and procedures, and trained the participants on the updated checklists. The USAID Health Service Delivery hospital team will follow-up with the trained supervisors on the implementation of the FBSS during FY20 Q4. Senior staff have submitted their quarterly FBSS reports for FY20 Q3. Through the virtual follow- up, USAID Health Service Delivery provided useful feedback for the senior staff to improve the quality of care using FBSS.

“We appreciate the USAID Health Service Delivery’s efforts in continuing to conduct the FBSS workshop virtually, despite the current conditions. It has been a new experience for health care providers attending, and the workshop will certainly improve FBSS implementation at related department”. Midwife Rima Odeh Head Nurse Maternity Unit Zarqa New Governmental Hospital Photo 1: Midwife Rima Odeh - Head Nurse of Maternity Unit at Zarqa New Governmental Hospital during the FBSS Workshop during June 8-10, 2020

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

Sub-result 1.2 Increased community involvement to promote and increase demand for RMNCH+ services

A. Community Engagement

During FY20 Q3, USAID Health Service Delivery continued to strengthen the capacity of HADs, HPS, and CHCs. USAID Health Service Delivery worked with HCAD counterparts at different levels to mobilize communities, further develop their capacities for health promotion, and obtain community feedback to support RMNCH+ services

a) Community Mobilization and CHCs

During FY20 Q3, USAID Health Service Delivery worked in close collaboration with the HCAD to strengthen 80 active CHC members’ capacity and performance within MOH HC catchment areas. These CHCs provided platforms to reach out to RMNCH+ service users. The USAID Health Service Delivery community engagement team helped HCAD to raise awareness and mobilize RMNCH+ service users to develop local solutions for health gaps and problems. See Annex 13 for a list of active CHCs.

To strengthen further the capacity of CHCs to mobilize and engage their communities, USAID Health Service Delivery and the HCAD used the Community Mobilization Manual to train four CHCs. The manual includes sections on community engagement and asset mapping, planning and activity design, event management, advocacy, networking, and communication skills.

USAID Health Service Delivery customized the training to facilitate virtually. The training emphasized the power of the community to promote change and contribute to RMNCH+ service improvement.

USAID Health Service Delivery and the HCAD trained 83 participants. Sixty-five were community members and 18 were HC staff, who are also CHC members.

“I would like to thank USAID Health Service Delivery for maintaining communication and follow up with the health directorate and CHCs. I believe that using virtual platforms to conduct trainings is such a great and productive measure to continue working in light of this pandemic.” Dr. Mustafa Al Atrash – Assistant Director of Madaba HAD / MOH Photo 2: Dr. Mustafa Al Atrash, Assistant Director of Madaba HAD during the Networking and Advocacy Skills for CHCs Virtual Training on June 21, 2020

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

Additionally, USAID Health Service Delivery continued providing assistance to facilitate access to RMNCH+ services during the COVID-19 pandemic. USAID Health Service Delivery, in close collaboration with the HCAD, worked to engage CHCs to contribute in increasing demand for quality RMNCH+ services through:

• Supporting the HCAD in customizing RMNCH+ health messages to share through social media platforms.

• Providing technical support to CHCs to activate or reactivate CHCs’ Facebook pages/groups.

• Providing technical assistance for HPS and CHCs to disseminate education and awareness messages in their communities through Facebook pages and WhatsApp Photo 3: RMNCH health message posted on groups. Kufur Youba CHC Facebook Page in June 2020 During FY20 Q3, USAID Health Service Delivery, in collaboration with the HCAD, customized 58 RMNCH+ health messages. Moreover, CHCs posted 2739 RMNCH+ health messages on their Facebook groups, and CHCs shared 2895 RMNCH+ health messages on CHCs’ WhatsApp groups.

In addition, during FY20 Q3, USAID Health Service Delivery continued supporting 16 MtMBSG, who held 22 virtual sessions during the quarter. USAID Health Service Delivery provided virtual technical assistance for female community volunteers, who led these awareness raising sessions, on the advantages of breastfeeding and provided social support and information for pregnant and breastfeeding women. One hundred and forty- five women participated in the community-based MtMBSGs.

In FY20 Q3, USAID Health Service Delivery shared the MtMBSG trainer and trainee manual with HCAD. The manual contains guidelines on how to support and create MtMBSGs, for their future reference.

“I would like to thank USAID Health Service Delivery for their great role in providing the updated information to the Directorate by developing an MtMBSG manual, as well as holding a meeting with breastfeeding facilitators, in order to encourage them. I believe that it was a very successful experience.” Eng. Amani Al Zoubi, HCAD Staff Member / MOH Photo 4: Eng. Amani Al Zoubi, MOH HCAD Staff Member in June, 2020

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

b) Health Promotion Program

USAID Health Service Delivery supports the MOH Health Promotion Program to enhance and increase HC awareness of RMNCH+ services by sharing effective ways to educate and motivate clients to use health services and commit to healthy behaviors. In FY20 Q3, to support the MOH’s journey to self-reliance, USAID Health Service Delivery, in collaboration with the HCAD, conducted a “Virtual Health Promotion Supervisors’ Coordination Workshop”. The purpose of this workshop was to define the progress and challenges related to implementing health promotion and community mobilization events. Moreover, the Photo 5: Ms. Nahed Zghoul, Ajloun Health Promotion Supervisor coordination workshop highlighted the collaboration attending the virtual Health between the HCAD and USAID Health Service Delivery Promotion Supervisors’ to spread awareness on COVID-19 prevention. Coordination Workshop in June 2020

“I would like to take the opportunity to thank HPS in all directorates for their efforts, and a special thanks to USAID Health Service Delivery for their distinctive role in preparing health awareness messages related to COVID-19 and RMNCH+ topics as well as their support to conduct this workshop.” Dr. Abeer Mwaswas – Director of the Health Communication and Awareness Directorate / MOH

c) Community Feedback

In FY20 Q3, USAID Health Service Delivery’s community engagement team worked with the HCAD to strengthen the role of CHCs within ISDIC sessions, so they can better represent community voices and community feedback on health services. Additionally, USAID Health Service Delivery modified the Community Scorecard (CSC) methodology in response to midterm evaluation. However, USAID Health Service Delivery is working on customizing a virtual TOT training for the HCAD on the CSC facilitation, and USAID Health Service Delivery will conduct this training in FY20 Q4.

B. RMNCH+ Community Outreach Program

USAID Health Service Delivery implemented the RMNCH+ Community Outreach Program to support health promotion and health education activities as part of the continuum of care for RMNCH+ services. The program focused on raising awareness, increasing access, generating demand for comprehensive and high quality RMNCH+ services, and changing behavior toward positive RMNCH+ practices. Under the Community Outreach Program, female CHWs provided information on RMNCH+ topics for women of reproductive age and children under five using Social and Behavior Change Communication techniques, encouraging women and children in these age groups to seek services from qualified providers when necessary.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

The household visits provided an opportunity for one-on-one interpersonal communication, providing a safe and private environment for the women of reproductive age to ask questions, seek information on various health issues, and identify appropriate health services nearby. CHWs received continuous training and coaching to raise awareness, promote healthy behaviors, and generate demand for RMNCH+ services among the beneficiaries. The Community Outreach Program focused on lower income households that have an unmet need for RMNCH+ information and services in Jordan.

USAID Health Service Delivery began the Community Outreach Program in FY18 through sub-agreements with two Community Outreach implementing partners, IFH and JAFPP, in 19 districts. In FY19, USAID Health Service Delivery expanded the Community Outreach Program, through a third sub-agreement with implementing organization Blumont, which brought outreach activities into 11 additional districts. IFH and JAFPP also expanded into new districts, so that by the end of FY19 the three implementing organizations were active in 37 districts across all 12 governorates, with a total of 168 CHWs, 18 supervisors, and the supporting management structure.

Blumont’s period of performance ended on January 31, 2020, and their implementation ended in 11 districts. IFH and JAFPP continued implementing in 29 districts. However on March 16, 2020, due to COVID-19 concerns, USAID recommended suspension of all household visits under the Community Outreach Program. USAID Health Service Delivery, upon USAID guidance, terminated the Community Outreach Program soon afterwards.

In FY20 Q3, USAID Health Service Delivery worked on program closeout with IFH and JAFPP. Both IFH and JAFPP returned the tools and equipment used by the CHWs during their household visits, including tablets (with the exception of the 14 noted below), visibility materials (vests and caps), family planning bags, and the remainder of the Direction Slip booklets. Both IFH and JAFPP requested to retain the information, education, and communication (IEC) materials to use in their clinics to raise awareness and improve quality of care provided. IFH also requested USAID Health Service Delivery to retain the 14 tablets used in an anemia-screening program, to sustain the Anemia Screening and Management Program in IFH clinics. USAID Health Service Delivery approved both requests, e.g, retaining the IEC materials and the anemia-screening program tablets.

C. Innovation Grants

USAID Health Service Delivery developed the Innovation Grants program to attract and fund grants that support a wide range of innovative approaches or interventions to improve access to and quality of RMNCH+ services, targeting underserved communities including both Jordanians and Syrians living in Jordanian communities. USAID Health Service Delivery defines “innovation” as the use of service delivery, outreach, community, research, or interventions that were not part of ongoing programs in Jordan, and that had the potential to achieve improved health results.

USAID Health Service Delivery awarded five innovation grants to four grantees. Two of these grants ended in February 2020, while the remaining three terminated early at USAID’s request due to COVID 19. During FY20 Q3, the closeout process continued for the following five grants:

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

1. Healthy Community Clinic (HCC) implemented by the Royal Health Awareness Society (RHAS), to promote positive RMNCH+ health behaviors at MOH comprehensive HCs (Terminated March 22, 2020, due to COVID-19).

2. Health Promotion Youth Clinic (HPYC) also implemented by RHAS, targeting youth at the University of Jordan with positive RMNCH+ health behavior messaging and information (Completed February 28, 2020).

3. Technology to Improve Access to RMNCH+ Services implemented by IFH, to increase awareness and improve access to RMNCH+ services within their clientele and beyond by developing a phone application and Queue Management System (QMS) to facilitate client scheduling, queuing within the clinics, track contact time, and patient satisfaction (Completed February 28, 2020).

4. Breaking the Wall of Silence implemented by the Tafilah Women Charitable Society (TWCS) to promote a family environment safe and free of domestic violence in Tafilah Governorate by providing counseling to victims of domestic violence, and raising awareness of domestic violence, including gender based violence (GBV) broadly in the Tafilah Governorate (Terminated March 22, 2020, due to COVID-19).

5. Improve and Expand Existing GBV Services in Zarqa implemented by the Family Guidance and Awareness Center (FGAC) to improve the wellbeing of the victims, survivors, and women at risk of GBV in Zarqa governorate (Terminated March 22, 2020, due to COVID-19).

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

Result 2: Improved Quality of Integrated RMNCH+ Services

Improving RMNCH+ services requires strengthening provider competency in delivering high quality, evidence-based RMNCH+ services (Sub-result 2.1), and strengthening the management of services delivered (Sub-result 2.2). Both results require capacity building and use of data for decision-making.

Sub-result 2.1: Improve provider competency and behavior to deliver evidence-based RMNCH+ services

A. Primary Health Care

Early in April 2020, to facilitate access to integrated RMNCH+ services during the COVID- 19 pandemic, USAID Health Service Delivery supported the MOH’s WCHD in initiating a virtual training program to enable targeted HCs and NGO clinic staff to provide virtual MCH services and counseling for the following client categories:

• Recurrent antenatal care • Postnatal care • Recurrent family planning • Recurrent child health care

To ensure consistent and systematic virtual client-provider interactive health dialogue for MCH counseling and services, USAID Health Service Delivery assisted the WCHD to develop the following materials:

• Standardized procedures to guide health care providers while conducting virtual client- provider interactive health dialogue. • Customized counseling checklists based on client profiles including information related to the COVID-19 pandemic. • Frequently asked questions and answers to support the client-provider interactive health dialogue highlighting COVID-19 and Gender Based Violence (GBV).

Starting May 2020, USAID Health Service Delivery assisted the WCHD to strengthen the capacity of SDP health care providers to identify client profiles, by utilizing MCH service logbooks. USAID Health Service Delivery facilitated 101 virtual training sessions for 293 midwives, nurses, MCH supervisors and WCH Unit Heads from 14 HADs and 25 NGO clinics. USAID Health Service Delivery assisted WCHD in building the capacity of HADs, HCs, and NGOs clinic health care providers to conduct virtual client-provider interactive health dialogue. USAID Health Service Delivery, together with WCHD conducted eight virtual training workshops to 370 staff members. Upon the WCHD request and due to the government shutdown, USAID Health Service Delivery rescheduled the following training workshops to happen in Q4:

• Woman and Child Health Services Comprehensive Counseling. • TOT on IUD Insertion and Removal. • TOT on Implanon Insertion and Removal.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

Photo 6: Midwife Tagreed Al-Majaly from Photo 7: Balqa WCH Unit Head and MCH MCH Clinic in Tabrbour HC in Amman Supervisors attending the Interactive Client- attending the Interactive Client-Provide Provide Dialogue virtual training on June 2, Dialogue virtual training on June 8, 2020 2020 at Balqa HAD Offices

B. Training Program for Newly Hired General Practitioners (GPs)

USAID Health Service Delivery and the HCAC, in collaboration with the MOH, concluded the training program for newly hired MOH GPs. The purpose of the training program is to build GP capacity to provide and manage high quality PHC services and meet client expectations. During FY20 Q4, USAID Health Service Delivery will hand over the program package to MOH Human Resources Planning and Employee Affaires Directorate.

C. Private Sector Providers

USAID Health Service Delivery added topics related to COVID-19 pandemic to the “Private Sector Training Plan.”

During FY20 Q3, USAID Health Service Delivery conducted a “Nutrition during Pregnancy and IPC Measures related to COVID- 19” workshop. Thirty-one private physicians from five governorates (Amman, Irbid, Zarqa, Ma’an and Aqaba), in addition to physicians from Al-Amal Hospital attended the workshop. This workshop provided physicians with 3.5 continuous medical educational (CME) hours.

USAID Health Service Delivery conducted “Frequently Asked Questions during COVID-19 Pandemic related to Pregnancy, Breastfeeding and Child Health” training workshop. Twenty-one private physicians from four governorates (Amman, Irbid, Zarqa, and Aqaba) attended the workshop. This workshop provided physicians with 1.5 CME hours.

“Thanks to USAID Health Service Delivery for continuous efforts and for the great virtual training especially on IPC related to COVID-19, as we are back to our clinics and in urgent need to be familiar with such precautions and updates to ensure providing safe services to our clients.” Dr. Taghreed Al-Haj Ali, Private Clinic in Abu Alanda in Amman

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

During FY 20 Q3, USAID Health Service Delivery conducted a virtual refresher training on the didactical part of Copper IUD insertion and removal. Twenty-two private male and female physicians attended the three-day virtual training (for two hours per day). Participating physicians were from Amman, Irbid, Zarqa and Aqaba governorates. Trainers included case studies, questions and answers, power point presentations and videos within the interactive training.

USAID Health Service Delivery started conducting the practical part of the IUD training individually at physicians’ private clinics. The trainer uses a Zoe pelvic model and related IUD insertion and removal checklists to train the physicians. This training will credit participants with 12 CME hours.

During FY 20 Q4, USAID Health Service Delivery will continue conducting the practical Copper IUD Photo 8: Practical Copper IUD insertion and insertion and removal training using the pelvic removal training at Dr. Mihaela Al-Shaikh models at physicians’ clinics. clinic in South Marka in Amman on June 22, 2020 Sub-result 2.2 Strengthening management to support delivery of high-quality RMNCH+ services USAID Health Service Delivery supported a suite of activities to strengthen the leadership and management of RMNCH+ services at all health system levels, including facilities, HADs, hospitals, NGOs, and at the central level. This work includes the Manager Certification Program, FBSS, and the ISD Recognition Program. All of these activities continued into FY20, and this Quarterly Report describes them in more detail under Sub-result 1.1

A. Jordan’s Maternal Mortality Surveillance and Response (JMMSR) System

a) Directorate Advisory Group (DAG) Meetings

USAID Health Service Delivery, in collaboration with the MOH and implementing partner, the Eastern Mediterranean Public Health Network (EMPHNET), planned a workshop for selected DAG members nominated by the MOH’s NCDD to be held on March 18. However, due to the government shutdown, USAID Health Service Delivery rescheduled a virtual workshop for May 13-14, 2020. The objectives of this workshop were to explain the Three Delays conceptual framework, as a comprehensive approach in maternal death review, and to strengthen the capacity of DAG members to identify contributing factors to maternal deaths by applying the Three Delays Model to specific scenarios.

The USAID Health Service Delivery JMMSR team, in collaboration with the MOH, developed the workshop materials, designing all workshop materials and tools to use in a virtual training.

The workshop covered the following topics:

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

• Causes of and contributing factors to maternal deaths.

• Applying the Three Delays Model to the causes of and contributing factors to maternal deaths.

• Reviewing maternal death case scenarios and analyzing them using the Three Delays Model analysis framework to identify contributing factors to maternal deaths.

USAID Health Service Delivery created a WhatsApp Group for the workshop beforehand, and added all participants to the group. USAID Health Service Delivery shared a video of Dr. Nashat Taani, Director of the NCDD, with participants. Dr. Nashat welcomed the participants and encouraged them to engage with this virtual workshop. He also thanked the USAID Health Service Delivery team for organizing the workshop. He then highlighted the main contributing factors to maternal deaths from the findings of the National Maternal Mortality Report for 2018, based on the Three Delays Model, and emphasized the importance of utilizing this model to identify avoidable factors to prevent similar maternal deaths from occurring in the future.

Next, the facilitation team shared recorded presentations with participants. The presentations focused on clarifying the main causes of and contributing factors to maternal deaths, and explaining the Three Delays Model framework. The USAID Health Service Delivery team then worked through a maternal death case scenario to explain how to apply the Three Delays Model to identify the contributing factors to maternal deaths.

The second part of the workshop included an interactive analysis of maternal death case scenarios, to allow participants to apply their knowledge of the Three Delays Model framework. The facilitation team shared three maternal death case scenarios with We need to work on developing new participants via the WhatsApp group. policies and protocols to be adopted Participants then identified the contributing within the Jordanian health care system factors that led to the deaths, and grouped to provide appropriate maternal and these according to the Three Delays Model. In obstetric care in a standard manner across hospitals. These should be addition, participants provided appropriate accompanied by appropriate training for recommendations for actions at the health doctors for effective implementation.” facility and/or HAD levels. The participants were highly engaged, and fruitful discussions Dr. Hani Al-Aqili, took place among them. They identified useful Head of Jerash DAG recommendations for future action.

Due to the government shutdown, USAID Health Service Delivery could not conduct field visits to support DAG members and/or focal points. However, USAID Health Service Delivery provided virtual support using designated WhatsApp groups and/or the phone to ensure the continuity of the JMMSR system’s implementation. Moreover, in April 2020, USAID Health Service Delivery supported DAG members within the Amman HAD to conduct a virtual DAG meeting, to complete the review of the pending 2019 maternal death cases.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

b) National Advisory Group (NAG) Meetings

USAID Health Service Delivery supported the NAG to hold a series of virtual NAG meetings, to complete the review of the pending 2019 maternal death cases. In April, the NAG held five NAG meetings to review 18 maternal death cases. In May, the NAG held four meetings to review 13 maternal death cases, nine of which were late maternal death cases. During the May 22 meeting, the NAG discussed the lack of data available for late maternal death cases, which prevented them from understanding the circumstances surrounding the deaths, making it difficult to assign the cause of death. NAG members agreed that it would be best not to continue the review of late maternal death cases for 2019, and rather just state the total number of cases in the National Maternal Mortality Report for 2019.

In FY20 Q3, USAID Health Service Delivery supported the selected NAG members and the NCDD to hold meetings for the objective of validating the 2019 maternal death data. In FY20 Q4, USAID Health Service Delivery will continue to provide the NAG and the NCDD with needed technical support to finalize the second National Maternal Mortality Report.

c) JMMSR System Findings and Response Dissemination

In line with the responses raised by the JMMSR system, USAID Health Service Delivery worked with the multi-sectoral C/S Oversight Committee to adopt a quality improvement program to reduce unnecessary C/S deliveries in Jordan. The committee developed a National Guideline to Support Vaginal Births and Reduce Primary Caesarean Sections, based on the latest evidence-based practices. This guidelines aim to achieve a safe reduction in the existing rate of primary C/S deliveries in Jordan, through standardizing health care provider practices

In FY20 Q2, in response to the National Maternal Mortality 2018 findings, USAID Health Service Delivery coordinated with obstetrics and gynecology specialty managers from all sectors to support the Advance Life Support in Obstetrics (ALSO). In FY20 Q3, USAID Health Service Delivery completed the procurement process to purchase ALSO training equipment for the Jordan University Hospital (JUH). USAID Health Service Delivery will deliver the equipment during FY20 Q4. The JUH will use this equipment to commence training health care providers on using the ALSO in Jordan.

Furthermore, USAID Health Service Delivery, in collaboration with the MOH’s NCDD, strengthened the capacity of the DAG members to apply a comprehensive approach in maternal death review using the Three Delays Model. This model helps to identify contributing factors to maternal deaths and to make decisions on the appropriate response at the level of the directorate.

B. Health Management Information Systems

In FY20 Q3, USAID Health Service Delivery’s health management information systems (HMIS) team continued supporting MOH ETITD staff to sustain the JMMSR information system (IS). During the government shutdown, the HMIS team supported USAID Health Service Delivery staff to conduct virtual meetings and seminars, enabling staff to continue key activities, including work with the private sector.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

a) JMMSR Information System (JMMSR IS)

The USAID Health Service Delivery HMIS team supported the JMMSR IS by implementing different change requests from the technical users on the system. To promote the MOH’s self-reliance, the HMIS team actively involved the MOH’s ETITD in all revisions of the IS. To facilitate MOH involvement, USAID Health Service Delivery conducted two virtual OJT training sessions for the MOH’s ETITD development team, to enable them to respond to revision requests. The revisions included, but were not limited to, developing a dashboard for all JMMRS indicators, modifying the calculation of age at death, adding more fields on the focal points notification page, making changes to ICD-10 (International Classification of Diseases) field to enable multiple selection, and updating the list of participating health facilities.

In FY20 Q3, the HMIS team completed the JMMSR IS documentation to support the MOH’s ETITD in sustaining the JMMSR IS and to serve as a technical reference for future maintenance. The documentation covers the following areas:

• JMMSR system flow and user journey • User and admin manual • Technical and source code documentation • Network and system administration manual • Security controls

b) RMNCH Community Outreach Information System

To sustain field visit activities, including data collection after the closeout of the Community Outreach Program, USAID Health Service Delivery handed over the Outreach Information System application to IFH to host on their data center.

C. RMNCH Manager Certification Program

As mentioned above and due to the COVID-19 pandemic and government shutdown, USAID Health Service Delivery terminated some of HCAC’s sub-award activities including the RMNCH Manager Certification Program. HC managers who attended the program will receive certification of attendance.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

USAID HEALTH SERVICE DELIVERY SUPPORT TO THE NATIONAL COVID-19 PREPAREDNESS AND RESPONSE PLAN 2020 FOR JORDAN

On March 19, Abt Associates received a request from the USAID AO to develop new activities within USAID Health Service Delivery’s mandate to support the National COVID- 19 Preparedness & Response Plan 2020 for Jordan. USAID Health Service Delivery is working in close collaboration with the MOH’s CDD to address the following pillars from the plan: Pillar 7 on Case Management, Pillar 8 on Operation Support and Logistics, and Pillar 2 on Risk Communication and Community Engagement.

Support the National COVID-19 Preparedness and Response Plan – Pillar 7 (Case Management)

During FY20 Q3, USAID Health Service Delivery supported the MOH CDD in developing the “Clinical Guidance and Protocols for COVID-19 Case Management.” USAID Health Service Delivery developed this guidance using the most updated evidence from the WHO and CDC, in addition to the current knowledge emerging from countries with high levels of COVID-19. USAID Health Service Delivery adopted and adapted the best available resources to the Jordanian context, and engaged national experts to review it. The Clinical Guidance and Protocols target health care providers from both PHCs and hospitals in Jordan. The guidance and protocols will serve as a standardized framework for clinical decisions to support best practices for COVID-19 case management and related IPC measures.

USAID Health Service Delivery, in collaboration with CDD, updated the protocols during this quarter, when WHO’s new case definitions were released early in June 2020. In collaboration with the MOH, USAID Health Service Delivery will continue updating the guidance and protocols when needed. The guidance was developed in both English and Arabic versions.

The Clinical Guidance and Protocols for COVID-19 Case Management includes the following:

• Screening and triaging of suspected and confirmed COVID-19 Cases • Clinical management protocol of confirmed COVID-19 Cases • Clinical management of pregnant confirmed COVID-19 Cases • Clinical management of children confirmed COVID-19 Cases • IPC measures related to COVID-19

In addition, USAID Health Service Delivery developed the “Clinical Guidance and Protocols for COVID-19 Case Management – Training Manual.” The purpose of the training manual is to guide the MOH trainers through the training workshop modules to develop the knowledge and clinical management skills for health care providers working at both the PHC and hospital level. This training manual consists of six modules. Each module has its own training sessions including objectives fitting the learning needs of specific target groups of health care providers, a detailed agenda, and training activities with the appropriate materials needed for each activity. The first and second modules target health care providers at the PHC level, while modules three through six target service providers at the hospital level.

The six modules are:

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

• Module 1: Screening of Suspected COVID-19 Cases and IPC Measures at PHC Level

• Module 2: Antenatal Care and Breastfeeding during COVID-19 Pandemic at PHC level

• Module 3: Screening and Triaging for Suspected and Confirmed COVID-19 Cases and Clinical Management Protocol at Hospital Level

• Module 4: Screening and Triaging for Suspected and Confirmed COVID-19 Cases and Clinical Management Protocol for Pregnant Woman with Confirmed COVID-19 at Hospital Level

• Module 5: Screening and Triaging for Suspected and Confirmed COVID-19 Cases and Clinical Management Protocol for Children with Confirmed COVID-19 at Hospital Level

• Module 6: Screening and Triaging for Suspected and Confirmed COVID-19 Cases and Clinical Management for Critical Confirmed COVID-19 Cass at Hospital Level

USAID Health Service Delivery, in collaboration with the MOH’s CDD, conducted a TOT workshop as a preliminary step to establish a core of MOH trainers across the Kingdom’s 14 HADs to support Pillar 7 on Case Management of the National COVID-19 Preparedness & Response Plan 2020.

Trainees included MOH internists, epidemiologists, public health and community medicine specialists, pediatricians, Ob/Gyns, family physicians, emergency medicine staff, and IPC coordinators from HADs, hospitals, and PHCs. USAID Health Service Delivery’s expectation is that the diversity of participants with different specialties will enable HADs to easily expand the training to other staff within both PHC HCs and hospitals.

TOT trainers were from both the public and the private sector, including trainers from Jordan Universities, Jordan University of Science and Technology and King Abdullah University Hospital, the MOH, the King Hussein Cancer Center, and private health care specialists. The trainers provided a wealth of information and personal expertise on dealing with COVID-19 cases. They enriched the training by providing scientific evidence based information and personal practical experiences in dealing with COVID-19 cases during the pandemic.

Trainees addressed important points through their interactive comments and questions. They showed a high level of commitment and satisfaction of the training content, materials, trainers, and training preparations. They emphasized that the training will enable them to better screen and manage COVID-19 cases, including pregnant woman, children, and critical cases, along with expanding the training to other service providers from both PHC and hospital levels. While 85 physicians and registered nurses from the 14 HADS attended the TOT, only 52 participants completed the certification requirements, including attending at least four of the five TOT days and passing the post-test by 70% or more for physicians and 60% or more for registered nurses and IPC coordinators).

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

“This TOT on “Clinical Guidance and Protocols for COVID-19 Case Management” is an excellent opportunity. We will transfer the great updated, evidence-based information to health care providers, to enable them correctly screen and manage suspected and confirmed COVID-19 cases. After the TOT we will develop a training plan at the level of Mafraq HAD and start training.”

Dr. Ahmed Al-Khawaldeh – Mafraq HAD Assistant Director for PHC and COVID-19 Focal Point / MOH, June 23, 2020

By mid-June 2020, the MOH assigned HAD COVID-19 focal points to work with USAID Health Service Delivery in implementing the activities related to Pillar 7 (case management). The focal points will evaluate the 52 participants who successfully completed the above- mentioned requirements. The focal points will conduct the evaluation during the upcoming trainings by the co-trainers, using a unified checklist, typically used by the MOH to evaluate trainers. By expanding this training to health care providers in hospitals and PHC settings, providers will be better prepared in all MOH facilities to manage suspected and/or confirmed cases of COVID-19.

USAID Health Service Delivery assisted the WCHD and the CDD in conducting nine virtual training workshops for PHCs on Modules 1 and 2, plus five workshops for hospital staff on Modules 3, 4, and 5. These workshops aimed to improve the MOH staff knowledge and ability to screen, triage, and manage suspected and confirmed COVID-19 cases, including for pregnant woman and children with confirmed COVID-19.

Photo 9: Mafraq HC staff attending the virtual training on Photo 10: A physician from Princess “Screening and IPC Measures for COVID-19” on June 15, 2020 Basma Hospital attending a virtual training workshop on May 28, 2020 Training workshops on Module 1 assisted HCs managers and head nurses to better prepare their centers to deal with COVID-19 cases.

Photo 11: Signs on chairs and on the floor in front of the registry waiting area, as well as establishment of a waiting area in the front yard to ensure social distancing in Sweileh Health Center in Amman HAD

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

Table 3 below provides more information on these training workshops, displaying the workshop title, the targeted MOH staff, number of sessions, and number of participants.

Table 3: COVID-19 training workshop titles, targeted staff, number of sessions and number of participants Number of Number of # Training Title Targeted MOH Staff Sessions Participants Conducted HAD Director Assistants for PHC, Screening of Suspected Quality Coordinators, 1. COVID-19 Cases and IPC IPC Coordinators, 4 199 Measures – Module 1 HC physicians, head nurses, registry staff, and IPC coordinator HAD Woman and Child Health (WCH) Antenatal care and Unit Heads and MCH breastfeeding during 2. supervisors 5 255 COVID-19 pandemic at HC physicians, PHC level – Module 2 midwives, nurses and CSS staff Screening and Triaging for Hospital emergency Suspected and Confirmed room staff, physicians COVID-19 Cases and and nurses, internal 3. 3 271 Clinical Management medicine physicians, Protocol at Hospital Level surgeons and other - Module 3 specialties Screening and Triaging for Suspected and Confirmed Hospital Ob/Gyn COVID-19 Cases and (Obstetrics Clinical Management Gynecology) specialists, 4. 1 139 Protocol for Pregnant midwives and nurses Woman with Confirmed from Ob/Gyn wards COVID-19 at Hospital and clinics Level – Module 4 Screening and Triaging for Hospital pediatric Suspected and Confirmed specialists and nurses COVID-19 Cases and from both pediatric 5. Clinical Management 1 128 floors and NICU Protocol for Children with (Neonatal Intensive Confirmed COVID-19 at Care Unit) Hospital Level – Module 5

During FY20 Q4, USAID Health Service Delivery will continue to support the CDD and the WCHD in expanding these workshops, and will conduct a workshop on Module 6 for critical COVID-19 cases to the staff within hospital Intensive Care Units (ICUs).

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

Support the National COVID-19 Preparedness and Response Plan – Pillar 8 (Operation Support and Logistics)

A. COVID-19 Hospital Readiness Assessment

USAID Health Service Delivery, in collaboration with the MOH’s CDD and the IDQCD, adapted and translated the “Public Hospital Readiness Checklist for COVID-19.” The WHO-EMRO originally developed this checklist. The checklist helps hospitals to manage effectively increases in COVID-19 cases, including planning for surge capacity when needed. At the same time, there is a need to ensure the continuity of all other essential services and establish a safe environment for health care providers and others within the hospital, including patients, visitors, and support staff. The MOH nominated two MOH hospitals (Zarqa New Governmental Hospital and Al-Hussein (Al-Salt) New Hospital) to conduct the initial assessments. The purpose of the initial assessments was to test the viability of using the adapted checklist and identify any further refinements needed to the checklist before widening its use in other public hospitals in Jordan.

In preparation for the assessment, USAID Health Service Delivery and the MOH conducted a virtual training for the assessment teams. Twenty-three participants from Zarqa and Balqa HADs, in addition to the two nominated hospitals attended the training. The workshop aimed to orient assessors on the key concepts and principles of hospital assessment, using the WHO-EMRO adapted hospital assessment checklist, and managing the assessment process and report writing. Ultimately, the MOH determined that assessors from the MOH’s CDD and IDQCD and USAID Health Service Delivery should carry out the first two assessments.

“This training came at the right time, as the Zarqa New Governmental Hospital team was preparing to be COVID-19 ready.”

We have learned the value of using the Adapted WHO Hospital Readiness Checklist for COVID-19 to ensure our hospital’s readiness and resilience in the face of this pandemic.”

Photo 12: Dr. Mabrouk Al-Sreihein - Zarqa New Dr. Mabrouk Al-Sreihein Governmental Hospital Director during the Zarqa New Governmental Hospital Virtual Training Workshop on Hospital Readiness Director / Ministry of Health Assessment Using the Adapted WHO Checklist conducted by USAID Health Service Delivery during June 10-11, 2020

During FY20 Q3, USAID Health Service Delivery, in collaboration with the MOH’s CDD and the IDQCD, conducted the assessment for the two nominated hospitals. The assessment findings will support the MOH and hospital managers in making informed decisions, developing a roadmap, and creating strategies addressing priority areas. USAID Health Service Delivery anticipates that this will lead to strengthening hospital preparedness for responding to COVID-19 transmission scenarios.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

In addition, the findings will help the MOH and USAID Health Service Delivery refine the checklist further for rollout to other MOH hospitals in Jordan. Annex 12 includes the assessment report, “Assessment of COVID-19 Readiness in Two MOH Hospitals.”

During FY20 Q4, USAID Health Service Delivery and the MOH will finalize the “Public Hospital Readiness Checklist for COVID-19” refinements. Then, USAID Health Service Delivery, in collaboration with the MOH, will conduct hospital readiness assessments in nine additional MOH hospitals.

In FY20 Q3, USAID Health Service Delivery held a virtual meeting with the MOH nominated COVID-19 focal points from 14 HADs. The purpose of the meeting was to discuss and agree on their roles and responsibilities in implementing Pillars 7 and 8 activities, including establishing multidisciplinary teams within each HAD. USAID Health Service Delivery assisted the CDD in drafting the terms of reference for the multidisciplinary teams to accomplish the necessary activities in line with Pillars 7 and 8.

B. Enhancement of Health Map Mobile Application

Another important aspect of USAID Health Service Delivery’s support to Pillar 8 of the National COVID-19 Preparedness & Response Plan 2020 is working with the MOH’s ETITD to enhance the existing MOH Mobile Health Map Application.

In FY20 Q3, USAID Health Service Delivery worked jointly with the MOH’s ETITD to design the enhancement of the existing MOH Mobile Health Map Application by adding functions pertinent to COVID-19 services provided at each facility level. The enhancements will leverage and use the existing Mobile Health Map application to cover the following services:

• Mapping out the available RMNCH human resources at the health facility level to enable clients to connect with providers for tele-health services, while simultaneously protecting the privacy of providers. • Allow for two-way communication between health care providers and their clients. • Allow health care providers to share IEC materials with their clients, to conduct the virtual client/provider interaction. • Allow the clients and others in the community to share their health concerns and needs with available health care providers who work within their catchment areas.

On June 24, 2020, Abt awarded the development of the enhancement of the Mobile Health Map application to Infograph, a leading local firm that developed the original application. Infograph will complete the development and pilot testing within the first two months of Q4.

In FY20 Q4, USAID Health Service Delivery will strengthen the capacity of the MOH’s ETITD team at the central level and IT focal points at the HAD level to maintain and support the implementation of the enhanced Mobile Health Map Application.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

C. Support Teleworking during the COVID-19 Pandemic

In FY20 Q3, USAID Health Service Delivery’s HMIS team significantly supported teleworking during and after the government shutdown. The HMIS team expanded their support to the USAID Health Service Delivery staff to conduct online meetings and webinars, enabling them to continue key activities, including work with the private sector. The HMIS team supported virtual NAG and DAG meetings, thus enabling the full functionality of the JMMSR system. During FY20 Q3, the HMIS team supported 220 virtual sessions with the MOH and the private sector, in addition to virtually supporting the MOH’s ETITD technical team in joint activities.

Support the National COVID-19 Preparedness and Response Plan – Pillar 2 (Risk Communication and Community Engagement)

In FY20 Q3, USAID Health Service Delivery, in collaboration with the HCAD, developed and disseminated health education and awareness messages related to COVID-19. These messages were prepared based on references from both WHO and CDC. HCAD ensured the upload of the COVID-19 health education messages on the MOH website: (https://corona.moh.gov.jo/uploads/Files/d119a421-b3bc-484a-8aac-d6584b74d928.pdf).

USAID Health Service Delivery, in collaboration with the HCAD and the HPSs, supported the CHCs to disseminate the newly developed COVID-19 health messages within their communities, using their social media platforms such as Facebook and WhatsApp.

In FY20 Q3, CHCs shared 3398 COVID-19 health messages on their Facebook pages and 4545 messages on their WhatsApp groups. In FY20 Q3, using the activated social media platform, Anjara CHC and Anjara MOH Health Center staff supported the MOH Rapid Response Teams to carry out random COVID-19 tests in the area of Anjara in Ajloun. The CHC role during this Photo 13: COVID-19 health activity included: message posted on Al-Hashimieh CHC Facebook Page in June • Posting announcements, using their social media 2020 platforms (Facebook page and WhatsApp groups). • Encouraging community members and HC clients to be tested. • Distributing safety and prevention leaflets. • Distributing masks and gloves to community members. • Supporting compliance with social distancing instructions. • Helping Anjara Health Center staff in organizing the queue to prevent crowding. Photo 14: Anjara CHC USAID Health Service Delivery supported Anjara CHC to activate Supported the MOH Rapid Response Teams to Carry out their social media platforms, which served as their primary means Random COVID-19 Tests in of communication with the local community to encourage their June 2020 participation in the above activity.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

Support the National COVID-19 Preparedness and Response Plan – Pillar 3 (Surveillance, Rapid Response Teams, and Case Investigation)

On July 14, 2020, the USAID AO informed Abt Associates that Pillar 3 activities would not be needed at this stage. Accordingly, USAID Health Service Delivery will not pursue these activities, and USAID Health Service Delivery will remove them from the COVID-19 workplan.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

4. COLLABORATION AND KNOWLEDGE SHARING

A. USAID HEALTH SERVICE DELIVERY IMPLEMENTING PARTNERS a) MEDICINES TECHNOLOGIES, AND PHARMACEUTICAL SERVICES (MTAPS)

USAID Health Service Delivery met with the MTaPS team, currently focusing on supporting the MOH with IPC. Both teams introduced their COVID-19 related activities, and discussed how to coordinate on IPC activities. USAID Health Service Delivery and MTaPS agreed to share information and materials, and to collaborate as much as possible. b) LOCAL HEALTH SYSTEMS SUSTAINABILITY (LHSS)

USAID Health Service Delivery met with LHSS Jordan several times, to coordinate COVID- 19 response efforts. First, each team discussed its overall approach to COVID-19 related capacity building, including target groups, methodologies and mechanisms to deliver capacity building. The teams also discussed potential areas of collaboration. USAID Health Service Delivery shared its training plans and training materials with the LHSS team. Per USAID guidance, USAID Health Service Delivery is primarily building COVID-19 related capacity within the public sector, while LHSS will focus on private sector health care providers. However, towards the end of the quarter, USAID recommended that USAID Health Service Delivery coordinate with LHSS, to invite private sector stakeholders to Pillar 7 trainings organized by USAID Health Service Delivery.

B. PARTNER ENTITIES IN HOST GOVERNMENT AND OTHER DONOR AGENCIES a) MOH

USAID Health Service Delivery works with multiple central MOH and HAD departments to strengthen their technical capacity and to support their long-term self-reliance. During FY20 Q3, USAID Health Service Delivery expanded its collaboration to work with additional counterparts, such as the CDD in planning and implementing Pillars 7 and 8 of the National Preparedness and Response Plan for COVID-19. In addition, USAID Health Service Delivery worked with the MOH to establish a national roster of trainers from the public and private sectors. USAID Health Service Delivery and its MOH counterparts, including the Institutional Development and Quality Directorate, also established a team of assessors to conduct a hospital readiness assessment using the WHO checklist.

Additionally USAID Health Service Delivery supported the HCAD in implementing Pillar 2 (Risk Communication and Community Engagement) of the National Preparedness and Response Plan for COVID-19 b) RMS

During FY20 Q3, USAID Health Service Delivery supported RMS hospitals through capacity building activities and in planning and implementing activities under Pillar 7 of the National Preparedness and Response Plan for COVID-19.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

c) The United Nations agencies: United Nations Population Fund (UNFPA)

During FY20 Q3, USAID Health Service Delivery representatives attended the quarterly virtual meeting conducted by the United Nations Population Fund (UNFPA) for the Reproductive Health Technical Working Group. The meeting focused on the COVID-19 pandemic, including impacts of the government shutdown on service provision. d) WHO

In FY20 Q3, USAID Health Service Delivery agreed with the WHO-EMRO to adapt and use the “Public Hospital Readiness Checklist for COVID-19.” USAID Health Service Delivery, with the MOH’s CDD and the Institutional Development and Quality Control Directorate, conducted assessments in two MOH hospitals to test the adapted WHO checklist in public hospitals and the applicability to scale up. WHO-EMRO provided USAID Health Service Delivery with advice regarding the checklist and assessment process. The WHO-EMRO team will continue to engage, and the collaboration is important as Jordan assesses its hospitals’ readiness. In the next quarter, USAID Health Service Delivery through USAID will share with WHO-EMRO the results and lessons learned from implementation of the checklist.

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

5. PLANNED ACTIVITIES FOR NEXT QUARTER

In FY20 Q4, USAID Health Service Delivery will achieve the following deliverables in accordance with the FY20 Work Plan:

Table 5: List of Planned Deliverables/Milestones for FY20 Q4 1) Summary report on PHC collaborative sessions for each ISDIC cycle developed Summary report on women and child health services comprehensive counseling training 2) workshops developed 3) Summary report for joint collaborative sessions between PHC and hospitals developed 4) CHC community mobilization and health promotion reports generated 5) Summary report on hospitals collaborative sessions for each ISDIC cycle developed Summary report on TOT for "Aseptic Preparation and Administration of IV Medications 6) and Fluids Guideline" developed 7) Summary report on hospital postpartum counseling developed 8) CSS fully functioning in 70 percent of PHC SDPs 9) Community engagement training package disseminated 10) Second Annual National Maternal Mortality Report finalized with MOH 11) JMMSR system training reports developed 12) Summary reports on LARC training workshops developed 13) Enhanced Health Map Mobile Application developed Capacity of the MOH’s ETITD team to maintain and support the implementation of the 14) enhanced Mobile Health Map Application developed 15) National clinical practice guidelines for reduction of C/S developed Support the National COVID-19 Response Plan Jordanian- relevant COVID-19 training materials finalized and uploaded on the MOH 16) website 17) Virtual training on case management protocols for health care providers conducted 18) Readiness plans for 11 public sector hospitals developed 19) Multidisciplinary teams in 14 HADs and 11 public sector hospitals trained 20) Enhanced/Updated Mobile Health Map Application Module with COVID-19 functions Reports on Mobile application development and management training for ETITD staff 21) generated

USAID Health Service Delivery FY 20 Q3 Progress Report Submitted to USAID on July 29, 2020

6. BRANDING, COMMUNICATIONS AND DISSEMINATION

A. KEY COMMUNICATION ACTIVITIES IN FY20 Q3 Table 6: Key Communication Activities in FY20 Q3 No. Event Date 1. April 2, 2020 2. April 13, 2020 3. April 19, 2020 4. April 22, 2020 JMMSR NAG Virtual Meetings to Complete the Review of 5. April 26, 2020 Maternal Death Cases in 2019 6. May 3, 2020 7. May 10, 2020 8. May 17, 2020 9. May 22, 2020 10. June 7, 2020 11. JMMSR NAG Virtual Meetings to Validate the Data for June 10, 2020 12. Maternal Death Cases in 2019 June 14, 2020 13. June 28, 2020 Oversight Committee Virtual Meeting to Review the Baseline Data in Selected Hospitals and Finalize the National Guidelines to 14. May 18, 2020 Support Vaginal Births and Reduce Primary Cesarean Section Deliveries in Jordan

In FY20 Q3, USAID Health Service Delivery also conducted a series of virtual training workshops and activities to support the National Response Plan for COVID-19. USAID Health Service Delivery submitted summaries of these activities (including quotes and photos) to the USAID DOC Office to help publicize these activities through USAID social media. Please see Annex 14 for these summaries and links to the related USAID social media posts on Facebook.

B. CALENDAR OF PLANNED OUTREACH AND COMMUNICATION EVENTS FOR FY20 Q4

In FY 20 Q4, USAID Health Service Delivery will conduct the following events:

Table 7: Activities Planned for Next Quarter No. Event Timing Audience JMMSR NAG Virtual Meeting to Complete the 1. July 7, 2020 JMMSR NAG Members Review of Maternal Death Cases in 2019 Joint Meeting for Handover MOH, USAID and USAID 2. July 23, 2020 of the ISDIC Program Health Service Delivery

USAID Health Service Delivery is implemented in Jordan by Abt Associates Address: Wadi Saqra, Arar Street, Building No. 201 P.O. Box: 851275, Sweifieh 11185, Amman, Jordan Landline: +962 6 5687730/ Fax: +962 6 5687731 [email protected]