~ Mothercare- U S Agency for International Development -·"9--·

MotherCare Summary Report October 1, 1993 - September 30, 1997

and

Annual Workplan October 1, 1997 - September 30, 1998

liff,ift) ~ t~W•'J: ~ MotherCare- U S Agency for International Development -·"9--· .. Office of Health :W:-): John Snow, Inc This publication was made possible through support provided by the Office of Health and Nutnt10n Umted States Agency for International Development (USAID), under the terms of Contract No HRN-C-00-93-00038-00 and John Snow, Incorporated (JSI)

The contents and opmions expressed herem are those of the author(s) and do not necessarily reflect the views ofUSAID and JSI Table of Contents

A Country Map

,.., B MotherCare s V is10n -'

,.., c MotherCare s Conceptual Framework(s)/Pathway -' • Figure 1 Conceptual Framework of Safe Pregnancy Program Demand and Supply 4 • Figure 2 How Does Essential Obstetric Care Fit mto this Framework? 5 • Figure 3 Mother/Baby Package 6 • Figure 4 Elements of EOC 6 • Figure 5 Pathway to Survival 7

D MotherCare's Integrated Reproductive Health Approach 8

E MotherCare's Accomplishments (By USAID SOs and IRs) 11 F MotherCare m Act10n - Country Specific Interventions • Box 1 A Partnership to Improve Maternal and Newborn Care m Indonesia 21 • Box 2 From Research to Action The Development of an IEC Campaign m South Kahmantan, Indonesia 22 • Box 3 Introducmg Family-Centered Maternity Care (FCMC) m Moldova 23 • Box 4 Expansion of Family-Centered Maternity Care m Ukraine 24

G Fmancial Summary of Years 1 - 4 25

H MotherCare Workplan for Year 5 27

Appendices 1 DO Summary 47 2 FS Summary 51 3 Annual Workplan Budgets for Year 5 (Core and DO's) 55 4 Prehmmary Lessons Learned 59 5 Country Synopses 65 6 Applied Research Summary 95 7 Country Workplans 103 8 MotherCare Pubhcat1ons List , 175 9 MotherCare Web Site (summary ofh1ts) 189 10 MotherCare Products List 195

Moldova,

Uganda

Hondurac;)

Malawi,

Indonesia,

Thailand,

Uganda)

Ecuador,

India,

Zambia

Peru,

Pakistan

Guatemala, Malawi,

Gumea,

(Boltv1a,

Ukrame,

tea fnd1a,

Egv-pt,

Indonesia,

Entrea,

(Ghana

Russia,

Ame1

'11:

Bolivia, Honduras

Benm, Peru,

Latm

Ghana,

Afnca

Involvement

Projects

Health

Countries

Pro1ects

Reproductive

Interventions

Pro1ects

Research

1997

MotherCare

Integrated

Targeted

Reg10nal

Applied

Dtcembo B MOTHERCARE'S VISION

Reproductive health is a state ofcomplete phvsical mental and social well-be mg and not me1 elv the absence of disease or znfirmit} zn all matters relatzng to the reproductive svstem and to its functwns and processes (Chapter 7 7 2, Programme of Act10n, ICPD Cairo 1994)

MotherCare seeks to implement a woman-centered approach for reproductive health care through a broad range of mtervent10ns, mcludmg commumty-based approaches to maternal and pennatal mortality reduction quality antenatal care mcludmg prevention and control of sexuall) transmitted diseases, plus improved nutnt10n through educat10n and distnbut1on of 1ron-folate tablets improved normal deliverv care and management of complications, postpartum services aimed at recogmzmg and treatmg complicat10ns and special newborn care, mcludmg exclusive breastfeedmg and post-partum/post-abort1on family plannmg

MotherCare 1s findmg ways to improve the dehvery ofth1s mtegrated reproductive health package most effectively through the ngorous use of quahtatlve and quant1tat1ve research techmques applied m different field settmgs MotherCare env1s1ons the reduct10n of maternal and neonatal mortality m the long-term, a more immediate mcrease m demand and utihzat10n of such services, and the accurate assessment of the impact of any mtervent10ns Furthermore MotherCare stnves to effect pohcy with its results and findmgs of such assessments

By these means, MotherCare strives " to demonstrate the feas1b1hty of prov1dmg a package of effective, appropriate maternal and neonatal care services and education to women and their mfants m selected developmg country settmgs "

(Project Purpose, Project Design Summary Logical Framework, MotherCare I Fmal Evaluat10n August 1993)

MotherCare s mtegrated approach 1s outlmed m Sect10n D below

C MOTHERCARE'S CONCEPTUAL FRAMEWORK AND PATHWAY TO SURVIVAL

MotherCare's framework for understandmg Safe Motherhood 1s comprised of both supply and demand mputs as conceptualized m Figure 1 below This framework summarizes how mputs of a program are converted through processes (activities) to produce results at the program level (outputs) and, over time changes at the population level (outcomes) Specifically, this framework demonstrates how maternal and permatal health mtervent10ns are expected to impact on populat10n-based behav10rs MotherCare views Safe Motherhood outcomes not only m terms of survival of the woman and newborn but also m terms of their health

F \WORKPLAN\FRAMEWK WPD

3 Previous Page Blank &

...

pact)

health

and

maternal

and

Health

women •

•

~se

OUTCOMES

(health

permatal/neonatal mortality Reduced

Improved

newborns of

proved

Demand

Appropriate

Service

status

and

access

status

dec1s1on-makmg

demand

supply

Program

phcated

! OUTPUTS

va1lable

Normal Com Family Recogn1t1on

Costs

Transport

lmage/Acceptab1hty Efficiency Quality

Service - -

- - -

Service - A

- - -

Mortality

Pregnancy

evaluatton

safe

acqu1s1t10n/

Status

transport

services*

and

Safe

and

of (N

arm

behav10rs

Care Wantedness

Complicated Health

Management

Trammg

IEC Commodity Research superv1s10n

d1stnbut10n

Pregnancy PROCESS

- -

Operations pregnancy

- -

- - A

Maternal/Pennatal

Neonatal

children

Framework

Special

women

for factors

for

newborns

factors

(EsOC)

safe

services*

Impact

strategies

integration

Value Cultural Demand

and

- -

- Care

Conceptual

partnerships

Service

Sectoral Delivery infrastructure Pubhc/pnvate

md1v1dual

status

Organ1zattonal structure pregnancy

- Obstetric

- -

WPD

Program

status

and

Project

Essential

health nutnttonal

support

Figure

Care

INPUTS

code/

~~~~~~~~~~~~~~~~~~~~~~~J~I

Supply

lat10ns Evaluation

m1strattve

Education Women's Women's

SES !

Poht1cal Resource The

Legal

allocatton regu

Soc1etal/cultural - - - -

*Prenatal

Pohttcal

adm

- system - ~

Demand

Supply

\WORKPLAN\FRAMEWK

Source

""'

~..,,,

4'- ... On the demand side soc10-cultural and ind1v1dual factors influence the value placed on women and newborns their health and nutritional status and the demand for children These factors m turn affect pregnancy status and demand for services Appropriate use of services and improved health behav10rs will result ma declme in maternal and permatal mortality and improved health for the mother and newborn if they are met by quality services Appropriate service demand depends on the woman s pregnancy status Many types of providers may be able to manage normal pregnancies, but maternal complications and those complications that may kill a newborn require specialized care often at a greater distance and cost to the family than normal pregnanC\ care Recogmt1on of these complicat10ns and appropriate and timely response, by families Figure 2 How does Essential Obstetric Care fit mto this framework? and providers, are essential for the survival of the woman and the EOC mcludes the management of problem pregnancies and referral for newborn such problems as anemia preeclampsia and prolonged labor EOC includes early detect10n and treatment to prevent the progression of Quality services are imbedded in problems so that they do not become emergencies as well as the treatment of severe poht1cal and adnumstrat1ve comphcat1ons systems, organ1zat10nal Emergency Obstetric Care (EmOC) 1s a subset ofEOC and responds to structures, and service and unexpected comphcat1ons such as hemorrhage and obstructed labor It operational elements on the does not include management of problem pregnancies momtonng of supply side (program level) labor or neonatal care Directed at savmg women s hves EmOC includes blood and IV transfus10n, These elements impact on the parenteral ant1b10t1cs oxytoc1cs and sedatives Cesarean section ventouse or forceps delivery, and manual availab1hty, access, quality removal of the placenta and evacuation ofretamed products of image and acceptability of conception Suturing laparotomy and hemoglobin est1mat1on would services offered at delivery sites also be included Moreover essential obstetric care However, focusing on EmOC does (see Figures 2 and 4) the maJor not allow for earlv 1dent1ficat1011 of comphcat10ns and prevention of their progression to hfe-threatenmg service intervent10n aimed at emergencies A broader array of essential obstetric care services may managmg the direct obstetric help to decrease the seventy of comphcat10ns and ensuing deaths (for comphcat1ons leadmg to maternal example severe anemia as a result of hemorrhage or obstetric fistula death does not stand alone It is and vaginal prolapse resulting from prolonged labor) EOC mcludes the partograph and maternal wa1tmg homes part of basic maternity care, plus all the elements listed 111 EmOC which includes appropriate prenatal and postpartum care, Services can be focused to emphasize 'basic' EOC another subset of plus normal b1rthmg care (as EOC It mcludes all EOC elements except surgery, anesthesia and shown m Figure 3 for the Mother blood replacement All pregnant women should receive these services which can be provided Baby Package of WHO) at the first referral level (health center maternity or basic hospital) by non-physician providers such as medically tramed m1dw1ves This approach does not demand highly The availab1hty, access and tramed ob/gyn spec1ahsts or fully equipped operatmg theaters and quality of these services, plus therefore has the potential to brmg services closer to women Fmally their acceptab1hty and efficiency MotherCare recognizes that all women should have access to basic maternity care or management of normal pregnancies contribute to the demand for theu and dehvenes and that EOC will only be needed for those who have difficult use by women and fam1hes To pregnancies or comphcat10ns

F \ WORKPLAN\FRAMEWK WPD

5 ensure these services have and mamtam such characteristics thev must be supported through effective management and supervision trammg commodit) acqmsition and distnbution mformation education and commumcations efforts (IEC) research and evaluat10n and alarm and transportat10n systems

Figure 3 Mother/Baby Package

Motherhood

...f (.) .!! ... ~ CD f j! !!? > ... c -... (.)... c ... a; .::: u .l!! CD c c 0 ...... = c :s w"'.a 0 Basic Maternity Care

PRIMARY HEAL TH CARE

EQUITY FOR WOMEN

Sour1>e WHO 11194

F 1gure 4 El emen t sof EOC Basic EOC Essential Obstetric Care EmOC surgical obstetrics x anesthesia x

blood replacement x x management of problem pregnancies x medical treatment x

x manual procedures x x momtormg of labor x neonatal special care Source The Evaluation Project

Fmally, effective pohcy underpms this entire program, and can take the form of political statements, committees, operational plans, budget allocat10ns, regulat10ns and leg1slat10n Outputs resultmg from pohc1es focused on improvmg the survival and health of women and their newborns mclude service delivery pomts that provide all the essential obstetric funct10ns or those dedicated to a port10n of these services, such as emergency obstetric care or neonatal special care

F \ WORKPLAN\FRAMEWK WPD

6 To facilitate the conceptuahzat10n of this framework. and to brmg together the commumtv and service delivery components discussed above MotherCare has outlmed four steps that reqmre attention to improve the chances for survival of the mother and her baby This Pathwa\ to Survival (see Figure 5) begms with recogmtion of the problem (Step 1) by the woman her tam1h and/or health providers who may not be eqmpped to manage the problem The woman and her family need to decide to seek care (Step 2) and must overcome bamers to access (Step 3) Access issues such as cost transportation weather cond1t10ns Figure 5 chlldcare and percept10ns of how the woman will be treated mfluence whether or not the family will decide to seek care The final step is the actual quality of care (Step 4) provided to women MotherCare mtervent10ns aim to improve each step along this pathway

.... W1thm this framework, MotherCare has conducted quantitative and lbxlocNmoN qualitative research to identify barriers to and opportumt1es for ST.EP I hoaUIM°' survival and improved health, and feasible mtervent1ons to overcome them This research has mfluenced MotherCare to target its efforts m .... three strategic areas 1) 1mprovmg quality of care 2) changmg behaviors of health providers, families, and commum ties and 3) [~· ~I supportmg policy formulation MotherCare' s efforts to improve ...... quahty of care mclude developmg protocols to set standards of care as well as gmde trammg, bmldmg provider teams w1thm and among STBP3 ACCU&TIJ levels of staff, prov1dmg m-serv1ce trammg to improve techmcal and ~ mterpersonal skills and strengtlienmg referral 111eclia111 srns H@alth .... providers are taught mterpersonal commumcat10n and counselmg (IPC/C) skills to help them address women sand families needs STEP 4 ~ They use mformat10n, educat10n and commumcat10n (IEC) materials with clients m explammg the danger signs of complicat10ns and work ...... with them on plans of action By 1mprovmg the flow of IEC m the commumty, 1t is expected that demand and utilizat10n of quahty SURVIVAL services will mcrease Moreover, promotmg policy formulation and commumty mob1hzatlon allows programs to function m a supportive environment

Through momtoring and evaluatmg this mtegrated approach the effectiveness of its 1mplementat10n and its impact on appropriate use of services and providers' performance are measured Costs of use of mtervent10ns will be determmed as well

MotherCare focuses primarily on an mtegrated reproductive health approach (as discussed more fully m Section D below), with addit10nal efforts m some countries on targeted mtervent10ns which look at the means of implementmg specific components of maternal care These targeted mtervent10ns mclude anemia prevent10n and control antenatal, mtrapartum and postpartum care STD prevent10n and control, family centered maternity/neonatal care, and research and education on female gemtal mutilat10n (FGM) In add1t10n, MotherCare funds six applied research projects

F \ WORKPLAN\FRAMEWK WPD

7 which address specific quest10ns on effectiveness of mtervent10ns or on varymg the means of 1mplementmg known mtervent10ns Each of these approaches 1s contnbutmg to MotherCare s understandmg of what is necessary to achieve Safe Motherhood A descnpt10n of the md1v1dual countrv programs and applied research projects can be found m Appendix 4 The map m Section A pmpomts the 22 countnes m which these MotherCare sponsored projects can be found

D MOTHERCARE'S INTEGRATED REPRODUCTIVE HEALTH APPROACH

MotherCare's project act1v1t1es center around the needs of a woman and her baby durmg pregnancy, birth and the postpartum penod MotherCare seeks not only to reduce maternal and neonatal mortality and morb1d1ty, but to opt1m1ze the pregnancy and birth experience for the woman and newborn Recogmzmg that poor nutnt1on, mfect1ons, and unwanted and m1st1med pregnancies contnbute to poor health of mothers and thelf newborns, MotherCare has added or substituted components which address these problems to the trad1t10nal package of maternal and neonatal mtervent10ns to form an mtegrated reproductive health approach

MotherCare' s strategies to optimize the pregnancy and birth expenence mclude two mter-related concepts 1) 1mprovmg the quahty of care provided to women and neonates m the health services and 2) mcreasmg the ability of women and fam1hes to use services when needed MotherCare emphasizes onentmg care so that it 1s more women-centered and is provided m an atmosphere m which women and theIT fam1hes are recogmzed as equal partners with health providers m dec1s1on-makmg about care The health of both mother and baby are mcluded because MotherCare believes that a pregnancy outcome for a woman cannot be considered "good" unless she also has a healthy baby To implement these strategies, project act1v1t1es are concentrated at the d1stnct level, pnmanly with M1mstnes of Health as partners Recogmzmg the impact of policies on the health of women and newborns MotherCare also promotes nat10nal pohc1es that support this mtegrated reproductive health approach

To improve the quality of care, protocols for the antenatal, mtrapartum and postpartum management of women and babies with normal and complicated courses are developed with the Mm1stry of Health and other stakeholders These protocols form the basic package of mtervent10ns m MotherCare's mtegrated reproductive health approach MotherCare recogmzes that mherent m "quahty" of services is a need for them to be acceptable and culturally appropriate for the commumty In addit10n, as providers improve their mterpersonal communication skills, women and families may more clearly understand the mformatlon transmitted to them, which m tum may facilitate their equal participat10n m the dec1s10n-makmg process Thus, MotherCare's competency-based trammg programs mclude an emphasis on those chmcal and mterpersonal skills necessary to successfully implement the package of mterventions

In add1t10n to improvmg the quality and content of services, MotherCare uses commumty-based qualitative research (a "community diagnosis") to identify reasons for poor use of services Once barners to care are determmed, MotherCare designs and implements mformation, educat10n,

F \ WORKPLAN\FRAMEWK WPD

8 commumcat10n and counselmg (IEC/C) strategies specific for the locale These strategies address many of the issues related to access and use of services (e g poor awareness ot rnmphcat1ons, percept10ns of quahty and effectiveness of health services) Vanous media are used - mcludmg rad10 soap operas rad10 spots, posters leaflets, and mfluential communm members - to promote d1scuss10n and a better understandmg of maternal and newborn health among members of the commumty

MotherCare addresses maternal and neonatal nutnt1on concerns m several ways Foremost is MotherCare s effort to improve iron supplementation programs m countries through promotion of iron folate tablets durmg pregnancy and m the postpartum penod This effort is conducted usmg fac1hty- and commumty-based distribution models A key goal 1s promotmg the recogmt10n by the commumty and health care providers that anemia 1s a senous medical comphcat10n of pregnancy for both mother and baby and that iron folate supplementat10n can prevent and treat anemia Problems such as women's beliefs about milk msuffic1ency maternal v1tamm A deficiency, and poor dietary habits durmg pregnancy and lactation also are mcluded m the mtegrated reproductive health package 111 several countries Exclusive breastfeedmg 1s promoted as a key neonatal survival mtervent1on

Reproductive tract mfections (RTis), especially syph1hs, have well-established negative impacts on the health of women and babies, but few countries mclude mtervent10ns to address them m their maternal and newborn care programs MotherCare has conducted studies to establish the prevalence of selected RTis 111 MotherCare designated countries where rates are unknown Results of these studies are used to define the appropriate mtervent10n strategy to address these mfect10ns for the country specific package of mtervent10ns For example, syphilis mfect10n during pregnancy has been 1dent1fied as a maJor contributor to permatal mortality among some populations and mcreasmgly 1s bemg recogmzed as a fac1htator for sexual HIV transm1ss10n MotherCare has developed a trammg manual to promote chmc-based syphilis screemng and treatment for pregnant women and their partners m those countries with a known high prevalence of syphilis

A woman risks death each time she becomes pregnant, so prevent111g unwanted and mistimed pregnancies 1s crucial to preventmg unnecessary maternal deaths Family plannmg for postpartum and postabort10n women 1s an important mtervent10n to address the problem of more unwanted and m1st1med pregnancies MotherCare begms its family plannmg efforts by 1dent1fymg the contraceptive methods that are acceptable to the women, providers, and policymakers Counselmg and prov1s1on of services to mcrease the use and the effectiveness of the selected methods are mtegrated mto antenatal and postpartum care Moreover, MotherCare promotes exclusive breastfeedmg for the first six months postpartum, both for its contraceptive effect as well as for the nutrit10nal value to the baby

A given country's package of mterventlons 1s designed to mclude only those mterventlons that address maJor maternal and permatal health problems and for which the country has the necessary material and human resources for effective implementation The goal 1s to design a

F \WORKPLAN\FRAMEWK WPD

9 package of mtegrated reproductive health mtervent1ons for women and their babies dunng pregnancy and the immediate postpartum penod which are appropriate and sustamable for the country MotherCare's role is to assist countnes m definmg this package m improvmg the quality of the delivery ofth1s package, and m mcreasmg the commumty's knowledge and use ot the mtegrated reproductive health services

F \ WORKPLAN\FRAMEWK WPD

10 E STRATEGIC AND PROGRAM OBJECTIVES ACCOMPLISHMENTS IN 1997

SO 2 Increased use of safe pregnancy, women's nutr1tlon, famdy plannmg, and other ke\ reproductive health mtervent10ns

IR 2 I Approaches and technologies to enhance key reproductive health mterventions identified, developed, evaluated and d1ssemmated

Research

• Completed prelimmary analysis of the commumty baselme surveys m Indonesia and Bolivia • RFP for pennatal study m Egypt Sub-contract awarded to Amencan Umversity m Carro to carry out the research Research design and prehmmary questionnaues developed • Conducted qualitative formative research for the Breastfeedmg Support Group m Pakistan • Published methodological cnt1que of permatal mortality studies by Donna Espeut m MotherCare Matters • Conducted literature review of reproductive health m India • Conducted literature review of pennatal health m Egypt • Conducted literature review of permatal health m Honduras • Conducted literature review of reproductive health m Pakistan • Overview of methodology for permatal mortality studies m the developmg countnes conducted by Donna Espeut, draft final report available • Conducted abortion study m Pakistan • Conducted Knowledge, Attitude and Practice study of providers m reproductive health m Pakistan • Completed qualitative research on anemia and Iron supplementat10n m Honduras • Completed draft field gmdes form-depth mterv1ews and focus groups Topic areas covered by the gmdes were pregnancy-related issues, labor/delivery-related issues, neonatal issues, and anemia • Designed focus group gmdes and mterview gmdes around the neonate In Egypt and Honduras, given MOH mterests and the local research firms found, sigmficant adaptations were made MOH participated m the final design of the gmdes • Designed and adapted field gmdes for commumty diagnosis m Egypt Given MOH mterests and the capacity/preferences of the research firm contracted to conduct the CD the field gmdes underwent sigmficant adaptation MPPH participated m the final design of the gmdes • Completed anemia prevalence baselme study and secondary analysis of nsk factors for anemia m Malawi, Bolivia, Indonesia, India, and Guatemala • Designed study on uon sulfate supplements and d1stnbut1on systems m Bolivia • Fmahzed research protocols for 2 addit10nal studies m Indonesia 1) Anemia mformation dissemmat10n to couples at the time of marnage registrat10n, and 2) Et10logy

\\ of anemia among pregnant women m South Kahmantan

Program Implementation

• Project Hope developed and implemented a trammg curriculum on antenatal care mcludmg iron deficiency anemia prevention and control • Translated manual for screemng and treatment of syph1hs mto Spanish m Bolivia Providers will be tramed to mtegrate this component mto antenatal services • In collaborat10n with the Nat10nal Secretanat of Health, Bolivia, developed protocols for screenmg, d1agnos1s, and treatment of iron deficiency anemia to be mcluded m National Protocols for Obstetric and Newborn Care • Integrated anemia control m the obstetric and newborn case management trammg curriculum for Bolivian physicians, nurses, and nurse auxihanes • In Bolivia, developed manual on how to use IEC materials

See IR 2 4 below for additional Program Implementation Protocols and Trammg Curricula relevant to IR 2 1

Program Momtormg and Evaluation

• Developed momtoring and evaluation mdicators for Bolivia and Indonesia • Carned out evaluation of the Safe Motherhood Program m India at the request of the GOI • earned out evaluation of Maternal Health Programs m Bangladesh at the request of GOB • Developed evaluation plans for Indonesia and Guatemala programs

Apphed Research Studies

• IP AS contmued trammg midwives m their two mtervent10n districts, K wanu South and East Al(lm of the Eastern Reg10n Extens10n and additional fundmg given to IP AS for more data collect10n m study of midwives providmg mcomplete abortion services mcludmg use of manual vacuum aspiration A prelimmary report of the research was published m MotherCare Matters m October 1997 The project was presented at AID m September 1997 and at a dissemmation meetmg m Ghana, October 14-17, 1997

• Data collection for the Thailand part of the WHO multi-centered antenatal care trial has been completed Awaitmg data from other centers m the study so that analysis can contmue

• In Uganda, Dr Ron Gray and colleagues have completed data collect10n on STD control for maternal and mfant health and are analyzmg the data for the final report and

12 publishable paper A prelimmary report of the research was published m MotherCare Matters m October 1997

• Peru study on the impact of iron supplementat10n on school performance m adolescent girls has been completed and a draft paper has been submitted by Inst1tuto de Invest1gac10n Nutnc1onal (IIN) Peru The mvest1gators presented a poster m Canada at the International Nutnt10n Congress, July 1997

• In Uganda, the Pacific Institute has completed a draft of their final report on part1c1patorv research with adolescents for control of STDs Fmdmgs were presented at APHA m November 1997

Collaboratmn

• World Health Organ1zat1on

Part1c1pated m cost study m Bolivia val1datmg the Mother-Baby Package spreadsheet

• PAHO and Quality Assurance Pro1ect

DevelopecttheLAC Imtiative for distnct level safe motherhood programs and policies m Honduras, Ecuador, and Bohvia Quality Assurance Project also JOms this effort to improve quahty of services

• World Bank

MotherCare completed the evaluation of the Child Survival and Safe Motherhood (CSSM) Program supported by the World Bank with techmcal gmdance and execution by UNICEF .. MotherCare earned out the evaluat10n of 8 maternal health projects m Bangladesh at the request of the Government and the World Bank "' Marge Koblmsky assisted with the design and development of matenals for the Bank's annual trammg meetmg

• UNICEF

"' Marge Koblmsky gave a presentat10n on efforts to raise commumty awareness, June 9, 1997 "' In Guatemala, UNICEF is supplymg iron folate tablets for MotherCare project areas "' MC/Indonesia and UNICEF sponsored National Policy Workshop on Anemia (Jakarta) "' In Moldova, MotherCare, PCS and UNICEF are collaboratmg on a national program for family-centered maternity care (see Box 3)

13 Marge Koblmsky co-presented a full-day semmar to DFID representatives of Peru and Bohvia with Oona Campbell, LSHTM July 1997

• European Economic Umon

Scalmg up the package of mtervent10ns of five health zones m Guatemala to others m the eastern part of the country with EEU support

• APHA

.. Marge Koblmsky presented a 30-mmute talk on Lessons Learned m Safe Motherhood at the APHA Safe Motherhood sess10n m Indianapohs, November 9-10, 1997 Marge Koblmsky is to organize an APHA Safe Motherhood sess10n for 1998

• International Congress of Nutrition

16 representatives from five countries presented findmgs from MotherCare-funded anemia control programs at the International Congress of Nutrition, Montreal

• Other Cooperatmg Agencies

.. Developed permatal mortality study tool for Guatemala with BASICS "' Collaborated with OMNI and CCH m Bolivia on anemia .. Held the LAC Reg10nal anemia control workshop m Cochabamba lessons learned m the design of programs for the control of anemia due to iron deficiency from MotherCare and OMNI sponsored projects MC/Washmgton staff member attended the Nat10nal Micronutrient Strategic Planmng Meetmg m Honduras organized by the International Eye F oundat10n with fundmg from OMNI MotherCare contmued workmg with the Asia Foundat10n m Pakistan, providmg techmcal assistance to selected NGOs that are workmg m various areas of maternal health m collaborat10n with community-based orgamzations m their area MotherCare, with A VSC, JHPIEGO and SEATS, worked m Russia m a breastfeedmg trammg that has been scaled up to the oblast level Adapted the Breastfeedmg trammg materials for Russia from those produced by the Institute of Reproductive Research at Georgetown Umversity and by Wellstart With MSH's Rational Management of Reproductive Health Commodities, MotherCare is developmg a cost format and analysis of commodities "' With PHR, MotherCare is carrymg out a situation analysis of three African countries

14 (Afnca Imtiative)

• Umversities

MotherCare has been workmg closely with higher academic mstitut10ns mcludmg The Johns Hopkms Umversity School of Hygiene (lecturmg at semmar senes and courses through the International Health Department), Georgetown Umversity (supplymg matenals for Russia LAM/Breastfeedmg trammgs), and George Washmgton Umversit\ Marge Koblmsky taught at LSHTM' s Reproductive Health short course m June Jul\ 1997

Meetmgs

• Jeanne McDermott presented and participated m WHO meetmg on Neonatal Tetanus • Marge Koblmsky and Jeanne McDermott each presented at the Safe Motherhood Consultation m Sn Lanka • Jeanne McDermott and Diana Beck each presented at the Annual Meetmg, Amencan College of Nurse Midwives • MC/Washmgton staff member presented "Controllmg maternal anemia -- what can we do?" to audiences at USAID, Johns Hopkms Umvers1ty School of Hygiene and Pubhc Health, and the World Bank • Orgamzed and funded neonatal Symposmm m Madhapradesh m India • Funded participat10n of Neonatal Researchers from India to the Neonatal Symposmm m Nepal • Zahid Huque presented on maternal health s1tuat10n m the developmg countnes at a workshop organized by Save the Children Fund • MotherCare central and field staff presented at USAID monthly dissemmation senes

IR 2 2 Improved pohc1es and mcreased pubhc and private sector resources and capacity to deliver key reproductive health services

Pohcy

• Designed model for costmg of reproductive health services, concentrated on maternal and newborn care (with MSH- Rational Drug program and USAID) • Obtamed agreement from five pharmaceutical companies to produce standardized, improved packagmg for iron folate tablets m Indonesia • Launched pnvate sector pill supply distnbut10n program m Indonesia • Completed cost study m Bohvia and currently developmg cost package for mumcipahty dissemmat1on and use

Capacity Bmldmg

15 • Provided mternat10nal and local techmcal assistance on qualitative research methods to three anemia control study sites m India • In Pakistan, Asia Foundation/MotherCare/Wellstart gave a TOT workshop usmg a commumty-based curriculum on breastfeedmg • The Indonesian Midwifery Associat10n (IBI) organ1zat1on development contmues Peer review and contmmng education is m place and IS helpmg to remforce knowledge through m-serv1ce trammg (See Box 1) • With the MOH staff m Indonesia and doctors m the district hospitals of Guatemala maternal and permatal audits contmue, providmg a peer review among physicians and other providers

See IR 2 4 (Quahty of Essential Obstetnc Services mcreased m selected countnes) below for add1t10nal Capacity Bmldmg act1v1t1es relevant to IR 2 2

Collaboration

• World Health Orgamzat10n

Assisted with national protocol development for Bohv1a's congemtal syph1hs prevent10n program Under nat10nal pohcy, screemng and treatment of seropos1t1ve women and partners will be mtegrated mto antenatal services

• PAHO

~ Developed and d1ssemmated Nat10nal Protocols ofBohvia m collaborat10n with PAHO

IR 2 3 Access to essential obstetric services mcreased m selected priority countries

Formative Research

• Completed Commumty Diagnosis m Egypt (prehmmary report submitted) and Honduras (final report submitted) In Honduras, research focused on the pennatal penod, with emphasis on the newborn

Program Implementation

• Designed, produced and pretested IEC matenals which address health seek.mg behaviors for curative and preventive maternal and newborn care These matenals are currently m place m Bohvia, Indonesia and Guatemala Evaluat10n of the IEC strategy to address these behav10rs is planned with md1cators specified for both Bohvrn and Indonesia • Developed IEC/C prmt materials m Bohvia • logo poster safe maternity symbohzed with Aymara representat10ns • nghts of pregnant women poster 16 • prenatal care poster for use ms1de the health fac1hty to md1cate where services are rendered ms1de the fac1hty • emergency care pamphlet to be given to pregnant women • counselmg cards for signs of comphcat1ons m pregnancy, partum post-partum and with neonate for use by the health provider • counselmg cards for anemia (iron tablet mtake, behefs) • In Bolivia, developed a 60 chapter radio soap opera dealmg with signs of comphcat10ns durmg pregnancy, partum, postpartum and with neonate which was aired through five rad10 stations The soap opera stresses the need to take immediate act10n by gomg to the fac1hty and addressed ways to deal with access issues, cost, and maltreatment at the hospital In add1t10n, the soap opera addressed the consequences of mact10n for both the woman and her baby Other act1v1t1es/products mclude • spots for husbands rad10 capsules encouragmg the husband to save money to go to a health facility m case of a comphcat10n The need to take immediate action 1s also stressed • rad10 contest promotmg active part1c1pation of women • In Indonesia, designed, pre-tested and produced IEC prmt materials (see Box 2) • Bidan wall poster "The Bidan 1s Here for You" • Brochure/leaflet for contmgency planmng Message from the Governor's Wife • Pregnancy flyer targetmg husbands Message from Guru IJai • Safe Motherhood flyer targetmg fam1hes Message fro Guru IJai • Dukun referral booklet Messages for TBAs • Breastfeedmg counselmg booklet • Anemia counselmg cards for pregnant women • Anemia counselmg cards for post-partum women • Flyer for iron pill retailers • Banner for iron pill retailers • Remmder card for takmg iron pills • Poster promotmg iron pills Message from Guru IJa1 • IEC booklet More Act1v1t1es to Reduce Maternal Mortality • IEC booklet on anemia and iron pills • Developed and produced IEC radio spots m Indonesia • Promote Bidan di desa's role m commumty and m postpartum programs • Informs fam1hes about seriousness of comphcat1ons and the need for immediate action • Anemia tablets must be taken daily Tablets do not make the baby bigger nor mcrease your blood • Developed and produced IEC prmt materials m Guatemala • rights of pregnant women poster • signs of comphcat1ons flyer • anemia poster • counselmg cards on comphcat10ns, anemia • remmder card for iron tablets • In Guatemala, developed and produced radio spots • signs of comphcat10ns, take immediate act10n • take uon tablets daily 17 Program Momtormg and Evaluation

• Conducted a momtormg process and developed an impact survey of the soap opera m Bohvia

IR 2 4 Quality of essential obstetric services mcreased m selected countries

Research

• Carried out health fac1bty analysis (SA) m Egypt usmg the WHO model • Completed study design, 1mplementat1on, analysis gmdelmes, data analysis, and report of the Situation Analysis m Egypt • Camed out fac1bty-based neonatal care study m Egypt • Completed Health Fac1bty Assessment study m Bolivia • Conducted profile survey of vdlage-based midwives m Indonesia to determme characteristics and act1v1t1es

Program Implementation Protocols and trammg curricula

• Adapted Family Centered Matermty Care Curriculum for Moldova (see Box 3) • Implemented competency-based trammg m Bolivia, Indonesia, Guatemala, Ukrame, Zambia usmg cumculum developed reported last year (for a description of competency based trammg m Ukrame, see Box 4) • IPC/C trammg manual, designed to mcrease health provider commumcat10n and counselmg skills with women was developed, pre-tested, and used m trammgs m Bohvia • In Indonesia, developed IPC/C trammg manual for B1dan di desa usmg anemia as core message

Program Momtormg and Evaluation

• Implemented hospital registers m Indonesia and Guatemala • Implemented register for activities of village-based m1dw1ves m Indonesia • Implemented Peer Review and Contmumg Education at chapter meetmgs by IBI (National Midwifery Association m Indonesia) m South Kalimantan • Implemented supervisory visits to follow-up with providers who received trammg m Bohvia The experience of these VlSlts will be used to design a supervis10n program that can be implemented by the government • Developed prehmmary evaluation plans for trammg m Indonesia and Guatemala

See above under IR 2 1 for addit10nal Program Implementation Protocols and Trammg Cumcula relevant to IR 2 4

18 MotlzerCare Responses to SOs 1, 3 and 4

MotherCare' s mterventions also mclude sigmficant attent10n to SOl (Increased use bv women and men of voluntary practices that contnbute to reduced fert1hty), pnmarily through attent10n to

• Family planmng counsehng has been strongly mtegrated mto antenatal and postpartum care m Indonesia and Bohvia, with IRH providmg techmcal assistance to the Bolivian trammg courses

• LAM is mtegrated mto trammg courses m Russia as well as m the trammg programs of Bolivia and Indonesia

MotherCare's mterventions also address S03 (Increased use of key child health and nutntion mterventions), through the followmg

• Developed neonatal care curncula and protocols m Indonesia and Bohvia

• Quest10ns on knowledge of newborn comphcat10ns and related behav10rs, newborn care ( e g breastfeedmg), and tetanus knowledge and immumzat10n, are m the baselme surveys of Bohvrn and Indonesia

• Behav10rs around birthmg and newborn care were mcluded m the Commumty Diagnosis, and expanded for use m Egypt, India and Honduras

• Community-based permatal study is underway m Guatemala

• Syphilis prevalence m Bohvia sets the stage for mtervemng to reduce poor pennatal outcomes A standard case defimt10n for congemtal syph1hs has been determmed m this study

• Pilot tested exammmg newborns' eyes for conjunctivitis as a sign of maternal R Tis m Indonesia

• Breastfeedmg m Russia has been mcreasmg m two oblasts as a result of MotherCare/SEATS mterventions

• Several researchers and potential Indian collaborators participated m a permatal meetmg m Nepal

To address S04 (Effective mtervent10ns to reduce sexual transmiss10n of HIV/STD identified, strengthened, implemented and evaluated m emphasis countnes) and its program objectives, MotherCare

• MotherCare contmues to identify ex1stmg RTI prevalence m Indonesia, as well as syphilis prevalence m Bohvia

19 MotherCare provides prehmmary lessons learned m Appendix 3 These lessons will be venfied and elaborated through the evaluation of the project

20 F MotherCare m Act10n Country Specific Interventions

Box 1 A Partnership to Improve Maternal and Newborn Care In Indonesia

Over the past five years m Indonesia, nearly 60,000 m1dw1ves have been tramed to brmg maternal and newborn services closer to women These m1dw1ves are based m villages and are responsible for the women m thetr village Jkatan B1dan Indonesia (JBI), the profess10nal midwifery organization m Indonesia, 1s workmg with the Mm1stry of Health (MOH) to meet the on-go mg needs for superv1s1011 and contmumg educat10n of these m1dw1ves

With technical assistance from the American College ofNurse M1dw1ves (ACNM) through the MotherCare II Project, the MOH has taken respons1b1hty for conductmg a competency-based m serv1ce education program to remforce essential m1dw1fery skills for m1dw1ves m three districts m South Kahmantan To reduce the burden on the MOH system, a system of Peer Review and Contmumg Educat10n was developed and 1s bemg managed by IBI Under the Peer Review system trained m1dw1ves are v1S1ted twice a year by m1dw1ves tramed to carry out peer reviews accordmg to a checklist Specifically, m1dw1ves check registers and conduct observations 1f possible of more frequent skills, such as use of the partograph, antenatal screenmg, mfect1on control, and newborn resusc1tat10n IBI uses the mformat1on obtamed through the peer review process to 1dent1fy topics for contmumg educat10n sessions provided durmg thetr regular chapter meetmgs of members

The technical assistance provided by ACNM has supported IBI to assume respons1b1hty for the cl1111cal competency of its members The peer review process gives JBI an opportunity to provide a supervisory structure for its members ma supportive and collegial atmosphere Tins process allows m1dw1ves to evaluate the m1dw1fery practice of other m1dw1ves based upon standards defined by the professional organization When defic1enc1es are 1dent1fied, mechanisms can be put mto place to address these gaps, whether at an md1v1dual m1dw1fe level (e g on-the-spot trammg) or at a group level ( e g 111-serv1ce session at an IBI chapter meetmg)

21 Box 2 From Research to Action The Development of an IEC Campaign m South Kahmantan, Indonesia

MotherCare's work m South Kalimantan, Indonesia illustrates the process of developmg and 1mplementmg a community-based mformat10n, educat10n, commumcat1on and counseling (IEC/C) behavior change campaign The aims of the campaign are to improve awareness of obstetric and newborn complicat1ons w1thm commumt1es, and to mcrease utihzatlon and quality of routme and essential care durmg pregnancy, delivery and the postpartum penod

Tl11S process entails several steps, starting with assessment and reporting of findings determining desired outcome or change, then developmg and 1mplementmg a strategy, and finally momtormg and evaluatmg the process and impact

A commumty d1agnos1s was earned out m South Kahmantan m the sprmg of 1996 to learn about community reproductive health beliefs, values, and behaviors, the process of dec1dmg to seek care for pregnancy-related and neonatal complications, and barners to usmg preventive and essential health services Usmg the pathway to survival, MotherCare analyzed the findmgs of the community diagnosis to 1dent1fy barners to recognition, dec1s10n-makmg to seek care, and log1st1cs to reach quality care This analysts, m turn, fed mto the development of a relevant IEC/C strategy and monitormg and evaluation plan

For example, m the Commumty D1agnos1s, MotherCare found that women generally consider pregnancy to be a natural phenomenon not reqmrmg special attent10n, and that women tend to mamtam a normal workload durmg pregnancy Moreover, the research showed that women are not aware of the signs of mfect1on nor of their potential seventy MotherCare then 1dent1fied desired outcomes or changes that would help to improve the survival and health outcomes for women and their newborns For example, some desired changes would be for women to take extra care of themselves durmg pregnancy, reduce their workloads, and avoid overexertion, and for women and fam1ltes to recognize key danger signs such as bleedmg, fever, convulsions and swellmg of face and hands MotherCare used these research findings and desired outcomes to mform the IEC/C strategy 111 Indonesia For example, to address these particular issues of problem recognit10n, two different flyers were developed - one for husbands and one for pregnant women/fam1ltes - with messages about pregnancy bemg a special time when women should not overexert and adv1smg fam1hes to recognize bleedmg as a sign of comphcat10n These flyers currently are bemg distributed to women durmg prenatal v1s1ts, and to couples durmg marnage reg1strat1on MotherCare will carry out a post survey assessment to determme, among other md1cators, the percent of women and family members able to recognize signs of complications By comparmg this post-survey to the baselme, MotherCare hopes to show that these materials can help women and fam1hes to change their behaviors

MotherCare's commumty-based research has provided critical mformat1on useful for des1gnmg JEC/C materials By relatmg strategies to research quest10ns, program planners can assure that materials address, m an acceptable manner, the issues 1dent1fied w1thm the community

22 Box 3 Introducmg Famdy-Centered Matermtv Care (FCMC) m Moldova

With the d1ssolut1on of the Soviet Umon, the newly mdependent states have been strugglmg with updatmg thetr health care systems The Soviet svstem functioned with httle mput from women or thetr fam1hes and was cut off from the advances made by the West over the last 30-40 years The Soviets downplayed the importance of m1dw1ves and other non-physicians providers and mstead emphasized phys1c1an educat10n In 1996 Moldova requested assistance to re-format and update their maternal and newborn health care system

111 response to this-request, the Amen can College of Nurse M1dw1ves (ACNM), through the MotherCare/JSI Project (MC), has provided technical assistance to Moldova to mtroduce a more famtly-centered approach m mtrapartum and postpartum care and to mtroduce appropnate use of technology Family-Centered Matermty Care (FCMC) emphasizes education and preparation for ch1ldb1rth to enable the pregnant woman to take a knowledgeable and active role m promotmg her own health and that of her baby It encourages mvolvement of the pregnant woman's family members or other persons of her choice m her care and preparat10n for ch1ldb1rth and motherhood, and 111v1tes thetr supportive presence durmg labor and birth It focuses on enhancmg and supportmg the normal birth process, screenmg for dev1at1ons from normal birth and mtervenmg only when those deviations occur Such an approach avoids unnecessary use of mvas1ve, uncomfortable and/or restr1ct1ve procedures FCMC provides for skm-10-skm contact between mother anc1 newborn 1mmed1ately after birth mm1mal separation of mother and mfant and early m1t1at1on ofbreastfeedmg It also promotes roommg-m and other practices which fac1htate breastfeedmg and encourages contact between the newborn and other family members

ACNM/MC conducted quahtat1ve research among pregnant and newly dehvered woman, their husbands, and health care providers to obtam their opm1ons about the care they received 111 pregnancy and birth under the old system This mformatlon was mcorporated mto the adaptation for Moldova of a competency-based FCMC curnculum developed by ACNM/MC for Ukrame ACNM/MC obstetncian-m1dw1fe consultants served as master tramers ma tram mg of tramers (TOT) course and role modeled collaborative management The trammg mcluded one week of theoretical mformat1on and a second week of supervised clm1cal expenence The clm1cal week mcluded 24-hour coverage so that a woman commg to the maternity and choosmg FCMC would be provided care throughout her labor and delivery UNICEF/Moldova will support the trammg of providers by these tramers

The FCMC TOT was the first mterd1sc1plmary tram mg m Moldova m recent years with obstetnc1ans, neonatolog1sts and m1dw1ves workmg together durmg the two week penod MC partnered with UNICEF/Moldova to support the trammg of providers at four trammg sites An evaluation process of the 1mplementat1on ofFCMC has been developed and data should be available by June 1998

23 Box 4 Expansion of Family-Centered Matermty Care m Ukrame

MotherCare/JSI (MC) with technical assistance from the American College of Nurse M1dw1ves (ACNM) mtroduced family-centered maternity care (FCMC) to two sites m Ukrame (Donetsk and Odessa) m May 1996 An advanced course to remforce FCMC and to address the management of comphcations w1thm an FCMC philosophy m these two sites plus a basic course for two add1t10nal sites are planned for early 1998

The purpose ofth1s program ts to promote a more part1c1patory and less mterventlomst type of maternity care MotherCare has estabhshed tram mg sites and conducted tram mg of trainers (TOT) us mg a competency-based cumculum for m1dw1ves and phys1c1ans Implementat10n of FCMC at the tram mg sites and further trammg of providers are the respons1b1hty of the tramers and a technical workmg group estabhshed at each site

The "basic" FCMC courses mclude one week of theoretical mformat1on plus a second week for clm1cal experience The clinical week mcludes 24-hour coverage and provides collaborative management by m1dw1fe/obstetnctan teams for any woman who comes to the maternity choosing family centered care In September 1997, a v1s1t was made to assess the 1mplementat10n of FCMC at the two trammg sites m Donetsk and Odessa, to 1dent1fy content for an "advanced" course for these sites, and to plan for the mtroduct1on of FCMC mto two more sites m Lv1v and the Crimea

Based upon the findmgs from the v1s1t, FCMC has been implemented at the two trammg sites m Donetsk and Odessa, but more fully m Odessa Enforcement of sanitary regulations has been a maJor obstacle m the 1mplementat1on of FCMC Despite some d1fficult1es, anecdotal evidence md1cates pos1t1ve changes are happenmg Unfortunately, the monitormg system for FCMC (1 e, % of mothers who breastfeed m the delivery room, % of Cesarean sect10ns, % of labors that are mduced, etc ) at these sites has not yet been implemented, but MotherCare 1s currently m the process of settmg 1t up Once this system 1s m place, data will be collected and should be available by June 1998

24 12/15/97

MOTHERCARE II SUMMARY OF EXPENDITURES FOR MOTHERCARE CONTRACT (CORE & "Q")

Balance of Balance of Ce1hng Obhgat1ons Expenditures I Obligated Ce1hng Funds

I I !Core Contract $20 986 840 $19 311 281 $12 253 853 I $7 057 4281 $8 732 987 I

IRequirements

I '1) DO #1 -WID - Malawi $210 92J $210 924 $83 175 $127 749 $127 749 b) DO #2 - Guatemala (CLOSED) $50 000 $50 000 $45 508 $4 4921 $4492 13) DO #3 - Guatemala (CLOSED) $499 934 $499 934 $499,337 $597 $597

4) DO #4 - Bohv1a $2 587 574 $2 415 000 $1 796 534 $618 466 $791 040 I

5) DO #5 - Indonesia $5 251 402 $5 251,402 $2 579 915 $2 671 487 i $2 671 487 I 16) DO #6 - Russia $200 000 $200 000 $138,557 $61 443 $61 443: :7) DO #7 - Pakistan $1 000 000 $1 000 000 $449,331 $550 669 $550 6691 1 18) DO #9 - Ukraine $99,729 $99 729 $99 399 $330 $330 19) DO #10 - Egypt $2 107 953 $2, 107 953 $587 357 $1 520 596 $1 520 596 110) DO #11 - Moldova $298 796 $298 796 $53 058 $245 7381 $245 738 i

11) DO #12 - Africa lrnt1at1ves $155 882 $155 882 $0 $155 882 I $155 8821 12) DO #13 - LAC I rnt1at1ves $450 000 $450 000 $0 $450 ooo I $450 ooo I 113) D0#801-Ukrame $436 4971 $436 497 $413 $436 084 $436 084 I I

EXPSUMWK4 25 MOTHERCARE WORKPLAN FOR YEAR 5

Act1V1ty Country Completion Responsible Resources Party (Core or DO) Q Q Q Q c 1 2 3 4 c Po hey Cost Studies Indonesia x x x x ZH, with PHR DO - Indonesia :p (#231 *) CD Bolivia (#31, x CC, C L1ssner DO- Bolivia .....-ct 32,33) K Capra Core 0 Guatemala x CC, E Bocalett1 FS - Guatemala ms= (#70) FHI Agreements with 18 mun1c1paht1es m Boltv1a x RP DO - Bolivia ltj 5 MotherCare d1stncts regardmg '3 IEC/C strategy 1mplementat1on _Q t1) Presentat10ns of research results for Egypt x R Gipson, CC DO- Egypt pohcy makers and rep officials (MOHP, USAID, and others) ...... tit D1ssemmat10n Semmars - study Indonesia x x E Achad1, ZH DO - Indonesia 6 findmgs and strategy developmg, ~ momtormg and evaluat10n data

Guatemala x E Bocalett1, FS - Guatemala CC,PD Bohv1a x MCI Bohv1a, CC DO- Bolivia Afnca x MMc,CC DO-Afnca Imtiat1ve Initiative Team Core LAC Intiative x MMc,CC DO-LAC lmtiat1ve Team

Russia x SEA TS, MC, CC DO - Russia

N Qt =Quarter I Q2 =Quarter 2 Q3 =Quarter 3 Q4 =Quarter 4 CC= Completion Contract .....i * Numbers m parentheses ltnk act1v1ty to a correspondmg product number See Appendix I 0 for complete list of MotherCare products Activity Country Completmn Responsible Resources Party (Core or DO) Q Q Q Q c 1 2 3 4 c Po hey D1ssemmat10n Seminars - cont - - cont - Presentation of CD research to Egypt x R Gipson, CC DO- Egypt pohcymakers, Rep Officials Meetings for MOH personnel to Guatemala x RP, E Hurtado, FS - Guatemala disseminate study findings, IEC cc matenals, etc Bolivia x G Seoane, DO - Bolivia V Kaune, CC D1ssemmat1on Seminars on Indonesia x LE, Endang DO - Indonesia Anemia Results Achad1 Bohvia x LE, ED, (CC) DO- Bohv1a India x LE,AP Core MN Malawi x LE, LSHTM, Core MN Project HOPE Honduras x ED (LE), (CC) FS - Honduras (breastfeed mg evaluation)

N oo QI =Quarter I Q2 =Quarter 2 Q3 =Quarter 3 Q4 =Quarter 4 CC= Completmn Contract

* Numbers m parentheses lmk act1v1ty to a correspond mg product number See Appendix I 0 for complete hst of MotherCare product~ DO)

Bohv1a Egypt Indonesia Indonesia Indonesia Egypt

Egypt Bolivia product~

Honduras

- - -

Resources

(Core

DO DO-

DO- DO- DO DO FS DO-

DO-

Contract

MotherCare

LZ,

list

CC,

Completion

Kaune,

Oldham

Party

Rivera

SPAAC, AP,CC, SPAAC,

V V

SPAAC NN, L

AP,

Grybosk1,

Responsible

CC=

Marsaban

RP,

RP, and Ada RP, and

PATH/AH K RP, RP,NN, cc RP, J and RP, Ada J cc

NN,LZ

complete

for

x x

c c

Appendix

Completmn

=Quarter

See

x x x

x x

x x x x

12)

number

(#72)

(#50)

Country

product

Egypt

Honduras Bolivia(#

Indonesia

Indonesia Indonesia (#86) Egypt

Honduras

(#86) (#86) Bohv1a

=Quarter

corresponding

Diagnosis

D1agnos1s

Results

act1v1ty

Results

Commumty

Activity

lmk

=Quarter

Commumty

Report

parentheses

Analysis m

research Conduct

Re-analysis

Fmal

results

Numbers

=Quarter

Behavior

Change

1-V '° DO)

Indonesia

Egypt Indonesia

Egypt

Indonesia Pakistan

Bolivia

product~

Honduras

Guatemala

Resources

(Core

DO-

DO DO

DO- DO

DO- DO-

Contract

MotherCare

LZ,

hst

Completwn

Hurtado,

Oldham,

Party

Gunawan

NN,

Kaune,CC

Kaune,

Z1z1c,

Responsible

CC=

RP,

PATH/AH

RP,

RP,AP

RP,NN, L RP,NN,JH,

V RP,CC

cc RP, ZH

AH,

complete

for

Appendix

x x x

Completmn

=Quarter

See

Done

x x

x x x x

x x x

Q Q

number

(#13,

#114)

Country

product

Egypt

Honduras

Indonesia

Bolivia (#184)

Bohv1a

Egypt

#15)

Pakistan

(#186)

Guatemala

#15) (#111, Indonesia

(#64)

=Quarter

Safe

correspondmg

community

Motherhood

Safe

puskesmas

act1v1ty

mcludmg

for

Activity

Development

hnk

component

=Quarter

HSS

Strategy

Materials,

Workshop

parentheses

IEC

Motherhood

involvement

Implementat10n IEC

IEC

doctors

Numbers

=Quarter

cont

Behavmr

Change

)

.... DO)

LAC Bolivia

Bolivia

Indonesia

products

Guatemala

Honduras

Guatemala

Resources

(Core

DO-

DO-LAC

DO-

Contract

MotherCare

CC,

team

list

Completion

LAC

MMe,

Party

lmtiattve

Imtiat1ve

(CC)

(OMNI)

Kaune,

Hurtado,

Responsible

ED,

ED,LE

E ED

LAC

LAC ED

Imhat1ve

team,

V team, MMe,

complete

for

x x x

x x

x 3 x

Appendix

x x

Quarter

Completmn

See

number

Country

product

Bolivia

Honduras

Guatemala

reg1strat1on)

(marriage Bolivia

Ecuador

Indonesia Honduras

based

facility-based

Guatemala

community-

Quarter

correspondmg

act1v1tles

Anemia

services

act1v1ty

Activity

health

lmk

Quarter Mob11tzat1on

Development

with

parentheses

linkages

Materials Community

Numbers

Quarter

cont-

Behavior

Change

1.JJ

DO) DO)

or or

products products

Indonesta Indonesta

Bohvia Bohvia

Bohv1a Bohv1a

Honduras Honduras

Resources Resources

(Core (Core

DO DO

FS FS

DO-

DO DO

Contract Contract

MotherCare MotherCare

of of

hst hst

(CC) (CC)

Completion Completion

= =

Party Party

ED, ED,

CC CC

Responsible Responsible

LE LE

complete complete

ED,CC ED,CC

ED ED

LE, LE,

for for

c c

0 0

I I

4 4

Q Q

4 4

x x x

3 3

Q Q

Appendix Appendix

x x x x

x x

x x x x

x x

2 2

Quarter Quarter

Q Q

Completion Completion

= =

See See

1 1

x x

Q Q

Q4 Q4

number number

report report

3 3

Country Country

product product

Honduras Honduras

registration) registration)

Bohv1a Bohv1a

Indonesia Indonesia

fac1hty fac1hty

(final (final

(marnage (marnage

community community

#204) #204)

Quarter Quarter

= =

Q3 Q3

IEC IEC

corresponding corresponding a

to to

2 2

Anemia Anemia

activity activity

of of

Activity Activity

lmk lmk

Quarter Quarter

= =

Q2 Q2

parentheses parentheses

m m

Materials Materials

Implementat10n Implementat10n

I I

Numbers Numbers

Quarter Quarter

= =

* *

QI QI

cont cont

~ ~

Behavmr Behavmr

Change Change - DO)

Ukrame

Boltvta Russia

Boltvta

Boltvta Egypt Egypt

product~

Honduras

Resources

(Core

DO-

DO DO-

DO-

Contract

MotherCare

JMc

AP,

hst

Completion

Coles

Party

CC RP,

Egypt,

Ugalde,

Ugalde

Be1tnshv1lt,

Blanco,

Glatle1der

CC=

Responsible

Mercer

JMc, S L

J M MC/

JMc,

Consultant

CC,

complete

for

c c

3 x

Q Q

Appendix

2 x

x x

Completion

=Quarter

See

Q Q

mg)

number

(#35)

(#120)

for

(#45)

#47)

Country

Basic

Advanced

(#123)

(#124)

product

•

• Ukrame

Umvers1ty)

(FCMC)

Bolrvra manual

Honduras (Medical

trainer's

(neonatal

#16) curnculum) (Superv1S1on Russia

Bohvra

TBA section Egypt

(breastfeed

Egypt (maternal

syphtlts)

(#46,

=Quarter

corresponding

obstetric

for

act1v1ty

Activity

hnk

care

=Quarter

IPC/C

Curricula

development

newborn

parentheses

mcludmg

Trammg

Protocol

and

Numbers

=Quarter

Service

Dehvery

t,~ DO)

Egypt

Bohv1a

Indonesia Indonesia Indonesia

Indonesia

Indonesia products

Honduras

Guatemala

- -

Resources

(Core

DO- DO FS

DO-

Contract

MotherCare

JMc,

Coles

hst

Completion

JMc,

Party

RP,

Goldman

Tom

Beck

Beck, Beck

Achad1

Responsible

CC=

D E

Consultant,

Consultant, E

Consultant, E MOH/Kanw1l, D

AH CC,

Consultant

Ahcia,

ED JMc,

JMc,

complete

for

x 3

Appendix

x x

Q Q Q

Completion

=Quarter

See

number

(#38)

for

tramers)

Country

product

Indonesia

(#80) Honduras

Indonesia

Indonesia Egypt section

Bolivia

TBA (neonatal

(#202) Guatemala

(community anemia)

=Quarter

m 6

corresponding

Hospital

puskesmas

Martapura

puskesmas

desas

for

and

from

mm1-LSS

act1v1ty

Kem1haan

for

IPC/C)

btdan

Activity

hospital

b1dans

lmk

Bud1

=Quarter

for

development

providers

(mcludmg

preparatton

Jakarta

parentheses

Protocol

level

Hospital m

Trammg

Site

Trammg

dtstncts workshop

TOT

Numbers

=Quarter

cont

Dehvery

- Service

DO) DO)

or or

products products

Indonesia Indonesia

Bohvta Bohvta

Bolivia Bolivia

Moldova Moldova

Bohvta Bohvta

Ukrame Ukrame

Guatemala Guatemala

Resources Resources

(Core (Core

FS FS

NIA NIA

DO-

DO DO

NIA NIA

DO-

Contract Contract

MotherCare MotherCare

of of

JMc, JMc,

CC CC

JMc, JMc,

h'lt h'lt

Completion Completion

Party Party

(CC) (CC)

CC CC

Ugalde, Ugalde,

CC= CC=

Blanco, Blanco,

Glatle1der Glatle1der

Glatletder Glatletder

Mercer, Mercer,

Responsible Responsible

Mercer Mercer

(CC) (CC)

J J

JMc JMc

MC/Guatemala, MC/Guatemala,

complete complete

JMc, JMc,

MCllndones1a, MCllndones1a,

JMc, JMc,

MC/Bohvta, MC/Bohvta,

S S

M M

P P

M M

P P

JMc JMc

cc cc

J J

cc cc

JMc, JMc,

J J

JMc, JMc,

for for

c c

0 0

I I

x x

4 4

x x

3 3

Q Q Q

Appendix Appendix

x x

2 2

Completion Completion

=Quarter =Quarter

See See

x x

1 1

x x

Q Q Q

Q4 Q4

number number

(#8) (#8)

and and

FCMC) FCMC)

3 3

Country Country

119) 119)

product product

Indonesia Indonesia

Bohvm Bohvm Moldova Moldova

Bohvta Bohvta

Ukrame Ukrame

faculty) faculty)

Moldova Moldova

FCMC)(#l23, FCMC)(#l23,

Ukrame Ukrame

(Syphths (Syphths

Guatemala Guatemala

Boltvta Boltvta

Boltvm Boltvm

(Baste (Baste

(Medical (Medical

(Basic (Basic #124) #124)

Advanced Advanced Control)(#35) Control)(#35)

(# (#

(#16) (#16)

(Superv1s1on) (Superv1s1on)

mg mg

=Quarter =Quarter

Q3 Q3

correspond correspond

a a

to to

2 2

trammg trammg

act1v1ty act1v1ty

of of

Act1V1ty Act1V1ty

lmk lmk

tramees tramees

=Quarter =Quarter

IPCIC IPCIC

of of

Q2 Q2

mg mg

parentheses parentheses

m m

mcludmg mcludmg

lmplementat10n lmplementat10n

Tram Tram

1 1

Numbers Numbers

=Quarter =Quarter

* *

QI QI

cont cont

Service Service

Delivery Delivery

w w v. v.

DO) DO)

or or

DO-

product5 product5

Russia Russia

Resources Resources

(Core (Core

Core Core Indonesia? Indonesia?

DO DO

Core, Core,

Core Core

Contract Contract

MotherCare MotherCare

of of

hst hst

Completion Completion

= =

Party Party

CC CC

Responsible Responsible

MSH MSH

ACNM ACNM

Be1tnshv1h Be1tnshv1h

ACNM,DB ACNM,DB

complete complete

CC,L CC,L

for for

c c

0 0

I I

4 4

x x

4 4

3 3

Appendix Appendix

x x

2 2

Quarter Quarter

Q Q Q Q

Completmn Completmn

== ==

See See

1 1

x x

Q Q

Q4 Q4

number number

3 3

Country Country

product product

Russia Russia

Quarter Quarter

= =

Q3 Q3

manual manual

corresponding corresponding

a a

delivery delivery

to to

2 2

+trainers +trainers

service service

act1v1ty act1v1ty

commod1t1es commod1t1es

#167) #167)

use use

Activity Activity

lmk lmk

SM SM

Quarter Quarter

(#81, (#81,

edttlon edttlon

= =

of of

improve improve

Q2 Q2

3rd 3rd

to to

universal universal

HM/HN HM/HN

LSS LSS

(#166) (#166)

costing costing

parentheses parentheses

m m

Tools Tools

• •

with with

I I

Numbers Numbers

Quarter Quarter

= =

* *

QI QI

cont-

Service Service

Delivery Delivery

C...J C...J 0\ 0\ Activity Country Completion Responsible Resources Party (Core or DO) Q Q Q Q c 1 2 3 4 c Momtormg and Baselme Survey Report (mcludmg Indonesia x x T Marshall, RE, DO - l ndonesra Evaluation anemia) (#84) ZH

Bohvia x x ZH, RE,CC DO - Bolivia (commumty health estabhshment baselme) (#20)

Guatemala x LE, ED, CC FS - Guatemala (#208)

Egypt x x x x SPAAC,ZH DO- Egypt (SPAAC SA and CD) (#50)

Momtormg and Evaluat10n INDONESIA

• anemia x x x x LE DO - Indonesia • IEC (#206) x x x x x RP, L ZlZlc, NN DO - Indonesia AP, Field staff

• Hospital x x x x x C Ronsmans, DO - Indonesia Registers JMc, ZH Report (#89)

• IPC/C x x x x x DO - Indonesia Morntormg

• BdD x x x x x D Beck, JMc DO - l ndonesra Register

(.,J -..i QI =Quarter 1 Q2 =Quarter 2 Q3 =Quarter 3 Q4 =Quarter 4 CC= Completion Contract * Numbers m parentheses lmk act1v1ty to a corresponding product number See Appendix I 0 for complete list of MotherCare products DO)

Indonesia

Bolivia

products

Honduras

Guatemala

- -

Resources

(Core

DO-

DO- FS FS

FS FS

Contract

MotherCare

NN,

hst

=Completion

Party

Consultant

(LE),

VK,

Wirth,

Espeut

Achad1,

Bocalett1

Hurtado

Bocalett1

Goldman,

Bailey

Responsible

M E D

LE,ED

ED,

RP,

JMc, E RP ED

E JMc,GG P

JMc,

complete

for

x x

Appendix

x x x

Quarter

Completion

See

x x 1 2

x x

number

Audit

mg/

(#200)

Country

MPA

IPC/C

IEC

anemia climcal

Aux1hary

IEC

tram Curriculum register Nurse

chmcal

Hospitals report

anemia tram

TBA

anemia

product

•

BOLIVIA

• •

•

GUATEMALA •

•

• HONDURAS •

•

Quarter

a correspond

acttv1ty

Evaluat10n

Activity

lmk

and

=Quarter

parentheses

cont

Momtonng

and

Numbers

=Quarter

Momtormg Evaluatmn

-cont

00 ActIV1ty Country Completmn Responsible Resources Party (Core or DO) Q Q Q Q c 1 2 3 4 c OTHER COUNTRIES

Malawi x x x LE, LSHTM, C01e MN (anemia only) Project HOPE

India x x x x LE,AP Core MN Momtormg and Evaluation ofTrammg Zambia x F Ganges, JMc Core Evaluatmn - cont - Boltv1a x x JMc, G Gilson DO- Boltv1a Indonesia x JMc, S Miller, DO - Indonesia DB

plus post-partum program Guatemala x JMc, G Gilson FS - Guatemala Moldova x J Mercer, JMc DO- Moldova Ukrame x P Glatle1der, DO- Ukrame JMc

Monitoring and Evaluation Indonesia x ZH,MK,NN, Core and DOs Workshop D Espeut Boltv1a x Guatemala x Health Information Momtormg with Boltv1a x x x x A Cortmo1s, DO- Boltv1a extra monthly report R Egmluz

vJ '° Q 1 =Quarter 1 Q2 =Quarter 2 Q3 = Quarter 3 Q4 =Quarter 4 CC = Completion Contract * Numbers m parentheses lmk act1v1ty to a corresponding product number t;ee Appendix 10 for complete IJ5t of MotherCare product<> Achv1ty Country Completmn Responsible Resources Party (Core or DO) Q Q Q Q c 1 2 3 4 c Apphed Fmal Reports received Peru (3) x x ED App Res funds Research (#132, #133) Uganda x x Core (#145, #146) Indonesia x Core (#127) Z1bunta x LE App Res funds (Indonesia) Ghana (#143) x JMc, Pl (IPAS) Core I Thailand x JMc, PI (WHO) Core (#144) Perinatal Study Egypt (#52) x x R Langsten, ZH DO -Egypt Honduras x x RP FS - Honduras (#103, #104, #105) Guatemala x x E Bocalett1, FS- Guatemala (#71) JMc, BASICS

+:>.. o QI= Quarter I Q2 =Quarter 2 Q3 =Quarter 3 Q4 =Quarter 4 CC= Complet10n Contract * Numbers m parentheses lmk act1v1ty to a correspondmg product number See Appendix I 0 for complete hst of MotherCare products

DO) DO)

or or

product<> product<>

MN MN

are are

ResourcEs ResourcEs

(Core (Core

Core Core

contract contract

Complet1onl Complet1onl

Core Core

Contract Contract

Mother( Mother(

of of

ZH ZH

hst hst

Completion Completion

Espeut Espeut

Hurtado Hurtado

Lynch Lynch

Party Party

D D

E E

S S

Espeut, Espeut,

CC= CC=

Responsible Responsible

D D

complete complete

D D

ZH, ZH,

ED,LE ED,LE

ZH ZH

ED,LE ED,LE

JMc JMc

ED, ED,

LE LE

LE,RG LE,RG

LE, LE,

for for

x x

x x x x

c c

0 0

I I

x x x

x x

4 4

x x

3 3

Appendix Appendix

x x x x

x x x x x

x x

Completion Completion

=Quarter =Quarter

See See

1 1 2

Q Q Q Q Q

Q4 Q4

number number

3 3

Country Country

product product

=Quarter =Quarter

on on

Q3 Q3

at at

corresponding corresponding

a a

of of

perinatal perinatal

(#142) (#142)

#139) #139)

SM SM

to to

Pregnancy Pregnancy

and and

Control Control

managers managers

of of

m m

(complet10n (complet10n

2 2

(#134, (#134,

Quahtat1ve Quahtat1ve

qual qual

act!Vlty act!Vlty

152) 152)

( (

7) 7)

of of

(2) (2)

Anemia Anemia

13 13

conducting conducting

companson companson

program program

Acttv1ty Acttv1ty

lmk lmk

(#211) (#211)

(#210) (#210)

( # # (

on on

ofTrammg ofTrammg

=Quarter =Quarter

for for

Anthropometry Anthropometry

studies studies

(#135) (#135)

study(# study(#

Expenences Expenences

data data

Papers Papers

Q2 Q2

level level

(#134) (#134)

Paper Paper

)(#225) )(#225)

Overview Overview

Supplementation Supplementation

tor tor

parentheses parentheses

m m

mortality mortality

Handbook Handbook

Guidebook Guidebook

momtormg/evaluatlon momtormg/evaluatlon

baselme baselme

d1stnct d1stnct

quant quant

Program Program Women's Women's

permatal permatal

Cross-country Cross-country

Pal Pal

Evaluation Evaluation

Cross-country Cross-country

paper) paper)

Research Research

LAC LAC

Anemia Anemia Cross-Country Cross-Country

Iron Iron

Papers Papers

(#141) (#141)

I I

Numbers Numbers

=Quarter =Quarter

* *

QI QI

Leadership Leadership

Techmcal Techmcal

~ ~ - Act1V1ty Country Completion Responsible Resources Party (Core or DO) Q Q Q Q c 1 2 3 4 c Techmcal Papers - cont - Leadership - cont - Methodological cnt1que of x x D Espeut, ZH Core MotherCare II diagnostics (# 159) Russia qualitative research paper x AP, SEATS DO- Russia (?) workmg paper on FGD results m Russia (#122) 5 country paper on Community x x NN,RP, Core Diagnosis results (# 155) C Baume

Community Diagnosis Package x x x x C Baume, Core (#156) NN,AP, RP IEC Materials Compendmm (#188) x x x RP,JH Core From Research to Action (IEC) x x JH, NN, RP Core Poster Presentation (Sn Lanka and NCIH) (#163)

Assumptions of a Reproductive x x NN,MK Core Health Agenda (IUSSP presentat1on/IFPP Journal subm1ss10n) (#161)

Models paper (#160) x MK,JH,O Core Campbell

Opmion paper (#162) x MK Core Maternal Mortality Secondary Egypt x x 0 Campbell DO - Egypt Analysis paper (#228) R Gipson

Permatal/Neonatal Mortality Study Egypt x Consultant, CC DO - Egypt (#5 l)

~ Ql =Quarter l Q2 =Quarter 2 Q3 =Quarter 3 Q4 =Quarter 4 CC= Completion Contract N * Numbers m parentheses lmk act1v1ty to a corresponding product number See Appendix I 0 for complete list of MotherCare products Act1v1ty Country Completion Responsible Resources Party (Core or DO) Q Q Q Q c 1 2 3 4 c Tech meal Papers - cont - Leadership - cont - TBA trammg and Evaluation paper Guatemala x E Hurtado FS - Guatemala (#65)

TBA trammg and hospital referral Guatemala x P Batley FS - Guatemala (#229)

Monitoring System m Guatemala Guatemala x E Hurtado FS - Guatemala (#68) P Batley MC/Guatemala

Quahtat1ve Research and tts Guatemala x P Bailey FS - Guatemala apphcatton (#74) E Hurtado MC/Guatemala

Women's Group Methodology and Guatemala x E Hurtado, CC FS - Guatemala Results (#72)

STD papers (2 papers)(#34) Bohvta x S Blanco DO - Bohv1a and K Southwick Core

Vahdatton Study paper (#27) Bolivia x K O'Rourke DO- Bohv1a Cost Studies (3 papers) Bolivia x x K Capra DO - Bohv1a and (#31, #32, #33) C L1ssner Core

Paper Quahtat1ve Research to Bolivia x x V Kaune, JH, DO- Bohvta Results (IEC m Bolivia) (#17) RP,NN

Municipal Bulletms (#226) Bohv1a x x G Seoane DO- Bohv1a Intent Study of Radio Soap Opera Bolt via x CC, V Kaune DO- Boltv1a (#18)

Rationale for Use of Drugs m Bolt via x MC/ Boltv1a, CC DO- Boltv1a Maternal Health Care (#227)

..i:. vJ QI =Quarter I Q2 =Quarter 2 Q3 =Quarter 3 Q4 =Quarter 4 CC = Completron Contract * Numbers m parentheses lmk act1v1ty to a correspond mg product number See Appendix I 0 for complete list of Mother Care product'> DO)

Indonesia

Resources

(Core

Core

Core Core

Core

Core Core

Contract

JH,

Completmn

Party

RP,

PHR

AP,

Zazn,

O'Reilly

Bentley

Cohen, Be1tnshv1h,

Responsible

Glatle1der

S A

P LE, Kan

ZH,

AP ZH

LSHTM,

AP,LE

NN, JH,ZH CC,

4 x

x x

Quarter

Completion

Q Q

Country

Indonesia

India India

Quarter

196)

197)

(#92)

of Hospitals

(#23

180)

Age

Anemia

Three

Research

Control

Women

Study

Attending

Indonesia

cross-site

Assessment(#

1mplementat10n

1mplementat1on

Activity

Age

Control

Matters

(#193)

Quarter

D1agnos1s

among

Anemia

Climes

Reproductive

paper

for

Quahtat1ve

Quahtattve

(#128)

Effectiveness

Kahmantan,

Strategy

RTls/STDs Reproductive

Outpatient

Cost

Anemia (#109) process/program Overview

Anemia

Overview Strategies

(#110) process/program Women Malawi

MotherCare Adolescent

lnd1a/Bangladesh

Community

NIS

Quarter

cont

Techmcal Leadership

.j::>.

.j::>. Act1V1ty Country Completion Responsible Resources Party (Core or DO) Q Q Q Q c 1 2 3 4 c

Tech meal Meetmgs Leadership - cont - Asia Regional Anemia Control x AP, LE Core MN Breastfeedmg Evaluat10n x ED,LE FS - Honduras D1ssemmat10n (Honduras)

Regional presentations of Honduras x RP,AP FS - Honduras Community D1agnos1s results Egypt x RP, L Oldham DO- Egypt

NCIH (5 abstracts submitted) x D Beck Core J Mercer P Glatletder NN,JH

"""Vl QI= Quarter I Q2 =Quarter 2 Q3 =Quarter 3 Q4 =Quarter 4 CC= Completion Contract * Numbers m parentheses lmk act1v1ty to a corresponding product number See Appendix I 0 for complete hst of MotherCare products DO)

Indonesia

nrr~11rl<

Bohv1a

- -

Resources

(Core

DO DO

Contract

nP.ufnthpr(

Completion

Party

Responsible

CC=

ZH ZH cc

romnfPtP

for

c c

x x

x 3

Aooe-ndfY

2 x

Q Q Q

Completion

=Quarter

1 See

x x

number

Country

oroduct

Indonesia

Bohvta

=Quarter

use

correspondmg

and

act1v1ty

analysis

Activity

lmk

=Quarter

Meetmgs

mformatlon

Workshop

Meetmgs

parentheses

Meetmgs

PKK

District

CAT HMIS

Numbers

=Quarter

meal

cont

Tech

..i::.. Leadership

°' Appendix 1 Delivery Order Financial Summary

47 MOTHERCARE II

SUMMAR'LOF DJ;.LJ\l_l'IBYOROEBS_AS__QE_9L30/97_

- - - ~----~------DO# - -- Amount-- - Expenditure Balance ----- Countrv Ce1hnci O~l!gate_!__ _ Thru 9/30/97 As of 9/30/97 Start Date End Date -~Summary____ Notes

1) WID MALAWI 210 924 00 210 924 00 83 174 78 127 749 22 09/30/93 05/31/98 Anemia Study thru LSHTM 2) GUATEMALA CLOSED 50 000 00 50 000 00 45 507 62 4 492 38 09/30/93 04/30/94 Completed 3) GUATEMALA CLOSED 499 934 00 499 934 00 499 337 37 596 63 09/14/94 03/31/97 Completed 4) BOLIVIA 2 587 574 00 2 415 000 00 1796534 34 618 465 66 09/27/94 06/30/98 Long Term Country Program 5) IN DON ES IA 5 25140200 5 25140200 2 579 914 60 2 67148740 09/30/94 09/29/98 Long Term Country Program 6) RUSSIA 200 000 00 200 000 00 138 557 07 61 442 93 09/28/95 08/29/98 Short Term TA to two Oblasts 7) PAKISTAN 1000000 00 1000000 00 449 331 05 550 668 95 09/25/95 09/30/98 Long Term Country Program 9) UKRAINE 99 729 00 99 729 00 99 399 36 329 64 09/29/95 09/30/96 Short Term TA to two Oblasts 10) EGYPT 2 107 953 00 2 107 953 00 587 357 02 1 520 595 98 09/29/96 09/28/98 Long Term Country Program 11) MOLDOVA 298 796 00 298 796 00 53 057 94 245 738 06 09/30/96 09/30/98 Short Term TA four trg sites 12) AFRICA INITIATIVES 155 882 00 155 882 00 0 00 155 882 00 09/01/97 09/29/98 Short Term TA to Uganda Malawi and Ghana 13) LAC INITIATIVES 450 000 00 450 000 00 0 00 450 000 00 09/30/97 09/30/98 Short Term TA to Honduras Bolivia and Ecuador 801) UKRAINE 436 497 00 436 497 00 412 68 436 084 32 09/01197 09/30/98 Short Term TA to 4 Oblasts

'------13.348.691 00 13 176 117 00 6 332 583 83 6,843 53317

Previous Page Blank

.I=>-04/97 WORKPLAN WK4 '° Appendix 2 Field Support F1nanc1al Summary

Previous Page Blank Sl

WK4 WK4

Notes Notes

Cancelled Cancelled

WORKPLAN WORKPLAN

WACH WACH

I I

Program Program

Programming Programming

Country Country

Program Program

Term Term

Program Program

Health Health

Program Program

Country Country

AFE AFE

Country Country

Long Long

CPT CPT

Term Term

Country Country

with with

Term Term

WACH WACH

Long Long

_§yn:i_fl!ary _§yn:i_fl!ary

funding funding

Reproducllve Reproducllve

Development Development

Care Care

Reproductive Reproductive

Term Term

for for

study study

Long Long

for for

CARE/Zambia CARE/Zambia

of of

with with

and and

for for

Long Long

with with

IEC/C IEC/C

with with

FGM FGM

along along

for for

utrhzed utrhzed

Quality Quality

for for

D1agnos1s D1agnos1s

TA TA

Sexual Sexual

be be

utrhzed utrhzed

on on

Study Study

will will

are are

utrhzed utrhzed

spent spent

utilized utilized

Term Term

--~---

collaboration collaboration

m m

Funds Funds

Community Community

Perinatal Perinatal

Short Short

Community Community

Anemia Anemia

Funds Funds

Adolescent Adolescent

Research Research

Funds Funds

Adolescent Adolescent

Funds Funds

$0 $0

000 000 000 000

4~ 4~

000 000

377 377

300 300

756 756

917 917

000 000

440 440

464 464

791 791

413 413

102 102

$90 $90

$70 $70

$56 $56

$93 $93

$64 $64

$82 $82

$61 $61

$550 $550

$160 $160

$239 $239

$211 $211

$150 $150

$272 $272

9/30/97 9/30/97

$2 $2

of of

Balance Balance

As As

J J

I I

:Bl001lt :Bl001lt

$0~ $0~

$OJ $OJ

$0 $0

~~ ~~

623 623

083 083

244 244

536 536

560 560

587 587

000 000

209 209

000 000

$6 $6

$10 $10

$43100 $43100

$88 $88

$27 $27

$80 $80

$38 $38

$425 $425

$177 $177

$100 $100

$250 $250

$100 $100 9/30/97 9/30/97

$1597 $1597

Expenditure Expenditure

Thru Thru

I I

Pflge Pflge

ooo ooo

ooo ooo OOClJ OOClJ

000 000

ooo ooo

000 000

ooo ooo

000 000

$90 $90

700 700 $70 $70

$80 $80

$550 $550

$160 $160

$250 $250

$100 $100

$300 $300

$490 $490

$150 $150

$300 $300

$100 $100

$260 $260

$100 $100

$250 $250

$3 $3

Amou-nt--

Obl!~ate_!__ Obl!~ate_!__

of of

_9130/97 _9130/97

1997 1997

1996 1996

1997 1997

1996 1996

1995 1995

Year Year

Previol!i~ Previol!i~

OF OF

_Obligation _Obligation

Funds Funds

E_UN_QS_AS E_UN_QS_AS

su_pfQRT su_pfQRT

Mrcronutnent Mrcronutnent

SUPPORT SUPPORT

Mrcronutnent Mrcronutnent

Country Country

FIELD FIELD

OEFL~LD OEFL~LD

------

INDIA INDIA

GUATEMALA GUATEMALA

INDIA INDIA TOTAL TOTAL

HONDURAS HONDURAS

GUATEMALA GUATEMALA

INDIA INDIA

BENIN BENIN

ZAMBIA ZAMBIA

GUATEMALA GUATEMALA

INDIA INDIA GUATEMALA GUATEMALA

PERU PERU ZAMBIA ZAMBIA

HONDURAS HONDURAS

GUINEA GUINEA

GUATEMALA GUATEMALA

'.l4/97 '.l4/97

18) 18)

16) 16)

15) 15)

17) 17)

12) 12)

14) 14)

13) 13)

10) 10)

11) 11)

8) 8)

7) 7)

9) 9)

6) 6)

5) 5)

1) 1)

3) 3)

2) 2) 4) 4)

SU!\llMA_RY SU!\llMA_RY

Vi Vi

(.,.) (.,.) f----- Appendix 3 Annual W orkplan Budgets for Year 5 (Core and DO's)

55 Contract No HRN 5966 C-00 3038-00 MotherCare Contract Annual Workplan Budget for FY98

-- FY 1997 BUDGET ------CORE DESIGNATED CORE ------TOTAL OELIVERY ORDERS TOTAL ~ TOTAL FIELD OYB OYB OYB OYB OYB OYB ICORE+FS lndones a Bolivia Pakistan Moldova Egypt Ukrame Russ a·- Africa lnl LAClni ANEMiA DELIVERY CORE DO SUPPORT MICRO LAC AIMI BHR ANE FGM OYB 00#5 D0#4 00#7 00#11 D0#10 00#8<:1!_ ____QQ_#E!._ _QO_~ ____!!3 00#1 OR~RS I COUNTRIES (All countnes nclude JSI Slaff Salanes)

Long Term Indonesia 0 $2 671 487 $2 671 487 $2 671 467 Bolivia (After June 1998) $565939 S29625 595 564 $791 040 $79t 040 $1386604 Gualemala Field Support $914 073 914073 $0 $914 073 Pakistan 0 $550669 $550 669 $550 669 Egypt 0 $1 520596 $1 520 596 St 520 596 Malwai S123 619 123619 $127 749 $127 749 $251 568 $0~ Sub-total Long Tenn $565 939 $914 073 S153444 so so so so soS1633456 S2 671 487 $791 040 $550 669 so S1520596 $0 -- so so S127 749 $5661 541 ST294997

Short Term Inda $12 227 $173 057 185 264 $0 $t85 284 Zambia $254 689 254 689 $0 $254 689 Honduras $440 874 440 874 $0 $440 874 Peru $35 550 35550 $0 $35 550 Guinea & Erflr1a (FGM) $154 681 154681 $0 $154 681 Russe 0 $61 443 $61 443 $61 443 Ukraine 0 $436 084 $436 084 $436 084 Moldova 0 $245 738 $245 738 $245 738 Benm $272 464 272 464 $0 $272 464 LAC lnlbabves $8086 8088 $450 000 $450 000 $458 088 Afnca lmbaUves $363414 363 414 $438 064 $436 084 $799 498 SITA AIM! (Ma!SWI Kenya & Zambia) 0 $0 so STTABHR $94 9t2 94912 so $94 912 0 Sub total Short Tenn $0 $1015104 $173057 $371 502 so $94912 $0 $1546&1 $1809956 $0 $0 $0 $245738 so $436 084 $81~ $438 084 $450 000 so $1 629 349 -Sl 439 305 TOTAL COUNTRIES $565939 $1929877 $326 501 $371 502 $0 $94 912 so $154 681 S3 443 412 $2 871.487 $791 040 $550 889 S245 738 S1 520 596 $438 084 $&_!~_!_$436 084 $450 000 $1_!!_l49 ST~•o s90 $1013'3"2

11 INFO DISSEMINATION $137 359 137 359 $0 $137 359

Sub total Info Dissemination $137 359 $0 $0 $0 $0 $0 $0 $0 S137 359 $0 $0 so so $0 $0 $0 so~- $0 $0 $137359

Ill WORLD WIDE POLICY TAG/Research Meebng $80000 80000 $60 000 Conferences/Meebnas $40000 $35 000 75000 $75 000 Sub total World Wide PolJcy $120 000 $0 $35000 $0 $0 $0 $0 $0 $155 000 so $0 $0 $0 $0 $0 $0 $0 ~so --$0 i1s50oo

IV WORLD WIDE TECHNICAL DEVJ QA sot

Travel $100000 $50 000 150000 $150 000 Consultants $40000 $30 000 70000 $70 000 Subcontracts $1139 456 1 139 456 $1 139 456 f--- - Sub total World Wida Tech Dev $1279456 $0 $80 000 $0 $0 $0 $0 $0 $1 359 456 $0 $0 $0 ----so ---,-0 f.-$0 so -so $0 $0 $0 $1 359 456

V APPLIED RESEARCH

IPAS Ghana $28 910 28 910 $2891011 John Hopkins Peru $3266 3 266 $3 266 JIN Peru $26 731 26 731 $26 73t John Hopkins Uganda $29410 29410 s2s 410 I Weslem Consortium Uganda S27 760 27 760 Khon Khen Univ Thailand $48 785 48 785 ~~~~:~I Vl --J Pag Previous Page Blank 974 281 2t3 836

000

$89

$B2t $855 $254 $134

TOTAL

$181049'

J1~4S1~ CORE

soi

101

TOTAL

ORDERS

DELIVERY

749

-- -

O_Q#1

5127

ANEMiA

000

_!!=!_

LACfl

----

------

---so

U.36014

Afnciiiif

--2.0_!1_?._

443

---

$61

00#8

Russa-

Ukraine

$4360114 00#801

D0#10

•1520596

Egypt

15 33

738 796

882

298 155

450000

D0#11

$245

Moldova

f---

ORDERS

669

Ce1llng

Ceiling

00#7

Celllng

Celling

Ceiling

Pak1slan --$0

.!:550

DELIVERY

PM PM

Dollar

Doflar

-$0

040

00#4

Belvia

S791

Moldova

Afrilni LAC

417

671

00#5

Indonesia

:12

FY98

3038-00

BUDGET

for 16

836 281 213

557

497 138

953

1997

89974

C-00

821 134000 855

16D

200000

436

OYB

$254

TOTAL

1000000

2107

$1810494

Contract

i'-'ORE+FS+

Budget

5966

HRN

Ce1llng

Cellrng Ceiling

OYB

Ceding Ceiling

Cerhng FGM

$154681

No PM

PMCe1hng

PMCedmg PM

Workplan

MotherCare

Dollar

•o

OYB ANE

Annual

Contract

Russa

Ukraine

Pakistan

Egypt

OYB

BHR

59,912

•O

402 581 188

924

OYB AIMI

251

587 574

210

LAC

OYB

CORE

li371502

Cell

500

001

Ce1hng

$3000

Celling

OYB Cellmg

Dollar

$195

MICRO

$191600

5640

DESIGNATED

PMCe1lng

PMCe!lrng

11) Doller

ORDERS

Dollar

(00

921177

FIELD

SUPPORT

DELIVERY

Indonesia

Bolivia

Anemia

974

836

713

281

584

$89

811994

CORE

S254

$659

$821

$131000

S3.969

840

1947

986

Indonesia

Research

Univ

COSTS

Supplies

Costs

Applied Celhng

Salanes

Mada

D1red

General/Admln

Staff

Dollar PMCeilmg

GadJeh

JSI Sub-total Equipment Other

ADMINISTRATIVE

Sub-total

TOTAL

CORE

vt Appendix 4 Preliminary Lessons Learned

59 Prehmmary Lessons Learned

1 Applied Research • Askmg focused quest10ns provided focused answers • Peer review strengthens the pnont1zat1on of the research issues pursuea

General research • Need quality control m data collect10n • Analysis plan for programmatic use done before (S1tuat10n Analysis) • Trammg Needs Assessment - purpose and objectives should be more clear re use • Project group must part1c1pate m selection ofresearch consultants • Consistent use of same consultants • Bid out implementation of studies/research • Populat10n-based surveys are not necessarily efficient for Safe Motherhood projects • Records/registers are major mtervent1ons for Safe Motherhood but feas1b1hty needs to be exammed • Success of hospital records/registers depends on who you work with at nat10nal level

2 Anemia • A nutnt10n pomt person 1s needed for every country/project m order to guarantee that the rmcro!lutne!lt mterve!lt10n strategy moves forward • The effectiveness of the anemia control component mcreased sigmficantly when MotherCare was able to work with strong national programs (e g, Bolivia MOH) which were already fully committed to addressmg the problem of iron deficiency anemia (IDA) m target populations • The quality of MotherCare programs' anemia control act1v1t1es rose (e g, baselme s1tuat1on analyses, quahtat1ve research on determmants of anemia momtormg/evaluat1on systems) with mcreased amounts of techmcal assistance • In nearly all cases, on-site traimng m use of hemocues was a mandatory step for successful 1mplementat10n of baselme anemia prevalence surveys • In nearly all cases, techmcal assistance 1s needed throughout the quahtat1ve research process If possible, the mvestment of time and resources for m1tial "pre-research design' phase qualitative research methods trainmg of pnmary mvestlgators (as m India) produces improved study results, better counselmg and education matenals, and ultimately greater impact on iron deficiency anemia • The broader MotherCare programs mterpersonal skills trammg pos1t1vely affected delivery of anemia control services • Incorporate specific, tailored messages emanatmg from the quahtat1ve research findmgs for development of the most effective anemia control IEC matenals For example messages m Indonesia countered the behef that iron supplements would result m large babies, difficult delivenes, and impaired maternal health, not jUSt with a statement denymg that this would happen, but balancmg the fear with mformat1on concemmg the greater nsk that low birth weight posed to mfant well-bemg

61 • Support for MotherCare project staff participat10n m regional and mtemat10nal conferences was an effective mechanism for dissemination of anemia control program expenences and contnbuted to MotherCare staff professional development

3 IEC Lessons on Qualztat1ve Research/IEC Implementation (General) • Qualitative research is t1me-consummg and difficult The skills and time necessary for conductmg high quahty quahtatlve research often are underestimated • Focus groups are better used to explore beliefs, practices, and perceptions than to explore knowledge For gathermg mformat10n on knowledge, other methods, such as free hsts pile sorts might be more useful and should be considered/explored • A MotherCare/Washmgton pomt-person or team must work contmuously on both budget and techmcal matters with ent1t1es contracted to do research or matenal development • The commumty diagnoses and IEC/C matenals conducted and produced by and for MotherCare represent a wealth of mformation To facilitate future research endeavors on IECIC programs, all matenals should be comptled and pohces regardmg theu distnbut10n and use should be developed To facilitate cross-country leammg and assure appropnate mformat10n archival, local offices (where they exist) and/or MotherCare DC should have all data collect10n mstruments and raw data • The commumty diagnosis research has been useful m determmmg strategy for Safe Motherhood program planmng and m gettmg at the "why" for behaviors, actions, decisions, etc • An m-country research expert who 1s on-staff 1s essential In general, countnes with a research advisor (knowledgeable about quahtat1ve research) workmg on-site were able to conduct good quality research and produce high quahty reports of findmgs, whereas those without an m-house specialist encountered difficulties m the conduct, analysis, and wnte up of the research • The competence of the entity selected to conduct the quahtative research must be carefully scrutm1zed before bemg contracted MotherCare should develop selection cntena by which to Judge the competence of the firm(s) under consideration • Genenc data collection mstruments, while useful, must be modified/adapted m-country to ensure appropriateness of study methods and mstrument content • Appropnate mput from techmcal advisors and field staff mto questionnaue design helps assure quality and appropriateness of data collect10n mstruments To ensure that such mput occurs, staff travel schedules and obligat10ns must be factored mto the design process and schedule

62 • The quality of qualitative research reports can be improved if the entity contracted to conduct the research has explicit and detailed gmdelmes regardmg expectat10ns/dehverables and is given feedback on areas needmg greater detail or attent10n • The development and implementation of IEC/C strategies and materials must derive from the quahtat1ve research findmgs • Countnes with a dedicated IEC staff person on-site to oversee the entire product10n process are better able to momtor the quality of IEC materials and to implement an IEC program than are countries workmg without such on-site expertise • Government mandates and policies must be mcorporated mto IEC/C strategies as appropriate • Where strict review of material content occurs and where there is ongomg supervision of product development, high quality IEC materials can be produced m-country • The best results from the pnvate sector were produced m cases where MotherCare was very specific about the content/details of the desired research and/or IEC product • Thorough review of all IEC/C matenals for content accuracy and acceptab1hty is essential prior to final, large-scale professional product10n This review should be conducted by both m-country and MotherCare/Washmgton techmcal staff

!EC lessons related to Safe Motherhood • Women know about many obstetric and neonatal comphcat10ns but often do not consider them to be severe and do not believe the signs of these comphcat1ons reqmre immediate act10n (1 e, to go to a health fac1hty) • Women and their families often lack confidence m the care provided at health fac1lit1es This lack of confidence combmed with perceptions of poor quality care are reasons for low service use • Real and perceived costs of services transportat10n problems (cost and availability) and distance to health fac1ht1es mfluence the decision to seek care • Health providers often do not recogmze the obstacles/barners women must surmount to access health facihties and therefore, do not appreciate the effort, sacrifice, and cost mvolved • Where health providers do recogmze obstacles and barners, they generally blame external factors ( e g , cost of services, transportation, chent lack of knowledge) for low levels of service use Health providers rarely acknowledge their own behavior as a factor that mfluences the decis10n to seek care • Health personnel do not recogmze the impact of women's/family's behefs and practices on the dec1s10n to seek care

63 4 Trammg • Pre-service trammg is needed for sustamab1hty " Profess10nal degree does not necessanly make a competent provider • Competency contnbutes to improved mot1vation of providers • Need to mvolve MDs, staff, policy makers from the outset - they must 1dent1fy their own problems and be mvolved m design of protocols, trrumng etc • At outset, 1dent1fy and focus attent10n on how dec1s1on makmg system is set up For example • cond1t10n of site • prov1s10n of drugs • deployment of staff • bamers to practice • Use of formal mechamsms (MOU) can be useful at vanous levels • TNA supplies mformat10n for country - more helpful m educatmg country nat10nals about knowledge m-country than m 1dent1fymg precise trammg needs of providers • For design, use expert team to go m and 1dent1fy areas of need ( usmg their common sense) - don't need huge tools • Team leader country nationals need stronger support with difficult policy issues • USAID still needs lots of advocacy work - contmual smce m-country staff changes • Product10n of m-country tools such as curncula, protocols is a long process that reqmres time, and timely TA as appropnate Involvement of host country • TA should be consistent m field testmg - contmmty m TA is directly proport10nal to success of programs • D1stnbut10n of protocols even with several days of mtroduct1on/onentat10n does not mfluence use of them • Need to focus more on the normal before trrumng m the comphcat10ns • Competency-based trrumng needs to look at time availab1hty - select trammg topics based on time available • Tramers should take course they are planmng to tram m and then return to learn to be tramers (e g, Bolivia) • Establish cntena to use m select10n of sites and tramers

5 Momtormg and Evaluation • On-gomg momtormg and superv1s1on of the community diagnosis process (design, conduct of research, and report-wntmg) is necessary to ensure quahty control of process and products " Given appropnate momtonng, it is feasible to work with pnvate groups and such collaboration can lead to product10n and d1stnbut10n of high quahty IEC/C matenals • If you do not know if an md1cator should go up or down, do not mclude it on the hst of md1cators

64 Appendix 5 Country Synopses

65 MotherCare

COUNTRY ACTIVITIES

December 1997

l§f,111) ==...:=rr::

December 30, 1997 Previous Page :Blank 67 This pubhcat10n was made possible through support provided by the Office of Health and Nutntion, Umted States Agency for International Development, under the terms of Contract No HRN-5966-C-00-3038-00 and John Snow, Incorporated (JSI)

The contents and opmions expressed herem are those of the author(s) and do not necessanly reflect the views ofUSAID and JSI

December 30 1997 68 List of Acronyms

ACNM Amencan College of Nurse-Midwives AIDS Acqmred Immune Deficiency Syndrome AIMI Afnca Malana Imuative ANC Antenatal Care AU OS RC Amencan Umversity of Cairo's Social Research Center BCC Baroda Citizens Council CA Cooperatmg Agencies CM Community Matermty CPTAFE Coordmation of Tradit10nal Practices Affectmg the Health of Women and Infants EOC Essential Obstetnc Care EPB Expanded Promot10n of Breastfeedmg FCMC Family Centered Matermty Care FGM Female Gemtal Mutilation FHI Family Health International GRMA Ghana Registered Midwives Associat10n HIS Health Informat10n Systems IBI Indonesian Nat10nal Midwife Association IEOC Information, Educat10n, Commumcat10n and Counselmg IN CAP Institute of Nutnt10n of Central Amenca and Panama IPC/C Interpersonal Commumcat10n and Counselmg IR Intermediate Results IRH Institute for Reproductive Health JSI John Snow, Inc KAP Knowledge, Attitudes and Practices LAC Laun Amenca and Canbbean LAM Lactat10nal Amenorrhea Method LLUH Liga de la Lactancia/Honduras LSHTM London School of Hygiene and Tropical Medicme LSS Life Saving Skills MCH Maternal and Child Health MOH Mmistry of Health MOHP Mmistry of Health and Populat10n MPA Maternal and Pennatal Audit NGO Nongovernmental Orgamzat10n NUEYS National Umon of Entrean Youths OMNI Opportumties for Micronutnent Interventions OYB Operatmg Year Budget PAHO Pan Amencan Health Orgamzat10n PATH Program for Appropnate Technology m Health PHR Partnership for Health Reform PNI Pakistan NGO Imuauve PROCO SI Programa de Coordmac16n en Supervivenc1a Infanul PRODIM Programa para el Desarrollo de la Infanc1a y de la Mu1er PVO Pnvate Voluntary Orgamzation PVOH II Pnvate Voluntary Orgamzauon Health II

December30 1997 69 QAP/URC Quality Assurance Pro1ect!Umversitv Research Corporat10n RFP Request for Proposals SEATS Family Planmng Service Expans10n and Techmcal Support SPAAC Social Plannmg, Analysis & Admimstrauon Consultants STC Save the Children STD Sexually Transmitted Disease SWACH Survival for Women and Children Foundation TBA Traditional Birth Attendant TOT Trammg of Tramer UNFPA Umted Nations Population Fund UNICEF Umted Nations Children's Fund USAID Umted States Agency for International Development WHO World Health Orgamzauon

December 30 1997 70 MOTHERCARE INTEGRATED REPRODUCTIVE HEALTH APPROACH DEMONSTRATION PROJECTS

Bohv1a

Dates of Pro1ect November 1994 - September 1998 Fundmg Sources Delivery Order, OYB Transfer Collaboratmg Agencies National Secretanat of Health, OMNI Subcontractors ACNM, PATH, STC/Bohv1a, Marketmg SRL, Network Consultants, H1pnos1s, C1entif1ca Consultora Populat10n Served 650,000

The long-term goal of this demonstration proiect 1s to assist the National and Regional Secretanats of Health, in partnersh1pw1th the d1stncts and munic1palit1es, to reduce maternal and neonatal mortality and morb1d1ty and promote healthy mothers and newborns MotherCare 1s carrying out the proiect in five d1stncts of La Paz and Cochabamba, through interventions designed to improve the quality of and access to essential obstetric care (EOC) and neonatal and reproductive health services, and with strategies designed to promote nat10nal policies which guarantee quality standards for performance and fac1lit1es

Quality of Care Bolivia does not have a clinical m1dw1fery cadre available, which means traming is targeted to nurse aux1lianes, nurses and phys1c1ans MotherCare 1omed the National Secretanat of Health to develop practice protocols for handlmg obstetnc and neonatal complicat10ns at health posts, health centers and hospitals These protocols mclude both clinical and counselmg gu1delmes on how to treat and counsel women and newborns A network of capable tramers has been tramed to provide on-going training through hospital-based courses plus supervlSlon m the field The MotherCare training curnculum reflects an integrated strategy, as it includes mformat1on on anemia and syph1hs control durmg prenatal care, and the prov1s1on of counseling m postpartum family planning, including lactational amenorrhea method (LAM) Providers are currently bemg tramed to implement the practice protocols, and fac1lit1es are worlGng to improve their environments to be more receptive to the clients Simultaneously, efforts are being made to guarantee regular d1stnbut1on of supplies needed to manage normal and complicated obstetric and permatal cases

MotherCare 1s conducting research as part of this mtegrated approach For example, anemia research has been earned out w1thm the MotherCare d1stncts, results md1cate that few pregnant women receive iron pills, and those receiving pills do not always take them as recommended by health providers In response to this fmdmg the anemia component of the proiect goes beyond trammg to ensure adequate distribution of iron pills at the community level Moreover improvements are bemg made m the messages and counselmg provided to women about takmg iron pills and the consequences of anemia MotherCare has also studied syphilis among pregnant women, and, based on the fmdmgs of this study, the pro1ect 1s contnbutmg to the plannmg and development of an mtervention strategy aimed at decreasmg maternal syphilis and preventing congenital syphilis A syphilis training manual has been adapted and validated in the Bolivian context

December 30, 1997 71 Behavior Change MotherCare/BohVIa s behavior change strategv aims to increase the use of maternal and neonatal health services through the promot10n of courteous attent10n to the mother' and greater emphasis on the family Quahtat1ve research has been earned out to 1dent1fv knowledge attitudes and practices surrounding pregnancy, including access issues These issues are bemg addressed through a commumty-based mformat10n education and commumcat10n (IEC) approach to mcrease commumtv awareness of the danger signs of pregnancy, labor and delivery, and appropriate and timely actions MotherCare is work.mg with a local graph1cs/med1a orgamzat1on (H1pnos1s) to develop IEC/C matenals Prmted materials (posters, flvers, calendars etc) are bemg distributed, and a 60 chapter radio soap opera on maternal health is bemg broadcast

Policy The treatment protocols have been distributed by the National Secretariat of Health as standards of practice to public sector health providers, mternational orgamzat10ns and nongovernmental orgamzat10ns (NGOs) throughout the country Add1t1onally, national po hey has been formulated m response to fmdmgs from the syph1hs study To aid m the formulat10n of pohcy, cost models are bemg developed for use m the Bolivian context A cost study has been conducted to calculate the cost estimates of the WHO Mother-Baby Package Cost Model for "ideal" treatment accordmg to Bohv1a's protocols versus "actual" cost of treatment

MotherCare part1c1pates m the Technical Workmg Group for the First Ladies of the Americas and attended the First Ladies Meetmg m December 1996 to support the First Lady s 1mt1attves m maternal mortality reduct10n, adolescent health care and maternal nutrition MotherCare collaborates with the Nat10nal Secretariat to promote pohc1es to sustam quality mtegrated reproductive health services, mcludmg a model of care for handling maternal and neonatal morb1d1ty and mortality m the five project districts, protocols for treatmg obstetric and neonatal comphcat10ns, and protocols for mtegratmg syphilis screenmg and treatment mto antenatal services MotherCare is also ass1stmg the National Secretariat in the review and rev1s10n of Nat10nal Health Information Systems (HIS) to improve the data available on maternal and permatal mortality and morb1d1ty

While the proiect's ma1or focus is on the public sector, assistance m methodologies and strategies to reduce maternal and neonatal mortality are available through PROCO SI, a local orgamzat1on MotherCare is also supportmg the rephcat10n of the Bohv1a Inqms1v1 "Warm1 pro1ect to other NGOs and private voluntary orgamzat1ons (PVOs)

Country Staff La Paz Lzszmaco Gutierrez Traznzng Specialzst Miguel Ugalde Pasaje 490, Casa 4 Research Advisor Ramzro Eguzluz La Paz, Bolzvza STD Advisor Stanlry Blanco Tel 591-2-434-017 Nutntzon Coordznator, Advisor Juan Carlos Arraya Fax 591-2-430-949 Health Fznanczng Advisor Kathenna Capra HIS Asszstant Ana Mana Vargas Project Director Guzllenno Seoane Adminzstrator Lilzana Medznaceli IEC!C Advisor Veronzca Kaune Secretary Lilzana Benguna Traznzng Research Advisor Fernando Fznot

December 30, 1997 72 Cochabamba HIS Supervisor Andrea Cortznozs HIS Asszstant Mano Sona Secretary Blanca Gumuczo

Egypt

Dates of Pro1ect October I 996 - September I 998 Fundmg Source Delivery Order Collaboratmg Agency MOHP Subcontractors SPAAC, AUC/SRC Population Served 1,000,000

The Government of Egypt has developed a long-term Healthy Mother/Healthy Child Pro1ect, to be funded by USAID, which will follow USAID's Child Survival Program In the meantime, the Government of Egypt has expressed mterest m and mv1ted MotherCare to undertake bndgmg act1v1t1es m the form of operations research studies and mtervent10ns m two Governorates m Upper Egypt To this end, MotherCare has negotiated with USAID to develop a pro1ect to provide technical assistance to the Mm1stry of Health and Population (MOHP), Government of Egypt MotherCare opened an office m Cairo m October 1996 and has signed a Memorandum of Understandmg outlmmg its goals and ob1ect1ves with the MOHP Directorates of two designated Governorates m Upper Egypt Luxor and Aswan Offices m these two Governorates are open and fully operational The goal of the MotherCare II Proiect m Egypt is to assist the Government m ach1evmg its ob1ect1ves of reducmg maternal and permatal mortahtv bv I) decreasing the prevalence of anemia and reproductive tract mfect10ns, 2) 1mprovmg obstetnc care for comphcat10ns and postpartum care and_3_)_1mprovmg the health of newborns

To reach these ob1ect1ves, MotherCare is stnvmg to develop strategies to improve the access of women and newborns to appropnate health care services, improve quahty of care of maternal and neonatal health services at vanous service delivery fac1ht1es, enhance national pohc1es for creating a favorable environment related to maternal and pennatal health services, and pilot test a package of maternal and neonatal health services m the two Governorates MotherCare is coordmatmg National and Governorate level workshops with the aim of determmmg maior comphcat10ns related to pregnancy, labor and delivery These workshops also assist m evaluatmg the level of postpartum and newborn care and the poss1b1hty of determmmg the prevalence of anemia and syph1hs

Research and activities MotherCare/Egypt sponsored a preparatory workshop to review lessons learned from MotherCare s prev10us experience with assessment and methodological issues related to the planned S1tuat1on Analys1s!f rammg Needs Assessment and Community Diagnosis Study The Social Plannmg, Analysis & Admm1strat10n Consultants (SPAAC) has been selected through a request for proposals (RFP) as the preferred implementmg mst1tute for the study Instruments have been fmahzed and data collection has begun

MotherCare is also supportmg a community-based study on permatal mortality Through a compet1t1ve RFP, the Amencan Umvers1ty of Cairo's Social Research Center (AUC/SRC) has

December 30 1997 73 been selected to implement this studv

Other MotherCare activities include 1) assessing the service delivery situation including infrastructure chmcian slGlls, supphes and eqmpment 2) conducting a commumtv diagnosis to identify barners to access to antenatal, natal and postpartum services for women and newborns 3) determining means of reaching women with appropnate messages for improved maternal health services, and 4) facihtating the design of the supervisory svstem for reproductive health Interventions designed 1omtly by MOHP and MotherCare will be field tested m the two pilot areas m Upper Egypt This field testmg will be used to determine appropnate wavs to mtroduce a momtormg svstem for maternal and neonatal health services, to develop competencv-based trammg matenals for service providers, to improve the quahty of management of maternal and neonatal health comphcat10ns, to develop service packages for reproductive health through workshops, to sens1t1ze pohcv makers on the magmtude of problems of maternal and pennatal mortality and the opportumties to intervene, and to set up steermg committees to promote the use of protocols, md1cators and the health management system

Country Staff Cairo 1 Abdel Megeed El Rema"{y Pro;ect Director Reginald Gipson Bab El-Louk, Cairo, Egypt Health Services Specialist Tel 20-2-354-7691 Dr Ali Abdel Megezd Fax 20-2-356-4649 _ Fznanczal Manager HfJzem !l1fJ11so11r Secretary Nadia Moustafa

Aswan Luxor Maternal Child Health Specialist pending Dr George Sanad Secretary/Financial Manager Manal Abdel Gzlzl

Guatemala

Dates of Pro1ect October I 994 - September 1998 Fundmg Sources Delivery Order, Field Support Collaborating Agencies MOH, the Populat10n Council, FHI Subcontractors FHI,ACNM Populat10n Served 1,000,000

Durmg 1989-1993, m the mterventmn area of rural Quetzaltenango, IN CAP tramed government nursmg staff to tram over 400 traditional birth attendants (TBAs) m three-day sessions m the recogmt1on and timely referral of maternal and newborn complications Trainers worked with doctors at the referral hospital and health personnel at the health center/post levels m order to develop and implement protocols for recogmt1on, referral and/or management of comphcatmns The trammg placed a strong emphasis on fostenng good work.mg relationships between the different levels of health care and improvmg humane treatment of both women and TBAs by health staff, pnmanly through mdiv1dual sensitizat10n Posters were also placed m all health fac1htxes remmdmg health care providers that everyone m the commumty 1s work.mg together to save the hves of women and theu newborns

The current pro1ect focuses on work.mg closely with the Mmistry of Health (MOH) to improve

December 30, 1997 74 services and increase use of services through provider training and a communitv- and fac1htv based IEC strategv MotherCare continues to work in Quetzaltenango and, since September of 1994, has been work.mg in the health areas of Solola San Marcos and Totomcapan adding the Retalhuleu and Such1tepequez areas in 1997 MotherCare assistance in Guatemala aims to 1) improve quahtv of services through technical competencv and interpersonal commumcat1on and counseling (IPC/C) training at all levels, and 2) mobilize communities bv he1ghtenmg awareness of maternal neonatal health needs through an IEC strategy, work.mg with women's orgamzat1on and supportmg commumtv maternities as an alternative to normal delivery at home or at the hospital

Quality of Care Smee hospital obstetric services m Guatemala are limited and formal m1dw1fervwas abolished 20 vears ago many women continue to deliver either at home or in hm1ted hospital fac1ht1es MotherCare has conducted qualitative research m commumt1es and hospitals to 1dent1fy barners - includmg cultural, geographic and econormc obstacles - to usmg hospital services To improve quality of maternal care, health personnel are being tramed not only to understand cultural beliefs and barners that their clients face, but also to modify their own technical and interpersonal sk.1.lls in prov1dmg care

Based on protocols developed dunng MotherCare I and subsequently adapted to the nat10nal level, MotherCare has developed competency-based curncula with assistance from ACNM Currently, MotherCare is training health care providers in the six health areas to 1dent1fv and respond qmckly to obstetrical and newborn complications and to improve their IPC/C skills At the community level, TBAs are being tramed to improve their technical knowledge so that they can more effectively recognize and refer obstetrical and neonatal comphcat1ons Issues mcluded in the TBA trainmg curnculum include anemia control, LAM, neonatal resusc1tat1on and postpartum family plannmg

MotherCare has assisted m the development of maternal mortality reg1stnes for monitoring and data collection These registries have also become vital instruments for case management and traming All health providers are tramed to use the reg1stnes and to apply them to improve the quality of services provided

Community Mobilization Community mob1lizat10n is a key factor m the Guatemala pro1ect Commumt1es have worked with hospitals to provide alternative delivery sites called Community Matermt1es (CMs) These matermt1esw1ll provtde quality prenatal, delivery, postpartum and gynecological services m the community, respectmg Mayan cultural trad1t10ns Two community matermt1es have been established to date, with plans to open four more by the end of the pro1ect

MotherCare has also designed a communication strategy based on the fmdmgs of qualitative research The pro1ect 1s d1ssemmatmg IEC materials which were developed from this strategy, mcludmg brochuresdescribmgobstetricaland perinatal danger signals and posters describmghow to treat clients in a humane way A radio program has been recorded to promote the recognit10n of comphcat1ons of pregnancy mcludmg anemia, and to urge the prompt referral of women to hospitals when comphcat10ns appear - -

Fmallv, MotherCare 1s workmgw1th several women s groups m the six health areas, offermg them a series of seven part1c1patorveducat1onal sessions on maternal and neonatal health The sessions are based on a 'triple A" approach which entails three steps Autod1agnos1s,Analys1s, and Action MotherCare has added a fourth A,Aprendzza7e, or "learning" in English

December 30 1997 75 Country Staff Blvd Lzberacwn 15-86, Zona 13 Edz.ficw Obelzsco Of 307 Guatemala CztJ-', Guatemala Tel 502-3-318-072 Fax 502-3-323-988

Pro;ect Dzrector Elizabeth Bocalettz Health Area Coordinators Yadma Vzllasenor de Cross, Solo/a, Enka Jacobs, Totonzcapan Gustavo Bamos, Quetzaltenango, Migdalia Solares de Celada, Retalhuleu (pending approval), Alqandro Ruano, Suchztepequez (pending approval) !EC Advzsor Elena Hurtado Logzstzcs Coordinator Patncia de Leon T raznzng Advisor Alzcza Ruano Monztonng and Evaluation Advisor German Aguilar Anemza Advzsor Sandra Recznos Admznzstrator Julzo Bolanos Secretary Rocxana de Campo

Indonesia

Dates of Pro1ect October 1994 - September I 998 Funding Source Delivery Order Collaborating Agency MOH Subcontractor IBI, PATH, ACNM, PCI Populatmn Served 900,000

MotherCare is workmgw1th both the Mmistry of Health (DepKes) and the Indonesian National Midwife Association (!BI) at the central and provmcial level to meet the long-range maternal and newborn health needs of Indonesia In the province of South Kahmantan, MotherCare is designing, implementmg, momtormg, and evaluating a program to strengthen the ex1stmg maternal/neonatal health system for dehvenng clusters of preventive and curative (case management) health services to pregnant, partunent and postpartum women and their newborns The proiect is also work.mg with IBI to strengthen its mst1tut1onal capacity, pnmanly at the nat10nal level, but also m the provmce of South Kahmantan, to better respond to the needs of its members Components of the MotherCare/IndonesiaProiect mclude I) improved quahty of services through in-service training of midwives (bzdan) based m health centers and hospitals, and village-based m1dw1ves (hzdan dz desa), supported by a peer review and continumg educat10n system through the provincial chapter of !BI, 2) improved referral, 3) behavioral change m the community and of providers through an mtegrated IEC strategy, and 4) the formulation of pohc1es that will support these m1t1at1ves

Quality of Care

MotherCare'sstrategyfor improvmg quality of care includes trainmg and contmumg education for bzdan/bzdan dz desa, v1s1tmg women at home durmg the postpartum penod, conductmg maternal and permatal audits (MPAs), and improvmg maternal and child health (MCH) management and referral systems

December 30, 1997 76 Competency-based and IPC/C Traznzng To ensure midwives and village m1dw1ves improve and mamtam the Ir level of knowledge and skills MotherCare is workmgw1th the MOH and IBI to develop a Trammg!ContmumgEducation Svstem for South Kahmantan With the support of ACNM, Life Savmg Slulls (LSS) trammg has been adapted to meet the local needs m South Kalimantan LSS tram mg teaches midwives skills to recognize and manage obstetncal comphcat10ns As of earlv August 1997, 102 bzdan and 80 bzdan dz desa had been tramed, with Peer Review and Contmumg Education bemg put m place as these m1dw1ves complete their trammg Through these efforts a model approach to m-service trammg for bzdan and bzdan dz desa 1s bemg developed In order to ensure consistencv m the clinical management of maternal morbid1tv cases at all levels, small LSS workshops have also been conducted for doctors and bzdan at hospitals and health centers (puskesmas) to anent them on partograph use (a labor management tool), mfecuon prevention, and mfant resusc1tat10n

With technical assistance from PATH, MotherCare developed a five-module trammg workshop to tram bzdan dz desa m IPC/C Six master tramers have been selected and tramed, and they have tramed 530 bzdan dz desa m the three distncts to improve their mterpersonal communicat10n slulls An IPC/C slulls observat10n tool has been developed and pre-tested, observers have been tramed, and observations of bzdan dz desa IPC/C skills has been initiated

Maternal and Pennatal Audit To improve data collect10n and help establish the real numbers of maternal and neonatal deaths, bzdan dz desa are bemg tramed to conduct a verbal autopsy m the community to determme the cause of death, both medical and non-medical MotherCare developed a new verbal autopsy form for MPA activities which has been pilot tested m all three distncts Additionally, MotherCare 1s providing assistance to revise the national gu1delmes for MPA

MCH Management MotherCare is supportmg the MOH's effort to improve management of the MCH Program through mtensive supervis10n at each level, from the proVInce to the bzdan dz desa By mcreasmg supervISion, reportmg and recordmg mformat1on is becommg more consistent and thorough and can be used to understand issues that need to be addressed m each distnct Management problems such as lack of eqmpment and supplies are bemg identified through MPAs and are then addressed at MCH Management meetmgs

Behavior Change

MotherCare/lndonesiais worlung to improve the response of the community (women, fam1hes, commumty health workers, mcludmg TBAs) to the problems and complications of pregnancy, particularly to mcrease the appropnate and timely use of maternal health services Improved breastfeedmg practices also are bemg emphasized and a bzdan dz desa breastfeedmg manual has been developed and fmahzed A communitv-onentedlEC strategy has been developed to mcrease community awareness about the importance of carmg for the health of pregnant and postpartum women, recogmt1on of maternal comphcat10ns and w1llmgness to seek care when comphcat1ons anse Prmted materials (posters booklets, flyers and calendars) have been developed m accordance with the fmdmgs of quahtat1ve research To address anemia, MotherCare has helped to produce leaflets on anemia control and 1ron-folate supplements A rad10 program addressmg anemia, safe motherhood and the image of the bzdan dz desa 1s currently under development and 1s due to be launched m November 1997 As a complement to these matenals, MotherCare has mvolved local orgamzatmns and leaders to remforce these messages to the community

December 30 1997 77 Anemia

MotherCare is work.mg with the provmc1al MOH to increase knowledge about anemia and increase demand/compliance for iron pills Baseline data was gathered and is bemg analvzed MotherCare has tramed all bzdan dz desa in the three d1stncts on anemia and has provided them with matenals to help increase knowledge and demand MotherCare is also workmg with the MOH to increase the supply of iron pills through the pnvate sector Five ma1or pharmaceutical companies have agreed to produce standardized packagmgof iron tablets to be sold at everv level Several IEC matenals mcluding rad10 spots have been developed specifically to address anemia

In addit10n to the complet10n of a prevalence study and a survey of small shop owners to determine the feasibility of prov1dmg iron pills m these shops, a fac1hty-based et10logv studv to determme the relat1onsh1p among anemia, hookworm, uon deficiency, and v1tamm A defic1enc1es is underway The program has conducted quahtat1ve research on the beliefs about anemia and barners to takmg iron pills In add1t10n, MotherCare/lndones1a1s g1vmg postpartum women iron pills and v1tamm A capsules to address nutntional defic1enc1es durmg this penod

As a rephcauon of past MotherCare work m Indramayu, MotherCare is also providmg fundmg to Proiect Concern Internat10nal (PCI) and Helen Keller International to conduct an anemia control program m the Maluku

Momtonng Systems and Program Evaluation

MotherCare is momtonng and evaluating the implementat10n and effect of the mtervent1ons bemg undertaken together with MOH and IBI Part of this momtormg mcludes the mod1ficat1on of hospital Labor and Delivery Registers MotherCare has worked with all the hospitals and one health center (puskesmas) with a s1gmftcant number of dehvenes to revise the registers to include mformat10n on referral, comphcat10ns and case management The hospitals began usmg the registers m September 1996 with contmumg momtormg and assistance from MotherCare As data is collected, MotherCare will conduct a prehmmary analysis and return this mformatton to the fac1ht1es for their use m 1mprovmg quality of care MotherCare has also mstituted Bzdan dz Desa Registers, which village m1dw1ves who have received the LSS trammg complete m order to document services provided to each pregnant woman m her community

Country Staff lakarta Pro1ect Director Endang Achadz fl /end Ahmad Yam KM 5, No 112 Maternal-Child Health Advisor Dzana Beck Bana1annaszn, Indonesia Program Manager Surekha Cohen Tel 05-11-251-891 Admzmstrator/Fznanczal Manager Fax 05-11-251-891 Marwan Tan1ung Secretary Agustzn Ida Suryantz Intern Lara Zzzzc South Kalimantan Pro1ect Implementation Officer Gunawan Supratzkto Research Coordinator Alz Zazn Health System Specialists Dr Dyahsuslam, Dr Lusza Mzennan, Dr Hendra Setzawan Secretary Soraya BA

December 30, 1997 78 OTHER MOTHERCARE INTEGRATED REPRODUCTIVE HEALTH PROJECTS

Hondw-as

Dates of Pro1ect January 1996 - September 1998 Fundmg Source Field Support Funds Collaboratmg Agencies MOH, PRODIM, OMNI, BASICS, STC/Honduras, LLUH Subcontractors ACNM, FHI, Dr Ada Rivera

MotherCare is providmg technical assistance to the MOH m Honduras to strengthen the quahty of obstetric and child health services under the USAID Health Sector II proiect m nme districts of Honduras Technical assistance to this project is bemg planned and provided through a collaborative network of cooperatmg and mternat1onal agencies W1thm this strategy, MotherCare 1s prov1dmg technical support to strengthen the quahty of maternal and child health services, part1c1patmg m the s1tuat10n analysis of select service delivery fac1ht1es, supportmg the development of protocols for district level nurse-physician teams m the management of obstetric comphcations, and collaboratmg with BASICS to conduct a community-based neonatal study with recommendations for an mtervent1ondirected towards promotmgthe health of the newborn

MotherCare collaborated m the development of the S1tuat1on Analvs1s tool, which was used by a local subcontractor to conduct the S1tuat1on Analysis MotherCare is part1c1patmg m the analysis of data A MotherCare consultant and a team of local consultants assisted m the development of obstetric management protocols for d1stnct hospitals Protocols for management of obstetric comphcat1ons by nurse aUXIharies and nurses workmg m health centers m rural areas have been developed with technical mput from PAHO and UNFPA MotherCare is part1c1pating with the MOH in training nurses and phys1c1ans to use these protocols and clinical procedures

In collaborat1on with BASICS and the MOH, MotherCare has planned the research design to assess permatal mortality MotherCare has awarded subcontracts to L1ga de la Lactanc1a Honduras (LLUH), Save the Children Honduras (STC/Honduras) and Programa para el Desarrollo de la Infanc1a ~ la Mu1er (PRODIM) to conduct this quahtat1ve research MotherCare also has contracted Dr Ada Rivera to conduct a literature review on perinatal research conducted in Honduras and to coordinate the perinatal research efforts

MotherCare is collaborating with OMNI to strengthen the prenatal iron supplementation program in Honduras OMNI, through a local PVO, supported the National M1cronutnent Survey to identify maternal anemia prevalence, MotherCare has conducted quahtat1ve research to 1dent1fv barriers to talung iron supplements As part of this technical assistance package the USAID Mission asked that m March 1997, MotherCare conduct the final evaluation of the community-based Breastfeeding Promot10n Activities, which were supported by Wellstart s Expanded Promotion of Breastfeeding Program (EPB)

No local MotherCare Staff

December 30 1997 79 India

Dates of Pro1ect 1994 - 1998 Funding Field Support Collaborating Agencies MOH Subcontractors SWACH, St John's Medical College, RUHSA, BCC, Dr Margaret E Bentley

MotherCare has worked with NGOs under the PVOH II Pro1ect to give technical assistance through scheduled workshops m state-of-the-art issues m reproductive health care and m quahtat1ve research on sexually transnutted diseases (STDs) MotherCare is also work.mg with four NGOs on programs to address issues related to anemia - its prevalence, etiology, and perceptions of women and providers regarding anemia and iron folate tablets - and to evaluate mtervent1ons implemented to address these issues

With respect to anemia, MotherCare is fundmgfour Indian PVOs, (SWACH m Chandigarh, St John's Medical College m Bangalore, RUHSA m Vellore and Baroda C1t1zen's Council (BCC) m Baroda) to implement anemia control programs m areas wt th populat10ns of 100,000 each Each program ts worlGng to reduce anemia m pregnant women and adolescent girls or newly marned women In several programs, chmcal signs will be assessed for usefulness m screenmg for severe anemia which is extremely high m India (20% of pregnant women are severely anemic) If pallor is sens1t1ve enough to 1dent1fy cases of severe anemia, It will be used to give special attent10n to reduce severe anemia All PVOs have been tramed m quahtative methods m a workshop conducted by Drs Margaret E Bentley (Johns HoplGns Umvers1ty) and Shubhada Kanam (MS University of Baroda) and are currently conductmg qualitative research on beliefs about anemia and bamers to takmg iron pills

Two overview papers will be wntten on this anemia qualitative research, one will detail the process of feedmg research results mto program plannmg and mtervenuon design and deliverables, and the other will present the results of the data

No local MotherCare Staff

Paktstan

Dates of Pro1ect October 1995 - September 1998 Funding Source Delivery Order Collaborating Agencies BASICS, Wellstart/EPB Subcontractors Aga Khan Umvers1ty, The Asia Foundation

MotherCare is part1c1patmg m the Pakistan NGO Imtiat1ve (PNI), m collaborat1on with the Asia Foundat10n, m prov1dmg technical assistance to expand/develop the capacity of local NGOs m reproductive health programmmg Spec1f1cally, this pro1ect aims to bmld NGO and commumty based orgamzat1on knowledge and skills to improve access and delivery of reproductive and child health services w1thm their programs To this end, a senes of quahtat1ve research workshops (Autod1agnos1s) and a S1tuat10n Analysis of five NGO climes has been conducted A demonstration pro1ect m Karachi with the Aga Khan University aims to improve pregnancy

December 30 1997 80 outcomes Wellstart and Basics are coordmatmg with MotherCare to provide technical assistance Through part1C1patmg PVOs MotherCare mav have opportumtv to conduct small proiects on anemia control An mitial workshop will mtroduce the importance of anemia and wavs to address it to participatmg PVOs Add1t1onallv a proposal has been submitted to MotherCare to contmue the breastfeedmg activities that were m1tiated bv Wellstart/EPB

The pro1ect is conductmg competency and IPC/C trammg at a vanetv of levels A commumtv based curriculum on breastfeedmg has been developed and 1s bemg field tested Trammg of tramer (TOT) workshops for NGO tramers are bemg earned out usmg this cumculum MotherCare has also conducted a workshop on counseling slGlls and the use of educat10nal materials Moreover, the pro1ect is implementmgan IEC/C strategy for commumtv-basedhealth systems Local radio programs form a part of this strategv, and MotherCare 1s supportmg an evaluation of these programs so they can focus on select topics to help mothers overcome bamers to desired practices Add1t10nally, a rad10 drama has been developed to promote optimal breastfeedmg practices

In addition, MotherCare is supportmg the Asia Foundation to conduct formative studv on the Safe Motherhood Intervention m Baloch1stan A prehmmary assessment has been conducted with Bolan Medical College

Country Staff Pro;ect Coordinator Naveeda Khawa;a

December 30 1997 81 MOTHERCARE TARGETED INTERVENTIONS

Benin

Dates of ProJect June 1996 - September 1998 Fundmg Source Field Support Funds Subcontractors Sourou Gbanbadge (pendmg approval), The Johns Hopkms Umversity School of Hygiene and Pubhc Health

To assess the status of prenatal, mtrapartum and postpartum and neonatal services with respect to quality, access and demand, MotherCare supported a needs assessment m three geographic departments of Be nm m early 199 7 MotherCare currently IS supporting research on the quahtv of essential obstetrical care at the primarv and secondary hospital levels withm Benm

No local MotherCare Staff

Eritrea

Dates of ProJect September 1 996 - September 1998 Fundmg Source Core funds Collaboratmg Agencies MOH, NUEYS (pendmg approval), SEATS Subcontractor PATH

MotherCare/PATH 1s prov1dmg technical support toward the erad1cat1on of female gemtal mutilation (FGM) acuv1t1es m Eritrea, which will be included under the SEATS country work.plan approved by the Ministry of Health The collaborat10n of MotherCare with the SEATS activities will allow an expanded FGM effort m Eritrea A MotherCare/PATH consultant participated m the Safe Motherhood Conference m October 1996 with a presentat10n on FGM and conducted a needs assessment as part of the FGM mtervent10n The National Umon of Eritrean Youths (NUEYS) has submitted a proposal for the MotherCare/SEATS FGM erad1cat1on pro1ect, and the proposal is currently pendmg approval It 1s env1s10ned that the FGM activities and the process for carrying out the activ1t1es will be verv similar to those m Gumea (see below)

Guinea

Dates of Proyect June 1996 • September 1998 Fundmg Source Field Support Collaboratmg Agency CPTAFE Subcontractor PATH

MotherCare/PATH IS work.mg through a local NGO, Body for the Coordmauon of Traditional Pract1cesAffectmgthe Health of Women and Infants (CPTAFE), to 1om current efforts towards the eradication of FGM practices m Gum ea CPTAFE has 10 years of experience m Gumea and has successfully called attention to the seriousness of FGM practices Their efforts have received acknowledgment and support of the Mm1stries of Health and Education MotherCare/PATH 1s

December 30 1997 82 assisting CPTAFE in conducting a qualitative and quant1tat1ve studv of FGM practices in two regions (middle and upper) of Guineas four reg10ns

The ob1ect1ves of the study are to 1denufv 1) the prevalence of the practices, 2) the resulting chmcal and psvcholog1cal comphcat10ns of these practices, and 3) the attitudes knowledge and behav10rs surrounding these practices The study will 1dent1fv the prevalence of FGM and comphcauons experienced by girls and women pnor to, during, and after the procedure and 1t will analyze the knowledge, attitudes and practices (KAP) related to FGM among women men, youth (girls and boys) 11 years of age and older, leaders and health pracut1oners The pro1ect will document and studv commumt1es' current source of ant1-FGM mformatton Research results will be d1ssemmated at nat10nal and reg10nal workshops

In the process of supporting CPTAFE in the preparation, conduct and analvs1s of this research, MotherCare is also ass1stmg CPTAFE in strengthenmg its inst1tut1onal capab1hty To this end, quant1tat1ve and quahtat1ve research traming is being earned out to create technical resources m the nat10nal and reg10nal CPTAFE bureaus servmg as ant1-FGM advocacy centers Quantitative and quahtat1ve FGM research instruments have been developed by PATH for use m Gumea, and PATH has trained staff m their use Staff have also been trained to use Epilnfo to create data entrv files for a KAP survey, and data collection is underway

Malawi

Dates of ProJect September 1995 - May 1998 Fundmg Source Core Funds Collaborating Agency ProJect HOPE Subcontractor LSHTM, The Manoff Group

Pro1ect HOPE is implementing an anemia control program m Southern Malawi with technical assistance given by the London School of Hygiene and Tropical Medicine (LSHTM) The program covers a populat10n of 125 ,000 people who hve on or around two tea estates, with pregnant women as the target group Pre-intervent10n research includes quahtat1ve research to determine beliefs about anemia and bamers to talGng uon pills, a fac1hty-based et10logy study that will determine the possible causes of anemia (iron, fohc acid and B-12 defic1enc1es, paras1t1c infect10ns, and hemoglobinopath1es), a biolog1cal/soc1odemograph1c survey to determine the prevalence of and nsk factors for anemia, and current p1ll-talGng behav10r, and a survey of the supply system to determine bottlenecks m the public sector supply system and availab1hty of iron pills in the private sector A market survey has been completed with the purpose of determining pnces of common foods in the impact area

Results from the etiology study have been submitted to LSHTM for mterpretat1on and report wnting LSHTM has submitted a draft report on the baselme survey for the Anemia Control Program which 1s under review A secondary analysis on the nsk factors for anemia has been conducted as well, and a report on the effect of mild anemia on the productivity of women has been submitted

The intervention mcludes development of appropriate IEC and counselmg matenals, trainmg of health workers both on the tea estates and in the M1mstry of Health serving surrounding areas, addressing the multiple causes of anemia, community-based d1stnbut10n to ensure that iron pills are readily available throughout pregnancy, and improved supervision and flow of iron pills through better planning and a reporting system Currently, operations research (quahtat1ve,

December 30, 1997 83 prevalence and risk, supplies and et10logv studies) have been completed and IEC materials have been developed Pro1ect Hope 1s developing a trammg curriculum on antenatal care (ANC) mcludmg anemia and the government is supplvmg 1ron-folate tablets Both mid-term and post evaluat10ns are planned to determine pro1ect outputs and outcomes Evaluat10n of the effect of the mtervent1ons (lookmg at prevalence of anemia among pregnant women and recentlv delivered women) is planned for June 1998

MotherCare is exploring the poss1b1hty of Malawi as a site to develop an integrated antenatal care program (as defmed by WHO Technical Working Group on Antenatal Care) to improve the quahtv of antenatal care services Such an effort would be done m collaboration with the Malaria m Pregnancy Workmg Group of USAID Africa Malana Imt1at1ve (AIMI)

Moldova

Dates of Pro1ect October 1996 - September 1998 Fundmg Source Delivery Order Collaboratmg Agency MOH, UNICEF Subcontractor ACNM

MotherCare is supporting Family Centered Maternity Care (FCMC) in Moldova, and ACNM is implementing activities to develop a curnculum and trammg course in support of this in1tiat1ve Two trammg sites have been selected to demonstrate the impact of FCMC training, and an m serv1ce educat10n program on FCMC has been planned for early November 1997 Moreover, MotherCare has helped to establish a technical workmg group to 1dent1fv wavs of 1mplementmg FCMC ACNM is also developing an evaluat10n plan for this pro1ect with partners m Moldova (UNICEF, MOH, etc )

Peru

Dates of Assistance April - June 1996 Fundmg Source Field Support Collaboratmg Agency ReproSalud, Movnmento Manuela Ramos Subcontractor None

MotherCare provided a consultant for a two month penod to tram Mov1m1ento Manuela Ramos, the implementing agency of ReproSalud, m the methodology of the autod1agnos1s process (as earned out under MotherCare I Bohv1a, Save the Children "Warm1" pro1ect)

December 30 1997 84 Russia

Dates of Pro1ect September 1995 - August 1998 Fundmg Source Delivery Order Collaboratmg Agencies Oblast and City Health Department, SEATS Subcontractor ACNM

MotherCare 1s part1cipatmgm the SEATS/MotherCareNovosibirsk/PnmorskvKra1 Collaborative Reproductive Health Proiect which includes a senes of reproductive health trammg courses, mcludmg a TOT course for physicians, midwives and feldshers m Novosibirsk and Pnmorskv Krai As a complement to the familv planmng course prepared bv SEATS, MotherCare/ACNM has developed the Breastfeedmg!LAM trammg manual for trainers and a participant manual m English and Russian, for use m the courses This course includes the md1cators to monitor change m breastfeedmglroommgm and LAM practices These mdicators will be mcluded with the familv plannmg mformat10n and reported on a quarterly basis MotherCare has and will contmue to provide tramer consultants throughout the hfe of this proiect to both locations A consultant has conducted site visits to collect momtonng information, examme this mformat10n for mconsistenciesor errors, and meet with local staff to discuss the data collected and provide on site trammg if confusion with mformation recordmg exists

Ukraine

Dates of Pro1ect September 1995 - July 1996 Fundmg Source Delivery Order Collaboratmg Agencies MOH, Donetsk Regional Center for Maternal and Child Care Subcontractor ACNM

MotherCare, m coordination with other cooperatmg agencies (CAs), aimed to strengthen the quality of obstetncservices mat least two sites m Ukrame, through a senes of trammgworkshops designed to enhance the slalls of midwives and physicians worlang m these facilities After the m1tial country assessment, and talang mto consideration the mput of other CAs (AVSC, JHPIEGO, Georgetown !RH), it was determmed that MotherCare would establish a trammg center at Donetsk Regional Center for Maternal and Child Care to tram tramers from Donetsk and Odessa m family-centered birth mg practices Pnor to the trammg, MotherCare m1t1ated the development of technical worlanggroups (membership chosen by the Donetsk and Odessa staff) These groups were established to promote plan and monitor trammg activities and oversee the monitoring and evaluat10n activities m both sites MotherCare/ACNM prepared the first draft of the Familv Centered Maternity Care curriculum, and the technical worlGng group participated m the review and rev1s10n of the curriculum pnor to the m1t1at10n of the trammg The two-week trammg course consisted of one week of theory and one week of clinical work for tramers from Odessa and Donetsk This trammg was conducted m May of 1996 at the Donetsk Trammg site MotherCare sent two ACNM m1dw1fe tramers and one JS! obstetnc1an to the trammg The Donetsk trammg site turned the maternity over to the tramers for the clinical trammg The trammg approach demonstrated the complementary role of m1dw1ves and obstetricians dunng labor and delivery In August of 1996, both Odessa and Donetsk will conduct an m-serv1ce

December 30 1997 85 trammg course at their respective sites The MotherCare consultants also worked with staff from both sites to identifv the practice mdicators and to set up a svstem to monitor and report these mdicators on a quarterlv basis Dehverv Order funds were completelv utilized m June of 1996

Dates of Pro1ect September 1997 - July 1998 Fundmg Source Delivery Order Collaboratmg Agencies MOH Subcontractor ACNM

Bmldmg on the experience of trammg m Donetsk and Odessa, the goal of this proiect is to establish Family Centered Maternity Care m four proiect sites m Ukrame through trammg of health care providers m FCMC techniques Two new trammg sites, Lv1v and Cnmea are bemg assessed, and Donetsk and Odessa have been v1s1ted to 1dent1fv content for follow-up tram mg and advanced FCMC Tasks under this delivery order mclude I) fac1htatmg acceptance of familv centered matermty care by selected matermty houses through trammg of maternity providers, and 2) estabhshmg profess10nal support lmkages among a core group of family centered matermtv care tramers and technical work.mg groups from the four sites to develop sustainable FCMC and breastfeeding trammg

December 30 I 997 86 Zambia

Dates of Pro1ect August I 996 - September 1998 Fundmg Source Field Support Collaboratmg Agencies CARE Zambia Subcontractor ACNM

MotherCare is workmg m support of CARE Zambia's program goal to reduce reproductive morb1d1t1es and mortalities m the female adolescent populatmn by upgradmg the quahtv of reproductive health services for adolescents MotherCare support is focused m Lusaka, with trammg mterventmns designed to strengthen antenatal chmcal and counselmg skills for chmc teams (family plannmg providers and antenatal and labor nurse staff) to reach adolescents In September 1996 a needs assessment was conducted m seven pubhc sector fac1ht1es' antenatal services Based on the fmdmgs of this needs assessment, ACNM developed an m-serv1ce antenatal care curnculum targetmg adolescents for use by CARE Zambia Trammg 1s bemg conducted by CARE Zambia's PALS pro1ect and aims on 1mprovmg skills of those prov1dmg antenatal services to adolescents, mcludmg nurses, midwives and chmcal lab staff Trammg was m1t1ated m March 1997

Simultaneously, s1m1lar skills are bemg given to adolescent peer counselors who are already worlGng m the community m family plannmg promotmn Under their expanded role, the peer counselors encourage adolescents to use antenatal services early m pregnancy to mcrease their awareness of possible danger signs of pregnancy MotherCare is also assistmg CARE m the development of pro1ect md1cators and is estabhshmg a momtonng and evaluation system These activities are bemg earned out under a 1 7-month subcontract between MotherCare and CARE Zambia

December 30 1997 87 MOTHERCARE APPLIED RESEARCH PROJECTS

Through a peer-review process, MotherCare has selected and funded six applied research pro1ects

Dates of Pro1ect October 1995 - August 1998 Title "Tra1n1ng Non-Phys1c1an ProVJders to Improve Post-Abortmn Care" Research Organ1zatlons !pas/Health Research Unit and the Ministry of Health/Ghana

The overall goal of this proiect is to improve women's reproductive health by expanding access to and improving ex1stmg services for treatment of comphcat1ons from unsafe abortmn Through this research mtervent1on, midwives at lower-level health facihties are provided With trammg and technical assistance m the management of complications due to abortmn, provis10n of post abort10n family planning, and appropriate lmks to other reproductive health services The spec1f1c obiect1ves are to demonstrate that a post-abort10n care program provided by m1dw1ves or other non-physicians is safe and feasible at the community level, improves access to emergencv hfe-savmg care, is acceptable to women, providers and pohcv makers, and improves linkages between treatment of comphcat10ns and other reproductive health care needs

Trammg has been earned out and tramed midWives are pract1cmgtheu new skills m public health centers and maternity homes

Pnnc1pal Investigator Dr Deborah Billings, !pas

Other Involved Individuals and Agencies • Dr Joseph Taylor, In-country representative, !pas/Ghana • Traci Baird, Program Associate, !pas • Victor Ankrah and Srephen Ntow, Ministry of Health, Ghana • Kathlyn Ababzo, Ghana Registered Midwives Association (GRMA)

Dates of Pro1ect August 1995 - June 1997 Title "An Impact Evaluation of Low-Dose Vitamin A Supplementatmn on Maternal and Neonatal Infectmns and Prematurity" Research Organ1zat10n Gad1ah Mada University, Indonesia

MotherCare is funding Gadiah Mada University m Indonesia to carry out this mdiv1dually random1zed, placebo-controlled, double-masked efficacy trial to assess the impact of low-dose v1tamm A supplementation during pregnancy on maternal puerperal sepsis, neonatal sepsis, low birth weight, gestational age of the newborn, and the v1tamm A and hemoglobin status of mother

December 30, 1997 88 and newborn The hvpotheses are that the incidence of puerperal sepsis m the supplemented groups will be at least 45% lower than m the placebo group, and that the proport10n of newborns with low birth weight ( < 2500 grams) m the supplemented groups will be at least 25 percent lower than m the placebo group The mam proJeCt aims are to assess the eff1cacv of low-dose v1tamm A supplementation durmg pregnancv to prevent puerperal and neonatal sepsis and to descnbe its effects on fetal growth and the duration of pregnancv

Data collectron involves screenmg new pregnant mothers, regrstermg the study sample, makmg anthropometncmeasurements, collectmg blood samples The proiect has developed postpartum forms, tramed field staff and contmues to implement pilot field act1v1ties

Pnncipal Investigator Dr Mzchael Dzbley, Gad7ah Mada Unzverszty, Communzty Health and Nutntwn Research Laboratones, Faculty of Medzczne

Dates of Pro1ect August 1995 - October 1997 Title "Improving Iron Intake in Adolescents and Women of Fertile Age to Prevent Iron Deficiency Anemia" Research Organ1zauons Instituto de Invesugac16n Nutncmnal, Peru and The Johns Hopkins University School of Hygiene and Pubhc Health

MotherCare 1s fundmg this study m Lima, Peru through the Inst1tuto de Invest1gac1on Nutnc10nal, with technical assistance from The Johns Hoplans Umvers1ty The study aims to evaluate two different strategies to address or prevent anemia before women become pregnant One strategy 1s to mcrease dietary mtake of iron m non-pregnant, non-lactatmg women of reproductive age ( 18-39 5 years) The other 1s to improve the dietary mtake of adolescent girls hvmg m the commumtv and give them a weekly iron pill while attendmg school Thus, the study 1s attemptmg to reduce anemia dunng adolescence and pregnancy as well as improve women's health m general The strategies are I) an educational dietary mtervent1on to increase the mtake of locally-accessible iron sources with high b10-availab1hty, and 2) provISion of a regular weekly dose of supplemental iron to prevent or correct anemia m adolescents

Field work has been completed and researchers are currentlywntmg reports on the two modules

Principal Investigators Hzlary Creed-Kanashzro and Ndly Zavaleta, Instztuto de Investzgacwn Nutnczonal

Other Involved Individuals and Agencies • Dr Margaret E Bentlry The Johns Hopkins Unzverszty School of Hygzene and Public Health

December 30 1997 89 Dates of Pro1ect August 1995 - July I 997 Title "A Randomized Controlled Tnal for the Evaluat10n of a New Antenatal Care Model" Research Organ1zat10ns Khon Kaen Un1vers1ty, Thailand and World Health Organ1zat10n (WHO)

At Khon Kaen Umvers1ty m Thailand, MotherCare 1s fundmg one arm of this WHO multi-center tnal on the effectiveness of antenatal care Through a randomized, controlled tnal WHO m collaboration with other research mst1tut10ns, proposes to evaluate whether a program of antenatal care which emphasizes essential elements of care that have been demonstrated to affect pregnancy outcome is more effective than a tradit10nal program of antenatal care m preventmg maternal morb1d1ty and pennatal morbidity and mortality The relative cost of the two programs will also be assessed The ob1ectives of the pro1ect are to conduct a multi-center, random1zed controlled tnal, to establish the relative ments of each model, and to test whether the new model 1s more effective than the trad1t10nal multi-v1s1t model with regard to maternal morb1d1tv and permatal morbidity and mortality, satisfaction and cost

Pnncipal Investigator Dr Pzsake Lumbzganon, ](]ion Kaen Unzverszf)l, Department of Obstetncs and Gynecology, FaculfY of Medzcme

Other Involved Individuals and Agencies • Jose Vzllm, World Health Organzzatzon, HRP!HRN

Dates of Pro1ect April 1996 - June 1997 Title "Access to Reproductive Services Part1c1patory Research with Adolescents for Control of STDs" Research Organizations Uganda/Pac1f1c Institute for Women's Health/Makerere Un1vers1ty, Child Health and Development Centre

This study uses qualitative research methods to address the question of how reproductive health services, mcludmg AIDS/STD control mtervent10ns, can better reach adolescent girls and boys m Uganda The study uses peer groups to generate adolescent perspectives on JSsues such as knowledge of and sources of mformat1on concerning sexuality, contraception, and AIDS/STDs, sexual practices and perceptions of nsk for AIDS/STDs and unmtended pregnancy, attitudes towards condom use and the ab1hty of girls to negotiate use with their partners, adolescent recommendat10ns for service delivery models, and strategies to mcrease access for girls to STD services and overall reproductive health services The ultimate ob1ect1ve of this study is to respond to the need for mput from adolescents as well as the need to generate more support for reproductive health services that are accessible and acceptable to adolescents The fmdmgs from the research will provide essential mformat10n to programmers, pohcy makers and donors work.mg to improve adolescent reproductive health m Uganda

Pnncipal Investigator Lisa Bohmer, Pacific Institute for Women's Health

Other Involved Individuals and Agencies • Makerere Unzverszf)l, Chzld Health and Development Centre

December 30, 1997 90 Dates of Proyect August 1995 - July 1997 Title "STD Control for Maternal and Infant Health" Research Orgaruzat10ns The Johns Hoplons University School of Hygiene and Pubhc Health, Columbia University School of Pubhc Health and Institute of Pubhc Health, Makerere University

This study, funded m Uganda through Johns Hopkms Umvers1ty, addresses the pnmarv and secondary prevention of STDs durmg pregnancy The study is also assessmg the impact of STDs on adverse outcomes of pregnancv Researchers are testmg the hypothesis that mtens1ve STD control, achieved through strategies such as mass population-based STD treatment, can reduce maternal mfect10ns dunng pregnancy, resulting m improved outcomes of pregnancv and reduced maternal post-partum upper gemtal tract mfect1ons Specifically, the study exammes the impact of treatment on syphilis, gonorrhea, chlamydia, bactenal vagmosis and tnchomonas, as well as reduct10ns m adverse neonatal outcomes such as low birth weight, chonoammomt1s and ophthalmia neonatorum Add1t1onally, the study exarnmes the role and utility of STD mass treatment programs

Principal Investigators Dr Ron Gray, The Johns Hop"J..ms Unzverszry School of Hygiene and Public Health and Dr Mana Wawer, Columbia Unzversiry, School of Public Health

Other Involved Individuals and Agencies • Fred Wabwire-Mangen and David Serwadda, Institute of Public Health, Make1ere Unzversiry Kampala • Godfrey Kigozz, RaA.az Pro7ect, Entebbe • Lynn Paxton, Columbia Unzversiry, School of Public Health • Chuan7un Lz, The Johns Hop"J..ms Unzverszry School of Hygiene and Publzc Health • Nelson Sewankambo, Department of Medicine, Makerere Unzverszry

December30 1997 91 MOTHERCARE REGIONAL PROJECTS

Latin America

Dates of Pro1ect September 1997 - September 1998 Funding Source Delivery Order Collaboratmg Agencies PAHO, QAP/URC Subcontractors to be determmed

In an attempt to address the serious s1tuat10n of maternal mortahty and morb1d1tv m the Laun American reg10n, and bmldmg upon the USAID goal to protect human health and promote human welfare pohc1es to mamtam and sustam health and well-bemg, the Latm America and Caribbean (LAC)/RSD-PHN bureau has developed a results package with Strategic Ob1ect1ves designed to strengthen the dehvery of maternal health services ( spec1f1cally, EOC) and to promote pohcy formulation This package forms the basis for the LAC Imtiative to Reduce Maternal Mortalitv and Promote Healthy Mothers and Newborns which was launched at the F1rst Ladies Svmposmm on Children and the Summit of the Americas m La Paz, Bohv1a m 1996 This Imtiat1ve outlines three Intermediate Results (IR) d1rected towards improving availability of and community access to essential obstetric care (basic, emergency obstetric and newborn care) at first level of referral At the same time, three partners, PAHO, USAID/MotherCare and USAID/Quality Assurance pro1ect, are mandated to collaborate m the achievement of these Intermediate Results m three countries m the Reg10n

To this end, each partner will focus on a spec1f1c IR while work.mg together m the same geographical area through complementarycountrv strategies and mtervent10nsto reduce maternal mortality and morbidity USAID/MotherCare will work through NGOs/PVOs to strengthen community capacity to access maternal and newborn health services (especially EOC), part1cularlym the event of an apparent pregnancy-related complication (IR 1), USAID/Qualitv Assurance will strengthen the quality of EOC services through the support and promot10n of standards of practice for providers and fac1hues (health posts, centers and district hospitals) (IR 2), and PAHO will work with country governments to promote the necessary policies to address and sustam ISsues of quality of maternal health services and commumty access to these services (IR 3)

In the achievement of IR 1, MotherCare will work with and through local NGOs/PVOs (one per country) m Bolivia, Ecuador and Honduras These countries are recommended by the partners based on the stated national pnorit1es m these countnes to address maternal mortality and morbidity It 1s anticipated that the activities m each of these countnes will bmld upon and maximize efforts and resources already dedicated towards this goal

The activities of the partners will be divided accordmg to four phases (1) Pro1ect Start-Up (mcludmg development of a prehmmary work.plan, cntena for select10n of distncts and upon which to 1udge the NGOs/PVOs proposals, and an RFP to be distributed to NGOs/PVOs m Bolivia, Ecuador, and Honduras, and establishment of a local steering committee m each of the three countries, mcludmg representatives of MOH, USAID M1ss10n, PAHO representatives and m-country representatives of MotherCare and Quahtv Assurance proiects), (2) Pro1ect Implementation (mcludmg a "State of the Art" semmar m each country for policymakers, health

December 30, 1997 92 providers, and commumt1es to address methods and approaches to link the commumtv with the fac1ht1es, development of a work.plan to incorporate all ant1c1pated act1v1t1es through the first vear of the pro1ect, and techmcal assistance from MotherCare to local NGOs/PVOs through the local MotherCare Country Coordinators based in Bohv1a and Honduras and/or through MotherCare staff and consultants), (3) Pro1ect Momtonng and Evaluation through the estabhshment of monitoring and evaluat10n indicators, and (4) D1ssemmation of Information through d1sseminat10n meetings in each of the three countries The purpose of these meetings will be to share informat10n about pro1ect methodology used to strengthen qualitv and access problems encountered and trends in practice and behav10r as evidenced from the countrv monitoring svstems and v1s1ts bv the Countrv Coordinators and members of the local steering committee

MotherCare will 1dent1fv and hue Country Coordinators for Bohvia and Honduras, Qualitv Assurance will hire the Country Coordinator for Ecuador The MotherCare Countrv Coordinators in Bolivia and Honduras will be members of the local steering committees and will also work closely with the district stakeholders The MotherCare Country Coordinator in Bohv1a will also be responsible for technical support to the NGO/PVO awarded the contract in Ecuador and will work closely through the Quality Assurance Country Coordinator in Ecuador to ensure timely technical assistance

Africa

Dates of Pro1ect September 1997 - September 1998 Fundmg Source Delivery Order and Core Funds Collaboratmg Agencies PHR Subcontractor to be determmed

MotherCare has received prior funds from the USAID Africa Bureau to contribute to the bodv of knowledge regarding innovative country models designed to deliver essential obstetnc care m reducing maternal mortality and morbidity To accomplish this task, MotherCare has set up a Secretariat m Ghana, headed bv Dr Joe Taylor, and will collect a descript10n of EOC models m three AnglophoneAfncan countnes-Ghana, Malawi and Uganda Dr Tavlorwill orgamze and oversee all activities reqmred m the collection, analvsis and dissemmat1on of data from each of the three countries Data collect10n will be earned out in each country by countrv teams including an obstetncian,a m1dw1fe and a soCial sc1ent1st To ensure uniformity in data collect10n across the three countries, each team will follow an assessment criteria (prev10usly reviewed and agreed upon by the teams) to describe the models Through a senes of meetings in Ghana, the teams will review and analyze data, observing s1milarit1es and differences m the models, and will prepare documents which describe the models These documents will be presented and disseminated at a national meeting in Ghana for policymakers from the three countries and other mterested donors It is anticipated that the fmal document will be prepared for world-wide dissemmation

The above mentioned activities pnmarily focus on facility-based essential obstetnc care The additional funds through this delivery order will enable MotherCare to expand and complement these on-go mg activities with the mclus10n of a community-based NGO component Specifically, the community models earned out by local NGOs (women s groups, etc ) will describe 1nit1at1ves undertaken by the fam1hes and communities to reduce the delays in the dec1s10n to seek care in the event of a perceived comphcat1on and to actually reach the first level of referral The community NGO models will also descnbe successful linkages established between the

December 30 1997 93 communities and the providers at the fust levels of referral

The act1v1t1es earned out through the Secretanat to descnbe the EOC and commumtv NGO models will mclude the collaborat1on of Partnership for Health Reform (PHR) Proiect Representatives of PHR will work With the countrv teams to 1tem1ze the cost of the EOC models A workplan outlmmg all data collect1on and analysis act1v1t1es will be prepared under the guidance of the Secretanat

December 30, 1997 94 Appendix 6 Applied Research Summary

95 APPLIED RESEARCH ST ATVS REPORT

As of December 18, 1997 Country/ Report Due Received? Current Comments Researcher Date Status Thailand 9-30-95 ,[ current as extens10n requested KhonKaen U 12-31-95 ,[ of date until 9/30/98 to allow 3-31-96 ,[ completion of other 6-30-96 ,[ sites 9-30-96 ,[ 12-31-96 ,[ 3-31-97 .[ 8-31-97

Uganda 9-30-95 .[ missmg 3/31/97 JHU/Grey 12-31-95 .[ and final report 3-31-96 .[ 6-30-96 .[ 9-30-96 ,[ 12-31-96 .[ 3-31-97 Fmal 7-31-97

Uganda 6-30-96 .[ final report m draft - Pacific Institute 9-30-96 .[ format bemg finalized 12-31-96 ,[ 3-31-97 .[ 6-30-97 final

Ghana 9-30-95 .[ current as final report from m1tial IPAS 12-31-95 .[ of date study bemg written 3-31-96 .[ new study began Nov 6-30-96 .[ 1, 1997 9-30-96 .[ 12-31-96 ,[ 3-31-97 ..[ Fmal 7-31-97

IPAS II 3/31/98 8/31 /98 final

97 Previous Page Blank Peru 9-30-95 ,[ requested extension IIN 12-31-95 ,[ until 12/31/97 for 3-31-96 ,[ imtial study 6-30-96 ,[ 9-30-96 ,[ 12-31-96 ,[ need to clanfy if IIN II 3-31-97 ,[ needs to be extended 6-30-97 ,[

JIN II final 10/31197

Peru 9-30-95 ..[ m1ssmg JHU/Bentley 12-31-95 ..[ 12/31, 3/31 3-31-96 ..[ and final 6-30-96 .f 9-30-96 12-31-96 3-31-97 Fmal 7-31-97

Indonesia 9-30-95 .f need to extend GadJah Mada U 12-31-95 I awaitmg letter 3-31-96 I requestmg extension to 6-30-96 ,[ determme new date of 9-30-96 I completion 12-31-96 ,[ 3-31-97 Fmal 8-31-97

98 MOTHERCARE APPLIED RESEARCH SUMMARY

1 "Trammg Non-Phys1c1an Providers to Improve Post-Abortion Care," !PAS/Health Research Umt and the Mm1stry of Health/Ghana Subcontract No 5024-31 $129,726 00 8/11/95 -- 10/31/97 Prmc1pal Investigator Dr Deborah Bdhngs

Abstract The overall goal ofth1s project 1s to improve women's reproductive health bv expandmg access to and 1mprovmg ex1stmg services for treatment of comphcat1ons from unsafe abort10n Through this research mtervention, midwives at lower level health fac1hties will be provided with trammg and techmcal assistance m the management of comphcatJ.ons due to abortion, prov1s10n of post-abortion family planmng, and appropnate lmks to other reproductive health services The specific objectives are to demonstrate that a post-abortion care program provided by midwives or other non phys1c1ans 1s safe and feasible at the commumty level, improves access to emergency hfe-savmg care, 1s acceptable to women, providers and policy makers, and improves lmkages between treatment of comphcat10ns and other reproductive health care needs

2 "A Random1Zed Controlled Trial for the Evaluataon of a New Antenatal Care Model," Khoo Kaeo Umvers1ty, Thailand/World Health Orgamzataon Subcontract No 5024-32 Amount= $195,140 00 Dates 8/23/95 -- 8/30/98 Prmc1pal Investigator Dr P1sake Lumb1ganon

Abstract At Khon Kaen Umvers1ty 111 Thailand, MotherCare II will fund one arm of this WHO mult1- center tnal on the effectiveness of antenatal care Through a randomized controlled tnal WHO, 111 collaboration with other research mst1tut1ons, proposes to evaluate whether a program of antenatal care which emphasizes essential elements of care that have been demonstrated to affect pregnancy outcome 1s more effective than a trad1t1onal program of antenatal care 111 preventmg maternal morb1d1ty and pennatal morb1d1ty and mortality The relative cost of the two programs will also be assessed The objectives of the project are to conduct a multi-center random1zed controlled trial, to establish the relative merits of each model and to test whether the new model 1s more effective than the trad1t1onal mult1-v1s1t model with regard to maternal morb1d1ty and permatal morb1d1ty and mortality sat1sfact10n and cost

99 3 "An Impact Evaluat10n of Low-Dose V1tamm A Supplementat10n on Maternal .rnd Neonatal lnfechons and Prematurit)," GadJah Mada Umversity, Indonesia Subcontract No 5024-33 Amount= $199,942 00 Dates 8/11195 -- 6/30/97 Prmc1ple Inveshgator Dr Michael Dibley

Abstract MotherCare 1s fundmg GadJah Mada U111vers1ty m Indonesia to carry out tl11s md1v1duallv random1zed placebo-controlled, double-masked efficacy trial to assess the impact of low-dose v1tam111 A supplementat10n durmg pregnancy on maternal puerperal sepsis, neonatal sepsis IO\\ birth weight, gestat10nal age of the newborn, and the vitamin A and hemoglobin status of mother and newborn The hypotheses are that the mc1dence of puerperal sepsis in the supplemented groups will be at least 45% lower than in the placebo group, and that the proportion of newborns with low birth weight(< 2500 grams) in the supplemented groups will be at least 25 percent lower than m the placebo group The mam project aims are to assess the efficacy of low-dose v1tam111 A supplementation during pregnancy to prevent puerperal and neonatal sepsis and to describe its effects on fetal growth and the duration of pregnancy

4 "Improvmg Iron Intake m Adolescents and Women of Fertile Age to Prevent Iron Deficiency Anemia," Instituto de Investigacion Nutncional, Peru/Johns Hopkms Umversity Subcontract No 5024-28 Amount= $178,209 00 Dates 8/1/95 -- 6/30/97 Prmcipal Investigators Drs Nelly Zavaleta and Hiiiary Creed-Kanashiro

Abstract MotherCare 1s funding tl11s study m Lima, Peru through the Inst1tuto de Invest1gac1on Nutric10nal, with techmcal assistance from Johns Hopkms Umversrty The study arms to evaluate two different strategies to address or prevent anemia before women become pregnant One strategy will be to mcrease dietary mtake of iron m non-pregnant, non-lactat111g women of reproductive age (18-39 5 years) The other will be to improve the dietary mtake of adolescent girls living 111 the commumty and give them a weekly iron pill while attending school Thus, the study will attempt to reduce anemia durmg adolescence and pregnancy as well as improve women s health 111 general The strategies are I) an educat10nal dietary mtervent1on to mcrease the 111take of locally-access1ble iron sources with l11gh b10-availab1hty, and 2) prov1s1on of a 1egular weekly dose of supplemental iron to prevent or correct anemia 111 adolescents

100 5 '"Access to Reproductive Health Services Parhc1pato11 Research with Adolescent11 for Control of STDs," Uganda/Pacific Institute for Women's Health/Makerere Umvers1t), Child Health and Development Centre Subcontract No 5024-34 Amount = $94,249 00 Dates 4/11196 -- 4/30/97 Prmc1pal Investigator Lisa Bohmer, MPH

Abstract This study will use qualitative research methods to address the question of how reproductive health services 111cludmg AIDS/STD control mtervent1ons, can bette1 reach adolescent girls and boys 111 Uganda The methodology 1s the use of peer groups to generate adolescent perspectives on issues such as knowledge of and sources of mformat1on concern mg sexuality, contraception and AIDS/STDs, sexual practices and perceptions of nsk for AIDS/STDs and unmtended pregnancy attitudes towards condom use and the ab1hty of girls to negotiate use with then partners adolescent recommendations for service dehvery models, and strategies to mcrease access for girls to STD services and overall reproductive health services The ult11nate objective of this study 1s to respond to the need for mput from adolescents as well as the need to generate more support for reproductive health services that are accessible and acceptable to adolescents The findmgs from the proposed research will provide essential 111format1on to programmers poltcy makers and donors workmg to improve adolescent reproductive health 111 Uganda

6 "STD Control for Maternal and Infant Health," Johns Hopkms Umvers1ty/Uganda Subcontract No 5024-30 Amount= $196,064 00 Dates 8/1/95 -- 7/31/97 Prmc1pal Investigator Dr Ronald Gray

Abstract Tl11S study will be funded 111 Uganda through Johns Hopkms U111vers1ty and 1t will address the prnnary and secondary prevention of STDs durmg pregnancy The study will also assess the impact of STDs on adverse outcomes of pregnancy This study will test the hypothesis that mtens1ve STD control, achieved through strategies such as mass population-based STD treatment can reduce maternal 111fect1ons durmg pregnancy, resultmg m unproved outcomes of pregnancy and reduced maternal post-partum upper gemtal tract mfect1ons Specifically the study will exam me the impact of treatment on syph1lts gonorrhea, chlamydia bacterial vag111os1s and tnchomonas as well as reductions 111 adverse neonatal outcomes such as low birth weight, chonoammomt1s and ophthahma neonatorum Add1t1onally the study will examme the role and ut1ltty of STD mass treatment programs

101 Appendix 7 Country Workplans

Previous Page Blank 103 ,

,] _J a -4 :;i: f- $) c.n ~ :i: r Al 0 fTI () (T 0 a IJ l,I :r ;;$ n rr1 '-• tfo r is; , ...... G -" r r c. r

~ \t> .s. ::::;- \1) ) --::>

\) 0

;,) ~ s::l. - () --

(/) _) \-\ \ ~ ~ - (t

() ~

-...... ,._

-t

- 5

- -

-- -

---

-- -

I ---

-- -

----

---

-- ---

-----

------

____

---

BJ)ll"X

----

---- llAT

---

----

Gllst-"!

---

I --

- ---

- -

----

lb#

------

1>e.tx:stlolt--

PH!.)

- xfllhflH

------

- --- Rqat""1l-g (hlil

'-----

---

F.dnH6S

-- --

-- -

DCrt ----

!>DJ '8 - -- 1------

1>1nMCD1bl

ta.:icw<11ocflllllj!5i•

llleinp:lr

.. -

c----

.,,..,

Tral0111J

......

- -

I.SS

-- --

-----

'1J11mats,.._ il"llll

---

an ------

- I

m1P"9B~ ....

lhd.._...:

----

------

'YSkmdaclW!lcnblJdfet -

1*1ob

---

»M

.-.tt

Sf*n

----

-- CA

- ----

- tiny

- --

bio!ldnotb1l<9lllln

- -- .. ------

Blank

~ &mdlll>HlmllklnllPrnl

~sc.'911!:~~• nfy111

-- fh!O&f'tt"'

p-qilnr..-.¥C0!6tis

""'""

[1111-2W90iosop-IJ

flrelm

---

------

- -

-----

~an-

H~l\cordl~

llsl•llEl'.'-tll<

---

,..._ ,.._

Rrioll!"p-iloc

Slill1:1111111J e

- ,__

~ftrft --

~lMPA5'llll!n'itXIE

5 --

------

--- I

----

..._.,,,.

- 4 Page

------

----

«Y1

- ---

3rd~~HSS

ldomolll'p•n

I RlllrelE'<:-

""*r

--- --

---

18ll'*11l-- p-.jlcl

----

...... lo

--- """'"""'

---

op:rlf11

Mr.llC•

------

l'P

---

In~ botln

----

--- 9::1illles

---

:i: ___

---

IJDIZBlll --

------

----

lldl'Q

"1.-ctl

FlrR'll1G"~--"'--

Rlni1;1

R11Tin1r.rc.n.-e11anokdt llfltmlrt"""'mldV*llb:lJ'

SIJJt

"'1

.,...,,

----

.-i1111n1r1rvon:1'"""'"1111

rdctvofe<9

'"'ct'

------

'"'

----

artedmeet1111n11111:i1m-.ar

ir¥thoS;h•"""1h:ipkr,_

lllO'sB«Jl11l-11n71 --

-- __ ~ar~Bd'>T•flll1 -- ~(YdHtro ---

- ecw --!'--- --

!lrdma•oml'ofhD"

'"2-3 illlrll!'~~1nollh

!F-~IQll'pCCl

Previous

---

--- Tli9~

----

Tiell

---

- -

'I~

LS8

cl -----

---

-----

---~

l't

fJ11VC-I

_111lonll!

---

--- TGl:lo~d11!M:Jla -- --

!¥1Ca->illJhL""1C

...

'"INl'lllY I

----

.-~s

------

{Ftll2-MlllCl>1~

rt.n.l

.-.,,~'"'"

-- ~

!JllHcllA~ -

---

cydtol

!llnanclllo~...... rlalt11

--- ..-bit -

t•

BbrUoftlltceufaJ>lltlads.,.._---

t11

------

- -

......

ll"'°'Jlla!alll!ll'jlr

------

~!I ---

1!IP*-1•V-----

..._

._.

------fn?is1<1-IECrnmt!crt"4J - 1--

1--- - C'...._..onal3!Jstutlld!

-r.afftl.'J

- S-hlll!alon.IGnb"...,,, 1)1...,...,,"

,.._.. ~,,.dod•ont()Nlbft

Cll"lro

Txstidf

---

li~llMlllll

Tl'lrilg

•

ll>ft-trr

Nd'

tl1;!11C!I•

llCTTmY

......

Ldudlon

lla!k

V.lllbl"q>

Pl.tllc ~

Rt\!....,

Maiblig

Tr1t1~

C•1HW9T

~~.Od\11'1'~<'*

C.11111•

-----

Monkn'llJ

PtGr

L.$$

lladcrJ'Ob.Olfll\'a<~ r..ntallil~

lec,.Slltndwhood

111m1,e

lAnl!llnllltllf Contnui\ fld) IPCC F'MKl/llo1aflop

HoGp!* etD~eT..i l!(O acU&r..,,, --- Pi>EvaWon B

Nlbonlll

CClrtf•ml"11 Cc.t~-nlrtil

~sl'1

.tnmnalll..ine

IEC MPA llOOCllnnllJllcn LSS B11elne

;~Edalcn QJonLSS l PR.Olrf'3WR Ml'A Ml'lcn!DHMHIU!m.B µsi I

• JI, 1Tllorga.-...lcnll1¥

j :

•e: It.

~""llail119

,._

Cllftlml-ol ~M>fl"dsl

lll>q!«

c il~Sll>t ~

...... • ~

0 \JI

~ l

1 I I

[

I[ f' I 0

.µ G 0 0 ::!! '

4 J l ff; ;{) •1 ~ J ni ""Tl '-1 ~ r 4 I' fJ

GI a r [I I ln G n r

25.'i

- -

------

--- I -

-- -

encb -

- --

Tlr --

- --- -

- - ' ------

---

- -

Bor"j

I ------

------

---

------

3 ------

------

----

--- ' ---

•&Prmlllll

---

--- -

- ---

- £YAl..UATON ---- "2

---

----

"'1UffllngHSS

---- -

------

------~f(intrCE~

---

------

--- -

- ---

- -

----

-- ,___ -

-~ --- ·-'I

6 - - - -

- -

~~11~ -- - -

------

COPY - ~ --

- ---

, I ~-i=------

- -

------_

----

AUGUST ---

.,.~,,.,.

I -

GlllL

Ila

ewllill«1

- --

doll --

---- AVAILABLE

- 1st"""""'------

O>gdJVBIDt

.....

•acyCH•O!IJdyliltlJ"R"""'f•lll ---

ArWy$SOlornib6Cl1 .ll'lllp1af

~SOl~~

------BEST ------

-- -

----~ On!IOl"'LSSTrwirlng. HQ,~ ~~PR - -

---3"0-~8MlfCnftllal5

.___

------

------llt'lllbo~1DIBdorr

- 0

>----- >-----

---

I - -

- --

------

------I

---

------

-- 'llL-

- - .IUl'r -

- ---

ln!riltl!'"Ctllllll'\Jjl• -

.....

l!brUt8~"'!1---- - ~~

----

- ey.f• ....

- --

:w-

311"'"""'9 --

--- --

---

f\tlCdOft<>lnrul ------

------

~""'*"ct ~~ - -

,___ _ot..rrg1-

---

------

-- --

' ---

------

---

- - I

---

-----

------

-- .IUIQ - --

I ---

..... - GOVmlllCTMI~~

---

------

---

0'2I

eoonw1- I

...

----- T~oll

------

Slllllt ------

CClli'IOJlt!Cl~ttes--

------Cll0>¥4> ------ISon!Clt.,.ftltnlflr:hf.,,~

ClllP'.(l(.W-W-~.., -

!hdCbeil-rn~i.t.i - --- 'llj!-FP-

11~;;.\llOll

rrcf-

WUl.lfNTAnoNOFON

11.:x>~

~8dr.tlie9

~·~~-----

for

-eogar

_..,.,

••uullo~

Tall!

TX~ ...... ile1'Mt'I ,

1'IWTIJ ~

DM•r'"

matil!lhOod Rolf-1atRlO

..... ev.t..atln 5Uff

~r·~

Trll'*lJ

...

llas4fi.-e

Muller

Cmtlllln1

Slllls

1oH~UUlrull

Prall)ca ~-- LSS

l'ee'Awl- C~rU11Ec1l::a!IQll Fl.C>t•"'!I Oodoc!Ol>

lrollm •IW HOl,llbdWor1olhop 'Vftll!allap UWJlllfl• &~SUf; BtDCfremG'\' Qlnru11yllapie!t"! PKKY>"'1

' ~ lkDR1!1-A:W•'lllfReJi!Ca' llE

ia ' IEC'M:rf~ '1 f CGS!Effod e ,,,_.

1'11111.....0-c 8'D AISlo1$mtsL.iOl>i'l•ll'dDcd

~ it p. ea-

~ Rrl " MPA. II Carpntw ll'oodlnn!lJll«> ri

IBlaQlrimcnoev I< PRlltlntdlfR MPA

> Qj)lltlSS ~llltfaolPn•ocr•t 11ct11 ~

~-llM "-J'lapCllU"lil I>

~ ~ • ......

~ ~ ~

...... 0 ~ -l

!WIN

1'11frqt

frPHR

.... rtpat

9llt

------

Recel-...porTh; mo M!-

llll.alia..-----

811:1f:ni

sh(&} .IAllUMn

JN!nednVS

S'.DOIRIM!e! I

r:r

re""*'"'

_,,..

Pl.Ill

-~--

sqiles

Hoop...rutq>

allB,...... -nQ

~OIH.>1rfplrt 1111

.Md• 1o!l!l)to;t...-.:!Pusloetn>a•

O:noJtnt

l'IM'l.SS

......

Pdef -qi

1-iss

r.,_soi:1st I ~ii"~]

~,.i,,.,..,...m.tt

~~nry t,a1.1111""1M E-

fam1.

- H!IJti-

---

!nd-111atiden~11t------

_____

------; ~

FmlCU'\

----

IJ"1Cd

~!PA,

IEOSl!V~

,,.c1cm1oJ.--

c..trc

fir

tcomh>l5fwtll

1--SS 0'1gol11!US~---

l>Hlll~IUVll)'

~lt"aftbDC- - ....

Hrrilza1!!l---

...

glidol"""

flllnl•fo!Tmm'a'l,..

I ------~llls0'>311Cd- Cll:iee

[lr*lrg

tnll

l!lql!ded1Dt:er:ar"P«..iSl!f95

,,....,

~~a>rop:wt

·~l'orriow"h

----

COPY

b- r-

)hlretrJ!lJnedllnllr1'trM>C.--y

......

!ngqdltlny

P..,46BolJI'

---+-

a:--

------&....----

------I-

---+--

COllJl-~

- -

AVAILABLE

tlogum"Cls

•owiil•m I

BEST

Daltnp::it

------

....

1-i

~~~

~...,

I-

~•stll$

-p--

vtlrg --

---t---

raport

go,.

------

-a.o..---..11e•opo<1u-o11111r11re~co

l<1olp•

-----

---

GCfCllD

-----

r:::i:::

l'l'l!pnllon

----

-----

lllWllll

~ally----

-- -

1'11rte'5teOT1J..loc!l'tm9rlPC:C~

I t-

1--

1----

1---- L

l-- i---

)--

1--

~<(...-!riSWUWJl'.liPIOOO.Alll.IE

.-...... pcorvmc1---

c:r.e

Roi:lsflr

......

Ttt

TJarjrg

e.rjlmlHln

De.lfqnlln ,

11c1M1Y

....

e..-......

~$1Jol'.rn-F(D lllOll*'1oodl

lloll'er

T'**V tul-fl!Hfl

C:Q1'1110'¥ IMmlq>

Retl*'il!wlr\r

.,,,.

Plttoni

EmailM

...

....

lbr!mJ-l.allo•

~Cantla11Tntllll.,..tt11~ p L.sS

PCCM~rg

=~IW_.4a•

-·~ Co~~

~~ 1£0lllllfe. I.Mn!•~

8li) Pl

a.D~

&Ds.r....,. BcO B

e ""

Miii

~!::o!:noAldt

Co!itlB'loth•a1..,S1CO!tl'nll),;I$

~Lndotlltl:~fl!.-

flcD

/nNrjaE!illscino PopCOU'ICllRTl~-8clg

~llO

,~~R -Trtl~onTxSluctf I.SS UPA

810-g&"f-.D!Ml~ :"IJ1111l.B8

~lilf

f t " n ~

I<-

~ r l!COmllll:el"9~

jG•WlloMll!yW.llr

It f

" tt

<;f r ' 21 .>... (;;) ..... N ["'- '\I ~ ti: 3 8 CI a 'I ffi g IL ., l ..... lt! E t l' IJ) m CJ'l \t l>fl 19 MotherCare Egypt MatnarCant Prqect/Egypt 1 Abdel M.geea El Ramary SL Ball El L,.gllk, Ciilto. !gyot Fax • (202l 358 41649 Fax

To: Ms Colleen Conroy Prom Or Reginald F Gipson

F•X" CT03l 528-7480

a.te mber 1997

Dear C.ollccn.

I hope you had a m(..C Thdnk:,g1vmg holtday

As per youa request, please find our hst ofprodu<.."tS m the table below

1 Situation AnalySJSl'NA Results

2 Commuruty Dmgno~ Results x

J Pennata.l/Neonatal MortalJty Study x x

4 Essenttal Obsretnc Care Protocols (Doctors and Nurses) x Training Packa •es

S Maternal Mortality Srudy (Arabsc) & Pubhcatton Work.mg Sec Analysis (Enghsh) Paper

109 Previous Page Blank December 2 1997 fl. Presentations 1 M/CME Approach and Strategy to reduce MM 2 Competency Based Trauuns Methodology to unprove qw11ty ofMat Sav!ccs 3 Presentations ofresearch results for Policy Makers and Rep Ofbaals (M HP, USA.ID and other) 4 lntemanonal Conference orgaruud mamly by MC/Egypt (March 1998)

Best regards

110 ....

\lothuCare Pro1rcUEro pt l>HAI I - ~ov 24, 1997 Prehmmary/l>nfc Work Piao 1997-98 L 1 Ea.IlfJCAJ ACTIVITIFc; CoftllJleted Clcp 97 Oc.t 97 1'm-91 Da.-97 Jan-98 Fcb-98 Mar-98 Apr 98 Ma198 Ilm-98 M-98 A1~98 G lhJ/gn Supernslon SJ5tem -

H Mapping of JJ-1ft Dtatb1 ,_ ~- - - ._ __ ,__ __ T.Tliree WorkSbopi------·------1------. l ~s.•cw1eul SltuaUon. PosllJ(lnal 2 A.w!s..,fmdang rrom SA.'TNA x:u: '(XX J Prepare 111up1Lde for supenis10n CO)sttm ba&ellon findmgs and recommend.ItIons of 142 XX\ ltXX

.t Hold a uork!.hlp to finah7c the new S)"Stcm '(.'(."( S Apprm al ftom MCI\\, MOllP and USAID 16 Dc\-tlop and fina1tte 1 raining lumatla '"" for unpkmcnta11ot1of supemsaon n'$lem xx_, .

7 Provide Tr.urung XlOC 18fntroduce lhe syi;tnn fQr1mplement."1on an

the dist.nets of 1st phase XU lLU XJCC 19 Mappmg of M &. N Deaths 'tXX n."'i: I0 Two work."10Jl!Ioa deTelopmenl of sygem. ldcllllfVpnonlJcs chssrnunabon of lnfonnauonoonoerrung 11nprmerncu1 of Maternal and neonatal heahb x.u x.x:c ll..'l.'( u:x xxx X'l."I:

- ~ ' ) Mother<..are ProJed/Egypl llRAI I - Nol 24, 1997 Prehmma')/DrafC \Vork Plan 19!>7-98 ~ L TfCllNICAI ACTIVITIES Complc1ed Sep97 Oc.1-97 1'0\-97 Doc-9i Jan 98 Feb-91 Mar-9ft Apr-98 Mav 98 Jun-98 Jul 93 Aug-98 ~ I 'i O Support Nursing Schools and Org•n, ~lion$ - l SefVlte Protocols, Trauung cumcula and • "' ; ------otJJercdiabODal 11181molttrtJI be ~IY ------·- --- dtstnlJutod at l\tU Nunnng schoob whteb "111 be ln\'"Ol\'al 18 the dcvclopmcnl or

Umse nmtenuls. On~aing 'I 'l MC/F 1\ill lure a consultant to renew and ~ prcn1cle reoommeadalJOOJfiJr 1mproveme111.1 I J in lhe da\ll traarung ccnlcr ""'( J MC/E \\111support Fg)'phan Midw1ferv """ Trawng Program tn Aswan and l u'ot J ) ' districts IXX XXJI U.'( ttX \.'-"'C U't ~ xxx lOt.' ] ~ Assess lk fcastb1li\} of cstabhslung o Nohonal Midwiferv Association xxx u.i; r E. Comn111a/1]Dl11gaoM.lc Studr ..~ F. JEC $lr•tt'lfles aJJd I11tuv~atloaa I I l I Conduct mmmwuty du1gnosasstud.) I tu Identify bdlnen lu malema.I I and ne01181alhealth ca~ "l."a 12Deulop lEC strategic\ l\l lC'C( XX.'t • Delernuno the means of naclung 1\'0Dlell "I ''1lh awropnate 1ncssage1 - DC(efm)oc eltr11Ble nuys of impm1ag the access of "''Omen and aeoborru lo ienlCC • Determine strategies 10 collaborate \nth l\"OllteD s groups . tJ l:JcM:lopHealth Educabon Program XXA With l\"OCllell 8f'OU1'5 """ -i Pl.lot tesbng of the program In specafic xn xxx ux 100[ x:xx di!ltncls l

...... N _,..... '-'I

Mattwreart Pl'ClfllCl/EmlC 1" Abdel Megiied 8 Re!'Nly St Bab El UUl, ~Egypt Fad (2C2) 356 ~ Fax

Ta: Ms Colleen Conroy/ Mr Ken Ames

Fus (703) 528-7480 ... cu_. CFor...,_ CJ-- CJ•-- 11....,,.... eeom ...at. I .. K~ I Attached e. the Gantt Chart for the draft 1997/98 Work Plan (Deliverables) Iwfuch I sent last week. 1

2 The office space we found L!I centrally located between USAlD and MOHPf-HCP !'he space JS adequate, the pnce ts nght. and tt has enough office fimuturc:. So, er one week for puntmg, we could move m and be fully operattonal 1 We, therefore. decided to select this office since we:: only have 10months1 and need to move as soon as possible and .mminuzc down tuuc m the pr~

3 AUC Pennatal/Nconatal Mortaluy Study please see attached reV1r;ed ' .!rnpJ mentatJon PJan''

Best rcgar~

113 'i E:'llirLl' T ~ Lvi~(LQ.~a,&cl.~

Mother<...are .Pro1ect/Egi pt DRAFT • Nov 24, 1997 frd1m111al)/Dm.rt Work Plan 1997-98 I TiC1lN1CAL ACTIVITJJAc; f Comoletc:d Sm-97 Oci-97 Nm-97 .Dec-9" lan-98 Fcb-98 Mar-98 Apr-98 Mav-98 Jun-98 Jnl-9' Aue-98

A Essent/111 Obsttlrlc Protocols ....- ....------I Estabhsll revJCW COJIUIUUcc Done 12RC\1C\\ c.·mtmg protocols XX.t xxx 3 Prepare first draft XU 'LU ~ DtSlnbule ror feedbad . IU."'< lj Approval from MCJW MOHi' USIAD X'-'< I> Hue ObfGyn Coosullanl to 8.!ISISI I U1 the d~etopmentor the nx """ ~ D. Development of Humu Re.rour~a - I E.stabbslt Tr.urung Task Force xxx 2 Re\1ew eiusung Cllmcula and New Protocols lln 3 Re\ltw results of SA!TNN£'D Xltlt " Adapt. dc\.-clop and rma1u.cen Ttatrung XX.'l Cumc:uJa• """ .S T 0 T for OB, OP, and Nurses• 'UX ~ 16 frillnlfl8 for sel'VJcepro"ulers 'OCX 'Ut.~ 17 Develop RH Newsleller Ongoing 8 Dntnbure une mue e'\-ery4 monlhs Ongomg

C. l>upporl Medical Scboob 11ad Organla/1ons I I Protocols Traintog curric:ula and other educabonal IJldlenaJs \Hll be gn-en lo selected medical schools 'I\ 1uch ptrttapaic in the de\dopment of these matenals On 80ID3 2 Encouraget1lc plm;u:1us' asscaatlons to in. MC actmttesbe mvolved On going l Ncab ussessmen1 for rev1AOnor acacdrt.ut1onloertdir.at1on procedwr:; ~ xn 'LU

~ ( " (

... , -- ' ..j::>. MOTHERCARE II MotherCare II Guatemala - Maternal and Permatal Health Pro1ect Proposal for E\.pan~wn and Workplan for MotherCare II, Phase 11

I Overvie" Maternal and Permatal Health m Guatemala

Guatemala has the third highest maternal and mfant mortahtv m the Americas after Bolivia and ~ - Ha1t1 The maternal mortality ratio is estimated at 240/100,000 hve births, the mfant mo11aht\ rate is 5111000 hve births with higher rates m the rural highlands (UNICEF 1996) and a neonatal mortalit) rate of 16 7 per I 000 In e births (WHO 1996) Guatemala has an mstltut10nal cap..iLlt\ to provide maternity care for approximately 20% of the women leavmg the tradrnonal bnth attendant (TB As) as the primary provider of maternal and newborn care covermg 60-70% of all births and over 90% m the rural areas

A Summary MotherCare I Interventions and Results

MotherCare has been work.mg m Guatemala smce 1990 MotherCare I USAID supported project ( Tulv 1990 - August, 1993) was implemented through INCAP (lnst1tuto de Nutric1on de Centro i\merica y Panama) as a demonstration project to further diagnose problems 1elated to maternal and permatal mortality and morb1d1t1es and to test mtenent1ons along the P.:tth\\av to Sunn al for the mother and the ne\\ born The MotherCare I project site \\as lo<..ated m Quetzaltenango health area with an estimated population of 165 000 The project" a!:> designed to improve quality and access of maternal and neonatal sen ices provided m the commu111t1es th1 ough the TBAs and the health centers and district hospitals b" phys1c1ans and nur!>es Inten ent10ns at the health services level mcluded the development of protocols for use at hospital health center and health post to manage obstetric and neonatal comphcatlons This mtervent1on was complemented by an IEC campaign to sensitize providers to the cultural and trad1t1onal practices of the commumt), specifically, the woman her family and the TBA Over 400 TBAs were tramed to conduct clean deliveries and to recogmze comphcat10ns with timely and appropriate referral of woman with problems durmg pregnancy and with maternal and ne\\ born comphcat1ons durmg the mtrapartum and postpartum periods

Studies earned out under the Quetzaltenango Project assisted m the d1agnos1s ot the p1 obi ems ..is well as measurmg the outcome of the mtervent1ons (the commumty level - Vital Events Reportmg System, hospnal level - momtormg system for track.mg comphcat1ons and commu111t) referrals and medical audits of neonatal death~) The hospital studies showed a remarkable mcrease m the number of referrals (appro'\.1mately 3° o per\ ear) v.1th imphcation that this mcrease "Was pnmanly due to the improved quality at the hospital Also the reduction of neonatal mortality trom 38 3 m 1989 to 25 9 m 1991 was attributed to the 1mpro\ement of neonatal services through the arnval of a neonatolog1st and the use of the neonatal protocols

115 The MotherCare I Quetzaltenango Maternal and Neonatal Project provided the M1mstn of Health with a viable program design for 1mplementat10n m other health areas 111 the A..lt1plano

B MotherCare II Objectives and Interventions Support of USAID Strategic Ob1ect1\ CO\ and MOH National PrlOntJes

Subsequently the MotherCare II project e".panded its focus from a demonstration project to a national strategy with project mtervent10ns occurrmg m four health areas 111 the Altiplano - Solola (50%ofthe mumc1pahties) San Marcos (25 % of the mumcipahtres) Totomcapan (100% mumcipahties) and contmumg m Quetzaltenango (100% mumc1palmes) The MotherCare II project max1m1zes lessons learned from the MotherCare I demonstrat10n project as applied to national pnont1es to reduce maternal and perinatal mortaht1es and morb1d1t1es The p1oject also suppo11s USAID Guatemala Results Frame\\ork directed towards the Strategic Objective - Better Health t01 Rural Women and Children

In support of this Strategic ObJectn e US AID has identified three Intermediate Results and subsets under each (see Attachment 1 for the USAID Results Framew01k) -

• Intermediate Results 1 - More rural fmmhes use quality maternal child health sen ices • Intermediate Results 2 - Maternal-child health programs are well managed • Intermediate Results 3 - Stronger Guatemala commitment to maternal-child health

The MotherCare II project objectives pnmanly support the subsets under Intermed1.ite Results I \\1th support of select subsets under Intermediate Results 2 and 3

MotherCare Objectives -

1 ~trengthen essential obstetric care and permatal health care sen ices through commurnt\-bast-d trammg ofTBAs to 1dent1fy and refer women and newborns with complications and through the application of obstetric and neonatal protocols and trammg courses to upgrade skills and knowledge of health providers (general physicians nurses au'\1hary nurses) at health posts health centers and hospitals m managmg essential obstetric and permatal care (IR 1 2 1 3) as well as through the mitiat1on and use of facility data from the morntormg system mamtamed at the area hospitals and health centers (IR 2 4)

2 Increase' the knowledge of the commumty regardmg obstetric and perinatal problems with appropriate actions m the event of these complications through a commumty-based IEC strateg" to mcrease demand and appropriate and timely use of services (IR I 1)

3 Increase acceptability of obstetric and permatal health services by 1mprovmg mterpersonal commumcat1on skills (mteractions and counselmg) between the providers and clients and by refocusmg the obstetric care m three hospitals to make sen ices culturally appropriate services (IR 1 4)

116 ..+ Support commumtv mob1hzat1011 for the establishment of demonstration communlt\ matemlt\ centers 111 the 3 health areas for commumtv access to prenatal mtrapartum (normal dell\ eries) postpartum services provided bv local TB A..s and nurses and resident phvsicians (IR l 2 l 3) and to actively mvolve the commumty m decision- mah.mg m creat10n and support of the comm unit\ matermty centers (IR 2 3)

5 Support the MSPAS m the Development of National Pohc1es and Actions m Maternal and Permatal Health through the development of protocols for the management of obstetric and permatal comphcat10ns m three health areas and the d1ssemmat10n of 111format1on through nat10nal and local semmars (IR 3 3)

C Rat10nale Contmuat10n and E\.pans10n of the Objectives of MotherCare II durmg Phase II

The two year project/phase I held meetmgs and work.shops to dissemmate mformat10n and promote awareness of the maternal health care cond1t1on by local and central level health personnel The results of these work.shops and meetmgs mcluded an agreement bet\\-een the MSPAS and MotherCare about the Maternal and Permatal Health mtervent1on Active part1cipat1on and commitment from local health personnel v. as evident dunng the length of the two year project Hospital doctors and nurses were responsible for momtonng and documentmg maternal mortality Three of the four mtervent10n hospitals established a momtonng svstem designed with the assistance of MotherCare The four hospitals completed a Hospital Maternal Mortality Study \\1th MotherCare assistance which created av.areness of their maternal health cond1t1on

P1otocols for the Management of Obstetrical and Permatal Comphcations developed .md published bv the Quetzaltenango Project (MotherCare I), were re\ 1e\\-ed revised and adopted bv eight health areas and eight hospitals (four m MotherCare mtervent10n areas and four 111 the European Commumty mtervent10n areas) The revised version of the protocols mc..ludes Familv Plannmg Anemia and Interpersonal Commumcat1ons The protocols also received the tech1m.... il support of the Guatemalan Obstetrics and Gynecology Association

An 1mtial situational anal) sis was conducted to asses the mterest of the Health Areas to part1c1pate mto the mterventlon, and describe their s1tuat1on Results of the S1tuat10nal Analys1~ sho~ed limited human and material resources m hospitals deficiencies m trammg Jach. of essential obstetric care and lack of an mformat1011 svstem Most ot these problems were addressed durmg the two year mtervent10n Consohdat10n and establishment of the momtormg system protocols for management and m-serv1ces trammg are the challenge for the ne'\.t eighteen months

At the Health Centers and Posts an mventory of obstetrical and neonatal capacnv \\as conducted by the health personnel themselves, with the assistance of MotherCare It was earned out m 96 health services mcluded m the proje~t mtervent10n This

117 mventon showed that se'\eral health sen ices dtd not have the m1mmum baste equipment for maternal and permatal care therefore basic eqmpment '\\>as provided onlv to those services that needed 1t mcludmg sphygmomanometer stethoscope fetoscope metnc tape and suction pump

Trammg was conducted for health personnel m charge ofresolvmg maternal and perinatal problems at all levels of care Before trammg a pretest quest1onna1re was adm1mstered to most health providers tramed Results of the pretest sho'\\-ed that all health personnel grades were below 60 pomts (total was 100) In general the highest grades corresponded to physicians, followed by profess10nal and au\1hary nurses

Trammg m maternal and perinatal health addressed the mam comphcat10ns durmg pregnancy dehvery, postpartum and m the newborn plus breast feedmg fan11ly planning and anemia Trammg also mcluded Interpersonal Commumcat10n which addresses commumcat1on and mteract1on with patients, sociocultural bamers, referral and counter referral and quaht) of care

Qualitative research on knowledge attitudes and practices regardmg maternal and pennatal complications was camed out m eight Mm-an rural commumt1es \\'omen husbands and TBAs consistently showed a lack. of knowledge regardmg particular comphcat1ons such as malpresentat1on, premature rupture of membranes and prolonged labor It was found that men are the dec1s10n makers particularly for referral and TBAs most frequently attend women wtth any problems related to pregnancv delivery and postpartum Several recent cases of maternal mortality m the commumt1es were documented as well as factors affectmg the ut1hzat1on of MSPAS emergency services such as access1b1hty economic cons1derat10ns soc10cultural barriers perceptions of quahtv of care and actual quaht\ of care Fmallv appropriate commumcat1on channels to reach Mayan rural populat10ns were identified and recommendations were made on 1mprovmg maternal and neonatal health and estabhshmg commumty matermt1e<>

Based on the results of the research the MS PAS together with MotherCare staff 1dent1fied 1d1. .. tl behav 1or which should be adopted by the commumty and health personnel The ideal behav101 forms the basis for the IEC mtervent10n

MotherCare expects that at the mstltut1onal level, the IEC strateg) \\Ill contribute to the improvement m the quality of interpersonal relations m prenatal delivery postpartum and neonatal health services m selected health centers and hospltals The strategv mcludes refresher trammg on interpersonal commumcat1on usmg d1scuss1on gmdes regardmg bamers to referral and ut1hzauon of services for obstetric and neonatal emergencies Also 1t considers the establishment of a remforcement system to reward improvements m quality of care espec1Jlh regardmg mterpersonal relations and the mformat1on gn en to users

The commumty strategy mcludes act1v1t1es aimed at TBAs pregnant \\Omen and their husbands The strategy \Nill encourage TBAs to refer ma timely manner \NOmen \\Ith comphcat10ns or

118 'danger signs" durmg pregnanc\ dehveI) the postpartum and of ne\\

Seveial materials were developed tested/validated and are bemg unplemented Posters of" 10 Golden Rules" D1scuss1on gmdes regardmg bamers to referral Fhpchart with "danger signs" Pictorial referral forn1 for TBAs Book with pictures of "danger signs" Radio spots for mass communication on "danger signs"

The 1mplementauon of the IEC strategy is still m progress and will be completed durmg the 18 month extension, as well as other components of the mtervention

Lessons learned from "Phase I of MotherCare II as well as a changes m operational emphasis and mfrastructure by the MSPAS Maternal and Cluld Health DI\ 1s1on JUSt1fies the contmuat10n and e\.pans10n of MotherCare II mtervent1ons

The MSP AS mamtams the nat10nal pnonty to reduce maternal and mfant mortality b) 50% b\ the vear 2000" and is committmg 50% of the public sector budget to preventative health care This 1s also mcluded m the Peace Agreement recenth signed bv the Government ot Gudtemala and the msurgents To this end MSP AS is underscoring decentralization of services to the health areas m the effort to provide basis health sef\ ices to 100% of the populat1on e'\tendmg mto the rural commumt1es The restructurmg of the mfrastructure proposes to e'\tcnd health services through a comprehensive network of health personnel and commumtv volunteers The empha~1<> of this restrw.. tunng 1s two fold - to mcrease commu111t\ respom1htlm m deu<,1011- maJ...mg and at the same time strengthenmg quality and access of sen ices to the commumty In support of the national pnonties and mfrastructure focus, MotherCare II, Phase II 1s posed to support MS PAS m preparatory act1\ 1ties spec1ficallv w1thm the areas of health prO\ 1der tram mg and commumty education and mobd1zat10n The design of the MotherCare II, Pha~e II proJed mterventlons takes mto cons1derat1on the pnont1es and need of the MS PAS and is ba'>ed upon lessons learned from project 1mplementat1on of MotherCare II Phase I The lec;som. learned and specific results from MotherCare II, Phase I mtervent10ns will be detailed m a final report to be submitted m December 1996 at the complet10n of MotherCare II Phase I Thus this document mcludes only a prehmmarv anecdotal summary of lessons learned m the areas oftramm!!. IEC community mob1hzat10n and momtormg plan

Trammg

• the level of knowledge m management of obstetric and perinatal comphcat1ons for doctors and nurses 1s lov- and even lower for nurse au'\1hanes • health personnel, hospital directors and chiefs of health areas actively suppo1t the project through part1c1pat1on m trammg and the use of facility based data from the hosp1td.l

119 momtonng systems • theoretical protocol onentat1on for phys1c1ans at health area hospitals md1cated the need for an addit10nal competencv-based trammg course to manage obstetric and perinatal cases accordmg to these protocols • through an e\aluat1on conducted m collaborat10n \\1th Project Hope It \\as obsen ed that nurse aux1hanes at health centers and health posts have a lo\\ level of J...no\\ ledge m the management of obstetric and permatal comphcat1ons, • TBAs have v01ced a desire to mclude afocus on maternal anemia prevention and treatment • TBAs are key to 1dent1ficat1on and referral of obstetric and ne\\ born problems m the commumty

Commumty Mob1hzatton

• Motnatmg commumties m two health areas to create and mamtam commumt} matermt1es has yielded positive results However we are look.mg for st1ateg1es to improve the use and demand of services which will reqmre considerable support fi om project staff

IEC - Conmmmty D1agnos1s findmgs

• women recogmze TBAs as their support durmg delivery, • women, men and TB As recogmze the usefulness of services 111 the event of complications • despite recogmzmg the importance of the services several barriers e,..1st \\lh1ch impede use such as language shame fear of death, madequate quahtv of services • some comphcat10ns, such as prolonged labor are not recogmzed as problem::. dunng pregnancy

Momtormg

• health personnel are mterested m collectmg and usmg mformatton • completmg the momtoring form and anal) zmg the data reqmres add1t1onal techmcal assistance from project staff • use of mformat1on from the momtormg system is very useful m problem 1dent1ficat1on and 1mprovmg the qualnv of services

II MotherCare II, Phase II Project M1ss1on ,md Goal

A Project Goal To contmue to assist the MSPAS to decrease the maternal and perinatal morb1dny and mortality m Guatemala

120 The project goal will be addressed through objectn es designed to increase the quaht\ ot reproductive services at hospitals (basic and essential obstetric care and perinatal care) and health centers and health posts (prenatal care recogmtton of problems postpartum fanuh plannmg) and to increase the demand, use and access of the services bv the commumtv

B Project Objectives

The project objectives are categonzed bv Service Objectives Demand/Use ObJeCtJ\.eS Pohc\ Objectives as follows

Service Objectives

1 Improve the quahty of maternal and perinatal health m 4 target Health Area hospitals 2 Strengthen hospital level matermty staff in 4 target Health Area hospitals and health centers to collect, analyze, and use registry data 3 Strengthen and impro' e the quality of integrated reproductive health sen ices for pregnant and post partum women at target Health Are.a health centers .and posts

Demand/Use Objectives

4 Increase use of hospital services for women \Hth comphcated dehver1es and ob~tetnt .ind perinatal comphcat10ns occurrmg during the prenatal and postpartum penod'I 5 lncrea11e use of postpartum f.am1ly planning at target He.ilth Area health ct.nter~ .md hospitals 6 Increase hou11ehold and commumtv partlc1patlon in addressing problems rcl.1tt.d to reproductive and perinatal health through community mob1hzatlon efforts

Pohcy Objectives

7 Strengthen the capacity of the MS PAS and the Health Area staff to 1mpro' c the qu.1ht\ of maternal and perinatal health m the target Health Areas

C Location of Project and T .arget Audience

TheJJrOject strategies and studies will continue to be implemented m the same four Health Areas m the Altiplano with an mcrease in populat10n covered m certam Areas - QuetzaltLn •.mgo ( 1OO°;a of the mumc1paht1es) Totomcapan (100% of the mumc1pahties) Solo la ( 100% of the mumc1paht1es) and San Marcos (50 of the mumc1paht1es) 1 The target audience \.\ill mclude hospital staff, health center and health post staff lPh) s1uans nurses and nurse au.,.1h.mcs) and

1The poss1b1hty exists that if the Mm1stry requests it the project may pro\ 1de mm1mal support to Ch1maltenango

121 commumues (women, fam1hes, commumtv members mcludmg TBAs)

D Length of Project

MotherCare II Phase II will begm m January 1996 and will continue through Juh 1998

E Project Focus and Major Project Components

There will be a shght shift m project focus from MotherCare II Phase I to Phase II e\.pandmg reproductive services to community and forging commumcat1on 11111.ages between the commumty and health personnel at hospitals, health centers and posts

Durmg Phase II, MotherCare will ma\.m11ze experience gamed through work.mg with the commu111t1es to create and mamtam community matermt1es to promote further commumt\. mvolvement respons1b1hty by enablmg women/commumty groups to identify and address problems ofreproductlve health permatal and mfant health To tl11s end 1t 1s env1s1oned that commumt1es will be mvolved m such acuv1t1es as anemia control and treatment strategies such as iron folate d1stnbut1on schemes, partic1pat1on m commumt1-based permatal audits and community-based family planning activities

There will also be an e\.pans1on of trammg focus Durmg Phase I the trammg empha::.1s was on preparmg TBAs (2000) to conduct safe dehvenes and newborn care and to recogmze comphcat10ns and refer to hospital In Phase II, more emphasis will be placed on in-service trammg of hospital and health center staff The protocol trauung given to health personnel during Phase I underscored the need and desire on the part of health staff for add1uonal practical trammg Thus, under Phase II competency based-trammg is planned for hospital staff m managing basic and essential obstetnc and pennatal care, by capac1tatmg a network. of health area trainers (physician and nurse teams from health areas) Select hospital staff will also be trained to collect, analyze and use data from the hospital registers m assessing quality of obsteu IL and perinatal case management Trammg is also planned to upgrade nurse and nurse au'\1har:y sJ...11ls m prov1dmg mtegrated reproductive health services at health centers/posts

Project components include

Tra1pmg (IR I 2, I 3)

• Trammg of Tramers (TOT) course for master trainers (phys1c1an/nurse teams health area hospitals) to tram physicians and nurses m obstetnc and pennatal chmcal management and IPC sk1Ils), • Trammg ofTramers (TOT) course for master tramers (nurses) to tram nurse~ and au\.1hary nurses at health centers and posts to provide comprehensive prenatal care and postpartum family planning sen ice,

122 • Specialized Trammg course for immediate postpartum services for hospital ph\ s1cians • Integrated Reproductive Health Services at health centers and community \\-Ith mclus1on of family plannmg counselmg and serv 1ces anerma control and treatment • TBA trammg - refresher and new courses, • Curricula development mcludmg e\ a!uat1on frameworl-. - for pb\ s1cians nw ~es and am..ihary nurses, • Trammg Course for hospital phvs1c1ans m data collect10n analvs1s use

IEC/C and Commumty Mobilization (IR 1 l 2 3)

• Commumty-based IEC/C act1v1ty, • Commumty mob1hzat10n acuv1t1es, mcludmg implementation of autodiagnos1s process among women s /commumty groups, anemia control and treatment schemes and promote establishment of commumty matemltles, • Data collecuon and analysis trammg skills for hospital physicians

Health Area Capac1tv-Bmldmg (IR 1 2 1 3)

• D1ssemmat10n of Informat10n and Techmcal Meetmgs for policy makers commumtv members, medical assoc1atJons at central and health area levels

Commumty-Based Studies (IR 1 4)

• Studies- Pennatal Audit, Prenatal Cookie Iron Folate D1stnbution

D1agnost1cs (IR I I I 3)

• Trammg Needs Assessment for each trammg course - hospital and health center and post courses • S1tuat1on Analysis for Family Plannmg Service Readmess • Commumty-based Autodiagnos1s among commumtv womens groups

F Momtormg and Evaluataon Plan

A momtonng and evaluat10n plan is under development however the plan will momtor and evaluate mputs and outputs at all levels of the project m the fours health areas - from fac1hty to commumty levels (see Project Objectives and Indicators Matn\. ) While the mtervent1ons will be nnplemented m the four Altiplano Health Areas - Quetzaltenango, Totomcapan Solol.i San Marcos, the momtonng and evaluation data v.. 111 be rnllected from select mumc1paht1es v...1thm each health area, specifically Momostenango mumc1pahty m Totomcapan, Com1tanc1Jlo mumcipalny m San Marcos, Nahuala mumcipahty m Solola, San Carlos S1ja mumc1pahty m Quetzal tenango

123 The momtonng data will be collected from the dehven reg1stnes m the four Health l\rea hospitals and the- reg1stnes m the Health Centers The reg1stnes- ~ill provide such mformat1on as case fatality, use complications seen referral and other data) These registries \\ill provide momtonng data from the faciht1es throughout the hfe of the project

Commumty-based outcomes of the IEC/C and community mobilization actl\1t1es will be captured through the registries as well as possibly through obsen at10ns and mdn 1dual mten 1ev. s with women and families Two cross-sectional studies will be 11nplemented to p1ov1de pre and post mt en en ti on mformat10n from use1 s of sen ices regarding their exposu1 e to the d11ferent 111tervent10ns and their knowledge and practices

Prelnmnary thmkmg includes research activities to complement the evaluat10n acuvtt1es Add1nonal possibiht1es mclude

• Assessment of the dehverv S) stem and b1olog1cal impact of anemia control and pre\ ent1on • Mom tor compliance and impact of iron supplementat10n • Determme the reach and recall of the vanous IEC act1v1t1es (mass media punted matenal, preriatal c:i.re cou11selmg), and • Investigate TBA practices advice and counselmg given during pregnancy and dclner) acceptab1hty and effectiveness of rece1vmg iron from TBAs, and issues related to the use/referral or non-use of sen ices

G Staff

The techmcal and geographic focus and anticipated results of the mten ent1ons m Ph.ise II necessitate an mcrease m the techmcal quahficat10ns and capab!lrnes of the full-time Mothe1 Care staff Specifically, 1t 1s proposed that MotherCare II augment the full time techmcal staff to mclude a Trammg Advisor, an IEC Advisor and a Momtormg and fa aluat1on Advisor These advisors will work under the superv1s1on of the MotherCare II Project Coordinator (::.ee Attachment 3 for the Job Descnpt1ons of the three advisors) and will prov 1de techmcal assistance to the Health Area staff and the Health Area Coordmators based m the health areas Due to tht. volume of trammg and momtormg/evaluatJon act1v1t1es, 1t 1s ant1c1pated that the Trammg and the Momtormg Advisors will be based m the Health Areas Because of the volume of IEC materials to b~ produced centrally 1t 1s ant1c1pated that the IEC Ad' isor will be based m Guatemala City tra\ ehng to the areas to provide techmcal assistance and support Smee all techmc.il mtervent1ons will be implemented m the Health Areas 1t 1s ant1c1pated that three Area Coordmators will be needed to momtor all mtervent10ns m their areas Further one Area Coordmator should function as a ""deputv to the Project Director responsible for oversight of acuvmes m one area and coordmatmg acuvmes and mformat1on commg from the other Areas Coo1dmators The assignment of Health Area sites for each of the three Area Coordmators will be detenmned

124 Also the decentralized focus of the MotherCare II Phase II v.11! reqmre mamtammg the Quetzaltenango office This office will service as headquarters" for all Health .\.rea act1\ mes

H Results/Sustamab1hty

MotherCare II, Phase II will contmue to support the USAID Results Framework. as detailed m this report (I B MotherCaie II Ob3ective and MOH National Pnonties) Dunng Phase II, MotherCare will focus on p10vidmg results which v. ill lead to improved quality care at the community level as well as at health facilities ne\\ approaches m the dehvery of care that will increase coverage and access improved program plannmg through greater use of data greater awareness at the household level of comphcations and appropriate actions mcreased community dec1s1on-mak.mg and wider dissemmation of maternal and permatal issues at the pohcy level

The quality of maternal and permatal services '-Viii be improved m the four hospitals of the target areas through competencv-based clinical and IPC trammg of personnel b\ cm rymg out a s1tuat1onal analysis to assess current needs and changes smce the s1tuat10nal analysis implemented m Phase I bv assessmg J...nowledge of protocols to determme future trammg needs and by promotmg the mtegration ofreproductn,e services By strengthenmg the hospital and health center data collection system MotherCare will leave m place a sustamable mformation system to be used to mfoi m and assist m program management and plannmg Increased av.areness of comphcauon::, and use of services by women with comphcat1ons v. ill result from IEC activities and further trmnmg and emphasis on referral for TBAs and health center/post personnel By promoting the 111tegrat1on ofreproducme health services at the health center/post level and at hospitals there will be an mcreased use m postpartum family planmng The use of a community-based distn bu ti on strategy for iron sulfate v. ill mcrease coverage and access of services as well as increase community part1c1pat1on m dddressmg problems Fmally a senes of work.shops and meetmgs targeted at Mm1::,try personnel to dissemmate protocols stud\ findmgs and IEC materials will assist policv mak.ers to make more mformed decis10ns

I Collaborat10n Efforts

MotherCare II will contmue to collaborate with other agencies work.mg m Guatemala ma)l..imizmg lessons learned m the provision of reproductive health services and m des1gn111g trammg and IEC/C matters Specificall) MotherCare will consider collaborat1011 \\1th the Populat10n Counsel A VSC and the Reproductive Umt MSPAS to incorporate familv planning counseling and services mto the package of reproductive health services Also MotherCare v. ii I consider formats developed by others which potentiate distance learning

MotherCare will also collaborate with BASICS m conducting the community-based permatal audit and m m1t1atmg community mob1hzat10n activities m the same Health Areas m order to

125 f compliment each others etforts -- MotherCare v.. Ill address the maternal and pen natal issues while BASICS will address cluld survn al With respect to the latter MotherCare will also e>..plore the opportumues to work \\Ith NGOs m commumty mob1hzat1on act!\ 1t1es

Fmallv MotherCare ant1c1pated collaboratmg v.1th INCAP m the 1mplementat1011 ot the pren

III Pro1ect Interventrnns, Indicators and D.ita Collectrnn

Service Level Ob1ect1ves

Ob1ect1ve 1 Improve quahf) of matemal and permatal health services 111 four tm get Health Area Hospitals

Intervent10ns

• Conduct a Trammg Needs Assessment to test the knowledge of the protocols and 1dent1f\ sk.1lls for competency based trammg (Phvs1c1ans Nurses Au'\ Nurses) • Conduct a s1tuat1onal analvs1s m four areas for FP m hospitals and health center~ • Conduct m-serv1ce competency based Tra111111g of Tramers (TOT) (2 Phys1c1ans and I nurse from 3 Health Area Hospitals) • Develop hospital cumculum -- mcludmg chmcal IPC and tra1mng sk.1lb • Specialized trammg m postpartum family plannmg for hospital pin s1c1ans ( m collaborat10n Umdad Salud Reproduct1va and A VSC) • Conduct trammg 0 Hold group meetmgs with hospital staff and commumty representatives to review and share advances, bamers, etc

Descnpt10n of the mterventlons

This objecuve focuses on 1mpr0\ mg services and prov1dmg sk.1 lls at the hospital le\ el To m1tiate this act1v1ty, MotherCare ""111 conduct a trammg needs assessment of phvs1cmn~ and nurses m hospitals m Solola, Quetzaltenango Totomcapan and San Marcos to determme obstetnc, postpartum fam1lv planmng and permatal chmcal skills T\\O doctors and one nurse from each of the hospitals v. Ill be tramed as tramers at the referral Roose\ elt Hospital m Guatemala City The trammg v.11! mclude obstetrical and permatal clm1cal sk.11ls, IPC and u am mg sk.1lls

A s1tuat1onal analysis will also be conducted to assess the readmess of hosp!talc;; F::urnly plannmg sk.11ls trammg for the unmed1ate post partum (IUD and LAM) v.. Ill be prepm ed m collaborauon with the Rep1oduct1ve Health Umt of the M1111stry of Ht!alth and I'\ VSC

Group meetmgs will be held brmgmg together hospital staff and commumty representatives to

126 reflect upon the quaht) of sef\ ices bemg provided and identify e>..istmg barriers and share information on reproductive health These meetings will be held to sensitize the hospital as well as create a dialogue between service providers and the commumt)

IEC efforts for this objective mclude the promotion of the 'mother fnendlv hospital through the use of the '10 golden rules poster trammg m IPC 1dent1ficauon and recogmt1on of b1hngual personnel at the hospitals

INDICATORS FOR OBJECTIVE I INPUTS OUTPUTS DATA COLLECTION FREQUENCY OF SYSTEM COLLECTION

No of hospitals and % of\\omen v.ith Chart reviev. centers with protocols hospital delivel"\ read1lv available Hospital registries -- °to of hospitalized women No of phvs1cians nurses '~1th complications Peer re\ 1ew and au>.. nurses successfully tramed m % of deliveries monitored Case review obstetric care, perinatal with the par•ograph care IPC PPFP Observations % of women with C- No of trainers prepared section Pre-post test trainees to tram in skills according to competency based % of women with curriculum complications correctly managed at hospitals No of phys1c1ans trained to provide PPFP at % of women using PPFP hospital level before leaving hospital

No of meetings held to Case fatalnv rate for share information from women momtormg system client barriers etc Case fatahtv rate for newborns No of maternal and perinatal deaths at Perinatal mortahtv rate at hospitals hospital •

127 Ob1ect1ve 2 Stre11gtlze11 lwsp1tal and lzealtlz ce11ter staff mfour target Health Area lwsp1tals to collect, analyze a11d use reg1Stry data

Interventions

• Tram select hospital staff m collection analysis and use of data collected from hospital momtormg forms

Descnpt1on of the Interventions

MotherCare II Phase I developed a momtormg form for use by hospitals and health centers to momtor hospital and health center delivery care and outcome Hospitals and health centers m the MotherCare intervention Health Areas are presently collectmg data utihzmg these forms MotherCare Guatemala contmues to momtor the collection of data by the services and is ass1stmg the hospitals' staffs ability to analyze and use the data to improve their services Doctors at the hospitals hold penod1c meetmgs with the assistance of MotherCare Guatemala staff, to review the data and discuss cases and quality of services

Durmg Phase II, MotherCare will htre a Momtormg and Evaluation Advisor to develop trammg cumculum The Advisor will work closely with hospitals m the four Health Areas and health centers m the three demonstration mumc1pahties to tram staff to enter and analvze the data and mcrease staff capability to sustam this system

INDICATORS FOR OBJECTIVE 2 INPUTS OUTPUTS DAT A COLLECTION FREQUENCY OF SYSTEM COLLECTION

No of staff trained to % of hospitals correctly Hospital reg1stnes maintain analyze, use completing momtormg data from reg1stnes (registry) form Case review meetmg

No of meetings held to % hospitals usmg data m discuss use and findings problem solvmg from data

128 Ob1ect1ve 3 Strengthen and improve tlze quality of mtegrated reproductive lzealtlt services for pregnant and postpartum women m target Health Area Jzealth centers and posts

Interventions

• Trammg Needs Assessment HC/HP staff • Develop Curnculum for nurses and auxiliary nurses at HC/HP • TOT for HC/HP staff m prenatal care obstetric comphcat10ns detect10n and referral, anemia control, FP counseling • In service trammg (5 days) for aux nurses from HC/HPs m 3 demonstration mumc1pahues - mcludmg anemia, prenatal care post partum FP and obstetnc complications detect10n and referral • Case review with TBAs • Tram HC/HP staff m data collect10n from health center momtormg forms

Descript10n of the Intervent10ns

MotherCare II Phase I conducted an orientation for HC/HP staff m use of the protocols for management of obstetric complications Dunng Phase II a trammg needs assessment will be conducted of nurses' and aux nurses' knowledge ofreproductive health (prenatal care detection or obstetric comphcat1ons, FP, and anemia) Based on the results a TOT will be conducted followed by the development of an m-serv1ce trammg curriculum for reproductive health and IPC Staff from select mumcipahties will be tramed In addit10n, IEC materials will be developed and distributed focusmg on prenatal care, obstetric complications and post partum faimly plannmg

In add1t10n, HC/HP staff will periodically meet with TBAs to conduct case reviews and assess the quality of maternal and permatal care bemg provided by the TBAs

Staff will contmue to collect data on the health center momtormg form with technical assistance from the Momtormg and Evaluation Advisor

IEC activities related to this objective mclude developmg a "maternal child health package" to be used by service providers durmg prenatal care visits The package will provide mformat1on which should be shared with the patient related the prenatal v1s1t

129 INDICATORS FOR OBJECTIVE 3

INPUTS OUTPUTS DATA COLLECTION FREQUENCY OF SYSTEM COLLECTION

No ofHealth % of women receiving HC/HP registries Center/Health Post prenatal care personnel trained (nurses Observation of IPC au>. Nurses} in % of change in facilities reproductive health providing FP lnd1v1dual interviews (prenatal care obstetric care anemia FP % of women rece1vmg a MSPAS HMIS reports newborn care) and IPC complete dose of iron

No of women attend mg % of chents referred to at least one prenatal visit hospital for comphcat1ons by trained personnel % of women referred bv No ofHealth TBA Centers/Health Posts offering comprehensive % of pregnant women prenatal service FP receiving at least one anemia breast feeding prenatal visit b.} trained and counseling personnel

No of comphcat1ons referred to hospital

No of women receiving complete dose of iron

No of HC/HP staff trained to maintain registers

No of referrals by TBAs to HC/HP

130 Demand/use Ob1ect1ves

Ob1ect1ve 4 Increase use oflwspltal services for wome11 witlt complicated de/1venes a11d obstetric and 11eo11atal co111p/1cat1011s occurrmg durmg the prenatal and postpartum pe1 wc/r;

Interventions • Commumty-based IEC materials development and use • Client Counseling and Education • TBA evaluat1on • TBA training Course to recognize and refer complications (refresher and new course) • Training course for Health Center nurses auxiliary nurse • Traming for health post au\.Il1ary nurse

Description of Inten ent1ons

These activities are aimed at the community and v. Ill focus on mcreasing the u~e of hospitals tor comphcat10ns durmg pregnancv labor and delivery and the postpartum period A community based IEC campaign will be launched including various materials for use by TB As health center/post staff as well as materials for community and family education Materials will provide mformat1on for service pro\ 1ders (includmg TBAs) to detect and refer comphcat1ons ma timely manner In addition providers will receive traming in interpersonal commu111cat1on mcluding counseling m prenatal care family planning and detect10n and referral of comphcauons

The TBA trainmg conducted to date will be evaluated at the mmation of Pha~e II act1v1t1e~ Based on the findings of the evaluat10n the training will be revised and refresher trammg will be provided 1f necessary Add1t1onallv since MotherCare will e\.pand activities to co\ er all of Solola and 50% of San Marcos TB As not prev 10usly tramed will receive traming

HC/HP staff will hold penod1c meetings with the TBAs to discuss reasons for referral This v. ill provide an opportunity for Nurses Au\.1hanes and TBAs to rev1ev. TBA cases and the reasons they had for referral of cases to the health services

IEC. the IEC strategy developed dunng MotherCare II Phase I for mcreasmg the knowledge about danger signs durmg pregnanc\ and anemia will be fully implemented durmg Phase II

131 INDICATORS FOR OBJECTIVE 4 INPUTS OUTPUTS DAT A COLLECTION FREQUENCY OF SYSTEM COLLECTION

No of !EC act1v1t1es °to of women with Hospital registries carried out m the comphcauons managed at community the hospital e>.1t mterv1ews

No of materials % of women hospitalized Observe client counsel mg distributed with comphcat1ons referred by TBA family No ofTBAs evaluated self and trained % ofTBAs who correctly No of comphcat1ons describe the appropriate referred to hospital for action for compltcauons prenatal and PP compl1cat1ons by TBA and fam1I)'

132 i Ob1ect1ve 5 Increase use ofpostpartumfam1/v pla1111mg at target health Areas health center!. a11d lzosprtals

Interventions • Specialized training for physicians m collaborat10n \Vlth Reproductive Health Umt and AVSC • AU\.1hary Nurse trainmg for prenatal counseling and postpartum counseling and sen ice~

Descnption of Interventions

MotherCare will integrate family planning act1vltles mto Its pack.age of mtervent1ons As part of the trainmg planned for hospital staff, MotherCare '-Vil! Include post partum fanulv plannmg m the competency based cum cul um (Objective I) Specifically postpartum methods will be the focus for hospital levels mcludmg postpartum IUD and LAM Tlus component v. Iii be developed in collaboration v. Ith the Umdad de Salud Reproductiva and A VSC who are presenth prov1dmg trammg m post partum family planning methods

At the health center and post level, nurses and nurse aux1hanes will receive tram mg m prov 1dmg family plannmg counseling durmg prenatal care and postpartum v1s1ts An mventory will be conducted to identify all counselmg and trammg materials which currently e\.1st m-countrv on fmmly plannmg

INDICATORS FOR OBJECTIVE 5 INPUTS OUTPUTS DATA COLLECTION FREQUENCY OF SYSTEM COLLECTION

No of women accepting % of women using post Hospital and HC records postpartum methods at partum and registries health center % of change in women lnd1v1dual mterv1ews No of women counseled usmg post partum contraceptives No of women rece1vmg FP counseling at prenatal % of women saying they services received counseling

..,.., 1.) .) Ob1ect1ve 6 Increase household alld commumty part1c1pat1011 m addressmg problems related to reproductive and permatal health tlzrouglt commumty mobzl1zat1011 efforts

Interventions

• Trammg women s groups to identlf) and address problems related to maternal and perinatal health • Trammg community groups to address problems of service access and drug (iron folate) and family planning commodity distnbutton • Trammg for community promoters to carry out permatal audit (collaboration\\ 1th BASICS) • Carry out community-based iron d1stnbut1on scheme • Carry out community based prenatal cookie study (m collaborat10n with INC AP) • Community-based IEC matenals development and use • Client Counselmg and Education • TBA evaluation • TBA trammg Course to recogmze and refer comphcat1ons (refresher and new course) • Trammg course for Health Center nurses, au'\1hary nurse • Trammg for health post auxiliary nurse

This objective focuses on mcreasmg commumty mob1hzat1on MotherCare hopes to bmld upon the community committees established for the community maternities Usmg methods such as the autodiagnos1s process MotherCare hopes to mobilize commumt1es to establish local women s groups, local health comm1ss1ons or promote the formation of mother-child clubs at the community level to focus on maternal and family plannmg health and access issues

MotherCare will also conduct a commumty based permatal audit m collaborat1on with BASICS to determine perinatal mortahty and morb1d1ty rates In add1t10n, MotherCare will study the d1stnbut10n of ferrous sulfate through the TB As to pregnant women

134 INDICATORS FOR OBJECTIVE 6 INPUTS OUTPUTS DATA COLLECTION FREQUENCY OF SYSTEM COLLECTION

No of women s groups % of women self Reg1stnes established referring to health sen1ces Referrals No of self referrals to health center and hospital % of pregnant women taking iron supplement No of pregnant women Ind1v1dual interviews seen by TBAs receiving %of women with some iron knowledge of iron supplementation No ofv.omen with Ind1v1dual mterv1ews f...nowledge of iron % increase of !,.now ledge supplementation durmg regarding prenatal and pregnancy deliver. and postpartum sen ices No of women and men l,.nowledgeable about % l,.nowledge regarding quality prenatal and obstetric and perinatal delivery services comphcat1ons provided by health fac1ht1es % increase in knowledge of actions to tal...e

135 Pohcv Ob1ect1ves

Ob1ect1ve 7 Stre11gtlze11 MSPAS central and Health Area capac11} to improve tlte qualm of maternal and permatal Ilea/tit services

Intervent10ns

• National and Health Area Workshops and Meetmgs • National Indicators Meeting... • Informat10n D1ssemmat1on Meetmgs (momtormg data, study iesults) • D1ssemmatlon ofNat10nal Protocols • D1ssemmat10n of IEC Matenals • T echmcal Coordmat1on with Health Areas

In keepmg with the Government of Guatemala s desire to decentralize act1v1t1es, MotherCare will contmue to work with the Mm1stry of Health at the central level while focusmg efforts 111 the Health Areas Meetmgs will be held to brmg together health area staff and hospital staff to review and share findmgs from the act1v1t1es conducted m each area/mst1tut10n Add1t10nalh MotherCare will promote the mvolvement of Health Area staff as well as hospital staff m act1v1t1es to widely d1ssemmate their e'\.penences and lessons learned at a national level Health Area and regional levels

INDICATORS FOR OBJECTIVE 7 INPUTS OUTPUTS DAT A COLLECTION FREQUENCY OF SYSTEM COLLECTION

No of work.shops and No of Health Areas Reports of meetmgs held meetmgs held adoptmg protocols Hospital momtonng National Indicators (registry) forms meetmg held

No of technical meetmgs held with Health Area teams

136 JOB DESCRIPTIONS

137 Project Coordmator

The Project Coordmator will be based m Guatemala City and ~ill be responsible for all technical direction and project management She will oversee the implementation of the project strategies at the national MSP AS level and m the health Areas and communmes

This is a full time position ~h1ch calls for a combmat10n of techmcal and management/admm1strative skills Specifically the Project Coordmator should have a good understanding of Reproductive Health issues and strategies and have strong management and adm1mstrat1ve skills The Project Coordinator should also have an understanding of health mformat1on systems and research methodology

Dr Bocalett1 s respons1biht1es will include

• development of project strategy work.plan and budget for the hfe of the project • oversight and implementat10n of provider training, commumty based and clime based !EC/counseling and research strategies mcludmg materials development • coordinate and supervise the act1v1t1es of staff mcludmg all technical advisors and adm1111strat1ve staff, • promote partnerships with NGOs/PVOs and other donor and mternat1onal agencies • continue to coordmate and promote project activities with Mm1stry of Health personnel at the Health Area and Central areas • develop and provide oversight to the momtonng and evaluation component of the project • provide oversight for the techmcal and fiscal management of the project a::. well a-; the reports to MotherCare,/TSI, USAID Vv ashington and USAID Guatemala • contn bute to the body of h.nowledge of maternal and neonatal health issues through papers and presentations at local and mternauonal meetmgs and conferences

Qu.ihfic.it10ns

The candidate for this pos1t1on should be a phvsic1an with a strong understandmg about women <; reproductive health issues He/she should have strong management and admin1strat1ve sh.ills as v. ell a strong J...nowledge about research methodologies and understanding of hedlth mformatJon S) stems

In add1t1on this pos1t10n reqmres close collaborat1on with m1111str) of health personnel at both the central and health area levels Therefore, the candidate must possess the required sens1t1v1ty to manage poht1callv sens1t1ve s1tuat1ons The candidate must also be able to liaise closely with US AID staff as well as mternat1onal donors and agencies

138 IEC Advisor

The IEC Advisor will work under the supervision of the MotherCare Guatemala Project Coordmator The IEC Advisor v. Ill be located m the Guatemala Cn; office but v.1ll conduct regular visits to field sites to O\ ersee and monitor IEC act1vit1es He/She will undertake the followmg tasks and others as reqmred

• At the start of MotherCare II, Phase II the IEC Coordmator will submit to the Project Coordmator an annual workplan detailmg specific IEC act1v1t1es as descnbed m the MotherCare II Phase II Workplan and those pendmg complenon from Phase I of the project This work.plan v.-Ill mclude benchmarks and ant1c1pated results of these act1v1t1es

• Fmahze IEC matenals (prmt aud10 or visual ) not completed durmg Phase I

• Coordmate and supervise act1vit1es for Community Mob1hzatton component

• Identify and contract graphic des1gner(s) to develop IEC matenals 1denttfied for the follow-on IEC act1v1t1es

• Pretest all drafts m the field to assure the comprehensiveness and acceptab1htv of the matenals The Advisor will be responsible for des1gnmg the pre-test mstrument coordmatmg all logistics to carry out the pre-testmg trammg the mterv1ewers and \\!Ill present a report of the pre-test results

• Fmahze all prmt and/or aud10 matenals based on pretest results

• Develop request for proposals, review proposals select and subcontract local organization to produce the matenals The IEC Advisor v. 111 oversee the product10n to ensure quahty

• Develop a d1ssemmat10n and trackmg scheme for matenals

• Develop a Users' Guide for tramers of health personnel or community members 111 the use of the IEC matenals The Guide will mstruct the user hov.- to most benefit form the maten al

• Conduct trammg durmg the TOT m the use of the IEC material referrmg to the Commumty D1agnos1s results and showing how the material respond to those findmgs

• Design an IEC Monitormg S; stem mcludmg the followmg components

139 • Record exposure of target audience to IEC materials • Register target audience exposure the IEC mtervent1ons prmt materials, rad10, mterpersonal commumcat10ns at the health fac1htv • Production of quarterly momtormg report v.hich shows progress of IEC mtervent10n as expressed by the specific md1cators selected previously m the ongmal design

Quahficat1ons

The candidate for this position must be a Social Sc1ent1st or Commumcat10ns Specialist with at least 15 years mternat10nal experience m education and commumcat10n He/She must have field e>..penence and experience working with women's groups m the commumty

140 Momtormg and Evaluation Advisor

The Mo111tormg and Ev aluauon Ad\ 1sor will worh. under the supervision of the MotherCare Guatemala Coordmator In this posmon the Monitoring and Evaluation Advisor ~III be based 111 Quetzaltenango providmg technical assistance to the Health Areas specificallv the area hospnals and health centers in Solola Totomcapan San Marcos to implement the hospital and health center fac1hty-based momtormg system To this end the Momtormg and £\,aluation A..dvisor will provide technical support m training management and data analysis and use to ensure that the momtormg system is sustainable in the Health Areas by the close of MotherCare II Phase II in July, 1998 The specific tasks for the Momtonng and Evaluation Advisor mclude

1 Mo111tormg and E\ aluatton Work.plan

At the start of MotherCare II, Phase II -

• Develop an annual work.plan outlining all Monitoring and Evaluation act1vmes for the Health Areas falling under his respons1b1hty This work.plan will mclude benchmarks and anticipated results of these activities This work.plan will be submnted to the Project Coordinator for d1scuss1on and approval,

• Submit a monthly report to Project Coordinator 1dent1fvmg the status of work.plan activities,

• Review quahty and status of data being collected at the start of MotherCare II Phase II through the hospital and health center reg1stnes in the four health areas,

Trammg Course Development, Implementation and Follow-Up

• With the assistance of a consultant, develop a trammg course to tram hospital and health center staff m the collect10n, analysis and use of the data,

• Develop a trammg plan (schedule budget and ev-aluat10n plan) for the conduct of the trammg courses for hospital and health center staff m the four areas

• Submit Trammg Plan and Budget to the Project Coordinator for approval,

• Followmg the traming course conduct quarterly\ isits to hospitals and centers to assess the quality and use of data,

• Provide m-serv1ce refresher trammg as md1cated based on quarterly v1s1ts

Morntormg System Sustamab1hty

141 • Arrange and provide technical support to hospital staff and health center staff to part1c1pate m technical semmars and/or to travel to other areas to promote technical exchange between sites,

• Identify benchmarks for sustamab1hty of momtormg system at each site

• Wnte a technical workmg paper descnbmg the momtonng system and outcome mformat1on (see product below)

Products

• Techmcal Seminars - local, regional and mtemational • Techmcal Papers identified for publication

Quahficatlons

The candidate for this pos1t1on must be a physician or possess a Masters m Pubhc Health He/she should have experience m computer programming and data entrv as well as a mmimum of two years e>..penence m data analysis

The candidate should have pnor experience workmg m maternal health as well as pnor experience workmg with public health services

142 Health Area Coordmator

Health Area Coordinators will be hired to oversee and implement activltles in each of three Health Areas The Health Area Coordinators will be located m each of the Health Areas although one of the Coordinators will oversee activities in two Health Areas Another of the three Coordinators will be selected to coordinate act1v1t1es between the Coordmators and the Health Areas Add1t10nally, these Coordmators will sit m the "Jefatura de Area" or the MOH Health Area Offices In this manner coordmat10n with the Health Area staff can be mamtamed

These three positions will report directly to the Project Coordmator, but will coordinate technical act1v1ties with the Technical Advisors Tasks for the Coordinators will mclude

• Supervise and provide guidance on the implementation of the Monitoring system

• Coordmate activities and promote commumcat1on between the Maternal and Perinatal Health Project and the local NGOs commurnt\ committees Profess10nal Assoc1at1ons and the Ministry of Health

• Promote act1vltles related to sustamabihty and follow-up of the Health Services for each area

• Promote the establishment of a reproductive health umt in each of the Project mtervent1011 hospitals

• Supervise and implement, in collaboration with each Health Area all act1v1t1es mcludma: - IEC at the commumty level, - IEC at the Health Service level, - community mob1hzat1on, - trammg, - family planmng, - anemia

• Conduct research act1v1t1es at the hospital level such as a permatal audit

143 Trammg Advisor

The Trammg Advisor will work under the superv1s10n of the MotherCare Project Coordinator In this pos1t10n the Trammg Advisor will be based m Quetzaltenango m order to provide continual assistance to the trammg at hospital and health center/health post levels

Act1v1t1es for the Trammg Advisor will mclude, but not be limited to

• Develop an annual work.plan, outlmmg all trammg actn,mes and a tlmelme for act1vtt1es This workplan will include benchmarks and anticipated results of these activ1t1es This workplan will be submitted to the ProJect Coordmator for d1scuss10n and approval,

• Develop an assessment tool to conduct a trammg needs assessment and conduct the assessment for hospital, health center and health post personnel

• Prepare and develop trammg activities for all levels of care,

• Together with the Health Area Coordmator supervise and monitor all trammg act1v1t1es,

• With the assistance of an mtemational consultant, develop a TOT cumculum mcludmg obstetrical complications, anemia and family plannmg for hospital, health center and health post personnel

• Develop a plan for the Health Areas for follow up of trammg, as well as a trammg evaluat10n plan,

• Together with the Project Coordmator, provide techmcal assistance to other collaboratmg agencies who wish to replicate the trammg m other areas

Quahficat10ns

The candidate for this pos1t1on should be licensed m med1cme or related health sciences He/she must have clinical experience m women's reproductive health and should be experienced m trammg health personnel at the community level and at health services In add1t1on the candidate must have at least two years experience workmg m maternal health care as well as at least 3 years experience developmg activity plans with public health care staff

144 I

I"-- ' '- ',,_....,., J -c.::/ '

MotherCare/Bolivia

Work Plan

1998

145 A Project Goals

The MotherCare Project Goals will remam, to assist the National, Distnct, and Mumc1pal governments to decrease maternal and neonatal mortalities and rnorb1d1t1es through strategies to improve both the quality of services at aH levels and the access to and demand of services by the community

B MotherCare Bohv1a Project Strategy

Durmg 1997, the Ministry of Health disseminated National Protocols for the Management of Obstetnc and Neonatal Care throughout the country, at the same time m1tiatmg a national insurance program with prov1S1ons to provide free maternal and newborn services The availab1hty of protocols and insurance coverage throughout the country enabled MotherCare Bohv1a to design a program strategy to answer two maJor questions

... Does trammg of the health providers improve the quality of care? ... Is IEC/C needed to increase coverage for women with comphcat1ons at health facilities?

These questions will be answered through the project mtervent1on/control design with comparison of key md1cators from the MotherCare mtervent1on area (5 distncts 18 mumc1paht1es) m La Paz and Cochabamba against the control area of Illampu

The variation m the areas are proposed as follows-

... Area # 1 - The MotherCare mtervent1on area 1mplementmg all IEC/C, trammg, policy mtervent1ons,

... Area# 2 - Control One 1mplementmg only IEC mtervent1ons through MotherCare assistance

The comparison of the mtervent1on and control areas will be measured against 10 key indicators with data available at the end of the project m September, 1998

The key md1cators mclude 10 md1cators which will be measured through a facility- based momtonng system focusing on the quahty of prenatal, delivery, and postpartum services as well as a community-based approach to capture client perspectives The service md1cators will be collected through SNIS reports, clm1cal h1stones, registers and fac1hty based survey data, chent perspectives will be collected through client exit mterv1ews -

146 Key Indicators

Prenatal Care 1 Percent of pregnant women who have received at least one prenatal v1s1t 2 Percent of pregnant women who have received at least 4 prenatal v1s1ts 3 Percent of pregnant women who have received some 1ron tablets 4 Percent of pregnant women who receive at least 90 tablets of iron folate

Delivery Care 5 Percent of mstitut10nal dehvenes 6 Percent of dehvenes conducted by tramed personnel m the community 7 Percent of dehvenes conducted by tramed TB As 8 Met need for obstetric care

Facility-Based Case Mortahty 9 Early Neonatal Death m Hospital by birth weight

Chents Perspective 10 Percent of chents satisfied with service delivery

C MotherCare Bohv1a Objectives

The project objectives are designed to strengthen capac1t1es of National health care planners and pohcy makers to promote pohc1es designed to improve the quality of maternal and newborn services as well as the capab1lit1es of Regional, District and Mumc1pal health care planners, health care providers and communities (mcludmg NGOs) to implement strategies designed towards the same objectives The project objectives will also address issues of community access and demand Specifically, the MotherCare Bohv1a project objectives will -

1 Promote community-based and facility-based IEC/C strategies to increase appropnate access of and demand for maternal and neonatal services (IR 1)

2 Strengthen mst1tut1onal capacity at National, D1stnct, Municipal and Community levels to sustain quality services and community access to services (IR2)

3 Inform National, D1stnct, Municipal governments of project outcomes with recommendations for sustainable quahty services and access mtervent10ns (IR2)

4 Promote national pohc1es which endorse the prov1s10n of sustainable quality maternal and neonatal services (IR3)

147 I D Implementation of MotherCare Interventions

The MotherCare mtervent1ons identified under these strategies and objectives were m1t1ated under the MotherCare Bolivia Delivery Order #04 In fact, the mtervent1ons and act1v1t1es accomplished far exceeded the scope of work of Delivery Order #04 Therefore, the act1v1t1es descnbed m this Work Plan are a contmuatton and expansion of the Delivery Order #04 scope of work

Intermediate Result 1 (IRl)

Improved Practices for Child Survival, Reproductive Health For Men, Women, Adolescents And Children

To meet the reqmrements ofIRI, MotherCare developed the following Project objectives

1 Promote commumty-based and fac1hty-based IEC/C strategies designed to mcrease approprmte access to and demand for maternal and neonatal care

IRl 1 With the 1mplementat10n of the IEC/C campaign (focusmg on recogmt1on of and actions m response to the danger signs of pregnancy), 1t 1s ant1c1pated that there will be an increase m demand by women and couples to use health services, especially for obstetnc and neonatal emergencies MotherCare will also promote part1c1pat1on of and through community orgamzat10ns with mformat1on, education and communication strategies ffil.2 At the same time, It rs ant1c1pated that the trammg mtervent1on will increase the quality of services offered by the provider The interpersonal commumcat1on and counselmg sh.ills trammg rs designed to mcrease provider sens1b1hty to the trad1t1onal customs values and needs of the community (Table 1)

148

SEP SEP

AUG AUG

APPROPRIATE APPROPRIATE

JUL JUL

JUN JUN

INCREASE INCREASE

TO TO

MAY MAY

, ,

APR APR

, ,

i i

, ,

i i

DESIGNED DESIGNED

i i

< <

' '

MAR MAR

TIMETABLE TIMETABLE

i i

FEB FEB

< <

STRATEGIES STRATEGIES

JAN JAN

< <

CARE CARE

i i

IEC/C IEC/C

IH.C IH.C

i i

< <

IEC/C IEC/C

< <

NEONATAL NEONATAL

, ,

NOV NOV

< <

AND AND

OCT OCT

FACILllY-BASED FACILllY-BASED

111 111

l'l l'l

11 11

11101111 11101111

cx cx

n n

I I

f•«plton f•«plton

AND AND

~ ~

(mxtp (mxtp

ALl1on ALl1on

Quarterly Quarterly

~'!.!''d ~'!.!''d

momtonng momtonng

111 111

MATERNAL MATERNAL

Manauals Manauals

\\1th \\1th

produ,ed produ,ed

and and

\\Ith \\Ith

m1plemented m1plemented

and and

produced produced

1d,rs 1d,rs

produced produced

INDIC INDIC

lonn~ lonn~

~en1c,s ~en1c,s

signed signed

s1gn,d s1gn,d

produ,ed produ,ed

s11..11,d s11..11,d

111d 111d

colle

h.1pt<"rS h.1pt<"rS

l'ro\ l'ro\

•~ton •~ton

Campaign Campaign

(. (.

11th 11th

FOR FOR

•r•d •r•d

k k

Produced Produced

fonn~ fonn~

Dis,uss1011 Dis,uss1011

r1d10~ r1d10~

r.duucal r.duucal

t t

rtd1os rtd1os

I I

i\gr,cm,nt i\gr,cm,nt l'nallets l'nallets Puhhcity Puhhcity

I' I'

Contn<1S Contn<1S

60 60

uho uho

hpchart hpchart

R R Hq1ort~ Hq1ort~

I I

R,,,pt1011 R,,,pt1011

11..alth 11..alth

fom1~ fom1~

~ur-n ~ur-n

d,\dop,d d,\dop,d

11th 11th

1d10 1d10

ugn ugn

s s

1 1

R R

~pols ~pols

h< h<

R1dm R1dm

~ ~

s s

md md

Of!<."ra Of!<."ra

1~s1gn,d 1~s1gn,d

DEMAND DEMAND

ldmp ldmp

and and

md md

1p 1p

111 111

llu~h llu~h

'lo 'lo

Neonat1I Neonat1I

1.es 1.es

1111knal 1111knal

lusband lusband

r1d10 r1d10

llu~b llu~b

I I

IC<"> IC<">

1ge 1ge

d1stnb11t1on d1stnb11t1on

radios radios

Husbands Husbands

and and

111d 111d

sen sen

1 1

d1str1h11111m d1str1h11111m

AND AND

D1ss.1111n1tmn D1ss.1111n1tmn

t.l\111\fAflON t.l\111\fAflON

COMMUNITY-BASED COMMUNITY-BASED

Radio Radio

and and

11 11

sen sen

pad, pad,

and and

d1s

RESULT RESULT

loc1I loc1I

Op1:r Op1:r

he1lth he1lth

dl'trthllt< dl'trthllt<

panphlet panphlet

TO TO

edu,attonal edu,attonal

li\11'1 li\11'1

Spots Spots

Op,ra Op,ra

Ofx"ra Ofx"ra

health health

11111

to to

Opera Opera

t>latenal t>latenal

groups groups

Soap Soap

Obstetn

radio' radio'

and and

d1stnhtue d1stnhtue

from from

ION ION

and and

1d10 1d10

hpch'111 hpch'111

~01p ~01p

l'hn l'hn

Soap Soap

\I \I

and and

I I

Soap Soap

ACTIVITY ACTIVITY

momtor momtor

s s R

U U

radto radto

lhdto lhdto

radios radios

111 111

11.11101111 11.11101111

R,ports R,ports

\I \I

1nd 1nd

lhd10 lhd10

Radio Radio

produ,e produ,e

dtstnbute dtstnbute

1\ct1on 1\ct1on

' ' Qt1,,hua Qt1,,hua

11to1t~ 11to1t~ Radio Radio

\ \

'>lll\TH,\ '>lll\TH,\

I I

PROMOTE PROMOTE

ACCESS ACCESS

ts.. ts..

I I

111 111

1 1

teduu,al teduu,al

and and

IC IC

l.o.:al l.o.:al

Ile~ Ile~

llushand llushand

repnse repnse

-0 -0

+>

u1.1h1,d u1.1h1,d

tt\1lt1cd tt\1lt1cd

IH IH

'>11ot~ '>11ot~

mto mto

\pot~ \pot~

AM> AM>

()u·1rkrlv ()u·1rkrlv

Comph< Comph<

d1s~e1111111hon d1s~e1111111hon

sen sen

d1str1ds d1str1ds

and and

for for

Spots Spots

D1~~·1111111t< D1~~·1111111t<

I I

D, D, l'nnt l'nnt

~Up<'f\ ~Up<'f\

I I

1>,Hlop 1>,Hlop

Pubhqu Pubhqu

(olk<1 (olk<1

IJ,Hfop IJ,Hfop

able able

0 0

I I

\ \

I I

1 1

INTERMEDIATE INTERMEDIATE

I I

5 5

J J

7 7

2 2

4 4

8 8

6 6 9 9 '

< <

Mmutonng

a1..comph~hed

lll\ohdmenl

and

ac1..omphshed

elopt:d

1111pt...m,11t111g

tramed

1s1011

lilkd

filled

\\ofl..mg

de\

hlkd

Report

Interns

,pt~

onn~

fonns

1Ltl\lllt.S

Conummnv

Supt:n

lntems

C.omp<.l1llon

Broadca~t

.....

om1~

Prolo...ol

411111..ms

R1..1..e1pts

fmal

both

l!TIL

Spots

111

po~111on

lusb1nd

of\\ork

A)mara

Studu1l~

Spots

fBA dd1\

Co111po11e11l

NDI

hlanh1s

for

Ser\11..es

111\ohem•nl

astmg

111

veas

(<;ale

and

Rll

lusb.md

Opt.rall

•

~11111t11ng

<;pamsh

1..1111..111

(ID

UATION

return

lusband

s1..TC•l1~

llealth

broad

111

El\IENT

and

Soap

1111.:ms

Umversll}

radios

manual)

Ill\

part11..1p1te

Use

uo;age

Commuml}

radio

l:.\AI

hu,hand

lure

Opera

phcu11a to

dd1-..r

\\Oo

l\IOTIU

TURAI

10.S

ofa1..h\llles

a1..}

and

for

m-oups

11'\

Students

Soap

1110111tor

Montor Soap

11h\ers)

It\

mtent

oulhts

Codiabamba

Momtor

\\ann topics

hag.~

lltrl!'ls

rs1tv

111

<,I

Conumuul\

sdect

mat1..n1I ..

1d10

111d

(.omoe1111on and

and Study

and

JllCUI

111

Protocol

room

Radio

111

1~e

1se

1~e

d1sc11~s1011

Paz

n1..e U1m

\\lllll•ll

l'h~t11..

...

nnnortant

lloor

lotherhood

ram QUll'T

\l'PHOPIU

IA~hmer;

andOuechua

111

D1~tnhute

lntem~lup I\

<;nots

111d

Cities

R•pnse

·md

Ill undre,~mg

lmple1111..nl

d..hhn

4'upt:n

~upt:n

C..onduct

1Lll\lte5\

O..\elop

1\Juio11111..e

I Sup.-n

llu)

A11d1

('()\(l\IUM IFCICO,fRATl:.G\

Conunumt)

4 s

! !

;· ;·

< <

i<' i<'

i i

~ ~

i i

l l

<< <<

< <

<<< <<<

,r ,r

l l

Report Report

Fmal Fmal

Questionnaire Questionnaire

CARE CARE

Ofo Ofo

quest1onna1re quest1onna1re

nllng nllng

I\ I\

\\ \\

qucst1oru1a1re qucst1oru1a1re

anahs1s anahs1s

coll.:c11011 coll.:c11011

VI VI -

bnahzcd bnahzcd

Report Report

Data Data

Pretest Pretest

QUALi QUALi

I I

.s .s

2 2

·~ ·~

4 4 3 3 Intermediate Result 2

Improved Quahty and Increased Coverage of Community Services Estabhshed by Local Governments and NGOs

Developed through the following Pro3ect ob3ectives

2 Strengthen mst1tutlonal capac1t1es at Natmnal, D1stnct, Mumc1pal and Commumty levels to sustam quality services and commumty access to services

IR2 1 MotherCare will continue the capacity building interventions initiated under Delivery Order

.. strengthening 2 Regional Trammg Centers - one in La Paz and one m Cochabamba

.. trammg of providers ( obstetncians, general practitioners, nurses and nurse aux1hanes - 250 will have been trained by Sept 97) workmg at d1stnct hospitals, health centers and health posts in the MotherCare mtervent1on d1stncts of La Paz and Cochabamba .. supporting 24 master trainers to continue the conduct and evaluation ofth1s training

on-gomg supervison and evaluation of provider performance ( clin1cal and counseling skills and knowledge) post training

.. evaluating outcome of the trammg course curriculum in meeting pro3ect ob3ect1ves with rev1s1on of curriculum and procedures manual as md1cated and recommendations for follow-on training designs

providing technical assistance to PROCOSI members in components of quality of care and approaches to increase access and demand of services (based on lessons learned from MotherCare II interventions)

New trammg activities to be initiated m October FY 98 will -

.. develop new or revised train mg designs for 100 providers (based on evaluation of course and provider performance) which will promote sustainable quality of services and chent sat1sfact1on -

.. mtroduce/mcorporate curriculum for the management of obstetric and neonatal care into the medical university for interns in their final year ( 150 students m Cochabamba and 150 students m La Paz - 2 week course/student) (Table 2)

.. introduce and implement refresher training course for all providers trained dunng the monitoring and superv1s1on v1s1ts

152 introduce a syphilis training of trainers (TOT) course for three person team (biochemist, medical doctor and nurse) for La Paz and Cochabamba (Table 3)

~ Finally, through the checklists or other tools, MotherCare will evaluate the performance (chm cal and counseling sJ...1lls and knowledge), of the health personnel m the MotherCare D1stncts (Table 4)

153

TO TO

SEP SEP

LEVEL LEVEL

AUG AUG

JUL JUL

COMMUNITY COMMUNITY

JUN JUN

AND AND

MAY MAY

APR APR

MUNICIPAL MUNICIPAL

i i

MAR MAR

TIMETABLE TIMETABLE

DISTRICT, DISTRICT,

FEB FEB

SERVICES SERVICES

TO TO

JAN JAN

l5lcin.k l5lcin.k

TRAINING TRAINING

NATIONAL, NATIONAL,

ACCESS ACCESS

AT AT

DEC DEC

Page Page

< <

NOV NOV

COMMUNITY COMMUNITY

......

CAPACITIES CAPACITIES

OCT OCT

AND AND

prognm prognm

151on 151on

Pre,!ll)ti~~ Pre,!ll)ti~~

courses courses

coord111at1011 coord111at1011

h\t h\t

snpen snpen

the the

Trannng Trannng

SERVICES SERVICES

2 2

INDIC INDIC

contents contents

th• th•

lhe lhe

on on

of of

D1JI\ D1JI\

Oral\ Oral\

Drafl Drafl

Drall Drall

for for

mg mg

INSTITUTIONAL INSTITUTIONAL

mal mal

11111 11111

mal mal

Drill Drill

R1.porl R1.porl

Report Report

I I Drill Drill

I I

Plan Plan

meelmgs meelmgs

fuJal fuJal

tram tram

I I

RESULT RESULT

the the

of of

La La

QUALITY QUALITY

for for

ra1111.rs ra1111.rs

for for

of of

for for

TCSC TCSC

TE TE

fl fl

manual manual

d1111c1I d1111c1I

h~I h~I

151on 151on

linen linen

the the

lrammg lrammg

C.urn

111111ual 111111ual

during during

for for

1sors 1sors

ramers ramers

<\ <\

conlents conlents

lh1. lh1.

CSC) CSC)

per111a11I per111a11I

meetmgs meetmgs

for for

gtnde gtnde

thL thL

111od11ic111011 111od11ic111011

111od11ica11011 111od11ica11011

111od1li•allo11 111od1li•allo11

111od1hca11011 111od1hca11011

and and

leHls leHls

s s

(I (I

orl..shops orl..shops

of of

urnC'ulum urnC'ulum

supen supen

hsb hsb

of of

\\ \\

for for

and and

b~ b~

( (

CDO CDO

and and

S11p1.n S11p1.n

on on

1sorsll 1sorsll

CumlLuhnn CumlLuhnn

STRENGTHEN STRENGTHEN

SUSTAIN SUSTAIN

3L4UlrLd 3L4UlrLd

2 2

and and

praL11c• praL11c•

ched, ched,

lhe lhe

tramer tramer

pro.edur1.~ pro.edur1.~

ACllVITY ACllVITY

11nln2 11nln2

r'lmlng r'lmlng

rauung rauung

I I

Worl..shop Worl..shop

Lonl1.nt\ Lonl1.nt\

'lul!"'"'l~onrrr 'lul!"'"'l~onrrr

for for

l>dimhon l>dimhon

Re\le\\ Re\le\\

pracllce pracllce

Report Report

Paz Paz lrammg lrammg

Re\le\\ Re\le\\

Re\le\\ Re\le\\ Preparations Preparations Sup1.-n Sup1.-n

l>eli11111011 l>eli11111011 TCSC TCSC

lhe lhe

~l..11ls ~l..11ls

lhe lhe

comrh•allons comrh•allons

obsleln• obsleln• RL\IL\\ RL\IL\\

1.oord1111l1on 1.oord1111l1on

l l

lhe lhe

V1 V1

Ir Ir

I I

n n

I I

5 5

2 2

3 3

4 4

3 3

2 2

,\ ,\

2 2

INTERI\IEDIA INTERI\IEDIA Table Table '

s: >

·;.i

< <-cs

~\s•l

t•

•

{

•

~~i i~~

~~,,l< '!1 '1~~

~~1<1~~

~~> <~~

~~<...-..<~~

~~$ *l~~

~~« !~~

~~:.1:,S~~

~~/'~~~

~~(1,~~

~~ff>~~

~~'Li~~

~~11>«~~

~~>ll~~

~~<,. '~~

~~-:i-:~~

~~<.)~$~~

~~ili~~

~~1-., s'1~~

~~_,.~~

~~!··~~~

~~~ "e•~~

~~l >~~

~~lil«i~~

~~< '!t>i•~~

~~,.$$~~

~~, ,,~~

~~~1,~~

~~l >~~

~~II !!~ ii~~

~~>il~~

~~1 1~~

~~$ I~~

~~$~~~~

~~< <~~

~~'{ '~~

~~<:.~~

~~' ls'!>!! l~~

(

~~} >~~

~~~y 1<-< i~~

~~,i < >~~

~~< "s: 1~~

(

~~!sl«-j'<~'l"i ~"~~

~~>S t <~~

~~< rn ,.~~

~~< :.~~

~~< i "I~~

)

~~$ $ ' $~~

~~! s:~~

~~v>~~'S>:.'S~~~

~~s $ $~~

~~"'s s:~~

}

~~< ij h (~~

~~$< ~~~

~~$ !~~

~~'.l~~

~~<,.~~

~~<<'$ s: (~~

~~< >~~

~~' !,is~~

~~w< ,it~~

~~! 'ls.~1~~

~~>$...~~

~~.. •.~~

~~il.~~

~~l s! ls~~

~~s,,~~

~~,..:: «'~~

~~sl~ sl~~~

~~l >~~

~~' < s~~

~~,..<~~

~~>::. l l1l $ •1 «r~~

~~,fl~~

·i

~~<<<~~

~~<'$s:~~

~~-h<~~

~~>ii~~

~~l~{i$!~~

~~' ~i>~~

~~:' l~~

~~'$.~~

~~····::~~

(

~~ss $$ '§<~~

~~. __~~

~~<:-l's«~~

~~;, {~~

~~~$ r--s------3·~~

~~$« tEfl sl,, 1 ,l'Ji'• s: J~~

~~~v~l~~

~~~ $ ! !~~

~~! •~~

~~!'!~~

~~··~ l~~

~~~~ «~~

~~::·~~

~~j,>H~~

»~

~~> -:~~

~~,d< s!~~

~~iiJ < <~~

~~~~$•,1~~

~~.....~~

~~< ~~~~

~~, s~~

}

~~r·····~~

~~fl!"~~

~~<*{~~

~~idt4m~~

~~~s s~,:l«(~~

~~' 1~ l~~

~~< ~,.~~

~~ii i. !>~~

~~sq:~~

~~-:< i1: ij~~

~~l' :-<..v~~

~~!i'~~

«!

,«

~~<-: '~~

~~i < !~~

~~j { S:-:~~

~~<<< 'I".,,.~~

~~.:1(~~

~~tJ1<1 q;-.i i~~

~~l<~~~:~i;. l~~

~~,1;1k-iitl~~

~~~ri~1l~~t~~

~~i i~~

~~...~~

~~1 ,i,~~

~~~-=<<~~

~~i < «s~~

~~« <~~

~~f-:-:~~

~~l i ~~~

~~l'!~~

~~> $<$<~<~~

~~:c-=~~

~~i $~ «Ais«~~

~~di,.si;1<'~ < Al<@'4~t'~~

~~i, l l~~

~~L\al11al1011s~~

~~&up..r\lstons~~

~~courses~~

~~the~~

~~Report~~

~~Ro!ports~~

~~R1.ports~~

~~els~~

~~le\~~

~~Paz~~

~~AND~~

~~THE~~

~~f\lothcrC.are~~

~~Trammg~~

~~franung~~

~~PFWmNNFL~~

~~courses~~

~~accordmg~~

~~Cochabamba~~

~~OH'iH.TRIC~~

~~IUNA1AL~~

~~ordmg~~

~~els~~

~~1luahon~~

~~l{All\IM~~

~~llL\I l'l~~

~~f\lothl!rCare~~

~~and au~~

~~CO\IPLICATION'> E\~~

~~Super\1s1on Trammg~~

~~3 > i~~

;

~~LEVELS~~

~~SEP~~

~~::<-~~

;

~~' >~~

~~i ' l~~

~~; >~~

~~l '~~

~~' l :! il >;~~

~~AUG~~

~~l >~~

;

~~h '~~

;

~~JUL~~

~~COMMUNITY~~

~~i ! ' l~~

~~' '~~

;

~~-:<<::~~

~~JUN~~

~~AND~~

;

~~(,. '~~

~~MAY~~

~~( l~~

;

{

~~' ' ! >~~

~~1 ~ ~~~

~~' ;~~

;

~~; '~~

;

~~{ ~~~

~~, <~~

(

~~i :: ::~~

~~ii' ;;;~~

~~j' ::<::~~~

~~ii'~~

~~::::<~~

~~APR~~

«i

~~i j,~~

;

~~iih l< :::- ,i~~

~~<:::: :-::~~

~~< ~~~

~~;.<;.~~

~~MUNICIPAL~~

~~/~'~~

~~::<<:: l ,.,.~~

~~s '~~

~~i ' >~~

~~i '~~

~~TIMETABLE~~

(

~~MAR~~

~~'< I~~

~~' '~~

~~ii >~~

(

~~FEB~~

~~SERVICES~~

~~DISTRICT,~~

~~JAN~~

~~DEC~~

~~SUPERVISION~~

~~ACCESS~~

~~NATIONAL,~~

~~NOV~~

~~OCT~~

~~11a~~

~~COMMUNITY b)~~

~~111~~

~~appl\~~

~~1sed~~

~~sol\~~

~~CAPACITIES~~

~~the}~~

~~orkmg~~

~~l•duuques~~

~~111~~

~~p•ople~~

~~AND~~

~~''ho~~

~~1s1011111d~~

~~CllITILU(a~~

~~supen~~

~~fa.1hllc5~~

~~•01111•111prm1de~~

~~tough!~~

~~the~~

~~l'llotherC1r,~~

~~p•oplt.~~

~~peopk~~

~~tram.d~~

~~INDIC~~

~~are1~~

~~sup.n~~

~~folio\\~~

~~gO\~~

~~the~~

~~of of~~

~~capab1htv~~

~~use~~

~~the~~

~~111~~

~~le\~~

~~number~~

~~projed~~

~~Number~~

~~l'lhnual Number~~

~~problems~~

~~ead1~~

~~spe•1lic~~

~~Numb.r~~

~~the 111d~~

~~\\l11d1~~

~~correct(}~~

~~has1s~~

~~pro\lded~~

~~3LCOrdmg~~

~~Mlpporl~~

~~SERVICES~~

~~lhe~~

~~111~~

~~1s1011~~

~~INSTITUTIONAL~~

~~and~~

~~th•~~

~~1nd~~

~~for~~

~~perinatal~~

~~le\el~~

~~ofbolh~~

~~reg1m11I~~

~~processes~~

~~111~~

~~super\~~

~~lr11111ng~~

~~1nd~~

~~RESULT2~~

~~•Osts) bJses~~

~~loc1ll)~~

~~(equ1pm.n1~~

~~QUALITY~~

~~the~~

~~trammg~~

~~the~~

~~f1c1ht\~~

~~pr~edur•5~~

~~and~~

~~data~~

~~ice~~

~~national~~

~~mterpersonal~~

~~and~~

~~a1tu111011~~

~~course5~~

~~maternal~~

~~efc•ll\cness~~

~~svpl11hs~~

~~sen~~

~~superv1s1011~~

~~component~~

~~fJ•1l111es~~

~~comprom•~•S 1111pr0\~~

~~follow~~

~~follo\\~~

~~the~~

~~cases~~

~~and~~

~~the~~

~~pall.nls~~

~~mformah•~~

~~and~~

~~ACTIVITY~~

~~mumcmal~~

~~both~~

~~project~~

~~u111\ers1tv~~

~~resull5~~

~~ofs1lpen1s1on~~

~~transporlallon~~

~~STRENGTHEN SUSTAIN~~

~~111g~~

~~its~~

~~ernmental~~

~~lrammg~~

~~each~~

~~uluallon~~

~~go\ and~~

~~supponmg~~

~~Plamung~~

~~the 11111hl)~~

~~(\lanagement comphcated~~

~~dmg5 .om11111mcat1on d15tn•t~~

~~Plamung ree.ular~~

~~mdudmg~~

~~process •ommum•allon)~~

~~folio\\~~

~~1>.s1gi1~~

~~'-l~~

~~INTERMEDIATE 4~~

~~Table l~~

~~~ 3 Inform National, D1str1ct and Municipal governments and Commumtles of MotherCare Bohv1a Project outcomes with recommendations for sustamable quahty services and access mterventaons~~

IR2 1 MotherCare plans to compare the 5 d1stncts where all health personnel were trained on how to handle obstetric and neonatal emergencies with implementation of IEC/C campaigns directed towards women, couples and health personnel m commumttes, agamst the control district (Illampu) where only the IEC/C materials are distributed but the personnel are not tramed All MotherCare districts and the control d1stncts will use the same instruments to collect mformat1on For this, MotherCare will tram health personnel and will standardize the mformat1on mstruments (Table 4)

IR2 2 With the purpose to adequately monitor the changes produced m the 5 MotherCare mtervent1on d1stncts (18 mumc1paht1es), MotherCare will compare these results with results obtained m the control d1stncts, by usmg the IO key md1cators (quality, coverage, use of services and user sat1sfact1on) For this, we will obtam mformat1on from the monthly reports provided by the NHIS Add1t1onal mformat1on not provided m the monthly reports of the NHIS will come from the registers (validated by MC), as 1s the case of obstetnc and neonatal complications m d1stnct hospitals and reference hospitals (German Urqu1d1 and Women's Hospital) MotherCare will use exit mterv1ews, to measure the percentage of satisfied customers

~~158 INTERMEDIATE RESULT 2 Table 4~~

~~3 Inform National, D1stnct and Mu111c1pal governments and Commu111t1es of MotherCare Bohv1a Project outcomes with recommendations for sustamable qualtty services and access mterventlons~~

~~INFORMACION SYSTEM (MONITORING)~~

~~ACflVITY INDICATORS TIMETABLE~~

~~OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP~~

A l>l I l'\ll IOi'o 01 1111 111' \I 1\11 I 1101>01 oc,\ I 111.J out 11U•\llonnaires I on l\IOM fOIUM AJ\D QU \I In ( ()j', 11m1 I>\ I A 01/96 06/97 I lhta .olled1011 2 Cr.all on of a Data Ba\e D 1t1 lhse 111 worl..mg order

~~l Input ol .011e.1~JJ1t 1 mto th• D 1t1 ll 1~e D 111 111th• Dat1 B 1111..~~

~~4 (..!ualll\ control of the D1ta lhnl.. \ •rlhlallon ofD1ta Ill Data B ml..~~

~~5 I mal re\le\\ of momtonng mdhoJofog\ f 11111\LfSIOn of l\fdhod doc~~

~~6 I mal re\ te\\ of metho <~~

~~c Tlt>\11'1NG IN IMOJU\IAl IONS\ 'ffl<..l\IS C.ompleted final Cum•ulum I Elaboration oftrauung u1mculu111111CAls 1~~

~~2 l:.laborahon of trammg •Urnculum durmg courses Completed final C.umculunt~~

v. \0 3 Trannng m CAis l E''\ra quarterly report Trammg 111I00°o of areas i :> < j j < ,,, ...... ~ 4 Tra1111ng m CAls 2 Registers 1 ra111111g111 100° o of areas ' < $ ~ > ~ > 'P ' ', ii~>'l > « $ ,<.?$ ~ < « < $ q«l < j ,. < 6 Trammg m CAJs 4 Use of mformation Trammg 111I00°o of areas 'ii' !' ! ~ > > 7 fra111111gdurmg LOUrses l P \ Cbba i !! > I> D t\AI UAllON I User Sausfacuon I:"' mt en 1e\\ s f\11mten1ews '

2 U1scuss1011 on the acluevements 111durmg the final l'ropos'll DoLUlllenls > e\3luat1on > j F FINAL RI:l'Olff ON TllL H \"ELli\L v i ! I I m'll r~oort Comnlel~dli111l renort < ' 2 Presenlat1011 Pre~e11ta11011 ..

~~3 Prmlmg of the r.port ( IOOOcopies) and d1s1nb1111011 IOOOd1~tnbuled Lop1es of~~

~~lh.:: lmal doLlllll~nt ' '~~

~~°'0 Intermediate Result 3~~

~~Decentralized and Part1c1pat1ve System for Health Facd1t1es~~

~~4 Promotion of national pohc1es to endorse the provmon of sustamable quahty of maternal and neonatal services~~

~~MotherCare's act1v111es leading to National Policies~~

ffi3 1 MotherCare will disseminate mformat1on packages to 18 mumc1paltt1es where the project works by v1sitmg them, and d1stnbutmg municipal bulletins, including results from the community and facthty baselines, community d1agnos1s, cost studies, educational material, etc This mformat1on will provide greater mst1tut1onal and financial accountability for the mumcipaltt1es and other local orgamzattons m health programs for mothers and newborns (Table 5)

ffi3 2 MotherCare will show the advantages and disadvantages of its mtervent1ons (integrated model of trammg and IEC/C), for mothers and the newborn, to be d1ssemmated and replicated m other parts of the country This will include methodologies, technical instruments, norms, procedures curricula, educauonal and trammg material for easy use by local authont1es and health mst1tutions Data collected from the momtonng and evaluation of the integrated model will provide valtd documentation of the trammg and IEC/C components (Table 6) ffi3 3 The Project will carry out a cost study to be discussed with the National Health Mm1stry, Departmental Health Offices in La Paz and Cochabamba, the Maternal Health Insurance, Mumc1paht1es and Local Health Offices, on the cost of services and family expenses m the act1v1ties pack.age for mothers and newborn, which directly influence decision mah.mg and access to services This mformat1on will help Mayors' dec1s1on to budget municipal funds for these activities (Table 7) ffi3 4 The high prevalence of seropos1t1ve results found through the syph1lts study provides a model for promotion and 1mplementat1on of National Pohcy for the ehmmation of maternal and congenital syphilis m Bolivia MotherCare sponsored the development and analysis of the model and with the National Health Ministry and the WHO will develop a National Plan for the control of maternal and congenital syphilis (Table 8)

~~161~~

~~AND AND~~

~~j j~~

~~SEP SEP~~

~~' '~~

~~AUG AUG~~

~~MAT~RNAL MAT~RNAL~~

~~JUL JUL~~

~~OF OF~~

~~JUN JUN~~

~~., .,~~

~~MAY MAY~~

~~.. ..~~

~~MAY MAY~~

~~> >~~

~~QUALITY QUALITY~~

~~APR APR~~

~~APH. APH.~~

~~MAR MAR~~

~~TIMETABLE TIMETABLE~~

~~MAR MAR~~

~~TIMETABLE TIMETABLE~~

~~SUSTAINABLE SUSTAINABLE~~

~~FEB FEB~~

~~OF OF~~

~~JAN JAN~~

~~I I~~

~~DEC DEC~~

~~SYSTEM SYSTEM~~

~~PROVISION PROVISION~~

~~NOV NOV~~

~~IEC/C IEC/C~~

~~NOV NOV~~

~~THE THE~~

~~T T~~

~~OCT OCT~~

~~oc oc~~

~~(MONITORING) (MONITORING)~~

~~INFORMATION INFORMATION~~

~~ENDORSE ENDORSE~~

~~um<.n\ um<.n\~~

~~CBIJA CBIJA~~

~~.. ..~~

~~CUBA CUBA~~

~~y y~~

~~do do~~

~~TO TO~~

~~LP' LP'~~

~~INDIC INDIC~~

~~LP LP~~

~~produced produced~~

~~INDIC INDIC~~

~~111 111~~

~~Bulktms Bulktms proposal proposal~~

~~hpd11rt hpd11rt~~

~~I I~~

~~ori-shop~ ori-shop~~~

~~mal mal~~

~~11111 11111~~

~~f\kdmg~ f\kdmg~~~

~~I I~~

~~\\ \\~~

~~POLICIES POLICIES~~

~~rCare rCare~~

~~.. ..~~

~~1111ten1I 1111ten1I~~

~~Moth Moth~~

~~llU llU~~

~~unplementatron unplementatron~~

~~Ml\(, Ml\(,~~

~~NATIONAL NATIONAL~~

~~reg1st.r reg1st.r~~

~~111the5 111the5~~

~~rm rm~~

~~for for~~

~~Strategy Strategy~~

~~OF OF~~

~~1pah11es 1pah11es~~

~~\TION \TION~~

~~stem stem~~

~~SERVICES SERVICES~~

~~.. ..~~

~~\\orkshops \\orkshops~~

~~RLI\(, RLI\(,~~

~~I\ I\~~

~~s' s'~~

~~RESULf RESULf~~

~~IC:C/C IC:C/C~~

~~.,. .,.~~

~~ACTIVITY ACTIVITY~~

~~campaigns) campaigns)~~

~~bulletms bulletms~~

~~ACTIVITY ACTIVITY~~

~~the the~~

~~18111111u 18111111u~~

~~anal~sts anal~sts~~

~~nd10 nd10~~

~~6 6~~

~~UXllU>l UXllU>l~~

~~''llh ''llh~~

~~m~dmgs m~dmgs~~

~~d1\tnb1111011 d1\tnb1111011~~

~~flOi'iAI flOi'iAI~~

~~and and~~

~~SNIS SNIS~~

~~'i 'i~~

~~mu111c1pal mu111c1pal~~

~~regardmg regardmg~~

~~or or~~

~~and and~~

~~ITU ITU~~

~~Hl\L Hl\L~~

~~5 5~~

~~PROMOTION PROMOTION~~

~~NEONATAL NEONATAL~~

~~lo' lo'~~

~~0\ 0\~~

~~'"' '"'~~

~~C C~~

~~M111m1pal M111m1pal~~

~~Prepare Prepare~~

~~Regional Regional~~

~~'""I '""I~~

~~d1stncts d1stncts~~

~~Organ Organ~~

~~(materials (materials~~

~~Agreemen\s Agreemen\s~~

~~\ \~~

~~I I~~

~~\ \~~

~~I I~~

~~4 4~~

~~2 2~~

~~3 3~~

~~ACTl\'1111 ACTl\'1111~~

~~1 1~~

~~INTERMEDIATE INTERMEDIATE Tables Tables ND~~

~~SEP~~

~~1998~~

~~MATERNAL~~

~~1998~~

~~AUG~~

~~1998~~

~~JUL~~

~~QUALITY~~

~~1998~~

~~JUN~~

~~1998~~

~~MAY~~

~~1998~~

~~APR~~

~~SUSTAINABLE~~

~~1998~~

~~MAR~~

~~TIMETABLE~~

~~FEB~~

~~1998~~

~~PROVISION~~

~~COSTS~~

~~1998~~

~~JAN~~

~~THE~~

~~1997~~

~~DEC~~

~~~ !< j, ~ > ! '~~

~~ENDORSE~~

~~! 1~~

~~~ i~~

~~r-;~~~

~~1997 ~I~~

~~NOV~~

~~) ,.~~

)

~~...~~

~~$~<(~~

~~<~,..~~

~~1997~~

~~OCT~~

~~~::~~

~~< "<~~

)

~~POLICIES~~

~~mod~~

~~oflhe~~

~~,111d1es~~

~~and~~

~~1.es~1r.~~

~~d1scuss~~

~~\ahd1ted~~

~~colkLled?~~

~~lhe~~

~~p1.r,01111d~~

~~results~~

~~111~~

~~1111~~

~~NllS~~

~~been~~

~~proposed~~

~~th,~~

~~1h1.~~

~~lh•~~

~~\11lh~~

~~1h1.~~

~~11111111L1pah11es?~~

~~compklel}~~

~~INDICATOR~~

~~111fnr1111hon~~

~~111\oh~~

~~slud1es~~

~~NATIONAL~~

~~llas~~

~~1111,,~~

~~the~~

~~and~~

~~SERVICES them~~

~~111 use~~

~~RESULT~~

~~the~~

~~lh<~~

~~\\Ork~~

~~the~~

~~Pacl..age~~

~~111~~

~~Model~~

~~3Lquaml~~

~~actnnv~~

~~Molherhood~~

~~usmg~~

~~~fC/B Bab}~~

~~~IBP~~

~~Pnrknge~~

~~tlus~~

~~1111plemenlallon~~

~~ofSa1.aba~~

~~Safe~~

~~lhe~~

~~data~~

~~Moth1.r(.arL~~

~~111umL1pahh1.s~~

~~and~~

~~lhe~~

~~\\h1.re~~

~~Bnb\~~

~~Slllt))~~

~~NEONATAL~~

~~PROMOTION~~

~~\\1lh~~

~~Molher~~

~~7 of~~

~~scenarios~~

~~report~~

~~l\loth,thood~~

~~ACTIVITY~~

~~O~t~~

~~lhe~~

~~1110111lonng Ba~ehne~~

~~Model the~~

~~111al~~

~~1.ad11h1.~~

~~1-.1to1h1.~~

~~\\1th~~

~~d1~lr11.ls~~

~~S11re~~

~~111111111.1p1hl)~~

~~\lolher~~

~~Sludv~~

~~\\or!..~~

~~11111111.ip1lthes~~

~~lhL~~

~~INTERl\JEDIATE 1~~

~~Table~~

-t

II C:. l.osling of lhe MotherCllre project De\elopment ofa plan lo determme how Co group e\penscs Look into cost methodolo21es 2 ldenllf} the obJecllHs of the cost project 1 each Lthana e\cel spread sheet

~~] Re\ 1e\\ the fllotherC.are budget Is all !he budgets lrom from slan to fi111sh 1994 tO )997 ~Lil d1ed.edl~~

~~4 D.ia1I • 1d1 ol fllothLrC'tre s 3L\l\lhLS~~

~~5 ,\nahh the e\PLll~Lof Do.~tl1L hl\dlll• hl\L I 1n11h,~to a-..~~ the h. 11th I tins d 111? S\.r\ U..t."i~~

~~6 Re\ IL" the coopenllon gtnn to Moth.rCarc h\ olhLr~~

~~orga111nt1011s or 111~1111111011~~~

h r 7 l r. 111011ol a ~rr•adsh.etlor I h\<.. Jll the d 111b-.n ~ ..,"J the mput and an'llys1s of LO)kdeJI < ~.... ~-:\..( < i ? 1nformallo11 y ,~ /~... ' < < < h < I h '' I I ' , 8 Report (drafts and re\ 1en of the drafts) and final report

~~0\ ~ SEP~~

~~AND~~

~~AUG~~

~~MATERNAL~~

~~JUL~~

~~JUN~~

~~QUALITY~~

~~MAY~~

~~APR~~

~~SUSTAINABLE~~

~~TIMETABLE~~

~~MAR~~

~~FEB~~

~~PROVISION~~

~~THE~~

~~JAN~~

~~SYPHILIS~~

~~DEC~~

~~ENDORSE~~

~~;io~~

~~NOV~~

~~l4-30~~

~~OCT~~

~~POLICIES~~

~~drall~~

~~CVt..nl~~

~~report~~

~~copies~~

~~1'>1..'li~~

~~lnp~~

~~100~~

~~1000~~

~~IRJ~~

~~rL\~~

~~NJllOlldl~~

~~NATIONAL~~

~~M1nual~~

~~INDICATORS~~

~~SERVICES~~

~~RESULT~~

~~and~~

~~S)vh1hs~~

~~Plan~~

~~PLAN~~

~~prmhng~~

~~Natwnal~~

~~and~~

~~ofBohua~~

~~Plan~~

~~nnnual~~

~~.se'uaUy~~

~~Health~~

~~-SPAIN~~

~~swluhs~~

~~Nallonal~~

~~\ah~~

~~and~~

~~lor~~

~~Manual~~

~~-M11usl11~~

~~Care~~

~~new~~

~~ION~~

~~ln(Lnmtaonal~~

~~1fi~~

~~·ntatwn~~

~~J'iwn~~

~~...~~

~~1">1on~~

~~PROMOTION~~

~~NEONATAL~~

~~d11nunt1on~~

~~NATIONAL~~

~~MANUAL~~

~~frammg~~

~~lkallh~~

~~piescolatmu~~

~~2"d m111u1I~~

~~aull1onlJLS [\m..ncnce~~

~~trnn~n1tted~~

~~Mother congn.ss Mnustn~~

~~mLclmgs Dra\\111gs~~

~~RL\~~

~~Elmunatwn~~

~~TRAINING~~

~~Pnnlmg~~

~~PrLs~~

~~ACTIVITIES~~

~~WHO~~

~~V'I~~

~~111.!!\~~

~~mal~~

~~ELIMINA~~

~~A 3~~

~~nr111t1112~~

~~5YPHILIS~~

~~~Ir~~

~~1 ~\1,l11hs~~

~~INTER!\IEDIATE~~

~~Table~~

~~< <~~

~~i i~~

~~I I~~

~~' '~~

~~i i~~

~~I I~~

~~' '~~

~~I I~~

~~i i~~

~~II II~~

~~' '~~

~~I I~~

~~< <~~

~~i i~~

~~< <~~

~~l l~~

~~< <~~

~~i i~~

~~I I~~

~~i i~~

~~» »~~

~~I I~~

~~~ ~~~

~~< <~~

~~I I~~

~~< <~~

~~I I~~

~~i i~~

~~<, <,~~

~~~ ~~~

~~< <~~

~~'$ '$~~

~~' '~~

~~"':'$..,. "':'$..,.~~

~~,, ,,~~

~~< <~~

~~i i~~

~~< <~~

~~I I ' '~~

~~< <~~

~~;i..g ;i..g~~

~~' '~~

~~i i~~

~~<' <'~~

~~< <~~

~~ILl. ILl.~~

~~mts mts~~

~~•-ad1 •-ad1~~

~~rqmrt rqmrt~~

~~Wl)lt..S Wl)lt..S~~

~~cop11..s cop11..s~~

~~tr,11111..d tr,11111..d~~

~~tr1111cd tr1111cd tr11111..d tr11111..d~~

~~to to~~

~~Sl.f\ Sl.f\~~

~~1c1p 1c1p~~

~~p p~~

~~ls ls~~

~~p1..rsonnd p1..rsonnd~~

~~ut ut~~

~~Document Document~~

~~.. ..~~

~~1 n n 1~~

~~p p~~

~~IOOO IOOO~~

~~2000 2000~~

~~\I'>! \I'>!~~

~~All All~~

~~16 16~~

~~3 3~~

~~.. ..~~

~~ol ol~~

~~an.a an.a~~

~~LPZ LPZ~~

~~lite lite~~

~~M1nual M1nual~~

~~.Lntut .Lntut~~

~~RPR RPR~~

~~rt..sults rt..sults~~

~~of of~~

~~m1..I m1..I ol ol~~

~~of of~~

~~Mast1..r Mast1..r~~

~~of of~~

~~Cougr1$$ Cougr1$$~~

~~1999 1999~~

~~0\1..rall 0\1..rall~~

~~of of~~

~~ofSyph1hs ofSyph1hs~~

~~Posh.rs Posh.rs~~

~~STDs STDs~~

~~Impact Impact~~

~~ol ol~~

~~lor lor~~

~~lor10T lor10T~~

~~l'nntmg l'nntmg~~

~~1111..hstncts 1111..hstncts~~

~~su\lt.cs su\lt.cs~~

~~~\pluhs ~\pluhs~~

~~CBBA CBBA~~

~~ire ire~~

~~Ill Ill~~

~~p p~~

~~.. ..~~

~~111al 111al~~

~~'ilOll 'ilOll~~

~~I I~~

~~Pnnl111g Pnnl111g~~

~~Momtonng Momtonng~~

~~l l~~

~~Mcdmg Mcdmg~~

~~Momtormg Momtormg~~

~~PAHO PAHO~~

~~Prese:nln[Jon Prese:nln[Jon~~

~~Bohm1ne'l.-pette11cc Bohm1ne'l.-pette11cc~~

~~Team Team~~

~~LIMi\ LIMi\~~

~~Amerkan Amerkan~~

~~Pn Pn~~

~~Phruung Phruung~~

~~MONITORING MONITORING D1'icuo;-.io11 D1'icuo;-.io11~~

~~lVALUATION lVALUATION~~

~~TRAINING TRAINING~~

~~lOT lOT~~

~~Rqmrt Rqmrt~~

~~lOT lOT~~

~~1llcs 1llcs~~

~~0\ 0\~~

~~Jllllll~ Jllllll~~~

~~r r~~

~~d1stnbut10n d1stnbut10n~~

~~I I~~

~~l l~~

~~I I~~

~~'>lllll.f\ '>lllll.f\~~

~~2 2~~

~~3 3~~

~~3 3 7 7~~

~~) )~~

~~D D~~

~~c c~~

~~2 2~~

~~SUPERVISION SUPERVISION~~

~~TOT TOT 6 6~~

~~4 4~~

~~2 2~~

~~3 3~~

~~d1stnhu11011 d1stnhu11011~~

~~1..\alu1ho11 1..\alu1ho11~~

~~1..\aluahon 1..\aluahon actn actn~~

~~5% 5%~~

~~33% 33%~~

~~50% 50%~~

~~100% 100%~~

~~18 18~~

~~509% 509%~~

~~IR3% IR3%~~

~~I I~~

~~33% 33%~~

~~'\0% '\0%~~

~~100% 100%~~

~~1ooro 1ooro~~

~~100% 100%~~

~~77,9% 77,9%~~

~~256% 256%~~

~~IR2% IR2%~~

~~IOO% IOO%~~

~~100% 100%~~

~~3,6% 3,6%~~

~~23,5% 23,5%~~

~~33,33% 33,33%~~

~~IRI% IRI%~~

~~00 00~~

~~8167 8167~~

~~6000 6000~~

~~19000 19000~~

~~20000 20000~~

~~1660 1660~~

~~......~~

~~IRJ IRJ~~

~~285916,56 285916,56~~

~~8167 8167~~

~~10000 10000~~

~~2-1000 2-1000~~

~~20000 20000~~

~~53800 53800~~

~~l-t3889,97 l-t3889,97~~

~~175151,00 175151,00~~

~~IR2 IR2~~

~~IN IN~~

~~4000 4000~~

~~8167 8167~~

~~ISOOO ISOOO~~

~~68600 68600~~

~~AMOUNTS AMOUNTS~~

~~8000,00 8000,00~~

~~IRI IRI~~

~~131853,69 131853,69~~

~~1998-ALL 1998-ALL~~

~~22 22~~

~~4000 4000~~

~~0000 0000~~

~~6000 6000~~

~~I I~~

~~19000 19000~~

~~15000 15000~~

~~2-1000 2-1000~~

~~'\1800 '\1800 2-l500 2-l500~~

~~40000 40000~~

~~68600 68600~~

~~22481100 22481100~~

~~561660 561660~~

~~SEPTEMBER SEPTEMBER~~

~~AMOUNT AMOUNT~~

~~TOTAL TOTAL~~

~~$us $us~~

~~1997-~~

~~SEPTEMBER SEPTEMBER~~

~~cm cm~~

~~1s1on 1s1on~~

~~oh oh~~

~~Benefits/ Benefits/~~

~~Im Im~~

~~Centers Centers~~

~~SUMMARY SUMMARY~~

~~Bullctm Bullctm~~

~~Books Books~~

~~11 11~~

~~Production Production~~

~~and and~~

~~cduca110111l cduca110111l~~

~~Stud\ Stud\~~

~~anccs anccs~~

~~---J ---J~~

~~0\ 0\~~

~~1111111g/Supcn 1111111g/Supcn~~

~~BUDGET BUDGET~~

~~Equipment Equipment~~

~~S\ph1hs S\ph1hs~~

~~Impact Impact~~

~~Product Product~~

~~Momtonng/CASI/ Momtonng/CASI/~~

~~Costs Costs~~

~~n1.1tcnal/IEC n1.1tcnal/IEC~~

~~Rcg1stn Rcg1stn~~

~~Product Product~~

~~Communlt\ Communlt\~~

~~Murnc1p Murnc1p~~

~~AllO\\ AllO\\~~

~~Tr Tr~~

~~Sahncs Sahncs Tr,l\cl Tr,l\cl~~

~~33% 33%~~

~~33 33~~

~~IR3% IR3%~~

~~33,33% 33,33%~~

~~IR2% IR2%~~

~~33,33% 33,33%~~

~~1Rl% 1Rl%~~

~~89 89~~

~~16667 16667~~

~~18763,33 18763,33~~

~~IR3 IR3~~

~~-136171 -136171~~

~~31 31~~

~~16667 16667~~

~~38763 38763~~

~~IR2 IR2~~

~~-190-138,30 -190-138,30~~

~~33 33~~

~~16667 16667~~

~~38761 38761~~

~~IRI IRI~~

~~2910'\102 2910'\102~~

~~22 22~~

~~'iOOOO 'iOOOO~~

~~116290 116290~~

~~1217661 1217661~~

~~AMOUNT AMOUNT~~

~~lOTAL lOTAL~~

~~1hi.1t 1hi.1t~~

~~C\ C\~~

~~11 11~~

~~fin fin~~

~~0\ 0\~~

~~00 00~~

~~Project Project ODC ODC Mothe1 Care - I Rt - *Project app1 oved to 1998~~

Indicators Codes Momtormg System Venficahon System Basel me Target 1997 - 1998 Number of target audience by sex, age & HHR Population-based Quarterly evaluation 0 (1996) By 1998 50% ethnicity, who recognize (based on 1 1(1) survey at project's end, of reports by Sex/age respondent recall) a key program message 1998 MotherCare Quahtat1ve Women age 15-49 of a Mothercare-produced USAID-funded management staff research 82,191/ 164,381 IEC RSH or CS campaign or mass conducted 111 Men NA commumcation act1v1tyI Number of target 1996 (radio- Eth111c1ty NA audience by sex, age & eth111c1ty,exposed novel a) to program message of a Mothercare- produced USAID-funded RSH or CS ICC campaign or mass commumcatton act1v1ty

Number of Mothercare-produced USAI D- llHR Analysts of valtdation Quaitcrly evaluation 0 (1996) Annually funded RSH or CS educat10nal materials 1 1(2) mstruments of reports by 1997 10 /10 prmted that were validated through a MotherCare Project 111 mat' ls standard/approved methodology mcludmg management staff phase of 60160 clients of different sex, age & SCS I Total materials I rad10novelas number of Mothercare-produced USA ID- development 1998 + 51 5 printed funcled RSH or CS education materials mat'ls Number of pregnant women with at least HHR Quarterly service Quarterly evaluation 37% 40% 7,732/19,330 one prenatal v1s1t before 5th month of 1 2(5) stat1st1c reports by of reports by 5,913/15,879 By 1998 pregnancy to a health service m a providers MotherCare (1996) (Annual) MotherCare target area I Total number of management staff pregnant women with at least one prenatal Monthly SNIS reports v1s1tdurmg pregnancy to a health service by providers m a MotherCare target areas

~~0\ '° 30~~

~~1998~~

~~pop~~

~~health~~

~~3982~~

~~with~~

~~2 1~~

~~1997~~

~~Fairs~~

~~meetmgs~~

~~796~~

~~mumc1p10s~~

~~1998~~

~~Interactive~~

~~Health~~

~~CAI Meetmgs~~

~~Target~~

~~1998~~

~~In meetmgs 3 (20%) officials 2 (based growth) (Cumulative) 4~~

~~1996)~~

~~2 (~~

~~3900~~

~~nteract1ve~~

~~Basehne~~

~~Health Meetings~~

~~26 meetmgs (1996) officials 2CAI meetmgs8 Fairs with 3 I 4~~

~~health~~

~~System~~

~~staff~~

~~evaluation~~

~~reports~~

~~Verification~~

~~management management~~

~~Quarterly evaluation MotherCare of MotherCare~~

~~Quarterly of~~

~~reports~~

~~System~~

~~MotherCare~~

~~service~~

~~SNIS~~

~~act1v1ty~~

~~reports~~

~~providers~~

~~Momtormg~~

~~providers~~

~~Quarterly~~

~~stat1st1c Monthly staff Monthly reports~~

~~2(8)~~

~~HHR~~

~~Codes~~

~~Activity~~

~~type~~

~~broaden~~

~~h1gh-nsk~~

~~areas~~

~~attention~~

~~meetings~~

~~Mothercare~~

~~that~~

~~number~~

~~care,~~

~~plans~~

~~act1v1t1es,~~

~~target~~

~~signs~~

~~Total~~

~~medical~~

~~autho11t1es~~

~~health~~

~~part1c1pat1on~~

~~women~~

~~health~~

~~education~~

~~pregnancies~~

~~seek~~

~~danger~~

~~local~~

~~MotherCare,~~

~~Indicators~~

~~nsk~~

~~delivery~~

~~pnmary health~~

~~who~~

~~MotherCare~~

~~with~~

~~pregnant~~

~~health-related~~

~~ra1rs or~~

~~community~~

~~high-~~

~~commumty~~

~~mcetmgs~~

~~aOreas~~

~~recogmzmg~~

~~fcalth~~

~~--.J~~

~~Interactive~~

~~sustain~~

~~Mectmgs~~

~~CAI~~

~~preventive~~

~~expected implemented pregnancy dehvenes Number Number after target 3~~

~~& 4~~

~~develop 2 strategies~~

~~1998 1998~~

~~these) these)~~

~~m m~~

~~1997 1997~~

~~HCs HCs~~

~~18 18~~

~~0 0~~

~~18 18~~

~~0 0~~

~~18(allofMC's 18(allofMC's~~

~~0 0~~

~~of of~~

~~Target Target~~

~~1998 1998~~

~~1997 1997~~

~~1998 1998~~

~~mumc1p1os) mumc1p1os)~~

~~1997 1997~~

~~1998 1998~~

~~1997 1997~~

~~(80% (80%~~

~~Annually Annually~~

~~1998 1998~~

~~1997 1997~~

~~Annually Annually~~

~~me me~~

~~(1996) (1996)~~

~~New New~~

~~Basel Basel~~

~~New New~~

~~* *~~

* * act1v1ty act1v1ty

~~act1v1ty act1v1ty~~

~~0 0~~

~~* *~~

~~0 0~~

~~activity activity~~

~~0 0~~

*New *New

~~activity activity~~

~~0 0~~

~~activity activity~~

~~0 0~~

~~by by~~

~~of of~~

~~System System~~

~~staff staff~~

~~review review~~

~~reports reports~~

~~evaluation evaluation~~

~~by by~~

~~management management~~

~~staff staff~~

~~progress progress~~

~~management management~~

~~reports reports~~

~~Venficahon Venficahon Annual Annual~~

~~MotherCare MotherCare~~

~~management management~~

~~MotherCare MotherCare~~

~~reports reports~~

~~Annual Annual~~

~~Semi-annual Semi-annual~~

~~staff staff~~

~~MC MC~~

~~Semi-annual Semi-annual~~

~~of of~~

~~MC MC~~

~~of of~~

~~Semi-annual Semi-annual~~

~~of of~~

~~MC MC~~

~~by by~~

~~System System~~

~~field field~~

~~progress progress~~

~~staff staff~~

~~I I~~

~~reports reports~~

~~agre~ments agre~ments~~

~~& &~~

~~mumc1paht1es mumc1paht1es~~

~~Momtormg Momtormg~~

~~Signed Signed~~

~~Mothercare Mothercare~~

~~v1s1ts v1s1ts with with~~

~~supervisory supervisory~~

~~observattonal observattonal~~

~~reports reports Semi-annual Semi-annual Senu-annual Senu-annual~~

~~reports reports Semi-annual Semi-annual~~

~~reports reports~~

~~Semi-annual Semi-annual~~

~~1(4) 1(4)~~

~~1(2) 1(2)~~

~~2(1) 2(1)~~

~~1(1) 1(1)~~

~~3(2) 3(2)~~

~~HHR HHR~~

~~3 3~~

~~Codes Codes~~

*Wash *Wash

~~1998 1998~~

~~to to~~

~~I I~~

~~target target~~

~~and and~~

~~target target~~

~~RSI RSI~~

~~have have~~

~~thetr thetr~~

~~approved approved~~

~~formal formal~~

~~planmng-~~

~~health health~~

~~111 111~~

~~that that~~

~~Mothercare Mothercare~~

~~USAID USAID~~

~~Mothercare Mothercare~~

~~PAO PAO~~

~~counterpart counterpart~~

~~with with~~

~~111 111~~

~~m m~~

~~s s~~

~~the the~~

~~health health~~

~~established established~~

~~m m~~

*Project *Project

~~incorporated incorporated~~

~~Mothercare's Mothercare's~~

~~are are~~

~~protocols protocols~~

~~111-kmd 111-kmd~~

~~m m~~

~~commumty commumty~~

~~Mothercare Mothercare~~

~~have have~~

~~or or~~

~~lnd1cato1 lnd1cato1~~

~~and and~~

~~received received~~

~~IRJ IRJ~~

~~mcluded mcluded~~

~~DILOS DILOS~~

~~that that~~

~~with with~~

~~where where~~

~~mumc1paht1es mumc1paht1es~~

~~mu111c1paht1es mu111c1paht1es~~

~~DlLOs DlLOs~~

~~mumc1paltt1es mumc1paltt1es~~

~~cash cash~~

~~have have~~

~~a a~~

~~are are~~

~~norms norms~~

~~of of~~

~~of of of of~~

~~of of~~

~~trammg trammg~~

~~services services~~

~~areas areas~~

~~that that~~

~~where where~~

~~CS CS~~

~~quarterly quarterly~~

~~......~~

~~-....) -....)~~

~~health health~~

~~target target~~

~~provided provided~~

~~Number Number~~

~~agreements agreements &/or &/or~~

~~contnbut1on contnbut1on related related~~

~~meet meet~~

~~Number Number~~

~~areas areas~~

~~pnonties pnonties~~

~~Number Number~~

~~target target MotherCare MotherCare 1998~~

~~models~~

~~1997~~

~~1998~~

~~Documents~~

~~1998~~

~~end-1997~~

~~Target~~

~~998~~

~~1998~~

~~1997~~

~~Annually~~

~~3 (Cumulative) 25,000~~

~~Annually Package" Number~~

~~Total "Mother-Baby 23~~

~~activity~~

~~996)~~

~~(1996)~~

~~Baselme~~

~~new~~

*New

~~5,000 activity~~

* actavaty models

~~Documents~~

~~0 Number (1996) Total~~

~~System~~

~~staff~~

~~review~~

~~reports~~

~~evaluat10n~~

~~evaluation~~

~~staff~~

~~progress~~

~~Veraficataon~~

~~Annual~~

~~management~~

~~Annual MC reports~~

~~reports Semi-annual MotherCare~~

~~Semi-annual~~

~~management~~

~~MC of~~

~~of MotherCare~~

~~plans~~

~~System~~

~~progress~~

~~records~~

~~and~~

~~work~~

~~reports~~

~~Momtormg~~

~~Semi-annual~~

~~reports~~

~~Senn-annual Pubhcat1on Ongomg reports d1stnbutton~~

~~Analysis~~

~~d1stnbutton~~

~~Publication~~

~~1(2)~~

~~1(1)~~

~~4(3)~~

~~4(4)~~

~~HHR HHR~~

~~HHR~~

~~Codes~~

~~and~~

~~local~~

~~target~~

~~(1e~~

~~and~~

~~RSH~~

~~health~~

~~USAID~~

~~CS)~~

~~and~~

~~D1stnct~~

~~with~~

~~for~~

~~Manual,~~

~~health~~

~~and~~

~~Mothercary~~

~~USAJD~~

~~PAO~~

~~analysis~~

~~and~~

~~d1ssemmated~~

~~accompanied~~

~~assistance~~

~~the~~

~~hospitals)~~

~~pen-natal~~

~~care~~

~~established nat1onally~~

~~and~~

~~(national~~

~~protocols~~

~~financial~~

~~996,~~

~~developed~~

~~are~~

~~I Procedural~~

~~Centc1~~

~~community~~

~~maJor~~

~~GOB~~

~~&/or~~

~~Indicators~~

~~munic1paht1es~~

~~technical~~

~~for~~

~~produced~~

~~mcluded~~

~~Health~~

~~maternal~~

~~DILOS~~

~~where~~

~~mumc1paht1es~~

~~munic1paht1es~~

~~health-financing~~

~~delivery~~

~~issues~~

~~ready~~

~~(not~~

~~norms~~

~~are~~

~~for~~

~~manuals/texts~~

~~Techmcal~~

~~areas~~

~~where~~

~~quarterly~~

~~pennatal/obstetncal~~

~~service~~

~~-.)~~

~~Mothercare~~

~~Number meet~~

~~pnont1es target~~

~~USAID-funded~~

~~protocols,~~

~~areas Planned~~

~~f an CS~~

~~Number~~

~~approved No target~~

~~d1ssemmated~~

~~Hospitals 111tendcd~~

~~addressing~~

~~sustamab1hty~~

~~Number 1998~~

~~Safe~~

~~1997~~

~~18 18 18~~

~~Target~~

~~1997~~

~~1998~~

~~1997 1998~~

~~Motherhood"~~

~~Annually Annually~~

~~"Model~~

~~(1996)~~

~~{1996)~~

~~Baseline~~

*New

~~activity 0 0 act1v1ty~~

~~by by~~

~~System~~

~~review~~

~~reports reports~~

~~staff~~

~~progress~~

~~Veralicahon~~

~~Semi-annual Semi-annual~~

~~of MC of MC~~

~~System~~

~~progress progress~~

~~Momtormg~~

~~Semi-annual reports reports~~

~~Semi-annual~~

~~1(2)~~

~~1(1)~~

~~HHR~~

~~Codes~~

~~target~~

~~and~~

~~AID~~

~~health~~

~~Mothercare~~

~~PAO~~

~~m m~~

~~providers~~

~~the~~

~~established~~

~~are~~

~~sector~~

~~community~~

~~Indicators~~

~~included~~

~~DILOS~~

~~where~~

~~mumc1paht1es pnvate mumc1pahttes~~

~~are~~

~~of of~~

~~and~~

~~areas~~

~~where~~

~~quarterly~~

~~---1~~

~~!..J~~

~~meet~~

~~pnonttes levels) Number areas~~

~~target~~

~~Number~~

~~+ Appendix 8 MotherCare Publications List~~

~~Previous Page Blank 175 MotherCare Publications List 1997~~

~~YOUR NAME ______~~

~~ORGANIZATION ______~~

~~MAILING ADDRESS ______~~

~~E-MAIL ADDRESS ______~~

~~Ifyou would lzke to be added to our electronic dzssemmatzon lzst, please include your e mazl address~~

~~Please return this list to John Snow, Inc , MotherCare, 1616 North Fort Myer Dnve, 11th Floor, Arlington, VA, 22209 US A~~

Note Not all documents are available through MotherCare, and some documents are no longer m pnnt and are therefore unavailable Single copies of documents are provided free of charge Multiple copies may require a charge - contact us for possible costs Please allow 6 - 8 weeks for delivery

~~In spaces provided, please check those document{s} you wzsh to request, and when necessary, circle the language zn which you would like to receive them~~

~~WOMEN'S HEALTH~~

Kobhnsky, MarJone A, Judith Timyan and Jill Gay, eds 1992 "Women's Health at the Crossroads" Extracted from The Health of Women A Global Perspective. Partnership for Safe Motherhood. W ashmgton, DC The World Bank Requests for this publication should be sent to The World Bank, I 1818 H St., NW, Washington, DC 20433 (MOO!)

Kobhnsky, Maqone A, Judith Timyan and Jill Gay, eds 1992 The Health of Women, A Global Perspective Boulder, Colorado Westv1ew Press Requests for this publication should be sent to Westv1ew Press, 5500 Central Ave, Boulder, Colorado 80301-2877 (M002)

___Turman, Tonms, Carla AbouZahr and Mar1one Koblmsky, eds 1995 "Reproductive Health The MotherCare Experience " Supplement to the Imeroar1onal Journal of Gynecology and Obstetrics Vol 48 (suppl) (M003)

~~177 / Previous Page Blank SAFE MOTHERHOOD~~

___Kwast, Barbara E 1993 "The Role and Trammg of M1dw1ves for Safe Motherhood The Current Status of Gynecology and Obstemc Senes Volume 6 The Proceeding of the XIIlth \\i orld Congress of Gynecology and Obstetrics (MOS!)

~~___Kwast, Barbara E 1991 "Safe Motherhood A Challenge to Midw1ferv Practice' \Vorld Health Forum 12 1-6 (M052)~~

~~___Kwast, Barbara E 1993 "Safe Motherhood - The First Decade" Midw1fecy 9 105-123 (MOS3)~~

~~___..Meashem, Diana M, MarJone A Koblmsky and Anne Tmker 1991 Toward the Development of Safe Motherhood Program Gmdelmes Safe Motherhood Partnership paper (M054)~~

~~___MotherCare, John Snow, Inc June 1994 Healtby Pregnancy, Safe Delivery - The MotherCare Experience MotherCare Matters Vol 4, No 2-Special Edmon Avrulable m English, French and Spanish (MOSS)~~

___Gordis, Deborah, ed with contributions by Maqone Koblmsky, Colleen Conroy, Barbara Kwast and Kim Wmnard 1994 MOTHER.CARE Lessons Learned 1989 - 1993. Summary Emal Report MotherCare ProJect, John Snow, Inc , Arlington, VA (MOS6)

~~___MotherCare,John Snow, Inc 1994 MOIHERCARE. 1989-1993 Couorry Pro1ect Descnpuons MotherCare Pro1ect, John Snow, Inc , Arlington, VA (M057)~~

~~___United States Agency for International Development/Jakarta, Indonesia 1991 Notes on an Approprza.te Approach to Safe Motherhood MotherCare Working Paper #8, John Snow, Inc, Arlington, VA (MOSS)~~

____,_,aukaran, Virginia H, Ad1ty Bhattacharyya and Beverly Wmikoff 1994 Delivering Women Centered Maternity Care with Limited Resources Grenada Reproductive Health Matters, No 4 (M059) \ ---Kwast, Barbara E 1996 "Reduction of Maternal and Perinatal Mortality in Rural and Peri-Urban Semngs What Works)" European Journal of Obsremcs & Gynecology and Reproductive Biology Volume 69, p 47-53 MotherCare Pro1ect, John Snow Inc, Arlington, VA (M060)

~~---Tinker, Anne and Maqone A Koblinsky et al 1993 Makmg Motherhood Safe World Bank, Washington, DC Avatlable m English and Spanish (M061)~~

~~---MotherCare, John Snow, Inc October 1997 Leaming and Action zn the First Decade The MotherCare Experience MotherCare Matters Vol 6, No 4- Special Edmon Available m English and Spanish (M062)~~

~~I 78 MATERNAL & PERINATAL HEALTH~~

~~General~~

~~___.MotherCare, John Snow, Inc October 1992 Defining and Measuring Maternal Morbidm .A First Step Toward Action MotherCare Matters Vol 2, No 4 (MlOl)~~

~~___MotherCare, John Snow, Inc May/June 1992 How Can Maternal Mortalm• be Reduced:? MotherCare Matters Vol 2, No 2/3 (M102)~~

~~--~MotherCare, Johri Snow, Inc October/Nm.rem.her 1991 Is Perinatal Mortality a Useful Indicator of Maternal Mortality? MotherCare Matters Vol 2, No 1 Available m English, French and Spamsh (M103)~~

~~___MotherCare, John Snow, Inc March 1991 Reducing Pennatal Mortality Identifying and modzfyzngnskfactors MotherCare Matters Vol 1, No 4 Available m English, French and Spamsh (M104)~~

~~___MotherCare, John Snow, Inc September - December 1990 Pennatal Mortality The Uncounted Millions MotherCare Matters Vol 1, No 2-3 Available m English, French and Spamsh (M105)~~

~~___MotherCare, John Snow, Inc June 1990 Overview Maternal Health MotherCare Matters Vol 1, No 1 Available m English and Spamsh (M106)~~

~~___MotherCare, John Snow, Inc February/March 1995 On the Pathway to Maternal Health Results from Indonesia MotherCare Matters Vol 5, No 1 Available m English, Spamsh & French (M107)~~

~~___MotherCare, John Snow, Inc December 1995 Young Adults Is age a Risk Factor? MotherCare Matters Vol 5, No 2/3 Available m English, Spamsh & French, {M108) I~~

~~___MotherCare, John Snow, Inc August 1996 Improving Obstetncal and Neonatal Management Lessons from Guatemala MotherCare Matters Vol 5, No 4 Available m English, Spamsh & French {M109)~~

~~___Thouw, J 1992 Delegation ofObstetru: Care in Indonesia Imernauonal Journal of Gynecology & Obstetrics (Suppl) 545-547 {MllO)~~

~~179 Assessment~~

~~___Harrison, Ab1ga1l 1994 Assessmg Maternal and Pen-Neonatal Health Tools and Methods The MotherCare Experience MotherCare Pro1ect, John Sno~, Inc, Arlington, VA (M151)~~

___...Sch1eber, Barbara, Mano Me11a, Sara Kantz, Carlos Gonsalez, with Barbara E K wast 1995 'vfedzc.:zl Audzt of Early Neonatal Deaths INCAP/Quetzaltenango Maternal & Neonatal Health Proiect MotherCare Techmcal Workmg Paper #1, John Snow, Inc, Arlington, VA (M152)

~~___Koblmsky, Marge 1996 Para salvar la v1da MotherCare·Bohv1a, MotherCare Proiect,] ohn Snov. , Inc , Arlington, VA Available m Spanish only (M153)~~

~~___..MotherCare, John Snow, Inc August/September 1997 Methodological Issues zn Perinatal Mortalzty Research MotherCare Matters Vol 6, No 3 Available m English and Spamsh (M154)~~

~~Qualitative Research~~

___Carlm, Leslie E , Nanet P Ambaretnam, Carolyn Hessler-Radelet 1993 Qualitative Research for the Soczal Marketing Component of the Perinatal Regionalization Project, Tan;ungsan, West Java MotherCare Workmg Pa.per #19, John Snow, Inc, Arlington, VA (M201)

___The Center for Health Research, Consultation and Education (CIAES) 1991 Qualitative Research on Knowledge, A tt:tudes, and Practices Related to Women 's Reproducttve Health Cochabamba, Bolzvza MotherCare W orkmg Pa.per #9, John Snow, Inc , Arlmgton, VA {M202)

___Howard-Grabman, Lisa 1993 The ''Autodzagnoszs" A Methodology to Facilitate Maternal and Neonatal Health Problem Identzficatzon and Pnontzzatzon zn Women 's Groups zn Rural Bolivia MotherCare Workmg Paper #16A, John Snow, Inc, Arlmgton, VA (M203)

___Howard-Grabman, Lisa 1993 Planning Together A Methodology to Faczlztate the Development of Strategies and Actions to Address Pnonty Maternal and Neonatal Health Problems in Rural Bolivian Communities MotherCare Workmg Paper #16B, John Snow, Inc, Arlmgton, VA (M204)

~~---Moore, Mona 1990 Behavioral Determinants of Maternal Health Care Choices zn Developing Countries MotherCare Workmg Pa.per #2, John Snow, Inc, Arlington, VA (M205)~~

___..Public Op1D1on Polls, Ltd, Lagos, Nigeria 1993 MotherCare Nigerza Maternal Healthcare Pro;ect Qualztatwe Research Literature Review MotherCare Workmg Paper #17 A, John Snow, Inc, Arlington, VA (M206)

~~___..Public Op1D1on Polls, Ltd, Lagos, Nigeria 1993 MotherCare Nigerza Maternal Healthcare Pro1ect~~

~~180 Qualztatzve Research MotherCare Workmg Paper #17B, John Sno\'l., Inc, Arlmgton \A (11.:::-)~~

~~___Wedderburn, Maxme and Mona Moore 1990 Qualztatzve Assessment of Awrudes Affecting Chtldbzrth Chozces ofJamaican Women MotherCare Workmg Paper #5, John Snov., Inc , Arlmgton VA (M208)~~

___MotherCare ProJeCt 1993 Lograr la matermdad sm nesgos La expenencia de MotherCare en Guatemala. Bolivia y Ecuador 1989-1993 USAID and MotherCare, John Snow Inc , Arlington V .<\ Available m Spanish only Quantities are hm1ted (M209)

MotherCare, Guatemala 1996 Desde la comumdad,,,Percepqon de las comphcac10nes maternas ~ permatales y busquecia de atenq6n Proyecto de Salud Materna/MotherCare, PATH, Mm1steno de Salud Pubhca de Guatemala, MotherCare Washmgton, John Snow Inc, Arlmgton, VA Available m Spanish only Requests for tlus pubhcat10n should be sent to MotherCare Guatemala, Blvd L1berac16n 15-86, Zona 13, Edef1c10 Obebsco, oficma 307, Guatemala City, Guatemala (M210)

~~Applied Research~~

--~Bartlett, Alfred, Marco Antomo Bocalem, and Mana E Paz de Bocalem 1993 Use ofOxytoczn and Other ln1ectzons Dunng Labor in Rural Munzcipalttzes of Guatemala Results ofa Randomized Study MotherCare W orkmg Pa.per #22, John Snow, Inc , Arlington, VA (M251)

~~___Hight-Laukaran, Virg1ma 1991 Achieving Safe Motherhood with Limited Resources A Case Study of Maternal Care zn Grenada MotherCare Workmg Paper #6, John Snow, Inc , Arlington, VA (M252)~~

___Huque, A A Zaludul and Maqone A Koblmsky 1991 Maternal Mortality Level, Trends and Determinants Background paper presented at the MotherCare/World Bank Workshop on Gu1delmes for Safe Motherhood MotherCare WorkmgPaper#lO,John Snow, Inc, Arlington, VA (M253)

~~___Kelly, John and Barbara E Kwast 1993 "Epidemiological Study of Vesicovagmal Fistulas m Ethiopia" Internat1onal Urogynecolog1cal Journal 4 278-281 (M254)~~

~~---Kelly, John and Barbara E Kwast 1993 "Obstetric Vesicovagmal Fistulas Evaluation of Failed Repairs " Imernat1onal Urogynecolog1cal Journal 4 271-273 (M255)~~

--~Sloan, Nancy L, Lenm W Leon Camacho, Ernesto Pmto RoJas, Claudio Stern and Matermdad Isidro Ayora Study Team 1994 "Kangaroo Mother Method Randomized Control Tnal of an Alternative Method of Care for Stabilized Low Birthweight Infants " The Lancet 344 782-85 (M256)

~~___,K wast, Barbara E 1994 lndzcators for Obstructed & Prolonged Labor, Puerperal Sepsis & Postpartum~~

181 Hemorrhage Profile of Admissions, Hospital Management, Coverage and Referral For Tne S.ik Pregnancy Evaluation Pro1ect, The Carolina Population Center, m collaboration 'ti.1th Tulane Uruvers1ty and the Futures Group MotherCare Working Paper #21, John Sno'tl. Inc Arlington VA (M257)

___RochJatl, PoedJI, PraJitno Prabowo, Agus Abahdi, Benny Soeg1anto, Kresnavana Yahva with Barbara E Kwast 1995 An Antenatal Rzsk Sconng Svstem East Java Safe Motherhood Study Probolinggo District, East Java, Indonesia MotherCare Techmcal Workmg Paper #2, John Snov. Inc Arlington, VA (M258)

___..,Batley, Patricia E, Jose A Szaszch, Barbara Schieber 1995 Analysis ofthe Vital Events Reporting System of the Maternal and Neonatal Health Pro;ect Querzaltenango, Guatemala MotherCare Techmcal W orkmg Paper #3, John Snow, Inc , Arlmgton, VA (M259)

___Maternal and Cluld Health and Fanuly Planrung Programme and the Special Programme of Research June 4, 1994 World Health Orgaruzat1on Panograph m Management of Labour !fil_ Lancet, World Health Organization, Geneva, Switzerland (M260)

~~Program Implementation~~

~~---·George, Nicolette 1990 Interventions to Improve Maternal and Neonatal Health and Nutntzon MotherCare Working Paper #4, John Snow, Inc, Arlmgton, VA (M301)~~

___Griffiths, Marcia, Mona Moore and Michael Favm 1991 Communicating Safe Motherhood Uszng Communication to Improve Maternal Health zn the Developing World Paper presented at the MotherCare/World Bank Workshop on Gu1dehnes for Safe Motherhood MotherCare W orkmg Paper #14, John Snow, Inc, Arlington, VA (M302)

---Howard-Grabman, Lisa, Guillermo Seoane, and Chen Ann Davenport 1993 The Warm1 Pro1ect A Participatory Approach to Improve Maternal and Neonatal Health. An Implementor's Manual MotherCare, John Snow, Inc, Arlmgton, VA Available m English and Spanish {M303)

~~___Koblmsky, Mar1or1e A, Anne Tmker and Patncia Daly 1993 "Programmmg for Safe Motherhood A Guide to Action " Health Policy and Planning 9(3) 252-266 (M304)~~

~~___The Manoff Group 1993 Applying Social Marketing to Maternal Health Pro1ects. The MotherCare Experience MotherCare, John Snow, Inc , Arlington, V"A. (M305)~~

~~--~Schieber, Barbara and Heman Delgado 1993 An Iotervent1on to Reduce Maternal and Neonatal Mortality Quetzaltenango, Guatemala (M306)~~

~~182 Trazmng~~

___The Family Health Service ProJeCt, Nigeria, MotherCare/John Snov., Inc, The Johns Hopkm' Umvermy, PCS 1993 Interpersonal Commumcauon and Counseling Curriculum tor Mid\\ I\ es MotherCare, John Snow, Inc, Arlington, VA (M351)

~~INCAP, Guatemala 1993 Trammg Manual for Tramers of Tradmonal Bmh Attendants PRESENTL'\ UNAVAILABLE (M352)~~

~~___Marshall, Margaret A and Sandra T Buffington 1991 Life Savmg Skills Manual for M1dv.1ves Washington, DC Amencan College of Nurse-Midwives, 2nd edmon (M353)~~

MotherCare, Guatemala 1996 Guia para faqhtadores de comadronas Material visual para educaqon pamc1pat1va Mmisteno de Salud Pubhca y Asistencia Social Proyecto de Salud Materna-Pennatal, USAID y MotherCare,John Snow, Inc, Arlington, VA Available m Sparush only Requests for this pubhcat1on should be sent to MotherCare Guatemala, Blvd Liberaci6n 15-86, Zona 13, Edeficio Obehsco, oficma 307, Guatemala City, Guatemala (M354)

MotherCare, Guatemala 1996 Guia para faqhtadores de comadronas. Educaq6n pamcipat1va Mirusterio de Salud Pubhca y Asistencia Social Proyecto de Salud Materna-Perinatal, USAID y MotherCare, John Snow, Inc , Arlington, VA Available m Spanish only Requests for tlus publication should be sent to MotherCare Guatemala, Blvd Liberaci6n 15-86, Zona 13, Edeficio Obehsco, oficma 307, Guatemala City, Guatemala (M355)

MotherCare, Guatemala 1996 Guia para facihtadores de comadronas Contemdos tecmcos para comadronas Mirusteno de Salud Pubhca y Asistencia Social Proyecto de Salud Materna-Perinatal, USAID y MotherCare,John Snow, Inc, Arlington, VA Available m Spanish only Requests for thlS pubhcat1on should be sent to MotherCare Guatemala, Blvd L1berac16n 15-86, Zona 13, Edeficm Obehsco, oficma 307, Guatemala City, Guatemala (M356)

MotherCare, Guatemala 1996 Seiiales de pehgro del embarazo. parto y rec1en nacido. Cuando hay seiial de pehgro debe referir (a p1ctoral manual) Mirusteno de Salud Pubhca y Asmencia Social Proyecto de Salud Materna-Permatal, USAID y MotherCare, John Snow, Inc , Arlington, VA Available m Spanish only Requests for thlS publication should be sent to MotherCare Guatemala, Blvd Liberac16n 15-86, Zona 13, Edeficio Obehsco, oficma 307, Guatemala City, Guatemala (M357)

___MotherCare, Bolivia 1996 Hacia una atenci6n integral y humamzada de la mu1er No 1 de la sene Me;oramz.ento de la calu:lad educatzva de la auxzlzar de la enfermerza Mm1steno de Desarrollo Humano, Secretana Nac1onal de Salud, Escuela Tecmca de Salud, USAID y MotherCare, John Snow Inc, Arlington, VA Lmuted quant1t1es Available m Spanish only (M358)

~~MotherCare, Guatemala 1996 Redas de oro del trato a la paqepte (a poster) Ministeno de Salud Pubhca y Asistenc1a Social Proyecto de Salud Materna-Perinatal, USAID y MotherCare, John Snow, Inc,~~

183 Arlington VA A vatlable m Spanish only Requests for this pubhcat1on should be sent to MotherCare Guatemala, Blvd L1berac1on 15-86, Zona 13, Edef1c10 Obehsco, of1cma 307, Guatemala C1n Guatemala (M359)

Paluzzi, Patricia A, and Paulme Glatle1der Famtly-Cemered Materotty Care Trammg of Trainers Cumculum. Ukrame 1996, 2nd ed.mon A USAID supported collaborative pro1ect of the American College of Nurse-M1dw1ves under John Snow, Incorporated!MotherCare, Arlington, VA A va1lable m English and Russian PR.ESENTIY UNAVAILABLE (M360)

Marshall, Margaret May-June 1996 Workshop on Family Plannmg and Reproductive Health Trammg Curriculum for Breastfeedmg and LAM Sessions American College of Nurse-M1dw1ves under John Snov. Inc /MotherCare, m collaboration with SEA TS Available m English and Russian PRESENTLY UNAVAILABLE (M361)

Part1ci,pants' Manual for Workshop on Family Planmng and Reproducpve Health Trammg Curriculum for Breastfeeding and LAM Sess10ns American College of Nurse-M1dw1ves under John Snow, Inc /MotherCare, m collaborat1on wtth SEA IS Avadable m Russian only PRESENTLY UNAVAILABLE (M362)

~~Case Management and Protocols~~

~~___INCAP, Guatemala 1993 Guidelmes for the Management of the Panqpal Neonatal Emergencies for Reg1onal-Departmemal Hospitals (Guatemala) INCAP Pub No MDI/003 {M401)~~

~~INCAP, Guatemala 1993 Management of Obstetac and Neonatal Emergencies m Commumzy Health Centers and Health Posts (Guatemala) INCAP Pub No MDI/002 PRESENTLY UNAVAILABLE UNDER REVISION. {M402)~~

~~___JNCAP, Guatemala 1993 Obstemc Manag,emem Protocols for Regional-Departmental Hospitals (Guatemala) INCAP Pub No MDI/004 (M403)~~

~~---Kwast, Barbara E 1992 "Midwives Key Rural Health Workers m Maternity Care " lbternax10nal Journal of Gynecology and Obstetrics 38 (Suppl) S9-S15 (M404)~~

---Kwast, Barbara E, Suellen Miller, and Colleen Conroy 1993 Management of Life Threatemng Obstetacal Emergencies. Protocols and Flow Diagrams for Use by Reg1stered/L1censed Nurse M1dw1ves or Midwives m Health Centers and Private or Government Services MotherCare, John Snow, Inc, Arlington, VA (M405)

~~---MotherCare, John Snow, Inc Marzo/abrtl 1997 A Tribute to Jose Luzs Bobadilla MotherCare Matters Vol 6, No 2 Available in English and Spamsh (M406)~~

184 ____,Seoane, G, Kaune, V y Villazon, Julio Septiembre 1996 Diagnost1co. Barreras' v 1ab1hzadores en la Atencion de Complicac1ones Obstemcas v Neonatales MotherCare II Bolivia, John Snov. Inc Arlington, VA 22209 A vatlable only m Spanish Lmuted quantltles For multiple copies, please write MotherCare Bolivia, Lmmaco Gutierrez, Pasa1e 490, Casa 4, La Paz, Bolivia (M407)

____,Selwyn, Beatrice J, June 1997 Guidebook for Maternal and Neonatal Health Indicators PROCOSI Techmcal W orkmg Paper #4 Prepared for PROCOSI, La Paz, Bolivia MotherCare Pro1ect, John Snow Inc , Arlington, VA (M408)

~~MATERNAL AND NEONATAL IDANUS~~

~~___,.,Berggren, Gretchen G , with Michael Favin 1992 Lessons zn Tetanus Elzmznation Revmted MotherCare Workmg Paper #11, John Snow, Inc, Arlington, VA (M451)~~

___.,Faveau, V, M Mamdani, Robert Steinglass and Mar1orie Koblinsky 1993 "Maternal Tetanus Magnitude, Epidemiology and Potential Control Measures " Imernauonal Journal of Gynecology and Obstetrics 40 3-12 (M452)

~~___Keedle, Constance 1990 Eliminating Neonatal Tetanus An Annotated Bzblzography MotherCare Workmg Paper #1,John Snow, Inc, Arlington, VA (M453)~~

~~___REACH, and MotherCare, John Snow, Inc 1990 Neonatal Tetanus Ehmmation. Issues and Future D1rect1ons Meeting Proceedings, January 9 - 11, Alexandria, VA (M454)~~

~~NUTRITION~~

~~General~~

~~___Anonymous 1991 "Maternal Anthropometry for Prediction of Pregnancy Outcomes Memorandum from a USAID/WHO/PAHO/MotherCare Meeting " Bulletm of the World Health Orgamzauon 69{5) 523-532 {M501)~~

Krasovec, Katherine and Mary Ann Anderson, eds 1991 Maternal Nutation and Pregnancy Outcomes. Aothropometoc Assessment. W ashmgton, D C Pan American Health Orgaruzation, Scientific Publication No 529 Requests for tlus pubbcat1on should be sent to Pan American Health Orgamzat1on, 525 Twenty-third Street, NW, Washington, DC 20037 {M502)

~~---·Galloway, Rae and Mary Ann Anderson 1994 Prepregnancy Numt10nal Status and Its Impact on Biahwe1gbt SCN News No 11 P 6-10 (M503)~~

~~185 Anemta/Micronutnents~~

~~___....Baumslag, Naom.1 with Michael Favm 1992 Do Infants Under Su: Months ofAge l'V.eed Extr.2 lr011 2 A Probe MotherCare Workmg Paper #12, John Snov., Inc, Arlmgton, VA (M551)~~

___Jordan, Elizabeth A, and Nancy L Sloan 1991 The Prevalence ofMaternal Anemia zn Developmg Countries, 1979 1989 An Annotated Bzblzograpby MotherCare W orkmg Paper #7 A, John Sno-v.. Inc , Arlington, VA (M552)

___,Moore, Mona, Pandu Riono, and Sm Panaru 1991 A Qualttatzve Investigation ofFactors lnfluencmg Use ofIron Folate Tablets by Pregnant Women in West Java A Summary ofFindings MotherCare Workmg Pa.per #13, John Snow, Inc , Arhngton, VA (M553)

~~___MotherCare, John Snow, Inc Apnl 1994 Anemia and Women's Health MotherCare Matters Vol 4, No 1 Available m English, Spanish and French (M554)~~

~~___MotherCare, John Snow, Inc Apnl/May 1993 Anemia and Pregnancy MotherCare Matters Vol 3, No 112 {M555)~~

~~___,Sloan, Nancy L, Elizabeth A Jordan, and Beverly Wm1koff 1992 Does Iron Supplementation Make A Differencee MotherCare Workmg Paper #15, John Snow, Inc, Arlington, VA (M556)~~

~~___,Sloan, Nancy L, and Elizabeth Jordan 1992 Prevalence of Maternal Anemia tn Developing Countries MotherCare Workmg Paper #7B, John Snow, Inc, Arlmgton, VA {M557)~~

___Utomo, Buch, Pandu Rtono, Teguh Bud1ono, Endang L Achach, Gouranga Dasvarma, Mary J Hansell, Nancy L Sloan, James Phillips, David Leon, and Carolyn Hessler-Radelet 1993 The Alleviation ofMaternal Anemia zn Jndramayu Regency, Indonesia Results from the MotherCare Pro1ect Center for Child Survival of the Umversxty of Indonesia MotherCare Workmg Paper #23, John Snow, Inc , Arlington, VA {M558)

~~___MotherCare,John Snow, Inc November/December 1996 Mzcronutnentsfor the Health of Women and Newborns MotherCare Matters Vol 6, No 1 Available m English and Spanish (M559)~~

~~___MotherCare Pro1ect/USAID/John Snow, Inc July 1997 Improvmg the Qualrty of Iron Supplementat100 Programs. The MotherCare Experience (M560)~~

~~Breastfeed·ing~~

~~---Alvarez, Maria D 1990 Early Infant Feeding in Ham A Synopsis and a Proposal MotherCare Workmg Paper #3, John Snow, Inc, Arlmgton, VA {M601)~~

186 ___Gnffohs, Marcia and Mary Ann Anderson 1993 Gmde for Couorry Assessment of Breastteedmg Practices and Promotion The Manoff Group and the Umted States Agenc' for Imernat1onal Development MotherCare, John Snow Inc , Arlington, VA (M602)

___MotherCare/John Snow Inc , The Manoff Group and The LAC Nutrmon Sustamab1lm ProJect/URC and ISTI 1993 The State of Breastfeeding m Bolivia. Dom1mcan Republic. Ghana and Uganda. Practtces and Promouon. Summaries of the Emal Reports MotherCare, John Snov. Inc , Arlington, VA (M603)

~~SEXUALLY IRANSMITIED DISEASES (STDs)~~

___Coyle, Joseph and Sally Di Paula 1992 Women. Infants and STDs Opportumqes for Action m Develo.,pmg Coumnes. Report of the Conference held m Rosslyn, VA November 7-8, 1991 MotherCare, John Snow, Inc , Arlington, VA {M651)

~~___..Pido, Donna K 1993 MotherCa.re Marernal/Congemtal Syphilis Control Pro;ect Qualztatzve Research Report MotherCare Workmg Paper #18, John Snow, Inc, Arlington, VA {M652)~~

--.....Jenruskens, Fran~oise and Emily Obwaka 1994 Syphilis Control in Pregnant Women Clznzc Based Screening, Treatment and Counseling Services zn Nazrobz, Kenya MotherCare W orkmg Paper #20, John Snow, Inc, Arlington, VA (M653)

~~___.MotherCare,John Snow, Inc Oct/Nov 1994 STDs & Womens Health MotherCare Matters Vol 4, No 3/4 Available m English, Spamsh and French {M654)~~

~~___..Nersesian, Paula and Bill Brady November 1995 Controlling STDs/HIV Wtthin Dynamic Refugee Settmgs Refugee Pamcipat1on Network. Issue 20- Refugee Studies Programme, Uruversity of Oxford {M655)~~

___..,Brady, Wilham E, Judith Heichelhe1m and Nancy Newton, eds August 1996 Trammg Package for Prevem10n and Control of Syphilis m Maternal and Child Health Programs MotherCare, John Snow, Inc, Arlington, VA Available m WordPerfect 6 0/6 1 format on a 3 5 or 5 25 mch disk with accompanying slides and sample educational materials Paper copies may be requested, but we ask that if you have WordPerfect capabilities, you .wily request the disk due to the size and hm1ted number of the publication Please specify m the case that you would hke a paper copy or a 5 25 disk (otherwISe we wtll send a .3 5 dISk) (M656)

--~Southwick, Karen, Stanley Blanco and Ana Santander Febuary 1997 Estud10 de seroprevalencia y faqores de nesgo de sifths materna y cong{:mta. Bolivia 1996 MotherCare Pro1ect, MotherCare Boltv1a,John Snow Inc, Arlington, VA Available m Spamsh only (M657)

~~187 DOCUMENTS IN PREPARATION {Not vet available no orders will be processed)~~

~~+ Beck, Diana and Sandy Buffington Healthy Mother and Healthy Newborn Care Indonesia~~

~~+ Dusch, Erm Everyone Does It. But How Useful Is It' Screenmg for Anemia Usmg Chmcal Signs MotherCare, John Snow, Inc , Arlmgton, VA~~

~~+ Espeut, Donna Perinatal Research m Developing Countries A Review of Recent Literature and Methodological Issues MotherCare, John Snow, Inc, Arlington, VA~~

~~+ O'Rourke, Kathleen An Evaluation of the Impact of Commumty Orgamzat1on of Women on Perinatal Outcomes m Rural Bolivia. Save the Ch1ldren/Inqumv1 ProJeCt~~

~~+ W orkmg Paper on Qualitative Research Results from Vladivostok and Novos1b1rsk, Russia (Expected 1997)~~

~~188 Appendix 9 MotherCare Web Site (summary of hits)~~

~~189 AON~~

~~:isniny~~

~~AJDf~~

~~3Uilf~~

~~u.1dv~~

~~SJ!H~~

~~191 Previous Page Blank MotherCare HomePage One http v.wv. 1s1 com mtl mottKrc.m..~~

~~M 0th er careTM MotherCare IS a USAID project managed by John Snow • Inc (JSI) The MotherCare home page has been VlSlted 0002498 times smce 1127 /97~~

What is MotherCare? The MotherCare Project 1s a reproductive health care m1tiative focused on women m developmg countnes worldwide Our mtervent1ons mclude • commumty-based approaches to maternal and permatal mortality reduct10n • prevention and control of sexually transmitted diseases (STDs) • improved nutnt1on through education and d1stnbut1on of Iron-folate tablets • special newborn care • post-partum/post-abort1on family planmng • promotion of maternal and newborn health

~~Why does V\lh~t are the Ho\vis consequences Country reproductive 1\i1otherCare for\•Vomen Programs health matter? and nevvlxnns? responding?~~

~~i\11otherCare 1\1otherCare J\1otherCare Publications Partners Nevvs 1\11atters~~

~~The MotherCare Project 1s located w1thm the offices of ==..:=Fai;~~

~~1616 N Fort Myer Drive 1 lthfloor Arlmgton Virgzma 22209 USA Tel (703) 528-7474 Fax (703) 528-7480~~

~~Vzszt the JSJ home page by chckmg here Vzszt the JSJ/Omm Pro1ect home page by clzckmg here 193~~

~~12/10/9i >6 AM MotherCare HomePage One hnp 11w\H\ JSI com mtl mottKn. .i~~

~~Vzsll the JSJ/lmt1at1ves Pro1ect home page by cbckmg here Vzsll the USAID home page by chckzng here~~

~~Please send any comments or quest10ns to us by e-mail mothercare_proJect@Js• com~~

~~Last revised 10/30/97 Designed by Judith Heichelhe1m~~

~~194~~

~~12/10/97 I I ,:,6 t Appendix 10 MotherCare Products List~~

~~195 9198~~

~~due~~

~~Communtcat10n~~

~~and~~

~~Diseases~~

~~Puhlicatwns~~

~~Evaluation~~

~~Mutilation~~

~~Education~~

~~and~~

~~List~~

~~Transmitted~~

~~Researc;h~~

~~Genital~~

~~Report~~

~~Priority~~

~~Female Applied Information, Anemia~~

~~Paper Pubhcat10n Morntormg Protocols Fmal~~

~~Sexually~~

~~Tram~~

~~Codes FGM AR ANM IEC M&E PAP~~

~~PUB PRO RPT STDs~~

~~MotherCare~~

~~-.)~~

'°

~~td ~ ~ CD~~

~~~ § 1lu91!1 a ..., 0 !Pf) CD < =~~

~~VI-. VI-.~~

~~CC CC~~

~~\\uh \\uh~~

~~the the~~

~~PAllO PAllO~~

~~matcr11ls matcr11ls~~

~~from from~~

~~against against~~

~~a a~~

~~IEC IEC~~

~~with with~~

~~written written~~

~~workshop workshop~~

~~mterest mterest~~

~~to to~~

~~of of~~

~~complete complete~~

~~novel novel~~

~~disseminate disseminate~~

~~meet meet~~

~~of of~~

~~use use~~

~~to to~~

~~document document~~

~~descriptions descriptions~~

~~and and~~

~~Needs Needs~~

~~Analysis Analysis~~

~~Jll Jll~~

~~copy copy~~

~~detennme detennme~~

~~Write Write~~

~~Monitor Monitor~~

~~package package~~

~~check check~~

~~Momtormg Momtormg~~

~~and and~~

~~guide guide~~

~~Get Get~~

~~to to~~

~~PllR PllR~~

~~Data Data~~

~~3/98 3/98~~

~~NextStep'i NextStep'i~~

~~prmted prmted~~

~~too too~~

~~booklet booklet~~

~~counseling counseling~~

~~flyers flyers~~

~~mAymaraand mAymaraand~~

~~strategy strategy~~

~~Quechua Quechua~~

~~cards cards~~

~~syphilis syphilis~~

~~Comment-; Comment-;~~

~~1p 1p~~

~~fl fl~~

~~ready ready~~

~~by by~~

~~All All~~

~~clear clear~~

~~bemg bemg~~

~~progress progress~~

~~be be~~

~~and and~~

~~not not~~

~~m1t1ated m1t1ated~~

~~anemia anemia~~

~~m m~~

~~to to~~

~~Materials Materials~~

~~printer printer~~

~~9/98 9/98~~

~~Chapters Chapters~~

~~8/25 8/25~~

~~by by~~

~~IEC IEC~~

~~poster poster~~

~~used used chart chart~~

~~To To~~

~~prmted prmted~~

~~currently currently~~

~~recorded recorded~~

~~Done Done~~

~~1fprinted 1fprinted 60 60~~

~~aired aired~~

~~currently currently~~

~~Assessment Assessment~~

~~phase phase~~

~~Status Status~~

~~/98 /98~~

~~I I~~

~~9/ 9/~~

~~10/1/97 10/1/97~~

~~9/30/98 9/30/98~~

~~11/1/97 11/1/97~~

~~Date Date~~

~~.& .&~~

~~cc cc~~

~~MMe MMe~~

~~DC DC~~

~~iih1~-~~

~~n n~~

~~Joe Joe~~

~~---~~

~~MC MC~~

~~~ ~~~

~~Ann Ann~~

~~Pms Pms~~

~~iatcs iatcs~~

~~and and~~

~~·~4:. ·~4:.~~

~~Kaune Kaune~~

~~H1pnos1s H1pnos1s~~

~~Staff Staff~~

~~H1pnos1s H1pnos1s~~

~~Staff Staff~~

~~MC MC~~

~~Phoya Phoya Okong Okong~~

~~PHR/Abt PHR/Abt~~

~~Assoc Assoc~~

~~Taylor Taylor~~

~~Responsible Responsible~~

~~----~~

~~~-x ~-x~~

~~nl~g.a nl~g.a~~

~~and and~~

~~poster) poster)~~

~~IEC IEC~~

~~~~ ~~~~

~~women women~~

~~& &~~

~~how how~~

~~on on~~

~~for for~~

~~program program~~

~~Countries Countries~~

~~¥·L..v ¥·L..v~~

~~anemia anemia~~

~~NGO NGO~~

~~list list~~

~~paper paper~~

~~lndo lndo~~

~~from from~~

~~manual manual~~

~~flyer flyer~~

~~on on~~

~~~ ~ centers centers~~

~~opera) opera)~~

~~~""')::,.,., ~""')::,.,.,~~

~~pregnant pregnant~~

~~showmg showmg~~

~~(radio (radio~~

~~episodes episodes~~

~~(Like (Like~~

~~...._ ...._~~

~~African African~~

~~of of~~

~~by by~~

~~soap soap~~

~~(Report) (Report)~~

~~material material~~

~~t: t:~~

~~questions questions~~

~~health health~~

~~women women~~

~~community community~~

~~fac1ht1es fac1ht1es~~

~~& &~~

~~publishable publishable~~

~~groups groups~~

~~discussion discussion~~

~~action action~~

~~-----~~

~~rights rights~~

~~radio radio~~

~~for for~~

~~plan plan~~

~~to to~~

~~and and~~

~~mcluding mcluding~~

~~for for~~

~~learned learned~~

~~and and~~

~~Uganda) Uganda)~~

~~.\!, .\!,~~

~~signs signs~~

~~use use~~

~~pills pills~~

~~health health~~

~~comments) comments)~~

~~Anglophone Anglophone~~

~~casettes casettes~~

~~to to~~

~~in in~~

~~poster poster~~

~~EOC EOC~~

~~taken taken~~

~~I I~~

~~for for~~

~~3 3~~

~~action action~~

~~$> $>~~

~~manual manual~~

~~~~;;~~~,~ ~~;;~~~,~~~

~~health health~~

~~iron iron~~

~~lessons lessons~~

~~of of~~

~~mv1tat1on mv1tat1on~~

~~package package~~

~~& &~~

~~list list~~

~~how how~~

~~was was~~

~~of3 of3~~

~~Malawi Malawi~~

~~document document~~

~~(cont (cont~~

~~and and~~

~~from from~~

~~fhpchart fhpchart~~

~~poster poster~~

~~on on~~

~~pills pills~~

~~maternal maternal~~

~~Document Document~~

~~Written Written~~

~~research research~~

~~iron iron~~

~~women women~~

~~contmgency contmgency~~

~~posts posts~~

~~poster poster~~

~~questions questions~~

~~gmde gmde~~

~~anemia anemia~~

~~on on~~

~~campaign campaign~~

~~education education~~

~~models models~~

~~(Ghana, (Ghana,~~

~~Consists Consists~~

~~Collection Collection~~

~~Descnptwn Descnptwn~~

~~9198 9198~~

~~of of~~

~~spots spots~~

~~package package~~

~~m m~~

~~and and~~

~~Safe Safe~~

~~and and~~

~~IEC IEC~~

~~Program Program~~

~~radio radio~~

~~on on~~

~~(Report (Report~~

~~all all~~

~~Opera Opera~~

~~finalize finalize~~

~~and and~~

~~Care Care~~

~~Ghana Ghana~~

~~soap soap~~

~~Motherhood Motherhood~~

~~costing costing~~

~~Strategy Strategy~~

~~Priority Priority~~

~~Bohvia Bohvia~~

~~1997 1997~~

~~IEC IEC~~

~~Motherhood Motherhood~~

~~for for~~

~~Develop Develop~~

~~Radio Radio~~

~~materials materials~~

~~disseminate disseminate~~

~~Title Title~~

~~Uganda) Uganda)~~

~~Malawi Malawi~~

~~Safe Safe~~

~~Obstetric Obstetric~~

~~with with~~

~~18, 18,~~

~~PUB PUB~~

~~IEC IEC~~

~~PUB? PUB?~~

~~Code Code~~

~~December December~~

~~II II~~

~~MCll MCll~~

~~Bolivia Bolivia~~

~~MCll MCll~~

~~Bolivia Bolivia~~

~~MC MC~~

~~Africa Africa~~

~~Co1111try Co1111try~~

~~lmt1at1ve lmt1at1ve~~

~~17 17~~

~~13 13~~

~~15 15~~

~~148 148~~

~~ID ID~~

~~'° '°~~

~~\011rsday, \011rsday, MotherCare MotherCare I~~

~~out~~

~~( (~~

~~ask~~

~~submitted~~

~~Karen~~

~~action?~~

~~p1pers~~

~~where with~~

~~the~~

~~Steps~~

~~f/u~~

~~titles~~

~~and~~

~~Next~~

~~What title~~

~~Need Need~~

~~l[C~~

~~with~~

~~(in~~

~~materials~~

~~should~~

~~submitted~~

~~with~~

~~acceptance~~

~~radio~~

~~combine~~

~~study~~

~~for~~

~~publication~~

~~Comme11ts~~

~~Package~~

~~Also d1ssemmation #15~~

~~include This materials~~

~~purchasing~~

~~for~~

~~awaiting what?)~~

~~Should soon~~

~~draft~~

~~mid~~

~~Capra~~

~~Impact~~

~~was~~

~~will working~~

~~review~~

~~(10/97)~~

~~due~~

~~Craig~~

~~Levine~~

~~draft~~

~~Momtonng~~

~~Status study done forthcoming study~~

~~Katerina~~

~~working~~

~~Done~~

~~Draft~~

~~L1sner~~

~~Nov~~

~~on Under~~

~~Bill~~

~~CDC?~~

~~8/31198~~

~~12/1/98~~

~~6130196~~

~~Date~~

~~11115/97~~

~~DC cc~~

~~Umv~~

~~Health~~

~~Capra~~

~~Center~~

~~Capra,~~

~~Blanco~~

~~Kaune~~

~~L1sner~~

~~Houston~~

~~Diagnosis Responsible Staff~~

~~Katerina~~

~~Kathleen~~

~~Sciences~~

~~ORourke ofTexas at~~

~~Katerina~~

~~Craig~~

~~Karen~~

~~Southwick Stanley~~

~~papers~~

~~Journal~~

~~WHO~~

~~paper~~

~~and~~

~~Blanco)~~

~~article?)~~

~~with~~

~~review~~

~~study~~

~~peer~~

~~papers (Stanley~~

~~pubhshable~~

~~(T1tlle~~

~~for~~

~~validation~~

~~Southwick)~~

~~Spam~~

~~paper~~

~~article~~

~~the~~

~~paper~~

~~package~~

~~publishable~~

~~(Karen~~

~~study~~

~~Peru~~

~~Publishable Descnpt1011~~

~~cost~~

~~pubhshable~~

~~Conduct~~

~~report~~

~~pubhshable presentation~~

~~for~~

~~level~~

~~Radio~~

~~(of~~

~~(process~~

~~package WHO~~

~~package~~

~~Study~~

~~(Vahdat1on~~

~~the~~

~~baby~~

~~study~~

~~mumc1pal~~

~~opera)~~

~~study~~

~~Study~~

~~Title~~

~~Intent~~

~~soap impact)~~

~~use~~

~~Cost-study~~

~~Vahdat1on (quantitative)~~

~~study) mother Cost~~

~~STD~~

~~1997~~

~~18,~~

~~Code~~

~~IEC M&E~~

~~PUB~~

~~RPT PUB~~

~~STDs PUB~~

~~II Dec.ember~~

~~Cou11try Bolivia MC~~

~~Bolivia~~

~~Bohv1a MC~~

~~Bohv1a~~

~~Bohv1a MC~~

~~j!]'11rsday,~~

~~0 0~~

~~#I #I~~

~~1 1~~

~~) )~~

~~1998 1998~~

~~(I (I~~

~~Intro Intro~~

~~copies copies~~

~~already already~~

~~with with~~

~~which which~~

~~be be 1f 1f~~

~~written written~~

~~many many out out~~

~~January January~~

~~meet meet~~

~~wtll wtll~~

~~be be~~

~~exactly exactly~~

~~to to~~

~~rev1s10ns rev1s10ns~~

~~transht1on transht1on~~

~~to to~~

~~late late~~

~~how how~~

~~rmd rmd~~

~~any any~~

~~PAIIO PAIIO~~

~~CC CC~~

~~m m~~

~~1f 1f~~

~~out out~~

~~finish finish~~

~~to to~~

~~needs needs~~

~~left left~~

~~review review~~

~~and and~~

~~5 5~~

~~Report? Report?~~

~~translated translated~~

~~Determine Determine~~

~~parts parts~~

~~etc etc~~

~~& &~~

~~#2 #2~~

~~Fmd Fmd~~

~~sent sent~~

~~are are~~

~~PAHO PAHO~~

~~Jll Jll~~

~~NextStep~~

~~m m~~

~~by by~~

~~111 111~~

~~1mpl 1mpl~~

~~May May~~

~~would would~~

~~Intro Intro~~

~~of of~~

~~strategy strategy~~

~~available available~~

~~pieces pieces~~

~~versmn versmn~~

~~bulletin bulletin~~

~~# #~~

~~rev1ewd rev1ewd~~

~~Costing Costing~~

~~pubhshed pubhshed~~

~~TA TA~~

~~sh sh~~

~~IEC IEC~~

~~countries countries~~

~~eval eval~~

~~be be~~

~~helpful helpful~~

~~Spanish Spanish~~

~~PAHO PAHO~~

~~to to~~

~~need need~~

~~In In~~

~~Engh Engh~~

~~and and~~

~~informat10n informat10n~~

~~be be~~

~~descript10n descript10n~~

~~piece piece~~

~~Like Like~~

~~hm1ted hm1ted~~

~~LAC LAC~~

~~manual manual~~

~~Spanish Spanish~~

~~Comment'i Comment'i~~

~~to to~~

~~done done~~

~~#5&6 #5&6~~

~~0/97) 0/97)~~

~~1s 1s~~

~~(I (I~~

~~Ugalde Ugalde~~

~~done done~~

~~move move~~

~~9/30/98 9/30/98~~

~~be be~~

~~ts ts~~

~~progress progress~~

~~Done Done~~

~~may may~~

~~post post~~

~~developed developed~~

~~To To~~

~~Ugalde/Kaune Ugalde/Kaune~~

~~MC/Bol MC/Bol~~

~~MC/BOL MC/BOL~~

~~#I #I~~

~~#2 #2~~

~~Spanish Spanish~~

~~In In~~

~~Status Status~~

~~611198 611198~~

~~3/1/98 3/1/98 1/1/98 1/1/98~~

~~8/29/95 8/29/95~~

~~6/30/98 6/30/98~~

~~Date Date~~

~~CC CC~~

~~JM JM~~

~~cc cc~~

~~DC DC~~

~~Lisa Lisa~~

~~Fmot, Fmot,~~

~~Conroy Conroy~~

~~Blanco Blanco~~

~~Syphths Syphths~~

~~Goldman Goldman~~

~~Kathleen Kathleen~~

~~Seoane Seoane~~

~~Howard Howard~~

~~Gutllerrno Gutllerrno~~

~~Grabman Grabman~~

~~O'Rourke O'Rourke~~

~~Kaune Kaune~~

~~Ugalde Ugalde~~

~~McDermott McDermott~~

~~Jeanne Jeanne~~

~~MC/Bohvta MC/Bohvta~~

~~Susan Susan Colleen Colleen~~

~~MC/Bohv1a MC/Bohv1a~~

~~D1v1s10n D1v1s10n~~

~~MOH MOH~~

~~Stanley Stanley~~

~~Responsible Responsible~~

~~from from~~

~~to to~~

~~of#I of#I~~

~~In In~~

~~mtroducuon mtroducuon~~

~~cascading cascading~~

~~approach approach~~

~~tools tools~~

~~package package~~

~~comprised comprised~~

~~Spanish Spanish~~

~~other other~~

~~design design~~

~~manual manual~~

~~m m~~

~~training training~~

~~paclkage paclkage~~

~~and and~~

~~ltst ltst~~

~~costing costing~~

~~post post~~

~~trainers trainers~~

~~1mplementat10n 1mplementat10n~~

~~traming traming~~

~~superv1s10n superv1s10n~~

~~and and~~

~~of of~~

~~the the~~

~~check check~~

~~cumculum cumculum~~

~~health health~~

~~manual manual~~

~~and and~~

~~to to~~

~~5 5~~

~~complete complete~~

~~Report Report~~

~~mcludmg mcludmg~~

~~hosp hosp~~

~~Spanish Spanish~~

~~sustainable sustainable~~

~~evaluatmn evaluatmn~~

~~descriptmn descriptmn~~

~~2 2 &~~

~~A A~~

~~Training Training~~

~~trammg trammg~~

~~Descrtptwn Descrtptwn~~

~~m m~~

~~Plan Plan~~

~~Child Child~~

~~Its Its~~

~~Bohv1a Bohv1a~~

~~in in~~

~~Manual Manual~~

~~for for~~

~~Project Project~~

~~Maternal Maternal~~

~~Inqu1S1v1 Inqu1S1v1~~

~~Cumculum Cumculum~~

~~Superv1s1on Superv1s1on~~

~~Package Package~~

~~Trammg Trammg~~

~~on on~~

~~m m~~

~~Warrni Warrni~~

~~Cumculum Cumculum~~

~~1997 1997~~

~~Health Health~~

~~Impact Impact~~

~~The The~~

~~superv1s10n superv1s10n~~

~~and and~~

~~Trammg Trammg~~

~~Spanish Spanish~~

~~Title Title~~

~~Trammg Trammg~~

~~Aux1hary Aux1hary~~

~~Spanish Spanish~~

~~(printed) (printed)~~

~~Syphths Syphths~~

~~18, 18,~~

~~PUB PUB~~

~~TR TR~~

~~STDs STDs~~

~~TR TR~~

~~Code Code~~

~~De,ember De,ember~~

~~II II~~

~~Bohv1a Bohv1a~~

~~SCF SCF~~

~~MC MC~~

~~Bohv1a Bohv1a~~

~~MC MC~~

~~Bohvta Bohvta~~

~~MC MC~~

~~Bohvta Bohvta~~

~~Cou11try Cou11try~~

~~16 16~~

~~41 41~~

~~35 35~~

~~190 190~~

~~191 191~~

~~ID ID~~

~~0 0 13'/mrsday, 13'/mrsday, 1nd~~

~~due~~

~~and~~

~~review~~

~~submitted~~

~~Determine~~

~~product~~

~~want~~

~~1ffeas1ble~~

~~external~~

~~final~~

~~Steps~~

~~1fwe~~

~~for~~

~~review~~

~~Review~~

~~Next~~

~~date~~

~~decide d1ssemmate revisions post~~

~~Send Determme~~

~~(?)~~

~~days~~

~~1998~~

~~draft~~

~~only~~

~~given~~

~~this~~

~~for~~

~~before~~

~~Completion~~

~~comments~~

~~Comment~~~

~~for worked with~~

~~draft paid~~

~~due~~

~~For~~

~~Contract~~

~~due~~

~~received~~

~~draft~~

~~prog1ress~~

~~m I~~

~~Draft~~

~~12/15/98 Status~~

~~Under~~

~~d1scuss1on~~

~~9/1/98~~

~~12/31/97~~

~~Date~~

~~Kanam~~

~~and~~

~~(Social~~

~~Kreutzer~~

~~Elder~~

~~Parekh~~

~~Elder~~

~~Lynch~~

~~Dusch~~

~~Galloway~~

~~Respo11s1hle~~

~~Plannmg~~

~~SPAAC~~

~~Analysis Admm1stratmn~~

~~Leslie Consultants) Sean~~

~~Debbie~~

~~Rae~~

~~Erm Leslie~~

~~Leslie AnJou~~

~~Shubhada~~

~~(English/Arabic)~~

~~Experiences~~

~~report~~

~~and~~

~~Review~~

~~paper?~~

~~findmgs~~

~~analysis~~

~~Fmal~~

~~Descrtpt1011~~

~~research~~

~~publishable~~

~~Paper~~

~~paper~~

~~Adolescents~~

~~Needs~~

~~Anemia~~

~~all~~

~~Diagnosis~~

~~Matters~~

~~Research~~

~~Supplementation~~

~~Title~~

~~Community Analys1sfframmg~~

~~S1tuat1on~~

~~Assessment Iron~~

~~Pregnancy~~

~~Projects~~

~~Qualitative Overview~~

~~Anthropometry paper~~

~~MotherCare~~

~~199~~

~~18,~~

~~Code~~

~~RPT~~

~~IEC~~

~~ANM~~

~~December~~

~~Cou11try~~

~~Egypt MC~~

~~general~~

~~General~~

~~141~~

~~134~~

~~142~~

~~197~~

~~T/mrsdav,~~

~~at at~~

~~other other~~

~~(MC (MC~~

~~Review Review~~

~~180 180~~

~~gypt gypt~~

~~Present Present~~

~~with with~~

~~1998) 1998)~~

I-

~~due due~~

~~to# to#~~

~~1998 1998~~

~~CD) CD)~~

~~work work~~

~~date date~~

~~from from~~

~~tie tie~~

~~1ffcas1ble 1ffcas1ble~~

~~on on~~

~~(summer (summer~~

~~Steps Steps~~

~~report report~~

~~s1m1lar s1m1lar~~

~~the the~~

~~determine determine~~

~~NClll NClll~~

~~Matters Matters~~

~~countries countries~~

~~Do Do~~

~~March/April March/April~~

~~determine determine~~

~~Next Next~~

~~(IEC (IEC~~

~~163 163~~

~~submitted submitted~~

~~# #~~

~~be be~~

~~poster) poster)~~

~~Use Use~~

~~Com111e11tv Com111e11tv~~

~~2/15/98 2/15/98~~

~~To To~~

~~to to~~

~~poster poster~~

~~to to~~

~~for for~~

~~12/22/97 12/22/97~~

~~review review~~

~~by by~~

~~presentation presentation~~

~~Done Done~~

~~NCIH NCIH submitted submitted~~

~~forthcoming forthcoming~~

~~ED ED~~

~~comments comments~~

~~Under Under~~

~~(RG) (RG)~~

~~Status Status~~

~~9/1/98 9/1/98~~

~~10/1/97 10/1/97~~

~~4/30/98 4/30/98~~

~~2/15/98 2/15/98~~

~~Date Date~~

~~AP AP~~

~~KA KA~~

~~JH JH~~

~~NN NN~~

~~ED ED~~

~~DC DC~~

~~Pareja Pareja~~

~~Parekh Parekh~~

~~Nachbar Nachbar~~

~~Ames Ames~~

~~Dusch Dusch~~

~~Reynaldo Reynaldo~~

~~AnJOU AnJOU~~

~~Reynaldo Reynaldo~~

~~He1chelhe1m He1chelhe1m~~

~~Nancy Nancy~~

~~Judi Judi~~

~~Pareja Pareja~~

~~and and~~

~~Nancy Nancy~~

~~Ken Ken~~

~~Erm Erm~~

~~Responsible Responsible~~

~~m m~~

~~submitted submitted~~

~~and and~~

~~Projects Projects~~

~~campaign campaign~~

~~Lanka Lanka~~

~~IEC IEC~~

~~Experience Experience~~

~~Sn Sn~~

~~Research Research~~

~~the the~~

~~at at~~

~~on on~~

~~pp) pp)~~

~~D1agnos1s D1agnos1s~~

~~paper paper~~

~~Apphed Apphed~~

~~based based~~

~~(30 (30~~

~~of of~~

~~(presented (presented~~

~~NCIH) NCIH)~~

~~Booklet Booklet~~

~~Indonesia Indonesia~~

~~poster poster~~

~~to to~~

~~Community Community~~

~~Package Package~~

~~Publishable Publishable~~

~~Descrtptwn Descrtptwn~~

~~m m~~

~~the the~~

~~an an~~

~~of of~~

~~Action Action~~

~~South South~~

~~Egypt Egypt~~

~~to to~~

~~m m~~

~~Indonesia Indonesia~~

~~Diagnosis Diagnosis~~

~~Matters Matters~~

~~and and~~

~~findmgs findmgs~~

~~Bohvia Bohvia~~

~~Summary Summary~~

~~on on~~

~~Research Research~~

~~paper paper~~

~~Campaign Campaign~~

~~Development Development~~

~~1997 1997~~

~~Indonesia Indonesia~~

~~Community Community~~

~~Guatemala Guatemala~~

~~Executive Executive~~

~~booklet booklet~~

~~Kahmantan Kahmantan~~

~~IEC IEC~~

~~From From~~

~~The The~~

~~MotherCare MotherCare~~

~~Title Title~~

~~Pallor Pallor~~

~~18, 18,~~

~~IEC IEC~~

~~AR AR~~

~~PUB PUB~~

~~ANM ANM~~

~~Code Code~~

~~December December~~

~~general general~~

~~General General~~

~~Cou11trv Cou11trv~~

~~general general~~

~~lmrsday, lmrsday,~~

~~189 189~~

~~163 163~~

~~180 180~~

~~195 195~~

~~137 137~~

~~ID ID~~

~~-.i -.i~~

~~v.J v.J~~

~~0 0 1 (1et~~

~~late~~

~~Include~~

~~production MK~~

~~also~~

~~matenals~~

~~for~~

~~outline and~~

~~hut~~

~~draft~~

~~IrC~~

~~711~~

~~product~~

~~new~~

~~here~~

~~all~~

~~new~~

~~estimates~~

~~such~~

~~Develop~~

~~NextStepv anemia Gather separately? cost of~~

~~workplan~~

~~Begm~~

~~Dec~~

~~outline~~

~~fom1~~

~~the~~

~~placed~~

~~tal.e~~

~~catalogue~~

~~homepage~~

~~Comments~~

~~could~~

~~rom of the~~

~~tzat~~

~~wtth~~

~~Baume~~

~~techmcal #6~~

~~needs~~

~~development~~

~~progress~~

~~Status~~

~~reworking~~

~~concept Carol~~

~~paper done~~

~~draft ton~~

~~reconceptual~~

~~/98~~

~~9/1/97~~

~~2/l~~

~~9/30/98~~

~~5/31~~

~~Date~~

~~NN NN~~

~~Pareja~~

~~Nachbar~~

~~Nachbar Parekh~~

~~Nachbar~~

~~Baume~~

~~Huque~~

~~Baume~~

~~He1chelhe1m~~

~~Reynaldo~~

~~Respo11S1b/e~~

~~Judi~~

~~Reynaldo~~

~~Carol Anjou Nancy~~

~~Nancy~~

~~Reynaldo~~

~~Nancy~~

~~Carol~~

~~He1chelhe1m~~

~~Judi~~

~~Zah1d~~

~~research~~

~~booklet~~

~~evaluations~~

~~form~~

~~methodology~~

~~the~~

~~paper~~

~~tools~~

~~Bangladesh~~

~~and~~

~~Paper~~

~~Compendmm~~

~~Descr1ptto11~~

~~Package~~

~~action~~

~~publishable~~

~~lndta~~

~~trammg~~

~~Honduras~~

~~Cross~~

~~oflEC~~

~~staff)~~

~~D1agnos1s~~

~~Matters~~

~~Guatemala~~

~~(Bohv1a India,~~

~~and~~

~~mcludmg~~

~~paper~~

~~Package~~

~~Title~~

~~Indonesia Pakistan Malawi materials Compendmm~~

~~materials~~

~~Report/Cntrque~~

~~Commumty~~

~~Commumty results~~

~~country~~

~~1997~~

~~MotherCare~~

~~18,~~

~~Code~~

~~IEC~~

~~PAP~~

~~IEC~~

~~PUB~~

~~IEC~~

~~M&E~~

~~December~~

~~Cou11try~~

~~general~~

~~General~~

~~188~~

~~156~~

~~154~~

~~155~~

~~196~~

~~""lmrsday,~~

~~~ ..\:..~~

~~I) I)~~

~~1llcr 1llcr~~

~~etc etc~~

~~India India~~

~~date date~~

~~and and~~

~~Bullctm Bullctm~~

~~10 10~~

~~for for due due~~

~~due due~~

~~upon upon~~

~~when when~~

~~follow follow~~

~~to to~~

~~(WI (WI~~

~~feasible feasible~~

~~send send~~

~~exact exact~~

~~who who~~

~~1f 1f~~

~~approval approval~~

~~and and~~

~~Steps Steps~~

~~meetmg meetmg~~

~~details details~~

~~contmgent contmgent~~

~~pubhcatmn pubhcatmn~~

~~revise revise~~

~~determme determme~~

~~M&r M&r~~

~~more more~~

~~determme determme~~

~~fundmg fundmg~~

~~date date~~

~~determme determme Next Next~~

~~Campbell Campbell~~

~~on on~~

~~comments comments~~

~~Oona Oona~~

~~from from~~

~~awaitmg awaitmg~~

~~content content~~

~~structure/format structure/format~~

~~questionnaire questionnaire~~

~~Emphasis Emphasis~~

~~Comment~ Comment~~~

~~Sn Sn~~

~~for for~~

~~to to~~

~~at at~~

~~up up~~

~~bemg bemg~~

~~draft draft~~

~~mg mg~~

~~0/97 0/97~~

~~I I~~

~~pubhcat1on pubhcat1on~~

~~NClll NClll~~

~~worked worked~~

~~Lanka Lanka presented presented~~

~~submitted submitted~~

~~? ?~~

~~pend pend~~

~~Status Status~~

~~9/1/98 9/1/98~~

~~911/98 911/98~~

~~9/1/98 9/1/98~~

~~12/15/97 12/15/97~~

~~Date Date~~

~~MK MK~~

~~JH JH~~

~~DE DE~~

~~CC CC~~

~~DE DE~~

~~DC DC~~

~~Oona Oona~~

~~Judi Judi~~

~~WHO WHO~~

~~Espeut Espeut~~

~~PHR PHR~~

~~He1chelhe1m He1chelhe1m~~

~~Koblmsky Koblmsky~~

~~Marge Marge~~

~~Campbell Campbell~~

~~Donna Donna~~

~~MC MC~~

~~Donna Donna~~

~~Responsible Responsible~~

~~mortahty mortahty~~

~~Indonesia Indonesia~~

~~and and~~

~~studies) studies)~~

~~permatal permatal~~

~~document document~~

~~Case Case~~

~~Bohvrn Bohvrn~~

~~based based~~

~~m m~~

~~(Indian (Indian~~

~~paper paper~~

~~accompanymg accompanymg~~

~~studies studies~~

~~community community~~

~~on on~~

~~publishable publishable~~

~~pubhshable pubhshable~~

~~database database~~

~~Focus Focus~~

~~mterventmns mterventmns~~

~~Recent Recent~~

~~Descr1pt1011 Descr1pt1011~~

~~Cnt1que Cnt1que~~

~~Motherhood Motherhood~~

~~Quantitative Quantitative~~

~~Matters Matters~~

~~presentatmn presentatmn~~

~~Research Research~~

~~database database~~

~~Paper Paper~~

~~Safe Safe~~

~~II II~~

~~of of~~

~~MC MC~~

~~1997 1997~~

~~conference conference~~

~~Models Models~~

~~submission submission~~

~~Methodological Methodological~~

~~of of~~

~~Research Research~~

~~MotherCare MotherCare~~

~~Program Program~~

~~Title Title~~

~~Cost Cost~~

~~MotherCare MotherCare~~

~~18, 18,~~

~~PUB PUB~~

~~PAP PAP~~

~~M&E M&E~~

~~Code Code~~

~~Deumber Deumber~~

~~General General~~

~~general general~~

~~General General~~

~~general general~~

~~Cou11trv Cou11trv~~

~~lmrsday, lmrsday,~~

~~160 160~~

~~159 159~~

~~158 158~~

~~194 194~~

~~181 181~~

~~ID ID~~

~~N N ~ ~ prml~~

~~prmt~~

~~from~~

~~final~~

~~linah1e~~

~~Dec~~

~~date~~

~~dale~~

~~comments~~

~~after~~

~~complete~~

~~Steps~~

~~due~~

~~townie~~

~~MK Next~~

~~awa1tmg Marge~~

~~rev1s1on~~

~~verify~~

~~ram1ly copies~~

~~copies~~

~~Russian~~

~~ACNM~~

~~and~~

~~order~~

~~CommelltY~~

~~presentation Planning~~

~~Perspectives Conference submitted International~~

~~Covered task~~

~~English~~

~~first~~

~~draft~~

~~bemg~~

~~edition~~

~~0/97~~

~~I forthcoming Status~~

~~presented~~

~~China rev1s1on~~

~~complete~~

~~forthcoming being finalized 3rd forprmtmg~~

~~Draft~~

~~reviewed~~

~~needs written~~

~~/98~~

~~217197~~

~~3/1/98~~

~~511~~

~~611~~

~~12/31197~~

~~Date~~

~~MK DC~~

~~and~~

~~Koblmsky~~

~~Nachbar~~

~~SEATS~~

~~Polly~~

~~Jou~~

~~Respons1hle Marge~~

~~Marge~~

~~Koblinsky~~

~~Nancy~~

~~ACNM Margaret Marshall~~

~~Sandra Buffington~~

~~ACNM Marshall Margaret~~

~~Sandra Buffington~~

~~Laila~~

~~Judy~~

~~Breastfeeding~~

~~#166)~~

~~FCMC~~

~~(with~~

~~NIS~~

~~paper~~

~~manual~~

~~focusing~~

~~LAM~~

~~Publishable~~

~~Descnpt1011~~

~~publishable~~

~~reference~~

~~training~~

~~Issue~~

~~and~~

~~edition)~~

~~Manual~~

~~(3rd~~

~~Manual~~

~~Skills~~

~~Matters~~

~~Paper~~

~~Saving~~

~~Trainers'~~

~~M1dw1ves~~

~~Title~~

~~Op1mon~~

~~IUSSP Paper~~

~~Life~~

~~for~~

~~LSS~~

~~MotherCare~~

~~1997~~

~~18,~~

~~Code~~

~~PUB~~

~~December~~

~~Cou11try~~

~~general~~

~~General~~

~~162~~

~~11rsday,~~

~~161~~

~~165~~

~~166~~

~~193~~

~~with with~~

~~what what~~

~~1f 1f~~

~~pills pills~~

~~I I~~

~~of of~~

~~take take~~

~~rt rt~~

~~iron iron~~

~~Llena Llena~~

~~determme determme~~

~~Management Management~~

~~WllO WllO~~

~~status status~~

~~and and~~

~~with with~~

~~could could~~

~~and and~~

~~on on~~

~~date date~~

~~f/u f/u~~

~~with with~~

~~heck heck~~

~~this this~~

~~flu flu~~

~~to to~~

~~due due~~

~~to to~~

~~CC CC~~

~~feasible feasible~~

~~form form~~

~~get get~~

~~Translate? Translate?~~

~~RP RP~~

~~Elizabeth Elizabeth~~

~~evaluation evaluation~~

~~Guide Guide~~

~~Jll Jll~~

~~NextStepv NextStepv~~

~~iron iron~~

~~mto mto~~

~~were were~~

~~#35) #35)~~

~~not not~~

~~spots spots~~

~~because because~~

~~(see (see~~

~~real? real?~~

~~adapted adapted~~

~~were were~~

~~this this~~

~~Is Is~~

~~available available~~

~~Anemia Anemia~~

~~pills pills~~

~~delayed delayed~~

~~bemg bemg~~

~~Com111e11ts Com111e11ts~~

~~Spanish Spanish~~

~~a a~~

~~6/98 6/98~~

~~on on~~

~~have have~~

~~by by~~

~~bemg bemg~~

~~(we (we~~

~~collectmn collectmn~~

~~progress? progress?~~

~~m m~~

~~? ?~~

~~English English~~

~~completed completed~~

~~data data~~

~~Done Done~~

~~used used~~

~~copy) copy)~~

~~d1stnbuted d1stnbuted~~

~~done done~~

~~diskette diskette~~

~~Status Status~~

~~3/1/98 3/1/98~~

~~718191 718191~~

~~8/1/96 8/1/96~~

~~Date Date~~

~~cc cc~~

~~JM JM~~

~~cc cc~~

~~DC DC~~

~~JH JH~~

~~Judi Judi~~

~~Staff Staff~~

~~Hurtado Hurtado~~

~~Hurtado Hurtado Newton Newton~~

~~Hurtado Hurtado~~

~~MC MC~~

~~Brady Brady~~

~~Elena Elena~~

~~He1chelhe1m? He1chelhe1m?~~

~~Elena Elena~~

~~Judi Judi~~

~~Elena Elena~~

~~and and~~

~~He1chelhe1m He1chelhe1m~~

~~Bill Bill~~

~~Respo11s1ble Respo11s1ble~~

~~Nancy Nancy~~

~~groups) groups)~~

~~paper? paper?~~

~~counselmg counselmg~~

~~womens womens~~

~~mcluded) mcluded)~~

~~(with (with~~

~~materials materials~~

~~pubhshable pubhshable~~

~~& &~~

~~prmt prmt~~

~~manual manual~~

~~(Anemia (Anemia~~

~~Manual Manual~~

~~Report Report~~

~~spots spots~~

~~Trammg Trammg~~

~~Fmal Fmal~~

~~radio radio~~

~~materials materials~~

~~Trammg Trammg~~

~~Descr1pt1011 Descr1pt1011~~

~~of of~~

~~and and~~

~~for for~~

~~and and~~

~~Control Control~~

~~Programs Programs~~

~~Trammg Trammg~~

~~Mob1hzat10n Mob1hzat10n~~

~~Mob1hzat1on Mob1hzat1on~~

~~oftrammg oftrammg~~

~~and and~~

~~Maternal Maternal~~

~~Package Package~~

~~and and~~

~~m m~~

~~products products~~

~~Health Health~~

~~up up~~

~~Evaluation Evaluation~~

~~1997 1997~~

~~Method Method~~

~~Guide Guide~~

~~Community Community~~

~~wnte wnte~~

~~Commumty Commumty~~

~~descnpbon descnpbon~~

~~Title Title~~

~~TBA TBA~~

~~IEC/C IEC/C~~

~~Prevention Prevention~~

~~Child Child~~

~~Syph1hs Syph1hs~~

~~Trammg Trammg~~

~~18, 18,~~

~~TR TR~~

~~PUB? PUB?~~

~~RPT? RPT?~~

~~RPT RPT~~

~~M&E M&E~~

~~IEC IEC~~

~~STDs STDs~~

~~Code Code~~

~~TR TR~~

~~II II~~

~~December December~~

~~MC MC~~

~~.day, .day,~~

~~Guatemala Guatemala~~

~~general general~~

~~Country Country~~

~~72 72~~

~~65 65~~

~~64 64~~

~~207 207~~

~~164 164~~

~~ID ID~~

~~-....] -....]~~

~~0 0 l'-.l l'-.l ti~~~

~~m1leml~~~

~~malcn~~

~~wan!~~

~~#66~~

~~ILC~~

~~trC~~

~~this~~

~~Jll~~

~~#98~~

~~on 1f~~

~~want~~

~~see~~

~~with~~

~~Steps~~

~~check~~

~~check to~~

~~finah1e~~

~~Mailers~~

~~Next #58~~

~~product~~

~~combme Check d1stnbute~~

~~Office~~

~~PACT~~

~~Review~~

~~Manual~~

~~contract~~

~~Pohcy~~

~~materials~~

~~9/30/98?~~

~~IEC~~

~~IEC under~~

~~compendium~~

~~System~~

~~Comme11ts~~

~~for Get~~

~~for~~

~~Get After~~

~~Procedures~~

~~Assistance Personnel Recommendations and provided~~

~~Jndo 5025~~

~~#66~~

~~done~~

~~progress~~

~~done~~

~~NGOs~~

~~needs NGOs~~

~~be 4~~

~~progress~~

~~#53~~

~~finalized Status #58 5/98 to~~

~~draft by~~

~~done~~

~~7/1/98~~

~~9/1/98~~

~~Date~~

~~10/30/97~~

~~DC JM~~

~~AP JM~~

~~Kanam~~

~~Gilson~~

~~Goldman~~

~~Bentley~~

~~Huque~~

~~Beck~~

~~An1ou~~

~~(Indonesian~~

~~Respo11s1hle Alicia~~

~~(MC/Guate) Susan George McDermott Jeanne~~

~~Shubhada~~

~~Peggy~~

~~Parekh and~~

~~al Zah1d~~

~~M1dw1fery IBI Diana~~

~~Association)~~

~~manual~~

~~directory~~

~~comprised~~

~~personnel~~

~~package~~

~~membership~~

~~manual~~

~~#66~~

~~trammg~~

~~paper~~

~~report~~

~~#58~~

~~manual~~

~~procedures~~

~~complete~~

~~Descnpt1011 A~~

~~#53~~

~~publishable~~

~~evaluation~~

~~financmg~~

~~office~~

~~CSSM~~

~~site~~

~~the~~

~~manuals~~

~~site~~

~~Assessment~~

~~package~~

~~Overview~~

~~procedures?)~~

~~Quahtallve~~

~~cross~~

~~Quahtat1ve~~

~~cross~~

~~Motherhood~~

~~and~~

~~Safe~~

~~procedural~~

~~Title~~

~~Trammg Spanish~~

~~Research Anemia~~

~~paper process/program implementation~~

~~Research~~

~~Anemia paper process/program 1mplementallon~~

~~Review~~

~~the Component~~

~~IBI (or~~

~~1997~~

~~18,~~

~~Code~~

~~PUB ANM~~

~~M&E RPT~~

~~PRO~~

~~MCll~~

~~December~~

~~MCll~~

~~Co1111try~~

~~Guatemala~~

~~India IBI~~

~~India~~

~~Indonesia~~

~~rsday,~~

~~192~~

~~109 94~~

~~I07~~

~~IV o 00 ·-~~

~~1/98 1/98~~

~~Check Check~~

~~1fa 1fa~~

~~m m~~

~~dat1 dat1~~

~~Add Add~~

~~piece piece~~

~~meeting meeting~~

~~TBD TBD~~

~~1997 1997~~

~~action action~~

~~copy copy~~

~~M&r M&r~~

~~of of~~

~~a a~~

~~determine determine~~

~~9/98 9/98~~

~~at at~~

~~finah1ed finah1ed~~

~~Step~ Step~~~

~~to to~~

~~for for~~

~~be be~~

~~further further~~

~~analysts analysts~~

~~To To~~

~~files files~~

~~No No~~

~~Decide Decide~~

~~necessary/useful necessary/useful~~

~~Need Need~~

~~lBD lBD~~

~~M&E M&E~~

~~Next Next~~

~~1996 1996~~

~~been been~~

~~on on~~

~~M&E M&E~~

~~have have~~

~~only only~~

~~9/98 9/98~~

~~data data~~

~~based based~~

~~After After~~

~~Prehmmary Prehmmary~~

~~Com111e11t~ Com111e11t~~~

~~drafted drafted~~

~~materials materials~~

~~being being~~

~~developed developed~~

~~be be~~

~~draft draft~~

~~Done Done~~

~~to to~~

~~Done Done~~

~~used used~~

~~Status Status~~

~~/96 /96~~

~~/98 /98~~

~~3/1/98 3/1/98~~

~~9/l 9/l~~

~~8/1/97 8/1/97~~

~~1211 1211~~

~~Date Date~~

~~ZH ZH~~

~~RP RP~~

~~DC DC~~

~~and and~~

~~with with~~

~~Meg Meg~~

~~radio radio~~

~~Lara Lara~~

~~of of~~

~~ldrua ldrua~~

~~Wirth Wirth~~

~~Z1z1c Z1z1c~~

~~Meg Meg~~

~~Indonesia Indonesia~~

~~Umv Umv~~

~~Consultant? Consultant?~~

~~Lara Lara~~

~~Wirth Wirth~~

~~ZIZIC ZIZIC~~

~~production production~~

~~printing printing~~

~~private private Subcontract Subcontract~~

~~Respo11s1ble Respo11s1ble~~

~~as as~~

~~of of~~

~~for for~~

~~plan plan~~

~~of of~~

~~spots spots~~

~~used used~~

~~sales sales~~

~~flyer flyer~~

~~booklet booklet~~

~~manual manual~~

~~be be~~

~~quality quality~~

~~radio radio~~

~~to to~~

~~pill pill~~

~~fonn fonn~~

~~MPA MPA~~

~~and and~~

~~cards cards~~

~~fonn)) fonn))~~

~~referral referral~~

~~iron iron~~

~~contingency contingency~~

~~MPA MPA~~

~~for for~~

~~booklet booklet~~

~~1mplementat1on 1mplementat1on~~

~~gmdelmes gmdelmes~~

~~anemia anemia~~

~~Report Report~~

~~new new~~

~~du~n du~n~~

~~tabJ) tabJ)~~

~~IEC IEC~~

~~and and~~

~~reasdmess reasdmess~~

~~and and~~

~~banner banner~~

~~iron iron~~

~~plus plus~~

~~the the~~

~~prep prep~~

~~ofMPNMOH ofMPNMOH~~

~~etc) etc)~~

~~cards cards~~

~~booklet booklet~~

~~Analysis Analysis~~

~~tools tools~~

~~and and~~

~~for for~~

~~husb/fam husb/fam~~

~~of of~~

~~assess assess~~

~~retailers retailers~~

~~for for~~

~~(Bdd (Bdd~~

~~act1v1t1es act1v1t1es~~

~~to to~~

~~anemia anemia~~

~~Report? Report?~~

~~reminder reminder~~

~~pill pill~~

~~document document~~

~~flyers flyers~~

~~MPA MPA~~

~~Prehmmary Prehmmary (modtficatmn (modtficatmn~~

~~(gmdeline (gmdeline~~

~~services services~~

~~Tools Tools~~

~~a a~~

~~Synthesis Synthesis~~

~~Fmal Fmal~~

~~(Bdd (Bdd~~

~~iron iron~~

~~iron iron breastfeeding breastfeeding~~

~~posters posters~~

~~2 2~~

~~Descrtptw11 Descrtptw11~~

~~Tools Tools~~

~~Permatal Permatal~~

~~oflEC oflEC~~

~~Gmdlmes Gmdlmes~~

~~and and~~

~~ofBaselme ofBaselme~~

~~Analysis Analysis~~

~~and and~~

~~Materials Materials~~

~~1997 1997~~

~~Audit Audit~~

~~Maternal Maternal~~

~~S1tuat1on S1tuat1on~~

~~Synthesis Synthesis~~

~~Tools Tools~~

~~Evaluation Evaluation~~

~~Title Title~~

~~IEC IEC~~

~~18, 18,~~

~~M&E M&E~~

~~IEC IEC~~

~~Code Code~~

~~December December~~

~~II II~~

~~MC MC~~

~~daJ, daJ,~~

~~MC MC~~

~~Indonesia Indonesia~~

~~-MC -MC~~

~~Indonesia Indonesia~~

~~Cou11try Cou11try~~

~~87 87~~

~~200 200~~

~~199 199~~

~~~ ~ '° '°~~

~~184 184~~

~~206 206 ID ID to~~

~~tlm~~

~~the~~

~~'\\h1t~~

~~report~~

~~follow~~

~~drall~~

~~7ah1d~~

~~publish~~

~~issues?~~

~~and plan report~~

~~with~~

~~Grybowsk1 Stepv~~

~~brmg~~

~~meeting~~

~~mah7e~~

~~Update~~

~~Ne\:t~~

~~revised~~

~~Clairfy~~

~~Lara~~

~~M&E~~

~~with~~

~~(reanalyzing)~~

~~Translation~~

~~Paper~~

~~Report~~

~~paper~~

~~Paper~~

~~Indonesian~~

~~#?)~~

~~Worl-.ing~~

~~country~~

~~Com111e11tv~~

~~Country~~

~~synthesis~~

~~Central~~

~~Bahasa~~

~~(what~~

~~file in~~

~~1996~~

~~with~~

~~up synthesis~~

~~done~~

~~being~~

~~progress~~

~~Done~~

~~but~~

~~Status updated~~

~~Done~~

~~Needs~~

~~Preliminary~~

~~follow report~~

~~(9/96) report/synthesis Consultant country~~

~~report~~

~~done~~

~~3/1/98~~

~~1/1/98 6/1/98~~

~~1/1/98~~

~~Date~~

~~DC ZH~~

~~Juhe~~

~~Lara~~

~~Knstma~~

~~Consultant~~

~~Z1z1c~~

~~Marshall~~

~~Endang/~~

~~Respo11s1b/e~~

~~MC/Washington MC/Indonesia~~

~~LaraZ1z1c~~

~~Lara~~

~~Marsaban PATH Grybosk1~~

~~Tom al~~

~~McDermott~~

~~Jeanne~~

~~report~~

~~Country~~

~~survey~~

~~bamers~~

~~practices~~

~~baseline~~

~~the~~

~~work~~

~~measurement~~

~~ofcommumty~~

~~community~~

~~their~~

~~the~~

~~and~~

~~analysis~~

~~Sources~~

~~Analysis~~

~~Bdd~~

~~assess~~

~~services~~

~~Indicators Report~~

~~Descr1pt1011~~

~~Tools access~~

~~use~~

~~Quahtatlve~~

~~Quantitative~~

~~Profile~~

~~and~~

~~Report~~

~~D1agnos1s~~

~~and~~

~~D1agnos1s~~

~~Plan~~

~~Survey~~

~~survey~~

~~Title~~

~~Monitoring Evaluation~~

~~Indicators~~

~~Community Tools~~

~~Report~~

~~Community~~

~~Baseline~~

~~Bdd~~

~~1997~~

~~18,~~

~~Code~~

~~M&E~~

~~IEC~~

~~M&E IEC~~

~~RPT~~

~~M&E RPT~~

~~M&E~~

~~RPT~~

~~December~~

~~Cou11try Indonesia~~

~~-MC~~

~~Indonesia~~

~~-MC~~

~~Indonesia~~

~~-MC~~

~~Indonesia~~

~~Tl111rsday,~~

~~c:)~~

~~be be~~

~~1f 1f~~

~~Bl Bl~~

~~111 111~~

~~~amc ~amc~~

~~to to~~

~~M&I M&I~~

~~numbers numbers~~

~~report report~~

~~the the~~

~~copy copy~~

~~ver~mn ver~mn tool tool~~

~~rran~hte rran~hte 1998 1998~~

~~the the~~

~~clarity clarity~~

~~time time~~

~~1 1 Is Is~~

~~be be~~

~~1s 1s~~

~~C1el C1el~~

~~6 6~~

~~at at~~

~~Report Report~~

~~to to~~

~~that that~~

~~CR CR~~

~~there there~~

~~JM JM~~

~~at at~~

~~Fnghsh Fnghsh~~

~~topic topic~~

~~report report~~

~~January January~~

~~date date~~

~~details details~~

~~Is Is~~

~~aLlion aLlion~~

~~by by~~

~~evaluation evaluation~~

~~m m~~

~~on on~~

~~actions actions~~

~~with with~~

~~get get~~

~~due due~~

~~Step<; Step<;~~

~~Bl? Bl?~~

~~uat1on uat1on~~

~~to to~~

~~lurther lurther~~

~~skills skills~~

~~forprmtmg forprmtmg~~

~~modification~) modification~)~~

~~(based (based~~

~~Complete Complete~~

~~mto mto~~

~~JM JM~~

~~translation? translation?~~

~~as as~~

~~eval eval~~

~~Check Check~~

~~Further Further~~

~~determ111ed determ111ed~~

~~meetmg meetmg~~

~~presented presented~~

~~Check Check~~

~~files? files?~~

~~finalized? finalized?~~

~~No No~~

~~Ne'Ct Ne'Ct~~

~~not not~~

~~m m~~

~~work? work?~~

~~version version~~

~~1998 1998~~

~~Spr111g Spr111g~~

~~#167 #167~~

~~English English~~

~~copy copy~~

~~Field Field~~

~~Indonesian Indonesian~~

~~as as~~

~~June June~~

~~m m~~

~~done done~~

~~1f 1f~~

~~be be~~

~~Enghsh Enghsh~~

~~Indonesian Indonesian~~

~~same same~~

~~Bahasa Bahasa~~

~~sure sure~~

~~Done Done~~

~~1998 1998~~

~~May May~~

~~To To~~

~~Comme11ts Comme11ts~~

~~6 6~~

~~topic topic~~

~~English English~~

~~modified modified~~

~~and and~~

~~ed1t10n ed1t10n~~

~~for for~~

~~report report~~

~~second second~~

~~Bl Bl~~

~~progress progress~~

~~for for~~

~~bemg bemg edition edition~~

~~done done prmted prmted~~

~~first first~~

~~Done Done~~

~~and and~~

~~9/98 9/98~~

~~In In~~

~~Draft Draft~~

~~Status Status~~

~~/96 /96~~

~~6/30/98 6/30/98~~

~~9/30/98 9/30/98~~

~~1211 1211~~

~~Date Date~~

~~JM JM~~

~~ZH ZH~~

~~DC DC~~

~~and and~~

~~al al~~

~~et et~~

~~Cohen Cohen~~

~~Miller Miller~~

~~Beck Beck~~

~~ACNM ACNM~~

~~of of~~

~~MC MC~~

~~Surekha Surekha Diana Diana~~

~~Diana Diana~~

~~McDermott McDermott~~

~~Suellen Suellen~~

~~Jeanne Jeanne~~

~~Ronsmans Ronsmans~~

~~Carme Carme~~

~~Umv Umv~~

~~Indonesia Indonesia~~

~~Respomtble Respomtble~~

~~and and~~

~~data data~~

~~facility facility~~

~~b1dans b1dans~~

~~Review Review~~

~~for for~~

~~hospital hospital~~

~~health health~~

~~Peer Peer~~

~~the the~~

~~and and~~

~~of of~~

~~(LSS) (LSS)~~

~~of of~~

~~manual manual~~

~~analysis analysis~~

~~Education Education~~

~~Analysis Analysis~~

~~the the~~

~~desas desas~~

~~d1 d1~~

~~on on~~

~~trammg trammg~~

~~b1dan b1dan~~

~~final final~~

~~Contmumg Contmumg~~

~~Reports Reports~~

~~Report Report~~

~~survey survey~~

~~Quantitative Quantitative~~

~~Descrtpt1011 Descrtpt1011~~

~~for for~~

~~on on~~

~~for for~~

~~Report Report~~

~~mto mto~~

~~Healthy Healthy~~

~~and and~~

~~register register~~

~~guide guide~~

~~Postpartum Postpartum~~

~~systems systems~~

~~contmumg contmumg~~

~~a a~~

~~Reports Reports a a~~

~~system system~~

~~quahty quahty~~

~~planners planners~~

~~Mother Mother~~

~~and and~~

~~Analysis Analysis~~

~~and and~~

~~based based~~

~~dehvery dehvery~~

~~mg mg~~

~~Programs Programs~~

~~1997 1997~~

~~Healthy Healthy~~

~~Newborn Newborn~~

~~approach approach program program~~

~~m1dw1ves m1dw1ves~~

~~trammg trammg~~

~~education education Build Build~~

~~Evaluation Evaluation~~

~~Trammg Trammg~~

~~Care Care~~

~~complications complications~~

~~Hospital Hospital normal normal~~

~~Title Title~~

~~S1tuat1on S1tuat1on~~

~~18, 18,~~

~~PRO PRO~~

~~M&E M&E~~

~~TR TR~~

~~M&E M&E~~

~~TR TR~~

~~PR PR~~

~~M&E M&E~~

~~RPT RPT~~

~~PR PR~~

~~RPT RPT~~

~~M&E M&E~~

~~Code Code~~

~~December December~~

~~II II~~

~~MC MC~~

~~Indonesia Indonesia~~

~~MC MC~~

~~Indonesia Indonesia~~

~~Comlfry Comlfry~~

~~11rsday, 11rsday,~~

~~81 81~~

~~89 89~~

~~186 186~~

~~88 88~~

~~187 187~~

~~ID ID~~

~~N N ...... casL~~

~~the~~

~~new 1f~~

~~rinal~~

~~1998~~

~~for~~

~~and~~

~~Feb~~

~~achoo~~

~~whether~~

~~printing~~

~~Publish~~

~~per111atalog1st~~

~~completed~~

~~Steps~~

~~action~~

~~Kahmantan~~

~~mcluded~~

~~further date~~

~~date~~

~~Identify Next~~

~~review country?~~

~~Workshop~~

~~paper/report~~

~~South~~

~~Determine~~

~~postpone Get to~~

~~further~~

~~Get~~

~~Ard1~~

~~case) add~~

~~only~~

~~simulation~~

~~anemia~~

~~for~~

~~asked~~

~~country~~

~~[nghsh~~

~~Comments~~

~~has~~

~~case~~

~~(hke~~

~~lndo~~

~~but~~

~~(1997)~~

~~published~~

~~reviewed~~

~~presented~~

~~(Bl)~~

~~ednton~~

~~perinatolog1st~~

~~printed~~

~~Studies~~

~~progress~~

~~Bogor~~

~~Status to by~~

~~Family done in~~

~~Plannmg~~

~~m paper~~

~~First~~

~~done not~~

~~Done~~

~~311198~~

~~1/1/98~~

~~3131196~~

~~Date~~

~~DC JM~~

~~JM ZH~~

~~Child~~

~~Umv~~

~~Cohen~~

~~for~~

~~Beck~~

~~Marsaban~~

~~TriJatmo~~

~~Kevm~~

~~Indonesia?~~

~~Respo11s1ble Rach1mhad1 Dr~~

~~Ronsmans?)~~

~~Center~~

~~Survival of (Carine~~

~~Surekha~~

~~and ORellly~~

~~Juhe~~

~~Diana~~

~~for~~

~~study~~

~~RTI~~

~~one~~

~~and~~

~~ofvahdallon~~

~~analysis~~

~~trainers~~

~~for~~

~~report~~

~~(one~~

~~final~~

~~paper~~

~~ep1dem1olog1cal~~

~~data~~

~~manual~~

~~Report~~

~~Protocols Descrtpt1011~~

~~techmcal~~

~~Report~~

~~publishable~~

~~Trammg trainees)~~

~~Fmal~~

~~Health~~

~~and~~

~~Manual~~

~~RTI~~

~~Basic~~

~~Obstetric~~

~~Report Study~~

~~study~~

~~Comphcat1ons~~

~~Level~~

~~Needs~~

~~based~~

~~Obstetric~~

~~Kahmantan~~

~~Trammg~~

~~Title~~

~~Handlmg Emergency~~

~~Service~~

~~Vahdat1on~~

~~Neonatal Severe~~

~~South~~

~~Fac1hty~~

~~prevalence~~

~~IPC/C~~

~~Trammg Assessment~~

~~1997~~

~~18,~~

~~Code~~

~~PRO~~

~~PUB PR~~

~~STDs RPT PUB?~~

~~IEC~~

~~M&E~~

~~TR RPT~~

~~Dec.ember~~

~~MCll~~

~~Cou11try MC~~

~~Indonesia~~

~~-MC~~

~~Indonesia~~

~~lndonesm~~

~~202~~

~~201~~

~~Th11rsday,~~

~~1-...l~~

~~~"'~~

~~If If~~

~~to to~~

~~of of~~

~~1fa 1fa~~

~~Need Need~~

~~Rev1s1on Rev1s1on~~

~~arrival arrival~~

~~to to~~

~~Part Part~~

~~articles articles~~

~~How How~~

~~2 2~~

~~upon upon~~

~~advanced advanced~~

~~determine determine~~

~~monograph? monograph?~~

~~Generic? Generic?~~

~~Research? Research?~~

~~m m~~

~~due due~~

~~draft draft~~

~~translate translate~~

~~Wnte Wnte~~

~~publish publish~~

~~to to~~

~~Step-. Step-.~~

~~date date~~

~~Spamsh Spamsh~~

~~Will Will~~

~~mclude mclude~~

~~Applied Applied~~

~~m m~~

~~need need~~

~~Review Review~~

~~translations translations~~

~~basic? basic?~~

~~package? package?~~

~~Get Get~~

~~finalize finalize~~

~~Ne'~~

~~and and~~

~~date date~~

~~Will Will~~

~~m m~~

~~draft draft~~

~~thesis thesis~~

~~due due~~

~~English English~~

~~product product~~

~~as as~~

~~for for~~

~~waitmg waitmg~~

~~10/31197 10/31197~~

~~report report~~

~~A A~~

~~ongmal ongmal~~

~~Russian Russian~~

~~country country~~

~~6/98 6/98~~

~~Comment-. Comment-.~~

~~12/97 12/97~~

~~be be~~

~~completed completed~~

~~to to~~

~~progress progress~~

~~11/97 11/97~~

~~progress progress~~

~~through through extended extended~~

~~m m~~

~~TOT TOT~~

~~Completed Completed~~

~~m m~~

~~written written~~

~~needs needs~~

~~Status Status~~

~~/97 /97~~

~~6/1/98 6/1/98~~

~~/30/97 /30/97~~

~~12/31 12/31~~

~~I I~~

~~12/31 12/31~~

~~9/30/98 9/30/98~~

~~1 1~~

~~Date Date~~

~~ED ED~~

~~JM JM~~

~~cc cc~~

~~MMe MMe~~

~~DC DC~~

~~(JIN) (JIN)~~

~~(llN) (llN)~~

~~PCS PCS~~

~~Pl Pl~~

~~Judy Judy~~

~~de de~~

~~Polly Polly~~

~~Kanash1ro Kanash1ro~~

~~Zavaleta Zavaleta~~

~~with with~~

~~Hillary Hillary~~

~~JHU JHU~~

~~Quality Quality~~

~~and and~~

~~Creed Creed and and~~

~~Nelly Nelly~~

~~lnvest1gacion lnvest1gacion~~

~~lnst1tuto lnst1tuto Nutncional Nutncional~~

~~Peru Peru~~

~~lnvesllgac1on lnvesllgac1on~~

~~lnslltuto lnslltuto~~

~~Nutncional Nutncional~~

~~Mercer Mercer~~

~~ACNM ACNM~~

~~FLUX FLUX~~

~~Assurance Assurance~~

~~MC MC~~

~~Respo11s1b/e Respo11s1b/e~~

~~Health Health~~

~~adolescents? adolescents?~~

~~supplemental supplemental~~

~~advocacy advocacy~~

~~m m~~

~~of of~~

~~Ukrame Ukrame~~

~~the the~~

~~dose dose~~

~~users users~~

~~Reproductive Reproductive~~

~~anemia anemia~~

~~of of~~

~~non non~~

~~weekly weekly~~

~~and and~~

~~correct correct~~

~~Quality Quality~~

~~or or~~

~~(adaptation (adaptation~~

~~users users~~

~~of of~~

~~regular regular~~

~~a a~~

~~by by~~

~~Report Report~~

~~prevent prevent~~

~~report report~~

~~Can Can~~

~~papers) papers)~~

~~iron iron~~

~~(2 (2~~

~~Q Q~~

~~Fmal Fmal~~

~~cumculum) cumculum)~~

~~Curriculum Curriculum~~

~~Fmal Fmal~~

~~paper paper~~

~~Services Services~~

~~Perceptions Perceptions~~

~~Descr1pt1011 Descr1pt1011~~

~~m m~~

~~on on~~

~~of of~~

~~on on~~

~~from from~~

~~on on~~

~~a a~~

~~women women~~

~~Prevent Prevent~~

~~Women Women~~

~~Intake Intake~~

~~Anemia Anemia~~

~~of of~~

~~to to~~

~~m m~~

~~and and~~

~~with with~~

~~m m~~

~~Impact Impact~~

~~and and~~

~~kitchens kitchens~~

~~Iron Iron~~

~~family family~~

~~Reports Reports~~

~~Girls Girls~~

~~School School~~

~~Research Research~~

~~Age Age~~

~~the the~~

~~care care~~

~~mtake mtake~~

~~curriculum curriculum~~

~~labor labor~~

~~care care~~

~~for for and and~~

~~Ecuador Ecuador~~

~~on on~~

~~Deficiency Deficiency~~

~~on on~~

~~Group Group~~

~~mg mg~~

~~Supplementation Supplementation~~

~~Fertile Fertile~~

~~lmprovmg lmprovmg~~

~~1997 1997~~

~~community community~~

~~Dietary Dietary part1c1patmg part1c1patmg~~

~~Iron Iron~~

~~Adolescents Adolescents~~

~~of of~~

~~Adolescent Adolescent~~

~~Indices Indices Performance Performance~~

~~Iron Iron~~

~~Study Study~~

~~FCMC FCMC~~

~~Tram Tram~~

~~focus focus~~

~~delivery delivery~~

~~centered centered~~

~~maternity maternity~~

~~Qualitative Qualitative~~

~~Honduras Honduras~~

~~Bolivia, Bolivia, Title Title~~

~~Focus Focus~~

~~18, 18,~~

~~PUB PUB~~

~~AR AR~~

~~ANM ANM~~

~~PUB PUB~~

~~AR AR~~

~~ANM ANM~~

~~TR TR~~

~~RPT RPT~~

~~Code Code~~

~~Deumber Deumber~~

~~Peru Peru~~

~~Moldova Moldova~~

~~lmhahve lmhahve~~

~~LAC LAC~~

~~Counlrt-~~

~~132 132~~

~~133 133~~

~~Tlmrsda.h Tlmrsda.h~~

~~119 119~~

~~118 118~~

~~147 147~~

~~ID ID~~

~~hJ hJ~~

~~l.,,J l.,,J - be~~

~~genwc~~

~~ACNM~~

~~print~~

~~with~~

~~pad.aging~~

~~curriculum d1stnbuted~~

~~med~~

~~f/u~~

~~and~~

~~term~~

~~Ner:tSteps~~

~~SEATS~~

~~will FCMC~~

~~Def~~

~~Frances JM~~

~~ed1t1on~~

~~2nd~~

~~Co111111e11t"i~~

~~will~~

~~English~~

~~under~~

~~12/97~~

~~May~~

~~draft~~

~~rev1s1ons developed~~

~~final~~

~~review~~

~~Status Done?~~

~~done? some~~

~~1/1/98~~

~~611196~~

~~4/1/98 111/98~~

~~Date~~

~~DC AP~~

~~Pat~~

~~Leila~~

~~Judith~~

~~Betty~~

~~Judy~~

~~Gerber~~

~~Pauline~~

~~Ganges~~

~~Parekh~~

~~and~~

~~Respons1hle Willow~~

~~An1ou (MC/SEATS collaborat1on)~~

~~Pauline~~

~~Paluzzi~~

~~Mercer Glatle1der~~

~~Mercer ACNM Be1tnsv1lh Glatle1der~~

~~ACNM Frances Farrell~~

~~results~~

~~focus~~

~~group~~

~~neonatal~~

~~appropriate~~

~~focus~~

~~adolescent~~

~~control~~

~~use~~

~~with Russia~~

~~including~~

~~other~~

~~mfect1on~~

~~report?~~

~~paper~~

~~manual~~

~~curriculum~~

~~Working Descr1pt1011~~

~~training~~

~~breastfeeding/LAM~~

~~Training resuscitation technology~~

~~trammg~~

~~evaluauon~~

~~Paper~~

~~for~~

~~trainers~~

~~nurse~~

~~Cumculum~~

~~ANC~~

~~Research~~

~~for~~

~~TOT~~

~~for~~

~~Basic~~

~~Advanced~~

~~trainers~~

~~Title~~

~~Quahtallve~~

~~FCMC~~

~~for~~

~~FCMC~~

~~Cumculum TOT~~

~~Curriculum m1dw1ves Adolescents~~

~~1997~~

~~18,~~

~~Code~~

~~PUB?~~

~~Dec.ember~~

~~Cou11try Russia~~

~~Ukraine~~

~~Ukrame~~

~~Zambia~~

~~ID 122~~

~~123~~

~~124~~

~~12'i~~

~~TlmrsdaJ,~~

~~--<_~~