Tajikistan Maternal and Child Health Program Performance Report: October – December 2009 Quarter – 1, Year - 2 Cooperative Agreement # 119-A-00-08-00025-00 Submitted by: Mercy Corps –Tajikistan ACRONYMS & ABBREVIATIONS AL Adult learning ANC/PNC Antenatal and Postnatal Care ARI Acute Respiratory Infection BCC Behavior Change Communication CBO Community Based Organization CDH Central District Hospital CHE Community Health Educator CHL Centers for Promotion of Healthy Lifestyles C-IMCI Community Integrated Management of Childhood Illness CS Child Survival CSFE Child Survival Final Evaluation CtC Child-to-Child DIP Detailed Implementation Plan DOH Department of Health – Sughd Oblast & District levels EPC Essential Perinatal Care ETS Emergency Transport System Feldsher Lowest level of healthcare worker, a medic GMP Growth Monitoring and Promotion Hukumat District-level government head ICA-EHIO Institute of Cultural Affairs –Empowerment & Human Involvement Organization IDA Iron deficiency anemia IFA Iron-folic Acid IMCI Integrated Management of Childhood Illness jamoat Local sub-district government structure (several villages per jamoat) KPC Knowledge, Practice & Coverage Survey LQAS Lot Quality Assurance Sampling MCH Maternal Child Health MOE Ministry of Education MOH Ministry of Health of Tajikistan – national level MOU Memorandum of Understanding OB/GYN Obstetrics & Gynecology Specialist RCHL Republic Centre for Healthy Lifestyle SCSP Sughd Child Survival Project SIDA Swedish International Development Agency SUB Rural hospital with physicians & midwives but with limited in-patient care TJS Tajikistan somoni TOT Training of Trainers UNICEF United Nations Children’s Fund USAID United States Agency for International Development VAT Value Added Tax VDC Village Development Committee WHO World Health Organization 2 Executive Summary: This quarter witnessed progress within all project activities, especially quickly building on the support and approvals received from the Ministry of Health of the Republic of Tajikistan (MoH), in the last quarter, for training of the IMCI and Safe Motherhood components. An intense training schedule was employed during this quarter to make up for the delayed trainings and for capacity strengthening of health providers. The MCH Program finally received MoH approval to roll out training in the New Standards for Safe Motherhood in all districts. Therefore, training in the New Standards for Essential Perinatal Care (EPC) were completed in the Continuation Districts where USAID and Mercy Corps’ Child Survival Project was implemented. Since October, a total of 8 training workshops were completed for New Standards for EPC/Safe motherhood in the project area. Following completion of the MCH baseline assessment in Hisor District, a Detailed Implementation Plan (DIP) development workshop was conducted with key program stakeholders from Hisor District to design the work plan to supplement the primary MCH DIP. Three IMCI training workshops were conducted during the last quarter, each for 9-days in MCH target districts. Based on a MoH decree and requests from the National IMCI Center, three IMCI directors from Istaravshan, Chakalovsk and Kairakkum were included to the trainings as participants. Oblast IMCI personnel also participated in these training activities. After conducting two nine-day IMCI training workshops, Mercy Corps, together with the Sughd IMCI Center, listed 16 health providers who received ToT training. Based on the MoH decree, the ToT training of IMCI was conducted in Khujand City from November 9-13th. The same participants received “Follow up observation training” from November 16th-20th. At the end of the previous quarter, with the assistance of the USAID country office, Mercy Corps finally received official approval from the Ministry of Education of the Republic of Tajikistan (MoE) to initiate Child-to-Child (CtC) activities within the scope of the Project. A Knowledge, Attitude and Practice (KAP) survey was conducted from October 6 to October 9, 2009. From November 2nd, 13 out of the 31 schools of Spitamen district started training on Personal Hygiene for school children-trainers. Trained school children received brochures on personal hygiene including hand washing. 465 school children-trainers from 31 schools of Spitamen are now rolling out CtC related health topics to their peers. Significant progress was achieved this quarter to further the community and household level activities that are instrumental to the success of this program. A total of 81 village development committees (VDCs) have been formed and 156 Community Health Educators (CHEs) were identified and trained in the four districts of Gonchi, Hisor, Matshco and Taboshar. Community Health Educators (CHEs) and medical staff of Hisor district were trained in Behavior Change Communication during this quarter. Hisor was the last of the target districts to receive this training. A total 18 training sessions for Adult Learning (AL) and thematic training on Acute Respiratory Illness (ARI) were organized for CHEs and medical staff in MCH districts. Center for Promotion of Healthy Lifestyles (CHL) representatives and Mercy Corps staff were fully involved in conducting the training. Health education sessions in the program reached a total of 34,173 individuals, an average of 13,687 targeted program participants each month. CHEs made an average of 1645 home visits per month and referred an average of 238 persons per month to health facilities for vaccination, respiratory infections, postnatal and pre-natal care, burns or other injuries. Emergency transport was used in 485 instances to transport care needing pregnant mothers or other emergency cases in the last quarter in the program area. Renovation of Zafarabad District CHL was completed. Assessment of water and sanitation conditions at health facilities (medpoints, health centers) in Gonchi District was conducted. 3 The Program organized joint monitoring visits in close cooperation with the national MoH and Sida partners, ACTED and Aga Khan Foundation. As well, a CHL sustainability workshop was organized in Isfara town. Cross learning visits were organized in Asht District. This is the first quarter performance report for the second year of the Mercy Corps and USAID Tajikistan Maternal and Child Health (MCH) Project, covering the period October through December 2009 under Cooperative Agreement # 119-A-00-08-00025-00. This report includes the following sections: 1. Accomplishments of the Program 2. Status of Activities 3. Planned vs Actual Status of Activities (October– December 2009) 4. Key Monitoring and Evaluation Activities in the program 5. Constraints and Challenges 6. Program Management System Update 7. Partner Relationships 8. PVO Coordination/Collaboration in Country 9. USAID Mission Collaboration Background Over the five-year implementation period, the MCH project aims at reducing infant and maternal mortality by improving the health of women and of children under five years of age. Mortality rates in some districts of Sughd Oblast in the North of Tajikistan are among the worst in the country. The project is in its second year of implementation in Mastchoh, Tabochar, Gonchi districts of Sughd Oblast and Hisor District of the RRS Oblast. The project additionally works in four districts of Sughd where Mercy Corps previously implemented a four-year USAID-funded Child Survival program – Spitamen, Asht, Shahristan, and Zafarabod. In these districts, the MCH Project is supporting continuation of some specific, time-bound activities to assure sustainability and complete coverage of improved technical skills of Department of Health (DoH) staff. As the target districts are considered to be underserved areas, the MCH Project encourages greater government engagement in issues of mother and child health and promotes the adoption of healthy behaviors and key interventions. The project expects to benefit 220,068 people (127,231 women of reproductive age and 92,837 children under five). The goal and objectives are to be achieved by building DoH capacity to address the challenges of sustainable, quality service delivery, and promoting behavior change and community mobilization to take appropriate responsibility for health. The objectives of the project are as follows: 1. Increase the percentage of mothers of children under two years who practice improved feeding, caring, and health-seeking practices. 2. Increase the percentage of women who receive adequate maternal and newborn care. 3. Increase the capacity of the DOH health facilities to deliver quality maternal and child health services. 1. Accomplishments of the Program: 4 In this quarter MCH Program worked closely with government structures and further strengthened relationships with the Ministry of Health and Ministry of Education and their respective structures at the oblast and district levels. Following approvals from the MoE, staff were recruited for the CtC component of the MCH program and a detailed implementation plan (DIP) was developed for program activities in the Hisor District (Hisor activities were launched after the districts in Sughd Oblast and therefore required an additional complementary process for DIP development). In continuation districts of Zafarabad, Asht, Spitamen and Shahristan, Mercy Corps’ health team conducted a mini Knowledge, Practices and Coverage (KPC) survey for monitoring program components. Program staff organized joint monitoring visits in close cooperation with national MoH and Sida partners (Acted and