Tajikistan Maternal and Child Health Program

Quarterly Report #11 Reporting Period: April 1, 2011 - June 31, 2011

Cooperative Agreement # 119-A-00-08-00025-00 Submitted by: Mercy Corps –Tajikistan

TABLE OF CONTENTS

1 Acronyms and Abbreviation…………………………………………...………………. 3

2 Introduction……….……………………………………………………………..……… 4

3 Program Overview and progress towards indicators….………………………………4

4 Status of Activities………………………………………………………………...…….. 8

4.1 Community Development…………………………………………...………...... 7

4.2 Behavior Change Communication (BCC)………………………..………….... 9

4.3 Child-to-Child (CtC)………………………………………………...………….. 9

4.4 Safe Motherhood…………………………………………………..…………... 10

4.5 Integrated Management of Childhood Illness (IMCI)……………………… 11

4.6 Monitoring & Evaluation activity …………………………………………….13

4.7 Post Partum Depression (PPD)………………………………………….…….14

4.8 Nationwide Polio Immunization Campaign………………………………….14

5 Planned vs. Actual Status of Activities………………………………………………..15

6 Constraints/Challenges…………………………………………………...……………16

7 Success Story: Healthy behaviors, Healthy babies !………………………………....17 ACRONYMS & ABBREVIATIONS

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. INTRODUCTION This is the eleventh quarterly performance report for the third year of the Mercy Corps and USAID Tajikistan Maternal and Child Health (MCH) project, covering the period of April 1, 2011 through June 30, 2011 under Cooperative Agreement #119-A-00-08-00025-00.

3. PROJECT OVERVIEW AND PROGRESS TOWARDS OBJECTIVES Project Overview: Over the five-year implementation period, the MCH project aims to reduce infant and maternal mortality by improving the health of women and of children under the age of five years. Mortality rates in some districts of the Sughd Oblast in northern Tajikistan are among the worst in the country. The project is in its second year of implementation in the Mastchoh, Taboshar, Gonchi districts of Sughd Oblast and in the Hisor district of the RRS Oblast.

As the target districts are considered to be underserved areas, the MCH Project encourages greater government engagement on the issues of mother and child health and promotes the adoption of healthy behaviors and key interventions at the community level. 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 the capacity of district level Department of Health (DoH) toward addressing the challenges of sustainable quality service delivery, and promoting behavior change and community mobilization at community and household level. 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 facilities to deliver quality maternal and child health services.

Progress towards Project objectives: The midterm review for the project was conducted during this quarter that included a Knowledge, Practice and Coverage (KPC) Survey, as well as, other qualitative assessments. Progress has been witnessed in all project activities towards objectives, especially, empowerment and health education among target groups of health workers and community members.

Under Behavior Change strategies following activities have been completed during this quarter to support the first objective of increasing the percentage of mothers of children under two years who practice improved, feeding, caring and health-seeking practices. Mercy corps organized special events in all eight districts to mark the World Child Protection Day on June 1, 2011 to boost the health messages among the caregivers, mothers, in the schools and the communities in the area. This event emphasized how children’s health is crucial to child protection and survival. Key individuals of the community gave encouraging speeches concerning health issues. For example, religious leaders talked about health issues by relating teachings from the holy Quran. Their speeches were very motivating and encouraging of behavioral change of people in the community. Also, the Child-to-Child health promotion component continued its main activities in Hisor and Taboshar districts. In this quarter, health education sessions on pure water, worms and diarrhea have been conducted for Student’s Trainers and Responsible Teachers in these two districts. Indeed, provision of health education sessions among school children has made an impact on the behavioral attitudes of people in the communities as by reinforcing the health messages especially for the children. For example, one of the CtC students, who is a grade eight student from School #77 in Hisor district shared:

“When I go home after school, I gather my brothers, sisters and their friends and teach them what I have learned. It’s very exciting, when I wash my hands with soap, my sisters and brothers repeat what I did”.

Regarding the second and third objectives MCH project continues to follow up and conduct support visits to the health centers of target districts to monitor and support the application of trainings that was conducted for rolling out the national standards in safe motherhood. During this quarter, the Project provided assistance to the health providers of health centers in Rosrovut Jamoat in Gonchi district and Faizi Sulton in Mastcho district. With the help of the administration of the health centers, the organizational problems of the centers have been resolved. Assistance was provided to reorganize the maternity houses with more effective health services. Activities of the health staff were observed during health center visits and, as a result, collaboration between volunteers and midwives has improved in quality due to a common focus on achieving the new national standards in safe motherhood. Still, the health centers have a significant need for strong counseling skills. Overall, the situation and functionality of the health facilities are improving and resulting in positive change in the health status of the population.

MCH project also conducted monitoring activities for the Integrated Management of Childhood Illnesses (IMCI) by the district monitors and IMCI director in Mastcho district. Nine health providers were monitored in seven health centers for IMCI skills. The main purpose of conducting this monitoring activity was to assess the knowledge and skills obtained during IMCI trainings. The monitoring results found that the adoption of IMCI methods for classifying, treating and counseling illnesses has developed positively. It was also observed that some of the conditions supporting the IMCI work have also improved. For example, refrigerators and scales are now available in the health centers. Also, adequate amounts of Oral Rehydration Solution (ORS) packages were available in all monitored health facilities, a significant step in implementing the IMCI activities implying progress in both access and delivery of quality MCH health care. This trend needs to be nurtured and replicated throughout project duration.

Monitoring & Evaluation (M&E) Activity: Mercy Corps Tajikistan has conducted Mid-term Knowledge, Practice and Coverage (KPC) survey for Maternal and Child Health (MCH) Program in all eight MCH districts; Asht, Shahristan, Spitamen and Zafarabad (old) and Gonchi, Mastcho, Hisor and Taboshar (new). The midterm KPC survey training and collection of data continued from 30th of April 2011 to 13th of May 2011. In short, the survey results reveals that knowledge of women about Diarrhea has increased significantly as compared with the baseline survey that was conducted in 2009 where only 20.10% mothers had knowledge about the signs of severe diarrhea sign. Now, 80.83% of mothers can indicate more than two signs of severe diarrhea which is a very positive change in the intervention area. In relation to Maternal and Child Nutrition, breastfeeding, one of the key indicators for behavioral changes, shows unexpected positive results with the percentage of mothers who exclusively breastfeed their babies increasing from 37% to 84.50% in the midterm KPC survey 2011, as compared with the baseline survey 2009.

QUARTERLY DATA FOR USAID PRIORITY MCH INDICATORS

(This indicates progress towards Objective Two of MCH in quantitative terms: Increase the percentage of women who receive adequate maternal and newborn care)

Health Facility based data: 2011 Indicators April May June Total Total in 2011

1 Number of 1180 1085 1065 3330 6849 deliveries with a SBA 2 Number of 1128 1065 1043 3236 6641 women receiving AMSTL 3 Number of 1086 1053 1062 3201 6668 newborns receiving essential newborn care 4 # of cases of child pneumonia treated with 308 282 663 945 1936 antibiotics by trained facility staff 5 # of cases of child diarrhea treated 91 180 367 638 812

Community and health facility based data: 2011 People received April May June Total Total in 2011 training under the program 6 Maternal/newborn 14435 13726 14774 42935 52886 health 7 Child health and - - - - 23858 nutrition

4. STATUS OF ACTIVITIES

4.1 Community Development / Mobilization Community mobilization and strong behavior change communication can provide a lasting impact on community-based health programs. During this reporting period, community development activities were focused on engaging community members’ participation throughout the midterm review process including, the KPC Survey and qualitative assessments in all eight MCH districts.

Additionally, MC staff conducted health education sessions on care and nutrition of pregnant women for the all new MCH districts: Gonchi, Mastcho, Hisor and Taboshar. These health education sessions are designed to provide the most important information regarding antenatal check-ups and nutritional requirements for pregnant women, as well as, general precautions during the pregnancy.

Table-1 Details of Educational session for community April-June 2011

Number of participants

Men Women

Month District Theme

law

of HH visit of

Number of meetings of Number staff Medical Father Other Children with 2 years Pregnant women Mother Other TOTAL Number Care & Nutrition for April Pregnant Women and Taboshar Vaccination 110 39 27 36 287 73 188 384 995 84 Care & Nutrition for April Pregnant Women and Mastchoh Vaccination 431 270 28 29 1162 485 787 1041 3532 247 Complementar April y feeding, Gonchi malnutrition 839 387 479 374 2598 1438 1579 803 7271 348 Care & Nutrition for April Pregnant Hisor Women 308 109 86 101 1326 453 331 343 2637 158 Care & Nutrition for May Pregnant Women and Taboshar Vaccination 84 28 13 26 277 60 149 254 779 63 Care & Nutrition for May Pregnant Women and Mastchoh Vaccination 412 236 33 39 1022 452 796 954 3296 346 Complementar May y feeding, Gonchi malnutrition 806 375 409 315 2498 1400 1570 783 6975 279 Care & Nutrition for May Pregnant Hisor Women 315 155 47 76 1521 476 287 288 2676 322 Care & Nutrition for June Pregnant Women and Taboshar Vaccination 123 37 16 31 273 83 168 308 879 73 Care & Nutrition for June Pregnant Women and Mastchoh Vaccination 411 251 14 17 1256 490 778 934 3489 232 Care & Nutrition for June Pregnant Gonchi Women 807 370 500 416 2480 1364 1506 836 7101 322 Care & Nutrition for June Pregnant Hisor Women 317 85 92 379 1686 519 256 373 3305 240 Total 4963 2342 1744 1839 16386 7293 8395 7301 42935 2714

Training on the topic of “Birth Planning” continued for Village Development Committee (VDC) members during this reporting period. The Birth Planning is a process of providing safe delivery in the health facility and care of mother and child after delivery. The birth planning or preparedness includes: 1. Recognize danger signs and complications during pregnancy (by women and family members): bleeding, convulsions, pallor, labored breathing, headache, swollen hands or face, fever; and know what to do and where to go if they arise. 2. Develop an appropriate birth plan and set aside resources for normal birth and for emergencies noted below. 3. Select an appropriate place for delivery. 4. Identify a skilled birth attendant to be present at delivery. 5. Develop an appropriate household emergency birth plan, including where, when, and how to obtain referral care. Households need to plan for emergency transport to the health center or hospital in case of unexpected complications; need to identify potential blood donors and also identify the decision-maker in the family (if it is not the woman herself). The Birth Planning trainings were attended also by local midwives, representatives from Jamoats and local taxis.

Emergency Transport arrangements were made after completion of trainings. Now a number of Emergency Transports are functioning in four MCH districts. Local midwives and VDC members are beginning to complete the Birth Planning Matrix for pregnant women. Refer to Table 2 for the Birth Planning statistics.

Table-2 Birth Planning Training data: District # of Training # of # of # of # of trips Birth Plans conducted Participants Emergency Emergency used for (matrix) on Birth Transport ( trips made pregnant developed Planning Cars) during this women organized quarter Gonchi 20 260 41 123 56 133 Mastchoh 20 177 52 62 14 6 Taboshar 6 56 19 15 - 8 Hisor 16 178 11 - - - Total 62 671 123 200 70 147

4.2 Behavior Change Communication Apart from the routine household visits and health education sessions mentioned in Table-1, Mercy Corps organized actions devoted to the World Health Day and World Child Protection Day mentioned before in all MCH districts: Asht, Shahriston, Spitamen and Zafarobod (old) and Gonchi, Mastcho, Hisor and Taboshar (new) on 1st of June 2011. These actions were supported by Mercy Corps’ MCH program with the help of local jamoats. These actions provided an opportunity to collect a larger number of people and raise awareness about disease and their prevention. Involvement of religious leaders played a vital role in promoting behavior change, as they read verses from the Quran about health during their speeches. The participants of the action witnessed the colorful cultural events and musical performances of children.

4.3 Child-to Child Health Promotion

The Child-to-Child health promotion component under MCH project continued its activities in Taboshar and Hisor districts during this quarter. Three schools in Hisor district conducted trainings on pure water for student’s trainers and responsible teachers. Another training on worms was conducted for student’s trainers in 26 schools of Hisor district. In total, 409 students and 45 responsible teachers were trained on the topics mentioned above. Also, in 6 schools of Taboshar, sessions were conducted on diarrhea for 166 student’s trainers and 14 responsible teachers. Currently, CtC is being implemented in two MCH districts: Hisor and Taboshar. Monitoring activities reveal that the CtC project has had an impact on the levels of behavioral change of many schoolchildren in the target districts. For example, proper hand-washing is an action that promotes a healthy body. “Now I realize that how much microbes I used to swallow,” says the Child-to-Child project student-trainer with surprise.

The Child-to-Child project student-trainer is a grade eight student of School #77, Mavlonjar village of Hisor district. He has a large family and is the eldest of seven children. His father is a driver and mother is a house-wife. Child-to-Child program has been functioning in his school for a year and participating in student-trainers’ lessons encouraged him to join the program. He is now learning how to spread information about health and practices teaching at home.

“When I go home after school, I gather my brothers, sisters and their friends and teach them what I have learned. It’s very exciting, when I wash my hands with soap my sisters and brothers repeat what I did”.

Inspired by the work he and his friends are doing, he believes that he can prevent his brothers, sisters and other children in the community from getting infectious diseases through changing their behavior towards hand-washing practices.

In general, the CtC project is expected to cover 7,654 households through 5,034 schoolchildren (Grade 3rd to 7th) in Hisor district. Also, 785 schoolchildren will cover 3,439 households in Taboshar district.

4.4 Safe Motherhood Trainings for ob-gyns on New Standards on Managing High Risk Births were organized in Mastcho and Gonchi districts. Training package has been developed by national trainers and approved by the MoH of Tajikistan. Following methods of teaching were used during the training: illustrated lectures, brainstorming, role plays, discussions and presentations. Trainings were conducted in the Central District Hospitals with the support of hospital administration and Sughd DoH. Safe Motherhood component complements the Maternal and Child Health Program and provides trainings for ob-gyns, midwives, and resuscitation specialists on Physiological births, bleeding, hypertensive cases, and antenatal care. After the trainings, monitoring of implementation was completed, followed by discussions and meetings. In each relevant facility, organized working groups on introduction of package and internal monitoring systems were established. Following the approval of Labor management, High Risk deliveries package and ToT by GIZ, the project conducted trainings for obstetricians and gynaecologists in the program area. A total number of 16 standards/protocols were introduced such as: Management of high- risk births, Redirection practices, premature deliveries, Prevention of Respiratory distress syndromes, tocolytic therapy, antenatal rupture of membranes, antibiotic prophylaxis, induction of deliveries, Amniotomy, unsatisfactory progress of labor. See the below mentioned table 3 for Safe Motherhood training test results.

Table-3 Safe Motherhood Training test results # District Training Date Participants Pre-test Post-test title

1 Gonchi New April 5-8, Ob-gyns 43% 71% Standards on 2011 managing high risk births 2 Mastcho New April 12- Ob-gyns 51% 86% Standards on 15, 2011 managing high risk births

The results of the pretest showed that the participants have a low percentage of management knowledge of high-risk births such as premature, obstructive, management of labor in preterm rupture of membranes, and referrals of patients. After conducting monitoring in each district, special working groups have been formed to discuss the action plan to address identified problems with responsible persons. The Working Group meets every week at the Central District Hospitals and works to ensure safe motherhood. Each district hospital, maternity house and antenatal care facility has begun internal monitoring according to plan. The monitoring process involves the administration of hospitals and deputy Chief Doctor. For example, in Mastcho district, the Deputy Chief Doctor monitors washing hands of health providers, he relies on the observation method, and the Chief Doctor, uses the method of spontaneous unplanned visits to monitor partogram usage. Each obstetrician-gynecologist conducts trainings for midwives, and a midwife from the District hospital holds a session for health providers in primary level.

There are also follow-up support visits to the Health Center of Rosrovut Jamoat of Gonchi district, Village Hospital of Urtakurgan and Health Center of Faizi Sulton in Mastcho district. During these visits, assistance is provided to health providers along with help from the Health facility administration and organizational problems such as repairing of delivery rooms ensuring for smooth delivery have resolved (for example, the Urtakurgan Village Hospital reorganized the maternity ward for more effective health services). Overall, the work in these well established medical institutions is organized in collaboration with volunteers and midwives striving to work according to New Standards, although they have not yet received such training. The main problem in these facilities is poor counseling skills.

In short, a close cooperation with the Sughd DoH, hospital administration and regular monitoring and analysis of results provides more effective results. For example, the internal monitoring that was established recently in the districts levels gives a possibility to discuss each issue and make plans for further improvements.

4.5 Integrated Management and Childhood Illnesses (IMCI) During the last quarter in February and March 2011, monitoring visits were conducted in Hisor and Mastcho districts. The district IMCI monitors and directors conducted the monitoring activities. In total, 7 health facilities and 13 health care providers were monitored. However, in this quarterly reporting period from March 28th to April 2nd of 2011, monitoring activities were conducted by the district monitors and IMCI directors. Seven health facilities were visited, where nine health providers were monitored. The result reveals that in all seven monitored medical facilities receive of patients are well organized in the health facility and conditions like tables, lights in the rooms and documents were in place, work plan was developed and systemized. In all health facilities scales and refrigerators are available. Adequate amounts of Oral Rehydration Symptom (ORS) packages were also available in all health facilities. Unfortunately, it was noted that health providers who were monitored do not fill the IMCI forms completely and accurately (see results from chart below). IMCI Monitoring in Mastcho

Impact: Monitoring is conducted to strengthen the knowledge and the skills obtained during trainings. It is also intended to foster improvement of health services for sick children. It is designed to help identify the weak sides of the project and provide solutions of the main problems concerning health services. The MCH team also provided counseling on how to improve IMCI introduction. In short, the monitoring results reveal that there is enough work for the IMCI component and particularly in the areas of post training and monitoring an increase is warranted.

4.6 M&E Activity: During this quarterly reporting period, Mercy Corps Tajikistan has conducted Mid-term Knowledge, Practice and Coverage (KPC) Survey in all eight Maternal and Child Health (MCH) districts; Asht, Shahriston, Spitamen and Zafarobod (old) and Gonchi, Mastcho, Hisor and Taboshar (new). The KPC midterm survey was carried out during months of April and May, 2011. Mercy Corps office and field staff members all participated in the Midterm KPC survey. The main purpose of carrying out the Mid-term KPC survey was to obtain the mid-term data and measure the impact, sustainability and effectiveness of MCH program in the intervention areas. Data collection was based on the key program indicators such as Maternal and Child Nutrition, Diarrheal Diseases, Maternal and Newborn Care, Breastfeeding and Immunization. It must be noted that a four-day KPC survey training was conducted for the survey supervisors and interviewers. Trainers were skilled Mercy Corps staff and the training materials were based on KPC Training and Participants modules. A 30 cluster sampling strategy was used for the site selection and collection of data. The data analysis used EPI info & Excel programs.

The survey results reveal that the knowledge of women about Diarrhea has increased significantly as compared with the baseline survey that was conducted in 2009 where only 20.10% mothers had knowledge about the severe diarrhea signs while now 80.83% of mothers can indicate more than two signs of severe diarrhea, which is a very positive change in the intervention area. Regarding the area of Maternal and Child Nutrition, Breastfeeding practice, key indicators for behavioral changes, showed improvement positive results with the percentage of mothers who exclusively breastfeed their babies increased from 37% to 84.50% in the midterm KPC survey 2011 as compared with the baseline survey 2009 (The Mid term Report is soon to be finalized and submitted to USAID). Also during this quarter, the program M&E unit has completed analysis of the KPC survey report. The M&E section is planning to prepare an M&E Guidebook for the field staff and organize a series of M&E trainings for the field staff. The main objectives of these initiatives are to increase the capacities of field staff and Village Development Committee (VDC) members and also to establish good monitoring systems at the community level.

4.7 Post Partum Depression (PPD) Last year, following an initial discussion between the Volunteer Services Overseas and Mercy Corps Tajikistan country management staff about the maternal mental health issues (post partum depression) and its impact on the mothers, early childhood development, families and on the larger community, agreed to have a joint exploration and needs assessment. MCH had a VSO volunteer travel to Khujand two times. The VSO volunteer and MCH staff met MoH officials, brain-stormed with staff, met health facility-based staff, conducted community visits and did some initial exploratory discussions about maternal mental health (Post Partum Depression), especially about the current situation and support mechanisms in the family, community, as well as, facility level under the MCH project. Mercy Corps completed a brief survey with new moms about the symptoms of post partum depression as well. Based on the report, VSO and MCT agreed to recruit/host a full time VSO volunteer. This year we have a full time VSO volunteer, with 30 years experience in psychological health interventions, for one year from early March. She is working with us on a small pilot for a more in-depth survey in 7 districts to be followed by development/translation of curricula for health providers, community members and families for training, supporting and monitoring as well as documenting the outcomes and lessons. MCH staff are in touch with the WHO Department of Mental Health and Substance Abuse as they are interested in sharing the materials that WHO has developed and collaborating in implementation (technical support). Presently the survey has been completed and survey results indicated there is higher than expected risk rate of postpartum depression in the surveyed areas. Research in other parts of the world indicates that if a mother suffers from postpartum depression, this mental illness can have a negative impact on her long term health, her child's long term health, and may result in developmental problems in the future for her child. The benefits of intervention and reduction of postpartum depression reap double benefits, assisting and improving the mental and physical health of women and as a result the mental and physical health of their children. Improved mental and physical health can impact long term maternal and infant mortality rates which are a key focus in Mercy Corps Maternal and Child Health programs.

During this quarter, another focus was the Post Partum Depression (PPD) project. The materials were translated, adapted to the country context and prepared for presentation. A survey questionnaire was developed for the study and carried out in the 7 Maternal and Child Health MCH Program districts; Asht, Shahristan, Spitamen and Zafarabad (old districts) and Gonchi, Mastcho and Taboshar (new) districts. The main purpose of conducting the survey under the PPD project is to collect contributing information regarding potential features of high risk among women who have children under the age of one year in the target districts. Lots Quality Assurance Sampling (LQAS) methodology was used for the collection of data. From each district, 19 women with children under one year were interviewed and the data was collected by survey questions administered by trained field coordinators. Further work will be planned after data analysis has been completed. After analyzing the data it is anticipated that a pilot project is planned to implement the PPD project in two districts out of seven surveyed districts. The primary criteria for the implementation of the project in the pilot districts will be based on high risk of PPD results based on the survey results.

4.8 Nationwide Polio Immunization Campaign

Between, April 25th to 18th 2011, Mercy Corps staff was actively involved in the next monitoring of National Polio Immunization Campaign. The Polio Campaign is organized by UNICEF Tajikistan and supported by Mercy Corps field staff. All necessary materials like monitoring forms were provided by UNICEF Tajikistan. The monitoring forms were completed by MC Field staff.

5. PLANNED VS. ACTUAL STATUS OF ACTIVITIES (April – June 2011)

The Following table is from the DIP and lists all the planned activities for the last quarter with comments indicating the status of each activity.

Activity Comments

April May June

Technical and management training for paid staff x x x Ongoing Cascade training on Care & Nutrition of Pregnant x x x Ongoing women & Birth Planning Monitoring activities continuation and new districts x x x Ongoing Midterm KPC survey x x Completed Post Partum Depression (PPD) survey training x Completed

Child-to-Child (CtC)

Comments

May June Activity April Training for teachers in Hisor and Taboshar x x x Ongoing Training for high class student-trainers x x x Ongoing Training for school children x x x Ongoing Final KAP survey in Taboshar Will be conducted in the next quarter M&E of project activities x x x Ongoing Monthly meeting with partners x x x Ongoing meetings with DoE

Maternal Newborn Care

Activity Comments

April May June Follow up support visit x x x Ongoing

Safe Motherhood training based on national standards x Conducted in Mastcho & Gonchi Roundtable meeting with DOH trainers-monitors & x Completed representatives from the government Joint Monitoring visit with MoH & DoH x x x Ongoing

Post Partum Depression survey x Completed

IMCI and Childhood Illnesses

Comments

May June Activity April Monitoring of medical workers x x Ongoing Roundtable meeting with MOH, DOH & trainer x Ongoing monitors

Community Based Activities

Comments

May June Activity April Community mobilization x x x Ongoing Cross visits for CHEs, VDCs x x x Ongoing Printing of Diarrhea brochures for beneficiaries x x Completed

6. CONSTRAINTS/CHALLENGES No major constraints or problems were reported during this quarter. It must be noted that the academic year ended for school children during this quarter which made gathering trainers more of a challenge in Taboshar. There were many school competitions as well as end of the academic year which affected the attendance of trainers to sessions.

7. SUCCESS STORY Healthy behaviors – healthy babies! Gonchi district is one of the areas where MCH project has been implemented. The area is mostly mountainous and major parts unreachable during winter period due to heavy snowing. Like other regions of Tajikistan, the bulk of work at home and in fields falls on the shoulders of women due to high migration rates. The community of Daleni Bolo, a village located 110 km away from the northern capital of Tajikistan Khujand is the next village that will have a new topic within MCH program – Care and Nutrition for Pregnant Women for target groups conducted by Community Health Educators. Approximately 34,317 people are trained on this topic by cascade approach in all communities where the project works. During the training on this topic the participants learn the importance of healthy nutrition, having some rest during day time, personal hygiene, danger signs during pregnancy, delivery and postpartum periods, and food intake increase during the time of pregnancy and breastfeeding One of the men in this community (Daleni Bolo) who is a father -in -law for 3 daughters-in-law says after participating in the training that: “I have three daughters -in -law at home now, two of them are now pregnant I will go home now and convey the message that they cannot work (not allowed to work) in the field anymore as we now want a healthy babies and healthy mothers”. As the result of these trainings and behavior change efforts the recent Mid-term review survey conducted in May found out that the project indicators on knowledge of women who can describe 2 danger signs for pregnancy has reached 77,50 % while in baseline it was 11.40 % of respondents. Another indicator that has shown an increase is per cent of men who can describe 2 danger signs for delivery of a woman has increased to 57.52 % while at the beginning it was 10.60%.