StopPalu+ President’s Malaria Initiative (PMI) Program Component Quarterly Report (Quarter 2, FY 2020)
April 30, 2020 This publication was produced for review by the United States Agency for International Development. It was prepared by RTI International.
StopPalu+ President’s Malaria Initiative (PMI) Program Component Quarterly Report
January 1–March 31, 2020 Cooperative Agreement No. 72067518CA000015
Prepared for [REDACTED] Agreement Officer’s Representative (AOR) USAID/Guinea Telephone: +224.657.10.4433 [REDACTED]
Submitted by [REDACTED] COP StopPalu+ RTI International 3040 East Cornwallis Road Post Office Box 12194 Research Triangle Park, NC 27709-2194
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TABLE OF CONTENTS Page
List of Figures ...... iv
List of Tables ...... v
Abbreviations ...... vi
1 Executive Summary ...... 1
2 Introduction...... 4 2.1 Background...... 4 2.1.1 Malaria context in Guinea ...... 4 2.2 Program Description ...... 5 2.2.1 Project goal and objectives ...... 5 2.2.2 Partners...... 5 2.2.3 StopPalu+ results framework ...... 5
3 Activities by Result (IR) ...... 7 3.1 IR 1: Increased Use of LLINs by the Population ...... 7 3.1.1 Sub-IR 1.1: Increased knowledge and skills of health care providers and community leaders on malaria prevention and the effectiveness, correct use, and care of LLINs ...... 7 3.1.2 Sub-IR 1.2: Increase ownership of effective LLINs through continuous and mass distribution...... 13 3.1.3 Sub-IR 1.3: Increased awareness of family members of the need for vulnerable populations to be protected from malaria...... 19 3.1.4 Lessons learned and proposed adaptations (IR 1) ...... 23 3.1.5 Activities Planned for Next Quarter (IR 1) ...... 23 3.2 IR 2: Increased Use of IPTp During Antenatal Visits ...... 23 3.2.1 Sub-IR 2.1: Improved technical capacity and interpersonal skills of providers ...... 23 3.2.2 Sub-IR 2.2: Increased knowledge of women and other family members of the benefits of ANC visits, including IPTp ...... 27 3.2.3 Sub-IR 2.3: Alternative approaches to improved access to IPTp services rolled out ...... 27 3.2.4 Sub-IR 2.4: Increased availability of SP and ancillary supplies ...... 28 3.2.5 Lessons learned and proposed adaptations (IR 2) ...... 29 3.2.6 Activities Planned for Next Quarter (IR 2) ...... 29 3.3 IR 3: Increased Prompt Care-Seeking and Treatment ...... 29 3.3.1 Sub-IR 3.1: Improved technical and interpersonal skills of providers in malaria diagnosis and care ...... 29
StopPalu+—Quarterly Report—January to March 2020 iii 3.3.2 Sub-IR 3.2: Increased availability of quality diagnostic tests and treatment at facilities and community level ...... 43 3.3.3 Sub-IR 3.3: Increased knowledge and awareness by communities and family members of seriousness of childhood illnesses, key signs, and symptoms, and when treatment is ineffective ...... 44 3.3.4 Lessons learned and proposed adaptations (IR 3) ...... 45 3.3.5 Activities Planned for Next Quarter (IR 3) ...... 45 3.4 IR 4: Increased Full Dose of SMC Delivered in a Timely Manner ...... 45 3.4.1 Sub-IR 4.1: Increased awareness by community and family members of the need for infants and children under 5 to be protected from malaria ...... 45 3.4.2 Sub-IR 4.2: Increased availability of SMC (SP+AQ) and commodities for continuous and mass distribution during high-transmission season in targeted districts ...... 47 3.4.3 Sub-IR Transversal 1. Increased community involvement in and support for malaria prevention and care ...... 49 3.4.4 Sub-IR Transversal 2: Improved capacity of NMCP (central, regional, district) to manage, implement, and monitor prevention, care, and treatment activities ...... 51
4 Project Management Activities...... 60 4.1 Project Deliverables ...... 60
5 Other Activities ...... 63
6 Main Activities for the Next Quarter ...... 64
Annex 1: Performance Report for Quarter 2, FY 2020 (Jan–March 2020) ...... 65
LIST OF FIGURES Figure 1: Malaria endemicity in Guinea ...... 4 Figure 2: Results framework ...... 6 Figure 3: Availability and condition of LLINs in the 5 prefectures of Boké Region ...... 16 Figure 4: Use of LLINs in the 5 prefectures of Boké Region ...... 17 Figure 5: Availability and condition of LLINs in the 5 prefectures of Labé Region ...... 17 Figure 6: Use of LLINs in the 5 prefectures of Labé Region ...... 18 Figure 7: Availability and condition of LLINs in the 3 prefectures of Kindia Region supported by PMI ...... 18 Figure 8: Use of LLINs in the 3 prefectures of Kindia Region ...... 19 Figure 9: IPTp round 3 coverage rate in the 5 communes of Conakry Region...... 26 Figure 10: IPTp round 3 coverage rate per commune in the 14 prefectures ...... 26 Figure 11: Average MDRT pre and post-test performance by region ...... 31 Figure 12: Average microscopy performance by region during FY 2020 Quarter 2 supervision visits ...... 34
iv StopPalu+—Quarterly Report—January to March 2020 Figure 13: Average performance trend in microscopic diagnosis in PMI zone in Quarters 1 and 2, FY 2020 ...... 35 Figure 14: 2019 SMC coverage rate per round and per district ...... 48 Figure 15: SMC coverage per round (cycle) ...... 48 Figure 16: % of households who received a CHW visit during the previous month (Boké) ...... 56 Figure 17: % of households who have a good knowledge about malaria (Boké) ...... 56 Figure 18: % of households who received a CHW visit during the previous month (Kindia) ...... 57 Figure 19: % of households who have a good knowledge about malaria (Kindia) ...... 57 Figure 20: % of households that reported that they received malaria information through these main channels (Kindia) ...... 58 Figure 21: % of households who received a CHW visit during the previous month (Labé) ...... 58 Figure 22: % of households that reported that they received malaria information through these main channels (Labé) ...... 59
LIST OF TABLES Table 1: Details of home visits conducted by CHWs during Quarter 2 (January– March 2020) ...... 7 Table 2: Number of group discussions facilitated by project-trained field agents; number of people reached ...... 8 Table 3: Summary of community dialogues per region and health centers ...... 23 Table 4: National standard level classification of competence in microscopy ...... 30 Table 5: Supervision scores for health facilities ...... 43 Table 6: Details of community case management conducted by CHWs during the reporting period (January–March 2020) ...... 44 Table 7: Proposed COVID-19 mitigation activities ...... 63
StopPalu+—Quarterly Report—January to March 2020 v ABBREVIATIONS ACT artemisinin-based combination therapy AL artemether/lumefantrine AMF Against Malaria Foundation ANC antenatal care APIC Association pour la Promotion des Initiatives Communautaires APROSAG Association pour la Promotion de la Santé en Guinée AQ amodiaquine BCC behavior change communication BSD Bureau of Strategy and Development CAG community action group CAM Club des Amis du Monde CBO community-based organization CENAFOD Centre Africain de Formation pour le Développement CHU Centres Hospitaliers Universitaires CHW community health worker CJMAD Comité des Jeunes Mon Avenir D’abord CMC communal medical center CNFRSR Centre National de Formation et de Recherche en Santé Rurale de Maferinyah CRS Catholic Relief Services CSH Comité de Santé et d’Hygiène (Health and Hygiene Committee) DCS Direction Communale de la Santé (Communal Health Directorate) DHIS 2 District Health Information System 2 DPS Direction Préfectorale de la Santé (Prefectural Health Directorate) DQA data quality analysis DRS Direction Régionale de la Santé (Regional Health Directorate) EPI Expanded Program on Immunization EQC external quality control FY fiscal year GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria HR human resources HRH2030 Human Resources for Health 2030 ICMNI integrated management of childhood and newborn illnesses ICN Instance nationale de coordination du Financement du Fond Mondial IEE Initial Environmental Evaluation INAASPO Initiatives et Actions pour l’Amélioration de la Santé des Populations IPC interpersonal communication IPTp intermittent preventive treatment of malaria in pregnancy IQC internal quality control IR intermediate result
vi StopPalu+—Quarterly Report—January to March 2020 KAP knowledge, attitudes, and practices LLIN long-lasting insecticide-treated net M&E monitoring and evaluation MCDI Medical Care Development International MDRT Malaria Diagnostic Refresher Training MICS Multiple Indicator Cluster Survey MOH Ministry of Health MSF Doctors Without Borders (Médecins sans frontières) NGO nongovernmental organization NMCP National Malaria Control Program NMSP National Malaria Strategic Plan PCG Pharmacie Centrale de Guinée (Central Pharmacy of Guinea) PCR polymerase chain reaction PMI President’s Malaria Initiative PSM Procurement and Supply Management project RBM Roll Back Malaria RDT rapid diagnostic test SBCC social and behavior change communication SGPD Solidarité Guinéenne pour le Développement SMC seasonal malaria chemoprevention SMS short messaging system SNIS National Health Information System (Système National de l’Information de la Santé) SP sulfadoxine/pyrimethamine SP+AQ sulfadoxine/pyrimethamine plus amodiaquine TWG technical working group USAID United States Agency for International Development WHO World Health Organization
StopPalu+—Quarterly Report—January to March 2020 vii
1 EXECUTIVE SUMMARY The President’s Malaria Initiative (PMI) Program Component (StopPalu+) is a five-year project (December 2017–December 2022) with the goal of assisting the Government of Guinea in reducing malaria-related morbidity and mortality by 75% compared with 2016 levels. This will be achieved through multiple interventions in prevention, diagnosis and treatment, and capacity building of the National Malaria Control Program (NMCP) while increasing community involvement in and support for malaria prevention and care. RTI International is implementing StopPalu+, supported by sub-partners Jhpiego, Centre Africain de Formation pour le Développement (CENAFOD), and Medical Care Development International (MCDI). In the past five years, Guinea has made tremendous progress in malaria control, substantially reducing malaria prevalence in children under 5, annual malaria incidence, and in-patient deaths. Despite this progress, malaria remains the most burdensome communicable disease in Guinea. The entire population of 12.1 million remains at risk, with approximately 1 million cases reported in 2016, accounting for 31% of outpatient visits. The Multiple Indicator Cluster Survey (MICS) showed that malaria prevalence in Guinea is quite heterogeneous, with prevalence ranging from 1.9% in Conakry to 30.2% in N’Zérékoré. The goal of the National Malaria Strategic Plan (NMSP) 2017–2022 is to reduce malaria morbidity and mortality by 75% by 2022. During Quarter 2 of fiscal year (FY) 2020 (January–March 2020), one major project activity was to support the Ministry of Health (MOH)/NMCP develop and submit the new proposal for the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) New Funding Mechanism (2021–2023). To implement this activity, the project team was part of the proposal team and supported several workshops and meetings in Conakry and the prefectures. To increase the availability and households’ use of long-lasting insecticide-treated nets (LLINs) distributed in 2019, the project team, in collaboration with field agents and community health workers (CHWs), conducted several rounds of home visits. During these visits, the teams assessed the availability of nets in the households, helped hang nets where needed, and promoted correct and regular use of LLINs. A total of 4,711 households were visited. In addition to the home visits, the project also broadcast 534 public service announcements (spots) via 26 radio stations and 38 spots via 2 television stations to promote regular and correct use of LLINs as the best means to prevent malaria. The project also continued to support routine LLIN distribution in health facilities through the antenatal care (ANC) and Expanded Program of Immunization (EPI) units. During the reporting period, the project supported the transportation of 127,150 LLINs and vouchers in 12 districts and the Matoto commune. During Quarter 2, 42,267 LLINs were distributed through routine distribution. To increase access to and use of LLINs by vulnerable populations, the project supported community distribution for people who make their living from begging and other people with disabilities living behind Donka hospital. A total of 101 households received 278 LLINs. During Quarter 2, FY 2020, the project team worked with Communal Health Directorates (DCSs) to train 29 new health providers from private health facilities in Conakry on malaria prevention, diagnosis, and treatment. Training included various modules to build health providers’ capacities, such as ways providers can increase the use of intermittent preventive treatment of malaria in pregnancy (IPTp) during ANC and EPI visits and health providers’ skills in conducting integrated malaria case management (which includes routine LLIN distribution as well as the use of rapid diagnostic tests [RDTs]). The project also supported
StopPalu+—Quarterly Report—January to March 2020 1 refresher training for 83 heads of health posts in the Labé Region and 336 CHWs in the regions of Boké and Labé. In addition, StopPalu+ trained 58 lab technicians from 36 health facilities from the region of Boké and Labé on malaria diagnosis (microscopy and RDT use). It is important to mention that the President of Guinea declared a state of emergency on March 26, 2020 and prohibited all workshops to reduce the transmission of COVID-19. Therefore, the project suspended all training until further notice. To further build capacities and skills, the project conducted on-site trainings for 215 providers in health facilities (hospitals and communal medical centers [CMCs] of Conakry and the regions) that were identified during supervision visits as needing additional support. The project teams conducted supervision visits at both the facility and community levels to assess the quality of services provided and to reinforce competencies where needed. To promote early care-seeking and inform the population about the malaria diagnosis and treatment services available, the project broadcast 252 radio spots and 36 television spots. Another large part of StopPalu+’s efforts focused on preparation for the FY 2020 seasonal malaria chemoprevention (SMC) campaign in seven districts to increase malaria prevention among children ages 3–59 months. During this reporting period, the project team worked with the NMCP and other partners to revise the SMC tools for social and behavior change communication (SBCC), monitoring and evaluation (M&E), commodity management, and supervision sessions. The project also supported the macro-planning activities that helped estimate the human and material resources needed for the campaign as well as the development of the agenda and timeline for SMC campaign activities. To increase community involvement in malaria control activities, StopPalu+ supported existing community action groups (CAGs) in the four regions supported by the project to implement their action plans. The CAG members conducted 76 community dialogues in their communities to discuss malaria issues such as the use of LLINs for purposes other than to protect family members against malaria and negative rumors concerning the mass drug administration of praziquantel. The project continued to support monthly monitoring meetings at health centers and Prefectural Health Directorates (DPSs), followed by data quality analysis (DQA) activities in the facilities identified during monthly meetings as having possible data issues. The project also supported monthly meetings of the various technical working groups (TWGs). The project supported the DPS and Regional Health Directorate (DRS) semiannual meetings in the regions of Boké, Kindia, and Labé and in 9 prefectures. The monthly meeting for the month of March was WHO- and MOH-recommended conducted with adherence to the following preventive measures for COVID-19 COVID-19 preventive measures recommended by • the World Health Organization (WHO) and the All participants must wash their MOH (see text box). In some health centers and hands before entering meeting districts, the project team had to conduct the rooms. meetings over the course of more than one day to • Limit the number of people in a respect the social distancing rules. room to less than 20 people at a time. • Keep 1 to 2 meters of distance between participants. • Use masks, when available.
2 StopPalu+—Quarterly Report—January to March 2020 The main results for StopPalu+’s second quarter of performance in FY 2020 are the following: • 4,711 households visited by the project team • 278 LLINs distributed through community distribution to 101 households • 42,267 LLINs distributed at health facilities • 26 national SBCC trainers trained • 786 radio spots and 72 television spots broadcasted • 58 lab technicians trained on malaria diagnosis (microscopy and RDT use) • 112 health providers trained on malaria case management • 336 CHWs benefited refresher training on malaria community case management • 215 health providers received on-site training on malaria case management • 40,177 people tested for malaria by CHWs • 16,233 people treated for malaria by CHWs • 128,834 home visits conducted by CHWs • The macro-plan and the agenda for the FY 2020 SMC campaign developed • The SMC tools revised and validated • 76 community dialogues organized by trained CAGs • 465 health centers’ monthly monitoring meetings supported • 57 DPS monthly monitoring meetings supported • 4 DRS and 9 DPS meetings supported
StopPalu+—Quarterly Report—January to March 2020 3 2 INTRODUCTION
2.1 BACKGROUND
2.1.1 MALARIA CONTEXT IN GUINEA Guinea has made tremendous progress in malaria control over the past five years, substantially reducing malaria prevalence in children under 5, annual malaria incidence, and in-patient deaths. Despite this progress, malaria remains the most burdensome communicable disease in Guinea. The entire population of 12.1 million remains at risk, with approximately 1 million cases reported in 2016, accounting for 31% of outpatient visits. The Multiple Indicator Cluster Survey (MICS) showed that malaria Figure 1: Malaria endemicity in Guinea prevalence in Guinea is quite heterogeneous, with prevalence ranging from 1.9% in Conakry to 30.2% in N’Zérékoré (Figure 1). The major malaria vectors in the country are members of the Anopheles gambiae complex, including An. gambiae s.s., An. arabienesis, and An. melas (on the coast), as well as members of the An. funestus complex. The goal of the National Malaria Strategic Plan (NMSP) 2018–2022 is to reduce malaria morbidity and mortality by 75%. NMSP implementation has benefited from the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has contributed approximately $50 million, and the President’s Malaria Initiative (PMI), which provides $12 million per year.
4 StopPalu+—Quarterly Report—January to March 2020 2.2 PROGRAM DESCRIPTION
2.2.1 PROJECT GOAL AND OBJECTIVES The goal of the StopPalu+ project is to assist the Government of Guinea in its efforts to reduce malaria-related morbidity and mortality by 75% compared with 2016 levels. The project’s primary results include the following: 1. Increased use of long-lasting insecticidal nets (LLINs) by the population 2. Increased use of intermittent preventive treatment of malaria in pregnancy (IPTp) during antenatal care (ANC) visits 3. Increased prompt care-seeking and treatment 4. Increased numbers of children receiving the full dose of seasonal malaria chemoprevention (SMC) delivered in a timely manner 5. Increased community involvement in and support for malaria prevention and care 6. Improved capacity of the National Malaria Control Program (NMCP) (central, regional, and district levels) to manage, implement, and monitor prevention, care, and treatment activities For each result area, our operational strategy integrates and links the inputs, processes, and systems required for strong results.
2.2.2 PARTNERS RTI International’s partners for StopPalu+ include the following: • Jhpiego: Jhpiego works to improve the use of IPTp during ANC visits. • Medical Care Development International (MCDI): MCDI provides StopPalu+ with evidence-based and context-appropriate approaches to consensus-based diagnostic training and capacity building, monitoring and evaluation (M&E) of laboratory practices and collaborative quality improvement, and country-owned solutions for enhanced performance. • Centre Africain de Formation pour le Développement (CENAFOD): CENAFOD works to increase community involvement in and support for malaria prevention and care. • Local partners include five Guinean nongovernmental organizations (NGOs) with demonstrated PMI program results in social and behavior change communication (SBCC), social mobilization, and support to community health workers (CHWs): − Association pour la Promotion des Initiatives Communautaires (APIC) − Club des Amis du Monde (CAM) − Comité des Jeunes Mon Avenir D’abord (CJMAD) − Initiatives et Actions pour l’Amélioration de la Santé des Populations (INAASPO) − Solidarité Guinéenne pour le Développement (SGPD)
2.2.3 STOPPALU+ RESULTS FRAMEWORK The project’s main objective as well as the four main results (called Intermediate Results [IRs]) and the two Transversal Sub-IRs are shown in Figure 2. The sections that follow describe the activities carried out for each of these results, with a separate section on project management.
StopPalu+—Quarterly Report—January to March 2020 5 Figure 2: Results framework
6 StopPalu+—Quarterly Report—January to March 2020
3 ACTIVITIES BY RESULT (IR)
3.1 IR 1: INCREASED USE OF LLINS BY THE POPULATION
3.1.1 SUB-IR 1.1: INCREASED KNOWLEDGE AND SKILLS OF HEALTH CARE PROVIDERS AND COMMUNITY LEADERS ON MALARIA PREVENTION AND THE EFFECTIVENESS, CORRECT USE, AND CARE OF LLINS During Quarter 2, FY 2020, StopPalu+ implemented the following activities: Activity 1.1.1 Develop and implement an SBCC campaign for LLIN uptake, proper use, and care During the reporting quarter, to increase LLIN uptake, proper use, and care, the project, through its NGO partners’ field agents, supported CHWs in conducting door-to-door visits to monitor the regular and correct use of LLINs and, if needed, hang LLINs and disseminate key messages on IPTp and malaria case management. The project supported CHWs to conduct 128,834 home visits during which they reached 562,135 people, including 320,249 women. The details of these activities are presented in Table 1.
Table 1: Details of home visits conducted by CHWs during Quarter 2 (January– March 2020) Number of home Number of people reached Prefecture visits conducted Men Women Total Boffa 7,668 13,970 17,480 31,450 Boké 10,834 27,101 31,060 58,161 Coyah 6,264 12,099 16,616 28,715 Conakry 2,220 5,839 7,222 13,061 Dinguiraye 7,416 15,771 21,436 37,207 Dubréka 8,331 17,786 23,551 41,337 Forécariah 10,332 21,367 28,892 50,259 Fria 4,454 10,311 14,016 24,327 Gaoual 7,341 15,075 18,658 33,733 Koubia 5,457 13,245 12,299 25,544 Koundara 5,378 8,132 11,603 19,735 Labé 19,128 28,231 41,600 69,831 Lélouma 10,824 14,806 24,473 39,279 Mali 12,496 21,209 27,561 48,770 Tougué 10,691 16,944 23,782 40,726 Total 128,834 241,886 320,249 562,135
Discussion groups facilitated by the project’s NGO partners To increase knowledge about malaria and promote the practice of healthy behaviors related to malaria prevention and treatment, the project’s 112 field agents conducted 1,553 group discussions and reached 24,713 people, including 14,327 women, in the 14 prefectures and 5 communes covered by the project (see Table 2 for details of the discussions in prefectures). These discussions took place in health centers and public places such as soccer fields, marketplaces, hair salons, and sewing salons. During the reporting quarter, the messages focused on promoting the correct and regular use of LLINs, adherence to ANC visits, and IPTp for pregnant women.
StopPalu+—Quarterly Report—January to March 2020 7 Table 2: Number of group discussions facilitated by project-trained field agents; number of people reached Number of group Number of people reached Prefectures discussions Men Women Total Boffa 107 794 764 1,558 Boké 155 1,302 2,030 3,332 Conakry 492 1,775 2,735 4,510 Coyah 50 280 502 782 Dinguiraye 100 1,049 1,409 2,458 Dubréka 86 448 740 1,188 Forécariah 83 671 859 1,530 Fria 92 453 728 1,181 Gaoual 89 840 1,059 1,899 Koundara 45 631 557 1,188 Koubia 20 230 351 581 Labé 69 731 986 1,717 Lélouma 45 297 424 721 Mali 67 515 670 1,185 Tougué 53 370 513 883 Total 1,553 10,386 14,327 24,713
A field agent during a group discussion in Koundara A field agent during a group discussion in Dibia health center
Activity 1.1.2 Update communication materials for all aspects of LLIN use, care, and maintenance Distribute 2020 calendars with key messages During the reporting period, StopPalu+ distributed the 2020 calendar produced during the previous quarter with key messages that promote correct and regular use of LLINs and early care-seeking. The 3,500 calendars were disseminated to facilities, CHWs, civil society organizations, community-based organizations (CBOs), NMCP, and partner radio stations. Produce radio and television spots with key messages The project produced radio and television public service announcements (spots) that promote regular and correct use of LLINs as the best way to prevent malaria. In total, 534 radio spots and 36 television spots were broadcast. Produce storyboards with LLIN information During the reporting period, the project produced 3,500 copies of the validated storyboard. This storyboard explains how to correctly use LLINs, LLIN care and maintenance techniques, and the importance of regular and correct LLIN use. These copies will be distributed to public and private health facilities and to CHWs and field agents. They will be
8 StopPalu+—Quarterly Report—January to March 2020 used during CHW home visits, facilitators’ groups discussions, and at facilities during routine LLIN distribution and as part of ANC and immunization visits. Support the display of SBCC materials in health facilities To reinforce the information and education that health providers convey to the public and that community members who visit public health structures supported by the project view, the project team initiated the steps to ensure that SBCC materials are displayed in health facilities. This activity, covering all the health districts, was deemed necessary after several observations revealed the lack or insufficiency of posters disseminating key messages on malaria control products and services available (prevention, diagnosis, treatment, etc.) and messages on health behaviors recommended to fight malaria. As the project made these materials available, it took the opportunity to emphasize that health providers should also convey these key messages during their consultations with patients. Many surveys have shown that people listen to instructions/advice (and follow those instructions/advice more closely) when they come from health workers.
Posters displayed in the health center of Dabiss The CHWs of Coba health center receiving 2020 calendars Organize a village vigil During home visits in the urban commune of Boké, the project regional team, along with the field agents, noted that people in the Kofia neighborhood (quartier) were using their LLINs for purposes other than protection during sleep (LLINs were used to protect vegetable gardens). To understand this behavior and better help these households shift their behavior, the team met with them. During these discussions, the team discovered that the women gardeners who took their produce to market were using LLINs to protect their vegetable gardens. The team organized a meeting with 10 groups of women who raised produce for the market. During the meeting, the following observations were made: • These vegetable crops represent the main source of income for these women. • They were not knowledgeable about the benefits of using LLINs as malaria protection. • Some households had several LLINs available from the national mass distribution campaign and the routine distribution. • The use of LLINs for various purposes (other than sleeping) in this market gardening space is a traditional practice used by previous generations. • By using these LLINs as a protective barrier, they spend less on the purchase of protective equipment (wire mesh, wire, wood, recycled fishing nets, etc.) and chemicals to combat the intrusion of insects and other species in vegetable gardens such as herbivores. The reflection of the white nets even scares away biting birds.
StopPalu+—Quarterly Report—January to March 2020 9
The LLINs used to protect a vegetable garden A women working in her vegetable garden
At the end of the meeting, the projec team proposed to organize a social mobilization event targeting women to discuss this issue and share more information about malaria and its means of prevention and treatment. Because most of these women work late and are not available during the day, the participants proposed to organize a village vigil. During this village vigil, key malaria control messages were discussed: • The use of LLINs by the whole family is the most effective means of malaria prevention. • Early care-seeking at a health facility or with a CHW is necessary as soon as a fever appears. • There are dangers from malaria for the population in general and for pregnant women (premature birth and abortion for pregnant women, sometimes even death, etc.) and children under five in particular. • There are economic consequences from contracting malaria (absenteeism at work, absenteeism at school, high expenses in cases of severe malaria). • Malaria products and services are available and free in all public health facilities and with CHWs. To reinforce this awareness, two videos were played. The first one was an animated video about malaria created for children, and the second video was created by two famous comedians in Guinea, Kabakoudou and Grand Devise, on the importance of using LLINs correctly and regularly. In addition, artistic and cultural performances accompanied by dance competitions and question-and-answer contests between girls and boys were an effective way to keep the guests awake and engaged. At the end of the event, the women said they understood the importance of using LLINs to protect themselves and their loved ones against malaria, and they made a commitment to remove LLINs from the vegetable gardens and to educate their friends to do the same.They asked the project to conduct more of these vigils in other neighborhoods to stop the practice of using LLINs for other purposes.This vigil was also an opportunity to present to the community the CHW for their area, who had been trained and equipped by the StopPalu+ project on malaria prevention, case management of simple malaria cases, and referral of severe cases. A total of 67 people participated in this activity, including 23 children, 17 men, and 27 women, with 4 women’s group leaders.
10 StopPalu+—Quarterly Report—January to March 2020
A girl received a 2020 calendar for providing a correct Participants watching a video during the village answer to a question. vigil
Activity 1.1.3: Enhance provider training and supervision Train national SBCC trainers During Quarter 2, FY 2020, the project team worked with the NMCP to train a pool of national SBCC trainers. A national consultant, supported by the project SBCC Advisor, used the revised SBCC training manual to facilitate the training March 10–14 in Conakry. The participants were the communications officers of the Guinea’s DRSs and DPSs, the staff of the National Health Promotion Service and the NMCP, and communications officers from NGOs implementing malaria control activities. A total of 26 participants were present, including 8 women. Objective of the workshop: To enable the trainers to reinforce the capacities of the CHWs, health providers, and field agents implementing SBCC activities in the fight against malaria. Topics covered in the training: The workshop was launched by the NMCP Coordinator and the representative of the Regional Health Director of Conakry. During the 5-day workshop, the following topics were discussed: • General information on communication • SBCC • Communication strategies, techniques, tools, and materials • Basic information about malaria • Means to prevent and treat malaria • Current malaria status • Actors involved in malaria prevention and control, and their roles • Development of community action plans and work plans for field agents to implement SBCC activities to control malaria • Preparation and presentation of an awareness and training session
StopPalu+—Quarterly Report—January to March 2020 11 The training used the following participatory techniques: • PowerPoint presentations • Brainstorming • Question and answer sessions • Group work followed by presentation and review in plenary • Group discussion At the beginning of the training, each participant took a pre-test to assess their baseline knowledge about the training’s objectives. The pre-test was a questionnaire with seven questions, each worth 10 points. For the 25 participants who took the pretest, the average of all the questions’ scores ranged from 2 to 7, and only 6 participants scored at least an “average median” (scores greater than or equal to 5). In the post-test, the average of scores ranged from 3 to 9, and 18 participants obtained scores greater than or equal to 5. This demonstrates that overall, participants increased their knowledge level, with the number of participants who obtained the average median increasing from 6 to 18. However, this training showed that these trainers need annual refresher training to be able to reinforce their knowledge and competencies. An additional determination from this training is that not all these trainers can be used as an SBCC trainer. The project will only use the trainers that scored higher than 7. At the end of the training, the participants made the following recommendations: • Separate the SBCC training from integrated malaria training. • Use the national SBCC trainers for all SBCC training of both CHWs and health workers. • Increase the number of SBCC training days for the current integrated malaria training from 1 day to 2. • Create a network (WhatsApp account) of national SBCC trainers to share good practices and experiences.
The NMCP Coordinator [left] and the representative of Participants during a working group session the Conakry DRS [right] during the opening ceremony
Train health providers and CHWs During the reporting period, the project, in collaboration with the NMCP, conducted several trainings on malaria prevention, diagnosis, and treatment. In total, 112 health providers (new health providers in Conakry and health post staff in the prefectures of Koubia and Tougué) and 189 CHWs in the prefectures of Koubia and Mali benefited from these trainings.
12 StopPalu+—Quarterly Report—January to March 2020 Trainings included a session on LLIN use and care, with job aids for demonstrations such as how to hang up, properly use, and store an LLIN. To improve supervision after training, StopPalu+ worked with district health teams and health facility heads to conduct regular supervision sessions. Please see Activity 3.1.6 for more details.
3.1.2 SUB-IR 1.2: INCREASE OWNERSHIP OF EFFECTIVE LLINS THROUGH CONTINUOUS AND MASS DISTRIBUTION During Quarter 2, FY 2020, to further increase household LLIN ownership, StopPalu+ supported the NMCP to implement routine and continuous LLIN distribution through following activities.
Activity 1.2.1 Support routine LLIN distribution at health facilities Integrate routine LLIN distribution in the health posts To continue ensuring universal coverage and/or replace old and damaged LLINs, StopPalu+ integrated routine LLIN distribution in two health posts situated on the islands of Boom and Room. To implement this activity, the project team conducted a one-day training for the staff of these facilities. The training focused on the following: • The target population of the routine LLIN distribution (pregnant women during the first ANC visits, children under one year during their first vaccination) • The tools to be used (vouchers, registers, etc.) • The management of LLINs • The key messages and the job aids At the end of the training, the project provided each of the health posts with a stock of LLINs, vouchers, and registers. The health posts will start routine distribution in April. Continue to support routine distribution in integrated health facilities During the reporting quarter, the project continued to support routine distribution in all public and private health centers covered by the project and in the 171 integrated health posts. During Quarter 2, FY 2020, StopPalu+ worked with the NMCP, Pharmacie Centrale de Guinée (Central Pharmacy of Guinea [PCG]), private carriers, and the DPSs to deliver the following numbers of nets: • 14,640 LLINs to health facilities in Matoto commune (Conakry Region) • 52,400 LLINs to health facilities in the districts of Boffa, Boké, Fria, Gaoual, and Koundara (Boké Region) • 39,450 to the districts of Coyah, Dubréka, and Forécariah (Kindia Region) • 15,650 LLINs to the districts of Labé, Mali, and Tougué (Labé Region) • 5,000 LLINs in the district of Dinguiraye The project also provided LLIN distribution vouchers to public health facilities. During the reporting period, the heath facilities in project covered area distributed 42,267 LLINs through routine distribution. It is important to mention that in the 5 prefectures of Boké Region and the prefecture of Dinguiraye, which received nets procured by the Against Malaria Foundation (AMF) for the mass LLIN distribution campaign in 2019, routine distribution in the health facilities was not implemented because AMF had not approved the use of the remaining nets (stored in these facilities) to be used for routine distribution. This problem reduced the number of LLINs distributed during routine distribution in the PMI zone. However, at the end of March 2020, AMF asked the NMCP and StopPalu+ to conduct an
StopPalu+—Quarterly Report—January to March 2020 13 inventory of the remaining nets in each health facility, and after that they will approve the use of the nets for routine distribution. The project team collected this information during the monthly March meeting. We expect to receive AMF’s approval in April. In addition, the project team conducted several supervision activities in all the supported prefectures/communes to conduct a data quality analysis (DQA) on routine LLIN distribution data. The results showed an improvement in the quality of data and a better use of tools (registers and vouchers). The few discrepancies between the data reported and the data in the primary health facilities’ tools are due to counting errors or to new staff performing the task without training or orientation. During the supervision sessions, the teams continued to emphasize that the health center heads must use data from the pharmacy rather than individual units for reporting the number of LLINs distributed in routine distribution.
Mother receiving a net for her child at the health Transport of LLINs to the health centers for routine center distribution
Activity 1.2.3 Identify and target vulnerable and hard-to-reach populations for LLIN distribution Community LLINs distribution to vulnerable populations in Conakry To increase LLIN ownership among vulnerable and hard-to-reach populations, StopPalu+ identified and reached out to a member of a city situated behind the national hospital of Donka. This city has a population of 514 people, mainly composed of people with disabilities and others who mainly live by begging along the Donka road and who do not have LLINs. The residents of this city live in precarious conditions. The houses are made of sheet metal and wood and do not have toilets. Families go out in the morning to beg and only come back in the evening. The city is hidden behind the hospital. An analysis conducted in Donka national hospital’s pediatric unit, nutrition services, emergency unit, and the HIV treatment center showed that the residents of this city are the most frequent patients of these services. They have consultation visits on a recurring basis (1 to 2 times per months), and nearly 10 children are seen for malaria per month. To protect these families against malaria, the project regional team conducted an enumeration of the households in this city, counting the following: 101 households, 514 people, 278 sleeping spaces, 282 women (including 30 pregnant), and 48 children under 5 years of age. At the end of the enumeration, the project team distributed 278 LLINs to these households’ representatives on March 27, 2020. The team also encouraged them to correctly and regularly use these nets for all the family members and every night.
14 StopPalu+—Quarterly Report—January to March 2020
Home visits during enumeration Beneficiaries from the “hidden” city behind Donka hospital receiving their LLINs
Distribution of LLINs for army forces During the reporting period, the project supported the NMCP (at their request) to distribute LLINs to soldiers' duty stations throughout the country. Soldiers stay at their stations all day and night, and therefore they are at risk for mosquito bites if they do not use nets. A total of 2,450 LLINs were distributed to the armed forces’ representatives. The distribution ceremony was chaired by the Director of the MOH cabinet and the Health Director General of the armed forces.
[REDACTED], Director of the MOH cabinet [REDACTED], Health Director of the armed forces
Activity 1.2.4 Conduct community outreach activities to promote and monitor correct LLIN use and care During Quarter 2, FY 2020, the project team, in collaboration with civil society organizations and CBOs, conducted door-to-door visits to monitor the regular and correct use of LLINs in the regions of Boké, Conakry, Kindia, and Labé. Because of the importance of this activity to increase the availability and use of LLINs by households, the project team organized this activity in all 14 prefectures and 5 communes of Conakry during this reporting quarter.
StopPalu+—Quarterly Report—January to March 2020 15 Assessment objectives • Determine the household coverage rate of LLINs (universal coverage) • Determine the coverage rate for sleeping spaces • Understand the level of use of LLINs in the communities • Determine the LLIN utilization rate by age group • Assess the state of LLINs used in households
Results from Boké Region Availability and condition of LLINs In the Boké Region, a total of 2,280 households were surveyed in the 5 prefectures. The results indicate that 84% of visited households were adhering to universal coverage (1 LLIN for 2 people), and 85% of the sleeping spaces were covered by an LLIN. The district of Boffa had the highest universal coverage rate with 94%, and Koundara the lowest with 79%. Boffa had the highest sleeping space coverage rate with 88%, while Boke had the lowest with 83%. These rates corroborate the results of the LLIN monitoring survey carried out by AMF, which found an average rate of sleeping spaces coverage of 85% in these prefectures. All LLINs inspected (100%) were in good condition, and this is explained by the fact that most of the LLINs were from the 2019 mass distribution campaign. (Figure 3)
Figure 3: Availability and condition of LLINs in the 5 prefectures of Boké Region
Household survey, Boké Region, Jan-Mar 2020 120 100 100 100 100 100 100 100 94 84 85 87 84 88 84 85 79 83 80 83 80
60
40
20
0 Koundara Gaoual Fria Boffa BokéTotal Région
%% of of households households with with 1 LLIN 1 LLIN for 2 for poeple 2 people %% of of sleeping sleeping spaces spaces covered covered with withan LLIN an LLIN %% of of LLIN LLINs in good in good condition condition
Use of LLINs The results show that 89% of children under 5 surveyed slept under LLINs compared with 85% of pregnant women. The highest rate among under-5 children was found in Fria with 94%, and the lowest rate in Boffa 77%. (Figure 4) However, 77% of those older than 5 years surveyed had slept under mosquito nets the previous night. The highest rate was recorded in Boké with 85%, and the lowest in Koundara with 59%. This low rate in Koundara is explained by many adults’ perception that there are no mosquitoes during hot periods and they do not need to use an LLIN.
16 StopPalu+—Quarterly Report—January to March 2020 Figure 4: Use of LLINs in the 5 prefectures of Boké Region
Household survey, Boké Region, Jan-Mar 2020
100 93 95 94 95 93 91 89 89 85 85 90 81 82 82 77 77 80 75 70 59 61 60 50 40 30 20 10 0 Koundara Gaoual Fria Boffa Boké Total Région
% of children under 5 who slept under an LLIN the previous night % of people over 5 years who slept under an LLIN the previous night % of pregnant women who slept under an LLIN the previous night
Results from Labé Availability and condition of LLINs In the Labé Region, a total of 1,650 households were surveyed in the 5 prefectures. The results indicate that 94% of visited households were adhering to universal coverage (1 LLIN for 2 people), and 76% of the sleeping spaces were covered by an LLIN. The district of Tougué had the highest universal coverage rate with 100%, and Mali the lowest with 90%. Koubia had the highest sleeping space coverage rate with 94%, while Lélouma had the lowest with 69%. Of the LLINs inspected, 88% were in good condition, with the highest rate in Koubia (99%) and the lowest rate in Labé (80%). (Figure 5) Figure 5: Availability and condition of LLINs in the 5 prefectures of Labé Region
100% 99% 99% 100% 93% 93% 93% 91% 94% 87% 90% 79% 80% 75% 76% 80% 69%
60%
40%
20%
0% Labé Tougué Lélouma Mali Koubia %% MILDA of LLINs Accrochées hung %% Ménages of households qui disposent with 1 d'une LLIN MILDA for 2 people pour deux personnes %% MILDA of LLINs en bonein good état condition
StopPalu+—Quarterly Report—January to March 2020 17 Use of LLINs In the households visited in Labé Region, an average of 94% of children under 5 slept under an LLIN the night before the survey. Koubia had the highest rate with 100%, and Lélouma had the lowest rate with 89%. On average, 88% of household members age 5 and over reported having slept under an LLIN the night before the survey. The highest rate was found in Koubia with 99%, and the lowest was in Lélouma with 78%. (Figure 6)
Figure 6: Use of LLINs in the 5 prefectures of Labé Region 120%
99% 100% 99%100% 100% 100% 96% 96% 94% 94% 91% 89% 89% 90% 84% 78% 80%
60%
40%
20%
0% Labé Tougué Lélouma Mali Koubia
%% desof people 5 ans et over plus 5utilisant using anles LLINMILDA %% Des of children mois de 5under ans utilisant 5 using les an MILDA LLIN %% desof pregnant femmes enceintes women usingutilisant an les LLIN MILDA
Results from Kindia Region Availability and condition of LLINs In the 3 prefectures of Kindia Region supported by the project, a total of 781 households were surveyed. The results indicate that 80% of visited households were adhering to universal coverage (1 LLIN for 2 people), and 78% of the sleeping spaces were covered by an LLIN. The district of Forécariah had the highest universal coverage rate with 81%, and Coyah the lowest with 78%. Forécariah had the highest sleeping space coverage rate with 89%, while Coyah had the lowest with 66%. (Figure 7)
Figure 7: Availability and condition of LLINs in the 3 prefectures of Kindia Region supported by PMI
89% 78% 80% 81% 78% 80% 73% 74% 76% 72% 64% 66%
Coyah Dubreka Forecariah TOTAL
%% deof LLINs MILDA hung accrochees %% deof sleeping Couchettes spaces couvertes covered %% deof households menages ayant with 1 1 LLIN MILDA for 2pour people 2 personne
18 StopPalu+—Quarterly Report—January to March 2020 Use of LLINs In the households visited in Kindia Region, an average of 88% of children under 5 slept under an LLIN the night before the survey. Forécariah had the highest rate with 94%, and Coyah had the lowest rate with 75%. On average, 74% of household members age 5 and over reported having slept under an LLIN the night before the survey. The highest rate was found in Forécariah with 85%, and the lowest was in Coyah with 61%. (Figure 8). The number of pregnant women who slept under LLINs the previous night was 81% in the 3 prefectures, with extremes ranging from 67% in Coyah to 87% in Dubréka.
Figure 8: Use of LLINs in the 3 prefectures of Kindia Region
LLIN use in the communities
% of persons sleeping under an LLIN the previous night % of children under 5 sleeping under an LLIN the previous night % of pregnant women sleeping under an LLIN the previous night
3.1.3 SUB-IR 1.3: INCREASED AWARENESS OF FAMILY MEMBERS OF THE NEED FOR VULNERABLE POPULATIONS TO BE PROTECTED FROM MALARIA During Quarter 2, FY 2020, StopPalu+ implemented the following activities: Activity 1.3.1 Conduct multisectoral outreach and SBCC activities
Organize radio programs During the reporting period, the project radio partners donated free airtime to organize 5 roundtables and 7 interactive programs to inform the population about malaria control activities. During these one-hour programs, the participants promoted the following behaviors and emphasized the key messages below: • The correct and regular use of LLINs by the whole family is the most effective way to protect against malaria, especially pregnant women and children under 5 who are the most vulnerable. It is important to maintain and properly care for LLINs in order to make them most effective (wash when it is dirty with unbleached soap, repair the holes with a needle when necessary, etc.). • Early care-seeking is important; visit a health facility or a CHW as soon as a fever appears (within 24 hours after the onset of fever) to receive a free and effective 3-day
StopPalu+—Quarterly Report—January to March 2020 19 treatment. This will help minimize the risk of severe malaria and its consequences (hospitalization, expenses, absenteeism from work for parents or from school for children…). • For pregnant women, taking sulfadoxine/pyrimethamine (SP) from the 13th week of pregnancy until childbirth, with a month between doses, will protect both the pregnant woman and her baby from malaria, which has harmful consequences for their health.
Roundtable radio program in Labé Interactive radio program in Koundara
Organize community dialogues In addition to these radio programs, the project team continued to work with field agents and CAG members to organize community dialogues in the four regions supported by the project to engage communities in solving problems identified during supervisions of health facilities and household visits. The points debated during these dialogues varied from one region to another. In the region of Conakry, 7 community dialogues were organized in the health facilities that had a high malaria incidence in the month of January to discuss the low rate of health facility visits and the low rate of use of LLINs by community members. A total of 193 people, including 117 women, participated in these dialogues. During the dialogues, the participants gave the following reasons for their community’s low rates mentioned above: • Long distance between their neighborhoods and the health centers (participants advocated for a health post closer to them) • The heat in the houses reduces their ability to use the net every night (the feeling of being suffocated under the mosquito net) • Insufficient beds in their houses compared with the number of people, so many people sleep outside and cannot use LLINs The project team and the health facility representatives explained the importance of visiting the health facilities, especially for pregnant women for prenatal care, children for immunization, and the general population when they have fever. They explained that all malaria products and services are available in the facilities free of charge. They also emphasized the importance of using the nets every night and for all the family members to prevent malaria. The facility representatives shared information on the number of malaria cases received in the month of January and explained that the high number of cases are due to community members not using prevention methods: pregnant women do not come to their ANC visits so they do not take SP, the low rate of LLIN use, etc. A woman leader who is a loyal LLIN user made the following point:
20 StopPalu+—Quarterly Report—January to March 2020 “As long as we don't decide to apply the rules that help us fight malaria, malaria will tire us, and you who refuse to sleep under a net will continue to infect us.”
Community dialogue at Simbaya Gare Community dialogue at Port
All the meetings ended with the commitment of the participants, especially women, to use their health center and increase the use of LLINs by their family members. Health authorities have promised to report to the next level on the need for a new health post. In the region of Boké, 23 community dialogues (7 in Boffa, 15 in Boké, and 1 in Fria Prefectures) were carried out by the CAGs under the supervision of the field agents and project staff. A total of 1,225 people, including 625 women, participated in these dialogues. The themes developed during the dialogues focused on the following: • The causes of the high incidence of malaria • The role of local officials in the fight against malaria and the referral of early cases • The benefits of continued use of preventive measures in communities (environmental sanitation, the use of LLINs, and the use of IPT in pregnant women) • Importance of early care-seeking in the context of effective antimalarial products and services available at both health facility and community levels • The consequences of malaria, especially for pregnant women and children under 5 years of age • The importance of monitoring pregnant women and children under the age of one for compliance with their vaccination schedule During the dialogues, the participants mentioned that the number of CHWs is not enough to cover all the villages (for example 2 CHWs to cover 9 big villages). In many villages where people are fishers, they spend most of the night out waiting for the canoes. They participants also explained that during the rainy season, it is very hot in the houses, which make it uncomfortable to use the nets. The agents and project team emphasized the importance of regular and correct use of LLINs. They also said that it is possible to use the LLINs even outside. They explained that people should wear long sleeved clothes to protect themselves against mosquito bites. The discussions resulted in the following recommendations: • Regular and correct use of LLINs by the community • The revitalization of the practice of religious leaders and local authorities raising awareness on the use of LLINs • Sanitation of the environment and the referral of pregnant women and children under one year to health facilities
StopPalu+—Quarterly Report—January to March 2020 21 • The need to seek care at the health facilities and from the CHWs in case of any fever • Increase in the number of CHWs In the region of Labé, the project team and the field agents supported the CAGs to organize 23 community dialogues (15 in Labé and 8 in Mali Prefectures). A total of 922 participants attended these dialogues, including 334 women. The themes focused on the use of LLINs, regular attendance at health centers by pregnant women as well as early care-seeking, particularly by using CHWs’ services in villages/sectors. During the discussions, the following problems were identified: • Non-involvement of heads of sectors, including village authorities, in monitoring the use of LLINs • CHWs cover several villages that are distant • Insufficient use of mosquito nets in some households At the end of the dialogues, the participants made the following recommendations: • Establish a watch committee chaired by the President of the District to improve the use of LLINs • Make sector leaders responsible for the use of LLINs in their villages • Periodically organize sanitation sessions in public places • Strengthen awareness-raising activities • Rapidly visit a CHW in case of signs of malaria
Community dialogue in Lombonna Community dialogue in Madian Taibata
In the region of Kindia, 23 community dialogues (13 in Forécariah and 10 in Dubréka) were organized by the CAGs with the support of project team and field agents. A total of 626 people, including 388 women, participated in these dialogues. The main topics discussed during these dialogues were as follows: • Regular and correct use of LLINs • Sanitation of households and public places • Attendance at health facilities in the case of fever During the dialogues, the participants gave the same reasons as in the other regions and committed to increase the use of LLINs and visits to the health centers.
22 StopPalu+—Quarterly Report—January to March 2020 Table 3: Summary of community dialogues per region and health centers Number of Number of participants Régions Health centers dialogues Total Women Simambossia 1 33 24 Port 1 21 13 Boulbinet 1 19 9 Conakry Kassa 1 42 31 Koulewondy 1 14 10 Dixinn 2 64 30 Total Conakry 7 193 117 Labé 15 579 240 Labé Mali 8 343 94 Total Labé 23 922 334 Boké 15 784 422 Boké Boffa 7 399 187 Fria 1 42 16 Total Boké 23 1,225 625 Forécariah 13 301 163 Kindia Dubréka 10 325 225 Total Kindia 23 626 388 Total 76 2,966 1,464
3.1.4 LESSONS LEARNED AND PROPOSED ADAPTATIONS (IR 1) Although LLINs are available in most households, correct and regular use is still low, especially in the dry season. To address these challenges, the project will continue to strengthen home visits and community dialogues to encourage households to use LLINs. In addition to these activities, the project will also implement mass media communication activities.
3.1.5 ACTIVITIES PLANNED FOR NEXT QUARTER (IR 1) • Continue to support routine LLIN distribution in the health facilities. • Conduct home visits and community dialogues to promote correct and regular use of LLINs. • Implement SBCC activities to promote correct and regular use of LLINs.
3.2 IR 2: INCREASED USE OF IPTP DURING ANTENATAL VISITS During Quarter 2, FY 2020, to improve IPTp uptake, StopPalu+ trained health providers (at health posts and health centers) and CHWs, conducted on-site trainings, and conducted several supervision activities to assess the quality of the services and continue to build the capacity of health workers.
3.2.1 SUB-IR 2.1: IMPROVED TECHNICAL CAPACITY AND INTERPERSONAL SKILLS OF PROVIDERS For Quarter 2, the project implemented the following activities:
StopPalu+—Quarterly Report—January to March 2020 23 Activity 2.1.1 Support provider training on technical and interpersonal communication (IPC) skills To improve the technical and IPC skills of health providers, the project team used national and regional trainers to conduct training for 29 new health providers in Conakry and refresher training for 83 health post staff in the prefectures of Koubia and Tougué and 376 CHWs. The participants were trained on integrated malaria case management protocol, including IPTp.
Training for heads of CHWs in Koundara Training for heads of health posts in Tougué
On-site trainings for ANC staff on IPTp During Quarter 2, as part of strengthening the capacity of providers on the prevention and control of malaria during pregnancy, a series of on-site training for ANC providers was carried out in health centers in the regions of Boké, Conakry, Kindia, and Labé. These facilities were identified during supervision visits as needing improvement in filling out ANC registers and data collection for the monitoring of IPTp uptake for pregnant women. To implement this activity, the project developed a job aid for the on-site training and oriented the malaria focal points on this tool. The objective of this training was to empower focal points to conduct on-site training for ANC providers in their commune/prefecture and ensure the updating of ANC registers through supervision in collaboration with field agents. After the malaria focal points were trained, they went to the health facilities and conducted on-site trainings with the support of the project team. Objectives: • Have ANC providers educate and advise pregnant women on how to prevent malaria during pregnancy. • Update providers on the administration of IPTp. • Guide participants on how to properly fill out the ANC registers and collect cohort monitoring data. Methodology: The methodological approach used during these sessions was based on the participatory method centered on the learners. The trainers used the techniques of brainstorming, illustrated talks, demonstrations, and practical exercises to facilitate exchanges and understanding.
24 StopPalu+—Quarterly Report—January to March 2020 During these training sessions, the following topics were discussed: • General information about malaria: the definition of malaria, its mode of transmission, manifestations, biological diagnosis and treatment of the disease in general and in pregnant women in particular • Prevention of malaria in pregnant women: the routine distribution of LLINs to pregnant women, IPTp, and the communication of key messages using an “image box” to encourage behavior change • Properly filling out ANC registers: explanations using the user’s guide, followed by practical exercises to support the explanation. The frequent errors encountered in filling out the register and the methods of quality control were also explained. Finally, the participants were asked to update the registers using the ANC forms. • Collection of ANC / IPTp data in the register: the frequency of data collection, collection techniques, and characteristics of quality data A total of 176 ANC staff benefited from these on-site trainings (19 in Conakry, 123 in Boké, and 34 in Kindia).
On-site training of ANC staff On-site training of ANC staff in the health center of Tombolia
Activity 2.1.2. Monitor provider provision of IPTp During the reporting quarter, the project staff continued to use new ANC registers provided by the National Health Information System (SNIS) to monitor the number of pregnant women who received their third round of IPTp or more. For this quarter, these are the cohorts of pregnant women included in July, August, and September 2019. In the 19 health districts supported by the project, the target of 60% of minimum expected coverage of IPTp round 3 was not reached in six of them (Kaloum, Matoto, Boffa, Boké, Fria, and Mali). The highest coverage rate was found in the Koubia health district (91%), followed by Gaoual (86%) and Matam and Lélouma (83% each). The lowest coverage rate was found in the Mali health district (38%), followed by Matoto (40%). The low coverage rate observed in Mali could be explained by the high turnover of ANC agents in most of the health centers, which affects the quality of follow-up.
StopPalu+—Quarterly Report—January to March 2020 25 Figure 9: IPTp round 3 coverage rate in the 5 communes of Conakry Region
83% 82%
68% 63% 56%
40%
KALOUM DIXINN MATAM MATOTO RATOMA CONAKRY
Figure 10: IPTp round 3 coverage rate per commune in the 14 prefectures
91% 86% 83% 80% 76% 74% 70% 72% 63% 62% 64% 57%
44% 44% 38%
The project will continue to support the districts that had the lowest coverage rate to conduct outreach activities and use SMS to remind pregnant women to attend their ANC visits. Activity 2.1.3 Improve supervision of providers and tracking of pregnant women During Quarter 2, the project’s Boké regional team conducted a supervision visit to health facilities, targeting ANC services to assess the quality of IPTp services and to help correct issues in the ANC forms. During this activity, the teams also identified overdue ANC forms by month and by locality and wrote a list of these pregnant women. The list was given to the CHWs covering these localities so they could ask these women to come to the health centers for their ANC visit. The team called the women who had their phone number on the ANC form, and this strategy helped to catch up several pregnant women who missed their
26 StopPalu+—Quarterly Report—January to March 2020 appointments. A total of 1,291 ANC forms were updated in the various health centers and health posts of the region, to the great benefit of pregnant women.
Project team supporting the updating of ANC forms
In addition to this specific supervision described above, StopPalu+ conducted several other supervision activities and supported the DPSs and DCSs to conduct their bimonthly supervision visits. These supervision visits integrated all malaria control activities, including IPTp. For more details please see Activity 3.1.6.
3.2.2 SUB-IR 2.2: INCREASED KNOWLEDGE OF WOMEN AND OTHER FAMILY MEMBERS OF THE BENEFITS OF ANC VISITS, INCLUDING IPTP During the reporting quarter, StopPalu+ implemented the following activities: Activity 2.2.1 Implement SBCC activities to promote ANC and IPTp To promote ANC and IPTp services, the project implemented several SBCC activities. See Activity 1.3.1 for more details.
3.2.3 SUB-IR 2.3: ALTERNATIVE APPROACHES TO IMPROVED ACCESS TO IPTP SERVICES ROLLED OUT During Quarter 2, FY 2020, StopPalu+ implemented the following activities: Activity 2.3.1 Support provider outreach services StopPalu+ supported the health centers of Dabiss (Boké), Koba (Boffa), and Lombonna (Labé) and the health posts Kitto, M’bendia (Boké) and Serima (Labé) to conduct outreach activities to provide health services such as IPTp and the Expanded Program of Immunization (EPI) to eligible patients, test all cases of fever, treat positive simple malaria cases, and refer negative or severe cases to the necessary higher health facility. Methodology: The activity consists first in identifying the pending ANC forms according to the localities of the pregnant women, then providing this list to the CHWs during the monthly meeting so they can inform these pregnant women of the agreed date of the outreach activity and the place. Field agents were used to support the health facilities in preparing the activity. The teams were made up of staff from the health posts, ANC and EPI agents from the health center, the CHWs in the area, field agents, and the regional StopPalu+ team. During the outreach activities, CHWs test all cases of fever, treat all confirmed cases, and refer severe cases. The fixed teams at the health posts offered preventive and curative services, but also
StopPalu+—Quarterly Report—January to March 2020 27 carried out communication activities on the importance of adhering to the ANC schedule of visits and SP uptake by pregnant women. Results: These activities helped reach 70 pregnant women who subsequently received their SP. A total of 328 children, including 192 girls, from different villages were vaccinated during the outreach activities. These results demonstrate the impact of the outreach activities in improving the health of community members, especially vulnerable people.
Beneficiaries during the outreach activities
3.2.4 SUB-IR 2.4: INCREASED AVAILABILITY OF SP AND ANCILLARY SUPPLIES For Quarter 2, FY 2020, StopPalu+ implemented the following activities: Activity 2.4.1 Collaborate with the PSM project on macro-planning and stock management StopPalu+ continued to work closely with the Procurement and Supply Management (PSM) project, the district malaria focal points, and the NMCP team to monitor the supply of commodities at health facilities. To reduce the risk of stock-out between deliveries by the PCG, the project team supported the health facilities conduct stock inventory of malaria commodities and also worked with the DPSs/DCSs to distribute any over-stock to facilities that are out of stock.
Stock inventory in the health center of Kolabouyni Stock inventory in the health center of Kounsitel
28 StopPalu+—Quarterly Report—January to March 2020 3.2.5 LESSONS LEARNED AND PROPOSED ADAPTATIONS (IR 2) Although SP is the most available malaria drug in the health facilities, its uptake is low, especially for IPTp rounds 2 and 3. This is because pregnant women do not adhere to their ANC visit schedule. To address this issue, the project team will continue to work with CHWs so they can identify pregnant women during their household visits and refer them to the health facilities. The project will also support the health facilities that have the lowest rate of IPTp round 3 coverage so they can conduct outreach activities to provide services to eligible women. If possible, in the context of COVID-19, the project supports the use of SMS in some health facilities to remind pregnant women of their ANC visits.
3.2.6 ACTIVITIES PLANNED FOR NEXT QUARTER (IR 2) • Train health providers in Conakry and Kindia Regions. • Integrate the use of SMS to remind pregnant women of their ANC visits in the prefectures of Matoto, Boffa, and Boké. • Conduct supervision activities. • Support health facilities’ outreach activities.
3.3 IR 3: INCREASED PROMPT CARE-SEEKING AND TREATMENT During Quarter 2, FY 2020, to increase prompt care-seeking and treatment, the project conducted a training for new health providers and a refresher training for heads of health posts and CHWs on integrated malaria case management. The project also trained lab technicians on malaria diagnosis (RDT and microscopy). In addition, the project conducted on-site training in health facilities identified during supervision as needing capacity building. Furthermore, the project conducted several supervision activities to assess the quality of care and continue to build the capacity of health providers.
3.3.1 SUB-IR 3.1: IMPROVED TECHNICAL AND INTERPERSONAL SKILLS OF PROVIDERS IN MALARIA DIAGNOSIS AND CARE During Quarter 2, StopPalu+ implemented the following activities:
Activity 3.1.1. Strengthen malaria diagnostics for case management Refresher training of lab technicians During the reporting period, to reinforce the capacities of lab technicians, the project conducted a basic malaria diagnostic refresher training (MDRT), which took place in three sessions from February 24 to March 20, 2020. A total of 58 laboratory technicians (including 12 women) were trained, including 20 for the Labé Region, 20 for the Kindia and Conakry Regions, and 18 for the Boké Region. The refresher training sessions covered 36 structures, including 9 for the Boké Region, 14 for Labé, 6 for Conakry, and 7 for the Kindia Region. The sessions were facilitated by national microscopy experts trained by the StopPalu+ project.
Goal: Capacity building of laboratory technicians in biological diagnosis of malaria.
StopPalu+—Quarterly Report—January to March 2020 29 Materials and method: These trainings activities began with the Training topics for MDRT implementation of waste management • General information on malaria provisions, followed by the presentation of participants and the adoption of the calendar • Slide preparation spread over five days. Training topics are • Practical work to review slides for presented in the textbox here. Trainers used a parasite detection, parasite participatory method, with slide presentations, question-and-answer sessions, review of identification, and parasite validated slides, and practical work (preparation quantification of thick and thin smear slide, RDTs). All the • Use of RDTs participants did a pre- and post-test, both • theoretical and practical. The performance level Microscope maintenance and classification is based on a WHO scale, as insurance shown in Table 4. • Quality of malaria diagnosis During these sessions, two new facilities were integrated into the list of facilities approved for malaria microscopy—the health center of Sanoyah (KM36) and the AGBF clinic of Labé.
Table 4: National standard level classification of competence in microscopy
National standard levels Parasite detection Parasite identification Parasite quantification LEVEL A (expert) ≥ 90% ≥ 90% ≥ 50%
LEVEL B 80% - < 90% 80% - < 90% 40% - < 50%
LEVEL C 70% - < 80% 70% - < 80% 30% - < 40%
LEVEL D < 70% < 70% < 30%
Evaluation of the participants: A pre-test was conducted to assess the basic knowledge of each participant on malaria. The key areas tested were related to the pathogenesis of the disease, laboratory knowledge, and quality assurance, and a post-test was conducted to assess the knowledge acquired during training. At the end of the training of the 58 lab technicians, the average performance in the key areas improved in the following manner: • In parasite detection, the average score went from 79% in the pre-test to 91% in the post-test. • In parasite identification, the average score went from 59% in the pre-test to 71% in the post-test. • In parasitic quantification, the average score went from 18% in the pre-test to 47% in the post-test. • In overall theory, the average score went from 52% in the pre-test to 87% in the post- test. The participants increased their level of performance on the biological diagnosis of malaria in general.
30 StopPalu+—Quarterly Report—January to March 2020 Figure 11: Average MDRT pre and post-test performance by region
Average MDRT Pre- and Post-Test Performance by Region FY20 Q2 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Pre-Test Post-Test Pre-Test Post-Test Pre-Test Post-Test Pre-Test Post-Test Parasite Detection Parasite Identification Parasite Quantification Theory
Conakry/Kinda Boké Labé PMI Zone average training scores
Despite this progress, when we refer to the WHO standards, we note that the participants have a good level in parasite detection (whose minimum score standard is 80%), but poor in identification of the species (whose performance is 71% in the post-test, which is lower than the WHO minimum score of 80%). In parasite quantification, the overall performance of 47% is lower than the WHO minimum score of 50%. Therefore, all participants must strengthen their levels in parasite identification and parasite quantification.
Strengths of trainings: • Effective presence and motivation of participants • Availability of all training materials
Areas to improve: • Low level of certain participants in identification and parasite density • Defect of certain microscopes • Repeated use of validated slides • The defect of some WHO-validated slides Recommendations: At the end of the trainings, the following recommendations were made: Facilitators to Participants: • Continuously improve the levels of malaria microscopy • Put into practice the knowledge acquired in their respective health facilities • Pass on the training to other health providers Facilitators to NMCP and StopPalu+: • Perpetuate the continuous training of lab technicians • Ensure regular monitoring (formative supervision) • Provide facilities with appropriate materials and reagents • Find new banks of WHO-validated slides for future training sessions • Maintain the training microscopes in good condition.
StopPalu+—Quarterly Report—January to March 2020 31
Participants during the pre-test
Conduct on-the-job training and coaching for providers and lab technicians As part of capacity building for providers in biological malaria diagnosis, the project team organized on-the-job training sessions in the regions of Kindia and Labé. For the Labé Region, it focused on malaria microscopy, which involved the facilities of the Labé regional hospital, the Labé army clinic, and the urban health center of Koubia. A total of 12 agents were trained, including 9 women. The themes developed during this training session were as follows: • The methods of blood sampling, the preparation and the adequate coloring of thick smear and thin smear slides • The study of the morphological characters of the different plasmodial species • The method of preparation of the dye and its use • Laboratory biosecurity and biomedical waste management • The basic notions of quality assurance and quality control • The distinction between artefacts, figurative elements of blood, and parasites • Standard operating procedures For the Kindia Region, the on-site trainings focused on the correct practice of the RDT. Health providers came from all the services (pediatrics, emergency, general medicine, maternity, laboratory) of the prefecture hospital of Coyah. A total of 127 agents, including 80 women, benefited from this training session. The topics discussed were as follows: • Definition of RDT • Typology of RDT • Difference between RDT Care Start and SD Biotine • Biosecurity • How to perform an RDT
32 StopPalu+—Quarterly Report—January to March 2020
On-site training at the hospital of Coyah On-site training in the army clinic of Labé
Conduct quarterly supervision visits As part of the follow-up on recommendations from previous supervision visits, the StopPalu+ project, in collaboration with the NMCP, conducted a formative supervision of certain structures in the Boké, Conakry, and Kindia Regions. It is important to mention that the supervision was not done in the Labé Region because one case COVID-19 was confirmed in Labe. Main objective: The main objective of malaria diagnosis supervision is to evaluate the implementation of the recommendations from previous supervision visits.
Specific objectives of laboratory supervision • Observe the technicians as they work • Identify technicians’ capacity gaps or weaknesses • Correct these gaps (personalized training) • Encourage and support technicians (work morale) • Review equipment, reagents, and consumables • Fill in the supervisory grids • Evaluate the technicians’ performance • Formulate recommendations • Share supervision results with the health authorities
Results of the malaria diagnosis supervision and assessment To assess laboratories’ performance, these supervision visits include testing technicians’ diagnostic skills for reading slides. Some of the slides used were from the facility (internal quality control [IQC]) and some were WHO-validated slides (external quality control [EQC]). For IQC, the team checks slides read by the technicians and rates the agreement (concordance) between the two readings. For EQC, technicians read slides provided by WHO, and their responses are checked against the WHO-validated results. The project team used electronic data collection with tablets using SuveyCTO. This method helped improve data quality and allowed the project to receive the results in real time.
StopPalu+—Quarterly Report—January to March 2020 33 This supervision involved 154 staff, including 75 women, and covered 23 facilities. • For parasite detection, 147 slides were read, of which 126 were concordant (86%). • For parasite identification, 105 slides were read, of which 81 were concordant (77%). • For parasite quantification, 63 slides were read, of which 38 were concordant (60%). The average performance in parasitic detection in the PMI area is 86%, 77% in parasitic identification, and 60% in parasitic quantification for this quarter. The IQC system is functional in supervised structures except certain health centers that do not conduct microscopy.
Figure 12: Average microscopy performance by region during FY 2020 Quarter 2 supervision visits
Regions' average performance during this quarter
100% 89% 90% 86% 86% 86% 82% 80% 77% 77% 69% 70% 60% 60% 60% 57% 50% 50%
40%
30%
20%
10%
0% Conakry Boké Kindia PMI'S Average performance during this quarter
Parasite Detection Parasite Identification Parasite Quantification
Monitor improvements and changes in lab technicians’ performance For this quarter, the supervision results showed good performances in all the three regions on parasite detection and parasite quantification, with the rates above the WHO standard of 80% in detection and 50% in quantification. However, for parasite identification, only the Boké Region was above the standard of 80%. The comparison of the laboratory supervision visits in Quarters 1 and 2, FY 2020, shows a decrease in performance in both parasite detection and quantification, even though the WHO standard performance rates were reached (see Figure 13).
34 StopPalu+—Quarterly Report—January to March 2020 Figure 13: Average performance trend in microscopic diagnosis in PMI zone in Quarters 1 and 2, FY 2020
Follow up of trends performance average in PMI area
100% 90% 90% 86%
80% 77% 71% 70% 67% 60% 60%
50%
40%
30%
20%
10%
0% Parasite Detection Parasite Identification Parasite Quantification
First Quarter Second Quarter
Strength of the supervision visits: • Good performance of technicians on parasite detection • Good functioning of the quality assurance system • Providers' commitment to good microscopic diagnosis Areas to improve: • Weaknesses in parasite identification and quantification, despite several trainings • The defect of the microscopes of Boffa, Coyah, and Donka and Ignace Deen hospitals • The presence of the two types of RDTs at the Prefectural Hospital in Coyah Recommendations: • Equip Coyah, Boffa, and Donka and Ignace Deen hospitals with new microscopes • Provide health facilities with Giemsa and methanol
StopPalu+—Quarterly Report—January to March 2020 35
IQC slides Two types of RDTs found in a Coyah laboratory
Activity 3.1.2 Conduct on-site training for providers in technical and IPC skills During Quarter 2, StopPalu+ conducted on-site training for providers at health facilities that were identified during supervision visits as having some capacity reinforcement needs. These on-site training sessions offered project staff the opportunity to share basic malaria control information with the health facility staff, especially new staff members and interns who are performing tasks with no training on national guidelines and protocols. In the region of Conakry, the project team organized on-site trainings in 19 health centers and reached 248 health workers, including 196 women. Depending on the problems identified during the supervision sessions, the project team focused on the following topics: • Prevention activities (routine LLIN distribution, IPTp) • Malaria diagnosis (RDT use) • Case management of simple and severe cases (signs, treatment) • Data collection (primary tools use, monthly malaria forms, etc.) • Stock management • IPC methods for discussing early care-seeking with clients and adherence to ANC visits
On-site training in Dabompa health center Practical exercise at Tanènè health center
In the other regions supported by the project, these on-site trainings focused on malaria during pregnancy and are reported under Activity 2.1.1.
36 StopPalu+—Quarterly Report—January to March 2020 These trainings improved participants’ knowledge and skills, and they helped improve providers’ counseling skills. For example, many ANC staff in Conakry are complaining that pregnant women do not want to get another LLIN because they already have the nets that they received during the mass distribution campaign. The project team explained that health providers should tell the women that these new nets will help replace the ones that they already have when those become old. Project staff also emphasized the correct way to fill out the data collection tools for routine LLIN distribution. It is important to be able to track all the beneficiaries at any time. The trainings were also a good opportunity to explain the use of the new RDTs. Activity 3.1.3 Conduct training and coaching for hospital providers During the reporting period, the project team conducted coaching for the prefectural hospital of Coyah and the regional hospitals of Labé and Boké. The staff of the laboratories, the maternity services, and pediatrics benefited from these coaching sessions, which continued to build the capacity of health providers and improve the quality of services. The coaching was performed by the project team and the internal supervisors at these hospitals. Activity 3.1.4 Conduct training and refresher training for malaria case management
Training of new health providers at the health centers of Conakry During March 17 to 21, the project trained 29 new health providers (14 women) from the region of Conakry. The training was facilitated by two national trainers.
General objective: To reinforce the knowledge and competencies of health providers in health posts to provide malaria prevention, diagnosis, and treatment services according to national protocols and guidelines. Expected results: At the end of this training, participants will be able to properly ensure malaria prevention and treatment services according to national protocols and guidelines. Methodology: The training was facilitated with a participatory method and used the following techniques: illustrated presentations, discussions, question-and-answer sessions, brainstorming, group work, demonstrations, case studies, and summary at the end of each session. Training topics: For five days and in accordance with the terms of reference, all the sessions from the training manual were presented during the various training sessions.
Modules from the malaria prevention and treatment training manual • Session 1: General information on malaria • Session 2: Biological diagnosis of malaria using microscopy or an RDT • Session 3: Treatment of uncomplicated malaria according to national guidelines • Session 4: Treatment of severe malaria according to national guidelines • Session 5: Management of malaria in pregnant women • Session 6: Preventing malaria in pregnancy • Session 7: Prevention of malaria in children. • Session 8: LLINs and means of prevention • Session 9: Inventory management and procurement • Session 10: Data management • Session 11: BCC in the fight against malaria • Session 12: Proper waste management
StopPalu+—Quarterly Report—January to March 2020 37 To evaluate the efficacy of the training, participants completed a pre-test and a post-test. At the pre-test, 9 participants answered fewer than 50% of the questions correctly, and 4 participants answered 80%–100% of the questions correctly. During the post-test, none of the participants had fewer than 50% correct, and 24 participants answered between 80% and 100% correctly.
Participants during the training in Conakry
Refresher training of health providers at health posts During Quarter 2, as part of capacity building for health providers, StopPalu+, in collaboration with the NMCP, organized a refresher training for 83 heads of health posts from the prefectures of Koubia (38) and Tougué (45). In total, four sessions (5 days each) were held. One regional trainer and one trainer from the DPS facilitated the sessions. Pre- and post-test results: To evaluate the efficacy of the training, participants completed a pre-test and a post-test. In the Tougué health district, during the pre-test for RDT performance, only 9% of the participants had a rate ≥80%, and only 4% had ≥80% for malaria prevention and case management. In the first post-test, on the correct performance of the RDT, 47% had ≥80% and 53% took the post-test again. On the prevention and management of malaria (clinical), 65% had the ≥80% required, while 35 % had to re-take the post-test. At the end of the trainings, the project team identified the facilities where the participants with the low performance rates came from. A total of 14 facilities were identified and will benefit from on- site trainings and more supervision sessions to continue to improve their capacity and skills. In addition, it should be noted that 30 out of 45 participants were new agents and were in their first management of a health facility. In the Koubia health district, we observed at the pre-test on the performance of the RDT, 16% of the participants were able to have the required rate (≥80%) and 53% in prevention and case management. In the post-test, for the correct performance of the RDT, 82% had the required rate and 18% took the post-test a second time to have the required rate. For the prevention and management of malaria, 100% of the participants had the required rate at the first post-test. After the trainings, the team identified 6 facilities with low performance scores to be supervised more frequently to improve the quality of service. In Koubia, 10 out of 38 participants were new agents and in their first management position.
38 StopPalu+—Quarterly Report—January to March 2020
Participants during the training in Tougué Participants performing RDT during the training
Refresher training of CHWs During the reporting period, StopPalu+ worked with the NMCP and the DPSs to conduct refresher training for existing CHWs in the prefectures of Koubia, Gaoual, Koundara, and Mali. The training’s goal was to strengthen the capacities of CHWs to provide prevention and management care for uncomplicated malaria cases, refer severe cases, and use effective SBCC techniques.
Specific objectives for the community case management training for CHWs At the end of the training, CHWs will be able to do the following: 1. Define, describe modes of transmission and ways to prevent malaria 2. Identify the clinical, biological signs of malaria and classify simple and severe malaria 3. Develop and interpret an RDT for malaria confirmation 4. Ensure proper waste management 5. Ensure the management of uncomplicated malaria according to the national policy 6. Recognize severe malaria and be able to do pre-referral treatment and to refer 7. Organize awareness-raising activities on the need to have a healthy environment and promote other means of protection 8. Provide communication for behavior change activities at the community level
The trainers used illustrated presentations, question-and-answer sessions, brainstorming, videos, role-playing, and demonstrations. A total of 336 CHWs (Gaoual 80, Koubia 60, Koundara 71, Mali 125) benefited from the training.
Pre-test and post-test: The pre- and post-tests on malaria prevention and case management were conducted for all the sessions in the five health districts. The pre-test consisted of evaluating the CHWs’ level of knowledge before the beginning of the training in order to evaluate the progress made at the end of the training. The post-test allowed the trainers to validate the participants' understanding and acquisition of knowledge according to the objectives assigned by the project (the participants who have 85% correct answers at the post-test pass the training).
StopPalu+—Quarterly Report—January to March 2020 39 All 387 CHWs validated their training by obtaining 85% of correct answers during the post- test. It should also be noted that among the trained CHWs, there were 23 new ones, including 6 women, in Mali, and 21, including 4 women, in Koubia. This made a total of 44 new CHWs trained, including 10 women.
RDT practice during the training in Koundara CHWs during the training in Koubia
Activity 3.1.5 Conduct training for microscope maintenance
Microscope maintenance training Maintenance is today a major problem in almost all health facilities where the devices are used, particularly in biomedical analysis laboratories. A situational assessment of microscopes in certain laboratories conducted by StopPalu+ in March 2018 shows that 46% (or 71/153) of the microscopes were in poor working condition and really need maintenance. The cause of these failures according to the same assessment was due to the absence of a maintenance monitoring program in the field. To help solve this problem StopPalu+, in collaboration with the National Directorate of Laboratories, organized a training at facilities, which has improved microscope maintenance, keeping them in good condition for better case management. This workshop took place January 24–25, 2020, in the oncology training room of CHU Donka, bringing together 27 participants from all health centers and the four CMCs (Ratoma, Minière, Matam, and Coleah) of Conakry region. Objective: Strengthen the capacity of microscopists on preventive maintenance for the microscopes
Methodology: The methodology used during this microscope maintenance training session was a participatory method supported by a slide presentation and a question-and-answer session. This session was held by a biomedical engineer (from the Mamou Institute), assisted by trainers from the StopPalu+ project.
Procedure: The training started with a pre-test on general knowledge of the microscope. The trainer then made a brief presentation on good laboratory practices, the description of the microscope and its typology, and the principles of operation. The participants followed up with related questions on the topics presented, and solutions were brought up during the discussions.
40 StopPalu+—Quarterly Report—January to March 2020 Demonstrations on errors frequently made by participants during routine work in their respective facilities were identified and progressively corrected during these demonstration sessions on microscope maintenance. Before the end of the second day, the participants took a post-test to measure the progress of knowledge on microscope maintenance after the training. The National Director of Laboratories of Guinea chaired the opening and closing ceremonies, during which underscored the importance of this workshop and encouraged the participants to concentrate during the training. He also asked the organizers to extend these types of training to other regions of the country.
Results: At the pre-test, 18 participants out of 27 (67%) reached or exceeded the average of 50%; this revealed a deficiency on the concept of microscope maintenance. At post-test, 24 participants out of 27 (89%) reached or far exceeded the average of 80%, and 5 of the 27 participants (about 19%) reached the score of 100%. We conclude that all participants significantly increased their knowledge of microscope maintenance during this training workshop.
Strengths of the training: • Effective presence and motivation of participants • Availability of all training materials • Good organization of the training workshop
Conclusion and Recommendations: Maintenance constitutes an important and essential step to keep equipment in good condition to always provide the predefined quality service. This training workshop has largely contributed to strengthening the capacities of lab technicians from different facilities, to effectively fight against the misuse of microscopes through adequate and regular preventive maintenance. At the end of these training sessions, the following recommendations were made: From trainer to participants: • Sustain good laboratory practices • Identify the right places to install or store the microscopes • Strictly observe the microscope cleaning procedures • Ensure regular maintenance of the microscope in accordance with WHO standards • Share the knowledge gained with colleagues in their respective facilities • Post the maintenance guide in laboratories From the trainer to the workshop organizers: • Ensure periodic monitoring (supervision) of participants in the various facilities • Provide all the materials (cleaning solution) necessary to properly ensure preventive maintenance • Perpetuate these refresher training courses to avoid falling back into old habits
StopPalu+—Quarterly Report—January to March 2020 41
Participants during microscope maintenance training
Activity 3.1.6 Improve supportive supervision for case management During Quarter 2, FY 2020, StopPalu+ worked with the MOH to support the national supervision structure as described below:
Supervision of public and private health facilities During the reporting quarter, the project team and malaria focal points carried out formative supervision activities in all 19 health districts supported by the project. The project also supported the 5 DPSs of the region of Labé to conduct supervision visits in the health facilities. These supervision sessions reached a total of 184 health facilities divided as follows: 12 hospitals, 124 health centers, and 48 health posts. Because of their formative nature, the sessions helped strengthen the capacities of 1,064 health workers, including 639 women, in the areas of IPTp, routine LLIN distribution, case management, and data management. Overall, the best performance was observed in the area of case management (93%), with extremes ranging from 82% (Matoto) to 100% (Dixinn), followed by the commodity management at 90%. This good performance in the field of case management can be explained by the increase of on-site trainings and formative supervision visits carried out by the project team and focal points as well as the training of providers. The performance in commodity management is due to the increase of physical inventory conducted by health facilities with the support of malaria focal points and fields agents. The areas of weakest performance were the dispensation of products and LLINs at the point of sale and data management, respectively 82% and 86%. Performance ranged from 71% (Gaoual) to 95% (Mali). The poor performance in the dispensing of products is explained by the inadequacies in working conditions and insufficient storage of the distribution vouchers. For data management, the health districts of Matam (50%), Coyah (57%), and Tougué (61%) had the lowest performance. These poor performances are explained by the under- notification of patients, especially in hospitals/CMCs, the insufficient filling of RUMERs, and the low level of data collection carried out by certain heads of health posts.
42 StopPalu+—Quarterly Report—January to March 2020 For all the weaknesses noted, the supervisors have taken corrective measures and proposed recommendations, the level of execution of which will be evaluated during the next supervision sessions. Facilities identified as performing poorly will be prioritized during next quarter's supervision in order to monitor their progress.
Table 5: Supervision scores for health facilities
Performances per area ANC Adhere to Health (LLIN/ ANC EPI Consultation national Data Overall Regions districts IPTp) (LLIN) (LLIN) services guidelines Stores collection score Dixinn 83% 95% 81% 90% 100% 90% 83% 89% Kaloum 74% 89% 81% 84% 90% 87% 100% 86% Conakry Matam 94% 86% 88% 93% 100% 50% 85% Matoto 75% 86% 76% 79% 82% 98% 96% 85% Ratoma 82% 74% 80% 91% 99% 81% 100% 87% Boffa 94% 90% 82% 53% 89% 88% 96% 85% Boké 93% 90% 83% 80% 92% 90% 88% 88% Boké Fria 88% 87% 81% 87% 87% 82% 94% 87% Gaoual 86% 89% 71% 76% 83% 92% 94% 85% Koundara 91% 85% 75% 86% 85% 92% 100% 88% Coyah 86% 92% 83% 85% 89% 91% 57% 85% Kindia Dubréka 93% 98% 90% 91% 99% 97% 97% 95% Forécariah 83% 77% 74% 83% 98% 95% 82% 85% Dinguiraye 94% NO 92% 96% 94% 94% 87% 93% Koubia 87% 82% 77% 93% 96% 83% 77% 85% Labé 91% 92% 80% 89% 94% 88% 94% 90% Labé Lélouma 96% 93% 94% 88% 97% 90% 96% 93% Mali 92% 83% 95% 95% 97% 85% 76% 89% Tougué 84% 85% 82% 91% 99% 88% 61% 84% ZONE PMI 88% 87% 82% 86% 93% 90% 86% 87%
3.3.2 SUB-IR 3.2: INCREASED AVAILABILITY OF QUALITY DIAGNOSTIC TESTS AND TREATMENT AT FACILITIES AND COMMUNITY LEVEL During Quarter 2, FY 2020, StopPalu+ implemented the following activities: Activity 3.2.1 Ensure availability of diagnostic supplies and antimalarial treatment During Quarter 2, the project team worked with the DPSs and the malaria focal points to evaluate the quality of the distribution of malaria commodities done in February 2020. The goal was to assess how well the orders made by the health facilities were filled (needs were met). To implement this activity, the malaria focal points compared the quantity received to the quantity ordered by health facility and by district. This analysis showed the following results: • For the RDTs, 88% filled (88% of the quantity ordered was received by the health facilities) • For the artemether/lumefantrine (AL) for infants, 6% filled
StopPalu+—Quarterly Report—January to March 2020 43 • For the AL for small children, 34% filled • For the AL for adolescents, 65% filled • For the AL for adults, 122% filled The project team shared this information with the NMCP to advocate for an emergency distribution for some districts such as Koundara and Boffa, which did not receive their orders. For example, the district of Koundara only received 35% of the RDTs ordered, 0% of AL for infants, 57% of AL for children, 42% of AL for adolescents, and 34% of AL for adults. The project explained that the stock-outs impact the quality of services at all levels and explain the low performance in some facilities and by some CHWs (not 100% of suspected cases are tested, not all the confirmed cases are treated, etc.). The NMCP promised to take action and to improve the follow-up after each quarterly distribution of malaria commodities. Where possible, the project teams worked with the DPSs/DCSs and the heads of health centers to ensure that the CHWs have necessary commodities such as RDTs, antimalarial drugs, and ancillary supplies for case management of uncomplicated malaria and pre- referral treatment for severe malaria. In the 19 prefectures/communes supported by the project, the CHWs tested 40,177 people—among whom 16,591 were positive—and treated 16,233 people with artemisinin-based combination therapy (ACT) (Table 6).
Table 6: Details of community case management conducted by CHWs during the reporting period (January–March 2020) Number of people Number of RDTs Number of Number of treated with people Prefecture performed positive RDTs negative RDTs ACT referred Boffa 2,803 1,548 1,255 1,548 0 Boké 4,619 2,723 1,896 2,723 59 Coyah 1,876 1,271 586 1,270 1 Conakry 324 112 212 112 0 Dinguiraye 2,013 976 1,037 970 22 Dubréka 3,093 2,057 1,035 2,057 0 Forécariah 3,293 1,978 1,312 1,648 30 Fria 4,781 1,957 2,824 1,957 0 Gaoual 2,407 1,006 1,401 1,006 0 Koundara 763 328 435 328 29 Koubia 643 104 539 104 135 Labé 4,459 838 3,621 838 1 Lélouma 2,384 515 1,869 515 125 Mali 3,839 509 3,330 488 118 Tougué 2,880 669 2,211 669 39 Total 40,177 16,591 23,563 16,233 559
3.3.3 SUB-IR 3.3: INCREASED KNOWLEDGE AND AWARENESS BY COMMUNITIES AND FAMILY MEMBERS OF SERIOUSNESS OF CHILDHOOD ILLNESSES, KEY SIGNS, AND SYMPTOMS, AND WHEN TREATMENT IS INEFFECTIVE In quarter 2 FY 2020, StopPalu+ implemented the following activities: Activity 3.3.1 Facilitate stakeholder discussions on child morbidity and mortality from malaria. During the reporting period, the project supported the CAG members to conduct 75 community dialogues with 2,966 participants, including 1,464 women. These dialogues were an opportunity to discuss with community members on key malaria issues they are facing
44 StopPalu+—Quarterly Report—January to March 2020 and the preventive measures to reduce malaria transmission. For more details, see Activity 1.3.1. Activity 3.3.2 Tailor SBCC materials to promote early care- and treatment-seeking behavior Based on the knowledge, attitudes, and practices (KAP) survey results, StopPalu+ developed new messages and produced new radio and television spots to promote early care-seeking. During the reporting quarter, 252 radio spots and 36 television spots were broadcast.
3.3.4 LESSONS LEARNED AND PROPOSED ADAPTATIONS (IR 3) The main challenges in case management are adherence to national guidelines and protocols, especially in the hospitals/CMCs and private health facilities, and stock-out of malaria commodities. To overcome these challenges, the project team will continue on-site trainings and supervisions targeting hospital and CMC staff. The project will also monitor the distribution of malaria commodities planned for May 2020 and ensure that health facilities and CHWs receive the quantities they have ordered.
3.3.5 ACTIVITIES PLANNED FOR NEXT QUARTER (IR 3) • Train health providers of health centers on malaria case management • Conduct refresher training for CHWs • Support the national supervisory system • Monitor the Quarter 2 commodities distribution
3.4 IR 4: INCREASED FULL DOSE OF SMC DELIVERED IN A TIMELY MANNER During Quarter 2, FY 2020, StopPalu+ worked with the NMCP and the other partners to develop the macro-plan for the 2020 seasonal malaria chemoprevention (SMC) campaign and to revise training modules, SBCC materials, and data collection and monitoring tools.
3.4.1 SUB-IR 4.1: INCREASED AWARENESS BY COMMUNITY AND FAMILY MEMBERS OF THE NEED FOR INFANTS AND CHILDREN UNDER 5 TO BE PROTECTED FROM MALARIA During Quarter 2, StopPalu+ implemented the following activities: Activity 4.1.1 Develop and implement SBCC and outreach As part of the preparations for the 2020 SMC campaign, the NMCP and its partners organized workshops on March 9–10, 2020 to review the SMC 2020 implementation plan and management tools. All these tools and documents were validated on March 30. The aim of these workshops was to adapt the documents based on the lessons learned from the 2019 SMC campaign. Representatives of the NMCP and its partners (StopPalu+, Catholic Relief Services [CRS], Child Fund, Plan, and Doctors Without Borders [MSF]) participated in the workshop.
Methodology of work: For the revision of the implementation plan, the first draft of the plan proposed by a small team was shared with all participants so that they could comment on it before the workshop. Thus, during the workshop through a directed reading approach, the amendments made by
StopPalu+—Quarterly Report—January to March 2020 45 each participant were discussed objectively, and the document was revised based on the consensus. The revision of the tools was done through working groups for two days after presentation of the scope of work for the workshop. The participants were divided into four working groups: • Group 1: Training modules • Group 2: Data collection tools • Group 3: Supervision and monitoring tools • Group 4: Communication tools At the end of the breakout sessions, each group presented its work, which was discussed and amended in plenary. The main changes by topic are descripted below: Data collection tools • Insert a column for non-resident children • Insert a column for children who have benefited from the 3 rounds • Remove the column about the side effects from the register • Add the names of the health centers on the SMC cards • Add a form to collect data on the other health activities implemented during the SMC campaign • Add many new stock management tools • Replace tablets with blister as counting unit on all tools The StopPalu+ team proposed to use the tools already available and used by the CHWs because this will ensure that these data will be included in the health facility data and will facilitate the stock management at the end of the month. Training manuals • Include the other health activities (vaccination, integrated management of childhood and newborn illnesses [ICMNI]) in the existing training manuals Supervision and monitoring tools • Include the other health activities (vaccination, ICMNI) in the training manuals in existing tools (monitoring was done only in the PMI districts) Communication tools • Include SBCC messages about the other health activities (vaccination, ICMNI) • Include key messages on COVID-19 prevention measures During the validation meeting for these tools (done by teleconference), the participants recommended to not change the SBCC tools because of the lack of time to revise and produce these materials before the beginning of the campaign. It is important to mention that because of COVID-19, the borders and airports are closed; therefore, there is a high risk of a stock-out of supplies needed to produce these materials.
46 StopPalu+—Quarterly Report—January to March 2020 3.4.2 SUB-IR 4.2: INCREASED AVAILABILITY OF SMC (SP+AQ) AND COMMODITIES FOR CONTINUOUS AND MASS DISTRIBUTION DURING HIGH-TRANSMISSION SEASON IN TARGETED DISTRICTS During Quarter 2, StopPalu+ implemented the following activities: Activity 4.2.1. Support macro- and micro-planning for SMC campaigns During Quarter 2, the NMCP organized a 3-day annual planning workshop in Conakry to determine district SMC needs. The workshop included estimating SMC drug amounts (SP+ amodiaquine [AQ]), number of health care workers and volunteers (mostly CHWs) to be included in the campaigns and their training and supervision needs, as well as the range of communication and management tools to sensitize and mobilize communities and implement and monitor SMC. During the workshop, the participants developed an action plan for the timeline for the four rounds of SMC to be conducted in 2020. The first distribution round is planned for July 3–7, 2020. The plan took into account compliance with the COVID-19 prevention barrier measures for the implementation of SMC 2020 activities: 1. Less than 20 people for training sessions with respect of 1m between participants 2. Reduce the number of participants who will attend the synthesis meetings after each round 3. Postpone the integration of new activities that were planned (such as vaccination monitoring, ICMNI activities, etc.) 4. Distributors and supervisors will be provided with gloves and masks Activity 4.2.2 Coordinate procurement and distribution of SMC commodities During Quarter 2, StopPalu+ participated in the various meetings of the NMCP Supply Chain Technical Working Group (TWG) to discuss malaria commodities procurement, distribution, and use at all levels. During the March monthly meeting, the PSM project and CRS confirmed that the SMC drugs that were planned for the 2020 campaign are expected to arrive in country on time, with no delay despite the COVID-19 pandemic. Activity 4.2.4 Support annual workshop to present campaign results On January 2020, the project supported the NMCP to organize a 2-day information-sharing workshop in Conakry to share the 2019 SMC results (see Figure 14), the 2019 mass LLINs distribution campaign, best practices, and lessons learned, and to adapt strategies and methods for the next campaigns, as needed. General objective: Share the results and lessons learned from the four rounds of the 2019 SMC campaign with the different stakeholders and make recommendations to improve the 2020 campaign.
StopPalu+—Quarterly Report—January to March 2020 47 Figure 14: 2019 SMC coverage rate per round and per district
140
120
100
80
60
40
20
0
Passages CPS1 Passages CPS2 Passages CPS3 Passages CPS4
It is important to mention that for the 2019 SMC campaign, three rounds were done in the 8 districts supported by PMI because of the delay in getting FY 2020 funds. The coverage survey conducted by the University of Conakry with the support of the London School showed the results below:
Figure 15: SMC coverage per round (cycle) % received SMC % received % did not at least once SMC four times receive SMC Dinguiraye, Gaoual, Koubia, Koundara, 96.1% 11.1% 3.9% Mali, Tougue Labe, Lelouma 99.4% 1.1% 0.6% Dabola, Kankan, Kouroussa 92.9% 70.9% 7.1% Siguiri, Mandiana 63.8% 41.5% 36.2% TOTAL 85.5% 41.4% 14.5%
Strengths of the previous SMC campaign • Stakeholder engagement at all levels • Involvement of all the Health District’s team • Training of all actors on time • Positive contribution of monitoring to data quality • Comparison of the data reported to the DPS and the ones in the primary data collection tools • Leverage SMC campaigns for follow-up on other malaria services.
48 StopPalu+—Quarterly Report—January to March 2020 Areas needing improvement • Stock-out of SMC drugs for children 12 to 59 months • Under-estimation of target population in mining districts (GF districts) • Insufficient number of social mobilizers in some districts • Insufficient filling out of reference cards, registers, and SMC cards • Insufficient communication materials in households • Low motivation of community distributors
After the end of the workshop, the participants recommended the following: • Improve stock management • Monitor the correct filling out of supervision tools by the health center supervisors • Conduct a refresher training for distributors after the second round • Increase the number of distributor agents when considering hard-to-reach locations
3.4.3 SUB-IR TRANSVERSAL 1. INCREASED COMMUNITY INVOLVEMENT IN AND SUPPORT FOR MALARIA PREVENTION AND CARE During Quarter 2, FY 2020, to increase community involvement and support for malaria prevention and care, StopPalu+ implemented the following activities: Activity T1.1 Support implementation of the Community Mobilization Plan
Support CAG activities During Quarter 2, as part of the community mobilization strategy, the project continued to support CAG members to organize advocacy actions and community dialogues. CAGs represent a concentrated group committed to the improvement of malaria and other health indicators through community education. Each CAG is composed of 10 members, representing various populations and sectors in the community: the social mobilizer of the Health and Hygiene Committee (CSH) (youths or women), the head of the health center, a representative of the women’s or youth CBOs, a religious leader, a traditional healer, a representative of the environment, a local elected representative (another advisor different from the head of the CSH), one CHW, an education representative, and a representative of the local child protection committee. For this quarter, the CAGs organized 76 community dialogues (Boké 23, Conakry 7, Kindia 23, and Labé 23). At the end of the dialogues, the CAG members, with the support of the project, initiated 57 advocacy actions (23 in Boke, 4 in Conakry, 17 in Kindia, and 13 in Labé).
StopPalu+—Quarterly Report—January to March 2020 49 Successful CAG advocacy (#1) The CAGs of the Hafia health center conducted one advocacy action that succeeded. To help the health center find a solution to one of their major problems, the lack of running water, the CAG members, with the support of project team, conducted an advocacy action targeting religious leaders at the mosque to allow the health center to be connected to the mosque’s fountain and the head of the health center to pay for the installation. After the meeting with the two parties, they all agreed. Hafia health center has running water since March 25, 2020. Running water in the ANC unit, Hafia health center
Successful CAG advocacy (#2) On February 16 and March 15, under the leadership of the CAG members, two actions to clean the ditches took place in Dixinn district 1 and near the Dixinn mosque. This action, highly praised by the local authorities, led to the citizens giving their commitment to ensure that the cleaned sites are kept clean.
Cleaning of Dixinn Bora ditches near the youth center
The CAGs of the region of Labé conducted several home visits to promote regular and correct use of LLINs. In Boké and Kindia Regions, the CAG members conducted home visits to verify and promote regular and correct use of LLINs and organized sanitation activities. Activity T1.2 Support implementation of the Malaria SBCC Plan During the reporting period, based on the SBCC plan developed in FY 2019, StopPalu+ developed and produced new materials (storyboard, posters, radio and television spots). These materials are disseminated in all the prefectures and communes supported by the project.
50 StopPalu+—Quarterly Report—January to March 2020 3.4.4 SUB-IR TRANSVERSAL 2: IMPROVED CAPACITY OF NMCP (CENTRAL, REGIONAL, DISTRICT) TO MANAGE, IMPLEMENT, AND MONITOR PREVENTION, CARE, AND TREATMENT ACTIVITIES During Quarter 2, FY 2020, to improve the NMCP’s capacity, StopPalu+ continued to support coordination activities as well as monitoring and surveillance. Activity T2.1 Support NMCP coordination capacity During Quarter 2, StopPalu+ implemented the following activities: Support and facilitate MOH TWGs’ meetings The project continued to support and facilitate TWGs’ monthly meetings. Each TWG reviewed the implementation of their action plan and evaluated the level of implementation. It is important to mention that many activities planned for this reporting quarter were not implemented because most of the teams were busy writing the country GFATM proposal (2021–2023). In addition to the proposal, the main topics discussed during this quarter were the stock-out of commodities in the health facilities, the use of the remaining nets procured by AMF, the training of national SBCC trainers, and the celebration of 2020 World Malaria Day.
Meeting of the Case Management TWG Meeting of the Stock management TWG
Workshop to develop the 2020 annual work plan of the NMCP From January 16 to 18, 2020, the NMCP organized a workshop in Kindia to develop its annual work plan. A total of 41 participants from the NMCP, CRS, StopPalu+, GHSC-PSM, Plan Guinea, Child Fund, DRSs, and DPSs attended this workshop. After the presentation of the scope of work for the working groups and the new template of the annual work plan recommended by the MOH, which is different from that used by the NMCP in previous years, the participants were divided into the six following groups: • Group 1: Prevention • Group2: Support • Group 3: Supply and Stock Management • Group4: Communication • Group5: Monitoring and Evaluation • Group 6: Program management / Partnership The various working groups were asked to review the activities of the 2019 Operational Plan and identify those not carried out in 2019, explain the reasons for not carrying out these activities, renew/plan these activities in the 2020 work plan, describe the implementation
StopPalu+—Quarterly Report—January to March 2020 51 methods for each activity, and finally develop the scopes of work and budgets for these activities. At the end of the 3-day workshop, the documents from the working groups were compiled to make an annual and quarterly action plan for the NMCP. • Reinforce the integration of private health facilities. During Quarter 2, the project team organized a training of new providers in Conakry. Among the 29 participants, 13 were from private health facilities. The project conducted the supervision of many private health facilities that are integrated by the NMCP. During the supervision sessions, the project team took the opportunity to conduct on-site trainings and correct weaknesses that were found. • Support the NMCP to organize World Malaria Day events. During the reporting period, the project, in collaboration with other partners involved in malaria control activities, supported the NMCP to plan activities for the 2020 World Malaria Day celebration. Because of the COVID-19 restrictions, the NMCP and its partners proposed to use radio and television programs to celebrate the event and avoid any social mobilization. The actors agreed in the following activities: − Television spot with the commitment of national authorities (ministers, religious leaders, civil society members, etc.) to support the fight against malaria − A radio and television spot to announce the World Malaria Day and theme of the year: “Zero malaria starts with me.” − Produce some tee-shirts and banners with the theme of the day • Support DRS and DPS biannual coordination meetings. During Quarter 2, the project supported these meetings in the project coverage areas. Each health directorate presented results of health activities in its prefecture or region to all the actors, partners, and stakeholders. Participants discussed the trends of most diseases, the results of the monitoring of health facilities, and evaluation of the level of implementation of action plans. In all the regions, for malaria, each partner also presented its activities and shared the challenges faced and lessons learned. These meetings helped improve coordination at all levels. • Support NMCP to develop the GFATM proposal for 2021–2023. During the reporting period, one major activity supported by the project was to support the NMCP develop the GFATM proposal for 2021–2023. The project team was part of the proposal team; StopPalu+ also supported the cost of some workshops to develop the malaria and health system strengthening proposals and the national consultant. From January 27 to 31, 2020, the project supported the NMCP to organize a 5-day workshop in Coyah to develop the first draft of the proposal. A total of 50 participants attended this workshop. Participants were representatives from the MOH (DNGLM, BSD, IGL, PCG, Community Health), ICN, CRS, StopPalu+, Human Resources for Health 2030 (HRH2030), GHSC-PSM, USAID, MSF, civil society, Plan Guinee International, and Child Fund. The objectives of this workshop were as follows: • Develop an improved version of the funding request and continue the country dialogue with the participation of civil society members, the ICN, programs, the various ministerial departments concerned and technical and financial partners. • Finalize the description of the activities by module as well as their budgetary assumptions. The national consultant explained the working methodology to allow all participants to be sufficiently equipped with the working method.
52 StopPalu+—Quarterly Report—January to March 2020 To achieve the objectives of the workshop, a total of six working groups were formed around the following themes: • Group 1: Context and funding landscape • Group 2: Vector control • Group 3: Management • Group 4: Specific interventions • Group 5: Program management • Group 6: Strengthening the health system For each group, it was asked to write one module in accordance with the instructions in the funding request. The work itself was marked by two steps: 1. Read the narrative of the request followed by modification if necessary 2. Propose the list of activities per intervention, describe each activity, and estimate the budget At the end of the work group sessions, the representative of each group presented their work in plenary, and the rest of participants made their comments and the following recommendations were made for each group: Context and Financial Contribution Group: A request was made to update certain data on vector control and add the other partners who were not there with regard to the financial investment for malaria. Data from GFATM, USAID, WHO, World Bank, MSF are available in the file. Vector Control Group: After a sustained debate on several points presented by the group, the participants recommended to include the lessons learned from the 2016 and 2019 campaigns and increase the number of distribution days from five to seven days and to explain more on the larvae control (chemical and physical) by introducing into the narrative a clear description of the method to be proposed. Use epidemiological data to demonstrate how to lead the country towards pre-elimination in the specific area of prevention, improve the synthesis of distribution data at the health center levels, maintain prefectural synthesis meetings, and cancel regional synthesis meetings. Cancel the recruitment of national consultants at the regional level. Case Management Group: In accordance with the remarks made at the end of the presentation, the participants recommended to the case management group to clearly indicate how to reinforce the capacities of the health workers and CHWs to replace repetitive formal trainings, to describe the key populations in the narrative, use the audit report from the MOH to describe what has been said about the General Health Inspectorate, and harmonize the community health approaches of the Community Health Directorate and the NMCP to avoid redundancies. Specific Interventions Group: For this group, the participants recommended to harmonize case management and IPTp interventions at the health center and health post levels; comply with WHO guidelines for the revision of normative documents, explore innovative strategies such as digital health (ICT4D), increasing the number of months for SMC, and try to do IPTp. The use of SMS (rather than telephone calls) to remind pregnant women about their ANC visits has been used in Guinea with good results. Program Management Group: Specifically, the issue that was the subject of real discussion was the management of focal points. In discussions, it was announced that the MOH is in the process of hiring 38 malaria focal points. To this end, some participants asked the NMCP to make a transition plan pending the effectiveness of this initiative.
StopPalu+—Quarterly Report—January to March 2020 53 The workshop recommended that the group emphasize the flexibility of the Zero Cash policy in the narrative and include gender in all aspects of malaria control. Health System Strengthening Group: For this last presentation, the participants recommended to clearly define the priorities while knowing that the budget is limited, review the context and the national needs by emphasizing lessons learned, and determine what will be addressed by GFATM during the workshop in February in Nairobi.
The opening ceremony at Coyah Participants during the group work
This workshop helped develop an improved version of the funding request with the participation of all stakeholders. At the end of the workshop, the NMCP decided that a small group will continue to work on the proposal and the annexes the following week at StopPalu+ office. The project supported these meetings. From March 10 to 19, the Chief of Party participated in a workshop in Dakar, Senegal, to finalize the proposal as well as the budget and all the annexes. During the 10 days of work, the participants reviewed the project description, the list of activities, the table of performance, and the budget. The team also helped integrated the GFATM country team feedback into the documents. On Friday, Mar 20, the NMCP presented the proposal to the ICN to receive their last feedback before the submission on March 21. Activity T2.2 Support M&E surveillance and research StopPalu+ implemented the following: • Improve M&E data quality analysis (DQA) and use at the national level and among statistical analysts at the regional and district levels: To improve the quality of data collected at the health facility level, the project organizes monthly DQAs in project- supported facilities. Conducting DQAs has helped improve the quality of data and reduce discrepancies between data reported by the health facilities and those in the primary data collection tools. • In the region of Boké, the project team conducted DQA in 23 health centers. Only the health centers of Sareboido and Sambailo (Koundara) had small discrepancies in January 2020 between data reported and those in the primary tools. • In the region of Conakry, among the 25 health facilities where the DQA was conducted, only the CMC Kouchner had a large discrepancy between data reported and those in the primary tools. The team was very happy to note that the 21 public health centers supervised had 100% concordances in the reported data. • In the region of Kindia, the project team conducted DQA in 19 health centers. Only the health center of Bokaria had a large discrepancy in January 2020. The health posts of Sory Oulah et Tambayah had small discrepancies in February 2020 between data
54 StopPalu+—Quarterly Report—January to March 2020 reported and those in the primary tools. The team noted that the big health centers that have more than 1,000 patients per month such as Maneyah, Sanoyah, and the urban health centers of Mafoudia and Khorira, had very good data quality this quarter. • In the region of Labé, the project conducted DQA in 22 health facilities; only Daralabe and Fafabge had small discrepancies. The team noted a big improvement in data quality in the region. The results of the DQA in each district are presented during the monthly monitoring meetings. Health facilities with discrepancies are asked to give the reasons and commit to avoid such situation during the next months. Support the monthly monitoring meetings at both health facility and district levels During the reporting period, the project supported 465 health centers’ monthly monitoring meetings and 57 DPS monthly monitoring meetings. During these meetings, malaria data are collected, reviewed, analyzed, and validated by the participants. It is important to mention that for the meeting at the end of the March 2020, the project team had found ways to conduct these meetings while following prevention measures as recommended in the context of the coronavirus pandemic. In some health centers and DPSs, the meetings have to be held over two days to be able to adhere to the norm of less than 20 people per meeting with at least 1 m of distance between the participants. It is important to mention that for the reporting quarter, the 19 health districts/communes supported by the project had more than 100% of completeness and 98% of timeliness in the submission of monthly malaria reports.
Monthly meeting at Benty health center Monthly meeting at the DPS of Koubia
Support the NMCP to transition from the WinDev database to the DHIS 2 During the reporting quarter, as since the beginning of FY 2020, the StopPalu+ team is using the District Health Information System 2 (DHIS 2) for the monthly monitoring meetings. The team works with the DPSs/DCSs to ensure that all the malaria reports are entered in the DHIS 2 before the date of the meetings. During the meetings, the team reviews the data in the DHIS 2 for each health facility, analyzes the data, and makes any appropriate change. During the month of March 2020, the project team worked with the SNIS to update the list of health facilities that are integrated by the NMCP and submit their monthly report in the districts supported by PMI. This has helped improve the completeness in malaria reporting and reduced the differences between the data in the WinDev database and the DHIS 2. • Support the national supervision system. During Quarter 2, StopPalu+ provided financial and logistical support to the DPSs of the region of Labé for supervision activities at the health facility and community levels. Please see Activity 3.1.6 for more details. • Conduct periodic health facility and community visits in areas with high incidences of malaria. During the reporting period, the project conducted community visits in health
StopPalu+—Quarterly Report—January to March 2020 55 facilities in the four regions covered by the project. In the Boké Region, a total of 2,280 households were surveyed in the 5 prefectures of the region. In the 3 prefectures of Kindia Region supported by the project, a total of 781 households were surveyed. In the Labé Region, a total of 1,650 households were surveyed in the 5 prefectures of the region. During these visits, the teams assessed the availability and use of LLINs (see Activity 1.2.4 for more details), community knowledge about malaria, and the frequency of CHW visits to households. Results of the CHWs visits: Region of Boké Among the 5 districts of the regions where households were visited, Koundara and Fria had the highest number of households that received CHW visits (100%) during the month preceding the survey, followed by Boke (98%). Boffa had the lowest rate with 92% (Figure 16). The team will increase the supervision of CHWs in this district, especially in the health centers that had the lowest rates. In regard to the households’ level of knowledge about malaria, the districts of Koundara had the highest rate with 99% of correct answers, followed by Gaoual (88%). Boffa had the lowest rate with 92% (Figure 17). Figure 16: % of households who received a CHW visit during the previous month (Boké)
100 100 100 98 98 96 96 Boffa 94 92 Boke 92 Fria 90 Gaoual 88 Koundara 86 % de menage visité par RECO Boffa Boke Fria Gaoual Koundara
Prefectures of Boke region
Figure 17: % of households who have a good knowledge about malaria (Boké)
99 99 100 98 96 93 Boffa 94 92 92 Boke 89 90 Fria 88
% de %menage de Gaoual 86 84 Koundara 82 Boffa Boke Fria Gaoual Koundara Prefectures of Boke region
56 StopPalu+—Quarterly Report—January to March 2020
Region of Kindia Among the 3 districts of the region where households were visited, Dubréka had the highest number of households that received CHW visits (94%) during the month preceding the survey, followed by Forécariah 90%. Coyah had the lowest rate with 73% (Figure 18). The team will increase the supervision of CHWs in this district, especially in the health centers that had the lowest rates. In regard to the households’ level of knowledge about malaria, the district of Dubréka had the highest rate with 96%, followed by Coyah (94%), and Forécariah had the lowest rate (90%) (Figure 19). Based on these visits, CHWs (80%), radio (42%), and NGO field agents (32%) are the most-used communication channels in the region (Figure 20).
Figure 18: % of households who received a CHW visit during the previous month (Kindia)
94% 90% 86% 100% 73%
80%
60%
40%
20%
0% Coyah Dubreka Forecariah Total
Figure 19: % of households who have a good knowledge about malaria (Kindia)
96% 94% 98% 93% 96% 94% 90% 92% 90% 88% 86% Coyah Dubreka Forecariah Total
StopPalu+—Quarterly Report—January to March 2020 57 Figure 20: % of households that reported that they received malaria information through these main channels (Kindia)
100% 80% 49% 50% 31% 34% 17% 26% 19% 0% 0%
Region of Labé Among the 5 districts of the region where households were visited, Koubia had the highest number of households that received CHW visits (100%) during the month preceding the survey, followed by Lélouma 97%. Mali had the lowest rate with 86% (Figure 21). The team will increase the supervision of CHWs in this district, especially in the health centers that had the lowest rates. Based on these visits, CHWs (66%), radio (20%), and NGO field agents (7%) are the most-used communication channels in Labé Region (Figure 22).
Figure 21: % of households who received a CHW visit during the previous month (Labé) 105.00%
100.00% 100.00% 96.97% 95.21% 95.94% 95.00%
90.00% 86.14% 85.00%
80.00%
75.00% Labé Tougué Lélouma Mali Koubia
58 StopPalu+—Quarterly Report—January to March 2020 Figure 22: % of households that reported that they received malaria information through these main channels (Labé) 70% 66% 60% 50% 40% 30% 20% 20% 7% 10% 3% 0% 2% 2% 0% 0%
Organize mobile clinic During the reporting period, to increase access of malaria services to the communities who are hard to reach, the project team organized some mobile clinics. In the region of Boké, the health centers of Koulifanya (district of Boké) and Koba (district of Boffa) benefited from these activities. A total of 102 suspected cases (42 in Boké and 60 in Boffa) were tested, 30 positives (13 in Boké and 17 in Boffa), and all positive cases were treated. In the region of Labé, the mobile clinics were organized in Lombonna health center and the Serima health posts. A total of 18 suspected cases were tested with zero negative. In the region of Conakry, to celebrate International Women’s Day, RTI/StopPalu+ women organized a social mobilization event combined with a mobile clinic to provide malaria prevention and treatment services to people with disabilities who live at the City of Solidarity of Conakry on March 4, 2020. This city is in the commune of Ratoma and shelters poor and people with disabilities whose primary source of income is mendicity. According to the last 2016 census, the city has 116 families with 729 people. During the event, the RTI team carried out the following: • Disseminated key malaria control messages to 422 people • Visited all the households of the city and found that 118 LLINs were available, among which 86 were hung • Tested 59 people with fever, and 4 were positive (2 children under 1 year, a teenage girl, and an elderly woman) • Noted that 60 children slept under a net the previous night The beneficiaries were very happy with the visits, and they committed to follow the key health behaviors—the correct and regular use of LLINs, early care-seeking, going to ANC visits (for pregnant women), and environmental sanitation. The leader of the city also informed the RTI team about a second city located in Koloma. They recommended that the team visit that city and provide the same services for these vulnerable people too.
StopPalu+—Quarterly Report—January to March 2020 59
StopPalu+ senior technical advisor using an RDT for City members attending the awareness-raising event a child who has a fever
4 PROJECT MANAGEMENT ACTIVITIES
4.1 PROJECT DELIVERABLES During the reporting quarter, the project team continued to work with USAID team to review the project’s FY 2020 work plan and budget and to propose some activities to cut in order to enable the project to continue implementation up to December 2020 with the FY 2019 obligated funds. The following activities were reduced: • Training of health workers and CHWs • The number of supervisions of DRSs/DPSs • The number of entomology site visits The activities below were postponed to FY 2021: • KAP survey • Training of new CHWs • Standards-based management–recognition activities The project reviewed the work plan and the budget accordingly and submitted to USAID for approval on February 5, 2020. The work plan and budget were approved on February 14. Support the development of Global Fund—USAID/Guinea Operational Collaboration Framework In addition, the project worked with PMI and GFATM to finalize the Global Fund-- USAID/Guinea Operational Collaboration Framework considering the substantial increase in the malaria allocation from US$58 million to US$72 million under the 2020–2022 Funding Cycle from the Global Fund and the technical expertise of both donors. Objective: The purpose of this collaboration framework is to outline the primary support of each donor and their implementing partners. The following points of the framework will affect StopPalu+ geographic coverage and scope of work. • USAID/Guinea’s PMI activities will cover 18 districts starting from April 2020 (down from 19); and Global Fund’s malaria activities will cover 20 districts starting from April 2020 (up from 19). The prefecture of Dinguiraye will be supported by GFATM.
60 StopPalu+—Quarterly Report—January to March 2020 • SMC: USAID/Guinea’s PMI SMC coverage will remain unchanged with support to seven (7) health districts: Lélouma, Labé, Gaoual, Koundara, Mali, Tougué, and Koubia; Global Fund’s SMC support will cover 10 districts: Siguiri, Mandiana, Dabola, Kouroussa, Kankan, Faranah, Mamou, Pita, Dalaba, and Dinguiraye (new); MSF/Belgium will self-finance SMC in Kouroussa (including SP+AQ) and hold a 5th round in Kouroussa as a pilot. • Institutional support: Global Fund and USAID agree to the importance of supporting the NMCP and the central planning department (BSD) to reform their training and supervision activities. Current trainings include training of trainers, and multiple vertical training of new recruits and retraining of existing and aging health services providers. The regional consultations that were held at the regional level during the 2020 country dialogue process highlighted the need to substantially improve the quality of the trainings and their follow up • Institutional support to strengthen the NMCP: Both Global Fund and USAID have conducted a capacity assessment and begun implementation of a capacity-building plan for NMCP. Both partners will review these assessments and plans to determine what are the most effective next steps. An audit will be implemented if needed. • Global Fund has agreed to fund NMCP running costs while both partners will continue advocacy work with the MOH for them to assume these costs in addition to filling key positions at the program. USAID and Global Fund will discuss the division of labor for NMCP capacity building on an annual basis during MOP development. The project has requested a formal notification from USAID to cease the support to the district of Dinguiraye and mentioned it in the finalized Global Fund--USAID/Guinea Operational Collaboration Framework. The AOR is working on it. Staffing and Human Resources (HR) Staff recruitment. During the reporting period, RTI advertised the job description for the recruitment of three malaria focal points for the prefectures of Dubréka, Forécariah, and Gaoual to replace the previous staff members who resigned. The project has received almost 50 CVs and plans to finalize the process during the next quarter. The project has also started the recruitment process for the HR Officer and will finalize that during the next quarter. All staff recruited will benefit from an orientation to explain the roles and responsibilities of different staff members, the project’s harmonized approach for successful implementation, and a gender training on how to integrate gender considerations into all project activities. Internal Pause-and-Reflect sessions. During the reporting quarter, StopPalu+ regional offices conducted an internal Pause-and-Reflect session that included a thorough examination of StopPalu+’s M&E data as well as the activities implemented to respond to the project learning questions. During these sessions, the following actions were taken: 1. Evaluation of the level of implementation of the quarter action plan: January–March 2020 2. Exchanges on the difficulties encountered during the quarter for the implementation of activities 3. The filling of MERLA Templates from the reporting quarter of January to March 2020 4. Presentation of key indicators overdue in the Region 5. Information sharing on COVID-19
StopPalu+—Quarterly Report—January to March 2020 61 At the of the sessions, the following recommendations were made: 1. Closely monitor the supply of health facilities with anti-malaria drugs 2. Increase supervision of community activities to identify non-performing CHWs and health facilities 3. Promote the referral of pregnant women to the ANC units 4. Ensure the support and follow-up of monthly meetings 5. Provide the CHWs with enough quantity of anti-malarial commodities (RDTs, ACT, gloves, cotton) 6. Make the list of the health posts recognized by the health districts and which report monthly data 7. Explain the adjustment system for a better understanding of this topic 8. Explain the strategies to use to improve the quality of home visits and the referral of malaria cases in the community 9. Strengthen collaboration between heads of health centers and NGO field agents
Pause and Reflect session in Kindia Pause and Reflect session in Labé
Procurement During Quarter 2, after the validation of the SMC 2020 data collection tools and communication materials, the project began the procurement process of these tools. The project also worked with the home office to procure the PCR equipment and reagents for the insectary. However, we expect some delays due to the COVID-19 pandemic. Partnership Collaboration with local NGOs. During Quarter 2, StopPalu+ continued to work with the field agents of the six local NGO partners. These NGO field agents supported the project in implementing BCC activities and supervision and monitoring of health centers and CHWs. The NGOs are the following: Association pour la Promotion des Initiatives Communautaires (APIC) Association pour la Promotion de la Santé en Guinée (APROSAG) Club des Amis du Monde (CAM) Comité des Jeunes Mon Avenir D’abord (CJMAD) Initiatives et Actions pour l’Amélioration de la Santé des Populations (INAASPO) Solidarité Guinéenne pour le Développement (SGPD)
62 StopPalu+—Quarterly Report—January to March 2020
5 OTHER ACTIVITIES
Participation in the review of the contingency plan for malaria control activities in the COVID-19 context In order to maintain the implementation of malaria control activities in the context of the COVID-19 pandemic, the NMCP, in collaboration with its partners, developed a mitigation plan taking into account the prevention of SARS-COV infection. To develop the plan, the participants used the guidelines from PMI and WHO. The proposed mitigation activities by malaria intervention are as follow:
Table 7: Proposed COVID-19 mitigation activities Intervention Reduction Measures Recommendations Case management • Provide health workers and • Ensure that the COVID-19 prevention CHWs with protective equipment messages will not weaken the early care- • Harmonize motivation bonuses seeking. to retain health workers and • Collaborate with the ANSS and the CHWs national directorate of community health to give key messages to health workers and CHWs. • Schedule a meeting with DNGEM, NMCP, ANSS, and partners Capacity building • Postpone investigation activities • Prefer teleconferences instead of face-to- and monitoring of according to the evolution of the face meetings the implementation pandemic • Reduce supervision and training to a of interventions • Increase the number of training minimum (review, sessions • Communicate with DRS / DPS / DCS by supervision, • Limit the number of participants teleconference training, meeting, per session to 20 with respect for survey) barrier measures • Provide distributors with • Plan all stages of implementation prevention kits • Follow the evolution of the pandemic to SMC • Comply with barrier measures at decide whether to maintain or postpone all stages of the process • Reduce all new activities during the campaign • Conduct monthly physical • Make available enough stock at the inventories facility level • Anticipate supplies to structures • Consider possible delays at international • Introduce a new therapeutic line level for the case management • Stock management Assistance from neighboring countries in the event of a stock- out at national level • Presumptive treatment according to the evolution of the pandemic • Internal and external adjustments IPTp and LLINs • Comply with preventive barrier • Avoid direct contact during administration measures • Provide facilities with SP uptake kits • Strengthen communication
StopPalu+—Quarterly Report—January to March 2020 63 6 MAIN ACTIVITIES FOR THE NEXT QUARTER • Support the use of SMS to remind pregnant women about their ANC visits • Conduct refresher trainings for health providers • Conduct refresher training for CHWs on malaria case management • Conduct microplanning and training for SMC campaign • Support the NMCP to organize the 2020 World Malaria Day • Conduct SBCC activities
64 StopPalu+—Quarterly Report—January to March 2020 ANNEX 1: PERFORMANCE REPORT FOR QUARTER 2, FY 2020 (JAN–MARCH 2020) FY20 Data FY20-Q1 FY20-Q2 FY20-Q3 FY20-T4 annual Indicators Source Baseline achieved achieved achieved achieved target Notes PROJECT LEVEL INDICATORS All-cause mortality rate This indicator will be in children under 5 years EDS/ 60 for reported in Quarter 4 AL1 66(EDS2018) NA NA of age (U5) (per 1,000 MIS thousand with the results of MIS live births) 2020 Prevalence (children aged six to 59 months This indicator will be with malaria infection 15% (MICS reported in Quarter 4 AL2 EDS/MIS NA NA 10% confirmed by microscopy 2016) with the results of MIS and/or rapid diagnostic 2020 text [RDT]) IR1: Increased use of LLINs by the population This indicator will be % of pregnant women 28.1% reported in Quarter 4 1.1 who slept under an LLIN EDS/MIS/ NA NA 50% (EDS18) with the results of MIS the previous night* 2020 % of children U5 who This indicator will be slept under a long-lasting 26.6% reported in Quarter 4 1.2 insecticide-treated net EDS/MIS/ NA NA 50% (EDS18) with the results of MIS (LLIN) the previous 2020 night* This indicator will be Proportion of Population reported in Quarter 4 1.3 with Access to an ITN EDS/MIS/ NA NA TBD with the results of MIS within their Household 2020 # of LLINs purchased This indicator will be with USG funds and Project reported in FY 2022 1.4 1,335,000 NA NA distributed through a records (no mass campaign in mass campaign 2020) # of LLINs purchased by This indicator will be other donors and Project reported in FY 2022 1.5 distributed with USG 2,111,150 NA NA records (no mass campaign in funds through a mass 2020) campaign
StopPalu+—Quarterly Report—January to March 2020 65 FY20 Data FY20-Q1 FY20-Q2 FY20-Q3 FY20-T4 annual Indicators Source Baseline achieved achieved achieved achieved target Notes During the reporting period, 42,267 LLINs were distributed in the health centers through ANC and EPI services # of LLINs distributed Reports on in the 4 regions and 1.6 through routine health 606,126 40,447 42,267 240,000 the prefecture of distribution (ANC, EPI) facilities Dinguiraye supported by PMI: Boké: 3,972; Kindia 9,838; Labé: 10,528; and Conakry: 17,399 # of persons trained in LLIN distribution, micro- A total of 112 health Project planning, enumeration, 112 (38 workers received 1.7 training 33,661 39 (3) 200 distribution, hang-up, women) training on the LLIN reports and/or promotion using distribution: USG funds % of persons who recall This indicator will be hearing or seeing LLIN 1.BCC. KAP 19.4% (KAP reported in FY 2021 use and maintenance NA NA 50% 1 survey 2018) with the results of the messaging within the last KAP survey 6 months IR2: Increased use of intermittent preventive treatment of malaria in pregnancy (IPTp) during antenatal visits % of pregnant women This indicator will be who received at least 35.5% (EDS reported in quarter 4 2.1 three doses of SP during EDS/MIS/ NA NA 50% 2018) with the results of MIS their last pregnancy* 2020 (survey) % of pregnant women who received at least Health This indicator will be 2.2 three doses of SP during facility 67,02% NA NA 60% reported in Quarter 4 their last pregnancy* reports FY 2020 (routine) 448 (103 199 (23 During this quarter, women), women).39 the project trained 448 # of health workers Project 112 (38) heads of people including 103 2.3 trained in IPTp with USG training 3,630 health 1255 post and women on malaria funds* reports workers 160 (20) case management and 336 CHWs including IPTp. (65) CHWs
66 StopPalu+—Quarterly Report—January to March 2020 FY20 Data FY20-Q1 FY20-Q2 FY20-Q3 FY20-T4 annual Indicators Source Baseline achieved achieved achieved achieved target Notes % of persons who recall This indicator will be 2.BCC. hearing or seeing KAP 34% (KAP reported in FY 2021 NA NA 45% 1 malaria-in-pregnancy survey 2018) with the results of the messaging KAP survey IR3 Increased prompt care seeking and treatment During the quarter In progress, the project trained 336 new % of community health CHWs including 65 Project 77.40% 77.40% workers (CHWs) capable 77.40% women on RDT use 3.1 training (2,105/ (2,105/ 85% of using RDTs at the (2,105/2,720) Previously 2,035 reports 2,720) 2,720) household level* CHWs had benefited from the training. Total 2,105 of the 2,720 planned During the reporting period, in the 14 prefectures and 5 communes of Conakry % of patients (all ages) (project coverage who tested positive (via area), 107,393 people microscopy or RDT) and Reports 97.14% 97.91% tested positive for 3.2 who received an from health 99.31% (217,764/ (105,149/ 97% malaria; among those, effective anti-malarial as facilities 224,181) 107,393) 105,149 received an reported by health effective anti-malarial. facilities* (Please note that these data are collected by health facilities).
StopPalu+—Quarterly Report—January to March 2020 67 FY20 Data FY20-Q1 FY20-Q2 FY20-Q3 FY20-T4 annual Indicators Source Baseline achieved achieved achieved achieved target Notes During the reporting period, in the 14 prefectures and 5 communes of Conakry (project coverage % of patients with area), there were suspected malaria who Reports 99.83% 97.81% 98.95% 291,876 suspected 3.3 received a diagnostic from health (236,290/ (397,670/ (288,806/ 99% malaria cases; among test (microscopy or facilities 236,701) 406,564) 291,876) those, 288,806 RDT)* received malaria tests. (Please note that these data are collected by health facilities) During the supervision of project staff and national supervisors in % diagnostic tests the regions of Labé, (microscopy and/or RDT) Project 88% Boke, Conakry, and 3.4 89% (250/280) 86% 90% interpreted correctly records (74/84) Kindia, 147 slides (positive – negative)* were read. 126 slides were interpreted correctly—86% correct detection rate. 506 (122 The project trained women), 506 health workers 199 (23 112 (38) (122 women) on # of health workers women).39 Project health malaria diagnosis: trained in malaria heads of 3.5 training 4,174 workers, 1327 112 health workers laboratory diagnostics post and reports 336 (65) (38 women), 336 with USG funds* 160 (20) CHWs and CHWs (65 women), CHWs 58 (19) lab and 58 lab technicians techs (19 women)
68 StopPalu+—Quarterly Report—January to March 2020 FY20 Data FY20-Q1 FY20-Q2 FY20-Q3 FY20-T4 annual Indicators Source Baseline achieved achieved achieved achieved target Notes
448 (103 women), 199 (23 83 (24) In total, the project # of health workers women), Project heads of trained 448 health trained in case 39 heads 3.6 training 4,423 post, 29 1,255 workers (103 women) management with ACT of post, reports (14) health on malaria case with USG funds* and 160 workers management (20) CHWs and 336 (65) CHWs
# of children under 5 During this quarter, who test positive for Health CHWs were able to malaria and receive 8,862 5,368 3.7 facility 121,474 60,000 treat 5,368 children treatment from a (4,460) (2,700) records under 5 against community health worker malaria (CHW) During this quarter, # of children under 5 that the CHWs referred for test positive for malaria Health treatment 38 children 3.8 and are referred by a facility 912 54 (29) 38 (20) 900 under 5 years who community health worker records tested positive for for treatment at a facility. malaria % of respondents who This indicator will be recall hearing or seeing 3.BCC. KAP reported in FY 2021 an early care seeking 17.2% NA NA 35% 1 survey with the results of the and treatment malaria KAP survey message
StopPalu+—Quarterly Report—January to March 2020 69 FY20 Data FY20-Q1 FY20-Q2 FY20-Q3 FY20-T4 annual Indicators Source Baseline achieved achieved achieved achieved target Notes During this quarter, 556,729 people (320,450 women) were reached by BCC activities during the home visits conducted by CHWs, group discussions conducted by NGO agents, and peer educators. # of people reached by Partner 3.BCC. NGOs, CBOs and CHWs 556,729 586,848 NGO 6,109,016 2,996,400 The regional 2 with malaria prevention (320,450) (334,576) records breakdown is and control SBCC Boké: 182,373 (98,651 women) Kindia: 123,811 (71,160 women) Labé: 223,428 (131,963 women) Conakry: 17,571 (9,957 women). Dinguiraye: 39,665 (22,845 women) RESULT 4: Full dose of SMC delivered in timely manner increased % of children U5 who Project received SMC during the 96% (project This will be reported in 4.1 SMC NA NA 95% first cycle of the report) Quarter 4 reports transmission season % of children U5 who Project received SMC during the 98% (project This will be reported in 4.2 SMC NA NA 96% second cycle of the report) Quarter 4 reports transmission season % of children U5 who Project received SMC during the 99% (project This will be reported in 4.3 SMC NA NA 99% third cycle of the report) Quarter 4 reports transmission season % of children U5 who Project received SMC during the This will be reported in 4.4 SMC 99% NA NA 97% fourth cycle of the FY 2021 reports transmission season
70 StopPalu+—Quarterly Report—January to March 2020 FY20 Data FY20-Q1 FY20-Q2 FY20-Q3 FY20-T4 annual Indicators Source Baseline achieved achieved achieved achieved target Notes % of children from 3 to 59 months of age in Project This will be reported in 4.5 target areas who SMC 86% NA NA 85% FY 2021 received SMC during all reports four cycles Reports on # of SMC doses health This will be reported in 4.6 (SP+AQ) administered to 3,782,242 NA NA 1,500,660 facility FY 2021 eligible children activities % of people who believe This will be reported in 4.BCC. that SMC reduces the KAP 90.9% (KAP FY 2021 with the NA NA 90% 1 risk of contracting survey 2018) results of the KAP malaria survey SUB-IR TRANSVERSAL 1: Increased community involvement in and support for malaria prevention and care % of women aged 15–49 EDS/MICS/ This will be reported in years who recognize 70.08% (KAP T1.1 KAP NA NA 75% Quarter 4 with the fever as a symptom of 2018) survey results of MIS 2020 malaria During this quarter, 76 community dialogues were carried out; Boké 23, Conakry 7, Kindia # of community 23, and Labé 23. dialogues organized by Project T1.2 344 44 76 200 These dialogues have the community about records enabled exchanges malaria control between local leaders and social strata on the problems they face in malaria control. % of people who can DHS/MICS/ 78.2% (KAP T1.3 identify at least two ways KSP NA NA 80% 2018) to prevent malaria survey
StopPalu+—Quarterly Report—January to March 2020 71 FY20 Data FY20-Q1 FY20-Q2 FY20-Q3 FY20-T4 annual Indicators Source Baseline achieved achieved achieved achieved target Notes # of members of local NGOs, CBOs who have received training in malaria control activities, In total, the project monitoring the use of Project trained 17 field agents T1.4 3,032 0 17 660 public services in records on the prevention and malaria-related services, treatment of malaria and advocacy with project support in the last reporting period A total of 54 community actions # of activities conducted were carried out by by the community action the various groups of Project T1.5 groups to resolve an 258 37 54 258 community actions to records identified health issue in find solutions to their community certain problems that citizens face in the fight against malaria This will be reported in % of people who think T1 KAP 97.3% (KAP FY 2021 with the that the consequences of NA NA 95% .BCC.1 survey 2018) results of the KAP malaria are serious survey SUB-IR TRANSVERSAL 2: Improved capacity of NMCP (central, regional, district) to manage, implement, and monitor prevention, care, and treatment activities % of health workers During the reporting nationwide with malaria- period, 1,305 health Project 84% related responsibilities 64% (992/ 59% (914/ center staff were T2.1 supervision (1,305/ 65% who received at least 1,557) 1,557) supervised in PMI records 1,557) one supervision visit area by the project every three months* regional team During the reporting # of quarterly period, the project coordination meetings supported the Project T2.2 held under NMCP's 3 1 1 4 organization of the records leadership with meeting RBM meeting in minutes distributed* collaboration with the NMCP
72 StopPalu+—Quarterly Report—January to March 2020 FY20 Data FY20-Q1 FY20-Q2 FY20-Q3 FY20-T4 annual Indicators Source Baseline achieved achieved achieved achieved target Notes # of bi-annual Pause and This activity will be Reflection sessions held Project T2.3 1 0 0 2 conducted in to institutionalize the records Quarter 4. CLA approach* # of laws, policies, procedures designed to During the reporting promote equitable period, the project access, use and quality Project supported the NMCP T2.4 of health services that 1 0 1 2 records develop and validate are analyzed, drafted or the new SBCC training revised, consulted on, manual. proposed and approved with USG Assistance
StopPalu+—Quarterly Report—January to March 2020 73