PMI/ARM3 QUARTERLY REPORT 15 APRIL 1 – JUNE 30, 2015 ______

FISCAL YEAR 2015, QUARTER 3 PROGRAM YEAR 4

JULY 2015

PMI/ARM3 Accelerating the Reduction of Malaria Morbidity and Mortality Program (ARM3)

Quarterly Report 15 April 1, 2015 to June 30, 2015 Fiscal Year 2015, Program Year 4

Submitted to: Michelle Kouletio, Agreement Officer’s Representative (AOR), USAID/ Carrie Rasmussen, Family Health Team Leader (FHT), USAID/Benin Mariam Oke Sopoh, National Malaria Control Program (NMCP) Coordinator Olga Agbohoui Houinato, Maternal and Child Health Director

Cover photo: A mother is grateful to health workers in Tanguieta Hospital who saved her daughter using ETAT guidelines Credit: ARM3

PMI/ARM3, Accelerating the Reduction of Malaria Morbidity and Mortality Program (ARM3), is funded by the United States Agency for International Development (USAID), under Cooperative Agreement

AID-680-A-11-00001. ARM3 is managed by Medical Care Development International (MCDI) as the prime, in collaboration with Management Sciences for Health (MSH). The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or of the United States Government.

Table of Contents

Acronyms ...... 3 Acknowledgements ...... 5 Executive Summary ...... 6 Introduction ...... 11 Result 1: Implementation of Malaria Prevention Programs in Support of the National Malaria Strategy Improved ...... 12 Sub-Result1.1a: IPTp Uptake Increased ...... 12 Sub-Result 1.1b: Upgrade Skills of Health Workers through Pre-Service and In- Service Training ...... 17 Sub-Result 1.2: Supply and Use of LLINs Increased ...... 18 Result 2: Malaria Diagnosis and Treatment Activities in Support of the National Malaria Strategy Improved ...... 19 Sub-Result 2.1: Diagnostic Capacity and Use of Testing Improved ...... 19 Sub-Result 2.2: Case Management of Uncomplicated and Severe Malaria Improved ...... 23 Sub-Result 2.3: Integrated Community Case Management (iCCM) Improved ...... 28 Result 3: The National Health System’s Capacity to Deliver and Manage Quality Malaria Treatment and Control Interventions Strengthened ...... 32 Sub-Result 3.1: The NMCP’s Technical Capacity to Plan, Design, Manage, and coordinate a Comprehensive Malaria Control program ...... 32 Sub-Result 3.2: Capacity to Collect, Manage and Use Malaria Health Information for M&E and Surveillance Improved ...... 34 Sub-Result 3.3: Capacity in Commodities and SCM Improved ...... Error! Bookmark not defined. Result 4: Cross Sectional Activities ...... 51 Financial Summary ...... 57 Annex 1: Cumulative Financial Report, October 3, 2011 through June 30, 2015 ...... 58 Annex 2: SF 425 ...... 59 Annex 3: Progress on ARM3 Year 4 Work Plan ...... 60

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Acronyms

ACPB Association des Cliniques Privées du Bénin ACT Artemisinin Combination Therapy AIRS Africa Indoor Residual Spraying Project AMCES Association des Œuvres Médicales Privées Confessionnelles et Sociales ANC Antenatal care ANCRE Advancing Newborn, Child and Reproductive Health Program APC Advancing Partners and Communities Project ARM3 Accelerating the Reduction of Malaria Morbidity and Mortality Program BCC Behavioral Change Communication CAME Centrale d’Achat des Médicaments Essentiels (Central Medical Stores) CDC Centers for Disease Control and Prevention CEBAC-STP Coalition des Entreprises Béninoises et Associations Privées Contre le SIDA, la Tuberculose, et le Paludisme CHW Community Health Workers CNAPS Comité National d’Approvisionnement des Produits de Santé / National Committee of the Supplies in Health Commodities DDS Direction Départementale de la Santé/ Departmental Directorate of Health DHS Demographic Health Survey DNSP Direction Nationale de la Santé Publique DPMED Direction de la Pharmacie du Médicament et des Explorations Diagnostiques DRZ Dépôt Répartiteurs de Zone (HZ Depots) DSME Direction de la Santé de la Mère et de l’Enfant/Directorate of Maternal and Child Health DTS Dried Tube Specimen ETAT Emergency Triage, Assessment and Treatment EUVS End Use Verification Survey FHT Family Health Team GFATM Global Fund to Fight AIDS, Tuberculosis, and Malaria GOB Government of Benin HF Health Facility HFS Health Facility Survey HMIS Health Management Information Systems HO Home Office HZ Health Zone HZT Health Zone Training Teams iCCM Integrated Community Case Management IMCI Integrated Management of Childhood Illness IPC Interpersonal Communication IPTp Intermittent Preventive Treatment for Pregnant Women JHU-CCP Johns Hopkins University – Center for Communication Programs LLIN Long Lasting Insecticide-Treated Nets LMIS Logistical Management Information System LNCQ Laboratoire National de Contrôle de la Qualité des Médicaments LOP Length of Project LQAS Lot Quality Assurance Sampling MCDI Medical Care Development International M&E Monitoring & Evaluation MEDISTOCK Commodities Management Program MC-LMIS Medical Commodities LMIS MOH Ministry of Health MOU Memorandum of Understanding MOP Malaria Operational Plan MSH Management Sciences for Health NGO Non-Governmental Organization NMCP National Malaria Control Program

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OTSS Outreach Training Support and Supervision PBF Performance Based Financing PIHI-C Paquet d'Intervention à Haut Impact Communautaire PISAF The Integrated Family Health Project PITA Integrated Annual Work Plan PMI President’s Malaria Initiative QA Quality Assurance RDT Rapid Diagnostic Test RDQA Routine Data Quality Assessment RMIS Routine Malaria Information System ROBS Réseau des ONG Béninoises de Santé/ Network of Beninese Heath NGOs SCM Supply Chain Management SNIGS Système National d’Information et de Gestion Sanitaires SOP Standard Operating Procedures SP Sulfadoxine-Pyrimethamine TOR Terms of Reference TWG Technical Working Group UNICEF United Nations Children’s Fund USAID United States Agency for International Development USG United States Government WHO World Health Organization

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Acknowledgements

ARM3 wishes to thank everyone who helped create this document as well as various technical and financial partners for providing constant support to Benin in the fight against malaria, including the National Malaria Control Program and the Directorate of Maternal and Child Health from the Ministry of Health, the Representations of the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) as well as our private sector partners: Coalition des Entreprises Béninoises et Associations Privées Contre le SIDA, la Tuberculose, et le Paludisme (CEBAC-STP); Association des Œuvres Médicales Privées Confessionnelles et Sociales (AMCES); Réseau des ONG Beninoises de Santé (ROBS); and Association des Cliniques Privées du Bénin (ACPB). In addition, we would like to acknowledge the USAID Benin Mission personnel for their technical guidance and financial support in the implementation of the ARM3 Project.

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Executive Summary

ARM3 Results Sub-Results Key Achievements/Challenges

1. Implementation of 1.1: IPTp uptake  Analyzed IPTp data in preparation for meetings malaria prevention Increased with the NMCP

programs in  Provided technical assistance to the NMCP for support of the the supervision of CHWs in BCC, IPTp, Malaria National Malaria Strategy improved Case Management, and LLIN distribution  Evaluated the effectiveness of ARM3 BCC activities  Disseminated mass media messages on malaria prevention and treatment during the 8th Annual World Malaria Day (WMD) in Benin o Aired 2 TV spot and 2 TV ‘infomercials’ on malaria prevention and treatment o Sent one SMS on the importance of LLIN use through the MTN network  Continued the Developed National Malaria Training Plan for in-service training with the NMCP for Ouémé-Plateau and Mono Couffo DDS

1.2 Supply and use of  Transferred proceeds from Phase 2 LLIN LLINs increased distribution campaign

o 33,841,642 FCFA ($58,000) transferred

from ARM3/CEBAC joint account to ARM3 account  Completed the incineration of the remaining 458 LLIN packages following approval from the Ministry of Environment

2. Malaria diagnosis 2.1 Diagnostic  Provided technical assistance to NMCP in and treatment capacity and use of updating of training materials on malaria activities in diagnostic testing diagnostics support of the improved  Trained 11 new microscopists in malaria national malaria strategy improved diagnostics through microscopy and RDTs  Provided refresher training for 35 lab supervisors on malaria diagnostics, including competency assessments  Transferred OTSS database to the NMCP and trained NMCP staff on its use

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Executive Summary

ARM3 Results Sub-Results Key Achievements/Challenges

2.2 Case management  Conducted synthesis session for 13 of uncomplicated and hospitals in Phase 2 of ETAT severe malaria  Finalized and validated the ETAT improved assessment protocol  Recruited a consultant to implement a situation analysis and propose a mechanism for the private sectors’ access to malaria commodities  Conducted EUVS in Zou Collines

2.3. Integrated  Continued to provide technical assistance to community case APC on the management, training and M&E of management NGOs implementing PIHI-C program activities. improved  Provided technical assistance to APC in the

training of trainers from NGOs in ICCM, training of CHW and M&E of malaria indicators.  Conducted group supervision of CHWs through monthly field visits using the supervision framework developed by APC  Organized a workshop to shared best practices and lessons learned from ARM3’s CommCare pilot project  Provided technical and financial assistance through ANCRE in the training of NGO and HZ personnel in the mHealth application/CommCare application  Provided technical assistance to DNSP on development of community iCCM M&E systematization document and review of the tools.  Transferred ARM3's experience on Community SCM System to ANCRE.  Provided technical assistance to DNSP and its partners in the design and oversight of PIHI-C coordination meetings

3. National health 3.1 NMCP’s technical  Provided technical assistance in the system’s capacity capacity to plan, organization of TWG meetings on M&E (1), design, manage, and to deliver and CM (1), and BCC (1) manage quality coordinate a

malaria treatment comprehensive and control malaria control interventions program enhanced

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Executive Summary

ARM3 Results Sub-Results Key Achievements/Challenges

strengthened 3.2 MOH capacity to  Developed epidemiological threshold definitions collect, manage and for malaria use malaria health  Provided Technical Assistance to the NMCP for information for the Biannual Supervision of Private Sector monitoring, evaluation Health Centers on RMIS and surveillance  Conducted an RDQA in Zou Collines and improved Borgou Alibori

 Conducted an Assessment of Health Workers’ Performance in Malaria Case Management in Health Facilities of Zou Collines

3.3 MOH capacity in  Conducted Supervision of LMIS users in 33 DRZs commodities and and 26 Hospitals supply chain  Provided technical and financial assistance to management improved the NMCP for the quantification of malaria commodities needs for 2016 and 2017  Conducted monthly supervision of stock management in all health facilities in two HZs  Organized Workshop on EUV Results in Atacora Donga and drafted an improvement plan for malaria commodities management  Conducted an EUV survey in Zou Collines  Provided internet connectivity for 34 DRZ managers at HZ level  Provided technical assistance to the NMCP in maintaining the functionality of Medistock  Provided technical assistance to the NMCP for the finalization of the ‘’Common Basket’’ document  Participated on the 2015 first session of the « Comité National des Approvisionnements en Produits de Santé (CNAPS)»  Conducted quarterly LMIS Supervision Feedback Workshops for decision making

 Provided logistical support to the NMCP in the Cross Sectional Behavioral Change supervision of CHW activities on IPTp uptake, Activities Communication (BCC) malaria case management, LLIN distribution and BCC activities  Provided technical assistance to the NMCP on World Malaria Day (WMD) preparations  Aired TV Spots and ‘Infomercials’ on Key Malaria Messages

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Executive Summary

ARM3 Results Sub-Results Key Achievements/Challenges

Program Management Field Office  Met with USAID Evaluators Team to Review Activities Preliminary Results from their Evaluation of

ARM3  Met with ANCRE and APC Regarding the Implementation of PIHI-C  Reviewed the DPA Project at USAID Office

 Observed the Implementation of the BCC Assessment in the Akpadanou and Kode Health Centers in the Commune  Participated in the COP Meeting organized by USAID  Met with CEBAC/STP to Discuss the Collection of Revenue from Phase 2 LLIN Distribution  Participated in a Meeting on the Private Sector Organized by ANCRE Participated in a Roll Back Malaria (RBM) Meeting  ARM3 COP’s visit to MCDI Headquarters  Transferred balance of 33,841,642 FCFA ($58,364) from CEBAC/ARM3 to ARM3/USAID joint account  Organized a tripartite meeting between APC and ANCRE ARM3 as part of PIHI-C implementation

Home Office  Aligned funding requests with approved budget backstopping and  Processed Accruals Report for USAID reporting  Supported the DPA Project in the development of

scenarios for health workers  Responded to information requests conducted by USAID mid-term evaluators  Provided technical support in the development of the ETAT assessment protocol  Provided support to ARM3’s malaria diagnosis advisor to conduct the validation of supervisors in malaria microscopy  Supported the field office in responding to USAID requests regarding the reprogramming of unspent MOP funds  Drafted letters to CEBAC requesting the transfer of funds to the joint ARM3/USAID account  Provided Guidance for the close-out of the Office

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Executive Summary

ARM3 Results Sub-Results Key Achievements/Challenges

 Held Discussions with the CDC and conducted follow-up on the close-out of the HFS report  Organized the visit of ARM3’s COP visit to MCDI HO in Silver Spring, MD  Conducted a programmatic/financial review for Year 4 work plan/budget and started the process for Year 5  Reviewed/revised the BCC preliminary assessment report

Partner Coordination  Maintained regular communication with MSH’s Project Director and followed up on programmatic/financial activities.  Processed payments to MSH in April 2015.

Partner Close-out Activities:  Completed close-out of activities with JHU-CCP and issued final payment.  Followed on the submittal of remaining information by Africare.

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Introduction

Accelerating the Reduction of Malaria Morbidity and Mortality Program (ARM3) in Benin is funded by the United States Agency for International Development (USAID). The ARM3 consortium, led by Medical Care Development International (MCDI) as the prime recipient, includes sub-grantee Management Sciences for Health (MSH). Two consortium partners, Africare and Johns Hopkins University-Center for Communication Programs (JHU-CCP), left the ARM3 consortium at the end of Year 3 due to the de-scoping of ARM3. The remaining ARM3 consortium works in partnership with the Benin Ministry of Health’s (MOH) National Malaria Control Program (NMCP), to implement the five year (October 1, 2011 to September 30, 2016) ARM3 malaria control program.

In collaboration with USAID/Benin’s President’s Malaria Initiative (PMI), ARM3 seeks to assist the Government of Benin (GOB) in improving malaria health outcomes in accordance with the NMCP’s guidelines and standards. The primary objective of ARM3 is to help the GOB achieve the PMI target of reducing malaria-associated mortality by 70%, compared to pre-initiative levels in Benin. In support of this PMI objective, the ARM3 program’s specific goal is to increase coverage and use of key life- saving malaria interventions in support of Benin’s NMCP Strategy. ARM3 seeks to complement and leverage the efforts of USAID through its APC and ANCRE projects as well as other donors (for example the Coopération Technique Belge, Global Fund to Fight AIDS, TB, and Malaria (GFATM), United Nations Children’s Fund (UNICEF), the World Health Organization (WHO) and private sector organizations) to reach the NMCP’s goal of eliminating malaria as a public health problem in Benin by 2030.

ARM3’s major results are as follows:

Result 1: Implementation of malaria prevention programs in support of the National Malaria Strategy improved.

Result 2: Malaria diagnosis and treatment activities in support of the National Malaria Strategy improved.

Result 3: The national health system’s capacity to deliver and manage quality malaria treatment and control interventions strengthened.

During the reporting period, ARM3’s new COP, Dr. Gilbert Adrianandrasana, traveled to the U.S. for a debriefing and orientation at MCDI’s home office in Silver Spring, MD. During the visit, Dr. Adrianandrasana met with MCDI staff providing technical and financial backstop to ARM3, including program, finance, and HR staff, and reviewed programmatic priorities including ARM3’s work plan for year 5 budget. In early June, ARM3 worked with USAID to reprogram unspent funds from the 2011 and 2013 MOPs. ARM3 also responded to information requests and questions submitted by the USAID evaluation team. As part of the evaluation, the evaluators also shared findings and recommendations from their evaluation of ARM3, including recommendations on setting up priority activities for the remaining period of ARM3 in years 4 and 5.

In May 2015, ARM3 conducted the BCC Assessment to determine the effectiveness of ARM3 BCC activities, specifically in improving attitudes, behaviors and management of malaria in pregnant women and children under 5 years. The final report was completed during the quarter and submitted to USAID.

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PMI/ARM3 QUARTERLY REPORT 15 APRIL 1 – JUNE 30, 2015

Result 1: Implementation of Malaria Prevention Programs in Support of the National Malaria Strategy Improved

ARM3 has been scaling-up prevention efforts through the expansion of intermittent preventative treatment for pregnant women (IPTp) and improved coverage of long-lasting insecticide-treated nets (LLINs) through social marketing of LLINs in the private sector and behavior change communication (BCC) activities. The two sub-results are: Sub-Result 1 (IPTp increased); and Sub- Result 2 (supply and use of LLINs increased). ARM3’s Behavioral Change Communication (BCC) Strategy was presented to the NMCP last year for their validation, this year the strategy will be included in the National malaria BCC strategy. The contribution of ARM3 BCC activities that were implemented were evaluated this year by determining how they contributed to behavioral change targets, such as increased IPTp uptake amongst pregnant women.

Sub-Result1.1a: IPTp Uptake Increased During this quarter, ARM3 pursued the dissemination of new IPTp guidelines and supported the airing of IPTp messages in preparation for the 8th Annual World Malaria Day in Benin.

Analyzed IPTp Data in Preparation for Meetings with the NMCP During this quarter and based on Routine Malaria Information System (RMIS) data, ARM3 used data from the last four years to analyze IPTp2 completion data. IPTp2 rate at national level rose from 35.4% in 2011 to 41% after one year of ARM3 implementation. In 2013, the IPTp2 uptake rate fell to 35.1% due to the 9 month nationwide stock-out of SP. In 2014, however, this rate increased to 42.8%, mainly as a result of the ARM3’s collaboration with the NMCP through multichannel BCC campaigns, training of health workers in MIP and interpersonal communication, joint formative supervisions, and improvements to supply chain management of malaria commodities including SP. The table below shows how the performance of the 12 regions varies. For example, Donga, Mono, Ouémé and Zou regions had reached an IPTp2 rate close to 50% and demonstrated a positive trend over the past 4 years but rates for Borgou, Alibori and Atlantique were about 20% lower (the high number of private sector health facilities in the Littoral which don’t provide SP to pregnant women free of charge may have contributed to lower rates). ARM3 will identify the best practices in HZs that are performing well and share them with HZs with the lower rates of uptake during an upcoming workshop that will involve all of project stakeholders. Also, ARM3 advisors for case management and M&E will continue to identify barriers/solutions to IPTp uptake in HZs, including in those were IPTp uptake rates have gone down since 2011.

Table 1: IPTp2 data from 2011 to 2014 per region and per HZ

2011 2012 2013 2014 Regions Health Zones (before ARM3) (Y1) (Y2) (Y3) 32.0% 35.2% 45.1% 50.2% Kandi‐‐Ségbana 33.8% 19.1% 21.7% 33.5% ALIBORI ‐Karimama 29.1% 25.9% 23.1% 30.8% Alibori 32.7% 25.5% 28% 36.4% Kouandé‐Péhunco‐Kérou 24.0% 33% 29.3% 53.8% Atacora ‐B‐T 59.2% 42.8% 31.6% 42.1% Tanguiéta‐‐M 29.5% 0.3% 22.3% 28.8% ARM3 Quarterly Report 15, April – June 2015 12 | Page

2011 2012 2013 2014 Regions Health Zones (before ARM3) (Y1) (Y2) (Y3) Atacora 36.2% 18.9% 27% 40.5% Calavi‐So ava 0.0% 42% 34.3% 42.7% ‐‐Zè 23.3% 113.6% 27.8% 39.8% Atlantique ‐Kopmassè‐Tori‐B 26.2% 28.7% 39.6% 43% Atlantique 25.2% 54.5% 34% 42% Bembèrèkè‐Sinendé 29.6% 39,3% 29.8% 39.6% Ndali‐Parakou 36.8% 47.8% 42.3% 45.1% BORGOU Nikki‐Kalalé‐Pèrèrè 52.2% 35.1% 14.5% 30.2% 24.7% 26.9% 24.1% 28,7% Borgou 36.1% 38.4% 26.8% 36.2% Dassa‐Glazoué 39.5% 41.2% 41.5% 46.5% ‐Bantè 45.8% 42% 35.3% 43.1% Collines Savè‐Ouèssè 16.1% 33.2% 42.4% 38.2% Collines 30.9% 39.2% 39.3% 42.9% Aplahoué‐‐D 47.3% 36.1% 26.3% 40.9% COUFFO Klouékamè‐Lalo‐ 27.6% 31.8% 32.4% 44.5% Couffo 33.7% 34.1% 29.2% 42.7% Bassila 34.7% 43.7% 34.4% 51.7% Donga ‐Ouaké‐ 26.3% 30.8% 43.5% 56% Donga 28% 33.3% 41.7% 55% 1‐Cotonou 4 45.4% 24.9% 32% 24.7% Cotonou 2‐Cotonou 3 47.6% 54.1% 33.8% 32.1% Littoral Cotonou 5 13.4% 31.1% 31.2% 34.7% Cotonou 6 51.5% 29.6% 26.7% 26.2% Littoral 40.8% 38.1% 31% 29.4% Comè‐Grand popo‐H‐B 41.1% 47.8% 41.2% 49.6% MONO ‐Athiémè 43% 52.8% 49% 58.3% Mono 41.6% 49.3% 43.5% 52.2% Adjohoun‐‐ 49.3% 45.3% 39.6% 49.9% Akpro‐missérété‐A‐A 44% 46.1% 40.2% 48.3% OUÉMÉ Porto‐Novo‐Sèmè‐A 32.3% 38.8% 42% 59.9% Ouémé 38% 41.8% 41% 55.1% Pobè‐Kétou‐Adja‐Ouèrè 48.9% 44.9% 49.8% 55.7% PLATEAU Sakété‐ 59% 33.6% 32.4% 35.8% Plateau 51,2% 39,9% 42,6% 47.4% Abomey‐‐D 40.3% 45,4% 42.1% 42.8% ‐Za‐‐Z 61.3% 107.9% 50.7% 55% ZOU Covè‐‐ 31.6% 56.4% 51.7% 47.6% Zou 39.9% 75% 47.8% 49.5% Total National 35.4% 41% 35.1% 42.8% **These data can be updated as the analysis is preliminary and additional data can be inserted

Provided Technical Assistance to the NMCP for the Supervision of CHWs in BCC, IPTp, Malaria Case Manageement, and LLIN distribution In April ARM3 continued its technical support to the NMCP for the supervision of CHWs (26 in 12 municipalities in the Mono Couffo departments). The supervision visits had the following objectives: (1) Identify the number of trained and functional CHWs in HZs; (2) review the quality of services and messages provided by CHWs to households; (3) assess CHW supply systems for malaria commodities; (4) validate reported malaria cases in communities and make recommendations on how to fix problems at ARM3 staff support the NCMP in the supervision of CHWs. ARM3 Quarterly Report 15, April – June 2015 MCD I Crédit 13 | Page

different levels. Services provided by CHWs include BCC activities in the prevention and management of malaria, treatment of malaria with ACTs (when RDT is positive), and referral to a health center if RDT is negative or if there are signs of severe malaria. After the field trip, a debriefing was held at the DDS with participation of a nurse from Lokossa- Athiémé, where the following observations were reviewed and discussed:

Observations  100% of CHWs had management tools (case management registers, IEC/BCC tools) and commodities (ACTs and RDTs)  100% of CHWs correctly filled out management tools and were able to interpret correctly the results of the RDT  100% complied with malaria case management guidelines related to the prescription of ACTs  81% of CHWs gave correct advice to mothers of children on when to return, and what to do before danger signs / severity of malaria;  85% of CHWs respected waste management procedures for RDTs  92% of CHWs have a safety box to put the needles;  CHW records on case management records of CHWs visited did not mention the age of the children treated (only the age group);  Case management records of supervised CHWs did not conduct follow up on children with fever/negative RDT results who were referred to health centers;  The Lokossa/Athiémé HZ is not involved in activities and receives no activity reports.

Recommendations

For CHWs: 1. Adhere to case management procedures for children under 5. 2. Keep track of referrals, including home visits to see if referred children were taken to the health center for treatment; raise mothers’ awareness regarding good child care practices. 3. Manage RDT waste as directed

For Palu Alafia Project1 1. Provide CHWs with the safety box for waste management of RDTs; 2. Strengthen collaboration between the project and the HZs. Involve HZ management teams in supervision and share activity reports; develop a consultation framework for partners for improved coordination 3. Supervision visits should remind CHWs to provide mothers with all necessary messages on malaria prevention and treatment for sick children

Accompanied the NMCP in the Implementation of National Malaria Campaigns In preparations for the 8th Annual World Malaria Day in Benin, ARM3’s BCC Manager held five working sessions in late May and early June with staff from the Community Based Intervention Service, Partnership and Advocacy (SIBCPP). During these sessions, the following activities were discussed: (1) update messages on LLINs flyers, SP and ACT for their dissemination on World Malaria Day; (2) select infomercials for broadcast on TV channels (Channel 3 and ORTB); (3) validate spots on IPTp/SP which were updated based on new IPTp policies (3 doses of SP instead of 2 doses). These sessions were approved by the NMCP.

1 CRS is operating in Lokossa HZ and supervises most of the CHWs working in the region

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Disseminated Mass Media Messages on Malaria Prevention and Treatment during World Malaria Day in Benin In collaboration with the NMCP, ARM3 aired forty-four (44) broadcasts of 2 TV spots on the importance of LLIN use and IPTp uptake by pregnant women on Channel 3 and ORTB TV. Likewise, two (2) infomercials produced respectively in Cotonou and Tchatchou with support from the NMCP and USAID were also released on the same television channels. These broadcasts were designed to raise the awareness among pregnant women and mothers with children under 5 on good practices in the fight against malaria (correct and consistent use of LLINs, taking the required doses of SP by pregnant women, case management for children under 5 with fever). These broadcasts reached nearly 2 million people, including over 750,000 women.

Other Communication Channel Used In collaboration with the NMCP and officials of MTN, an SMS message on the importance of using LLINs was validated and disseminated for 24 hours through the MTN network. This message helped raise the awareness of subscribers on the effectiveness of LLIN use during periods of heavy rainfall. Similar BCC messages can be disseminated through this network during the coming months. Compared to the previous quarter, ARM3 aired more messages through TV spots and infomercials on television channels during the evening hours to maximize the reach of the messages. However, ARM3 will continue to use other communication channels (i.e., radio show, popular skits, radio reality/infomercials, distribution of flyers through CHWs, health workers) to reach a greater number of beneficiaries who do not have access TV sets.

Table 2: Broadcasts of TV Spots on Malaria during the Reporting Period TV Canal TV Canal Program/Activity 3 ORTB Number of times TV Spot on the importance of using LLINs was aired 11 10 Number of times TV spot on importance of IPTp was aired 12 11 Number of times 2 TV ‘infomercials’ Against Malaria in Cotonou/Tchatchou was aired 6 4

Malaria prevention and treatment materials printed in preparation of the World Malaria Day.

Assessed the Effectiveness of ARM3 BCC Activities The BCC assessment conducted on May 11 to 15, 2015, was designed to evaluate the contribution of ARM3 BCC activities and campaigns in improving the knowledge and behaviors of pregnant women with children under 5 regarding malaria prevention and treatment. The protocol for the assessment, including data collection tools, were reviewed and approved by the NMCP during a working session held on April 28. The assessment was conducted in two departments: (1) Ouémé-Plateau (intervention area); (2) Photo of supervision team (NMCP, USAID and ARM3) during Mono-Couffo (control area). With technical field data collection activities; MCDI Credit support from ARM3 and the NMCP, 16 surveyors who were recruited and trained to collect data in the 16 selected health facilities. Supervision teams from the NMCP, ARM3, and USAID participated in the assessment.

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Keys Findings from ARM3’s BCC Assessment Findings from the BCC assessment show that BCC activities/messages implemented by ARM3 have had a positive effect in improving behaviors related to the prevention and management of malaria in pregnant women and children under 5:

Survey of Women

Awareness  65.9% of women in Ouémé and Plateau were exposed to awareness messages on malaria compared to 52.3% of women in the control group;  34.5% of women in the intervention group participated in community social mobilization against malaria compared with less than 10% of women in the control group. Knowledge  72% of women in the intervention group knew that fever is the main symptom of malaria compared to 58.3% of women in the control group;  94.9% of women in the intervention group reported that mosquitoes cause malaria compared to 87.1% of women in the control group who were not exposed (p <0.05). The level of knowledge increased with exposure;  76.4% of women in the intervention group knew that fever is the main symptom of malaria compared with 4% of women in the control group who were not exposed (p <0.05);  47.7% of women in the intervention group knew that ACT is the effective drug against malaria compared to 27.7% who were not exposed (p <0.01);  92.8% of women in the intervention group knew what to do to prevent malaria compared with 84.1% of women in the control group who were not exposed (p <0.05). Behavior  90% of children under 5 in the intervention group (9/10) had slept under an LLIN the night before the assessment compared to 80% (8/10) in the control group; o The level of LLIN use by pregnant women in the intervention group was higher compared to the control group (86.7% against 75%).  64.8% of pregnant women receiving prenatal care in the intervention group received a 2nd dose of IPT (IPTp2) under direct observation (DOT) compared to 43.2% of pregnant women in the control group;  66.2% of women who had a live birth during the past two years received two or more doses of IPTp during ANC visits versus 42.4% who were not exposed to BCC messages(p <0.01).

Survey of Health Workers  Half of providers (9/18) assessed were trained in 2014 on the prevention and management of malaria in pregnant women and the same number were trained on interpersonal communication. Seven (7) received both trainings;  All ANC health workers in the intervention group who had at least one year of experience working in health centers had heard and/or seen BCC messages about malaria disseminated by ARM3. These health workers were more exposed to messages on IPTp during pregnancy, use of mosquito nets and prompt treatment (with ACTs) for fever;  Regardless of training, all health workers interviewed knew that at least 2 doses of IPTp had to be administered to pregnant women before delivery. Health workers were also familiar with guidelines for the clinical examination during prenatal counseling sessions including screening and testing, treatment, and counseling advice/referrals;  In 80% of cases, health workers providing ANC services for their patients followed the recommended tasks and steps during ANC visits. However, health workers often do not properly welcome pregnant woman during their ANC visits;

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 In case of fever or positive RDT in pregnant women, all health workers administered or prescribed ACT (or quinine in certain cases of women in early pregnancy).

Sub-Result 1.1b: Upgrade Skills of Health Workers through Pre-Service and In- Service Training Each year, new students (nurses and epidemiologists) graduated from health-related schools and new health workers are recruited and sent on the field by the Ministry of health. All new staff must be trained on updated malaria guidelines. During this quarter, ARM3 worked closely with partners in proposing a plan to fill gaps in training for in-service health workers.

Continued to Develop the National Malaria Training Plan for in-service training with the NMCP for Ouémé-Plateau and Mono Couffo health zones Given the high turnover of health staff as a result of high recruitment and the retirement of staff, a training plan was developed for health workers in the Ouémé/Plateau and Mono/Couffo HZs. In total 43 doctors, 296 nurses, 338 midwives, 884 auxiliary nurses, and 52 laboratory technicians were identified as part of this plan (See table below):

Table 3: Number of Health Workers to be trained in malaria case management/IPTp in Mono Couffo and Ouémé plateau2 Total Number of Number of Health workers to be trained amount training days (FCFA) Midwives Auxiliary Lab tech Doctors: 5 days Regions Doctors Nurses /Nurses Nurses Nurses 5 days Ouémé/Plateau HWs 20 201 265 488 36 82,175,500 Midwives/ nurses: 3 days Mono/Couffo HWs 23 95 73 396 16 43,979,500 Auxiliary nurses: 2 Total 43 296 338 884 52 126,155,000 days Lab techs: 3 days

RESULTS: IPTp Uptake Increased

Indicator Baseline LOP Target FY4 Q3 Results Source

1) % of women who have Women who receive DHS final completed a pregnancy in the 3.0% Source two or more doses of SP 22.8% (Total) report, last two years who received DHS, 2006 during their last 24.2% (Urban) October two or more doses of IPTp pregnancy within the last 21.8% (Rural) 2013 during that pregnancy two years will reach 85% 1.a.) % of women attending Proportion of women RMIS results are antenatal clinics who receive 28.1% attending antenatal 41.7% from IPTp2 under direct observation Source clinics who receive (40,314/96,642) October to of a health worker RMIS, IPTp2 under direct December 2011 observation by a health 2014) No 2015 worker will reach 85% RMIS data available due to the scaling up of the DHIS2

2 These trainings on case management/IPTp will be conducted by the NMCP with technical assistance from ARM3. Additional trainings will be conducted for the private sector in Q4 (e.g, PROFAM).

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2) # of health workers FY4 Target: 100 private trained in IPTp using U.S. 0 sector health workers Total Year 4 is 107, Government (USG) funds Source trained on malaria case ( achieved in Q1) ARM3 Reports ARM3 management jointly Records with NMCP and ACPB. Training includes ANC, IPTp and HMIS using USG funds

Sub-Result 1.2: Supply and Use of LLINs Increased In support of Sub-Result 1.2, ARM3 has employed innovative approaches framed around public- private partnerships. Over the past year, ARM3 employed a target subsidy approach that permitted employees of the Coalition des Entreprises Béninoises et Associations Privées Contre le SIDA, la Tuberculose, et le Paludisme (CEBAC-STP or CEBAC) member companies to purchase LLINs at a subsidized price through an installment payment mechanism. Proceeds generated from the sale of LLINs over the course of two LLIN distribution campaigns (Phase 1 & 2), allowed CEBAC-STP member companies to cover the cost of distribution and support complementary activities, including malaria prevention and promotion of specific health behaviors. ARM3 will no longer directly support LLIN distribution through CEBAC-STP in project years 4 and 5. However selected member companies of CEBAC will continue to distribute LLINs using their respective CSR budgets. ARM3 has provided CEBAC-STP with the methodology and tools to conduct LLIN distribution and follow-up.

Continued to Collect Revenue from Sale of LLINs from Phase 2 Distribution Campaign The balance of funds from the sale of LLINs (FCFA 33,834,692) was transferred from the joint account CEBAC/ARM3 to the USAID/ARM3 account. The transfer order was co-signed by CEBAC President and ARM3 COP on June 16, 2015. Finally, ARM3 reimbursed expenses incurred by CEBAC amounting to 558,000 FCFA resulting from the repackaging and transport of LLINs to ARM3 field offices.

Completed the Incineration of the Remaining LLIN Packaging following Approval from the Ministry of Environment Following the incineration of an initial 50 LLIN packaging by Lafarge in February 2015, the remaining 458 packages of LLINs were transferred to the Onigbolo Lafarge plant, where they were incinerated from May 11- 16, 2015. Lafarge issued a certificate to ARM3 following the incineration.

RESULTS: Supply and Use of LLINs Increased

Indicator Baseline LOP Target FY4 Q3 Results Source 2) % of pregnant women % of pregnant women DHS final report, 74.6% (Total) who slept under an LLIN the 20% who slept under a LLIN October 2013 72.1% (Urban) previous night Source the previous night in 76% (Rural) DHS, 2006 intervention areas will reach 85% 3) % of children > 5 who % of children under five DHS final report, 69.7% (Total) slept under an LLIN the 20% who slept under a LLIN October 2013 68.8% (Urban) previous night Source the previous night in the 70.3% (Rural) DHS, 2006 intervention areas will reach 85%

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4) % of households with a % of households with a DHS final report, 74.6% (Total) pregnant woman and/or 25% pregnant woman and/or October 2013 72.1% (Urban) children >5 that own at least Source children >5 that own at 76% (Rural) one LLIN DHS, 2006 least one LLIN will reach more than 90% Note: ARM3 is not directly responsible for mass distribution of LLINs, and consequently has limited control over related outcomes; however technical assistance was provided to the LLIN mass distribution campaign conducted in October 2014.

Result 2: Malaria Diagnosis and Treatment Activities in Support of the National Malaria Strategy Improved ARM3 supports improved case management of both severe and uncomplicated malaria and improved diagnosis of malaria through use of microscopy and Rapid Diagnostic Tests (RDTs). Result 2 consists of three sub-results: Sub-Result 2.1 (diagnostics capacity and use of testing improved), Sub-Result 2.2 (case management of uncomplicated and severe malaria improved), and Sub-Result 2.3 (integrated community case management improved).

Sub-Result 2.1: Diagnostic Capacity and Use of Testing Improved During the reporting period, ARM3 continued to provide technical support to the NMCP in updating microscopy and RDTs training materials for malaria. In addition to the training of 11 new microscopists, ARM3 organized refresher training for OTSS supervisors from 34 health zones in order to strengthen their ability to properly supervise lab technician’s ability to validate thick/thin blood smears.

Provided Technical Assistance to the NMCP in the Updating of Training Materials on Malaria Diagnostics ARM3 worked closely with the NMCP in updating training materials for microscopists on malaria microscopy and RDTs for malaria, specifically the participant’s manual and trainer's guide. ARM3’s support was provided during a two-day workshop held in Cotonou from April 22-24, 2015 where participants included representatives from the NMCP (3), National Laboratory (1), National Hospital Center of Cotonou (1) and ARM3 (2). The following activities were conducted during this workshop: (1) Updating of participant’s manual and facilitator's guide; (2) development of questionnaires (theoretical assessments) for pre- and post-testing; (3) updating tools related to microscopy and RDTs procedures; and (4) malaria protocol.

Trained 11 New Microscopists on Malaria Diagnostics through Microscopy and RDTs From May 4 to 8, a 5-day training course was held in Porto Novo, for 11 microscopists from public (8) and private (3) facilities in Atlantique-Littoral, Ouémé-Plateau, and Zou-Collines departments. 36.4% of participants (4 of 11) were women. All participants were tested via pre-test and a post-test assessments consisting of: (1) theoretical exercise with a series of 20 questionnaires; (2) a timed (10 minutes per slide) practical interpretation consisting of 15 thick/thin blood smear slides both negative and positive with variable densities (including 3 WHO validated slides used for External Quality Assessment for species identification). Practical skills were assessed against the following indicators: Sensitivity, specificity, species identification, Plasmodium falciparum (Pf) and other species identification and parasites density calculation. Theoretical and practical evaluations results were presented as follows:

Theoretical Evaluation Pre-test and post-test results showed an improvement in the level of participant’s theoretical knowledge increased from 44% to 75% (gain of 31%). That indicates a very good assimilation of the theoretical exercises by microscopists as shown in the graph below.

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Graph 1: Results of the Theoretical Evaluation of Microscopists

20 19 17.75 1 18 17 16.25 16 15 14.5 15 13.5 13.5 14 12.75 11.75 11.5 12 10.25 9.25 10 8.25 8.25 MARK 8 7.25 7.25 6 6 5 4.7 4 2 0 P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P Practical Evaluation

All indicators related to skills and competencies showed positive improvement from pre to post‐test:  Sensitivity increased from 66% in pre-test to 76% post-test;  Specificity increased from 66% during the pre-test to 86% in the post-test.  Ability to identify Plasmodium falciparum increased from 83% in pre-test to 97% in the post-test.  Parasite density calculation increased from 15% to 52% from start to finish of the training.

Despite the observed improvements, regular monitoring of newly-trained microscopists will be needed to further improve their skills.

Graph 2: Results of the practical evaluation of Microscopists 97% 100% 86% 90% 83% 76% 76% 80% 66% 66% 66% 70% 60% 52% 50% 40% 30% 20% 15% 10% 0% Sensibility Specificity Species Pf Identification Parasite density Identification

Pretest Post‐test

Trained Laboratory Supervisors on Malaria Diagnosis Supervision and Conducted Competency Assessment In June, three refresher trainings sessions for microscopy supervisors on Outreach Training and Supportive Supervision (OTSS) were held in Porto Novo, in collaboration with the NMCP. OTSS supervisors (28 old and 7 new) from all 34 HZs were assessed through pre- and post-tests. In addition, there will be a follow-up supervision following the 4 days of the training. Participants’ practical skills were assessed against the following indicators: Sensitivity, Specificity, Plasmodium falciparum identification (Pf) and Parasite density calculation. The evaluation was conducted in two stages: theoretical and practical, and the results presented in the tables below:

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Theoretical Evaluation

Table 4 Results of the theoretical evaluation of OTSS HZ supervisors Pre-test Post-test Number of participants which a mark between 0-9 out of 20 (under the mean = 48.5% 2.8% insufficient level of knowledge) (17/35) (1/35) Number of participants which a mark between 10-15 out of 20 (acceptable level of 45.7% 31.4% knowledge) (16/35) (11/35) 5.8% 65.8% Number of participants which a mark between 16-20 out of 20 (2/35) (23/35

Practical Evaluation

Table 5: Old supervisors Competency Indicators Pre-test Post-test Gain Sensitivity 64% 76% 12% Specificity 93% 99% 6% Plasmodium falciparum identification 80% 88% 8% Parasite density identification 13% 37% 24%

Table 6: New supervisors Competency Indicators Pre-test Post-test Gain Sensitivity 54% 58% 4% Specificity 69% 74% 5% Plasmodium falciparum identification 69% 71% 2% Parasite density identification 12% 22% 10%

Graph 3 & 4: Results of the practical evaluation of the old/new HZ OTSS supervisors

RESULTS OF THE PRATICAL EVALUATION OF THE RESULTS OF THE PRATICAL EVALUATION OF THE NEWS OTSS SUPERVISORS OLD SUPERVISORS 100% 100% 99% 88% 86% 93% 80% 76% 76% 80% 74% 71% 80% 65% 64% 69% 58% 60% 69% 60% 60% 54% 37% 40% 40% 22% 20% 13% 20% 13%

0% 0%

Pre‐test Post‐test Pre‐test Post‐test

All indicators have improved in the post-test among old supervisors. However, these results are still below the performance standards set by WHO. Old supervisors perform well is for the assessment of “Specificity” as shown below. Otherwise, the low level of competency for the new supervisors is serious as they must validate the reading of slides of the lab technicians in their respective health facilities. In response to these results, ARM3 will provide technical assistance to the NMCP in setting up an external quality assessment system for use of standardized slides.

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Table 7: Comparison of OTSS supervisors’ competencies with WHO performance standards

WHO Old OTSS New OTSS Competency Indicators Requirements supervisors Supervisors Sensitivity 85% 76% 58% Specificity 80% 99% 74% Plasmodium falciparum identification 95% 88% 71% Parasite density 50% 37% 22%

Results may be explained by the following reasons:  During the practical evaluation, supervisors had a limited time to read each slide due to an insufficient number of test slides;  As a result of the free treatment policy for malaria, thick/thin blood smears are no longer prescribed by clinicians that require clients to pay at certain facilities, relying on the results from the RDTs. As a result, microbiologists are losing the ability to read slides;  Lower education level of new supervisors

Due to these issues cited above, the following actions are planned:  In collaboration with the NMCP, organize a 2nd OTSS field supervision in October 2015;  Provide monthly refresher trainings for old/new supervisors with low skills-set;  Revise OTSS supervision visits to quarterly instead of every six months;  Support the NMCP in obtaining standardized thick/thin blood smear slides to provide to field supervisors;  Support the NMCP in encouraging clinicians to prescribing thick/thin blood smears as part of diagnosis of suspected malaria cases at the health facilities equipped with a laboratory;  Initiate discussions with the NMCP and the HZ Coordinators to identify new qualified supervisors who can replace the supervisors who are being lost retirement and review the selection criteria for future OTSS supervisors.

Transferred OTSS Database to the NMCP and Trained NMCP staff on its use During the reporting period, ARM3 provided technical support to the NMCP in the collection, analysis and validation of data from the OTSS Round 14 supervision visit in their respective HZs. ARM3 continues to support the NMCP specifically in: (1) the transfer of the OTSS database to the NMCP, including the access code for users; and (2) in the training of the NMCP laboratory staff on how to use the OTSS database. Currently, data from 110 of the 118 sites has been entered in the database with technical support from ARM3 (information from the remaining sites will be available in July 2015).

RESULTS: Diagnostic Capacity and Use of Diagnostic Testing Improved Indicator Baseline LOP Target FY4 Q3 Results Source

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5) % of targeted health centers 95.8% Proportion of health 84% OTSS Round 13 that have the following: 1) Source centers with the (57/68) completed in personnel trained in malaria OTSS ability to perform PY3 Q4 June 2014 diagnostics, 2) no stocks‐ outs Round 7 biological diagnostics results affecting malaria diagnostics for malaria (either from OTSS 20 HZs received for 7 or more days, 3) a microscopy or RDT) 100% of funds for the functional microscope (non‐ will be 85% HFs with implementation of RDT facilities only) personnel OTSS for 63 HF. But trained in with this funding diagnostics they finally (68/68) conducted the 84% of HFs supervision within 70 with no stock Health Facilities out in diagnostics The calculation commodities of this indicator (57/68) is based on the 100% of HFs data from the 68 with a functional HFs that provide microscope (non‐ the requested RDT facilities information only) (68/68) 22) # of health workers PY1: 34 lab supervisors trained in malaria diagnostics Average provided with (including microscopy/RDTs) trainings refresher trainings on and case management with Lab: 1.4 malaria diagnosis Total of the Y4 is 179 USG funds Clinic: 1.3 supervision ARM3 training reports And FY4 Target: 100 46 (including private sector health workers trained on 35 OTSS malaria case supervisors and 11 management jointly lab tech ) with NMCP and ACPB. Training includes ANC, IPTp, diagnosis, treatment and HMIS using USG funds

Sub-Result 2.2: Case Management of Uncomplicated and Severe Malaria Improved During the quarter, ARM3 prepared the TORs for consultant (to begin work next quarter) to propose a mechanism for the allocation of malaria commodities to private sector health facilities, conducted the final collaborative session of the 13 ETAT phase 2 hospitals and validated ETAT assessment protocol.

Conducted Final Collaborative Session for Hospitals in Phase 2 of ETAT After 12 months of implementation, the 13 hospitals in Phase 2 of ETAT conducted a final session on April 28-30, 2015 to share best practices and lessons learned. Three members from each Quality Improvement Teams (QIT) and two members from each of the four departmental ETAT monitoring teams participated in the session with a total of 47 participants of which 23 were female. The session provided an opportunity to: (1) update the database with indicators from the past three months; (2) analyze ETAT results from each site; (3) review results for a full year of implementation; (4) identify and share best practices; and (5) develop the next steps for the continuation of activities. After one full year of implementation all indicators showed a positive trend except for the Case Fatality Rate during

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the first 24 hours following admission in emergency room which is above the acceptable threshold of 5%. This is can explained by: (1) Several new/non-trained-on ETAT health workers have been hired in the hospitals and were not briefed on ETAT procedures and therefore did not follow ETAT standards; and (2) equipment malfunctions or breakdowns at several facilities that were not in optimal condition. As part of the ETAT sustainability, each department has a monitoring team trained to be responsible for the continuation of the activities in his department.

Table 8 Progress of ETAT Indicators in the 13 Hospitals in Phase 2 (Sep 2014 to March 2015) September October November December January February* March Indicators 2014 2014 2014 2014 2015 2015 2015

1) Percentage of 90.7% 94.4% 84% 93.1% 88.1% 92.6% 93.2% children <5 evaluated (2,868/ (3,033/ (2,765/ (1,794/ (1538/ (1,184/ (1803/ upon arrival (process 3,162) 3,214) 3,290) 1,926) 1745) 1,279) 1935) Indicator)

2) Adherence Rate to 88.2% 92% 87% 90% 85% 85% 90% ETAT standards (process (285/323) (251/274) (242/278) (253/282) (269/317) (219/258) (272/301) Indicator) 3) Case fatality rate during the first 24 hours 8.3% 7.5% 14.1% 14.7% 9.9% 10.1% 12.9% in emergency (outcome (32/385) (22/294) (45/319) (34/232) (21/212) (15/149) (29/225) indicator) 4) Ratio of adherence to standards of severe 87.4% 87% 86.5% 89.5% 87% 86% 83% malaria case (782/ (708/ (758/ (774/ (763/ (556/ (660/ management (process 895) 817) 876) 865) 879) 646) 796) Indicator) 5) Case fatality rate for 3.8% 3.4% 3.5% 4.3% 3.8% 4.1% 6,1% severe malaria (outcome (57/1,481) (52/1,532) (41/1,174) (23/541) (12/314) (8/194) (19/309) indicator)

Graph 5: Percentage of Adherence to ETAT Standards for Severe Malaria and Case Fatality Rate for Severe Malaria in Phase II Hospitals

100 20 89.1 89.5 87.4 86.7 86.5 89.5 86.8 86.7 90 82.9 18 76.4 79.1 80 71.7 16 70 14 60 50.1 12 50 10 6.6 40 6.0 5.7 6.1 8 4.8 4.3 4.3 4.4 30 3.4 3.8 3.4 3.5 3.8 6 20 4 10 2 0 0

Month Rate of adherence to ETAT standards for severe malaria Severe malaria case fatality

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The case fatality rate for severe malaria decreased with the increase in the Ratio of adherence to standards of severe malaria case management in the hospitals. The Ratio of adherence to case management standards for severe malaria in the hospitals decreased during the last month due to the arrival of newly recruited health care providers and an increase in the number of malaria cases.

Finalized and Validated the ETAT Assessment Protocol The ETAT approach is a strategy for the management of severe malaria. The SNIGS shows that malaria accounts for 40.6% of all medical consultations and 30% of hospitalizations in health facilities in Benin (SNIGS, Appendix 1, page 85-87). The correct and timely management of severe cases can reduce mortality in children under 5. Given the positive results from the pilot phase for ETAT implementation, it was deemed important to conduct an assessment to assess the effectiveness of the ETAT approach in the management of severe malaria.

To this end, ARM3 developed a protocol for an ETAT assessment which has been approved by the DSME and the NMCP. The assessment will be implemented during the last quarter of year 4. The protocol will sample 22 hospitals that were enrolled to implement the approach and use a team of medical doctors and nurses to collect the data that have already been trained on the ETAT approach. The forms will also include information on challenges encountered during implementation and sections concerning the sustainability of the approach.

Recruited a Consultant to Implement a Situation Analysis and Propose a Mechanism for Private Sectors’ Access to Malaria Commodities The Ministry of Health in Benin wants to develop a partnership with the private health sector in the fight against malaria in Benin, since the private sector provides services to about 60% of the most vulnerable populations in Benin. To this end, the MOH has been striving to identify mechanisms through which the private sector can access malaria commodities. A consultant will be recruited for the purpose of defining a mechanism for private sector’s access to malaria commodities that are funded by PMI. More specifically, the consultant will: (1) catalog private health facilities in Benin using the most recent census conducted by the MOH; (2) propose a mechanism for private sector access to malaria commodities by type; (3) determine a supply mechanism for the private sector by type; (4) propose a system for monitoring the implementation of the mechanism, including compliance with procedures; (5) submit a procedure for the integration of these health facilities to the LMIS; and (6) submit a system for the evaluation and review of the proposed mechanism. During the reporting period, ARM3 drafted the terms of reference for the consultant. The recruitment process will start in the last quarter of 2015.

Conducted EUVS in Zou Collines During the reporting period, ARM3 worked jointly with the NMCP to conduct a EUV survey in the Zou Collines region. The EUV survey results followed the trends found during the 3 latest EUVs carried out in Atacora Donga, Atlantique Littoral and Borgou Alibori in that the level of compliance to malaria guidelines for uncomplicated malaria is very high. In fact, 99% of children under 5 with simple malaria received the correct antimalarial treatment (i.e. ACT) and only 1.3% of children under 5 tested negative were given an antimalarial. Even though the EUV is a statistically non-representative assessment, this achievement has been positively influenced through the action of ARM3 efforts that facilitated training and supervision of health care providers in malaria case management throughout the country. In addition, the Zou Collines EUV showed that 100% of the HF visited had ACTs available and were able to deliver this medicine to the patients in order to ensure an optimal treatment of uncomplicated cases. This is probably due to the collaboration of ARM3 and the NMCP in the strengthening of the malaria commodities supply chain management system through the LMIS to prevent stock-outs of ACTs and others commodities such as RDTs, Quinine, SP and LLINs.

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RESULTS: Case Management of Uncomplicated and Severe Malaria Improved

Indicator Baseline LOP Target FY4 Q3 Results Source

6) Percent of 36.7% (all 90% of suspected malaria 84.5 % (all ages) No 2015 RMIS data suspected malaria ages) cases will be tested via 363,766/430,268 is available due to cases submitted to 17.5% < 5 microscopy/RDTs preparations for the laboratory testing 52.6% ≥ 5 87.2% < 5 launch of the (171,473/196,655) DHIS2 Source RMIS 82.3% ≥ 5 FY11/Q4 (192,293/233,613) RMIS results are from October to December 2014

7) Percent of -- ≥ 95% of patients (all patients (all ages) ages) who tested positive 87.05% all cases who tested positive for malaria (via (1317/1513) for malaria (via microscopy or RDT) will microscopy or RDT) receive an effective anti- 80.56% who received an malarial (ACT) (634/787) < 5 anti-malarial Micro only ≥ 85% EUV Zou/Collines RDT only ≥ 95% 94.08% report, May 2015 (683/726) ≥ 5

Micro-all ages 2.21% (3/136)

RDT-all ages 93.13 % (1315/1412) 8) Percent of patients (all ages) 0.91% all cases who tested negative (5/551) for malaria (via

microscopy or RDT) 1.31% who received an < 35% of patients (all (4/306) < 5 anti-malarial ages) who tested negative for malaria (via EUV Zou/Collines -- microscopy or RDT) will 0.41% report, May 2015 receive an effective anti- (1/245) ≥5 malarial (ACT) Micro only < 35% Micro-all ages RDT only < 45% 0% (0/38)

RDT-all ages 0.96% (5/519)

No supervision Supervisory visits will be 9) Percent of conducted in case During the quarter conducted at 100% of targeted HFs that management. One ARM3 transferred to targeted HFs at least once received supervision -- OTSS conducted the NMCP the every 6 months

by the NMCP competencies on

under ARM3 TA. OTSS. Data are analyzing

ARM3 Quarterly Report 15, April – June 2015 26 | Page

RESULTS: Case Management of Uncomplicated and Severe Malaria Improved

Indicator Baseline LOP Target FY4 Q3 Results Source

10) Percent of Percent of children under- children under-five five with suspected <1% with suspected malaria (fever) in the last DHS final report, malaria (fever) in the two weeks who received 12.3% Source October 2013 last two weeks who treatment with ACTs in DHS, 2006 received treatment targeted areas will with ACTs increase to 85% 11) Percent of mothers / caretakers ≥ 90% of mothers / who sought caretakers who sought treatment with the <1% treatment with the use of use of ACTs for their ACTs for their under-five DHS final report, under-five children 6.7% Source children with suspected October 2013 with suspected DHS, 2006 malaria (fever) within 24 malaria (fever) hours of onset of their within 24 hours of symptoms onset of their symptoms Develop, review, update 12) Number of and implement with the schools of nursing MOH the guidelines and and educational Discussions started training curricula on institutions that have with 2 schools during 0 malaria diagnosis and 0 updated their the quarter for the treatment at a total of 4 malaria guidelines schools of nursing and planning of activities. and curriculum educational institutions

ARM3 training reports, Total to 13) Number of newly date: 48+24=72 Support training in clinical hired health workers IMCI for 72 newly hired trained in clinical health workers in the No additional Integrated -- 0 private sector to trainings were Management of contribute to national Childhood Illness conducted in IMCI in scale-up of clinical IMCI (IMCI) Year 4. IMCI training is reprogrammed for year5. 14) Number of ARM3 training hospitals that reports received a refresher training for severe Support refresher training No refresher training malaria case and supervision to ensure management for severe malaria appropriate management case management and referral practices for was conducted in 21/50 severe malaria to the remaining 29 hospitals this quarter. Instead hospitals (13 hospitals QA/QI expert provided nationwide training by 29 (total) participated in focused on the PISAF 17 public ETAT synthesis monitoring of ETAT 12 private session) indicators and ETAT

synthesis session

was hold

21 previously trained by PISAF +25 = 46 46/50

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RESULTS: Case Management of Uncomplicated and Severe Malaria Improved

Indicator Baseline LOP Target FY4 Q3 Results Source

FY14 Target: 100 private 23) Number of sector health workers health workers trained on malaria case Total Year 4 is 107, trained in case management jointly with ARM3 Training NMCP and ACPB. (achieved in Q1) Report management with Training includes ANC, ACTs with USG IPTp, diagnosis, treatment funds and HMIS using USG funds

Sub-Result 2.3: Integrated Community Case Management (iCCM) Improved During the quarter, ARM3 continued its technical assistance to DNSP / MOH, the ANCRE project, the APC project and local NGOs through different activities such as the restitution of the Commcare pilot project assessment results, the training of trainers on PIHI-C complementary modules. ARM3 provided technical assistance in the design of PIHI-C LMIS tools (case management record, drugs management registers) and training materials for CHWs.

Transferred Knowledge to APC on the Management, Training, and M&E of New NGOs Implementing PIHI-C From May 5-7, ARM3 participated in a workshop in Bohicon organized by APC on the implementation of PIHI-C in Bassila, Tchaourou, Kandi Gougounou Ségbana (KGS) and Covè Zagnanado Ouinhi HZs. The objective of the workshop was to bring together all NGOs (SIA N'SON, DEDRAS and ROBS) and stakeholders involved in the implementation of Community PIHI and share lessons learned and best practices in program implementation. The roll-out of PIHI-C in COZO HZ was delayed due to delays in the training of CHWs.

Table 9: Lessons learned/best practices from 6 months of ICCM implementation by local NGOs in Northern Benin Lessons learned Best practices

Success of community activities depends on the Allocating malaria commodities to the CHWs by the HZ leadership of the HZ coordinator. coordinator prevents stock-outs at community level The successful implementation of community

activities requires synergy among stakeholders.

3Community initiatives promote early referral.

Provided Technical Assistance to APC in the Training of Trainers from NGOs in ICCM, Training of CHWs, and M&E of Malaria Indicators In June, ARM3 participated in the training of trainers on PIHI-C organized by SIAN'SON and DEDRAS in the HZs of Djougou Ouaké Copargo (DCO) and Kandi Gogounou Ségbana (KGS). The objective of the training of trainers was to strengthen the capacity of HZs in the implementation of PIHI-C (e.g., modules on FP/RH, newborns and WASH).

3 Community initiatives refer to activities conducted by communities to resolve social problems

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Table 10: Number of trainers and CHWs trained by the NGOs implementing PIHI DCO KANDI Expected Trained Expected Trained Trainers 35 35 14 14 CHWs 532 524 105 36 TOTAL 567 559 119 50

Conducted Group Supervision of CHWs through Monthly Field Visits with a Supervision Framework Developed by APC ARM3 provided technical support in the monthly group supervision of 294 community volunteers in Djougou- Copago-Ouaké (DCO) HZ organized by SIA N'SON and PILP/Africare. This monthly supervision was an opportunity to collect data from activities held in March 2015. Overall, it was noted that all CHWs were filling out registers (265/294), particularly the CHWs from the villages of Kamourou, Gnangri, Gogoniga, Moatchoi and Soubroukou. However, CHWs had experienced a shortage of RDTs due to the national stock out that lasted about 9 months. Nonetheless, there was good compliance with the standard "Test Photo of CHWs during group-supervision at Djougou3 before Treat’' during the period when 10 CHWs had to health center MCDI. Credit treat children with fever. ARM3 has difficulty to regularly provide technical assistance in group supervision as NGOs are not organizing their activities on a monthly basis due to delays in budget availability.

Organized a Workshop to Disseminate Lessons Learned and Best Practices from ARM3’s CommCare Pilot Project In June 24, in collaboration with the community health service of the DSNP/MOH, ARM3 held a workshop to present the results of its assessment of the CommCare pilot project in Tchaourou and Bassila HZs. The objectives of the workshop were to present results after 12 months of implementation and share best practices and lessons learned. To date, a new version of the mobile application has been developed by ANCRE using recommendations and suggestions made by ARM3.

Table 11: Lessons learned and best practices Implementation Lessons Learned Best Practices Activity

Assessment of the  The CommCare system does  The “Case Sharing” and feasibility of CommCare not require a specific ‘stand- MEDISTOCK Web features are (as programmed by alone’ server innovative and should be explored ARM3) further Procurement of technical  Solar chargers purchased  Reliable low-cost phones reduce equipment should be adequate to charge implementation costs the selected smart phones  Android phones provide durable SIM Cards that don’t break easily Recruitment of Technical  Permanent staff should be in  Establish a technical team to monitor Staff place to provide regular project implementation monitoring of mHealth activities Programming of data  Technical resources at the local  Forms were developed using existing collection forms level to ensure the successful tools used by the MOH to monitor

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Implementation Lessons Learned Best Practices Activity

implementation of the project and manage the work of CHWs  Data should be synthetized into a ‘dashboard’ to permit easier access to relevant data by managers. Selection Criteria for  Selection criteria for CHWs  Select the most highly educated CHWs should take into account CHWs from villages to participate in education and performance project trainings level Training of Chef-Postes  Chef-postes, statisticians, local  Engage chef-postes to conduct to train CHWs consultants can provide trainings for CHWs effective trainings for CHWs  Local consultants who trained trainers and reduce costs reduced travel costs

Provided Technical Assistance in the Training of NGO and HZ Personnel in the mHealth/CommCare System Despite the transfer of competencies to NGOs responsible for implementing iCCMn, field visits that were conducted to assess the use of the CommCare system showed the following: (1) poor reporting despite the availability of internet credit; (2) telephones switched off/not charged; (3) CommCare application uninstalled/removed from phones; (4) Low-level use of phones; (5) CommCare was deleted on some of the phones; and (6) turnover of chef-posts. In an attempt to restart the CommCare system in the HZs, ARM3 collaborated with ANCRE in conducting a joint supervision of all NGOs and all stakeholders working with the system. The results of the supervision are shown in the following graphs:

Graph 6: Distribution of functional phones used by CHWs for the CommCare system The battery is functional (N=114, 45 in Bassila 82.6 and 69 in Tchaourou) 86.6 84.2 The earphone is functional (N=114, 45 in 60.9 Bassila and 69 in Tchaourou) 57.8 59.6 The solar charger is functional (N=113, 45 in 58.8 Bassila and 68 in Tchaourou) 20 43.4 The android phone is in good condition 64.3 (N=114, 44 in Bassila and 70 in Tchaourou) 79.5 70.2 0 20406080100 Percentage Tchaourou Bassila Group

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Graph 7: Distribution of phones with SIM card, internet, apps with chef posts and CHWs

User is aware of internet connection on the 77.3 phone (CHWs=114; Chefs Posts=22 ) 48.2

Presence of other applications on the phone 31.8 (CHWs=112; Chefs Posts=22 ) 16.1

The Android phone is used for other purposes 47.6 (CHWs=113; Chefs Posts =21) 40.7

The CommCare application is activated on the 80.9 phone (Total CHWs = 113; Total Chefs Posts =… 83.2

MTN SIM is available (CHWs =114; Chef Posts= 85.7 21) 93 0 102030405060708090100 Percentage

Chef Posts CHWs

Provided Technical Assistance to the DNSP in the Development of a Community iCCM M&E Systematization Document and the Review of Tools From May 5-7, a workshop on was held in Bohicon for the revision of the PIHI-C M&E tools at the community level. The objective of this workshop was to review/design tools to meet standards set out in the national guidelines. The workshop was attended by representatives from UNICEF, ARM3, ANCRE, DNSP, DSME, DPP, and DDS Zou/ Collines. Two presentations were planned during the workshop including the review and update of the management tools used in PIHI-C. In fact, this workshop helped to revise tools used for home visits. Key recommendations for the next steps were to develop a user guide, plan pre-test tools and incorporate community data in the National Information System and Management Statistics (SNIGS).

Transferred ARM3's Experience on Community SCM System to ANCRE The new PIHI program implemented by DSME and ANCRE faces the challenge of establishing a logistic management system (LMIS) should enable the collection of logistical data (monthly average consumption, stock used, etc.) in the community and in health facilities as well as to report HMIS at central level. Following the development of the roadmap describing the different stages of the process for the implementation of the PIHI-C information system and logistics management, ARM3 SCM team provided technical support to ANCRE. This included budgeting support for the evaluation of existing commodities and management tools, harmonization of malaria commodities LMIS tools, training of trainers and training of health workers, setting up the PIHI LMIS system, comprehensive supervision of health facilities, and final validation of the strategy and tools. During the quarter, the documents related to the implementation of PIHI-C LMIS, was finalized and made available to ANCRE. This document, which describes approaches to the implementation of logistics information system at the community level is divided into three sections: 1) opportunities, 2) recommendations, and 3) challenges and solutions.

Provided Technical Assistance to the DNSP and its Partners in the Design and Oversight of PIHI-C Coordination Meetings ARM3 participated in two PIHI-C coordination meetings, organized by the MOH, where the following issues were reviewed and discussed:  10 HZs (out of the 34 HZ) are not covered by the PIHI-C approach but will be covered under the next round of funding from the Global Fund.

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 The NGOs SIANSON and DEDRAS have not yet received support from the Community health Service of DNSP.  The DNSP Community health Service needs vehicles to address its technical support to partners  A clear guideline on the drugs management at Community level is necessary and a committee consisting of the DNSP, DPMED, NMCP, UNICEF, ANCRE, ARM3, and APC has been established for this.

Result 3: The National Health System’s Capacity to Deliver and Manage Quality Malaria Treatment and Control Interventions Strengthened

Sub-Result 3.1: The NMCP’s Technical Capacity to Plan, Design, Manage, and coordinate a Comprehensive Malaria Control program During the quarter ARM3 supported the NMCP in the organization of 3 technical working group meetings in case management, BCC and monitoring and evaluation. The role of these TWGs is sensitive and critical in taking important technical decisions regarding malaria control in the country.

Provided Technical Assistance in the Organizing TWG Meetings in BCC, M&E and CM

BCC TWG meeting On June 12, 2015, ARM3 participated in the 2nd meeting of the BCC TWG organized by the NMCP, where all partners, including NMCP, CRS, PSI provided updates on their BCC activities, specifically in preparations for World Malaria Day. Each partner presented their plans and BCC materials designed for dissemination during the event. Also during the meeting, a committee consisting of TWG members was set up to review ARM3’s BCC strategy before it is validated in a workshop. Finally, guidelines on the management of fever in children under 5, was reviewed by TWG participants.

Monitoring and Evaluation (M&E) TWG meeting The M&E TWG meeting was held on June 9, 2015 at the NMCP office. Twenty participants from the MOH/NMCP, CRS, AFRICARE, AIRS and ARM3 attended the meeting and discussed the following agenda items: (1) review of improvement on the PNLP1 proposed by ARM3, (2) preparations of the upcoming Malaria Indicators Survey (MIS); (3) preliminary results of the RMIS semi-annual supervision, and (4) updates on activities planned by each partner. The following points were reviewed and discussed during the meeting: 1. The TWG recognized the effort made by ARM3 for improving the PNLP1 data form and participants made their technical review before the document is finalized by the RMIS evaluation team. 2. In preparation for the upcoming Malaria Indicators Survey (MIS), CRS’s M&E officer announced that the survey would be delayed due to the Global Fund’s delayed approval. A committee consisting of staff rom CRS, NMCP, USAID and ARM3 has been set up to conduct the survey. 3. The preliminary results of the RMIS supervision were discussed during the meeting (refer to 3.2 for more details).

Table 12: ARM3’s Proposal to Improve the PNLP1 data form Femmes moins de 5 5 ans et Total (4) = Consultations externes enceintes ans (1) plus (2) 1+2+3 (3) Total des cas toutes causes confondues Nombre de cas reçus pour fièvre ou antécédents de fièvre Nombre de cas testés au TDR

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Nombre de cas avec TDR positifs Nombre de cas testés à la goutte épaisse Nombre de cas avec goutte épaisse positive Nombre de cas testés négatifs au TDR ou à la GE qui ont recu une CTA Nombre de cas traités pour paludisme simple n'ayant pas bénéficié d'un TDR ou d'une GE Traitement CTA prescrits Traitement CTA sortis en pharmacie Femmes moins de 5 plus de 5 Total (4) = Hospitalisation enceintes ans (1) ans (2) 1+2+23+4 (3) Total des patients hospitalisés Nombre de patients diagnostiqués pour paludisme grave Nombre de patients diagnostiqués pour paludisme grave avec TDR ou GE positif Nombre de décès dus au paludisme grave CPN1 TPI SP1 TIPI SP2 TPI SP3 Additional topics were discussed before the end of the meeting:  The 4 PALU INFO bulletins that were drafted since 3 months must printed and distributed shortly  PMI will take leadership in raising funds for the RMIS evaluation  The epidemiologic threshold steering has been set up (this technical committee will improve the model proposed by ARM3 and share it will all malaria stakeholders for validation)

Case Management TWG meeting The Case Management TWG was organized by the NMCP on May 27, 2015 with 19 participants from the Faculty of Health Sciences, CRS, USAID and ARM3. The main topic discussed was updates to the malaria case management guidelines. Participants also provided an update on future plans and activities concerning malaria case management and IPTp.

Table 13: Updates made on the Malaria case management guidelines 2011 Guidelines 2014 Guidelines Comments

Severe Malaria Case Management

Diagnostic confirmation only after Diagnostic confirmation before Confirmation by RDT test or microcopy 5 years of age in severe forms antimalarial treatment  Gluconate/Dihydrochloride Choose between these two salts of Quinine NB: As soon as the patient's condition  Gluconate/Dihydrochloride  Artemisinin dérivatives if improves, and can tolerate oral salts of Quinine intolerance medication with ACT for 3 days

 Artemisinin derivatives IPTp Uptake Two doses at 16 and 36 weeks of At each ANC visit from 16 weeks of At least 3 doses before delivery amenorrhea amenorrhea Limitation of 36 weeks of amenorrhea no longer applicable 2 doses with an interval of at 3 doses with an interval of at least 4 least 4 weeks weeks Pregnant woman co-infected with Pregnant woman co-infected with HIV HIV will receive only Pregnant woman co-infected with not receiving Cotrimoxazole will benefit Cotrimoxazole for opportunistic HIV will follow the PMTCT protocol SP infections ARM3 Quarterly Report 15, April – June 2015 33 | Page

The Case Management TWG made the following recommendations to the NMCP: 1. Assess if Diagnostic component should be maintained within the TWG case management 2. Start to increase orders of Artemisinin derivatives and decrease those of Dihydrochloride salts of quinine to progressively reverse the trend of treatment 3. Share and report to the NMCP the IPTp new update guideline to PLHIV before finalizing it 4. Distribute to hospitals including private clinics (ROBS, AMCES and ACPB) the policy for free treatment and the case management assessment audits 5. Include the instructions for free treatment protocol to Army hospitals and garrisons 6. Select one brand of RDT for a better management and efficiency 7. Insert the diagnostic component important issues into the agenda of the next TWG

RESULTS: NMCP’s Technical Capacity to Plan, Design, Manage and Coordinate a Comprehensive Malaria Control Program Enhanced

Indicator Baseline LOP Target Q3 Results Source 15) The number of The 4 NMCP TWGs BCC: 1 ARM3 program meetings held by the (M&E, SC, M&E: 1 reports NMCP technical working communications, and CM: 1 groups (M&E, supply case management) are chain, communications, meeting regularly as and case management) planned (2x per year)

Sub-Result 3.2: Capacity to Collect, Manage and Use Malaria Health Information for M&E and Surveillance Improved During the quarter, ARM3 helped the NMCP to improve RMIS and HMIS performances by conducting supervision of RMIS user and routine data quality Audit. In addition the performances of Zou Collines health workers in malaria case management have been evaluated. This will serve to determine the areas that will need to be improved for the upcoming training sessions of newly recruited health workers on malaria diagnosis, treatment and prevention.

Developed Epidemiological Threshold Definitions for Malaria During the M&E TWG meeting, ARM3 and the NMCP presented the first draft of the methodology proposed for developing epidemiological threshold definitions. This methodology is composed of 3 steps: 1. Obtain a chronological listing of uncomplicated malaria cases in each health facility. These HFs figures will be later aggregated by health zones in order to enable regional decision-makers to monitor their HZ malaria trends for taking action in case of an epidemic.

2. Organize in descending order monthly figures and eliminate upper and lower figures (gray shading in graph). Obtain the maximum, median, and minimum figures that will be used for the endemic channel. ARM3 Quarterly Report 15, April – June 2015 34 | Page

3. Construct the endemic channel from the maximum, median, and minimum. Plot these numbers on the graph

Participants were very interested in ARM3’s presentation and pointed out the fact that this activity will enable decision makers at many levels take actions and be aware of their malaria epidemic trends. At the end of the meeting, a committee composed of ARM3 and NMCP M&E was tasked to carry next the steps for the review and validation process with all 34 HZ statisticians and health facilities.

Provided Technical Assistance to the NMCP for the Biannual Supervision of Private Sector Health Centers on RMIS During the quarter, ARM3 provided technical and logistical support to the NMCP to carry out a nationwide supportive supervision at 206 data collection sites including 132 (64%) public sector and74 (35.9%) private sector health facilities in all 34 health zones. This is the first time that this supervision includes private sector HFs. This bi-annual supervision was conducted in May by 6 teams covering all 6 regions of the country. Each team was composed of individuals from the NMCP (both national and regional offices), HZ statisticians and ARM3 staff. The objectives were to: i) assess the level of knowledge of health workers use of the PNLP1 data form; ii) improve their level of knowledge; iii) check the accuracy of the collected data; iv) evaluate the concordance between data on PNLP1 data form and primary data sources; and v) formulate recommendations to resolve identified problems in order to improve quality of data. The methodology consisted of administering a questionnaire, verifying documents and providing feedback to health workers on data collection and quality assurance. The table below summarizes the results of the quarterly supervision.

Table 14: Select supervision indicators Borgou/ Atacora Zou Mono Atlantique Ouémé All 6 Indicator Alibori Donga Collines Couffo Littoral Plateau Regions % of chefs posts trained on RMIS 40.9% 22.7% 37.5% 54.5% 26.7% 37.5% 37.2% among those supervised

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Borgou/ Atacora Zou Mono Atlantique Ouémé All 6 Indicator Alibori Donga Collines Couffo Littoral Plateau Regions Availability of RMIS user guide 13.2% 34.4% 6.3% 0.0% 8.3% 7.7% 11.6%

Availability of 3 PNLP1 data forms 84.2% 90.6% 74.2% 90.9% 95.8% 87.2% 86.8%

Availability of PNLP2 data form 10.5% 46.9% 3.4% 30.3% 29.2% 25.6% 24.1% Accuracy of community data (comparing PNLP1 and primary 18.2% 38.1% 0.0% 14.3% 100% 6.7% 21.4% sources) Accuracy of outpatients data (comparing PNLP1 and primary 57.1% 90.5% 54.5% 50% 83.3% 33.3% 61.9% sources) Accuracy of inpatients data (comparing PNLP1 and primary 35.7% 81.0% 33.3% 33.3% 80.0% 60.0% 53.8% sources) Accuracy of prevention data (comparing PNLP1 and primary 41.7% 85.7% 66.7% 69.6% 83.3% 60.0% 69.6% sources) Accuracy of malaria commodities data (comparing PNLP1 and primary 25.0% 81.0% 81.8% 58.3% 83.3% 60.0% 65.3% sources) Level of knowledge of outpatients data 76.3% 90.3% 100.0% 71.9% 76.2% 79.5% 80.7% collection procedures Level of knowledge of prevention data 59.5% 87.1% 100.0% 68.8% 73.7% 82.1% 76.3% collection procedures Level of knowledge of the timeliness of 84.2% 100.0% 93.1% 87.5% 95.8% 92.3% 91.7% health facility level data

The following constraints have been identified by RMIS users in the field:  Only 37.2% of chefs posts have been trained on RMIS procedures (this situation is due to the fact that many of formerly trained chefs posts have retired and new personnel has been recruited. Training responsibilities have been transferred to the NMCP and no RMIS training has been conducted recently)  The RMIS user guide is available in only 11.6% of the visited health facilities  The PNLP2 data form that focuses on community data is not generally available (24.1%) and the available community data is less accurate (21.4%). The MOH does not provide enough information and guidance regarding the collection of such data and the chefs posts are not encouraged to collect community data that requires additional effort.  There is a multitude of forms to fill out every month.

As a result the following are proposed recommendations: i) train/brief newly recruited RMIS users (MOH personnel) on RMIS data collection procedures with a special emphasis on community data ii) disseminate an updated version of the RMIS guidelines and PNLP2 data form, iii); ensure better record keeping and filing of RMIS data collection forms and iv) ensure quarterly supervision of data collection sites.

Conducted a Routine Data Quality Audit (RDQA) in Zou Collines and Borgou Alibori The NMCP and ARM3 M&E team conducted an RDQA with the participation of 2 health department NCMP representatives, 2 national NMCP M&E staffs and 11 hospital statisticians. The RDQA was conducted in May. Based on the recommendation made by the NMCP, the focus of this RDQA has been the audit of malaria mortality data. The objectives were: i) determine the proportion of reported deaths that is really attributed to malaria, ii) conduct a rapid assessment of the quality of the malaria

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mortality data management, iii) identify difficulties encountered by all RMIS users when collecting malaria mortality data and iv) propose solutions and recommendations to tackle identified issues.

The methodology incorporated an improved version of the data collection tool designed by the NMCP for the audit of malaria mortality cases. The sampling framework was designed using the following criteria: (1) Borgou Alibori and Zou Collines regions were prioritized since they reported half of the malaria deaths in 2014; (2) HFs that reported at least 10 cases of malaria deaths in 2014 were prioritized for visits; and (3) of the HFs that met the first two criteria, 20% of malaria deaths were audited and patients selected randomly (patient records were not available during the visit of the audit team in regional hospitals in Borgou/Alibori). Of the HFs selected 93% (13/14) were visited.

Description of the audited cases A total of 182 patients records were audited in 13 hospitals.

Table 15: Distribution of the patients’ records audited for malaria deaths per health facility Health facility No. Percent Health facility No. Percent

HZ BANIKOARA 14 7.69 HZ NIKKI 47 25.82 HZ KANDI 5 2.75 HZ SAVALOU 8 4.40 HZ MALANVILLE 6 3.30 HZ SAVE 7 3.85 HZ BEMBEREKE 61 33.52 HC OUESSE 2 1.10 HOPITAL BOKO 5 2.75 HZ DASSA 10 5.49 HC KALALE 4 2.20 HZ COVE 10 5.49 HOPITAL GBEMONTIN 3 1.65 TOTAL 98 84 182 HC: health center HZ: health zone hospital The HZ hospital of Bembereke and Nikki reported the highest number of malaria deaths in 2014, and the Pediatrics ward reported the most. During the visit, the RDQA team met with hospitals staff to discuss reasons for the high number of deaths: 1) Personnel responsible for reporting mortality were not briefed on procedures for registering malaria mortality; this explained why children’s, mortality without confirmation via a malaria test, was classified as malaria; 2) these hospital are among the most frequently visited in Northern Benin; 3) hospital fees are very low (due to their status as faith- based and community-funded hospitals); and 4) patients have to travel long distances before reaching the hospitals and in most cases, their health has seriously deteriorated by the time their arrive. Table 15: Characteristics of audited cases Number Indicators Total % of cases Referred from another health facility 36 89 40% Reference Not referred from another health facility 53 89 60% Under five age 167 180 93% Age Age 5 and over 13 180 7% Male 88 181 47% Sex Female 93 181 Deceased between 0-24h of arrival at the HF 138 179 77% Period of death Deceased after 24h of arrival at the HF 41 179 23%

Correct Identification of Malaria Death Cases

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The evaluation team used the following criteria to assess the accuracy deaths due to malaria in each facility: 1) the death must be reported in the patient record, 2) a malaria microscopy or RDT result must be positive and 3) at least one sign of severe malaria sign must be reported. Based on these criteria, 77% of malaria deaths cases have been correctly reported. This data showed that there is an overestimation of malaria death reported in the RMIS. To tackle this situation in each HF the criteria for identification have been shared with the staff during debriefing session.

Table 16: Percentage of reported malaria death cases correctly identified Correctly Identified Health Facilities % n N HZ Banikoara 13 14 92.9% HZ Kandi 3 5 60% HZ Malanville 6 6 100% HZ Bembereke 43 61 70.5% Hopital Boko 4 5 80% HC Kalale 3 4 75% HZ Nikki 40 47 85.1% HZ Savalou 7 8 87.5% HZ Save 4 7 57.1% HC Ouesse 2 2 100% HZ Dassa 8 10 80% HZ Cove 7 10 70% Hopital Gbemontin 0 3 0.0% Total 140 182 76.9%

Quality of the Case management of malaria deaths Only 140 out 182 were deaths were confirmed due to malaria. Anemia was reported in 63% of the cases (88/140) and was the main sign for severity sign reported with severe malaria among cases that fit the criteria correctly. Management of anemia must also be handled competently in order to prevent malaria deaths associated with anemia especially among under 5 five children (93% in our sampling). Other severity signs were convulsions (54% or 75/140) and coma (17% or 24/140). Other signs metabolic acidosis, acute lung edema and kidney problems were not reported.

Conclusions This RDQA focused on malaria deaths data showed that:  Borgou/Alibori has the highest number of malaria related deaths  Malaria deaths occurred primarily in children under 5  Only 77% of reported malaria death fit the case definition criteria  Anemia (63%) and convulsions (54%) are the two main signs of malaria severity  Only 24% (33/138) of the severe signs were correctly handled by staff that treated the malaria mortality cases.  86% (118/137) of malaria deaths received the correct dosage of intravenous quinine

Recommendations:  For the NMCP: Share clear guidance on malaria death case definition with facilities and brief all RMIS users on malaria death case definition reporting guidelines  For the NMCP, DDMS, DDS, HZs and HFs: Ensure sufficient supply of high quality blood to treat anemia cases  For NMCP, DDS and HZs: Train staff on severe malaria case management

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Conducted an Assessment of Health Workers’ Performance in Malaria Case Management in Health Facilities of Zou Collines To complement the EUV survey, ARM3 and NMCP M&E and case management teams conducted a rapid assessment of the performance of health workers in malaria case management in the 20 HFs targeted by the EUV survey in Zou Collines. The objectives of the assessment were as follows: 1. Determine of the level of knowledge of the health workers on the national guidelines related to IPTp, diagnosis and uncomplicated and severe malaria treatment 2. Evaluate the health workers practices related to malaria suspicion, diagnosis with RDT, IPTp, interpersonal communication and malaria treatment 3. Identify the bottle necks in malaria case management and propose recommendations to sort the problems out.

The methodology used (including data collection tools) was a shortened version of the 2013 Benin health facility survey. This methodology was shared with the NMCP and CDC resident advisor for their inputs. The validation of the methodology was conducted at the NMCP office in June with the involved institutions. The sampling of this cross sectional evaluation consisted in the selection of the 15 health facilities (3 hospitals and 12 health centers) enrolled in EUV and the replacement of the 5 health zone depots by new health facilities.

Table 17: List of the HFs enrolled in the rapid assessment Regions COLLINES ZOU Abomey- Bohicon-za- Covè- Health zones Dassa-glazoué Savalou-bantè Agbangnizoun- kpota- Zagnanado- ouinhi

Cs Fita Cs Pira Cs Cs Sodohome Cs Sagon

Health Cs Yagbo Cs Logozohe Cs Lissazounme Cs Tindji Hz Cove facilities Hz Dassa Hz Savalou Cs Tanve Cs Cs Kpedekpo Cs Cs Ouedeme Cs Okouta-osse Cs Cs Cana Zagnannado The table below summarizes the data collection tools, method and the groups of individuals surveyed

Table 18: Data collection tools, method and the groups of individuals surveyed Data collection Data collection Target Collected information tool method Health workers Administered Doctors,  Knowledge on IPTp, diagnosis questionnaire questionnaire during nurses, and treatment guidelines interview midwives and  Difficulties in malaria auxiliary management and proposed nurses solutions Health workers Direct observation of the Doctors,  Respect of Interpersonal observation grid consultation of nurses, communication rule • < 5 children with midwives and  Malaria suspicion fever in dispensary/ auxiliary  Quality of the RDT pediatric ward nurses performance • pregnant women in  Treatment ANC HF grid Use of register and head of the HF  Availability of malaria Interview with head of and pharmacist commodities the HF  Availability of trained staffs in malaria case management The following are the results of our assessment

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Description of Surveyed Population Regarding the assessment of the knowledge of the HWs on malaria guidelines, a total of 97 health workers (74% female) were interviewed including 4 medical doctors, 12 midwives, 32 nurses and 49 auxiliary nurses. As far as the observation of HWs is concerned, 56 HWs were observed during the consultation of 22 under 5 five children with fever (17 in health facilities dispensaries + 5 in hospitals pediatrics ward) and 34 pregnant women (29 in HFs and 5 in hospital maternities).

Knowledge of Health Workers on Malaria Guidelines4  Only 37% of surveyed health workers who are in charge of malaria case management have a good knowledge of all malaria guidelines.  The level of knowledge varied from 24% to 53% based on the area of the case management (treatment or diagnosis).  The levels of knowledge of the trained health workers were higher compared to the non-trained. This can be explained by the fact that 51% (49/97) of the sample is composed of auxiliary nurses who are non-qualified health workers.  Newly recruited health workers have been deployed within health facilities and were not trained yet.  When evaluating the level of knowledge among qualified health workers, we found that 61% (28/46) have a good knowledge against 13% (6/45) among the non-qualified.

Table 19: Health workers knowledge on malaria guidelines

Variables n N % Additional Results

 66% (46/70) of trained had a good knowledge against Knowledge of malaria 50 94 53% 17% (4/24) of non-trained among respondents diagnosis guidelines  67% (32/48) of qualified HW have a good knowledge

Knowledge of  30% (21/69) of trained had a good knowledge against uncomplicated malaria 22 93 24% 4% (1/24) of non-trained among respondents treatment guidelines  40% (19/48) of qualified HW have a good knowledge Knowledge of severe  40% (23/58) of trained had a good knowledge against malaria treatment 37 91 41%  42% (14/33) of non-trained among respondents guidelines  28% (13/46) of qualified HW have a good knowledge  61% (25/41) of trained had a good knowledge against Knowledge of IPTp 49 96 51% 44% (24/55) of non-trained among respondents guidelines  63% (30/48) of qualified HW have a good knowledge Knowledge of all malaria  61% (28/46) qualified HW have a good knowledge 34 91 37% guidelines against 13% (6/45) among the non-qualified. Good Knowledge is defined as follows: Diagnosis (at least 5/ 6 good answers) uncomplicated malaria treatment (at least 4/5 good answers) severe malaria treatment (3/3 good answers) IPT (3/3 good answers)

Health workers practices in malaria case management The capacity of health workers in malaria case management is very good in terms of interaction with the patients. The quality of this interaction is the same in both qualified and non-qualified health workers groups: the quality of the interpersonal communication is very high (94%), 97% of HWs explained to the patients how to use their medicines and 79% advised patients on the use of LLINs. In addition 91% of HWs searched for fever that is a proof that they followed the recommendations’ of the national guidelines in terms of suspecting malaria. But an important effort needs to be made regarding the performance of testing with the RDTs (55%) and proposing IPTp to eligible women. The reasons

4 Malaria treatment and MIP guidelines were available in only 21 % of HFs

ARM3 Quarterly Report 15, April – June 2015 40 | Page

reported by the health workers who didn’t propose IPTp to the eligible patients were the following: the woman is doing a treatment of ACT or the woman is allergic to SP.

Table 20: Health workers practices in malaria case management

Variables n N % Additional Results

 Qualified = 94% (32/34) HW followed IPC guidelines 51 55 95%  Non-qualified = 90% (19/21)  Qualified = 94% (32/34) HW checked for fever or fever history 50 55 91%  Non-qualified = 86% (18/21)  Qualified = 53% (9/17) HW counseled women on IPTp 14 23 61%  Non-qualified = 83% (5/6)  Qualified = 60% (9/15) HW performed RDT correctly 16 29 55%  Non-qualified = 50% (7/14) HW explained how medicine should be taken to  Qualified = 93% (14/15) 29 30 97% patients  Non-qualified =100% (15/15)  Qualified = 80% (16/20) HW counseled patients on the use of LLINs 30 38 79%  Non-qualified = 78% (14/18)

Recommendations Based on the results on this rapid assessment, ARM3 recommends the following:  The NMCP should train the newly recruited health workers on malaria case management  The NMCP, DDS and HZs should ensure regular supervision of health workers on malaria case management and provide refresher training to those previously trained on malaria case management  Case management and diagnostic guidelines should be made available at HF level in digital and printed forms

Sub-Result 3.3: Capacity in Commodities and SCM Improved During the quarter, ARM3 assisted the NMCP in quantifying malaria commodities for 2016 and 2017 based on 2014 consumption data reports with a completeness of 83%. ARM3 helped organize the “quarterly LMIS Supervision feedback workshops for decision making" to share with decision-makers from all 34 HZs (Zone Coordinators Doctors, statisticians, Manager) the results of the LMIS performance results based on the national supervision and to make recommendations and develop a performance improvement plan. In addition, ARM3 continued to maintain Medistock functioning, provided G/DRZ with internet credit for data transmission and continued the supervision visits of 100% of the HF in the pilot zones of Parakou N’dali and CBGH HZs.

Conducted Supervision of LMIS users in DRZs and Zonal Hospitals Begun in late March, in anticipation of the 2016 and 2017 quantification needs, ARM3 and the NMCP conducted a nationwide supervision of the management of malaria commodities in 33 DRZs, 26 hospitals and 68 health centers. The results of the supervision will be available in the next quarter. Besides the usual objectives and indicators – inventory of available stock of malaria commodities, usable available stock (UAS) at DRZ the day of the visit, training of new depots managers on the calculation of logistics information and use of LMIS data – the team also collected logistical information for 2014 and assessed the completeness of the 2014 reporting by the health facilities. In order to strengthen data quality control, the methodology required supervisors to export their monthly LMIS health facilities’ MEDISTOCK v5 reports for the period of January-December 2014. These databases were compared to the ‘’rapports commands des ILP’’ for quality control.

ARM3 Quarterly Report 15, April – June 2015 41 | Page

Staff trained on malaria commodities LMIS strategy The percentage of workers trained on LMIS strategy has been declining since 2014. It is 91% for G/DRZ and only 39% for chef posts and auxiliary pharmacists. This can be explained by the turnover of MOH staffs in 2014 and the arrival of newly recruited staff in 2014. It would be helpful for the NMCP to increase supervisory training to cover this training gap.

Table 21: Proportion of health workers trained on the LMIS

Category of staff Number of staff trained on LMIS Total Number % GDRZ 30 33 91% Health Workers 61 156 39.1%

Table 22: Availability of LMIS management tools at health facilities Health facilities Availability of LMIS order form Total Number % No 4 12.1% DRZ Yes 29 87.8% Total 33 No 18 24.3% Health Facilities Yes 56 75.6% Total 74  87.88% of depots managers have a copy of MC-LMIS quarterly report command register.  75.68% of chef posts at health facilities have a copy of MC-LMIS- monthly command report.

Ideally, all facilities should have the appropriate management tools. Unfortunately, there was a gap between the G-to-G initial understanding – that the NMCP would cover this need – and the reality. ARM3 did not allocate funds to print these documents. Following the supervision, measures have now been taken by ARM3 to make records available at the DRZ and HFs levels. It is worth nothing that several health zones have already taken the initiative to print the LMIS registers with their budget: this is the case of Bopa-Come-Grand-Popo-Houeyogbe health zone. This initiative demonstrates the value that the health zone places on these forms, and the institutionalization of this activity.

LMIS Management

Graph 8: Use of the malaria commodities in visited HFs 100% 100% 99% 99% 100% 97% 96% 98% 96% 99% 90% 83% 80% 70% 60% 50% 40%

Percentage 30% 14% 14% 20% 10% 8% 10% 0%

Products The low level of the use of ASAQ appears clearly in the national supervision and confirms the trends observed in the various EUVs. Indeed, only 8 to 14% of visited facilities have ASAQ. This explains the high quantities in stock at CAME depots and the high risks of massive expired products. Without a

ARM3 Quarterly Report 15, April – June 2015 42 | Page

pharmacovigilance survey conducted on ASAQ use in HFs, many health providers reported the existence of secondary and side effects on patients taking such products. Second-line malaria treatment is not prescribed in health facilities. In light of the comments reported by HFs on the prescription of ASAQ, the Directorate of Pharmacy, Medicines and Diagnostics Explorations (DPMED / MS) is preparing a survey to decide whether to continue ASAQ in use in Benin health facilities. Completeness of LMIS reports by HFs Graph 9 shows the decline in monthly submission of ILP reports between 2014 and the Q1 of 2015.

Graph 9: Completeness of LMIS reports in HFs for 2014 and Q1 2015 92% 100% 85% 90% 84% 82% 82% 83% 80% 70% 66% 70% 60% 50% 40% 30% Percentage 20% 10% 0%

Regions

In 2014, 83% of health facilities nationwide reported consumption data, but only 65% did so in first quarter of 2015. This decline in the submission of reports is due to: 1) lack of registers in health facilities and DRZs, and 2) the absence of supportive supervision from the national level. From April 2014 to March 2015, ARM3 and the NMCP organized only one training supervision covering health facilities. This may also explain the decline the submission of ILP reports. During FY15, two supervisions have been scheduled; one has already been completed and is subject of this analysis. The second supervision is planned for August and is designed to resolve many of the problems identified in health facilities.

Provided Technical and Financial Assistance to the NMCP for the Quantification of Malaria Commodities Needs for 2016 and 2017 From June 25 to 27, a workshop was organized by the NMCP with the technical and financial support of ARM3 in Porto Novo, and malaria commodity needs were quantified for 2016 and 2017. This second quantification workshop (the first held in February 2014) focused on improving the national procurement plan. Eighteen (18) participants from the Ministry of Health structures (NMCP, DDS Ouémé Plateau, and health zones) and Technical and Financial Partners involved in the fight against malaria (Africare, CRS, Expertise France, UNICEF and USAID) attended the workshop. Participants used 2014 consumption data from public sector (originated in LMIS) and community level (reported by CRS - Africare and UNICEF) to estimate the needs for 2016 and 2017.

Participants focused on: (1) The validation/compilation of consumption data from health facilities for Jan 1, 2014 to Dec 31, 2014 (with 83% completeness rate); (2) validation/ compilation of community level consumption data transmitted by Africare, CRS and UNICEF; (3) formulation/validation of the various quantification assumptions; and (4) development of a quantification improvement plan in light of the comments/remarks made at the first workshop in February 2014. In order to ensure the quality logistics information collected from the peripheral level (health centers and communities) and sent to the central level that will be used in this quantification, a quality control check was done during the data entry process in Medistock V5. This data entry enabled the verification of the conformity between

ARM3 Quarterly Report 15, April – June 2015 43 | Page

of the information provided by the health centers and that available in Medistock (initial stock, available usable stock etc.). In addition, a comparison was made between the HFs monthly data exported in Medistock V5 and the consumption data reported electronically each quarter by depot manager and shared with the national level. The discrepancies found have been corrected. The completeness of 2014 health facilities data and data entry rate in Medistock V5 by region is reported as the graph below.

Graph 10: Completeness of LMIS reports per region and data entry rate in Medistock

Annual reporting rate MEDISTOCKv5 Data entry rate

100% 92% 90% 90% 82% 82% 84% 83% 85% 83% 84% 75% 70% 68%

OP AL BA ZC AD MC National

The panel adjusted health zone consumption data by factoring in the number of stock-out days and a projection of this data to achieve 100% completeness. The report of the quantification workshop is being finalized and will be reported on in QR16.

Conducted Monthly Supervision of Stock Management in Health Facilities in Two HZs The first two supervisions of all (100%) HFs in the health zones of Parakou N'Dali-and-Bopa Come Grand-Popo-Houéyogbé provided a baseline that allows us to measure the performance of health personnel involved in the malaria commodities supply chain. The following are the results from January to April 2015 of Parakou- N'Dali and those from April- May of CBGH5.

Table 23: LMIS Management in CBGH HZ Indicators Feb 15 Mar 15 Apr 15 May 15 Number of HFs-CBGH without zone hospital 47 47 47 47 96% 98% 98% 89% Number of HFs-CBGH visited 45/47 46/47 46/47 42/47 76% 100% 100% 100% Number of HFs-CBGH having LMIS order form 34/45 46/46 46/46 42/42 76% 78% 96% 96% Number of HFs-CBGH producing data collection on LMIS 34/45 36/46 45/47 45/47 20% 33% 64% 82% Knowledge on filling the LMIS order form by Chef posts 7/34 12/36 29/45 37/45

 The health zone supervision team was unable to visit 100% of health facilities because of the rainy season (April to June). HFs that were not visited were YEGODOUE – SOHOUNME - Dohi - TOKPA BADAZOUIN – Gbedji

5 Feb-Mar 2015 was discussed in detail in the Q14 report; the data is included here to provide more context)”

ARM3 Quarterly Report 15, April – June 2015 44 | Page

 Since March supervision, all of the health facilities were provided with management tools (malaria commodity register control, REMECOM, stock Sheets) for good traceability of inventory movements which justifies the consideration of 100% of health facilities with management tools compared to health facilities visited.  During the first two supervision visits, the completeness of reports was calculated based on the visited health facilities that had completed report registers. In April all of the HFs had the required registers and their chefs posts were briefed on how to complete it. During the April-May supervisions, this completeness is calculated on all health facilities in the health zone to assess performance after each supervision.  Substantial improvement was observed in the health zone: completeness increasing from 76% in February to 96% in May.  From February to May we note a significant improvement in HFs that correctly filled out the Malaria commodities command-report (20% to 82%).This improvement is easily noticed at the evaluation of the data by product and logistics information. For the same indicators Parakou-N'Dali results are reported into the table below:

Table 24: LMIS Management in Parakou N’Dali HZ Indicators Jan 15 Feb 15 Mar 15 Apr 15 Number of HFs- PN without zone hospital 19 19 19 19 100% 99% 100% 100% Number of HFs-PN visited (19/19) (18/19) (19/19) (19/19) 100% 100% 100% 100% Number of HFs-PN having LMIS order form (19/19) (19/19) (19/19) (19/19) 100% 100% 100% 100% Number of HFs-CBGH producing data collection on LMIS (19/19) (19/19) (19/19) (19/19) 16% 11% 21% 100% Knowledge on filling the LMIS order form by Chefs postes (3/19) (2/19) (4/19) (19/19)

The knowledge of chef posts in filling out the registers has improved from 16% in January to 100% in April. This reflects the willingness of the chefs posts to ensure data quality before submitting their reports. At the end of each field visit, a debriefing was held with the HZ coordinator to point out the main difficulties observed at health facilities.

Graph 11: % of HFs with Stock-outs of Malaria Commodities during the Day of Visit: CBGH HZ 66% 63% 63% 61%

29% 27% 27% 24% 20% 18% 13% 8%

AL 6AL 12 AL 18 AL 24 SP RDT PRODUCTS April May

The stock-out on the day of the visit increased from April to May because the HZ depots lacked stocks to cover the health facility needs. LMIS parameters recommended that depots must have 2 months products as minimum of stock, but that wasn’t the case.

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Table 25: Level of stock on April 30 at CBGH HZ depot CBGH SDU (Stock AMC (Average Products Month of available Monthly stock usable) Consumption) ARTEMETHER+ LUMEFANTRINE 20MG/120 MG (P/6) 5,671 2,172 2.6 ARTEMETHER+ LUMEFANTRINE 20MG/120 MG (P/12) 10 1,042 0.0 ARTEMETHER+ LUMEFANTRINE 20MG/120 MG (18) 4 590 0,0 ARTEMETHER+ LUMEFANTRINE 20MG/120 MG (P/24) 2,615 3,055 0.9 SULFADOXINE + PYRIMÉTHAMINE (500MG/ 25MG) 2,990 3,920 0.8 TEST DE DIAGNOSTIC RAPIDE (TDR) 306 3,540 0.1

This low level of malaria commodities stocks in the depot is often inherent to the disbursement of funds for the procurement of health products (not only for the malaria commodities but also for the entire health zone needs in supply). ARM3’s continues to remind managers on management procedures regarding commodities based on LMIS parameters. The depot managers were briefed on LMIS rules and compliance procedures regarding stock management. They agreed to follow all procedures moving forward.

Graph 12: % of HFs with Stock-outs of Malaria Commodities on Day of Visit: Parakou-Ndali

100% 93.3% 94.7% 90% 81.3% 82.4% 80% 70% 60% 50% 40% 30% 16.7% 20% 15.8% 11.1% 10.5% 11.1% 5.9% 0.0% 5.3% 5.3% 5.6% 5.9% 0.0% 10% 0.0%0.0% 0.0% 0.0% 0.0%0.0% 0.0% 0.0% 0% AL6 AL12 AL18 AL24 SP RDT

BASELINE (January 2015) February ‐15 March ‐15 April ‐15

Note that during the months of supervision indicated above, 90% of AL 18 (ARTEMETHER + lumefantrine 20MG/120 MG) has experienced a shortage at the facility level the day of the visit. SP and RDT is around 5% in April alone.

Success: This activity allowed the HZ medical officers to keep track of malaria commodities in their monthly technical meetings. Following a recommendation from the supervision visits, the Bopa health zone started to register information related to RDT and SP in pharmacies into the REMECOM registers.

Challenges: LMIS data validation session at TOKPA health facility,  Seek supervision of the national ARM3 Quarterly Report 15, April – June 2015 46 | Page

level to assess the performances reported in the various reports from February to May, 2015.  Remind HZ coordinators to comply with the timeline of malaria commodities order  Challenges were seen at the HZ level, with stock-outs flowing down to the facilities

Organized Workshop on EUV Results in Atacora Donga and Drafted an Improvement Plan for Malaria Commodities Manageement On April 22, a feedback workshop on the November 2014 EUV was held in Natitingou, with participation from DDS officials, HZ coordinators, HZ Statisticians, depot managers, NMCP and ARM3. The objectives of the workshop were to (1) Review problems identified during the EUV; (2) find solutions to the identified problems; (3) develop a plan to resolve problems jointly with the EEZ; and (4) make recommendations for improving the availability of malaria commodities and the improvement of quality of care for uncomplicated malaria at the health facilities. At the end of the presentations that showed supply chain and case management indicators, we recall that:  60% of visited health facilities had all of the 4 AL presentations  42% of visited health facilities had not submitted their LMIS reports on time  48% of health facilities were under-stocked in malaria commodities due to stock outs at the Natitingou CAME  A very low use of ASAQ at the HFs.

Close supervision (DRZ-HFs), data quality control, and the strong involvement of the EEZs are necessary to achieve an acceptable level of performance in the health facilities. It is important to develop a training plan for health personnel and to increase training supervision in health facilities for compliance with management guidelines and input management

Conducted EUV Survey in Zou Collines From May 26-29, the NMCP and ARM3 started data collection for the EUVS in 20 health facilities in the department of Zou Collines. Five of the six HZs that make up the department were selected randomly.

Graph 13: Index of availability of ACTs on the day of the visit

4 presentations of ACT 0 presentation of ACT 10% 0% 1 presentation of ACT 15%

2 presentations of ACT 3 presentations of ACT 25% 50%

0 presentation of ACT 1 presentations of ACT 2 presentations of ACT 3 presentations of ACT 4 presentations of ACT

According to the ACT availability index, all visited health facilities had at least one ACT category and were capable of handling a case of malaria during the day of the visit.

ARM3 Quarterly Report 15, April – June 2015 47 | Page

Graph 14: Under 5 malaria uncomplicated cases treated with ACTs

under 5 malaria cases under 5 malaria cases not treated with ACT treated with ACT(n= (n= 6) 629) 1% 99% under 5 malaria cases treated with ACT(n= 629) under 5 malaria cases not treated with ACT (n= 6)

There is a good performance in adherence to the treatmment policy for uncomplicated malaria. Indeed, 99% of uncomplicated malaria cases were treated with ACTs (over the period referenced: April 2015).

Graph 14: Percentage of Trained Staff

100% 80% 80% 72% 70% 59% 59% 60% 40% 20% 0% MCM Guidelines IPTp RDTs Microscopy Stock Management

The NMCP, with the support of its technical and financial partners, must continue with ongoing efforts to train/retrain a greater number of staff in malaria case management and stock management.

Provided Internet Connectivity for DRZ Managers at HZ level During the quarter, 28 DRZs received two (2) Internet Credit allocations (Moov and MTN) for April and June. Six DRZs received subscription for renewal Kanakoo package of 6 months starting in June 2015 for the export of LMIS data. This allocation facilitated LMIS HFs monthly data submission for 2014 in preparation for the quantification workshop. Most DRZs (25 out of 34) submitted their reports through the internet; while the other 9 were collected in person. DRZs with limited internet access (i.e., Malanville, Save, Klouékanmè, Lokossa) and those that didn’t conduct timely data entry (1-4 Photo of NMCP regional representative Dr. Agbangla and Cotonou, Djougou, Natitingou, Kandi; Banioara) the national NMCP supply chain manager Dr. Adjibabi verifying data during EUV. MCDI credit forced the ARM3 SCM team to travel to the field to collect data. Regarding the HZs with limited access to internet, it is important to re-evaluate the situation and determine the operational reliability of GSM operators during the next MEDISTOCK v5 supervision and make an inventory of Internet connection kits.

Regarding the DRZs that didn’t send their report on time, their health zone coordinators were informed to follow up on the data entry process. The next supervision will focus on: (1) Ensuring the ARM3 Quarterly Report 15, April – June 2015 48 | Page

functionality of MEDISTOCK v5 software at the DRZ level; (2) Save all MEDISTOCK databases from the 34 DRZ at ARM3 office; (3) Assess the data entry rate of monthly reports for the first half of 2015; (4) evaluate the accuracy rate of at least 5 monthly reports; (5) perform active data entry in the software if requested; (6) assure the maintenance of the software, if requested; and (7) Collect the monthly consumption data in visited DRZ the first semester of 2015

Provided Technical Assistance to the NMCP in Maintaining the Functionality of Medistock v5 In total, all 34 DRZs were using Medistock v5 software as of June 12, 2015. Maintenance is very important to the proper functioning of Medistock v5 for the management malaria commodities. Several managers shared their difficulties in using Medistock, including data exports, software installation, data entry and database update. To this end, four DRZs were visited to ensure the maintenance of the software:  ADD (Aplahoue/Dogbo/Djakotomey): The GDRZ lost certain functions related to the export of the database to the desktop. These functions were related to customer orders and deliveries.  KTL (Kloueanne/Tovklin/Lalo): Since January 2014, the KTL HZ has been thinking about replacing MEDISTOCK v5. Following the Porto Novo LMIS feedback workshop held in June, the HZ agreed to go back to using Medistock v5.  Cotonou 6: The depot manager lost access to the database and the ability to update the inventory list.  Cotonou 1-4: Once the depot manager left, no one was able to enter data. ARM3 trained HZ statistician on the software and related date entry tasks.

Provided Technical Assistance to the NMCP for the Finalization of the ‘’Common Basket” Document The ‘Common Basket’ document that defines the roles and responsibilities of each malaria program stakeholder (both the Ministry of Health and the technical and financial partners) was finalized at a workshop in Porto Novo in March. In June, ARM3 provided technical and financial assistance in a final review of the document during a workshop at the NMCP, which was chaired by the Dr. Oke, and attended by UNICEF, USAID, CRS, ARM3 and NMCP. The NMCP is responsible for finalizing and sharing the final document during the next quarter.

Participated in the 1st Session of « Comité National des Approvisionnements en Produits de Santé (CNAPS)’’ On June 23-24, 2015, the 1st session of the CNAPS was held in Cotonou, with participation from various structures of the Ministry of Health, DDS, health workers, pharmacists, UN agencies, USAID partners and NGOs. The objective of the workshop was to improve the availability and access to essential drugs, which requires: (1) Monitoring of 2015 supply chain plans and Early Warning System; (2) availability of health care products, and (3) the identification of appropriate alerts strategies to avoid stock-outs or overstocking (storage Problem on Microgynon of Depo-Provera and the unresolved ASAQ). Specifically, this session was also the opportunity to present two systems being developed in the Ministry of Health to improve the health information system (HIS):

1. The Health Information System DHIS2 (Data Health Information Software for a harmonized SIS) This is a data warehouse, which will integrate information subsystems, designed by the University of Oslo. Many countries, including Ghana, Liberia and , are already using the system, which has many advantages such as: (1) daily monitoring operations; (2) remote access to data for health authorities; and (3) transparency in the level of completeness. Funding for this program is made available by the SHSPP project (Strengthening Health System Program Performance) and a pilot phase will start in 8 HZs.

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2. An implementation strategy for a National LMIS This strategy will include all health related commodities that will be implemented nationally based on the experience and the success of malaria commodities LMIS supported by ARM3. The goal is to expand the LMIS to all products used by all central programs of the Ministry of Health.

Quarterly LMIS Supervision Feedback Workshops for decision making During the first week of June 2015, quarterly LMIS supervision feedback workshops were held in Porto/Novo and Parakou, which brought together all stakeholders participating in SCM, including HZ coordinators and statisticians, representatives from the NMCP and DDS. The objectives were to:  Present the results of the March 2015 national LMIS supervision (availability of commodities, filling and transmission of logistics information to the upper level etc.)  Identify management issues, potential bottlenecks in the supply chain in structures and barriers to reporting of health facilities.  Provide corrective actions and establish an implementation plan with the MCZ  Discuss traceability in the management of SP and RDTs  Make recommendations for improving the availability of commodities

The feedback workshop also allowed participants to find solutions to the different problems identified in health facilities during supervision visits, including: (1) lack of coordination between DRZ and HZ statisticians in ensuring timeliness and completeness of HZ reports; (2) accuracy and consistency between the various reports. It was recommended that HZ management teams (EEZ) be set up at each HZ to collect and validate LIMS data at least once per quarter, to ensure data quality.

RESULTS: MOH Capacity in Commodities and Supply Chain Management (SCM) Improved Indicator Baseline LOP Target Q3 Results Source

17) Number of quarterly and -- The national malaria commodity supply annual reports generated by 79.4% chain is functioning the LMIS per year (27 Health zones with an LMIS that sent their report LMIS regularly provides out of 34) quarterly and annual reports 18) Percent of government 80.3% ≥85% of government HFs with ACTs available for Source HFs have ACTs treatment of uncomplicated RMIS available for treatment malaria (PY1/Q4) of uncomplicated malaria for patients of 100% EUV Zou/Collines any age at any point in report, May 2015 time covered by project-supported EUV surveys 18.a) Percent of HFs 77.3% ≥85% of HFs report no RMIS results are reporting no stock‐outs of Source stock-outs of ACTs from October to ACTs RMIS December 2014. (PY1/Q4) 67.6% No 2015 RMIS data (746/1,103) available due to the scaling of the DHIS2

19) Percent of facilities in 0% Complete (100%) NB: Indicator has compliance with CAME implementation of been reformulated ARM3 program reforms reforms initiated in to reflect reforms reports CAME so as to implemented improved governance within CAME and transparency of its instead of CAME ARM3 Quarterly Report 15, April – June 2015 50 | Page

RESULTS: MOH Capacity in Commodities and Supply Chain Management (SCM) Improved Indicator Baseline LOP Target Q3 Results Source operations reforms implemented by other facilities. 20) Percent of facilities that Results Results from the ARM3 program submit an action plan in pending EUVS are analyzed reports response to the EUVS EUVS and used to identify EUV ATACORA management and Donga report was report operational issues in 100% restituted during the the commodity supply quarter with DDS chain system and HFs and each of the HFs submitted an action plan

Result 4: Cross Sectional Activities

Aired TV Spots and ‘Infomercials’ on Key Malaria Messages During the quarter, ARM3 aired mass media spots on the importance of LLIN use and IPTp uptake by pregnant women. Specifically, 2 TV spots were aired 44 times on TV Channel 3 and ORTB during period of heavy rainfall in June 2015. Another two ‘Informercials’ were aired in Cotonou and Tchatchou in collaboration with the NMCP and USAID. These broadcasts were aired to raise the awareness of the general public, particularly pregnant women and women with children under 5 regarding good practices in the fight against malaria. These broadcasts reached nearly 2 million people including over 750,000. TV spots on IPTp uptake were updated using the new policy document on IPTp/SP and validated by the NMCP and the BCC TWG.

Provided Technical Assistance to the NMCP on World Malaria Day (WMD) Activities As part of World Malaria Day (WMD) activities in Benin, ARM3 in collaboration with the NMCP reprinted and distributed IEC/BCC materials, including flyers on malaria prevention and treatment (e.g., LLIN use, ACTs) at various WMD events. The materials printed were initially updated in late May and subsequently validated during the BCC TWG in early June. The following IEC/BC materials were printed during the reporting period: (1) 90,000 flyers on ACTs; (2) 80,000 flyers on LLINs; (3) 200 pamphlets; (4) 1 banner; (3) and (4) 8 large posters on SPs and LLINs (updated).

Program management

Field Office Met with USAID Evaluators Team to Review Preliminary Results from their Evaluation of ARM3 On April 9, 2015, ARM3 attended a meeting organized by the USAID evaluators team to review preliminary results from the evaluation of USAID’s Program Portfolio Review for Integrated Family Health 2012-2015. As part of the evaluation, the evaluators also shared findings and recommendations from their evaluation of ARM3, including recommendations on setting up priority activities for the remaining period of ARM3 in years 4 and 5. Some of these recommendations to ARM3 were the following: (1) ARM3 should continue to encourage the MOH/NMCP to ensure the sustainability of project achievements and technical approaches; (2) ARM3 must collaborate closely with DDS / HZs to increase project results; (3) ARM3 must work closely with local NGOs to revolve problems regarding the motivation of and improved links to supply chain management systems to ensure the availability of malaria commodities. ARM3 Quarterly Report 15, April – June 2015 51 | Page

Met with ANCRE and APC Regarding the Implementation of PIHI-C On April 9, 2015, a coordination meeting was organized by APC, ANCRE and ARM3 to review problems regarding to the implementation of PIHI-C. Partners have noticed that NGOs are contacting USAID directly and limiting contacts with partners regarding technical assistance needs. NGOs are also withholding information, including their periodic progress reports and action plans, and limiting opportunities for feedback and support by partners. ARM3 and USAID partners, APC and ANCRE will work with USAID and relevant NGOs to improve coordination and communication mechanisms and facilitate the sharing of plans and reports.

Reviewed the DPA Project at USAID Office On April 21st, 2015, the ARM3 COP participated in a meeting at USAID office to discuss the implementation of the Data for Action Project (DPA). USAID asked DPA to make revisions to the project, maintain coordination with ANCRE, simplify reporting forms, and develop an M&E plan for project indicators.

Participated in the Implementation of the BCC Assessment On May 15, 2015 Michelle Kouletio, ARM3 AOR, and ARM3’s COP visited the Akpadanou and Kode health centers in the commune of Adjohoun-Porto Novo to observe the implementation of ARM3’s BCC assessment. During the visit, they met with the surveyors and worked to review and resolve challenges during the survey and data collection. They reported about the low number of women who agreed to be interviewed.

Participated in the COP Meeting Organized by USAID The monthly meeting of COP’s of projects financed by USAID was held on May 21st, 2015. Concerning to ARM3, the COPs discussed the need of an updated per diem rate for USAID projects to be applied during field visits: The current per diem rate was applied since 2000, and is no longer aligned with real actual cost of living in Benin, creating a distortion vis-à-vis the MOH staff who prefer to conduct missions with other partners who pay much higher per diem compared to that provided by the projects funded by USAID.

Met with CEBAC/STP to Discuss the Collection of Revenue from Phase 2 LLIN Distribution Meetings were held between Mr. Christophe TOZO, CEBAC’s President and ARM3 COP, Gilbert Adrianandrasana and Mr. Fructueux Rodriguez, ARM3 AFO. As a result of these meetings, FCFA 33,851.642 ($58,364.9) has been transferred to the ARM3 account and the joint account ARM3/CEBAC has been closed.

Participated in a Meeting on the Private Sector Organized by ANCRE ARM3 participated in the workshop organized by the ANCRE on June 2nd to 3rd, 2015 on the private health regulation in Benin. The objective of the workshop is to facilitate discussions and exchanges between stakeholders to analyze needs for establishing a more effective regulation regarding the private clinic opening and practicing authorizations in Benin and to identify constraints to this regulation and find alternatives for solutions. This is the continuation of the activities with the private sector initiated by ARM3.

Participated in a Roll Back Malaria (RBM) Meeting On June 3, 2015 the monthly meeting of RBM Technical was held at the Ministry of Health with the participation of Financial Partners. Five items were on the agenda: 1. Concept note to the Global Fund and Next Steps: The NMCP is the primary recipient 2. World Malaria Day. This year, the theme is the same as last year: "Save lives: invest in the fight against malaria." And the date of the celebration is set on July 3 in the public square of Aplahoué. 3. Case management at community level: Some presentations were done by AFRICARE based on 2014 and the first quarter 2015 data, the status of their order and the level of commodities stock. ARM3 Quarterly Report 15, April – June 2015 52 | Page

During this presentation, AFRICARE has focused on the ACT and RDT, safety boxes, gloves situation, quantities of commodities delivered, orders in progress, consumption, stock inventory available to CAME. 4. Presentation of the results of the study ''estimate of national product distribution costs in Benin and Kenya’: The study objective was to estimate the cost of ACTs and RDTs distribution from Central level to Peripheral levels through the health system to enable an accurate assessment regarding the delivery cost of malaria commodities to the end users and therefore enable accurate planning and budgeting. Also, it provided realistic estimates of distribution costs to be included in road maps and proposals, in order to improve access to antimalarial in countries with low and middle incomes. 5. Activities planned for each partners in April and May 2015 and those scheduled for June 2015.

ARM3 COP’s visit at MCDI Headquarters (involves field and home office) ARM3’s COP visited the headquarters of MCDI in Silver Spring/USA from June 23rd to July 1st 2015, for a briefing and orientation. The visit allowed him to meet with MCDI staff providing technical and financial backstop to ARM3 including program, finance, and HR staff, and review programmatic priorities including the ARM3 work plan for year 5 & budget, review of reporting procedures and finalization of the BCC assessment report. He also reviewed finance systems, including accounting systems, requests for funding with relevant finance staff.

Held Discussion with USAID and the NMCP on the use of Unspent MOP Funds ARM3’s COP and the NMCP participated in a meeting requested by USAID to agree on the use of MOP unexpended funds from years 2011 and 2013. Based on guidance provided by USAID and MCDI HO, the COP agreed with the AOR on the remaining amount available according to current ARM3’s Year 4 work plan and budget. A committee was stablished to review the development of reprograming proposals developed by the NMCP and ARM3 teams.

Home Office Backstopping and Reporting

Aligned Funding Requests with Approved Budget/Processed Accruals Report for USAID As part of the internal quality assurance process a review was conducted of the ARM3 tracking sheet, resulting in an improvement that now allows the team to track activities expenditure in real time. The accruals report for Quarter 3, 2015 was processed and submitted to USAID on June 10, 2015.

Supported DPA Project in the Development of Assessment Scenarios for Health Workers HO staff developed five scenarios to case management, IPTp, SCM and M&E to assess the decision making of MOH staff in implementing malaria activities. Once they are validated the DPA project, these scenarios will serve as the ‘baseline’ for the knowledge assessment of health workers.

Responded to Information Requests Conducted By USAID Mid-term Evaluators Following a review of the midterm review report (MRR) and in agreement with USAID, MCDI adapted the reporting template provided by Dr. Coulibaly and responded to information requests from the evaluators, including relevant information from ARM3’s Cooperative Agreement, approved work plans, budgets, and technical/financial reports. The evaluators subsequently sent additional questions/requests clarification to which MCDI responded.

Provided technical support in the development of the ETAT Assessment Protocol HO staff reviewed the draft ETAT assessment protocol developed by the field team and provided a revised version with comments.

ARM3 Quarterly Report 15, April – June 2015 53 | Page

Supported ARM3’s Malaria Diagnostics Advisor to Conduct the Validation of Supervisors in Malaria Microscopy Two sets of malaria slides, from the Archive of Malaria Slides developed by MCDI, were assembled and submitted to Benin to support the validation of 40 supervisors in malaria microscopy reading. The slides submitted have been validated and confirmed by a set of WHO level 1 readers and PCR.

Supported the Field Office in Responding to USAID Requests Regarding the Reprogramming of Unspent MOP Funds MCDI HO conducted a review of the budget and the MOPs for 2011 and 2013 in order to develop a funding ceiling aligned with USAID, Once sent to the field for final review, it was share with the AOR.

Drafted Letters to CEBAC Requesting the Transfer of Funds to the Joint ARM3/USAID Account In response to CEBAC demands to get an overhead payment to support the recovery of the remaining uncollected balance and to have the funds of the joint account transferred to ARM3’s account to support activities with private sector clinics, MCDI HO developed two letters that were shared with CEBAC Director and the NMCP Coordinator by ARM3’s COP.

Provided Guidance for the Close-out of Parakou Office In coordination with MCDI HO HR Manager and CFO, ARM3’s backstop staff developed a close out checklist and submitted it to the field. Based on agreements with the COP, field activities in Parakou will be conducted through September 15, 2015. A notice for termination of contracts has been issued and shared with the Ministry of Labor based on local Labor Law.

Held Discussions with the CDC and conducted follow-up on the close-out of the HFS report Responded to Susanne’s Powell (CDC) request regarding the completion of additional analysis, the submission of the HFS database and a dictionary of variables. A meeting with the CDC will be held in August 2015.

Organized the visit of ARM3’s COP to MCDI HO Dr. Gilbert Adrianandrasana’s visit to MCDI had been delayed due to ARM3 programmatic needs and priorities. However in May 2015, MCDI obtained approval from USAID for his visit and debrief at MCDI from June 24 to July 1st 2015.

Conducted Programmatic/Financial review of Year 4 work plan/budget and started the process for Year 5 A programmatic/financial review was conducted jointly with the COP; discussions were held regarding activities to be completed and/or rolled over to year 5. A preliminary estimation of unspent funds was conducted, including projections through September 2015. An HR analysis was also conducted for year 5 and staff through the end of the project was determined. A timeline and process for the development of the final year work plan and budget was developed.

Reviewed/revised the BCC Preliminary Assessment Report Reviewed the draft report and data submitted by the field team and worked with them in finalizing the report. Final review of report was conducted during Dr. Adrianandrasana’s visit to HO. Partner Coordination  Maintained regular communication with MSH’s Project Director and followed up on programmatic/financial activities.  Processed payments to MSH in April 2015.

Partner Close-out Activities:  Completed close-out of activities with JHU-CCP and issued final payment.  Followed up on the submission of outstanding materials/information from Africare. ARM3 Quarterly Report 15, April – June 2015 54 | Page

Major Challenges (per ARM3 Sub-Result) Private sector:  The plan proposed by CEBAC for covering the balance of XOF 16,476,000 from the sale of mosquito nets in the private sector was amended and approved by ARM3 but CEBAC has not yet submitted a timeline for its implementation. The balance remains still not covered.  A MOU was jointly signed by a health zone, the DDS, the NMCP and ARM3 which requires all concerned health zones to design and implement an operational plan based on the Performance Improvement Approach (PIA), which is the combination of the capacity building program in leadership, quality assurance in order to sustain the achievements of ARM3 project from the fight against malaria three-year plan and supervised by the Departmental Directorate Health. This MoU lasted from 29 January to 30 June 2014.  Despite the termination of MOUs since June 2014, the financial status of these entities and DDS is not yet closed and on February 2015, the balance in the account book reported XOF 745, 410. It remains a problem to solve during the last quarter of this current fiscal year. Case Management (the same as stated on Q14)  The turnover of staff at health facilities is a major challenge in the implementation of project activities as new health workers at health facilities need to be trained before they can start their work. ARM3 will continue to encourage health authorities to ensure that qualified and trained health workers remain in their positions for at least 3 years.  Budget constraints at the NMCP have reduced the number of supervision visits of case management and malaria diagnosis activities. Thereby reducing the performance indicators.  ARM3 will continue to work to ensure that ETAT indicators be incorporated into the next update of SNIGS. The inclusion of ETAT indicators into the PBF approach has also been addressed.  Stock-out of malaria commodities is being noted at some health facilities. Some officials are still holding on to commodities to sell them rather than make them available at their warehouses or they simply fail to order commodities on a timely basis. It is important to ensure that health authorities are fully involved in discussion on how to resolve issues concerning stock-outs. Monitoring/Evaluation  The set-up of DHIS2 started in late 2014. The HMIS office in Benin asked all HZ statisticians to stop entering RMIS/HMIS data into the LOGISNIGS software and to wait for the launch of the DHIS2 data entry platform. All staff have been waiting since early 2015 but no date has been set yet for the launch of platform and as a result RMIS data is not available. To address this, ARM3 will meet with NMCP and HMIS office teams and request that HZ statisticians to continue to enter RMIS data in LOGISNIGS software while awaiting the launch of the DHIS 2 data entry web platform.

Major Activities Planned for Next Quarter (Year 4, July – September 2015) Result 1: Implementation of Malaria Prevention Programs in Support of the National Malaria Strategy Improved Sub-result 1.1a: IPTp Uptake Increased  Meetings held in collaboration with the NMCP to analyze IPTp data, share lessons learned and best practices in IPTp uptake across HZs (including results of performance based financing)  Organized a workshop with the NMCP, ANCRE and DSME to review and analyze best practices on IPTp uptake during pre-natal visits  Mass media messages disseminated through 3 TV spots for the World Malaria Day in Benin on LLIN, IPTp, and prompt care seeking  Malaria prevention and treatment materials printed and disseminated in the World Malaria Day.  Effectiveness of ARM3 BCC activities evaluated  BCC Assessment Study results disseminated through 1 workshop, 2 days 20 participants

ARM3 Quarterly Report 15, April – June 2015 55 | Page

Result 2: Malaria Diagnosis and Treatment Activities in Support of the National Malaria Strategy Improved Sub-result 2.2: Improve Case Management of Uncomplicated and Severe Malaria Sub-result 2.2.a: Upgrade Skills of Health Workers on Clinical Management Sub-result 2.2.b: Implementation of the Performance Improvement Approach (PI) in Participating HZs and Hospitals.  Train health workers at private sector on IPTp and case management  Hired a consultant to develop a document that describe the state of the art and propose a mechanism to provide private sector clinics with malaria commodities  Organize two (two-day) workshops between the NMCP and private sector stakeholders (using the private sector platform; PSSP) to define access mechanism for the private sectors' access to malaria commodities  Assessment of the results of selected PMI supported ETAT sites (including those under PISAF) with the DSME and NMCP and the 6 DDS’, to validate the effectiveness and challenges of the approach (7 from national and departmental levels and a sample of district hospitals)  Protocol design and develop  Data collection; 3 teams of 3 for 8 days  Draft report prepared and disseminated  The national norms regarding the registration of private sector health facilities and the opening of new private sector health facilities are disseminated

Sub-result 2.3: Improve integrated Community Case Management (iCCM)  Group supervision of CHWs conducted through monthly field visit 0f 2-3 days with the supervision framework developed by APC  Technical and financial assistance to conduct two (2) data quality audits in a representative sample of CHW's and HFs in 5 HZs. (First DQA conducted with Y3 funds)  Parakou Team leader attended monthly staff coordination meetings and/or other technical meetings in ICCM and PIHI-C

Result 3: The National Health System's Capacity to Deliver and Manage Quality Malaria Treatment and Control Investigations Strengthened

Sub-result 3.1: Enhance the NMCP's Technical Capacity to Plan, Design, Manage, and Coordinate a Comprehensive Malaria Control Program  Technical assistance for the semi-annual PITA review

Sub-result 3.2: Improve MOH Capacity to Collect, Manage, and Use Malaria Health Information for Monitoring, Evaluation, and Surveillance  Technical assistance to the NMCP for the validation of RMIS data at regional level for the Palu- Info bulletin  Technical assistance provided for the publication of 4 PALU INFO Bulletins  Two (2) quarterly RDQAs conducted  Monitoring of availability and utilization of key antimalarial commodities at # health facilities conducted; conduct quarterly (4) EUVs  Health workers assessment in malaria case management conducted (activity biannually (integrated to EUV) Sub-result 3.3: Improve MOH Capacity in Commodities and Supply Chain Management  Advocacy with the MOH for the sign-off of the National Directives of Malaria Commodities by Minister of Health, approved directives copied and disseminated ARM3 Quarterly Report 15, April – June 2015 56 | Page

CAME's QA plan monitored biannually in Parakou, Nattitingou and Cotonou by ARM3 SMC staff Technical assistance provided to DRZ managers and statisticians to conduct LMIS supervisions to zonal/ departmental hospitals and health facilities (to support LMIS users in the proper use of LMIS tools, data quality and reporting through coaching) Jointly with NMCP and DRZ staff, provide quarterly supervision of stock management in all health facilities in 2 zones Quarterly LMIS Supervision feedback workshops for decision making conducted Internet connectivity for DRZ manager at 34 HZ level funded for 1 year and LMIS data availability at central level ensured Technical assistance provided for the operation and maintenance of MEDISTOCK

Result 4: Cross Sectional – BCC Disseminate BCC assessment findings to NMCP, USAID and others partners

ARM3 Quarterly Report 15, April – June 2015 57 | P a g e Annex 3: Progress on ARM3 Year 4 Work Plan

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N Result 1: Implementation of Malaria Prevention Programs in Support of the National Malaria Strategy Improved

Sub‐result 1.1a: IPTp Uptake Increased MOP 2014 1. Disseminate Policy document on 0 HFs received the 12. % of managers in $5,000 $20,000 In process 100 copies of Malaria in policy document IPTp, including WHO IPTp policy program areas who ‘’Facilitator Guides’’ Pregnancy on Intermittent recommendations document meet performance and 1,000 copies of 2. Provide Preventive Therapy printed and X X Y targets with currently ‘’Participant Manuals’’/ support for for Pregnancy disseminated via available human and Dissemination supervision and (IPTp) with the supervisory activities technological scheduled for year 5 refresher training NMCP and DDS resources of health workers 2. Provide technical Meetings held in 0 Meeting held $1,140 $4,560 In process Gathered requested in IPTp to support to the collaboration with 0 IPTp best data, Started data improve quality NMCP in the the NMCP to analyze practices report analysis and of service documentation of IPTp data, share developed. rescheduled meeting ($42,000 from IPTp and IPTp lessons learned and for Q4. X Y case performance data best practices in IPTp management) across HZs in public uptake across HZs and private sector (including results of health facilities performance based financing) Workshop organized 0 Workshop $5,880 $22,909 Not started Rescheduled for Q4 with the NMCP, conducted after the validation of ANCRE and DSME to X Y 0partners IPTp data analysis with review and analyze participating in the the NMCP best practices on workshop

ARM3 Quarterly Report 15, April – June 2015 60 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N IPTp uptake during pre natal visits MOP 2014 BCC 3. Provide technical Accompanied the 1 integrated $6,960 $27,840 Completed ARM3 provided 2. Proportion of National level and financial NMCP and DDS on supervision logistical assistance to children under‐5 BCC technical assistance to the national supervision conducted at HZ the NCMP during the years old who slept assistance NMCP for the of CHW BCC, LLITN level (1 during Q2) quarter under an insecticide‐ ($300,000) supervision of distribution and case treated net (ITN) the Community Health management X Y previous night MOP 2014 BCC ‐‐ Workers BCC, for

Support the roll‐ IPTp, malaria case 5. % of population out of the management, LLIN that recall three* key national malaria distribution and project messages for communication BCC household health strategy behaviors (*key 4. Supported the Accompany NMCP developed 170 000 $900 $3,600 In process ARM3 provided messages for NMCP in the for the flyers and technical and financial prevention of malaria implementation implementation of 2 mass media spots support to NMCP for and diarrhea and key malaria campaigns, national malaria aired during WMD the broadcasting of one family planning including the campaigns (e.g., and other TV spot (15 times) and message) design, printing of LLITN mass campaigns (2in one publi‐reportage (4

IPC materials and distribution, World Quarter 2) times) on malaria keys

dissemination of Malaria Day), X X X Y 6,160,000 persons messages.

TV spots on malaria including the design, reached through

prevention and printing of IPC BCC campaigns

prompt care materials and

seeking dissemination of TV

spots on malaria

prevention and

prompt care seeking ARM3 Quarterly Report 15, April – June 2015 61 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N Mass media $19,200 $76,800 In process ARM3 provided TA to messages the NMCP for the disseminated preparation of the through 3 TV spots world Malaria day. 3 TV X X Y for the World spots have been Malaria Day in Benin prepared and updated on ITN, IPTp, and (on IPTp) for the event. prompt care seeking Malaria prevention $10,527 $36,845 Completed BCC materials and treatment (pamphlet and flyers) materials printed and X X Y have been printed and

disseminated at disseminated World Malaria Day. Interpersonal 0 materials printed $9,425 $37,700 In process Numerous BCC tools communication 0 health centers have been shared in materials printed and X X X Y receiving materials Mono Couffo HFs but disseminated at IPC tools will be health centers disseminated in year 5. 5. Transfer ARM3's Documented ARM3's 1 report on ARM3's $5,924 Completed ARM3 BCC experience community BCC community BCC Community BCC has been documented experience to APC, experience report developed (1 and the document is ANCRE and NGOs implemented this quarter) available X Y (e.g., mass media, through local NGOs local radio spots, in collaboration with and community DDS and HZ, under level approaches) MOUs

ARM3 Quarterly Report 15, April – June 2015 62 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N on promoting net ARM3 community 0 community $7,554 In process ARM3 continued the use, recognizing BCC experience events transfer of competency danger signs of transferred to USAID 0 CHW trained on during workshop, field malaria, improving partners (APC, the promotion of visit during the quarter. care seeking ANCRE); local NGOs net use, recognizing behaviors, (“Sianson” and danger signs of including ANC “Dedras”); DDS BA malaria, increase of attendance, and and DDS AD and HZ care seeking IPTp uptake CRAMS, on the behaviors, and (through women's training of CHWs, increased ANC groups and CHWs) including LLIN/ITN X X Y attendance and

use, recognizing IPTp danger signs of malaria, and encouraging care seeking behaviors among women, including ANC attendance and IPTp uptake (3‐day workshop) 6. Conduct a BCC Effectiveness of 1 BCC Assessment $20,000 $70,000 Completed The 1st draft of the Assessment Study ARM3 BCC activities Study report report has been shared X X X Y to evaluate evaluated available with the USAID mission effectiveness of ARM3 BCC BCC Assessment 0 Workshop $3,960 $13,956 Not started Scheduled for Q4 interventions Study results X X Y organized and disseminated (1 Study results

ARM3 Quarterly Report 15, April – June 2015 63 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N workshop, 2 days 20 disseminated participants)

Sub‐result 1.1.b: Upgrade Skills of Health Workers through Pre‐service/In‐service Trainings MOP 2013 1. Provide technical Technical assistance 1 Report of the 12. % of managers in $1,632 $6,528 Completed ARM3 has started Support for pre‐ assistance in to identify gaps in status of malaria program areas who discussions with service strengthening the malaria curricula in curricula and meet performance Parakou University and institutions will capacity of health pre‐service training training plans in targets with currently ENATSE authorities and continue to be worker pre‐service institutions provided, X X Y pre‐service available human and the number of students provided through training institutions including assessment institutions technological who will be trained in the MOH of training plans, available (1 or this resources known curricula and malaria quarter) training materials Best practices and 0 Meeting $1,632 $6,528 Not started Rescheduled for year 5 lessons learned conducted shared with the X Y NMCP and pre‐ X service organizations through meetings MOP 2014 2. Provide technical Analysis of the in‐ 1 Document on in $1,140 $4,560 In process The analysis is now Preventative assistance for the service training service training conducted in 27 out of Activities IPT in assessment of in‐ situation of health available (1 for this 34 Health zones. Funds

Pregnancy service training and workers in malaria X Y quarter) are not available for 7 X 2. Provide recommendations prevention HZs of Atlantique support for towards diagnostics and Littoral supervision and developing an in treatment conducted

ARM3 Quarterly Report 15, April – June 2015 64 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N refresher training service training National malaria 1 National malaria $8,810 $35,240 In process The training plan is of health workers plan in Year 5 training plan for both training plan ready for 27 HZs out of in IPTp to pre‐ and in‐ service available for 27 HZs 34 and available for the improve quality training developed X Y out of 34 health schools. Funds of service with the NMCP (19HZs for this are not available for 7 ($65,000 training quarter) HZs of Atlantique and $60,000 Littoral supervision) 3. Provide technical Supervision visits and 0health workers $21,362 Not started Scheduled for assistance to the on‐the‐job training receiving refresher Q4; G2G funds were not NMCP in provided to health trainings and available supervision of workers, including supervision through health workers in benchmark ARM3 technical IPTp to improve assessments, one‐on‐ X X X X Y assistance on IPTp quality of service one training sessions at health facilities and dissemination of guidelines/tools on IPTp coverage Sub‐result 1.2.: Supply and Use of LLINs Increased Part of 2013 MOP 1. Incinerate LLIN LLIN packages $5,000 $20,000 Completed Lafarge‘s oven Case packaging collected incinerated based on 2. Proportion of incinerated all of the 508 LLIN packages management during distribution Ministry of children under‐5 508 packaging. incinerated (50 in diagnostics and campaigns with Environment years old who slept X Y Q2 and 458 for this treatment private sector, in recommendations under an insecticide‐ quarter) coordination with and approval treated net (ITN) the

($80,000) the MOH and the previous night Ministry of the

ARM3 Quarterly Report 15, April – June 2015 65 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N Environment

2. Provide technical Workshop organized 0 Workshop $5,780 $23,120 Not started Scheduled for year 5 and financial to promote private organized assistance on sector participation 0 private sector malaria‐related in malaria companies engaged education, training prevention, by in the Corporate and promotion disseminating the Social Responsibility activities for results of the LLIN initiative promoted private sector distribution X X Y by ARM3

organizations campaign in the which initially private sector, distributed the including assessment LLINs of the level of commitment to adopt a sustainability

plan 3. Provide technical Technical assistance 1 Report of ARM3 $5,100 $20,400 Completed Logistic and technical assistance to the for LLIN mass support to LLITN assistance was NMCP to conduct distribution mass distribution provided to the NMCP X Y LLIN distribution supervision provided available (0 for this for the supervision of campaign quarter) the campaign supervision and follow up Technical assistance 1 LLIN distribution $1,700 $6,800 Completed Data have been to conduct post LLIN campaign rapid analyzed and the distribution assessment report dissemination X Y campaign rapid available (1 workshop conducted assessment available with the this quarter NMCP this quarter) ARM3 Quarterly Report 15, April – June 2015 66 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N

4. Provide technical Technical assistance 1 Report of ARM3 $5,520 $21,205 Completed ARM3 provided assistance to the provided to the ITN supervision technical and financial NMCP and DDS for NMCP and DDS on available (1 for this support for this the semi‐annual annual supervision of quarter) activity in Mono supervision of ITN routine ITN X Y Couffo

routine distribution distribution in at 12 departments

Result 2: Malaria Diagnosis and Treatment Activities in Support of the National Malaria Strategy Improved

Sub‐result 2.1: Improve Diagnostic Capacity and Use of Diagnostic Testing MOP 2014 Case 1. Continue the 30 laboratories 191 laboratories 7. # of private/NGO $1,140 $3,420 Completed Management – dissemination of received SOP on received SOPs ( 0 health care providers Diagnostics SOPs on malaria malaria diagnostics X X X X Y this quarter) that follow policy on 3. Support diagnostics to use of RDTs in Supervision and laboratories and malaria diagnosis strengthening of updated training Provided technical 2 training materials $5,000 Completed Conducted this malaria materials assistance to NMCP updated and quarter diagnostic for the update of X X X Y reviewed activities training materials on ($200,000) malaria diagnostics 2. Provide technical 34 lab supervisors 102% of lab $26,154 $78,636 Completed A total of 35 lab techs assistance to the provided with supervisors with were trained during X X X Y NMCP in the refresher trainings on ability to perform this quarter assessment of the malaria diagnosis super‐vision during

ARM3 Quarterly Report 15, April – June 2015 67 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N competency of supervision Year 4 microscopists at peripheral health facilities

3. Provide technical Technical assistance 0 % of health $5,000 Not started Reprogrammed for assistance to the on the development workers that have year 5 NMCP for the of Quality Assurance ability to perform X X Y development of a (QA) plan for malaria malaria diagnostic QA Plan and a diagnosis established during Year 4 "road map" for and M&E provided year 4 on malaria Technical assistance 1 "Roadmap' $5,000 Completed The malaria diagnostics and provided to NMCP developed and 1 commodities forecast forecast of for the Development forecast conducted update was done in RDTs/microscopy of a “Roadmap” for this quarter. X X X Y supplies for year 5 malaria diagnostics and forecast of RDT/microscopy for year 5 4. Provide technical Needs assessment of 100% health $10,520 $31,560 Completed The assessment has assistance to the microscopes facilities where been carried out and NMCP in the (including purchase needs assessment results are now update of OTSS of new ones and of microscopes was available tools, the semi‐ repair of existing conducted (100% X X Y annual integrated ones) in 118 health for this quarter) supervision visits of facilities conducted the 118 OTSS (ARM3's Technical laboratories, and team indicates that the assessment of the 118 facilities are ARM3 Quarterly Report 15, April – June 2015 68 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N maintenance needs almost 95% of all of microscopes facilities and recommended the elimination of the following activity to avoid duplication: Public Health facility lab visited (with assistance from field based supervisor) Detailed synoptic 1 Map of the status $5,000 Completed The assessment has report/mapping of of microscopes that been carried out and health facilities need maintenance results are now conducted, including during Year 4 available number of labs by developed and department/HZ, # of available (1 for this X X Y microscopes, their quarter) condition, the specific repairs needed, and the estimated repair costs Assist NMCP in the 1 out of 2 QA visit $5,000 Completed ARM3 participated organization of the conducted this year during the quarter in two (2) on site 118laboratories the first supervision X X Y diagnostic visited (1 for this supervision by the 40 quarter) supervisors in the 34

ARM3 Quarterly Report 15, April – June 2015 69 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N HZs for the decentralized supervision Accompany NMCP in 1 Supervision $5,520 $16,560 Completed ARM3 participated annual malaria report available (1 during the quarter in supportive for this quarter) supervision. Results supervision trough are available in this malaria supervisors X X X Y report in the 34 HZs using the standardized check list adapted by NMCP from OTSS Malaria supportive 1 OTSS data entry $6,940 Completed Update has been supervision data form updated (1 for completed based on entry form updated oct‐dec 2014 the updated version of based on OTSS quarter) the NMCP’s Malaria X Y integrated Integrated Supervision supervision and new tool parameters requested by NMCP 5. Continue field DTS field testing 1 DTS field report $1,956 $6,287 Completed The DTS study has Testing of 'Dried conducted and and data base been completed during Malaria Positive results available for available during the quarter. Blood' evaluation, CDC data analysis Year 4 (1 for this Preliminary results are X X Y jointly with CDC quarter) reported in this document

ARM3 Quarterly Report 15, April – June 2015 70 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N 6. Provided Conducted training 2 trainings $6,960 $20,880 Completed 11 trained this quarter technical and of new conducted (1 for + 26 biotechnologists financial assistance biotechnologists in this quarter) from private sector to the NMCP in the malaria diagnostics X X Y 46 biotechnologists (ACPB network) in training of through microscopy/ trained (11 for this Q1=37 biotechnologist RDT (with the NMCP) quarter)

Sub‐result 2.2: Improve Case Management of Uncomplicated and Severe Malaria

Sub‐result 2.2.a: Upgrade Skills of Health Workers on Clinical Management MOP 2014 ‐‐ 1. Training of 100 private sector 107private sector 1. % of patients with $25,900 $111,641 Completed Target achieved; 107 Treatment private sector health workers health workers uncomplicated health providers from 3. Support quality health workers on trained on malaria trained on malaria malaria getting ACPB trained on improvement and malaria case case management case management correct treatment at malaria CM, including supervision of management, jointly with NMCP including ANC, IPTp health facility and IPTp, ANC, RDT use, X Y healthcare including ANC, and ACPB (trainings and HMIS in Year 4 community levels, uncomplicated/ severe workers at the IPTp, and HMIS. include ANC, IPTp (0 for this quarter) according to the malaria; facility level and HMIS) national guidelines, ($967,000) within 24 hours of onset of symptoms MOP 2014 ‐‐ 2. Undertake a Consultant hired to 1Term of reference $6,920 $27,680 In process Finalized consultant Treatment situation analysis develop a document developed 6. % of licensed TORs and launched 4. Support and propose a describing the state Document hospitals and clinics recruitment process malaria training mechanism for of the art and proposing the receiving regulatory X X Y for health private sector propose/construct a mechanism inspection every two workers malaria system for the developed years as required by ($75,000) commodities network of private law providers (e.g.,

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Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N access ProFam, AMCES) to Pilot on how to access malaria commodities from CAME Organize two (two‐ 0 workshops $9,080 $36,320 Not started Scheduled for Q4 day) workshops conducted (N/A between the NMCP because plan for and private sector next quarter) stakeholders (using the private sector X Y platform; PSSP) to define access mechanism for the private sectors' access to malaria commodities Monitor and 0 Follow up reports $1,500 $6,750 Not started Scheduled for Q4; document private available quarterly report will be sector commodities X X X Y established as soon as access each workshop is finished Disseminate lessons 0 stakeholders $1,157 $5,208 N/A Scheduled for Q4 learned informed on the X Y report (N/A because planned for next quarter)

ARM3 Quarterly Report 15, April – June 2015 72 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N 3. Provide technical Technical assistance 0 quarterly Not started Reprogrammed for assistance for the provided to the integrated year 5 implementation of NMCP for the supervisions on integrated implementation of malaria case supportive integrated management supervisions for supportive conducted in Year 4 X X X X Y private sector supervisions of health facilities on malaria case‐ case management. management in public and private sector health facilities 4. Provide technical Assessment (through 0 Report of the 11. % of hospitals In process Protocol has been assistance on the a meta‐analysis) of assessment staffed and equipped developed internally monitoring of the results of a produced and to provide triage, and shared before indicators related sample of PMI disseminated evaluation, and sending to DSME and to ETAT supported ETAT sites, treatment with USAID. Protocol now performance in including those urgency (ETAT) validated and the data

hospitals, under PISAF, collection in scheduled

validation of ETAT conducted in Y for the last week of X data, organizing coordination with July

learning sessions, the DSME and NMCP

and training of DDS and the 6 DDSs, to

teams on the validate the monitoring of ETAT effectiveness and indicators challenges of the approach (7 from national and departmental levels ARM3 Quarterly Report 15, April – June 2015 73 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N and a sample of district hospitals) Protocol designed $2,247 $6,763 X X Y and developed Data collected and $4,500 $5,220 Not started Scheduled for Q4 X X Y analyzed Draft report $2,500 $2,900 Not started Scheduled for Q4 prepared and X Y disseminated ETAT monthly data 13 ETAT hospitals $8,424 $37,908 Completed The ETAT database has validated in 13 new with monthly data been updated in 11 hospitals X X X Y validated in Year 4 ( out of 13 hospitals 13 for Q1 and 11 for this quarter) Two (2) learning 2 ETAT Learning $15,756 $63,024 Completed session organized for session reports X X Y the new 13 ETAT available hospitals organized Bi‐annual follow‐up 0 hospitals that $3,888 $17,496 Not started Reprogrammed for supervisions of the received quarterly year 5 12 hospitals ETAT follow up X X Y previously supervision implementing ETAT conducted Six (6) DDS teams 6 DDS teams $3,888 $16,458 Completed The 2 remaining teams trained on the trained on the were trained. X Y monitoring of ETAT monitoring of ETAT indicators indicators (2 for this

ARM3 Quarterly Report 15, April – June 2015 74 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N quarter)

MOP 2014 ‐‐ Case 5. Train health Two (2) IMCI 0 IMCI workshops 3. % of children $52,000 $208,000 Not started Reprogrammed for Management workers on workshops for 50 organized # under‐5 with year 5 3. Support integrated participants with health workers diarrhea treated with integrated management of ProFam clinics trained ORT and Zinc management of childhood illness organized X X X Y childhood illness (IMCI) 4. % of children (IMCI) training under‐5 with ($100,000) pneumonia taken for appropriate care MOP 2011: Case 6. Provide technical The national norms 0 private sector $2,500 $10,000 Not started Reprogrammed for Management and financial regarding the health facilities that year 5 treatment assistance to the registration of received national 5: Training and DNPS for the private sector health norms on the registration of registration of facilities and the X X X X Y registration and private sector private clinics and opening of new opening of private providers providers including private sector health sector health the dissemination facilities are facilities of national norms disseminated One advocacy (1) 0 Registration $4,540 $18,160 Not started Reprogrammed for workshop organized workshop year 5 to inform private conducted providers about the X X Y accreditation 0 Report available mechanisms and requirements

ARM3 Quarterly Report 15, April – June 2015 75 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N One (1) accreditation 56 private sector $16,500 $66,000 Completed 56 private health session organized for clinics registered facilities registered the registration/ with technical accreditation of X X Y assistance from private sector health ARM3 (56 for this facilities and quarter) providers

Sub‐result 2.3: Improve integrated Community Case Management (iCCM)

MOP 2014 ‐‐ 1. Provide technical Technical assistance 1 of technical 1. % of patients with $6,250 Completed ARM3 facilitated the Treatment assistance to APC, provided and meetings uncomplicated review of local NGOs 1. Technical MOH (DNSP and knowledge conducted 1of malaria getting PMPs assistance for NMCP) and the transferred to APC on technical correct treatment at community case new NGOs the management, documents shared health facility and X X X X Y management of implementing PIHI‐ training and M&E of (1 for this quarter) community levels, malaria, C in management newly recruited according to the pneumonia, and of contracts with NGOs implementing national guidelines, diarrhea NGO's, training, PIHI‐C program within 24 hours of M&E of community activities onset of symptoms ($200,000) case data, mHealth Technical assistance 2 training materials $770 $2,233 Completed tool, supervision to ANCRE in training updated 1 3. % of children (This work visits and of trainers from Trainings conduced under‐5 with complements the information based NGO's in ICCM, X X Y with the support of diarrhea treated Global Fund iCCM decision making training of CHW and ARM3 with ORT and Zinc program for M&E of malaria malaria indicators 4. % of children nationwide) Technical assistance No ARM3 feedback under‐5 with $6,250 Not started Waiting for USAID provided to review X Y provided pneumonia taken for (lead on activity) the protocol of the appropriate care ARM3 Quarterly Report 15, April – June 2015 76 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N baseline survey for PIHI‐C

Group supervision of 1 supervision $16,000 $25,110 In process One conducted this

CHWs conducted conducted 1 quarter through monthly Supervision reports field visits of 2‐3 days available with the supervision X X X Y framework developed by ACP (TBD during Monday meeting)

2. Implement, Qualitative/ 1 iCCM mHealth $14,000 $40,665 Completed Final report shared monitor, and quantitative field assessment report with partners document ARM3's assessment of available (1 for this X Y pilot mHealth ARM3's mHealth quarter) project in 2 HZs Pilot project jointly with APC conducted Documentation of 1 CommCare $25,000 Completed Final report shared

ARM3 CommCare systematization with partners pilot project document available developed (compile (1 for this quarter) all training X X Y documents, descriptions of implementation and best

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Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N practices/lessons learned) Provided technical 0 of personnel $10,000 Not started ANCRE has already and financial trained in mHealth performed this activity

assistance in the and 0 of training X X X Y training of NGO and sessions conducted HZ personnel on the m‐health application GSM CommCare 1 quarterly $5,000 $14,500 Completed Credit allocated to system functional supervision (for GSM CHWs and statisticians. and quarterly conducted functionality) The last quality supervision 294 of CHWs not started supervision will be conducted monitored (for quarterly conducted in X X Y (Consultancy, credit supervision) collaboration with for telephones, ANCRE. scheduled for maintenance of next April telephones, per diem for supervision) 3. Provide technical ARM3 community 1 M&E document $6,250 Completed ARM3 participated in support in the iCCM M&E developed (1 for all of the process of

integration of systematization this quarter) the development of community data document developed the document. The X X Y into HMIS final document is now available (national guidelines of PIHI M&E) Technical assistance 0 Report on the $6,250 In process ARM3 held discussions X X Y to APC and DNSP in assessment of the with partners in this

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Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N the improvement of reporting system regard. community‐data available reporting system, including data

quality. Participate in APC's 1 Report of the $1,500 $4,500 In process Phase one completed workshop with DNSP workshop available to review M&E tools developed by ARM3 X X Y as part of the integration of community data in to the HMIS

Technical and 0 data quality $10,336 $29,974 Not started Scheduled for Q4 financial assistance audits conducted to conduct two (2) data quality audits in X X Y

a representative sample of CHW's and HFs in 5 HZs.

4. Provide technical Provided technical 1 documents, $6,250 Completed assistance to assistance for the materials and tools

ANCRE and the review and adapted (1 for this MOH in the adaptation of quarter) X X Y adaptation of ICCM manuals, training materials and tools curricula and for PIHI‐C (Pacquet supervision tools for Intégré a Haut PIHI‐C

ARM3 Quarterly Report 15, April – June 2015 79 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N Impact au niveau communautaire)

5. Transfer ARM3's Implementation of 2 Documents $6,250 In process The roadmap PIHI experience on ARM3's Community available (one in document is shared Community Supply Supply Chain finalization process) with ANCRE and the Chain Management management system draft of the document System to ANCRE documented, barriers X X Y on barriers is available identified and and will be finalized in recommendations for Q4 the implementation of PIHI‐C 6. Technical and Parakou Team leader 5 Trip reports $18,100 $52,007 In process The Parakou team financial assistance participates in (3 for this quarter) leader participated in provided to NMCP, monthly staff 3 documents meetings in Cotonou DSME, DNSP, coordination delivered through to design community USAID and its meetings and/or technical assistance level PITA, contribute partners (APC and other technical (3 for this quarter) to MOP visit, ANCRE) in the meetings to support X X X X participate in the Y design and USAID and its ‘’comité de relecture oversight of PIHI‐C partners; Two ARM3 du document de PIHI and other staff in Cotonou communautaire‘’ and coordination provide technical participate in the meetings assistance to NGOS community level (Two 5‐day trips) partners periodic Funds provided to meeting

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Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N support USAID and 0activities $1,000 $3,000 Not started No request received at NMCP requests (i.e. supported by ARM3 ARM3 during the coordination quarter

meetings, support of Y activities not

included in work plan)

Result 3: The National Health System's Capacity to Deliver and Manage Quality Malaria Treatment and Control Investigations Strengthened

Sub‐result 3.1: Enhance the NMCP's Technical Capacity to Plan, Design, Manage, and Coordinate a Comprehensive Malaria Control Program

MOP 2014 1. Support the Technical support to 0 meeting reports 12. % of managers in $6,000 Completed Technical and financial Support capacity NMCP’s Annual NMCP in organizing available program areas who provided for the X X Y building of NMCP Implementation PITA preparatory meet performance preparation of 2015 Plan (PITA) by meetings provided targets with currently PITA workshop providing technical Technical assistance 1 PITA workshop available human and $1,190 $4,165 Completed Technical and financial support for the for the annual PITA held Report technological provided for the mid‐term and workshop provided available (1 for this resources organization for 2015 annual evaluation X Y quarter) PITA workshop

workshops 1 PITA excel sheet available (1 for this quarter) Technical assistance 0 Review of PITA $1,190 $4,165 Not started Scheduled for Q4 for the semi‐annual X Y conducted PITA review Hired a facilitator 1 Retreat planned $14,740 $51,590 Completed A consultant, Alfred and conducted a X X Y and organized and Koussemou, was retreat with NMCP, facilitator hired (0 recruited to lead the

ARM3 Quarterly Report 15, April – June 2015 81 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N ARM3 and PMI team for this quarter) retreat conducted by to align work plans, PMI teams (ARM3, objectives and AIRS, USAID, CDC) and results for year 4 NMCP 2. Provide technical Technical assistance 7 out of 16 TWG $6,000 Completed M&E, CM and BCCC assistance to provided to the meetings held per TWG meeting were Technical Working NMCP’s existing year and per held his quarter Groups (TWGs) in working groups on intervention area finding actionable leadership/policy and (3 for this quarter) solutions to key reform, human challenges for resources, and X X X X Y malaria technical groups in implementation, the areas of supply including support chain management, for the BCC and M&E, M&E TWGs in the communications, review of NMCP's diagnostic and case BCC management. communication Financial assistance 0 meetings of $1,600 $5,600 In process The official plan and data for the creation of a Malaria Diagnosis announcement of the collection/supervisi 6th TWG for Malaria TWG held per year 6th TWG is still pending X X X X Y on tools Diagnosis (not funded under IL19) provided Technical assistance 0 NCMP $6,000 In process Negotiations with the provided to the communication NMCP BCC unit started X X Y NMCP to integrate plan and BCC during the quarter ARM3's BCC plan into materials updated

ARM3 Quarterly Report 15, April – June 2015 82 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N the NMCP's communication plan M&E Technical 2 M&E quarterly $6,000 In process ARM3 provided TA to assistance provided technical assistance the NGOs in M&E to the MOH, ANCRE X X X X Y provided on BCC plans for PIHI at the and APC on BCC activities (1 for this community level. quarter) Provide NMCP with 1 consultant hired $34,000 $100,000 Completed ARM3 provided consultants (on need 1 Report of the consultant to NMCP basis) for the consultancies for submission of production of various available Global Fund concept X X X X documents (e.g., note. This quarter the strategy, training consultant finalized his manuals, GF work on the concept requests, etc.) note and get paid 3. Participate in Participated in PBF 0 PBF quarterly $3,200 $11,200 Not started Waiting for PRPSS Performance Based quarterly data reports available invitation; rescheduled Financing (PBF) dissemination X X X X Y for Q4 workshops meetings & developed reports Technical assistance 1 PMP developed (1 $6,000 In process Draft 0 is available; provided in the for this quarter) Meeting held with development of PBF USAID partners to performance identify key indicators. X Y monitoring plan for First draft of the DDS participating in document shared with PIHI partners. A task force composed of NMCP

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Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N PRPSS and ARM3 designed to finalize the performance framework. Develop jointly with 1 Malaria $5,174 $6,000 In process Draft 0 is available; NMCP and PMI the dashboard and Meeting was held with HZ malaria verification USAID partners to dashboard/verificatio protocol developed identify key indicators. n protocol, which will (1 for this quarter) First draft of the build on RBF document was shared quantitative with partners. A task measures (malaria in force composed of pregnancy, net NMCP PRPSS and distribution, X X X Y ARM3 has been treatment of designed to finalize the confirmed simple performance and severe malaria) framework as well as malaria analysis/action planning, supervision, data reporting, and supply chain management) 4. Support national National Malaria 1 National malaria 8. % of districts (HZs) $6,000 Completed ARM3 provided capacity building Strategy Plan strategy Plan reporting morbidity technical assistance efforts by providing reviewed and X Y reviewed and and mortality and financial support technical extended updated (0 for this indicators to the in Q1 assistance to the quarter) national program on

ARM3 Quarterly Report 15, April – June 2015 84 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N implementation of 1 Concept note a monthly basis $6,000 Completed ARM3 provided Technical assistance national strategies available (1 for this during the previous technical assistance in provided to NMCP and plans, quarter) 12 months M&E, SCM, BCC, and for development of X X Y protocols and 9. # of USG‐assisted case management; a Global Fund's new dashboards, health zones consultant was also model concept note including the correctly quantifying hired following Consultation to 0 Consultation commodity needs $6,000 Not started Scheduled to begin in USAID risk conducted according to Q3 based of USAID assessment procurement request recommendations X X X Y protocols. and action planning 10. % of health for direct funding facilities reporting no support to NMCP disruption of stock of Provide technical 1 Malaria antimalarial drugs (as $6,000 Completed The gap analysis was assistance to the commodities Gap specified in the completed before NMCP with Analysis conducted national drug policy) MOP 2015 visit. It

estimating and X X X Y (1 for this quarter) for more than one served during the X updating gap week during the Update of the analyses for ACT, previous 3 months. quantification done RDT, SP, and LLINs during this quarter

Sub‐result 3.2: Improve MOH Capacity to Collect, Manage, and Use Malaria Health Information for Monitoring, Evaluation, and Surveillance

MOP 2014 ‐‐ G2G funds were Advocacy to 1 Request to 8. % of districts (HZs) $1,235 Completed The NMCP and send Monitoring and not available, USAID/PMI for USAID/PMI reporting morbidity USAID officially met Evaluation rescheduled for Q2 funding RMIS submitted and mortality and the budget of the X X Y /Operations evaluation as a indicators to the evaluation has been Research preparatory step for national program on proposed jointly by Technical the update of RMIS a monthly basis ARM3 and NMCP M&E

ARM3 Quarterly Report 15, April – June 2015 85 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N Assistance to norms. during the previous teams 12 months strengthen RMIS Malaria 0 Malaria $1,235 In process Proposed ($200,000) epidemiological epidemiological methodology has been threshold definitions Threshold shared with M&E TWG X X Y developed in definitions and a committee has collaboration with developed been set up to conduct the MOH, M&E TWG activities Guidelines on 0 HZs participating $7,120 $19,471 Not started Scheduled for year 5 epidemiological in guidelines threshold developed X X Y dissemination (N/A

and disseminated because scheduled through workshops for Q3) 2. Provide technical Technical assistance 1 validation $8,160 $22,032 Completed All 2014 RMIS and assistance to to the NMCP for the workshops per HMIS data were ensure HMIS/RMIS validation of RMIS semester (0 for this validated under ARM3 X X X X Y data quality data at regional level quarter) technical assistance through validation for the PALU‐INFO workshops, bulletin supervision visits, Technical assistance 2 PALU info $770 $2,079 Completed 2 bulletins have been and Routine Data provided for the Bulletins published drafted with ARM3 Quality publication of 4 X X X X Y during Year 4 (2 support Assessments PALU‐INFO Bulletins issued for this (RDQA) quarter) Technical assistance 1 quarterly $20,640 $56,517 In Process One out of 2 bi‐annual provided to the supervision report supervision conducted X X X X Y NMCP on quarterly available supervision of 120

ARM3 Quarterly Report 15, April – June 2015 86 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N health centers on RMIS performance and data collection in 6 DDSs Two (2) quarterly 1 RDQA report $7,200 $19,545 In process One out of 2 X X Y RDQAs conducted available conducted 3. Provide technical Provide technical 0 Model design $2,000 $5,172 In process Contact established assistance to assistance to NMCP Scientific paper 2 with CREC and CDC; NMCP and CREC in and CREC in the abstracts submitted guidance provided by epidemiology/ento development of an the CDC RA on how mology data integrated X X X Y ARM3 can contribute analysis entomology data to achieve this analysis (includes publication and dissemination) 4. Provide technical Technical assistance 1 APC staff who $1,235 In process Technical assistance support to APC on to APC on M&E receive technical provided to APC for M&E provided assistance on M&E the redaction of community PIHI M&E X X X X Y document (meeting held in October)

MOP 2014 ‐‐ 5. Implement Monitoring of 2 EUVS report $52,278 $184,580 In process One EUV conducted Monitoring and quarterly End User availability and available this quarter in Zou Evaluation/ Verification Survey utilization of key 100% facilities that Collines. X X X X Y Operations (EUVS) in antimalarial submit an action Research collaboration with commodities at plan in response to Conduct EUV NMCP (with ARM3 health facilities the EUVS ARM3 Quarterly Report 15, April – June 2015 87 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N Surveys funding and staff) conducted; conduct ($150,000) quarterly (4) EUVs 6. Develop HZ's HFS tools adapted 3 tools available $1,235 Completed Tools adapted and clinical and validated with X X Y validated by USAID, performance NMCP and CDC NMCP and ARM3 metrics and Assessment of health 1 report available $26,000 $70,848 In process One out of 2 quarterly workers in malaria assessments assessment of case management conducted health workers conducted (biannual performance activity, integrated to conducted in EUV) X X Y malaria case management working jointly with NMCP and HZ's

7. Document best Documents on ARM3 0 documents $1,235 In process The list of scientific practices, lessons best practices and developed articles on ARM3 is learned and lessons learned available X X Y provide vision for developed and year 5 disseminated

MOP 2011 & 8. Provide technical Technical and 0 Therapeutic $70,000 $245,000 Not started The activity is already MOP 2013 Case and financial financial assistance to efficacy testing funded by the WHO Management assistance in NMCP and LNCQ for evaluation X X X Y Treatment ‐‐ conducting a therapeutic efficacy conducted 7. Therapeutic therapeutic testing on anti‐ efficacy testing malarial evaluation ARM3 Quarterly Report 15, April – June 2015 88 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N efficacy testing evaluation conducted

MOP 2011 ‐‐ 9. Participate and ARM3 team N/A $40,000 $20,000 N/A TBD based on Mission 2. Impact provide financial participated approval Evaluation assistance in PMI effectively in the PMI X X Y impact evaluation impact evaluation

10. Participate in ARM3 team N/A $2,900 $7,830 Completed ARM3 received an externally participated evaluation mission and funded mid‐term effectively in the X Y contributed as evaluation evaluation requested

Sub‐result 3.3: Improve MOH Capacity in Commodities and Supply Chain Management

MOP 2014 ‐‐ 1. Provide technical Advocacy with the 0 National 9. # of USG‐assisted $1,500 $5,250 In process Awaiting the MOH’s Pharmaceutical assistance in MOH for the sign‐off Directives approved health zones signature; ARM3 will Management strengthening the of the National by Minister of correctly quantifying continue to follow up. 1. Strengthen role of the malaria Directives of Malaria Health commodity needs logistics Commodities Commodities by National Directives according to management Supply Chain Minister of Health; disseminated at procurement information Management approved directives departmental and protocols. system (LMIS) System from the copied and X X X X Y HZ levels. and supply chain central level down disseminated management to the health 10. % of health ($550,000) facilities through facilities reporting no the improvement disruption of stock of of supply chain antimalarial drugs (as management, specified in the forecasting/quantif national drug policy)

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Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N ying, M&E, for more than one tracking, and week during the storage of malarial previous 3 months. commodities

2. Provide technical Technical assistance 1 supervision report $25,500 In process One Bi annual assistance to the provided to NMCP available (the supervision out of 2 NMCP in the for the bi‐annual report will be conducted under X X Y supervision of DRZ supervision of DRZ available next ARM3 support and CAME, and and CAME on malaria quarter) annual commodities quantification of Technical and 1 quantification $7,500 $26,250 Completed quantification malaria financial assistance workshop workshop were hold commodities for the preparation conducted during this quarter (formative of the Annual supervision of LMIS Quantification X Y system) workshops of malaria commodities conducted with the NMCP 3. Reinforce the Technical assistance 2 CAME $25,500 Completed The QA manual has Logistics provided to CAME to departmental levels been reviewed with Management strengthen the use of applying LMIS ARM3 support. The Information LMIS (adherence to (2 for this quarter) final validation is System (LMIS) the norms) at X X X X Y contingent on the implementation national/department approval of CAME (end through technical al levels including the of June 2015). Internal assistance, incorporation of trainings have already training, parameters for started ARM3 Quarterly Report 15, April – June 2015 90 | Page

Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N supervision, quality decision making in assurance and the management of information for malaria commodities decision making Technical assistance 1 Draft CAME $25,500 Completed The QA manual was including CAME's provided to CAME's quality assurance reviewed with ARM3 monitoring of LMIS for the Quality manual is updated support. The final parameters Assurance (QA) and available for validation is Manual review as validation (1 for this conditioned by the part of the follow on quarter) approval of CAME X X Y of the training in organogram planned France. Validation for June 2015. The workshop will be internal training has conducted with already started. CAME's financial support. CAME's QA plan 0 CAME warehouse $2,000 $7,000 Not Scheduled for May monitored biannually implementing started 2015 but the in Parakou, CAME's QA policy organogram validation Natitingou and visited is scheduled for next Cotonou by ARM3 july. X X Y SMC staff , in collaboration with the DPMED to improve sustainability Technical and 1 out of 2 LMIS $25,500 In process One out of 2 financial assistance X X Y supervision held supervision conducted provided for LMIS during the year (1

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Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N supervision for the for this quarter) validation of LMIS consumption data (this activity will be conducted jointly within the annual supervision to DDS ‐ below) Semi‐Annual 1 Report available $11,040 $38,640 In process One out of 2 supervision provided 6 DDS LMIS teams supervision conducted to LMIS staff of 6 DDS that received (includes supervision in a development/overvie quarterly basis X X Y w of supply chain 27 of Hospitals plans, on‐site training visited (done only through coaching and this quarter) validation of HZs LMIS data) Provide technical 34of HZs LMIS staff $25,500 In process One out of 2 assistance to the that receive supervisions NMCP to strengthen supervision from conducted supervision of 34 HZ NMCP on a LMIS staff by NMCP, X X Y quarterly basis (0 to ensure data for this quarter) quality and early warning of stock‐ outs/ overstocking

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Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N Technical assistance 2nout of 2 zonal $8,740 $30,590 In process One out of 2 provided to DRZ supervision supervision conducted managers and conducted by HZs statisticians to conduct LMIS supervisions to zonal/ departmental X X Y hospitals and health facilities (to support LMIS users in the proper use of LMIS tools, data quality and reporting through coaching) Jointly with NMCP At least 85% of $26,500 $92,750 In process 2 out of 3 monthly and DRZ, including operational users in Supervisions monthly supervision the two zones conducted. of stock management received in all health facilities supervision X X X X Y in 2 HZs, to ensure quarterly. improved LMIS completeness, data quality and stock availability Quarterly LMIS 2 feedback $55,824 $195,104 In process One out of 2 supervision feedback workshops conducted X X Y workshops for conducted decision making

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Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N conducted Internet connectivity The LMIS data $10,200 $35,700 Completed Activity has been for DRZ manager at available at national completed as planned 34 HZ level funded and departmental X X X X Y for 1 year and LMIS levels data availability at 34 DRZ connected central level ensured to internet 4. Provide technical Technical assistance 1 Semi‐annual $10,560 $40,000 Completed Activity has been assistance to the provided for the supervision by completed as planned; NMCP on operation and department; ARM3 took this maintaining maintenance of X X X X Y MEDISTOCK opportunity to make MEDISTOCK MEDISTOCK working and the post‐training functioning operational (0 for follow up for this quarter) MEDISTOCK V5 users 5. Technical Technical assistance $25,500 Not Rescheduled for Q4 assistance provided provided to started to Document best document SCM key 0SCM key activities practices, lessons activities conducted documented X Y learned and by ARM3 in years 1‐3 # of reports provide vision for and provide vision for available year 5 year 5

6. Technical MOU among LNCQ, $25,500 In process Discussions were held assistance for the NMCP, DPMED and with the LNCQ integration of SCM CAME, drafted and 0 Draft MOU regarding the MOU but X X Y LMIS among key shared with parties available it has not been partners to ensure finalized prompt quality

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Time frame Indicato ARM3 Project Funding Status of Activity End of Year 4 (Q1‐Q4) rs MOP Activity ARM3 Activity Indicator Target USAID/PMI Milestones/ USG for FY14 Summary Q Q Q Q (Updated on June Indicator Target *Activity Total Status at Outputs Indicato Progress Notes 1 2 3 4 30) budget cost end of Q2 r? Y/N analysis of anti‐ malarials provided

7. Technical Meetings held with $25,500 Completed Common Basket assistance for the PMI and NMCP held document validated development of to review mechanism 1 Mechanism the common for the development X X X Y proposal available basket proposal for and implementation (0 for this quarter) malaria supplies of the common provided basket Mechanism for a $6,610 $23,135 Completed Workshop conducted 1 Mechanism common basket validated (1 for this validated through quarter) workshop (one X X Y 1 Workshop workshop for 25 conducted(1 for participants this quarter) organized)

TOTAL $841,778 $3,177,277

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