Report on Plague Activities Period of Report: September1 to September 30, 2018

USAID COMMUNITY CAPACITY FOR HEALTH PROGRAM

Cooperative Agreement No. AID-687-A-16-00001 June 6, 2016 to June 6, 2021

Submitted to: Dr. Jocelyne ANDRIAMIADANA, AOR USAID/Madagascar in Antananarivo, Madagascar

Prepared by: JSI Research & Training Institute, Inc. USAID Community Capacity for Health Program – Mahefa Miaraka Résidence Lavalley Près Lot IIK 50H Mahatony Alarobia, Antananarivo (101)

This report is made possible by the support of the American People through the United States Agency for International Development (USAID). The contents of this report are the responsibility of JSI Research & Training Institute, Inc. (JSI) and do not necessarily reflect the views of USAID or the United States Government.

TABLE OF CONTENTS

Abbreviations 4 Executive Summary 5 Project Implementation 6 Financial Expenditures (Sept 2018*) 9

Abbreviations

CHV Community Health Volunteer

CSB Centre de Santé de Base (Basic Health Center)

DRSP Direction Régionale de la Santé Publique (Regional Health Directorate)

GOM Government of Madagascar

JSI JSI Research & Training Institute, Inc.

MOH Ministry of Health

SBCC Social and Behavior Change Communication

USAID United States Agency for International Development

WHO World Health Organization

Executive Summary In Madagascar, the plague season started in September 2018. During this reporting period the USAID Community Capacity for Health Program team, along with other technical and financial partners, has taken an active part in the Government of Madagascar’s plague preparation and response efforts at the national, regional, district, and commune levels.

From September 1 to September 30, 2018, the Program team participated in six meetings organized by the plague crisis units (four at the national level and three at the district level). During this period, one suspected case of bubonic plague (RDT not available) was reported by the Médecin Inspecteur of Morandava, Menabe Region. The case was successfully treated.

On September 13, 2018: one suspected case of bubonic plague (rapid diagnostic test unavailable) was reported by the Medicin Inspecteur of Morondava, Menabe Region. This was an imported case from Antsampandrano, district of Ambatolampy, Vakinankaratra Region). A team from the district was dispatched to investigate and respond to the case on the same day. The suspected case (40-year-old man) was successfully treated. The Regional and District Heath Offices conducted contact tracing for 6 people who were isolated and received preventative treatment for 5 days. The MOH officials in the district of Morandava also conducted disinfection activities in the area where the case and others had resided during their stay in Menabe for a religious gathering.

During this period, the Program trained community leaders and community health volunteers (CHVs) on plague prevention and response. As of September 2018, the Program trained a total of 3,182 people (85 commune leaders, 611 fokontany heads, and 2,300 community health volunteers, and 186 health providers). Details are presented in Table 1 and Figure 1 in Annex 1. The Program also used the opportunity of the launch of the Polio Campaign in Mahabo district, Menabe region to inform the public about plague and raise awareness of measures to be taken for prevention, care seeking and reporting of suspected cases. In addition the Program contracted with local radio stations to broadcast messages on plague. In total, these spots reached approximately 91,246 people during the reporting period.

Project Implementation The USAID Community Capacity for Health Program, locally known as Mahefa Miaraka, is a five-year (2016-2021) community-based integrated health program funded by the United States Agency for International Development (USAID). The Program is collaboration between the Ministry of Public Health, USAID, and JSI Research & Training Institute, Inc. (JSI). The Program provides tools and capacity-building training to around 10,000 CHVs, in addition to working with national and local government actors to strengthen the health system and health policies. Because of the Program’s expertise working at every level of Madagascar’s health care landscape, it is uniquely suited to partner in the fight against the plague.

The USAID Community Capacity for Health Program, locally known as Mahefa Miaraka, operates in a total of 4,885 fokontany (FKT), 456 communes, and 34 districts in the Analanjirofo, Boeny, DIANA, Melaky, Menabe, SAVA, and Sofia regions. The Program has the potential to provide services to approximately 6.1 million people, or 23.3 percent of the country’s total population (Figure 1).

Figure 1- Mahefa Miaraka’s Regions and Districts

On September 13, 2018, one suspected case of bubonic plague (rapid diagnostic test unavailable) was reported by the Médecin Inspecteur of Morondava, Menabe Region. A team from the district was dispatched to report to DRSP, investigate and respond to the case on the same day. The case investigation occurred in the evening, and the Regional Health Directorate was only able to report the case the following day (September 14, 2018) to the central MOH in Antananarivo, and to the DRSP of Vakinankaratra and the Médecin Inspecteur of Ambatolampy district. The suspected case (40- year-old man) was successfully treated using the new protocol (gentamicin injectable every 12 hours) as reported to MOH’s Directorate of the Health Monitoring and Epidemiological Surveillance (Direction de la Veille Sanitaire et de la Surveillance Epidémiologique, DVSSE) on September 20, 2018. This was an imported case from Antsampandrano, district of Ambatolampy, Vakinankaratra Region and the patient got his last injection in the CSB2 of Betafo, Vakinankaratra Region en route to his home. The Regional and District Heath Offices conducted contact tracing for 6 people who were isolated and received preventative treatment with doxycycline for 5 days. The MOH officials in the district of

Morandava also conducted disinfection activities in the area where the case and others had resided during their stay in Menabe for a religious gathering.

In support of the plague response in Menabe, the Program broadcast radio messages on the plague through local radio station and by messages through community radio listening groups. In addition, the Program conducted refresher trainings for CHVs and Fokantany Chefs during monthly meetings on plague prevention and response, and conducted community education sessions using the opportunity of the Polio Campaign.

During the period of September 1 to September 30, 2018, the Program team, along with other technical and financial partners, has taken an active part in the GOM’s plague response preparation and response efforts in its seven regions (Annex 1) and at the national level. In all seven Program supported regions, the team worked with the MOH regional and district health offices to reactivate the plague surveillance system. The Program’s teams participated in six meetings organized by the Ministry of Public Health, USAID and WHO for coordinated support during this period (six at the national level, three at the regional levels). Meetings at the national level focused on partner coordination, logistics, community mobilization and communication. The three district level meetings took place in Morandava District of Menabe Region where the case of bubonic plague was identified.

In addition to the response activities in Menabe and coordination meetings on plague response, the Program has contributed both technical and financial assistance in response to the plague epidemic. Details of the Program team’s plague response activities undertaken from September 1, 2018 to September 30, 2018 are presented below

1. Plague response training for community health volunteers (CHVs) and fokontany heads according to Ministry of Health (MOH)’s training curriculum

One of the Program’s most important contributions in the GOM’s plague response is the training of the community leaders at the commune and fokontany (cluster of villages) levels, community health volunteers, and the GOM’s health service providers at the regional, district, and commune levels. The objective of the trainings is for community actors to break the chain of transmission to reduce the spread of the plague outbreak. After the training, the community actors, including the CHVs and fokontany heads, (i) implement control measures of plague vectors; (ii) carry out information, education, and communication (IEC) activities, surveillance, and management plague-related activities at the community level; and (iii) ensure logistic support for community and GOM needs. Training also included plague surveillance, contact monitoring, and referral to health facilities, community response, and use of management tools.

As of September 30, 2018, the Program trained a total of 2,300 CHVs, 611 Chef FKT during monthly meetings, 85 commune leaders, and 186 GOM health service providers. Details are presented in Table 1 and Figure 1 in Annex 1. The trainings have provided necessary information and education to important stakeholders to coordinate their efforts in preparation and response for the anticipated epidemic, especially at the community level.

Table 1 Trainers, Providers, and Coordination Structures Trained (September 1 to September 30, 2018)

Trainers and Providers Community Total

Regional District Regions health health Health commune Village office office Center CHVs leaders heads officials officials Staff (EMAR) (EMAD) (CSB) Analanjirofo 0 0 0 0 0 0 0 Boeny 0 0 0 11 142 56 209 DIANA 0 0 0 0 0 0 0 Melaky 0 0 0 1 7 3 11 Menabe 40 18 9 57 802 382 1308 SAVA 0 0 0 0 0 0 0 Sofia 1 17 101 16 1349 170 1654 TOTAL 41 35 110 85 2300 611 3182

2. Reporting of suspected plague cases to CSB

Per the Ministry of Health’s plague response plan at the community level, CHVs must report suspected plague cases as they are discovered. To reinforce this plan, the Program trained and monitored CHVs’ reporting of suspected plague cases to CSBs as they occurred. During the reporting period, CHVs also conducted health education sessions to inform the community on the signs of suspected cases and the need for community members to report suspected cases immediately to CHVs and/or the CSB.

During this period, no cases of plague were reported by CHVs. However, after identification of the case in Morondava District, CHVs conducted educational sessions (or through home visits) in their respective communities on the plague and its prevention, including conducting collective cleanup in communities.

3. Broadcast messages on plague and plague prevention through local radio stations

As part of its Social Behavior Change and Communication (SBCC) approach, the Program contracts with 23 regional radio stations to broadcast radio programs developed by the MOH several times per week. During this period, local stations in Analanjirofo, Boeny, Menabe and Sofia broadcast messages on plague and plague prevention 429 times, reaching people 91,246 times. These media activities are designed to improve the general public’s knowledge and encourage them to adopt best practices in preventing plague.

Financial Expenditures (Sept 2018*)

ITEMS Current Period (USD) Human Resources Travel Equipment Supplies Training/Communication Overhead

TOTAL

• Total financial expenditures from Sept 2018 are not included in this report due to the fact that final financial reports on September expenditures will not be finalized until October 2018.

DISCLAIMER

JSI Research & Training Institute, Inc. 44 Farnsworth Street, Boston, MA, 02210 www.jsi.com