Tajikistan Maternal and Child Health Program Quarterly Report #10 Reporting Period: January 1, 2011 - March 31, 2011 Cooperative Agreement # 119-A-00-08-00025-00 Submitted by: Mercy Corps –Tajikistan TABLE OF CONTENTS 1 Acronyms and Abbreviation…………………………………………...………………. 3 2 Project Overview and Progress towards Objectives….………………………….….... 4 3 Status of Activities………………………………………………………………...……..7 3.1 Community Development…………………………………………...………......7 3.2 Behavior Change Communication (BCC)………………………..…………....8 3.3 Child-to-Child (CtC)………………………………………………...…………..9 3.4 Safe Motherhood…………………………………………………..………….…9 3.5 Integrated Management of Childhood Illness (IMCI)……………………….10 3.6 Water, Sanitation and Hygiene………………………………………….…….11 3.7 Monitoring & Evaluation activity……………………………………………..12 4 Planned vs. Actual Status of Activities………………………………………………..13 5 Constraints/Challenges…………………………………………………...……………14 6 Technical Assistance…………………………………………………...……………....14 7 Conferences/Workshops……………………………………………………………….14 8 Success Story: The man of the time………………………………………..………….15 2 | P a g e ACRONYMS & ABBREVIATIONS ARI Acute Respiratory Infection BCC Behavior Change Communication CHE Community Health Educator CHL Centers for Promotion of Healthy Lifestyles C-IMCI Community Integrated Management of Childhood Illness CtC Child-to-Child DIP Detailed Implementation Plan DOH Department of Health – Sughd Oblast & District levels EPC Essential Prenatal Care ETS Emergency Transport System Feldsher Lowest level of healthcare worker, a medic FGD Focus Group Discussion Hukumat District-level government head IMCI Integrated Management of Childhood Illness Jamoat Local sub-district government structure (several villages per jamoat) MCH Maternal Child Health MOE Ministry of Education MOH Ministry of Health of Tajikistan – national level OB/GYN Obstetrics & Gynecology Specialist PPD Post Partum Depression RCHL Republic Centre for Healthy Lifestyle RRS Regions of Republican Subordination SBA Skilled Birth Attendant STPHCO Strengthening Tajikistan Primary Health Care & Outreach SIDA Swedish International Development Agency TB Tuberculosis TJS Tajikistan Somoni TOT Training of Trainers USAID United States Agency for International Development VDC Village Development Committee WHO World Health Organization 3 | P a g e This is the tenth quarterly performance report for the third year of the Mercy Corps and USAID Tajikistan Maternal and Child Health (MCH) project, covering the period of January 1, 2011 through March 31, 2011 under Cooperative Agreement #119-A-00-08-00025-00. 2. PROJECT OVERVIEW AND PROGRESS TOWARDS OBJECTIVES Project Overview: Over the five-year implementation period, the MCH project aims to reduce infant and maternal mortality by improving the health of women and of children under the age of five years. Mortality rates in some districts of the Sughd Oblast in northern Tajikistan are among the worst in the country. The project is in its third year of implementation in the Asht, Shahriston, Spitamen and Zafarobod (old) and Mastchoh, Taboshar, Gonchi (new) districts of Sughd Oblast and in the Hissor district of the RRS Oblast. As the target districts are considered to be underserved areas, the MCH Project encourages greater government engagement regarding the issues of mother and child health and promotes the adoption of healthy behaviors and key interventions. The project expects to benefit 220,068 people (127,231 women of reproductive age and 92,837 children under five). The goals and objectives are to be achieved by building the capacity of district level Department of Health (DoH) while addressing the challenges of sustainable and quality service delivery, and promoting behavior change and community mobilization. The main objectives of the project are as follows: 1. Increase the percentage of mothers of children under two years who practice improved feeding, caring and health-seeking practices. 2. Increase the percentage of women who receive adequate maternal and newborn care. 3. Increase the capacity of the DoH facilities to deliver quality maternal and child health services. Progress towards Project objectives: Progress has been made towards the all above mentioned objectives as well regarding all project activities as per the project plan, especially, in the area of capacity development of health workers and communities to deliver quality maternal and child health services. Project proceeded further towards the first objective of increasing the percentage of mothers of children less than two years who practice improved feeding, caring and health-seeking practices at the household a multi-media based Behavior Change strategy has been followed in this quarter as well. Behavior Change Communication (BCC) activities engaged particularly local media in the dissemination of health messages. Mass media such as Mastchoh TV and Gonchi Radio was engaged to deliver messages about the mission of the project and the education session on HIV/AIDS. These messages reach to the deep pockets of population even in the hard to reach area. Mercy Corps began collaboration with the Mastcho District Newspaper office and published a special article providing basic information about the project’s goals and objectives. The use of mass media along with the interpersonal communication and support group interactive communication is a proven strategy to have more synergy for behavior change. The Child-to-Child component, compliments strongly, the first two objectives of the MCH project as proven under the Sugdh Child Survival Program. The CtC model involves training a teacher in each school, who then recruits or selects a group of 10th and 11th graders with 4 | P a g e leadership skills. These students become “student-trainers,” transmitting key messages to very young students or peers through age-appropriate activities such as songs, plays, and games. Under CtC project, staff conducted education sessions for Student-Trainers on Hygiene and Sanitation in twenty-six schools and on Pure Water in twenty-three schools of Hisor district. Student-Trainers also conducted an assessment for Hygiene and Sanitation among school children in the target schools. While some messages focus on behaviors the young children control themselves, such as personal hygiene and sanitation, there are also activities which inspire the children to promote certain healthy behaviors with their families such as use of purified water, handwashing, or other health issues. The student-trainers become engaged in health promotion outside of school as well. They remind families about immunizations, visit households to invite women to participate in educational sessions, assist the VDCs with clean-up campaigns, or notify health workers of sick children needing medical care which is a form of referral. There has been sustained progress regarding the third objective of the MCH project in regards to the increased capacity of the DoH health facilities’ staff. Under the Safe Motherhood component a series of monitoring visits to maternity facilities in remote areas of Gonchi and Mastcho districts were conducted. A series of training on Community Integrated Management of Childhood Illnesses (C-IMCI) was conducted with support from the regional IMCI center. The trainings consisted of theoretical and practical sessions focusing on households and provided advices and recommendations to be given mothers on childcare. The main focus was tracking the results of training with joint visits with specialists from the regional and district centers to monitor and support the practices of trained health providers on Safe Motherhood. It was reported that in some remote areas, the maternity houses (Mujum village of Gonchi and Zarafshon community of Mascho district) were closed due to lack of basic conditions for Safe Motherhood: the facilities were cold; the emergency kits were not in place and there was no water available. Mercy Corps MCH project has prepared a list of such facilities in the program area with the needs for the repairs and refurbishments to explore any additional resources. To complement the improved knowledge and behavior change the MCH project has a small component of budget allocated for priority improvements in the public water and sanitation facilities such as toilets in the health facilities and restoration of dysfunctional water supply system etc. The engage of community through VDCs, Jamoat, School administration and health staff at the facilities as well their full participation contribution in constructing/improving these facilities is central to this component. All water and sanitation related activities were coordinated with the USAID Environmental Compliance division and pass the compliance criteria for mitigation of impact. Water and Sanitation activities progressed successfully within the four Maternal and Child Health districts this quarter. The project handed over the construction of fifteen latrines and rehabilitation of one health center to the Health Centers of target districts. The reconstruction of a drinking water pump line has started in two targeted districts of MCH. For example in the Jamoat of Dalyoni Bolo a two-hole latrine was constructed and handed over to local Health Center authorities with the participation of VDC members and Jamoat representatives and almost 100 health facility visitors would be benefitting from this project. 5 | P a g e Improving access to information is one the most effective ways of promoting adoption of healthy practices. The project encouraged the