Guinea Ebola Response Plan

Maternal and Child Survival Program

Guinea

Ebola Response Plan

Quarterly Report Quarter 2, 2015 1 January 2015 – 30 March 2015

Submitted to:

United States Agency for International Development Cooperative Agreement No. AID-OAA-A-14-00028

Submitted by:

MCSP Guinea implementing partners - Jhpiego Save the Children

Submitted 20 May 2015

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TABLE OF CONTENTS

ACRONYMS AND ABBREVIATIONS ...... 3 EXECUTIVE SUMMARY ...... 4 INTRODUCTION ...... 6 GOAL AND OBJECTIVES ...... 6 RESULTS AND ACTIVITIES BY OBJECTIVE ...... 7 Objective 1 – Prevention at facilities ...... 7 1.1 Active participation of MCSP in national level coordination ...... 7 1.2 Conduct training for facility staff & train/update consultant trainers ...... 7 1.3 Procure and supply necessary sterilization and sanitation/waste management equipment ...... 11 1.4 Conduct routine quality assurance visits and provide additional follow-up support ...... 12 1.5 Monitoring and Evaluation ...... 13 1.6 Communications support as a tool for referral, logistics management and mentoring ...... 14 Objective 2 – Ebola virus disease (EVD) prevention within communities...... 15 2.1 Social and behavior change communication (SBCC) & sensitization ...... 15 2.2 Sensitization for civil society groups and CHW associations ...... 18 2.3 Contact-tracing and surveillance in affected sub-prefectures ...... 19 2.4 Coordination & technical support ...... 22

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ACRONYMS AND ABBREVIATIONS AC Agents communautaire (community health workers) CMC Centres Médical Communal (Communal Medical Center) DCS Direction Communautaire de la Santé (Community Health Directorate) DPS Direction Préfectoral de la Santé (Prefecural Health Directorate) DRS Direction Regionale de la Santé (Regional Health Direcotrate) DSVco Direction Sanitaire de la ville de Conakry EPI Expanded Program on Immunization EPMCD Ending Preventable Maternal and Child Deaths EVD Ebola Viral Disease IP Infection Prevention IPC Infection Prevention and Control MCHIP Maternal and Child Health Integrated Program MCSP Maternal and Child Survival Program MNH Maternal and Newborn Health MOH Ministry of Health MSF-B Medecins sans Frontiers- Belge NGO Nongovernmental Organization PPE Personal Protective Equipment SBM-R Standards-based Management and Recognition

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EXECUTIVE SUMMARY The goal of the MCSP Ebola Response Project in Guinea is to scale up efforts to prevent and control the spread of Ebola Viral Disease (EVD) to protect and maintain quality reproductive, maternal, newborn, and child health services.

The key achievements of the second quarter are listed below.

Objective 1: Prevention at facilities: Support healthcare workers and facilities to continue to offer high quality health services in a safe environment by strengthening infection prevention and control (IPC) practices through training, supportive supervision, and complementary monitoring and evaluation.

• Active participation of MCSP in national level coordination

o MCSP coordinated the establishment of a triage and isolation unit for medical and surgical emergencies at Donka National Hospital in collaboration with MSF-B, WHO, CDC, and the directors of the hospital. Since its inception, the unit has identified 51 suspected cases, 11 cases of which were confirmed positive for EVD (22%). o MCSP contributed to the development of several national strategies on IPC and rapid response teams

• Conduct training for facility staff & train/update consultant trainers

o From January to March 2015, MCSP trained 2482 providers on IPC practices, bringing the total to 2986. Training emphasizes understanding and preventing the transmission of EVD. Of the providers trained, 1950 are located in Conakry, 381 in Kissidougou, and 124 in Beyla. o 18 new IPT trainers were trained and qualified increasing the number of local trainers to 47 • Procure and supply necessary sterilization and sanitation/waste management equipment for training

o MCSP donated various material and equipment to national hospitals and the CMCs Ratoma and Matam, including hand washing units.

• Conduct routine quality assurance visits and provide additional follow-up support

o 58% of trained staff received supervisory visits to improve service quality and IPC performance within two weeks of training. o All services of national hospitals and CMS/CMS benefited from 1 to 3 coaching visits during the quarter.

• Monitoring and Evaluation

o MCSP completed the baseline evaluations of the 14 services of Kipé Hospital , the 5 CMCs in Conakry, and the Social Medical Center of John Paul II.

• Communications support as a tool for referral, logistics management and mentoring

o MCSP provided an orientation on the mobile mentoring program to trained providers.

Objective 2 – Ebola virus disease (EVD) prevention within communities: Support communities and their local leaders to combat disease transmission through improved contact-tracing, intensified social mobilization, and technical assistance to district health teams.

• Social and behavior change communication (SBCC) & sensitization on EVD prevention and hygiene promotion in affected sub-prefectures through public health committees & radio messages

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o Implemented a participatory community theater initiative that reached 3,075 community members in 5 urban municipalities in Conakry, 300 people in Forécariah, and 200 people in Coyah. o Organized soccer match in Kouroussa prefecture in coordination with prefectural officials and field partners (Guinean Red Cross, WHO, CERADE, CENAFOD), during which 4,300 spectators were exposed to Ebola awareness messages. o Ninety talks & sensitization sessions were carried out in the prefectures of Kouroussa, Beyla and Conakry, reaching 13,795 people. o Radio programs were developed and broadcasts 22 times in the prefectures of Conakry, Kouroussa and Beyla, reaching an estimated 47,200 adults and 6,000 children.

• Sensitization for civil society groups and CHW associations

o Conducted a series of focus groups with 463 members of the civil society of Dixinn-Conakry, including: community leaders, religious leaders, and representatives of women's and youth associations o Conducted an EVD training for 233 members of 67 civil society associations and 2 police brigades

• Contact-tracing and surveillance in affected sub-prefectures

o Conducted a two-day training on contact-tracing and surveillance for 710 community members in Beyla, Conakry, Kouroussa. Participants included pharmacists, medical street vendors, health care workers from private clinics, traditional healers, and religious leaders, o Conducted trainined for 100 private care providers from 50 private health clinics that are not registered with the MOH. o Provided support to the local DPS office supervising community health workers engaged in EVD surveillance.

• Coordination & technical support to the Direction Prefectural de la Santé (DPS) to help manage the EVD response at prefecture level

o Participated in coordination meetings at the prefectural level.

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INTRODUCTION The Maternal and Child Survival Program (MCSP) is a global U.S. Agency for International Development (USAID) cooperative agreement to introduce and support high-impact health interventions in 24 priority countries with the ultimate goal of ending preventable maternal and child deaths (EPMCD) within a generation. The Maternal and Child Survival Program carries forward the momentum and lessons learned from the highly successful USAID funded Maternal and Child Health Integrated Program (MCHIP), which has made significant progress in improving the health of women and children in over 50 developing countries throughout Africa, Asia, Latin America and the Caribbean. Under this activity, MCSP interventions build on the development of local training capacity among healthcare providers in Guinea with a focus on competency-based training methods that work to improve both knowledge and skills. These build from previous work specifically on infection prevention practices in health care facilities and a commitment to quality improvement and supportive mentoring and supervision to assist healthcare providers to translate new skills into ongoing practice at their worksites.

In order to contribute to the response to the current Ebola Viral Disease (EVD) epidemic in Guinea and the severe effects on health services, including increased risks for healthcare providers, USAID requested MCSP to develop a workplan to address the infection prevention and control (IPC) practices in facilities, as well as to work with communities to prevent disease transmission. The Ebola Response Project was approved for a period of nine-months from 17 November 2014 to 16 August 2015. The geographic focus areas were determined in collaboration with the National Ebola Response Coordinating Committee (CNLEB), CDC, OFDA and USG supported partners, such as Catholic Relief Services and Save the Children (who is leading Objective 2 in this project).

The focus areas for this project are the capital city of Conakry and three rural prefectures: Beyla, Forécariah, and Kissidougou. MCSP is supporting 55 target facilities in these areas: 3 national hospitals (Donka, Ignace Deen, Hôpital Sino-Guinéen), 3 prefectural hospitals (Beyla, Forécariah, Kissidougou), 6 communal medical centers (CMC; 5 in Conakry and 1 in Sinko, Beyla), 1 socio-medical center (Jean Paul II/ Conakry), and 42 health centers in the three prefectures.

The following report describes the activities and achievements of project from January to March 2015.

GOAL AND OBJECTIVES

The goal of the MCSP Ebola Response Project in Guinea is to scale up efforts to prevent and control the spread of EVD to protect and maintain quality reproductive, maternal, newborn, and child health services.

The key objectives of the Ebola Response are: • Objective 1 – Prevention at facilities: Support healthcare workers and facilities to continue to offer high quality health services in a safe environment by strengthening infection prevention and control (IPC) practices through training, supportive supervision, and complementary monitoring and evaluation.

• Objective 2 – Ebola virus disease (EVD) prevention within communities: Support communities and their local leaders to combat disease transmission through improved contact-tracing, intensified social mobilization, and technical assistance to district health teams.

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RESULTS AND ACTIVITIES BY OBJECTIVE

Objective 1 – Prevention at facilities: Support healthcare workers and facilities to continue to offer high quality health services in a safe environment by strengthening infection prevention and control (IPC) practices through training, supportive supervision, and complementary monitoring and evaluation.

1.1 Active participation of MCSP in national level coordination

During the quarter, Jhpiego has remained active within the National Coordinating Unit for the fight against Ebola. Highlights this quarter include:

1) The establishment of a triage and isolation unit for medical and surgical emergencies at Donka National Hospital in collaboration with MSF-B, WHO, CDC, and the directors of the hospital. This initiative is the first of its kind since the beginning of the Ebola epidemic. MCSP has provided inputs for rollout of activities and the management of trainers/supervisors trained by MCSP to provide technical assistance to staff working in that unit. From January 10 to March 31, the triage and isolation unit has identified 51 suspected cases, and amongst them 11 cases were found to be positive for the EVD (22%).

2) The results of the IPC baseline survey were disseminated to the national hospitals of Donka and Ignace Deen. The dissemination of the results enabled improved compliance in quality improvement targets and IPC performance by administrative and clinical leaders in each health facility.

3) MCSP contributed to the planning and evaluation of the national “Zero Ebola in 60 days” strategy. More specifically, MCSP has made significant technical contributions in five of seven supervisory axes of this strategy (i.e. review of local coordinating bodies, IPC management, monitoring activities of border checkpoints, and logistical coordination of the availability of IPC inputs).

4) MCSP contributed to the development and finalization of certain technical documents on IPC, including a screening form in health facilities, Standard Operating Procedures (SOPs) for rapid response teams (RRT) to lead investigations in cases of personnel infections.

1.2 Conduct training for facility staff & train/update consultant trainers

From January to March 2015, MCSP has trained 2482 providers on IPC practices with an emphasis on understanding and preventing the transmission of EVD. Of the providers trained, 1950 are located in Conakry, 381 in Kissidougou, and 124 in Beyla (see Tables 3, 4 and 5 below). Participants were distributed between 121 training sessions facilitated by national trainers who had received an update a week earlier. The five-day trainings were designed to disseminate information accompanied by simulated practice sessions in the classroom, and field visits in real-world situations in the various departments of area hospitals. These trainings bring the total number of providers trained since the start of the project to 2986. It should also be noted that 18 new trainers were trained in IPC clinical training skills, increasing the current number of trainers to 47.

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Demonstration of practices safe practices in the operating theater

Hand washing practice, following a checklist

Practicing glove removal during and handwashing during supportive supervision

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Table 1: Distribution of Health Personnel Trained in Conakry by Municipality

Commune/Type de structure Administrateur service sanitaire service Administrateur Agent Technique de (ATS) Santé Autre Biologiste Dentiste Dermatologue Etudiant Infirmier(ere) Ingenieur Laborantin Medecin DES Medecin/chirurgien Medecin/Generaliste Medecin/Genyco-Obstetric Non qualifié Nutritionniste Pediatre Pharmacien Pneumologue Professeur Sage femme P. Santé Sup. Tech. Technicien de laboratoire Technicien radio Grand Total Dixinn 42 2 45 16 13 45 220 2 4 17 56 235 26 3 17 16 6 68 1 4 1 839 Centre Médical Communal (CMC) 11 7 6 1 16 6 1 1 2 12 63 Hôpital Donka 31 2 38 10 13 44 204 2 4 17 55 224 25 3 16 13 6 56 1 4 1 769 OMS 1 3 4 ONG Internationale 2 1 3 Kaloum 1 26 1 33 12 24 169 10 35 24 187 11 1 6 11 1 7 29 1 1 590 Centre de Santé 3 3 Direction Préf/Com de la Santé (DPS/DCS) 1 1 Education 1 1 Hôpital Ignace Deen 26 1 33 12 24 166 10 35 24 184 11 1 6 11 1 6 29 1 1 582 Ministère de la Santé (MSHP) 1 1 2 Union Africaine 1 1 Matam 40 24 7 54 1 5 39 15 6 5 47 1 244 Centre Médical Communal (CMC) 40 24 7 54 1 5 38 15 6 5 47 1 243 Direction Préf/Com de la Santé (DPS/DCS) 1 1 Matoto 1 1 2 Direction Préf/Com de la Santé (DPS/DCS) 1 1 Structure privée 1 1 Ratoma 38 21 4 4 84 5 4 44 22 3 8 35 1 2 275 Centre Médical Communal (CMC) 33 19 4 4 49 5 4 40 22 3 7 35 225 Direction Préf/Com de la Santé (DPS/DCS) 1 1 Direction Régionale de la Santé (DRS/DSVCo) 1 1 Hôpital Kipé 5 2 35 2 1 1 2 48 Grand Total 1 146 3 124 39 13 73 528 2 20 52 89 505 74 1 3 32 40 1 13 179 3 6 3 1950

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Table 2: Distribution of Health Personnel Trained Within Each Prefecture

Préfecture/Type de structure Administrateur civil Administrateur Agent Technique de (ATS) Santé Autre Biologiste Etudiant Infirmier(ere) (Infirm. Spéc. Lepre)ISL Laborantin Medecin/chirurgien Medecin/Generaliste Medecin/Genyco-Obstetric Pharmacien Sage femme Technicien de laboratoire Grand Total Beyla 39 1 4 1 3 1 49 Centre de Santé 28 1 29 Centre Médical Communal (CMC) 4 1 2 7 Direction Préfectorale de la Santé (DPS) 1 1 2 Hôpital Prefectoral Beyla 1 1 2 Poste de Santé 7 2 9 Coyah 1 1 Structure privée 1 1 Faranah 2 2 Direction Régionale de la Santé (DRS) 2 2 Forécariah 54 5 10 6 12 6 1 3 2 99 Centre de Santé 38 3 4 5 1 2 1 54 Direction Préfectorale de la Santé (DPS) 1 1 Education 1 5 1 3 10 Hôpital prefectoral Forecariah 5 2 1 5 6 1 1 1 22 Poste de Santé 10 1 1 12 Kissidougou 1 272 1 17 39 1 5 4 6 8 3 22 2 381 Centre de Santé 145 1 8 12 1 1 11 179 Direction Préfectorale de la Santé (DPS) 1 4 1 1 7 Hôpital préfectorale Kissidougou 61 7 20 4 4 4 7 3 11 2 123 Poste de Santé 60 1 6 67 Structure privée 2 1 2 5 Grand Total 1 365 6 28 6 55 1 5 4 16 11 4 26 4 532

Table 3: Distribution of Health Personnel Trained by Type of Health Facility

Type de structure Beyla Coyah Dixinn Faranah Forécariah Kaloum Kissidougou Matam Matoto Ratoma Grand Total Poste de Santé 9 12 67 88 Centre de Santé 29 54 3 179 265 Centre Médical Communal (CMC) 7 63 243 225 538 Hôpital (HN, HR, HP) 2 769 22 582 123 48 1546 Direction Préf/Com de la Santé (DPS/DCS) 2 1 1 7 1 1 1 14 Direction Régionale de la Santé (DRS/DSVCo) 2 1 3 Ministère de la Santé (MSHP) 2 2 Education 10 1 11 Structure privée 1 5 1 7 OMS 4 4 ONG Internationale 3 3 Union Africaine 1 1 Grand Total 49 1 839 2 99 590 381 244 2 275 2482

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Two training sessions were organized and led by Professor Yolande Hyjazi, MCSP Chief of Party and Jhpiego Country Director, for the 32 Heads of Services at Donka and Igance Deen National Hospitals. The purpose of these sessions was to lead the Service Heads through the content of the IPC training that their staff completed and to discuss how they can lead and support improved IPC practices in their services.

1.3 Procure and supply necessary sterilization and sanitation/waste management equipment for trainings

In the effort to support IPC practices in health facilities, MCSP donated various material and equipment to national hospitals and the CMCs Ratoma and Matam, including hand washing units providers for service delivery facilities that were lacking them.

During the quarter, MCSP has supported the distribution of equipment and consumables IPC materials ( see list below) at priority sites so that services can be effectively supported.

Table 4: Summary of IPC Materials Donated to National Hospital and CMCs Materials Total Distributed Trashcans 120 L 9 Trashcans 30 L 697 Buckets with lid 391 Floor brush + handle 642 Bleach 1L 1164 Liquid Soap 1164 Broom + Handle 624 Broom 403 Mop 800 Boots 293 Bibs N-75 1512 Disposable gowns 2313 Masks N-95 /Bibs 3264 Plastic Garbage bags 50 L 231 Plastic Garbage bags 30 L 91 Plastic Garbage bags 120 L 11 Security Box 1423 Disposable Aprons 12000 Cleaning gloves 622 Goggles 337 Toothbrushes 1728 Diama soap 4312 Non-contaminated waste trashcans 96 Thermoflash thermometer 78

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1.4 Conduct routine quality assurance visits and provide additional follow-up support

Parallel to the provider trainings, supervisory visits were conducted to improve the service quality and IPC performance of trained staff. 58% of staff at all the targeted facilities, have been trained and supervised within two weeks of training.

All services of national hospitals and CMC / CMS benefited from 1 to 3 coaching visits during the quarter. The supervisors contacted the administrators of each facility for information and established a program for the visit with the IPC Focal Point and the head nurse of each facility. They spent four days in successive visits of the services, meeting the heads of departments and trained staff. Each supervisory visit focused on assessing that staff adhered to the following six competencies or standards:

o Wash their hands with soap and an alcohol-based solution; o Can easily prepare the 0.05%, 0.1%, and 0.5% chlorine solution; o Use PPE correctly based on mode of disease transmission; o Reasonably manage contaminated material until storage; o Manage waste at the source and follow proper protocol for their elimination; o Participate in the triage and screening of Ebola disease patients in their service.

• Key findings of the observations through coaching visits included: o Examination gloves are available in most sites; o Staff members are practicing hand washing procedures and preparation of chlorine solution in accordance to the standards in the majority of sites; o Hand washing posters are available in certain sites o Bins are available and well-labeled for waste management, and buckets are available for decontamination and high-level disinfectant solutions. o Staff are involved in the implementation of IP procedures in their respective sites; o Staff are taking initiative to make changes at their sites and implement Action Plan developed at the end of training

• The coverage of supervision visits, the number of trained providers who have received a follow-up visit, is shown in the table below: Table 5: IPT trained healthcare providers that have received supervision CHU (Donka, Ignace Deen) 67% (1117/1679) HN Kipe 95% (38/40) CMC (Ratoma, Matam, Minière, Dixinn, Flamboyant) 84% (423/502) CMS Jean Paul II 80% (28/35) District de Forecariah (HP, CS) 80% (160/199) District de Beyla (HP, CS) 89% (110/124) District de Kissidougou (HP, CS) 23% (73/381)

The supervision of staff is ongoing in Kissidougou where training was completed later than other areas. . • Field visits conducted in collaboration with programmatic partners, particularly WHO and CDC resulted in: o The implementation of triage and screening units in Conakry facilities: Donka, Ignace Deen, Matam, Ratoma, Flamboyants, Minière, Coleah, John Paul II, and Kipé Hospital o EVD investigations in Conakry hospitals of Ignace Deen, Coleah, Donka, and John Paul II o Interviews with focal points and department heads to assess the functionality of triage and screening units

• Orientation of support staff:

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o During the supervisory visits in health facilities, support staff received a 1-day IPC orientation with an emphasis on the nature and level of interventions. o 380 support staff members in the following health facilities: Table 6: Number of Support Staff Trained at Various Health Facilities Prefecture/Type de structure Nombre formés Beyla 24 Centre de Santé 13 Centre Médical Communal (CMC) 8 Hôpital 3 Dixinn 120 Centre Médical Communal (CMC) 9 Hôpital 111 Forécariah 27 Centre de Santé 18 Education 4 Hôpital 5 Kaloum 87 Education 7 Hôpital 80 Kissidougou 36 Centre de Santé 15 Hôpital 21 Matam 27 Centre Médical Communal (CMC) 23 Education 4 Ratoma 59 Centre Médical Communal (CMC) 20 Hôpital national Kipé 39 Grand Total 380

1.5 Monitoring and Evaluation Prior to the implementation of training and supervision activities, MCSP conducted a baseline assessment in all 55 targeted health structures to identify the current level of IP performance and the gaps that need to be addressed through training and on-site coaching. This evaluation also reviewed the availability of decontamination equipment and existing PPE. Selected evaluators were familiar with IP practices and/or use of performance standards as part of the SBM-R process.

In January 2015, MCSP evaluated the 14 services of Kipé Hospital, the 5 CMCs in Conakry, and the Social Medical Center of John Paul II. The tables below show the # of standards observed in each service or facility, the score obtained and the percentage of correct performance: o At Kipé: . 2 services obtained an IP performance score better than or equal to 70%. . 11 services (70%) obtained an IP performance score between 30% and 58%. . Only 1 service obtained the lowest performance score, at 22%.

o In 6 CMC/CMS (see table 5): . 3 structures (14%) obtained an IP poor performance score of 20%. . Only 1 service obtained a performance score of 30%. . 2 services obtained an IP performance score between 30% and 37%.

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Table 7: IP Performance Scores of Various Services at Kipé National Hospital

Table 8: IP Performance Scores of Various Services at CMCs and CMSs in Conakry

1.6 Communications support as a tool for referral, logistics management and mentoring:

During the various training sessions, providers received an orientation on the mobile mentoring program. The objective of this program is to enhance IP knowledge retention of trained providers, through the transmission of text messages on IP topics. 99% of participants agreed to enroll in the program and provided their phone numbers, thereby indicating the providers’ interest to capitalize on their newly-acquired knowledge.

The contact phone numbers for the trained providers have been entered into a database so that the messages can be sent using mHealth software. The IPC messages for SMS have been developed in consultation with stakeholders and are being tested for validation. Negotiations are being finalized with the telephone companies to support the costs of sending the messages.

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Next Steps for Objective 1:

1) Continue the supervision of providers trained in PCI in the field; 2) Continue participation in activities at the national coordination of the fight against MVE ; 3) Continue advocacy to institutionalize training and the supply of inputs for PCI in the country, at national level.

Social and behavior change communication (SBCC) & sensitization on EVD prevention and hygiene promotion in affected sub-prefectures through public health committees & radio messages

Save the Children International (SCI) as the lead MCSP partner for Objective 2 has conducted numerous outreach activities in Conakry and the prefectures of Kouroussa and Beyla to spread awareness around the disease of Ebola, with targeted messages concerning: prevention methods for those at risk, the management of rumors in schools and communities, the importance of safe burials, and the importance of monitoring contacts.

Due to the apparent reluctant acceptance of educational and sensitization messages within communities, the project has developed other outreach activities targeting religious leaders (imams & priests), community leaders, and leaders of associations. These activities enable them to identify the reasons for certain practices (safe burial, house spraying, follow-up of contacts) and mobilize them to be actively involved in raising awareness of their own communities.

Approaches used for outreach activities include:

 Participatory Community Theatre In order to reach a large number of people and perform a mass awareness in remote areas or where there is reluctance in Conakry, SCI has hired a theater troupe and designed a participatory theatre piece called “Le proces d’Ebola” (Ebola on Trial) to not only raise awareness but also to enable public discussion in a Q&A format around the importance of the national Ebola efforts and certain surveillance measures.

• Approximately 3,075 people participated in performances by the theatre troupe in the 5 urban communes of Conakry, including approximately 910 women, 730 men, 850 girls and 585 boys. • With the increase in positive cases and the reluctance towards Ebola prevention activities in Coyah and Forécariah, SCI decided to also bring several performances of the participatory theater activities to these areas to support the government in the campaign "Ebola ça suffit!" (Ebola, it’s enough!). o In Forécariah approximately 300 people attended – roughly 57 men, 72 women, 101 girls and 70 boys. o In Coyah with 200 people, disaggregated in 34 men, 51 women, 68 girls and 47 boys.

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Figure 1: Theater Group Conducting Sensitization

Figure 2: Spectators Watching a Theater Group

 Organization of Soccer Matches A soccer match for the fight against Ebola was organized in the prefecture of Kouroussa, chaired by the prefectural Coordinator and with the involvement of prefectural officials and field partners (Guinean Red Cross, WHO, CERADE, CENAFOD). The match was between two teams composed of women who work as vendors and teachers in Kouroussa. General Ebola awareness messages were conveyed by project staff during the event, with empahsis on the importance of safe burial practices, the importance of monitoring contacts and the importance of referring patients to the health centers.

This match brought together about 800 men, 2,000 women and 1,500 children, for a total of 4,300 spectators.

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Figure 3: Local Government Officials Attending the Soccer Match

 Raising awareness masses / education talks : Ninety talks & sensitization sessions were carried out in the prefectures of Kouroussa, Beyla and Conakry. These sessions focused on the Ebola prevention measures and active surveillance for cases, acceptance of hand-washing devices, the use of “thermoflash” thermometers and rumor management in schools. These awareness sessions were conducted in schools and communities by members of comités de veille villageois (CVV) in Kouroussa and Beyla, and by the communication and social mobilization supervisors in the communes of Conakry.

Approximately 13,795 people were reached by these messages with 5,130 women, 4,508 men, 2,126 girls and 2,031 boys. Table 9: Sessions of Social Behavior for Communication Change (SBCC) Prefecture Sessions Participants Reached Total SBCC Men Women Girls Boys Participants

Kouroussa 41 3,499 3,829 1,792 1,609 10,729 Beyla 20 879 772 255 373 2,279 Conakry 29 130 529 79 49 787 Total 90 4,508 5,130 2,126 2,031 13,795

 Radio Broadcasts

Round table radio discussions were organized with the staff from prefectural health offices and project staff to present key topics related to Ebola. These radio programs were organized in the prefectures of Conakry, Kouroussa and Beyla. The topics covered included: reluctance in the villages, safe burial practices, and the use of hand-washing devices to prevent the disease. 22 reruns of the broadcasts were made during the quarter.

Interactive sessions were also held asking questions of listeners who could call in. The callers who gave correct answers were rewarded with soap or a bottle of chlorine. One of the broadcasts was made in

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Table 10: Summary of Radio Broadcasts Conducted Estimation of Participants Reached (estimation of 10% of the Number of population listens to the radio) Type of Broadcast Sessions Adults Children Round Table 07 40,776 5,194 Interactive 08 6,457 823 program Total 15 47,233 6,017

2.2 Sensitization for civil society groups and CHW associations

 Organization of Community Focus Group To fully equip the decision-makers and empower them to influence their communities to discard the myths around Ebola, SCI completed a training of 463 members of the civil society of Dixinn-Conakry (community leaders, youth associations, Imams & priests, representatives of women's associations). The purpose was to: 1) Create a framework for discussion at Community level; 2) Allow different leaders and community members to comment on the reasons for resistance / stigma and misconception of EVD in their community ; 3) Encourage community members to become actively involved in seeking solutions to the challenges impeding response activities; 4) Facilitate and encourage community involvement in raising awareness and mobilization; 5) Understand the level of involvement of community leaders (imams, heads of districts, heads of sectors, CVS, youth representatives and women, AC, DCS and common ) are actively involved in the response against the Ebola epidemic in order to oust completely beyond our borders within a short time

Figure 4: Community Focus Group with Imams in Conakry

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Table 11: Summary of Community Focus Groups PARTICIPANTS Target Audience Men Women

Imams 220 0 Community Leaders 20 2 Comité de Veille 22 0 Community agents 11 2 Head of Sectors 130 5 Youth Leaders 25 0 Women Leaders - 24 Focal Point DCS 1 0 City Council Representatives 1 0 TOTAL 367 33

Of the 400 people trained, only 33 were women from women's associations which is only about 7%. Hence, there is a need to involve more women's groups in our future activities.

 Training for Civil Society associations The EVD training was originally planned for 58 civil society associations. However, the project was able to train a total of 233 members of 67 civil society associations, as well as members of two police brigades.

2.3 Contact-tracing and surveillance in affected sub-prefectures

 Training on Contact-Tracing and Surveillance These trainings were designed as two-day sessions with 20 to 25 participants per session, with the objectives that all participants acquire knowledge about: • Personal protection to prevent against infection. • The case definition of Ebola to permit active surveillance • The management of information for recommended secure referral (i.e. use of the Ebola emergency hotline number 115).

These trainings were particularly pertinent because the public’s loss of confidence in the public health system and fears of infection therein, have driven many patients/sick people to actively seek out private healers or practitioners, most of whom are illegal, unregistered, and untrained.

Table 12: Distribution of Participants of Training on Contact-Tracing and Active Surveillance

Prefecture

CVV CVV Type Total Clinics Health private Healers Leaders Medical Religious Members Workers in Workers

Of agent Pharmacists Street Sellers

Kouroussa 80 80 40 0 40 0 240

Beyla 50 0 40 50 200 30 370

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Conakry 50 0 50 0 0 0 100

Total 180 80 130 50 240 30 710

100 private care providers covering 50 private practices that are not registered by the Ministry of Health in Conakry were included in these trainings.

Figure 5: Training of Street Drug Vendors on Finding Active Ebola Cases

 Contact-Tracing and support of Community Health Committees (Comités de Veille Villageois - CVV) MCSP supported the respective DPS with contact-tracing in the prefecture by helping supervise community health workers (CHWs) that are involved in this type of surveillance. Contact-tracing efforts were supported especially by providing phone credit to supervisors, payment of per diems to CHWs, CHW supervision and training.

In addition, in December SCI positioned itself as the lead NGO in overseeing the set-up, training, and functioning of the CVV in five prefectures, including Kouroussa and Beyla.

Table 13 below shows the situation during the reporting quarter:

Table 13: Status of Contract Tracing and CVV-related Activities by Prefecture (includes Secondary Data) Kouroussa Beyla Indicators (Kankan (Nzérékoré Conakry Notes region) region) Number of contacts 0 97 2,126 traced by the MoH Contacts traced for 2% of contacts not followed are cases of refusal, 0 100% 98% 21 days (%) loss of sight , or travel

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Kouroussa Beyla Indicators (Kankan (Nzérékoré Conakry Notes region) region) With the increase in the number of contacts 28 Number of CHWs (from 585 contacts in February to 1096 in 70 CVV* 200 Community trained March), 28 new CHW were trained and Workers equipped to monitor the contacts in Matoto All members of CVV Kouroussa (462 members) Number of CVV received monthly premiums and work 70 30 supported equipment (boots, raincoats, soap 1carton / office) and t- shirts and hats

Supervision of the CVVs was conducted in the prefecture of Kouroussa where SCI has established 70 CVV, composed of 462 members all equipped with items to identify their participation in the CVV, contact monitoring kits (raincoats and boots), and a box of soap for the CVV office. In terms of motivation, each of the 462 CVV members in Kouroussa received their monthly per diem of GNF 400,000 (for the months of January and February 2015) as stipulated by the National Coordination and WHO (CNLEB).

The objective of the supervision was to evaluate the performance of CVVs in relations to: • The correct use of management tools • Promptness in producing weekly report • Completing weekly reports correctly • Conducting awareness sessions on preventive measures in the community following schedule

From the 70 Committees supervised in Kouroussa 54 (or 77%) were performing well and 16 were not effective (23%). The team of supervisors will increase monitoring in order to improve their performance.

In Beyla, MCSP set up and trained CVV members of 30 CVV. Monitoring and paying the monthly motivation was later handed to a local NGO funded by UNICEF at the request of the prefectural Ebola Coordinator.

Figure 6. Example of Kits handed out to CVV

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Figure 7. Distribution of Kits to CVV members in Kouroussa

2.4 Coordination & technical support to the Prefectural Health Directorate (DPS) to help manage the EVD response at prefecture level.

Several thematic groups (communication, surveillance, safe burials, and logistics) were implemented to enable all partners to contribute to the development of action plans within their programmatic/organizational foci responding to the EVD epidemic.

At the prefectural-level, and in the city of Conakry, MCSP is involved in each of the coordination meetings and shares the meeting minutes with the rest of the staff.

In supporting the DPS, SCI has provided equipment (a photocopier), fuel, and phone credit cards to the Beyla prefectural coordination.

Next Steps for Objective 2: • Explore the possibility of starting early recovery activities in the health sector, particularly around confidence-building in the health systems and sensitization around the need for vaccination and ante- & post-natal care. • Monitor the CVV in Kouroussa to determine if there’s a future for the CVV post-April/post-Ebola.

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PERFORMANCE MONITORING PLAN (PMP) Note: Number of facilities increased from 37 to 55 shortly after the start of the project to accommodate an additional prefecture INDICATOR* DEFINITION** AND DATA SOURCE FREQUENCY TARGET Results Q1 Result DISAGGREGATORS /COLLECTION OF DATA 17Nov-31Dec Q2_Jan-Mar METHOD COLLECTION 2014 2015 OBJECTIVE 1: [Prevention at facilities]: Support health care workers and facilities to offer safe and high quality health services by strengthening infection prevention and control practices through training and intensive supportive supervision IR 1.1: Delivery of Quality Health Services Improved IR 1.1.1: Availability of Integrated Quality MNCH Services Increase IR 1.1.3: Availability of Prevention, Care and Treatment Services Increased IR 1.1.4: Access to Health Services Improved 1.1.1 Number of National tools Number of national tools and service Project records Annual 2 (Curricula 2 and service provision provision guidelines related to PI, IPC Curriculum guidelines for IPC improve access to and use of health Standards/ updated prevention and treatment services drafted with USG support, Directives ?) Performance developed/adapted and by program. Standards adapted validated 1.1.2 Number of tools, Job aids, Number of tools, Job aids, IEC Project records Annual TBD 1 IPC performance IEC material materiel developed/Adapted for IPC standards for developed/adapted for prevention and treatment with USG assessment and IPC prevention and support monitoring treatment 1.1.3 Number of tools, Job aids, Number of tools, Job aids, IEC Project records Annual TBD IEC material for IPC materiel developed/Adapted for IPC prevention and treatment prevention and treatment with USG distributed support 1.1.4 Number of consultant Number of consultant trainers who Training database Quarterly 20 29 18 trainers updated/trained complete IPC training update or IPC to conduct training in IPC training qualification Disaggregated by : sex, cadre 1.1.5 Number/percentage of Number/percentage of staff in Training database Quarterly 2150 503 2482 staff in health facility who health facility who receive IPC Male: 1176 receive IPC training training Female: 1306 Disaggregated by : sex, cadre See report narrative for

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INDICATOR* DEFINITION** AND DATA SOURCE FREQUENCY TARGET Results Q1 Result DISAGGREGATORS /COLLECTION OF DATA 17Nov-31Dec Q2_Jan-Mar METHOD COLLECTION 2014 2015 #/cadre

1.1.6 Number of trained staff Number of trained providers who Supervision 2150 Focused on services 1426 who received post received post training follow-up at records at National training follow up their work site to support the Hospitals: Female: 793 supervision at 6 week/3 implementation of news skills and Donka 27 of 29 Male: 633 month behaviours. Igance Deen 17of 23 Disaggregated by : sex, cadre, Period: bi-weekly period (6 week, 3 month) in Conakry city and bi-onthly in By Cadre as follows: Médecin 480 ; Quarterly Beyla and SF 141 ; Infirmière 386; ATS 188; Forecariah Dentiste 34 ; Etudiant 29 ; prefecture Pharmacien 22 ; Biologiste 90; Laborantin 20 ; Pédiatre 21 ; Dermatologue 3 ; Tech Sup Santé 2 ; Professeur 1; Ing 1; Tech Radio3 ; Nutritionniste 2; pneumologue 1 ; Autre non défini 2. 1.1.7 Number of supportive Number of trained providers Supervision 444 (First visit is Supervision will supervision visits receiving supportive supervision at records (12 visits per considered post- begin next Quarterly conducted on site their work site. site during 6 training follow-up) quarter months 1.1.8 Number/proportion of Number/proportion of targeted Supervision 55 20 health facilities targeted health care health care facilities that have the records evaluated during facilities that have the following key components: the quarter. following key components - Dedicated space for patient isolation 0 /20 Quarterly - Changing rooms for healthcare workers - Separate area for cleaning/laundering contaminated supplies

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INDICATOR* DEFINITION** AND DATA SOURCE FREQUENCY TARGET Results Q1 Result DISAGGREGATORS /COLLECTION OF DATA 17Nov-31Dec Q2_Jan-Mar METHOD COLLECTION 2014 2015 - Separate area for cleaning staff who have handled contaminated supply but who do not have direct patient- care activities Disaggregated by : services type/facilities type 1.1.9 Number/proportion of Numerator: Number of health Supervision 55 20 health facilities health facilities that have facilities that have appropriate records evaluated during appropriate (and (standard and complementary) (and the quarter. sufficient quantity of) PPE sufficient quantity of) PPE for at least one month Denominator: total number of 6/17 health health facilities observed facilities Disaggregated by : services (Conakry, type/facilities type Forecariah) Quarterly 15/65 services (3 Nationals Hospital)

1.1.10 Number/proportion of Numerators: Number of health Supervision 55 20 health facilities health facilities that have facilities that have access to clean records evaluated during access to clean water in water in each service delivery point the quarter. each Service delivery Denominator: total number of point (SDP) health facilities observed Quarterly 8/17 healths Disaggregated by : services type/ facilities facilities type (Conakry, Forecariah) 33/65 services (3

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INDICATOR* DEFINITION** AND DATA SOURCE FREQUENCY TARGET Results Q1 Result DISAGGREGATORS /COLLECTION OF DATA 17Nov-31Dec Q2_Jan-Mar METHOD COLLECTION 2014 2015 Nationals Hospital)

1.1.11 Number/proportion of Numerator : Number of health Supervision 55 20 health facilities health facilities that have facilities that have access to records evaluated during access to disinfecting disinfecting agents the quarter. agents (and sufficient Denominator: total number of quantity for at least one health facilities observed 8/17 healths month) Disaggregated by : services type/ facilities Quarterly facilities type (Conakry, Forecariah) 37/65 services (3 Nationals Hospital)

1.1.12 Proportion of sites where Numerator: number of facilities Supervision 55 20 health facilities triage is correctly conducting triage of patients prior to records evaluated during implemented entry the quarter. Denominator: total number of supported health facilities/observed 9/17 healths Disaggregated by : facilities type facilities Quarterly (Conakry, Forecariah) 23/65 services (3 Nationals Hospital)

1.1.13 Proportion of health Numerator: number of facilities with Supervision 55 20 health facilities facilities with established established isolation area records evaluated during isolation area for suspect Denominator: total number of the quarter. Quarterly Ebola cases supported health facilities/observed Disaggregated by : facilities type 2/17 healths facilities

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INDICATOR* DEFINITION** AND DATA SOURCE FREQUENCY TARGET Results Q1 Result DISAGGREGATORS /COLLECTION OF DATA 17Nov-31Dec Q2_Jan-Mar METHOD COLLECTION 2014 2015 (Conakry, Forecariah) 0/65 services (3 Nationals Hospital)

1.1.14 Proportion of health Numerator: Number of health Supervision 0 20 health facilities facilities with presence of facilities with presence of waste in record evaluated during waste in the surrounding the surrounding areas the quarter. areas Denominator: total number of health facilities observed 13/17 healths Disaggregated by : facilities type facilities Quarterly (Conakry, Forecariah) 42/65 services (3 Nationals Hospital)

1.1.15 Number/proportion of Numerator: Number of health Supervision Annual TBD health facilities that have facilities that have fully functioning record fully installed/renovated incinerators to be able to properly and functioning dispose of the increased quantities incinerators of disposable and potentially (MCSP will advocate with contaminated materials donors currently Denominator: total number of purchasing incinerators to health facilities place at focus facilities) Disaggregated by : facilities type 1.1.16 Number/proportion of Numerator: Number of health Supervision Annual 12-15 (to be health facilities that have facilities that have appropriate record confirmed) appropriate autoclave autoclave provided, to ensure provided proper instrument processing, with USG support Denominator: total number of

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INDICATOR* DEFINITION** AND DATA SOURCE FREQUENCY TARGET Results Q1 Result DISAGGREGATORS /COLLECTION OF DATA 17Nov-31Dec Q2_Jan-Mar METHOD COLLECTION 2014 2015 health facilities 1.1.17 Number and percent of Numerator: Number of women Monthly report Quarterly TBD 4712 women delivering with delivering with assistance of a skilled assistance of a skilled birth attendant* (in health facilities birth attendant* trained with SBA). SBA is a trained nurse, or in IPC midwife or medical doctor Denominator: Number of birth at facilities. 1.1.18 Number of consultations Number of consultations in Baseline, Endline Monthly 5% over life at health facilities supported health facilities per of project. month Disaggregated by: type of service/type of structure 1.1.19 MCSP learning and results Number of reports, articles, etc. documented and completed to document Jhpiego 2 (Brief, disseminated to better learning Jhpiego Annual commentary) inform and advance policy dialogue IR 1.3: Health Systems Strengthened IR 1.3.2: Human Resources for Health Strengthened 1.3.1 Number and percentage Numerator: Number of facilities Supervision record Annual 55 of health facilities achieving / compliant with at least achieving/ compliant with 80% of IP performance standards at least 80% of through SBM-R process. performance standards of Denominator: total number of IP health facilities observed Disaggregated by : facilities type 1.3.2 Proportion of staff Numerator: Number of staff Supervision record Quarterly 100% Supervision will observed wearing gloves observed wearing gloves and begin next and appropriate PPE appropriate PPE when exposed to quarter when exposed to blood or blood or bodily fluids bodily fluids Denominator: total number of staff

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INDICATOR* DEFINITION** AND DATA SOURCE FREQUENCY TARGET Results Q1 Result DISAGGREGATORS /COLLECTION OF DATA 17Nov-31Dec Q2_Jan-Mar METHOD COLLECTION 2014 2015 observed Disaggregated by : sex, cadre, services type/ facilities type

1.3.3 Proportion of rooms Numerator: Number of rooms Supervision record Quarterly 100% Supervision will appropriately disinfected appropriately disinfected after begin next after patients’ discharge patients’ discharge or referral for quarter or referral for suspect suspect Ebola cases Ebola cases Denominator: total number of rooms observed Disaggregated by : facilities type 1.3.4 Average time between Average time between admission Monthly report Quarterly TBD ND admission and isolation and isolation for suspected Ebola for suspected Ebola patients improved patients improved Disaggregated by : service type/ facilities type 1.3.5 Proportion of sites where Numerator: sites where cleaning and Supervision record Quarterly 55 – 100% 20 health facilities cleaning and processing processing of instruments and other evaluated during of instruments and other articles is correctly completed the quarter. articles is correctly according to standard. completed according to Denominator: Total number of sites 13/17 healths standard. observed facilities (Conakry, Forecariah) 31/65 services (3 Nationals Hospital)

1.3.6 Proportion of staff trained Numerator: Number of staff trained Supervision record Quarterly 100% Supervision will on IPC that achieve a on IPC that achieve a score of 85% or begin next score of 85% or higher on higher on knowledge tests during quarter

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INDICATOR* DEFINITION** AND DATA SOURCE FREQUENCY TARGET Results Q1 Result DISAGGREGATORS /COLLECTION OF DATA 17Nov-31Dec Q2_Jan-Mar METHOD COLLECTION 2014 2015 knowledge tests during post-training follow-up supervision post-training follow-up visits supervision visits. Denominator: Number of total staff trained in IPC evaluated Disaggregated by: sex, cadre, service type, facilty type (Hosp, HC),period (6 week, 3 months), 1.3.7 Proportion of staff trained Numerator: Number of staff trained Frontline SMS Quarterly 100% ND on IPC that have a mobile on IPC that have a mobile phone and database phone and who receive all who received all SMS messages. SMS messages, within the Denominator: Number of staff phone network zones. trained on IPC to whom text messages were sent (in the areas covered and who have mobile phones) OBJECTIVE 2: Ebola virus disease (EVD) prevention within communities: Support communities and their local leaders to combat disease transmission through improved contact-tracing, intensified social mobilization, and technical assistance to district health teams. 2.1 Number of contacts District health Weekly ~2,000 traced by MoH with team data, (monthly for MCSP/SCI support MCSP/SCI data per diem payments) 2.2 Percentage of contracts District health Weekly >95% traced for 21 days team data, MCSP/SCI data 2.3 Number of CHWs trained Training records, Monthly 100 men, 100 and supported (total and payment records women per 10,000 population for per diems, within project area), by monthly reports, sex payment records for CHWs, training reports 2.4 Number of radio Radio records, Monthly 100 messages/sensitization payment slips to

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INDICATOR* DEFINITION** AND DATA SOURCE FREQUENCY TARGET Results Q1 Result DISAGGREGATORS /COLLECTION OF DATA 17Nov-31Dec Q2_Jan-Mar METHOD COLLECTION 2014 2015 broadcast and/or radio sponsored 2.5 Number of civil society Training records, Monthly 60 organizations trained attendance sheets 2.6 Number of Public Health Training records, Monthly 25 Committees supported payment records for per diems, monthly reports

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