FINAL REPORT STRENGTHEN NON-GOVERNMENTAL CAPACITIES TO FACE THE COVID-19 PANDEMIC IN NICARAGUA PROJECT (PREVENSIDA)

JUNE 2021 The contents of this final report are the sole responsibility of University Research Co., LLC (URC) and do not necessarily reflect the views of the United States Agency for International Development or the United States Government. Disclaimer This document is made possible by the generous support of the people of the United States of America, through the United States Agency for International Development (USAID) with funding from the U.S. President’s Emergency Plan for Relief AIDS (PEPFAR). PrevenSida is a project implemented by University Research Co., LLC (URC) under cooperative agreement No. AID- 524-A-10-00003. URC submits this report for USAID review. The point of view expressed by the authors of this publication does necessarily reflect the views of the USAID or the United States Government.

This document was prepared by University Research Co., LLC (URC) for review by the United States Agency for International Development (USAID). The views expressed by the authors in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

On the cover Delivery of disinfection kits to vulnerable populations. Photo credit: Carolina Arauz FINAL REPORT STRENGTHEN NON-GOVERNMENTAL CAPACITIES TO FACE THE COVID-19 PANDEMIC IN NICARAGUA PROJECT (PREVENSIDA)

REPORTING PERIOD: JULY 1, 2020 TO MARCH 31, 2021

Produced by Yudy Carla Wong Blandón PrevenSida Project Director Alexey Oviedo Rojas Admin/Finance Director

TABLE OF CONTENTS

Executive Summary ...... 1 Introduction ...... 7 Background ...... 9 Program Goals and Strategic Components ...... 15 Technical Report: Activities by Objectives and Results ...... 19 Coordination with Other USAID Programs and Donors ...... 49 MEL Plan ...... 54 Annual Plan Compliance...... 55 Activities to be Completed for Project Closure ...... 56 Final Evaluation/Systematization ...... 57 Branding and Marking ...... 58 Management and Staffing ...... 59 Financial Analysis ...... 60 Annex 1. Indicator Table ...... 63 Annex 2. CSOs Presented with the COVID-19 project ...... 65 Annex 3. Organizations Linked to Project Implementation ...... 67 Annex 4. RCCE Campaign Coverage – People Reached ...... 69 Annex 5. COVID-19 Portal Statistics...... 70 Annex 6. COVID-19 Capacity Building ...... 71 Annex 7. COVID-19 Course Registration and Participation by type (Nicaragua) ...... 72 Annex 8. On-Demand Course Registration and Completion ...... 73 Annex 9. Online Telehealth Counseling ...... 74 ACRONYMS AND ABBREVIATIONS

ACCCSida Coastal Campaign Against AIDS ADESENI Association for the Human Rights of Nicaraguan Sexual Diversity Admutrans Trans Women’s Association AMN Nicaraguan Medical Association AMODISEC Asociación Movimiento de la Diversidad Sexual ANICP+VIDA Nicaraguan Association of Positive People Fighting for Life ANIT Trans People Association AOR Agreement Officer Representative APRODER Association for Rural Development ASONVIHSIDA Nicaraguan Association of HIV Positive People CAR Central America Region CEPRESI Center for AIDS Education and Prevention CHW Community Health Worker CID Gallup Consulting in Develoment CO Citizens Observatory COMSALUD Community Mental Health Network COVID-19 Infectious disease caused by a newly discovered coronavirus in 2019 CSOs Civil Society Organizations CSSE Center for Sistems Science and Engineering DA Direct Asistence DCP Disease Control and Prevention DEC Development Experience Clearinghouse EMMP Environmental Mitigation and Monitoring Plan FADGANIC Fundación para la Autonomía y Desarrollo de la Costa Atlántica de Nicaragua FBO Faith-Based Organization GAO Western Self-Help Group GBV Gender-Based Violence GESI Gender Equity and Social Inclusion HIV Human Immunodeficiency Virus HRH Human Resources for Health ICT Information and Comunication Technologies ii Strengthen Non-Governmental Capacities to Face the COVID-19 Pandemic in Nicaragua Project (PrevenSida) IEC Information, Education and Communication Intrahealth Intrahealth International IPC Infection Prevention and Control JHU Cat Johns Hopkins University KM Knowledge Management KMVP Knowledge Management Virtual Platform MDS Movimiento de la Diversidad Sexual MEL Monitoring, Evaluation, and Learning MINSA Nicaraguan Ministry of Health MOH Ministry of Health MOU Memoradums of Understanding MSC Multidisciplinary Scientific Committee NGOs Non Guvernmental Organitation ODETRANS Organitation of Trans People PAHO Pan American Health Organization PASMO Pan American Social Marketing Organization PEPFAR President’s Emergency Plan for AIDS Relief PLHIV People Living with HIV PPE Personal Protective Equipment PrevenSida Project to prevent the transmission of HIV/AIDS RACCN Autonomous Region of the North Caribbean Coast RACCS Autonomous Region of the South Caribbean Coast RCCE Risk Communication and Community Engagement SDH Social Determinants of Health SICA Central American Integration System SITRADOTRANS Union of Trans Domestic Workers SOCO Single Overarching Communication Objective TOR Terms of Reference UMN Nicaragua Medical Unit UNICEF United Nations International Children’s Emergency Fund URC University Research Co., LLC USAID United States Agency for International Development WHO World Health Organization

Final Report iii Caption

iv Strengthen Non-Governmental Capacities to Face the COVID-19 Pandemic in Nicaragua Project (PrevenSida) EXECUTIVE SUMMARY

University Research Co., LLC (URC) implemented the The project’s technical approach was aligned to the United States Agency for International Development WHO-oriented global response pillars. Since project (USAID)/Central America Region (CAR) Prevent the onset, URC worked with civil society organizations Transmission of HIV/AIDS (PrevenSida) project with (CSOs), the private sector, and medical associations to funding from the U.S. President’s Emergency Plan for focus on five of these eight pillars: AIDS Relief (PEPFAR). On June 11, 2020, URC received a • Pillar 1: Country-level coordination, planning, and Notice for Funding Opportunity from United States Agency monitoring for International Development (USAID)/Nicaragua to • Pillar 2: Risk communication and community implement the Strengthen Non-Governmental Capacities engagement (RCCE) to Face Infectious Face COVID-19 Pandemic in Nicaragua project, with an increase in the total budget of $750,000 • Pillar 3: Surveillance, rapid response teams, and case and an extension until March 31, 2021. investigation • Pillar 6: Infection prevention and control (IPC) The disease caused by the coronavirus in 2019, known as COVID-19, has impacted Central America just like the • Pillar 7: Case management rest of world, affecting each country with various degrees The Project focused implementation across eight of severity. Unfortunately, the region lacks the robust departments (Managua, Masaya, Matagalpa, Leon, public health systems needed to prevent and contain the Chinandega, Granada, Estelí, and Carazo), where more outbreak. In Nicaragua, the country has extremely limited cases of COVID-19 are reported and expected. The direct capacity to face the COVID-19 pandemic, given its weak beneficiaries are leaders of CSOs, the private sector, health systems and significant gaps in its preparedness and medical associations. The eight departments and and response capacity. According to the World Health municipalities with the highest number of suspected Organization (WHO), in a scale of 1 to 5, Nicaragua is at COVID-19 cases are: 2, estimating that it could require up to 100% external support to face the epidemic. • Managua: Managua, Tipitapa, Ticuantepe and Ciudad Sandino The goal of the Strengthen Non-Governmental Capacities • Masaya: Masaya, Catarina and Nindirí. to Face COVID-19 Pandemic in Nicaragua project was to strengthen non-governmental organizations’ (NGOs’) • Matagalpa: Matagalpa and El Tuma-La Dalia capacities to face the COVID-19 pandemic in the country.

Final Report 1 • León: León and La Paz Centro Final report: Throughout the life of the project, between • Chinandega: Chinandega, El Viejo and Chichigalpa July 2020 and March 2021, URC implemented several activities that contributed to reaching the three project’s • Carazo: Jinotepe and San Marcos objectives, which are described in more detail in Section At the end of the nine-month period, URC aimed to 4. Overall, the project completed all its objectives and achieve the following expected results by objective: achieved most, except for one indicator. In several cases, the project exceeded its targets. The project did not 1. Trained key CSOs and private sector leaders on fully accomplish the one indicator because it estimated basic aspects of pandemic management, including that there would be 25,000 consultations, which was networking and coordination (Related to WHO’s Pillar 1) estimated based on the projections of the specialists Objective 1. Strengthen coordination and response who expected a second wave of the virus to produce among CSOs leaders and medical associations many more cases resulting in a larger number of people working on COVID-I9 pandemic response. seeking support. However, the estimates did not behave Target: 100 people trained that way. So, the initial assessment of 25,000 online services was higher than the actual demand. Although 2. Implemented RCCE strategy addressing key gaps of the project did not reach the estimated goal, the project knowledge and participation, including community still contributed to providing a high-quality service, and monitoring and online health counseling (Related to the medical organization in charge of these consultations WHO’s Pillars 2 and 3) notably improved the service. The project helped with this Objective 2. Implement RCCE activities focused on by developing a virtual app, training doctors, streamlining most vulnerable populations the diagnosis process according to WHO standards, and Target: 50,000 people reached with communication improving the registration and monitoring of cases. The and 25,000 with disinfection kits. project also completed the final project systematization 3. Trained CSOs, private sector human resources, report and the gender and COVID-19 analysis. community health leaders, and family caregivers on OBJECTIVE 1. STRENGTHEN IPC and community case management (Related to COORDINATION AND RESPONSE WHO’s Pillars 6 and 7) AMONG CSOS LEADERS AND MEDICAL Objective 3. Train Human Resources for Health (HRH), ASSOCIATIONS WORKING ON from CSOs and private sector, on IPC and community COVID-I9 PANDEMIC RESPONSE ease management Before the project carried out its interventions, the Target: 1,000 HRH trained and receiving medical grade country did not have an established network of CSOs Personal Protective Equipment (PPE) and disinfection kits. to implement coordinated actions. Furthermore,

2 there was little knowledge of the pandemic and WHO Inmunodeficiency Virus (HIV) and COVID-19 forum, and recommendations for formulating action plans against the RCCE strategy validation. Besides, they participated in the pandemic. One of the project’s achievements was the different work sessions where the project and partner developing a directory of 74 national and international CSOs shared their progress. CSOs. A breakdown of the types of organizations can The project also contributed to building local capacities be found in Objective 1, under Section 4, below and and forming a coordination network made up of at least Annex 2. The team presented the project to 39 (of these 40 CSOs. Each CSO worked and coordinated with partner 74) CSOs to find common areas of work and invite them organizations such as Association for Rural Development to participate in the project through sub-grants or the (APRODER), Cáritas Nicaragua, Community Mental Health modality of direct assistance, including the donation Network (COMSALUD), and the Nicasalud Network of disinfection kits and PPE. Fifty-three percent (53%) Federation. The medical associations coordinated efforts of the people who attended the presentation were with 35 specialist associations, including departmental women. During the initial stage of the project, several volunteers. All this to achieve the project’s objectives. organizations’ gaps to formulate emergency projects’ proposals became evident. URC and USAID adapted the OBJECTIVE 2. IMPLEMENT RCCE project to a more flexible direct assistant mechanisms ACTIVITIES FOCUSED ON MOST to support the local organizations’ RCCE activities in VULNERABLE POPULATIONS support of the project. The project implemented an RCCE strategy and activities The project project had estimated to train 100 national according to the WHO, U.S. Center for Disease Control leaders in COVID-19 case coordination, networking, and Prevention (CDC), and the baseline diagnosis and pandemic management, which was exceeded. A recommendations. The project also designed and total of 164 people (164%) were trained, of which 51% implemented RCCE activities with partner CSOs, were women. Fifty-one percent (51%) were national developed the COVID-19 Portal, and delivered disinfection leaders, 49% represented CSOs, 30% FBOs, 8% the kits to vulnerable populations. The project validated the private sector, 4% international organizations, 3% trade RCCE strategy with leaders of ten partner CSOs, and five union organizations, and 6% other organizations such as of them met the requirements to implement their own communication specialists (journalists). The KMVP helped RCCE strategy and activities under direct assistance the project organize meetings more efficiently and helped modality. Likewise, the COVID 19 Portal made information follow up on the commitments made by CSOs. As part of available to the public from official sources such as WHO, the project’s training, national leaders also participated Pan American Health Organization (PAHO), SICA, and in other training events such as “good practices in risk CDC. The portal has eight sections and provides relevant communication and community participation,” Human links to global, regional, and national data. Also, the

3 project created a dashboard, on the Portal, to monitor the OBJECTIVE 3. TRAIN HRH, FROM CSOS progress of RCCE activities implemented by these CSOs. AND PRIVATE SECTOR, ON IPC AND COMMUNITY EASE MANAGEMENT The project aimed to reach 50,000 people with the RCCE strategy and activities, which were superceded with Based on its preliminary research, the project determined the project reach 280,000 people. These results can be that both medical staff and CHWs had not received any verified through sources such as Facebook (154,199), training on COVID-19. The research also indicated they YouTube (83,385), educational materials (30,000), visits had little information on prevention, infection control, to the COVID-19 Portal (5,529), and massive email and case management at the community level. In turn, campaigns (1,887). Of the visits made to the COVID-19 the information they handled was weakly supported Portal, 58% were made by women. The project also by evidence. For this reason, the project designed and successfully reached indigenous and Afro-descendant delivered virtual courses both live and on-demand. populations from six municipalities in their local These courses were aimed at medical staff and CHWs languages. They were reached through radio/TV spots and covered prevention, infection control, and case and posters printed in Miskito and English. For this, the management topics. One of the live courses was project coordinated with nine CSOs, of which two were “COVID-19 and vulnerable populations - basic course”, FBOs (Moravian and Adventist Church), two work with whose general objective was to strengthen the efforts of sexual diversity populations Asociación Movimiento de la CSOs to face COVID-19 in Nicaragua, according to the diversidad Sexua (AMODISEC-RACCN) and Movimiento global response pillars established by the WHO. Other de la Diversidad Sexual (MDS-RACCS), three work live courses were “Communication of risks and basics with (PLHIV) (Future Life, Coastal Campaign Against of the COVID-19 pandemic”, “Community care during AIDS (ACCCS), Thesis), and two work with gender and COVID-19”, and “Update on treatments and news about women’s health issues (COMSALUD and Marijn). COVID-19 vaccines”.

Delivery of disinfection kits: The project delivered According to the live virtual courses’ records, 1,117 people 25,000 disinfection kits nationwide to vulnerable participated from Nicaragua, of which 56% were women populations through 25 CSOs, reaching 65 municipalities and were 44% men. Likewise, the project developed out of 153 existing (42% coverage), and three FBOs on-demand courses, and the records indicate that 325 (CÁRITAS Nicaragua, the Moravian Church, and the people registered, and of these people, 212 completed Adventist Church). Likewise, among the beneficiaries their courses and obtained a certificate of participation are 26 senior homes (approximately 1,300 elderly and (55% women and 45% men). Likewise, the records 170 caregivers), 76 medical dispensaries (about 37,140 indicate that 183 people (52% men, 48% women, and two patients, and 500 frontlines medical staff such as doctors, trans) of the 212 who obtained a certificate were from nurses, and community health workers (CHWs)). Nicaragua. The project also reached 86 municipalities out

4 of 153 existing nationwide (56% coverage) through the Subgrants/Direct Assitance: URC and six CSOs fully virtual campus. executed memorandums of understanding (MOUs) so that CSOs could implement activities, with a total funding The project supported the holding of a Medical Congress, of USD $26,854.82. As part of this, five campaigns were which had high participation and brought together more promoted, reaching 280,000 people through social media than 473 national and international doctors, and of which (Facebook, YouTube), radio, tv-cable, COVID-19 website, more than 50% were women. Additionally, the design of and printed educational materials. virtual applications allowed the project to systematize the information better and reach more users nationally and Progress toward achieving established targets based internationally. Through the online counseling app, the on the Monitoring, Evaluation, and Learning (MEL) Plan: project provided high-quality, real-time counseling and Below provides an overview of the activities implemented improved the quality and scope of the service offered by during the life of the project, which are reflected in Annex 1: Nicaragua Medical Unit (UMN) and CÁRITAS Nicaragua. • Strengthened CSO capacities by training a cumulative Regarding the number of people reached with these 164 national leaders in COVID-19 pandemic virtual apps, the project achieved the following: management and data analysis, achieving 164% of the annual target (100). • Online counseling app: 1,610 people served (65% women). • During this performance period reached 280,000 • Self-diagnosis app: 119 users reached (45% women people through mass media (Facebook, YouTube), and 3% trans). achieving 560%, means that their participation can • Telemedicine app: 236 people helped (56% women). be measured accurately, either through digital media reports (e.g., social networks, Google ads, COVID-19 Delivery of PPE and disinfection kits: The project website, marketing emails, delivery of educational delivered 500 PPEs to UMN, including a package with material) or another means (e.g., campaigns, three N95 masks and one box of 50 surgical masks each. educational materials, radio and TV). The project also provided them with 500 disinfection kits, which included 500 liters of gel alcohol and 500 liters • Since the online health counseling service launch on of 70% liquid alcohol. The project provided Caritas 500 September 16, 1,610 people have used the service. The PPEs, which contained a total of 500 face shields, 220 delay in launching the service, and the dropping of boxes with 50 units of surgical masks each, and 280 sets positive COVID-19 cases in Nicaragua since August with six triple-layer masks each. The project also provided 2020, possibly attributable to the guidance provided them with 500 disinfection kits consisting of 500 liters by CSOs, medical associations, and independent mass of 70% liquid alcohol, 500 liters of 3% chlorine, and 500 media, has influenced the result achieved, which is packages with four-bar soaps. 6.4% compared to the annual target.

5 • Trained a cumulative 669 health workers in COVID-19 case management and IPC, due to the significant participation in the Nicaraguan Medical Association’s (AMN’s) national medical congress, “Realities of COVID-19 in Nicaragua”. Goal of 500, achieving 133%. • Delivered a total of 25,000 disinfection kits acumlative to 25 CSOs, three FBOs (Caritas, the Morava church, and the Adventist church), 76 medical dispensaries, 26 senior nursing homes, and one Nicaraguan medical unit, reaching 65 municipalities from 17 departments of the country. This represents 100% of the total target established. The project delivered 1,000 PPEs and 1,000 disinfection kits to health staff and CHWs during this quarter. The project hired one temporary staffer to receive, organize, distribute, and deliver the kits.

6 INTRODUCTION

URC implemented the USAID/CAR PrevenSida project At the end of the project, URC expected the following: with PEPFAR funding. In June 2020, USAID/Nicaragua • Trained leaders of CSOs, the private sector, medical awarded URC a costed extension to implement the associations trained in fundamental aspects of Strengthen Non-Governmental Capacities to Face pandemic management, networking, and case COVID-19 Pandemic in Nicaragua project, with a total management. budget of $750,000 until March 31, 2021. The Strengthen • Implemented risk communication campaign Non-Governmental Capacities to Face COVID-19 targeted to vulnerable populations, along with online Pandemic in Nicaragua project had three objectives: 1) monitoring and consultation. Strengthen coordination and response among CSOs leaders and medical association working on COVID-I9 • Trained CSO and private sector health personnel in pandemic response; 2) Implement RCCE activities IPC and community case management. focused on most vulnerable populations, and 3) Train This document reports on the activities and progress HRH on IPC and community ease management. The made during the project’s execution, emphasizing project’s technical approach was aligned with five of the activities carried out in the last quarter of the project (Q2). eight WHO-oriented global response pillars.

The project’s beneficiaries were CSOs, medical associations, union organizations, private sector, CHWs, people with disabilities, the elderly, people with chronic diseases, children, women at risk of gender- based violence (GBV), people living with HIV (PLHIV), and transgender people from highly vulnerable communities. The prioritized geographical areas were those departments and municipalities with the highest number of COVID-19 cases reported: Managua: Tipitapa, Ticuantepe and Ciudad Sandino; Masaya: Catarina and Nindirí; Matagalpa and El Tuma-La Dalia; León and La Paz Centro; Chinandega, El Viejo and Chichigalpa; and Carazo: Jinotepe and San Marcos.

7 caption

8 BACKGROUND

COVID-19 WORLDWIDE Many countries have worked to implement comprehensive public health measures, such as On December 31, 2019, health authorities of the city of protection of high-risk populations, rapid identification Wuhan, Hubei province, China, reported 27 cases of of cases, tests, prompt isolation of patients, complete acute respiratory syndrome of unknown cause. The first contact tracing, and quarantine, toward containing infections were associated with a seafood and animal COVID-19 outbreaks below the threshold so that health market, where other types of animals were also sold. systems can avoid excess mortality. According to On January 7, 2020, Chinese authorities reported a new international evidence, one of the most important lessons coronavirus (until then, called 2019-nCoV) identified toward successfully stopping transmission and protecting as a possible cause of these first cases. On January 13, health systems has been the accurate diagnosis of all Thailand’s Ministry of Public Health reported the first COVID-19 cases and the quick and safe isolation and laboratory-confirmed case of the new coronavirus in a treatment of positive cases, depending on the context 61-year-old patient from Wuhan, China. On January 14, and severity of the disease. Japan reported a case of pneumonia with a history of travel to Wuhan, which was laboratory-confirmed for The approach and behavior of the pandemic have been 2019-nCoV. On January 21, the US Disease Control and different in every country. In this sense, in countries Prevention (DCP) reported the continent’s first confirmed with community transmission, generalized physical case. The patient had a history of travel to Wuhan, China. distancing measures and movement restrictions have been introduced at the population level, among other On January 30, the WHO issued the declaration of Public control measures to stop the spread of the disease, and Health Emergency of International Importance (PHEIC) for the have proven to be effective when they have been fully new coronavirus, signifying the presence of an extraordinary complied with. It should be noted that factors such as event that represents an increased risk of spreading a the economic and social impact have been determining new virus to other countries. On February 11, the WHO, in factors in the flexibility of measures for the reopening consultation and collaboration with the World Organization and return to the “new normal”, which have subsequently for Animal Health and the Food and Agriculture Organization caused spikes in the increase in cases or new outbreaks of the United Nations, named the virus COVID-19. On March 11, in some countries. the WHO issued the Declaration of Pandemic for COVID-19.1

1 COVID-19: The WHO Timeline of Actions. Available at: https://www.who.int/es/news-room/detail/27-04-2020-who-timeline---covid-19

9 Based on the COVID-19 Dashboard by the Center for in all cases. Also, over 200 experimental vaccines are Sistems Science and Engineering (CSSE) at Johns Hopkins under development, of which more than 60 are in the University (JHU) shows that over 126 million cases had been clinical phase. As of March 9, 2021, it is reported that over reported since the confirmation of the first COVID-19 case to 300 million doses have been administered in about 100 March 28, 2021. This includes 2,779,114 deaths worldwide.2 countries (0.9% worldwide).4 Although the availability of safe and effective vaccines represents a radical change, Variants of SARS-CoV-2. As PAHO/WHO reported in the people must continue wearing masks, keeping physical publication “Occurrence of SARS-CoV-2 variants in the distance, and avoiding crowds. Being vaccinated does Americas - Preliminary information,”3 the appearance not mean not adhereing to preventive measures and of mutations is a natural and expected event within the risking one’s health and others, especially since we evolution process of viruses. Since the initial genomic still do not know the degree to which vaccines protect characterization of SARS-CoV-2, this virus has been against disease and prevent infection and transmission.5 divided into different genetic groups. Some specific mutations define the viral genetic groups (also called lineages) that are currently circulating globally. With COVID-19 IN THE AMERICAS the information available to date, most of the changes According to the WHO as of March 19, 2021, 12,209,5107 in SARS-CoV-2 have had little or no impact on how it is cases and 2,680,469 deaths have been confirmed in the transmitted or the severity of the disease it causes. Americas.6 Additionally, as of March 10, 2021, the presence of worrisome COVID-19 variants have been reported in COVID-19 vaccines. As of February 18, 2021, at least 31 countries and the Americas’ territories.7 As part of its seven different vaccines have started to be delivered support and technical assistance, the PAHO/WHO has across three platforms, prioritizing vulnerable people issued 29 technical guides8 with essential and specific

2 JHU. Epidemiological update: Coronavirus Disease (COVID-19). March 28, 2021, Washington, D.C .: PAHO/WHO; 2020.Available at: https:// us.marca.com/claro/mas-trending/2021/03/22/6058a6e7ca47415f4b8b4573.html 3 PAHO/WHO. Occurrence of SARS-CoV-2 variants in the Americas. Preliminary information as of January 11, 2021, Washington, D.C. PAHO/ WHO 2021. Available at: https://bit.ly/2LeZBeX 4 BBC News. Vaccines against the coronavirus: what is the situation in your country? Available at: https://www.bbc.com/mundo/noticias-56025727 5 PAHO. COVID-19 vaccines. Available at: https://www.who.int/es/emergencies/diseases/novel-coronavirus-2019/covid-19-vaccines 6 WHO. COVID-19 Dashboard. As of March 19. Available at: https://covid19.who.int/table 7 PAHO. COVID-19 Epidemiological Update. As of March 16, 2021. Available at: https://www.paho.org/en/documents/epidemiological-update- coronavirus-disease-covid-19-11-march-2021 8 PAHO technical documents. As of March 19. Available at: https://www.paho.org/es/documentos-tecnicos-ops-enfermedad-por- coronavirus-covid-19

10 guidelines for planning a comprehensive response to Costa Rica, Nicaragua, Honduras, El Salvador, Guatemala, COVID-19, including the topic of vaccination. On January and Belize, as well as the Dominican Republic that it is also 31, 2021, the PAHO announced the first phase of delivery part of the SICA. Since the first SICA report, when the region of vaccines against COVID-19 in the Americas. These barely counted 73 confirmed cases and one confirmed vaccines will be delivered to 36 countries and territories mortality11, the case numbers have been issued weekly. that participate in the COVAX mechanism. According to On March 15, 2020, with the presence of all the Heads of the PAHO, the region will need to immunize approximately States of the eight SICA nations, the Regional Contingency 500 million people to control the pandemic. The goal is Plan against COVID-19 was approved. According to the to supply vaccines for at least 20% of the population of Presidents of the area, the plan is “oriented to complement each country through the COVAX mechanism to protect national efforts for the prevention, containment, and people at high risk. To achieve this goal, the deliveries treatment of COVID-19”, with five operational axles: Axis began in the second half of February and will continue to 1: Health and Risk Management, Axis 2: Commerce and be made throughout the second quarter of 2021. Likewise, Finance; Axis 3: Security, Justice and Migration, and two the countries that participate in this mechanism started transversal axles made up of Strategic Communication and preparing for the reception, distribution, and administration Management of International Cooperation.12 At present, of these vaccines. As of March 17, 28 million doses of the situation in these countries is highly complex. As of COVID-19 vaccines had been administered to populations March 10, 2021, official information from each country in Latin America and the Caribbean, while almost 138 reports a total of 1,231,908 confirmed cases, 25,229 deaths, million doses had been applied throughout the Americas.9 and 68.86% of recovered persons, with a prevalence of 20.787,65 cases per million inhabitants. Further, according COVID-19 IN CENTRAL AMERICA to official data from the SICA countries, shown below The Central American Integration System (SICA) portal in Table 1, the Dominican Republic reports the highest presents the most concrete and documented source on number of cases (109,735) of confirmed cases, Panama is the COVID-19 pandemic in Central America.10 On March 12, second (107,284), Guatemala third (86,623), Honduras in SICA issued its first report on the pandemic and the state fourth (72,306), Costa Rica in fifth (66,689), El Salvador in of the situation in the Central American region: Panama, sixth (27,954), and Nicaragua in seventh (4,065).13

9 PAHO. The number of deliveries of COVID-19 vaccines through the COVAX Mechanism in Latin America and the Caribbean is growing. Available at: https://www.paho.org/es/noticias/17-3-2021-crece-numero-entregas-vacunas-covid-19-traves-mecanismo-covax-america-latina 11 Report 1 - Central America and the Dominican Republic united against the Coronavirus (COVID-19). Available at: https://www.sica.int/ documentos/informe-1-centroamerica-y-republica-dominicana-unida-contra-el-coronavirus-covid-19_1_121415.html 12 SICA Regional Contingency Plan against Coronavirus. Available at: https://www.sica.int/coronavirus/plan 13 SICA-Portal March 10 2021. Available at: https://www.sica.int/coronavirus/graficas

11 Table 1: Distribution of confirmed cases in the SICA for countries COVID-19 IN NICARAGUA Countries Confirmed cases as of March 10, 2021 A 40-year-old patient with a history of traveling abroad was Honduras 72,306 the first positive COVID-19 case announced in Nicaragua, Costa Rica 66,689 on March 18. On March 20, authorities announced the Belize 1,669 second COVID-19 case, who was a Nicaraguan returning Panamá 107,284 to the country from Colombia, and on March 26, he República Dominicana 109,737 became the first COVID-19-related death in the country. El Salvador 27,954 Guatemala 86,623 Official epidemiological reports on COVID-19 have been Nicaragua 4,065 sporadic from the outset (currently carried out every 7 to 10 days). These reports give general information on Vaccination progress in Central America. In Central the number of patients recovered, active cases, follow- America, the start of vaccination has occurred on different up cases, and deceased patients. However, they do not dates. According to the vaccination plan in Central America offer disaggregated data, such as prevalence, incidence reported by BBC News, Costa Rica was the first country to by sex, age, and territory (departmental and municipal), start administering the vaccine in December 2020, followed which are necessary for planning response interventions. by Panama in January 2021, El Salvador and Guatemala Some CSOs in the medical sector (among them the UMN, in February 2021, and Nicaragua and Honduras in March the AMN, and the Multidisciplinary Scientific Committee 2021. The following table shows the type of vaccine and the (MSC) of Nicaragua14), human rights organizations, and number of doses needed, by country. organizations from the business sector have denounced

Table 2: Progress in the administration of the vaccine against COVID-19 in Central America Countries Vaccination start date # of doses administered Vaccine type and dose Honduras March 1, 2021 2,684 Moderna (2 doses) Costa Rica December 24, 2020 241, 724 Pfizer BioNtech (2 doses) Belize March 1, 2021 7,444 Oxford/AstraZeneca (2 doses) Panamá January 20, 2021 252, 313 Pfizer BioNtech (2 doses) El Salvador February 17, 2021 25,000 Moderna (2 doses) Guatemala February 25, 2021 30, 890 Moderna (2 doses) March 2, 2021 Sputnik V Nicaragua no data March 7, 2021 “Covishield” from India

14 Scientific Committee of Nicaragua demands to act with firmness and transparency in the face of COVID-19. Available at: https://confidencial.com. ni/comite-cientifico-de-nicaragua-demanda-a-ortega-actuar-con-firmeza-y-transparencia-frente-a-covid-19/

12 Table 3: COVID-19 Statistics as of March 3, 2020, according to MOH and Citizen Observatory Accumulated Accumulated Accumulated health Deceased health Source and reported period cases deaths workers workers MOH15 6,537 175 Citizen Observatory (suspected cases)16 13,237 3,002 883 115 the lack of transparency in the management of public (465), Chinandega (402), Rivas (353) and Granada (345). information related to COVID-19, that warns the population As shown in Table 3, together, they accumulate 11,301 cases of the risks of the virus and gives guidance on prevention (86%) and 2,366 deaths (79%). and containment measures. On March 1, 2021, the Government of Nicaragua Due to insufficient epidemiological information, as of announced the arrival of Sputnik V vaccines and the start last April, the COVID-19 Citizen Observatory was formed. of the voluntary COVID-19 vaccination campaign, which This group comprises of an interdisciplinary team that would be aimed at people with kidney failure and who provides information on Nicaragua’s pandemic situation. are registered in dialysis and hemodialysis programs, Community-based organizations and networks provide patients registered in oncology programs, and cardiology the data, becoming an alternative source of information, programs.17 However, the authorities did not provide more including disaggregated data with regular updates. details about the vaccination plan or the population that The table below provides information reported by the would be prioritized with these first doses. Additionally, it is Ministry of Health (MOH) and the Citizen Observatory. unknown whether the program will first immunize health The virus is present in all departments and municipalities care staff responding on the front lines to the COVID-19 of the country, which requires strategic interventions and pandemic. responses aimed at prioritizing the most affected territories. On March 16, the country received 135,000 doses of the According to the latest report from the COVID-19 Citizen Covishield vaccine developed by the Serum Institute of Observatory, as of March 14, 2021, the seven departments India. These vaccines were acquired through the COVAX with the highest incidence of cases and mortality from mechanism and the GAVI Alliance. A total of 432,000 doses COVID-19 are: Managua (4,965), Matagalpa (1,492), Leon are expected to be received in the first half of 2021 through (1,032), Estelí (847), Masaya (763), Madriz (637), Jinotega

15 John Hopkins University of Medicine Coronavirus Resource Center Mach 12, 2021. Available at: https://sites.google.com/pgconocimientovih.org/ centrodeayudacovid/monitoreo 16 Portal Of Citizen Observatory March 06, 2021. Available at: https://observatorioni.org/estadisticas-covid-19-nicaragua/ 17 CNN. The government of Nicaragua announces the start of voluntary vaccination against COVID-19. As of March 17. Available at: https://cnnespanol. cnn.com/2021/03/02/nicaragua-vacunacion-voluntaria-covid-19-orix/

13 the COVAX mechanism.18 According to the Ministry of other factors, such as new variants of the virus, events Health (MINSA), vaccination efforts will be aimed at people supposedly attributable to vaccines (ESAVI: like the cases with chronic diseases, the elderly, and health workers of thrombosis in people who had received the AztraZeneca until it covers 55% of the population, excluding this way a vaccine), and colossal misinformation generated through significant proportion of the community. Situations, such as social networks and media, can undermine the success of the lack of a vaccination plan, agreement among medical the vaccination efforts and the planned coverage. associations, civil society, and private sector, as well as

18 19 Digital. More vaccines are coming. Available at: https://www.el19digital.com/articulos/ver/titulo:113991-llegan-a-nicaragua-mas-vacunas

14 PROGRAM GOALS AND STRATEGIC COMPONENTS

The Strengthen Non-Governmental Capacities to Face - RCCE campaign implemented. COVID-19 Pandemic in Nicaragua project worked in - 50,000 people reached through USAID-supported coordination with CSOs, FBOs, the private sector, and mass media, including social media (disaggregated medical associations to implement interventions toward by channel, sex (where feasible), and age (where achieving its three objectives: feasible) 1. Strengthen coordination and response among - 25,000 online counseling services implemented. CSOs leaders and medical associations working on - 25,000 vulnerable people receiving disinfection kits. COVID-I9 pandemic response. • CSOs and private sector human resources trained on 2. Implement RCCE activities focused on most infection prevention and control and community case vulnerable populations; and management. 3. Train HRH from CSOs and private sector on IPC and - 1,000 health workers trained in C0VID-19 case community ease management. management and IPC (disaggregated by: CSOs, private sector, community health leaders, family PROJECT RESULTS caregivers, and sex) At the end of the nine-month period, URC aimed to - 1,000 health workers who received medical grade achieve the following expected results: PPEs and disinfection kits. • Key CSO, private sector, medical associations, and social leaders trained on basic aspects of pandemic STRATEGIC APPROACH management, including networking and coordination. This project was designed to respond to five of the eight - 100 CSO, private sector, medical association, and WHO-oriented global response pillars, as described below. social leaders trained in COVID-19 case coordination, • Pillar 1: Country level coordination and response networking, and pandemic management. planning: The project provided capacity building • Implemented RCCE strategy addressing key gaps of to address the basic and operational aspects of knowledge and participation, including community pandemic management. The capacity building monitoring and online health counseling. activities included immediate training of technical

15 personnel and use already-available resources, questions; and incorporated technical guides for including WHO online courses. health and community workers on COVID-19 that have Based on its mapping exercise, URC collaborated been developed by international organizations such with CSOs, medical associations, private sector as WHO, CDC, United Nations International Children’s organizations, and FBOs that work with vulnerable Emergency Fund (UNICEF), and the International populations. Also, it encouraged CSOs to document Organization for Migration, among others. The their contributions that help to reduce COVID-19 community engagement approach also included cases in their target geographic areas. At the end social monitoring and auditing through online surveys of the project, URC aimed to have trained 100 CSO and open forums. leaders who participate in the COVID-19 response and • Pillar 3: Surveillance, rapid response teams and preparedness. case investigation: The project supported the CSOs’ • Pillar 2: RCCE: The project developed a RCCE efforts to monitor the pandemic, including the Citizens strategy to tackle the lack of risk communication from Observatory’s activities and community action the Government and ensure that accurate information plans. As mentioned above, the project conducted about COVID-19 is available and accessible to the a mapping exercise of CSOs, medical associations, targeted vulnerable groups. The RCCE strategy private sector organizations, and FBOs that supported messages focused on prevention and self-protection. vulnerable populations. URC also carried out The project worked with media outlets to transmit epidemiological and social studies/analyses that key messages. The project planned RCCE activities provided reliable information to support decision- based on two-way communication, using social media making and response to COVID-19. URC also worked platforms that facilitate interaction with the target with the KMVP experts to design a self-diagnosis audience. This included the development of a virtual application to support identification and treatment of RCCE application for questions and answers and to mild COVID-19 cases. address rumors and myths. • Pillar 6: IPC: The project built the HRH (e.g., CHWs The project also used the Knowledge Management and physicians) capacity of those working at CSOs, Virtual Platform (KMVP) as the validated, available, private sector and community level. We offered virtual and accessible channel to provide real-time, trainings on IPC at health facilities, public spaces, evidence-based information that supported changes and community level. The project also worked with in behaviors toward minimizing the transmission of CHWs to build local capacity of vulnerable families COVID-19. The project also incorporated information, and individuals. We also provided disinfection kits, education and communication (IEC) messages including water and basic sanitation supplies, to the and materials; designed a bank of frequently asked same target populations.

16 • Pillar 7: Case management: Given that mild cases are managed at the community level by family caregivers, supported by CHWs, URC trained CHWs and physicians in how to manage cases at home, including identifying danger signs. The project also offered community surveillance trainings for CHWs and how to use thermometers to identify febrile cases that needed to be referred for evaluation to health networks. The project also developed a virtual application to provide online self-assessment and health counseling. Online counseling was provided by medical professionals specialized in the subject.

17 18 TECHNICAL REPORT: ACTIVITIES BY OBJECTIVES AND RESULTS

At the end of February 28, 2021, URC determine that OBJECTIVE 1. STRENGTHEN the project reached its objectives. In some cases, the COORDINATION AND project’s performance indicators were surpassed, except for one indicator that the project did not wholly achieve. RESPONSE AMONG CSOS As outlined in the indicator table (Annex 1), which is part LEADERS AND MEDICAL of the project’s MEL Plan, URC and USAID confirmed ASSOCIATIONS WORKING ON that the final result were satisfactory. Below provides an COVID-I9 PANDEMIC RESPONSE overview of the indicators’ results: The project proposed the following indicator for this • 164 CSO leaders trained (164%) objective: number of CSOs, private sector, medical • 280,000 people reached through RCCE activities (560%) associations, and union leaders trained in COVID-19 case • 25,000 people helped with disinfection kits (100%) coordination, networking, and pandemic management. • 1,000 health staff and CHWs benefited from PPE and The project trained 164 national leaders (164%) in disinfection kits (100%) COVID-19 case coordination, networking, and pandemic • 1,000 health staff and CHWs trained in COVID-19 management. Before the project carried out its interventions, the country did not have an established As noted above, the project did not acehive one indicator: network of CSOs to implement coordinated actions. • 1,610 online counseling services provided (6.44%) Furthermore, CSOs leaders had little knowledge of the pandemic and the WHO recommendations for The facilitating factors of compliance and the limitations formulating action plans against the pandemic. To for non-compliance are analyzed in the sections achieve this objective, the project developed the that follow by objective. The analysis of each specific following activities, which focused on promoting citizen objective’s results also covers transversal topics, such as participation with a GESI approach. These cross- citizen participation with a focus on gender equity and cutting themes are further analyzed in the project’s social inclusion (GESI), technological innovation, use of systematization report. The project also carried out other information for decision-making, capacity building, and activities that were focused on the use of information for adaptability to change. These cross-cutting themes are improved decision-making. also analyzed in the project’s systematization report.

19 Created a directory of CSOs working with vulnerable and CSOs’ participation in national and local level populations: The project carried out a mapping exercise activities to face the pandemic, among others. The survey to identify CSOs that work with vulnerable populations to also collected information about the types of training, find common work areas, generate a network to promote equipment, and financing needed to support these CSOs the project’s training activities and share experiences and populations to better deal with COVID-19. The survey throughout the project. URC identified 74 national and also was considered as a prerequisite for the CSOs to international CSOs. Twenty-three organizations work be eligible for a subgrant, direct assistance, or direct on health and development issues (twelve belonged donations of disinfection kits. to the Nicasalud Network Federation), fourteen work Exchange of good practices in the implementation with chronic patients (including Lupus Erythematosus of COVID-19 RCCE activities: The project held an Systemic and people with HIV), ten work on gender exchange activity for organizations to share RCCE best issues, seven are international organizations, five work practices and experiences as well as their progress with disabled people, five are scientific associations, five and efforts to contain the COVID-19 pandemic. Activity are organizations that work with transgender people, and participants included representatives from local five are FBOs. organizations (e.g., COMSALUD, APRODER, UMN, AMN, Presented the project to CSOs: URC invited 39 of the Caritas Nicaragua) and international organizations (e.g., 74 CSOs to an introductory meeting to learn about its Intrahealth International (Intrahealth), Pan American objectives and technical approach, as their work aligned Social Marketing Organization (PASMO), Save The with the project. A total of 53 (25 men and 28 women) Children, Interdisciplinary Consulting in Development participated in this meeting. This meeting also provided (CID GALLUP), and World Vision). Representatives the CSOs the opportunity to share their experiences, from the USAID-funded Sustainable HIV Knowledge work, and populations reached in support of responding Management (KM) project also participated. to COVID-19. Through the meeting, the project was able The organizations (national, international, CSOs, FBOs, to find areas for collaboration that could be supported academia) shared that they first learned about the through technical and direct assistances. (Annex 2) population’s needs in relation to COVID-19 to develop Developed and disseminated a needs assessment their RCCE campaigns. They also focused on evidence- survey: URC and USAID conducted a survey on based and up-to-date information aimed at the target COVID-19, which was directed at the vulnerable communities, vulnerable populations, and health staff. populations served by 39 different CSOs. The The communication campaign’s promoted a healthy survey collected information about the populations, lifestyle, the importnance of preventing the transmission communities, and geographic areas served, CSOs’ of the disease, and treatment options and available previous experience in COVID-19 case management, medical care. The campaign also incorporated cross-

20 cutting issues, such as GBV, stigma and discrimination, theme area. Presenters discussed that although Panama and psychological care. The organizations also used has a broad regulatory framework that protects PLHIV’s various communication channels (e.g., television, human rights, there are still discriminatory articles in its radio, social networks, virtual platforms, and print) to legislation. Stigma, discrimination, GBV, and unfair wages position educational messages and help strengthen also persist among the country’s key populations. The the knowledge, attitudes, and practices to prevent and second session consisted of four presentations by CSOs contain the COVID-19 pandemic. The exchance activity from Nicaragua who work with the PASMO-led HIV Care demonstrated the noble effort that these organizations and Treatment and HIV Prevention Services Projects. The made to reach the most vulnerable populations with a topics presented were related to the HIV care continuum, relevant approach. explaining best community practices to contribute to Nicaragua’s HIV care cascade. In this way, the CSOs World AIDS Day Virtual KM Forum: USAID PrevenSida presented how their activities are focused on detecting, project has regularly promoted the exchange of strategic referring, linking, and ensuring adherence to treatment of information and knowledge on HIV/AIDS. On December people living with HIV. 2, 2020, the project co-hosted the annual World AIDS Day forum with USAID implementing partners (e.g., Intrahealth, The third session consisted of seven presentations PASMO, Center for AIDS Education and Prevention related to HIV and COVID-19 KM, with presenters from (CEPRESI), and URC). The objectives of the forum, titled COMSALUD, APRODER, and CARITAS Nicaragua. “Ending the HIV/AIDS Epidemic Through Resilience and The central theme was the use of information and Impact”, was to make visible the impact of community communication technologies (ICTs) for the management actions carried out by various actors in the national HIV of epidemics and pandemics knowledge. In this last response across the Central America region, these key session, participants found that ICTs have played a actions included provision of high-quality prevention and crucial role in how activities are carried out, moving from treatment services, free of stigma and discrimination, and in-person to virtual ways. Activities such as training, empowerment of people through the use of data and monitoring & evaluation (M&E), continuous quality information technology as resources to face the epidemic. improvement, etc., have changed. This has maximized the use of communities of practice and online services Delegates from the different orgnaizations in Central delivery, where very satisfactory results have been America responding to HIV, officials from USAID and the observed. Organizations will continue to learn, innovate, MOHs of Guatemala, Honduras, El Salvador, and Panama, and adapt to this new context. and representatives from implementing partners attended the event. The event was divided into three sessions. Knowledge transfer: To guarantee the continuity, The first session, monitored by CEPRESI, encompassed management, and maintenance of the COVID-19 Portal, presentations in the social determinants of health (SDH) PrevenSida website, and the project’s Facebook page,

21 Figure 1: Websites developed by USAID PrevenSida project in Nicaragua It is important to recognize the importance of working with other civil society organizations, who do meticulous work to reach population groups that we might not be able to reach on our own, such as rural people, women living in remote areas, and people that do not have access to technology (APRODER)—extracted from the systematization report.

Women are the ones who usually mobilize in times of crisis. In the case of COMSALUD, we had active participation from women. The leader and representative of our organization is a woman. During the communication campaign execution, women developed the radio programs, took the pictures, managed the website, and defined the messages’ content. Those who were willing to be on URC and USAID carried out six working sessions to the ground, for example, in Karawala, were women. I think that our project’s focus, transfer the KM to the HIV Sustainable KM project. directed mainly towards women, was correct, The topics covered during these sessions included the and that contributed to the success of this management of the PrevenSida-developed portals and campaign. (Luis Barrera, COMSALUD)— the virtual campus, technical documents, promotional extracted from the systematization report. materials, design of new courses, generation of website statistics (through Google Analytics), payment of the on pandemic management, including the WHO platform, and data management, monitoring, and analysis recommendations for the formulation of national pandemic of the health self-assessment application. management plans, use of networks, and statistical analysis of data from safe sources for decision making. The COVID-19 project systematization report highlights the project’s work in creating local capacities, establishing To support KM, the project also created a network of 40 networks, and promoting technological innovation and diverse CSOs, as shown in Annex 3, which each organization adaptability. It is relevant to mention that the project working with its own networks. For example, the FBO acquired updated and evidence-based knowledge CÁRITAS Nicaragua works with 26 senior homes and 76

22 medical dispensaries. The Nicasalud Network Federation through live and on-demand training courses. Of those is made up of a network of thirteen organizations that work trained, 51% were women and 49% men. on health issues. The medical associations works with 35 Forty-nine percent (49%) represented CSOs, 30% FBOs, specialist associations that have volunteer networks at the 8% the private sector, 4% international organizations, 3% departmental level. The organization of these networks trade union organizations, and 6% other organizations facilitated the execution of the different activities, making it such as communication specialists (journalists). The possible and faster to achieve the project’s objectives. URC training topics included “COVID-19 and vulnerable also worked with USAID to adapt mechanisms and use populations”, “COVID-19 community care”, “Treatment direct assistance modality so that it would be possible for update and COVID-19 vaccines”, and “Training course CSOs to carry out RCCE activities. on COVID-19 for vulnerable populations”, among The project also used ICTs to successfully execute training others. All participating organizations benefited from activities aimed at community and health leaders. The the experiences shared during the training sessions, design of the COVID-19 Portal, the virtual campus, and meetings, virtual classes, and virtual applications. tools, such as Google Meet, facilitated the transfer of knowledge through virtual courses (live and on-demand), OBJECTIVE 2. IMPLEMENT RCCE and virtual discussion rooms. The project also contributed to GESI by training 164 national leaders in COVID-19 case ACTIVITIES FOCUSED ON MOST coordination, networking, and pandemic management, VULNERABLE POPULATIONS To fulfill this objective, the project proposed four Figure 2: Project’s Geographic Coverage indicators, which are presented in Annex 4: • An RCCE campaign implemented and an active RCCE coordination structure for COVID-19 supported through USAID project assistance: The project wholly achieved this goal (100%) • Number of people reached through USAID-supported mass media, including social media, disaggregated by channel, sex (where feasible), and age (where feasible): The project surpassed the goal set for this indicator and achieved 500% compliance. • Number of media outlets participating in the RCCE campaign: The project surpassed this goal and achieved 133% compliance

23 • Number of vulnerable people who received Figure 3: COVID-19 RCCE Strategy disinfection kits: The project reached 100% of the goal set for this indicator.

1. DESIGN, DEVELOP, IMPLEMENT, AND EVALUATE THE RCCE STRATEGY OF THE COVID-19 PROJECT The project developed an RCCE strategy that would allow CSOs to combat the COVID-19 pandemic in Nicaragua in an integrated way. We used available data from studies carried out by organizations such as PASMO, Word Vision, UNICEF, and CID GALLUP to provide strategic information on COVID-19.

The research findings and results are described below19: • The WHO Preparedness and Response Plan for coronavirus disease was unknown.20 • The national COVID-19 response was limited, especially concerning the definition and implementation of informational messages to prevent • The majority of the population knew generalities about and contain the COVID-19 pandemic. the disease. However, information and knowledge • There was little knowledge about the mandatory use of gaps persisted regarding the modes of transmission, masks in public spaces, control measures for physical identifying symptoms, and knowing when to go to the distancing, restriction of activities that involve crowding health facility, among others. and exposure to contagion, quarantine or limitation • Skepticism in the health system and fear of of mobility in territories with a higher incidence of contracting COVID-19 in hospital and health care suspicious cases, promotion of virtual lessons in schools centers caused people to avoid going to their and universities, promotion of working from home, when regular medical check-ups or visit the hospital if they possible, among other prevention measures. suspected they had contracted COVID-19.

19 URC/USAID PrevenSida. Project to strengthen CSOs to face the pandemic. Baseline diagnosis on COVID-19 information and communication gaps in Nicaragua. June 2020. 20 WHO. Preparedness and response plan for coronavirus disease. April 7, 2020. Available at: https://www.paho.org/es/documentos/plan-estrategico- preparacion-respuesta-para-enfermedad-por-coronavirus-2019-covid-19

24 • It was very noticeable the participation of civil society Figure 4: COVID-19 RCCE Campaign Message and the private sector in the national response, with interventions based on social responsibility that keep the population informed about prevention measures, care through online counseling, and virtual campaigns (#StayAtHome) • There was no recent experience regarding donations of disinfection kits for vulnerable populations, especially during a pandemic.

COVID-19 RCCE strategy in Nicaragua: The project developed, implemented, and evaluated an RCCE strategy toward strengthening the COVID-19 response and control The findings and PrevenSida’s experience supported the in Nicaragua by using ICT to disseminate evidence- development an RCCE strategy that would strengthen based information to the community, especially the most the CSOs’ actions and capacities to face the COVID-19 vulnerable people and health staff. The project developed and implement communication interventions aimed the RCCE21 strategy based on the following aspects: at vulnerable populations. The strategy emphasized/ grouped messages according to the disease cycle and • The WHO’s RCCE guidelines for responding to the target audiences. It also made sure messages had a focus pandemic, including actions regarding comprehensive on inclusion, rights, and interculturality. Alongside the health measures, activities for the population, and strategy, the project recommended CSOs to use PAHO’s actions at the community level. Single Overarching Communication Objective (SOCO)22 • Observed findings that highlighted gaps in COVID-19 methodology to focus their messages, communications, knowledge and practices and other cross-cutting and information campaigns on: i) What is the issue?; issues, such as stigma, discrimination, mental health, ii) Why is it necessary to focus on this issue (evidence- and media consumption preferences. based information), and why now?; iii) Who needs to • Needed adaptation based on the varied contexts of change behavior (target audience)?; and iv) What is the the country’s different territories and communities. change that we want to see in our audience as a result of our communication?

21 URC/USAID PrevenSida. COVID-19 RCCE. Technical assistance to incorporate information, education, and communication virtual technologies to implement the COVID-19 project. August 2020.

22 PAHO. Setting Communication Objectives (SOCO). Available at: https://www.who.int/risk-communication/training/Module-D1.pdf?ua=1

25 The project validated the RCCE strategy on August 14, Nicaragua Investiga, Divergentes, Voces en Libertad, and 2020, with 10 CSOs and other key partners, collected Articulo 66). They were trained on the role of journalism to valuable learning. An affirmative factor was the interest help flatten the COVID-19 curve. The team also included for the strategy expressed by our partners and allies, who risk communication concepts in courses with the objective were very actively participated in eight online sessions to of strengthening the response. These courses were share their progress. Each organization that developed attended by 669 health staff, 502 CHWs, and 164 CSO RCCE activities used the document produced by the leaders, including communication specialists. project as a reference. The document helped them design The project also provided technical assistance and their RCCE campaigns based on the disease evolution support to three CSOs in designing their RCCE campaign cycles, SOCO methodology, and the strategic approach proposals, developing script content for the production promoted by URC and the USAID PrevenSida project. of their TV and radio spots, and reporting progress. In the The campaign’s main slogan was “I take care of you, and direct assistance/subgrants section, we will expand on you take care of me!” called for individual and community the campaign’s results obtained by CSOs. solidarity. The campaign’s key messages were handwashing, maintaining physical distance, and the 2. COVID-19 PORTAL/WEBSITE use of masks. Four CSOs (APRODER, Cáritas Nicaragua, Based on the research findings, URC and USAID COMSALUD, and the Medical Association) developed determined that Nicaragua did not have an official their campaigns with the help of URC. They received mechanism to share critical information with the general technical assistance for the formulation of their proposals public, health professionals, and CSOs. The project and monitoring of their activities and results. This developed the COVID-19 portal to address this need for experience that yielded great results and strengthened available evidence-based information, with secure links the project’s support network. to reliable sources including regional and international organizations, universities, among others.23 The COVID-19 To further strengthen knowledge about COVID-19 and portal functions as the central platform for implementing implementing RCCE activities, the project also conducted the RCCE strategy and provides accurate and evidence- a series of virtual courses, including the trained of 50 based information and communications. journalists from 16 different media outlets. The media represented by type were: radio (Onda, Darío, Voice, The COVID-19 portal is a domain hosted on the HIV Notimax, Estero Romance, Corporación); press (La KMVP and is structured into eight sections. The first Prensa); television (Channel 10, Noticias de Bluefields, section (home) contains information from PAHO/WHO Notimatv, Telenorte); and virtual platforms (100% Noticias, and John Hopkins University on pandemic monitoring at

23 COVID-19 portal/website: https://sites.google.com/pgconocimientovih.org/centrodeayudacovid/inicio

26 the global, regional, and national levels. This information • Age: 38% of those who visited the portal were is updated automatically. The second section includes between 25 and 44 years old, followed by people over COVID-19 courses developed by the project and hosted 55 (28%), people between 18 and 24 (18%), and people in the KMVP. A third section contains the health self- between 45 and 54 (16%). assessment. Another section provides links to relevant • Devices they use to visit the COVID-19 portal: 70.6% sites and national health care services. The fifth section visited the portal through their mobile, 28.5% through includes a bank of more than 300 COVID-19 frequently their computer, and 0.9% through their tablet. asked questions, organized according to the evolution • Origin of the visitors: 68% were from Nicaragua, and cycle of the disease. Another section includes links to 32% were from Europe, the Americas, Africa, and Asia. international recommendations, technical guidelines, material kits for the media, and scientific studies from 3. DONATION OF DISINFECTION KITS prestigious international organizations and universities. FOR VULNERABLE POPULATIONS Also, the CSOs used this material to implement their COVID-19 RCCE campaigns in Nicaragua. At the beginning of the project, URC conducted a rapid needs survey to learn the status of the 39 CSOs in Monitoring of the COVID-19 Portal Dashboard: URC terms of training, equipment, and financing required included the COVID-19 portal in the PrevenSida website to implement RCCE campaigns and understand their to facilitate users’ access to updated information on experience working on COVID-19. Survey results showed COVID-19. The project created and placed a banner on that most of the population the CSOs serve are vulnerable 24 the PrevenSida website to promote the COVID-19 portal. people with chronic diseases, disabilities, and women Statistics of COVID-19 Portal Nicaragua (google.com). suffering violence. The results also showed that these URC developed the dashboard to monitor the use of organizations did not have the financial resources the COVID-19 Portal. Since its launch on September 4, to acquire and distribute kits to these vulnerable 2020 to March 21, 2021, the page was visited 7,305 times, populations. received 2,333 unique users, and served 4,261 sessions. The average number of pages consulted per session was Based on the analysis of the epidemiological information 1.71.25 (Annex 5) Below are additional statistics regarding from the Citizen Observatory, the survey results, and the those who visited the portal. demands expressed by the CSOs, the project planned the distribution of the donations. Given the decision to shift • Sex: 61% of those who visited the portal were women from grants to direct assistance, the project procured and 39% were men. kit materials from the best available suppliers, which

24 PrevenSida website. http://www.prevensida.org.ni 25 COVID-19 portal statistics. https://datastudio.google.com/reporting/a16bacee-2ff6-4110-bdd1-ffb937e5bee8/page/9h3iB

27 consisted of one liter of 70% alcohol, one liter of 3% Table 4: Disinfection Kit Distribution by Organization Type chlorine, one set of three triple-layer masks, and a four- Organization type Quantities pack of bar soaps. Each kit also contained educational People with chronic diseases (8) 1,851 materials on the correct use of masks and alcohol and Transgender people (5) 769 chlorine to disinfect surfaces. The project also procured Sexual diversity (4) 500 transportation and storage of the kits, and temporarily Gender, development, and health (4) 1,510 hired a logistics specialist to support packaging and Medical Unit (1) 1,000 distribution of the kits. As part of this effort, the project FBOs (3): 26 senior nursing homes and 76 medical 19,370 oversaw the warehouse’s operations (stocking, exits/ dispensaries entries, hygiene measures, etc.). The project supervised Total quantities distributed 25,000 the work to ensure compliance with established rules, adequate inventory control, shipping, and other and 75% of the beneficiaries are women, and for CSOs security measures, such as the use of delivery minutes that work on gender and violence issues, 100% of their with information for verification (name and telephone beneficiaries are women. The project actively promoted number of the people who received the shipment). This the inclusion of CSOs from the North and South adjustment in the modality (direct assistance) caused Caribbean Coasts, Miskito communities, and Creoles. the process to be a little slower, but as time plassed Catholic, Adventist, and Moravian populations also efficiencies were found and the processed became faster. received kits (Table 4).

The project delivered 25,000 disinfection kits to Lessons learned. URC and USAID PrevenSida vulnerable populations nationwide, through 25 CSOs, expected CSOs to receive grants to carry out the project and three FBOs (CÁRITAS Nicaragua, Iglesia Morava, and activities and purchase and distribute the disinfection Iglesia Adventista), reaching 65 municipalities from 153 kits. However, upon submission of their technical and to national level (42% coverage). The CSOs’ authorities financial proposal package, it became clear that the and leaders received and delivered the kits to the CSOs who had applied developed their proposals with beneficiary populations. Approximately 70% of the kits a developmental rather than an emergency approach. were given to women from vulnerable populations. Of To address this challenge, URC worked with USAID to the CSOs that work with people with chronic diseases, adapt URC’s execution mechanisms and switched to a between 50% and 70% of their benefited population are direct assistance modality. This modality meant that the women. One CSO reported that 25% of the beneficiaries project would oversee the entire purchasing, storage, were transgender, and the CSOs who work directly with and distribution process, which led the project to hire a transgender people said that 70% of the beneficiaries person responsible for logistics and procure warehouse were transgender women. Of the FBOs, between 65% space to store the disinfection kits.

28 This experience required flexibility in procedures and effort of solidarity with the most vulnerable populations. effective coordination with CSOs to ensure timely delivery The project’s systematization report highlights of the kits. This was only possible with the support of the the transversal themes of this objective, which are 25 CSOs, three FBOs, and medical association. Because summarized below: it was an emergency, the kits’ donations represented an

Table 5: Summary of Transversal Themes According to Systematization Report Transversal Theme RCEE Strategy COVID-19 Portal/Website Disinfection Kit Delivery Citizen Participation Integration of a network at the Interactivity platform with the Kits’ planning and distribution model with GESI Approach community level. population. required strong citizen participation, Fifteen (15) departments of the A one-way communication tool. achieving an equitable distribution based on available data. country were reached. Use of virtual meeting rooms APRODER implemented an RCCE through Google Meets The CSOs’ authorities and leaders participated in receiving and strategy with 30 CSOs and women’s In terms of GESI, the portal has a groups. delivering the kits to the beneficiary geographical scope. It is innocuous. populations. Caritas strengthened its network Allows learning and sharing with the media, dispensaries and Most of people who received kits homes for the elderly. Access to vulnerable populations were women. such as Trans and PLHIV. COMSALUD developed a campaign There was no exclusion. CSOs aimed at women from the South working with PLHIV, transgender Caribbean Coast people, gender issues, health, and development were included. Fifty-five percent (55%) of participants in risk communication At national level, 65 municipalities training sessions were women. out of 153 were served, including Miskito and Creole areas. Inclusion of indigenous and Afro-descendant populations, FBOs, transgender people, PLHIV. Educational materials, radio spots, and television spots were produced in Creole and Miskito.

29 Transversal Theme RCEE Strategy COVID-19 Portal/Website Disinfection Kit Delivery Networking A network made up of 40 CSOs, Collaborative work and sharing Kits were delivered through PASMO, CCN, Save the Children, and experiences were vital. authorities and CSO leaders. Intrahealth. Access to evidence-based They shared information, such as Technical support and monitoring of information. technical reports, photographs taken RCCE strategy by the project. Exchange of experiences. by the leaders making the deliveries. Monitoring and evaluation of Visits and follow-up with some indicators dashboard beneficiaries to verify the proper use of the kits. Technological Use of ICTs are a cost-effective COVID-19 portal. Monitoring through the RCCE Innovation option for future projects. Incorporation of new courses in the dashboard allowed tracking the The COVID-19 Portal, virtual platform virtual campus. planning and delivery of disinfection kits and PPE. effectively used to hold meetings, Development of kits with educational exchange experiences, presentation materials according to the evolution of results, and training. cycle of the disease. The RCCE campaign used social networks, text messaging (SMS), WhastApp, Telegram, WeChat, among others. Promote bi-directional communication through interactions with the public on social networks and radio programs Fourteen (14) radio stations and two (2) TV channels.26

26 Radio Manantial, Radio Centro, Radio Camoapa, Radio La Costeñisima, Radio Unica, Radio La Siempre Joven, Radio ABC, Radio Family, Radio San José, Radio Sky, Radio Camoapa, Radio Centro, Radio La Costeñisima, Radio Magnificat, Radio Corporación , Radio Stereo Romance, Sports Capsules, Radio Corporación) reaching more than 2,800,000 people. (Canal Católico Nicaragua, San José and Sr. de los Milagros de Estelí) and local cable (Cable/TV: NOTIMAT, Telenorte) with an estimated 301,250 users reached, according to rating studies by these media. The campaign on Facebook had 155,000 likes and on YouTube 88,385 views.

30 Transversal Theme RCEE Strategy COVID-19 Portal/Website Disinfection Kit Delivery Use of Strategic Diagnosis based on 26 investigations The portal is a means to help users in The epidemiological data were Information for from secondary sources. their search for information. used to guide a more equitable Decision Making Strategic guidelines and More than 400 educational distribution of the kits. The kits were recommendations made by messages were organized according sent where they were most needed. international organizations such as to the evolution cycle of the disease. WHO and CDC. Mapping of CSOs. COVID-19 Needs Survey. COVID-19 Portal. Monitoring and evaluation of indicators dashboard Capacity Building A condition for the excellent Access to new knowledge, live and Each kit accompanied by performance of the project and the on-demand, through documents, educational material with critical sustainability of CSOs actions. studies, research, and courses. recommendations for the correct Training through a series of virtual use of the mask and chlorine to courses both live and on-demand. disinfect household surfaces. Adaptability Flexibility to provide direct Sharing experiences through The assistance model was adjusted assistance instead of sub-grants. a mobile, tablet or computer from grants to direct execution, Development of kits with 20 pieces strengthened inclusion and allowing compliance with the of educational materials during the stimulated the participation of distribution schedule, focusing on emergency caused by IOTA and ETA transgender people. preparing for the second wave of the hurricanes. Resilience necessary for CSOs pandemic. Use of radio in communities with and the vulnerable population to little or no internet access. continue with their work dynamics. Printed materials in Creole or Miskito.

31 OBJECTIVE 3. TRAIN HRH FROM Each intervention carried out to comply with these CSOS AND PRIVATE SECTOR indicators is detailed below. ON IPC AND COMMUNITY EASE 1. LIVE TRAINING ON COVID-19 MANAGEMENT When the COVID-19 pandemic was declared, URC Based on the research results and the needs survey, and PrevenSida staff began to work from home, and described above, that facility and CHWs needed training implemented courses and other aspects of this project on COVID-19. The information they knew about COVID-19 virtually. In June 2020, the project carried out the first two prevention, infection control, and community case virtual events, which were the COVID-19 training course management was very general. The project designed for vulnerable populations and the essential guidance on a set of activities to address this need. To fulfill this COVID-19 course for journalists. objective, the project also proposed indicators: The project developed a totale of 17 online training events, • Number of health workers trained in COVID-19 case sessions to share good practices, virtual forum, and management and IPC: The project surpassed the goal research evaluations, as shown below in Table 6. A total of of 500 and trained 669 people (134%) 1,837 people (55% women and 45% men) registered for • Number of CHW trained: The project surpassed the these events and 1,684 people participated (55.5% women, goal was 500 and trained 502 people 44% men, and 0.5% transgender women). The participants • Number of health workers/CHWs who received came from Nicaragua and other countries, as shown in medical grade PPEs and disinfection kits: The project Annex 6. From Nicaragua alone, a total of 1,607 people reached the goal of 1,000 (100%) participated in the 17 events. Of these, 701 (44%) were male, 877 (55%) female, and 29 (2%) were transgender. Of the 17 • Number of online health counseling services events, the following stand out: three events were aimed at implemented: The project only reached 1,610 people, religious leaders through the training course on COVID-19 which is 6% of the goal of 25,000.

Figure 6: Online Courses

32 for vulnerable populations. A training event was directed to a need for the press to provide secure and evidence- CSO leaders working on HIV through the COVID-19 course based information. Fifty (50) journalists attended, 49 of and vulnerable populations. whom were from Nicaragua and represented 16 radio, print, and television media.27 The project held a workshop for journalists to address essential guidance on COVID-19. Most of the journalists The medical congress held by the AMN named “Realities were from independent media and were convoked in the face of COVID-19” aimed to update health staff in by the Violeta Barrios de Chamorro Foundation. The the management of COVID-19 across different medical Foundation extended a special invitation, as there was specialties, in addition to highlighting the role of doctors

Table 6: Online Trainings Sex Topic Men Women Trans Total 1. COVID-19 and vulnerable populations course, aimed at OSCs leaders 54 66 6 126 2. COVID-19 and vulnerable populations course, aimed at journalists 23 26 0 49 3. COVID-19 and vulnerable populations course, aimed at religious leaders (Caritas Nacional) 61 76 8 145 4. COVID-19 and vulnerable populations course, aimed at religious leaders (Caritas Nacional) 63 90 0 153 5. RCCE Strategy validation 11 12 0 23 6. Online counseling app validation 2 7 0 9 7. COVID-19 and vulnerable populations course, aimed at religious leaders (Caritas Nacional) 37 69 0 106 8. Online counseling app training 6 13 0 19 9. COVID 19 project and RCCE Strategy aimed at national leaders 81 83 0 164 10. Data Quality and Rapid Improvement Cycle 4 9 0 13 11. Medical Congress: COVID-19 and other health problems (doctors) 220 253 0 473 12. Congress: COVID-19 and other health problems (community) 8 23 0 31 13. Exchange of successful RCCE practices 12 9 0 21 14. KM component 10 15 4 29 15. HIV and COVID-19 KM Forum 35 36 4 75 16. COVID-19 Vaccine and Treatment Update 52 54 0 106 17. COVID-19 project closing 22 36 7 65 Total 701 877 29 1,607

27 Media that attended: Radio (Onda, Darío, Voz, Notimax, Estero Romance, Corporación), written press (La Prensa), television (Canal 10, Noticias de Bluefields, Notimatv, Telenorte), virtual platforms (100% Noticias, Nicaragua Investiga, Divergentes, Voces en Libertad y Artículo 66).

33 and thus contributing to the prevention, control of infections, National leaders. URC’s goal was to train 100 national and case management at the community level. More than leaders in pandemic management, strategies, and 500 doctors and CHWs participated in this event. The analysis of statistics on COVID-19. Through different participants from the national territory were 473 doctors. events, the project trained 164 national leaders (51% women and 49% men), achieving 164% compliance. The project also held a session on treatment and updates of the new COVID-19 vaccine. The objective was to Health workers. URC was committed to training 500 provide updated information on the COVID-19 vaccines health workers in prevention, infection control, and case authorized in Nicaragua, emphasizing the mechanism of management at the community level. The project trained action, adverse effects, contraindications, and updating 669 people (55% women and 45% men), achieving 134% key elements such as epidemiology, clinical, prevention, compliance. and treatment of COVID-19. These courses were updated CHWs. URC’s goal was to train 500 CHWs. The project with information based on evidence received in real-time, trained 502 people (56% women and 44% men) through such as a transmission mechanism, treatment based on different events carried out, achieving 100% compliance. evidence, and finally, the new COVID-19 vaccines, despite no batch of vaccines had yet been received in the country COVID-19 on-demand courses:28 Through the KMVP, at that time. The project held other events, such as: HIV/ URC and USAID PrevenSida designed and hosted more COVID-19 KM Forum, validation of virtual applications, and than eleven on-demand courses on HIV, human rights, RCCE strategy, among other activities. Annex 7 provides stigma and discrimination, gender-based violence, an overview of the types of people trained in pandemic gender, administration/finance, among others. Since the management, IPC, and community case management. COVID-19 project began, it has offered three courses Figure 7: On-Demand Courses

28 Virtual Campus. Available at: https://chsglobal-my.sharepoint.com/personal/nic_file_admin_urc-chs_com/Documents/Documents/ Yudy%20Carla%20Wong%20B/2020/Informe%20aprobados%20por%20Dra.%20Corriols/DEC%20de%20USAID/Plataforma%20 Virtual%20de%20Gestión%20de%20Conocimiento%20en%20VIH%20at%20https:/apps.pgconocimientovih.org/documentos/galerias/no- bajar-la-guardia-ante-el-covid-19/postal-red-social/

34 through the virtual platform, the first course COVID-19 communication and general community health actions and Vulnerable Populations: Basic Course, discusses against the COVID-19 module. The course lasts 2.57 hours. the essential elements to strengthen care measures The third course, “COVID-19 Vaccine and Treatment Update,” and the challenges faced by CHWs in mobilizing their has three modules. Module 1 covers the current status of communiting and promoting prevention measures, the COVID-19 vaccine. Module 2 is about epidemiology behavior changes, and caring for patients at home in the and clinic, and module 3 provides updates on available face of COVID-19. The 3.5-hour video course includes treatment. This course lasts 2.43 hours and was launched in recommended optional supplementary reading, which the second week of March through a mass mail campaign can be downloaded along with presentations. (mailjet). This course aims to provide updated information on the vaccines authorized in Nicaragua to face the COVID-19 The course has two modules. The first module contains pandemic, emphasizing the mechanisms of action, adverse the following topics: a) definition of community health effects, and contraindications. Also, it aims to share key care, b) specific actions in the face of COVID-19, elements about treatment, highlighting evidence on the c) general community health actions, d) risk epidemiology, clinic, prevention, and treatment of COVID-19. communication, and e) reference self-study material. As of March 14, 37 people have registered (23 women, 14 The second module contains the following topics: a) men), of which 25 are from Nicaragua (18 women, 7 men), communication and general community health actions, and of these, nine women have completed the course. In b) barriers and facilitators of communication between total, 212 people have registered (55% women, 45% men) CHWs and patients with COVID-19, c) patient behavior for the courses, of which 183 are from Nicaragua (41% men, change, d) recommendations to organize the community, 56% women, 3% trans), as shown in Table 7 and in Annex 8. e) key messages to prioritize on prevention measures, and f) patient management in the face of COVID-19. The project’s systematization report highlights the transversal themes of this objective, which are described The second course, “COVID-19 Community Care,” has in Table 8. two modules: The community care module and the

Table 7: On-Demand Courses Participants Activity Men Women Trans Total COVID-19 vulnerable populations 3 5 0 8 COVID-19 Community Care 5 9 0 14 Curso COVID-19 y poblaciones vulnerables, (asincrónico) 68 79 5 152 COVID-19 Vaccine and Treatment Update 0 9 0 9 Total 76 102 5 183

35 Table 8: Summary of Transversal Themes According to Systematization Report

Transversal theme Live training and asynchronous courses Citizen Use of the KMVP and implementation of live courses aimed at health workers and CHWs allowed broad participation at national level. Participation with People from 86 municipalities (out of 153) participated, for a coverage of 56%. GESI Approach Project had a database with over 1,837 CSO contacts. From Nicaragua, a total of 1,607 participated in the 17 events held. Of these, 701 were men (44%), 877 women (55%), and 29 (2%) were transgender people. On-demand courses registered participation of 325 people, of which 212 have obtained their certificate (55% women and 45% men). Of these, 183 are from Nicaragua (52% men, 48% women, and 2 trans). Participation in the Medical Congress was excellent, bringing together more than 473 national doctors, of which more than 50% were women. The topics that received more attention were pregnant women with COVID-19 and the impact of COVID-19 on the late diagnosis of breast lesions. Technological Through the COVID-19 Portal and the virtual campus, the project trained health staff and CHWs through six live courses. The live virtual Innovation course modality yielded good results and was a valuable tool to access and disseminate knowledge. Virtual campus allowed these training courses to be accessible beyond the national level and reach people from other countries in America and Europe. Different meeting rooms were created through the virtual campus, which facilitated discussion and decision-making for the participating teams. Despite internet access difficulties faced by many leaders, people from remote municipalities with limited internet access participated. Of the 153 municipalities, people from 86 municipalities were represented, achieving coverage of 56%. Project supported the medical congress’s holding, and due to the pandemic, the event was held 100% virtually and in real-time. Use of Strategic Information obtained through the virtual campus statistics made it possible to have a record of the health staff and CHWs registered and Information for participating in training events. Decision Making Also, it was possible to know other demographic information of participants, such as sex, type of organization, and geographic location. Information was helpful during the planning of new courses, which made it possible to apply new approaches, reorient the form of admission, as well as follow up on students who, for some reason, failed to obtain their certificate. Security was guaranteed at all times during the login/sign-up process of the participants. Capacity Building Courses were focused on strengthening the efforts of doctors and CHWs to face COVID-19 in Nicaragua. Focus was to influence infection prevention and case management at the community level, identify danger signs, and timely referral to the closest health units. Allowed CSO leaders and senior caregivers to improve their knowledge around COVID-19, self-care of people, especially people with chronic diseases and other health problems, and the follow-up of referred cases to avoid complications. Users’ credibility and trust towards the doctors and CHWs were essential to position the prevention measures such as the use of masks, alcohol for surface cleaning, physical distancing, hand hygiene, isolation, or quarantine when necessary. Adaptability Adaptation of medical health staff and CHWs to new technologies was a factor that contributed to the success of the live and on-demand courses. Use of platforms, such as Teachable within the virtual campus and Google Meet for the live courses, was accessible and practical. Municipalities such as El Tortuguero, Bluefields, Bilwi, and el Almendro could receive training through these modalities. Otherwise, it would not have been possible to have coverage at the national level. It is important to highlight the Prevensida team’s ability to adapt the courses and materials according to the new content (scientific, technological, advances in treatment, and vaccines). A unique platform aimed at health staff, CHWs, and other diverse public served by CSOs facilitated participation.

36 2. DISTRIBUTION OF DISINFECTION with six triple-layer masks each. The project also provided KITS AND PPES them with 500 disinfection kits consisting of 500 liters of 70% liquid alcohol, 500 liters of 3% chlorine, and 500 As noted above in Objective 2, the project conducted a packages with four-bar soaps. rapid needs survey to learn the status of CSOs in terms of training, equipment, and financing required to implement 3. DESIGN AND IMPLEMENTATION OF RCCE campaigns and understand their experience OF ONLINE APPLICATIONS working on COVID-19. Based on the analysis of the epidemiological information from the Citizen Observatory, The COVID-19 project included within its indicators the the results of the surveys, and the demands expressed development of an online health-counseling application by the CSOs, the project planned the kit distribution, as to be used by medical staff who provide care to a described above. Subsequently, the project procured the population vulnerable to COVID-19. Also, the project inputs from the best available suppliers. considered an online health self-assessment application to be available to the whole population. Likewise, the In additoin to work with the CSOs described above, the project supported the development of a telemedicine proejct worked with UMN, which is a medical movement application to be implemented by the health staff of organized after April 2018 that is currently in charge of Cáritas Nicaragua. Each application is detailed below: the online health counseling service described below. UMN provided direct assistance to people affected by Telehealth counseling application: URC, in alliance with Hurricanes ETA and IOTA and the COVID-19 pandemic. UMN, developed the health counseling app to address the The project delivered 500 PPE kits to UMN, including population’s vulnerability, their fear of being infected with a package with three N95 masks and one box of 50 COVID-19 when visiting health units, and their fear of being surgical masks each. The project also provided them discriminated against or stigmatized in the presence of the with 500 disinfection kits, which included 500 liters of gel disease. UMN was already providing health counseling alcohol and 500 liters of 70% liquid alcohol. services through four numbers and with the assistance of four doctors who took shifts every four days. During The project also support Caritas Nicaragua, which is a the months of June and July 2020, they provided 5,712 FBO with 76 medical dispensaries and 26 senior nursing consultations between calls and texts. Based on this homes nationwide. The project provided Caritas 500 experience, UMN wrote a scientific article on COVID-19 in PPE kits, which contained a total of 500 face shields, 220 Nicaragua, which was supported by URC and published in boxes with 50 units of surgical masks each, and 280 sets the Journal of Virology Research & Report.29

29 Journal of Virology Research and Report. Medical Advice Through Mobil Phone During the COVID-19 Pandemia, June - July 2020 at Nicaragua. Available at: https://www.onlinescientificresearch.com/articles/medical-advice-through-mobil-phone-during-the-covid19- pandemia-june--july-2020-at-nicaragua.pdf

37 How did the telehealth counseling app work?: Through Figure 8: Self-Health Assessment App a free service via WhatsApp, people who needed information or counseling about COVID-19 were connected to a doctor. A team of ten medical advisers was available. A form was created to standardize the care and diagnosis of users. The form also helped to improve the quality of service provided and relieved the workload of the medical staff so that they could dedicate more time to medical consultations. The prototype of the application contained two sections: • Agent’s section: This section was managed by three agents who received the call, filled out the initial data, and transferred the call to the available doctors. As of February 28, 2021, 1,610 consultations had been • Counseling doctor’s section: This section was provided, of which 65% were for women and 35% for managed by the doctor who provided the counseling. men. Of the people helped, 973 were through phone It collected the patient’s medical history and then calls and 637 through text messages. Most of the calls classified it according to the signs, symptoms, and correspond to people over 30 years of age (1,112 cases). epidemiological antecedents as suspected case, According to the origin, the majority of the consultations probable case, or confirmed case. Afterward, the were made from Managua (69%), followed by Masaya doctor guided the patients in the next steps. (5%), Matagalpa (5%), León (4%), Carazo (4%), Estelí Throughout the implementation process, URC provided (2%), Granada ( 2%), and other departments (2%). The individualized support to each doctor, and particularly app also received 120 cases from other Central American during the beginning of the implementation of the service, countries and the United States, as show in (Annex 9). the project emphasized the quality of the information Sustainability of the telehealth counseling collected and the classification of cases appropriately application: URC facilitated a work session to transfer according to the definition of PAHO/WHO. The project skills and knowledge to UMN authorities on the also participated in weekly meetings to analyze the data app’s administration, databases, and the generation that were being obtained. Call center staff and managers, of statistics. The UMN will continue to promote the medical advisers, and UMN authorities also participated application with the voluntary support of one or two in these sessions. doctors and will seek funds to continue providing the service for at least five more months.

38 Implementation of the Self-Health assessment app portal to continue being informed. If the case is classified (Community Survey): URC also developed the self-health as related to COVID-19, the application automatically assessment app (COVID-19 Community Survey).30 This suggests the user seek medical help, either through their instrument helps its users identify symptoms related to doctor or by calling the online health counseling service’s COVID-19 and classify cases as suspicious, probable, or free line. If the person suffers from chronic illness, the confirmed. Also, it helps them determine if they are part of application suggests seeking urgent medical attention. a high-risk group, either due to their lifestyle or their current Below is aggregated data from the Self-Diagnosis Survey. health condition. The online form has a disclaimer that According to the information shown on the dashboard, indicates that the application’s information is illustrative and the survey has been filled out 132 times. Below are some does not replace medical consultation with a specialist at highlights: any time. Likewise, it lets users know that when they start the survey, they accept the application’s terms and conditions. • Sex of respondents: 61 (46%) were women, 67 (51%) men, and four (3%) were classified as transgender. The form contains the following sections: a) • Country of origin: 91 (69%) were from Nicaragua, 17 sociodemographic data; b) current clinical picture (last 14 (13%) from El Salvador, nine from Honduras (7%), nine days); c) data on exposure to the virus in the previous 14 from Guatemala (7%), four from Panama (3%), and two days before experiencing symptoms; and d) risk factors. from other countries (1.5%). This application was validated by the team of doctors who provide care through the online health counseling service. Nicaragua Statistics: The project also considered their recommendations • Sex of respondents: 47 (52%) were women, 40 (44%) during the development of the tool. The project also used men, and four (4%) were classified as transgender. an algorithm links to the latest versions of suspected, probable, and confirmed cases established by the WHO on • Age: 50 (55%) between 18 and 40 years old, 39 (43%) case classification for COVID-19 surveillance. 41 to 60 and 2 (2%) more than 60. • Occupation: 56 professionals, 12 TSC, 11 unemployed, 6 When the user finishes filling out the form and housewife and 4 students. depending on their case classification, the tool provides recommendations. For example, suppose the tool • Symptoms: 43 (47%) people were classified as classifies the case as non-suspicious. In this case, it asymptomatic, and 48 (53%) were related to gives general advice and measures to avoid contagions, COVID-19. Of these, 16 (33%) were classified as a such as the use of masks, physical distancing, frequent suspected case and 32 (67%) as a probable case and hand washing, and constant checking of the COVID-19 0% confirmed cases.

30 The application link is the following: https://apps.pgconocimientovih.org/encuesta/dash-autodiagnostico/

39 • Municipality of origin of the cases classified as • COVID-19 virtual campus: This section shows the data suspected cases: 16 suspected cases ( 4 Chinandega, obtained about the courses that have been stored in the 2 Granada, 2 Managua, 1 Dolores, 1 Estelí, 1 León, 1 virtual campus. Users can take the course at any time, Jalapa, 1 Matagalpa, 1 Nindirí, 1 Siuna and 1 Ticuantepe). and upon completion, they can take a knowledge test to Of the 32 probable cases (12 Managua, 4 Granada, obtain a certificate of approval. To pass the course, the 2 Chinandega, 2 Dolores, 2 León, 2 Bilwi, 2 San person must satisfactorily answer 80% of the questions. Fernando, 2 San Rafael del Sur, 1 Ciudad Sandino, 1 This section’s statistics are the number of people Nindirí, 1 Jinotega, 1 Ticuantepe). registered, the number of people with a certificate of approval, gender, and participants’ location on the map. Sustainability of the health self-assessment application. URC facilitated a work session to transfer skills • Online counseling: The dashboard also records the and knowledge to USAID authorities on the app’s counseling data provided by physicians. These are broken administration, databases, and the generation of down as follows: the number of counseling performed by statistics. Also, URC sent a mass email to more than 1,500 text message and per call, the reason for the counseling, people to promote the use of the application. type of condition broken down by COVID-19 symptoms mild, moderate and other health problems, number of Implementation of the project indicators dashboard: calls by the department, and age. The goal was to reach The project designed a dashboard to monitor indicators, 25,000 people with online counseling. which is one of the sections (apps) continually updated with • RCCE strategy: Through technical and direct new data and with redesigned graphics. This dashboard assistance, the strategies at the local level will include shows the status of the following items: 1) training conducted a certain number of people to be reached. The goal live, 2) pre-recorded courses, 3) online health counseling was to reach 50,000 people through messaging via services, 4) monitoring of indicators of RCCE activities, 5) local media, which will be disaggregated by sex. delivery of disinfection kits and PPE, and 6) maps of the countries and municipalities of Nicaragua reached. • Delivery of disinfection kits and PPE: The project’s goal was to deliver 25,000 disinfection kits to vulnerable • Live conferences: For each event held online, populations; 1000 PPE and 1000 disinfection kits the dashboard shows the number of people who to medical workers and CHWs. The purchase and signed up for the event and the number of people delivery of 150 pulse oximeters were added. who attended the event. The statistics obtained for each event are topics of the conference or training • Map of municipalities: To measure the project’s activity, gender, type of worker participating in the geographic coverage since its beginning, the team conferences, type of organization, and participants added a chart that visualizes the municipalities of location on the map. origin of the people who have participated in the live virtual courses.

40 Telemedicine App (Caritas Nicaragua):31 Caritas USAID funds. Based on the information attained and in Nicaragua requested technical assistance to develop conjunction with the PrevenSida virtual platform team, an application to strengthen the medical monitoring of the project used an email marketing tool to disseminate patients suspected of COVID-19 and to provide counseling mass emails and promote short information campaigns. to families through the use of mobile devices in 20 health The project personalized each campaign and leveraged clinics located in 33 municipalities in 11 departments, the contact database of the PrevenSida project. The belonging to six dioceses of the ecclesial community project also continued to promote the use of its COVID-19 of Nicaragua. The project used Open Data Kit (ODK) portal/website and various pre- recorded courses. The technology to develop the application, which facilitated project designed and launched the following campaigns: data collection in an itinerant way, enabling the information • National Medical Congress “Dr. Aldo Martínez to be collected on the ground and then downloaded when Campos”, which was promoted three times. an internet connection is available. The support included • IOTA Hurricane informative materials and banner with creating infographics with educational messages related important links to support the people affected by this to the promotion, prevention, and health care in a “friendly” hurricane in Nicaragua. fashion. WhatsApp is used to send this material to users, which is grouped by topic (elderly, hand washing, general • COVID-19 informational materials to promote measures, work and family), and made available in PDF necessary measures in response to the increased format. This application was launched in January 2021. As number of cases during the second wave of the virus. of February 28, they have treated 236 people through the The message emphasized that the virus continues to telemedicine app, of which 56% were women. pose a threat to health and that it is important not to lower the guard. The project’s systematization report highlights the • Launch of the self-health assessment tool. transversal themes of this objective, which is described in Table 9. • Promotion of the exchange event on good practices in implementing RCCE activities. Designed and launched massive marketing • Promotion of PrevenSida’s event presenting the HIV campaigns to promote COVID-19 project events: KM component evaluation study results. During this period, the project implemented RCCE activities with CSOs. The project held several working • Promotion of the World AIDS Day Virtual Forum. sessions to share experiences and present the progress • Promotion and launch of the Community Care for of RCCE activities led by the CSOs that have received COVID-19 course.

31 Páramo Ricardo. Development of a tool for data collection via mobile technology with Open Data Kit. December 2020.

41 Table 9: Summary of Transversal Themes According to Systematization Report

Transversal theme Online applications (online health counseling, telemedicine, and health self-assessment) Citizen Due to the free access factor and multiple platforms of the different Apps, a more significant number of geographically distant populations Participation with was reached. GESI Approach Through the health self-assessment application, data on 3% of people who were transgender was captured. Mainly women benefited from telemedicine and online health counseling apps (65%). Telemedicine App, with interventions directed by CARITAS Nicaragua, was used more by seniors. Networking Through the online health counseling and Telemedicine Apps, links are provided to the latest diagnostic versions prepared by the WHO/ CDC and other agencies. In this way, the articulation of actors and complementarity of organizational competencies are stimulated. Strategic alliance with the UMN to implement the online health counseling app and CÁRITAS to implement the Telemedicine app strengthened their work with their networks and other CSOs. Technological Online health counseling and health self-assessment apps were designed with Open Source technology as the primary programming Innovation language and the Telemedicine app with Open Data Kit (ODK) technology. Apps became a primary axis for project implementation and a low-cost alternative solution for the population and the project. Use of Strategic Apps were conceptualized from their design as a source of information collection for community epidemiological surveillance of the Information for COVID-19 to contribute to decision-making. Decision Making Capacity building Online health counseling app allowed doctors to access online the latest information on case definitions, diagnosis, treatment, etc. In such a way, the response was standardized on evidence-based information.

Adaptability Technological evolution of apps during COVID-19 was a determining factor in building the population’s capacity to adapt, collaborate quickly, and provide greater access to medical staff to the general population. This also facilitated a rapid response from medical staff at times of increased demand and limited physical mobility.

Designing prevention materials for the “I take care of information to the population on the virus’s progression. you, you take care of me” campaign: As part of the RCCE On the contrary, the Government has continued to campaign, the project designed COVID-19 informational promote massive activities that favor the agglomeration materials to respond to an eventual second wave of people. The project believes that this material can help outbreak of COVID-19 cases in the country, in December reduce the number of people infected by COVID-19. The 2020. The project emphasized that the virus continues project uploaded onto the COVID-19 portal and can be to pose a threat to health and that it is important not to easily accessed through the following link: https://apps. lower the guard. The project developed and disseminated pgconocimientovih.org/documentos/galerias/no-bajar- these materials to address the Government’s lack of clear la-guardia-ante-el-covid-19/postal-red-social/

42 Designed infographics for live and pre-recorded events 3. The project reviewed communication materials (six in total): To visually share the progress of the COVID-19 content, such as radio and TV spot scripts, press project in different spaces (for example, meetings with releases, and posters, that each organization USAID implementing partners, CSOs, USAID/Nicaragua, developed as part of their communication campaign. URC headquarters), the project created six infographics. The 4. The project monitored the indicators of the campaigns project updated this information monthly with monitoring promoted by CSOs through social media. data from the COVID-19 portal, the dashboard with project’s 5. CSOs implemented campaigns through radio, cable/ indicators, RCCE activities, and live or pre-recorded courses TV, and social media. available on the KMVP platform. Results of the implementation of RCCE activities Subgrants/Direct Assistance: The selection committee approved five CSOs to receive direct assistance. Through • The project reached 280,000 (verifiable).32 direct assistance, the project is responsible for the • The estimated reach of the radio campaigns in 14 expenses incurred by the CSOs to achieve each their municipalities is around 1.4 contacts per person from a goals. Based on this modality, URC and CSOs signed population universe of 2,806,696 inhabitants. MOUs for a total of $26,854.82, as shown in Table 10. • TV’s estimated reach in two municipalities (Estelí The RCCE activities and results, from October 2020 to and Matagalpa) was a little more than one contact January 31, 2021, are described below: per person from a population universe of 292,543 inhabitants. According to this rating, the campaigns 1. The project designed a Google Sheet form to monitor reached 301,250 people in both municipalities. the campaigns promoted as part of the RCCE activities and collect the indicators’ information. The The activities carried out by CSOs are described below: instrument is available online and is directly linked to CARITAS NICARAGUA33 implemented an RCCE the charts that appear on the Dashboard in the “Risk strategy with the general objective of contributing to the Communication Strategy” section. strengthening of the community health services that the 2. The project trained CSO leaders in the use of the diocesan network provides in 13 departments in response form. Caritas (Teodoro Zamora), APRODER (Francisco to the COVID 19 pandemic, in geographical areas of six García), and the COMSALUD (Dolene Miller) dioceses of the ecclesiastical province of Nicaragua. participated in the work sessions, and they have The target population to be reached will be 25,000 men started using the tool to enter their data.

32 Verifiable means that participation can be measured accurately, either through digital media reports (social medial, google ads, COVID-19 website, marketing emails, delivery of educational material) or another means. 33 AMN. Final report. November 2020.

43 and women from families at the community level in 45 and the third event that was held on August 28, a total municipalities. The specific objectives were: of 106 people participated (37 men and 69 women). The 1. Provide accurate, precise, timely, and straightforward topics covered were related to risk communication and information to the population to act with conscience essential aspects of the COVID-19 pandemic. According and reason, taking as a reference that the pandemic to the pillars of the global response established by affects everyone. WHO, these topics aimed to strengthen the efforts of CSOs to face COVID-19 in Nicaragua, influence infection 2. Highlight the importance of protective measures for prevention and case management at the community prevention. level, and identify danger signs, and timely referral to the 3. Bring clear messages to vulnerable sectors of the nearest health units. countryside and the city, at the household, community, and agri-food levels. Provision of disinfection kits aimed at vulnerable populations: The project provided Caritas Nicaragua To achieve these objectives, Caritas Nicaragua obtained with 17,870 disinfection kits. Each kit contained one liter the following activities. of 70% alcohol, one liter of 3% bleach, four-bar soaps, and a pack of three triple-layer masks. In total, vulnerable Reach and type of media used: families from 49 municipalities of the 17 departments of • Radio: Six radio spots were scheduled on ten stations the country benefited. Also, 76 medical dispensaries that that were broadcasted 2,944 times, reaching 1,604,000 serve an average of 39,120 people every month, and 26 people. senior homes, where they house approximately 1,452 • Television: Messages were transmitted 630 times a seniors, benefited from these kits. week through two television channels, one national Provision of PPE and disinfection kits for health staff and the other regional. With this, approximately and community workers: The project provided Caritas 310,000 people were reached. with a total of 500 personal protective equipment and • Social networks: The Facebook pages of Caritas 500 disinfection kits. The PPE for health staff contained Nicaragua, television channels, and Cáritas partners a face shield, a box of 50 surgical masks, and a set of have 360,640 followers. There was much interaction five triple-layer washable masks. The disinfection kits between users when banners, audio messages, and contained one liter of 70% alcohol, one liter of 3% bleach, television spots were posted. and four-bar soaps. These 500 kits were delivered to health staff and community workers who operate in the Training of health staff and CHWs: A total of 145 people 70 medical clinics and 26 senior homes. The project (69 men and 76 women) participated in the first training also provided them with 70 pulse oximeters that were event. In the second event that was held on August 7, delivered to medical dispensaries. 2020, 153 people participated (63 men and 90 women),

44 COMSALUD34 is implemented an RCCE strategy • Six radio spots were transmitted 730 times through whose overall objective is to reduce the transmission the radio stations Siempre Joven, Unica, and La of COVID-19 in the most vulnerable population of the Costeñisima. The estimated reach was 183,495 people. Autonomous Region of the South Caribbean Coast • A program called “challenges and alternatives” was (RACCS) city. The specific objectives of the program are: produced and directed by a social communicator. This 1. Provide timely information to identify the signs and program was half an hour long and was transmitted 12 symptoms of COVID-19. times. The program managed to address 20 different 2. Provide information on prevention measures for the topics related to COVID-19. A total of 14 men and 14 transmission of COVID-19. women participated in the programs, and six men and seven women were invited to the programs. 3. Promote adequate measures for the prevention of COVID-19 at the family level. The scope of the RCCE strategy was: 4. Promote actions that contribute to maintaining fair • 183,495 people reached through the radios where mental health in the face of COVID-19. radio spots and programs were transmitted.

To achieve these objectives, COMSALUD conducted the • 301,250 was the estimated reach through television following activities: channels. • Worked with three radio stations with national • 1,440 likes, 6,618 followers, and 1,575 visits through reach (La Costeñisima, Única, and Siempre Joven) social networks (Facebook). to broadcast radio spots designed and approved With the support of the project, COMSALUD delivered by PrevenSida. Because the RACCS population is disinfection kits to 100 women. Each kit contained one multilingual, they created two spots in English and two liter of 70% alcohol, one liter of 3% bleach, four-bar soaps, in Miskito. English spots were about the prevention and a pack of three triple-layer masks. The beneficiaries of COVID-19 at home and the different actors’ were from Bluefields, Kukra Hill, Rama Kay, El Bluff, and responsibilities to prevent COVID-19. Laguna de Perlas. • Miskito spots covered the importance of social APRODER35 implemented a RCCE strategy to generate distancing and self-quarantine. COMSALUD also used a favorable public opinion and increased adoption of two Spanish spots that were produced by PASMO, COVID-19 prevention measures by populations in rural which focused on the correct use of a mask and new communities and urban areas of the territory of influence. ways of dealing with problems.

34 COMSALUD. Final Report. March 03, 2021 35 APRODER. Final Report. March 03, 2021

45 The strategy’s specific objectives are: • 100 kits were delivered to senior homes, people 1. Inform the population of rural areas of Boaco, with mental disabilities, and seniors who lived in the Chontales, and the RACCS, about the current status poorest neighborhoods of Juigalpa. of the pandemic, prevention measures, what to do if Impact stories. APRODER identified COVID-19 survivors and symptoms are suspected and how they can contribute attained their consent to document and record messages to reducing cases. inviting the population to take preventive measures and 2. Strengthen capacities through updated content show solidarity with those affected. One of the cases was so that community leaders in the area of influence that of an adult woman who was a victim of discrimination. develop proposals for community organization and Her message focused on being supportive and not the prevention of COVID-19. discriminating. The second case was that of a young cancer survivor, where he shared his fight against COVID-19. The To achieve these objectives, APRODER conducted the message was strongly directed to the younger population, following activities: inviting them to be more supportive and maintain prevention measures to care for the most vulnerable people. Scope of the RCCE strategy promoted by APRODER and partner organizations: Radio spot scripts. One of APRODER’s activities was to • Radio: 191,500 people were reached. One-hundred- develop and record radio spots to promote the prevention five-thousand people were reached through the of COVID-19. The spots were aimed at the rural sector and Boaco and Chontales radio station, and 86,500 people were transmitted on the local radio stations during two were reached through the Nueva Guinea radio station. high-audience programs. • Social networks (Facebook): the reach was 118,676 AMN launched an RCCE strategy to support a people through the Facebook pages of the partner communication campaign during the 50th National organizations and the local committees of the mayors. Medical Congress with the slogan “Reality of COVID-19 in Nicaragua”, held on October 22 to 24, 2020. The specific Disinfection kits for vulnerable populations: the project objectives of the program were to: delivered 250 disinfection kits containing one liter of 3% chlorine, one liter of 70% alcohol gel, four-bar soaps, and 1. Update health professionals on issues related to three triple-layer masks. These kits were distributed as COVID-19 and how it affects people’s health in follows: different life cycles. • 150 disinfection kits delivered to people with chronic 2. Contribute to improving knowledge about pandemic diseases, seniors, who live in the poor neighborhoods management, case management, and improvement of Camoapa. of people’s quality of life affected by the pandemic in Nicaragua.

46 To achieve these objectives, AMN conducted the • The YouTube channel where the event was following activities: Create the Congress Organizing broadcasted has 47 subscribers and 1,019 visits. Committee (COC) and subcommittees (e.g., scientific UMN requested financial support to implement a committee in charge of establishing the topics and campaign that would contribute to the Nicaraguan contacting the experts; logistics committee in charge of population’s health care, inside and outside the national ensuring connectivity conditions for the transmission of territory, and Central American residents through a free presentations; finance committee to arrange financial online health counseling service via WhatsApp. They support, and advisory committee to monitor the planning developed radio spots that mainly reached populations and execution process of the Congress). in rural areas and semi-urban neighborhoods and • With support from the Holistic Design, developed a residents of other countries, mostly in Central America. virtual platform and a registration form for participants, The radio broadcasted the spots through the “Sports and both before and at the event. Democratic Capsules” program transmitted by them on • Created a Zoom+ account to carry out the Congress. 540 AM and 97.5 FM. This program is also transmitted • Held rehearsal sessions with presenters and event through their website (radio-corporacion.com), their coordinators. Four pre-congress rehearsals were Facebook live, and their YouTube channel. This program held, three with speakers and one with coordinators. is broadcasted from 7:30 to 8:00 am and 1:30 to 2:00 There was an average attendance of 55-60% to the pm from Monday to Friday. One month after launching rehearsals, with an average duration of 2 hours each - the campaign on the program, 58 spots have been 8 hours total. broadcasted to an audience of 28,797 on YouTube and 167,400 on Facebook live. • Designed a marketing strategy to promote the Congress through social media (YouTube and Twitter).

Below are results from the Congress: • The medical Congress was the first virtual conference held in Nicaragua. • A total of 550 people participated, of which 483 were doctors and 67 health professionals, both nationally and abroad. • Twenty-nine expositions were held, of which 26 addressed COVID-19 and its relationship with other pathologies.

47 48 COORDINATION WITH OTHER USAID PROGRAMS AND DONORS

EXPECTED COLLABORATION: The project supported them in developing a telemedicine COORDINATION AMONG KEY application in 20 health dispensaries in 33 municipalities of 11 departments belonging to six Dioceses of STAKEHOLDERS Nicaragua’s Ecclesial Community. Caritas Nicaragua has During this period, the project has worked closely with received 17, 870 disinfection kits and 500 PPEs, which World Vision, Save The Children, and the Nicasalud were distributed in diocesan centers, 76 health clinics, Federation. The three organizations have participated in in more than 26 senior nursing homes, and vulnerable activities developed by the project, such as the validation population that goes to churches. process for the RCCE activities, online training courses, and good practice exchange session where World Vision URC also developed three online courses on COVID-19 and Save The Children shared their experiences. URC and vulnerable populations aimed at religious leaders. also has included other USAID implementing partners in Five hundred forty-seven people enrolled, and 485 various activities, such as medical congress, exchange people participated, representing a participation of of good practices, online courses, and the HIV KM 89%. More than 50 religious leaders from Guatemala forum and COVID-19 in World HIV Day forum. Among City participated in one of the events. The project also the organizations that participated in these activities worked with organizations that target PLHIV, such as are the PASMO, IntraHealth, the Violeta Barrios de the Nicaraguan Association of Positive People Fighting Chamorro Foundation, Global Communities, Fundación for Life (ANICP + VIDA), Nicaraguan Association of para la Autonomía y Desarrollo de la Costa Atlántica de HIV Positive People (ASONVIHSIDA), ICW, Western Nicaragua (FADGANIC), CID GALLUP, and the CEPRESI, Self-Help Group (GAO), Acción Positiva, Tesis y Vida among others. Futura. Organizations of transgender people also have been included, such as the Association for the Human The project also worked with three FBOs (Caritas de Rights of Nicaraguan Sexual Diversity (ADESENI), Trans Nicaragua, Adventist Church, and Morava Church), People Association (ANIT), Union of Trans Domestic including through their participation in online trainings. Workers (SITRADOTRANS), Organitation of Trans People The project also provided direct assistance to Caritas (ODETRANS), Asociación Movimiento Diversidad Sexual Nicaragua to carry out an RCCE activity from October (AMODISEC) de la RACCN, Movimiento de la Divesidad 2020 a January 31, 2020, for a total amount of $10,000. Sexual (MDS) RACCS, Movimiento de la diversidad

49 Sexual de Río San Juan, Fundación San Lucas and the recommendations from the WHO, PAHO, and CDC, Trans Women’s Association (ADMUTRANS). The Project technical guidelines, scientific studies from prestigious has provided disinfection kits to these organizations for international organizations and universities on COVID-19, their target populations. They also have participated in links to specialized search engines, documents from the different trainings and events organized by URC. international cooperation agencies on the impact of the pandemic, such as the World Bank, United Nations Agency, Lastly, the URC has been working in coordination with etc., specific information prepared by the Nicaraguan medical and scientific associations. As noted above, the MOH and others. The portal also has a specific training project selected AMN as an organization to receive technical space through the URC/USAID PrevenSida project’s virtual and direct assistance to implement their RCCE strategy. campus, where the courses developed by the project were hosted and facilitated live and on-demand. CROSS-CUTTING Sustainability and Capacity Building of Community AND OTHER ISSUES Groups: Through this project, URC has developed a series Global, Regional and National Guiding Frameworks: of virtual trainings related to pandemic management and URC has developed an approach that aligns with global risk communication strategy. CHWs, medical workers, WHO guidelines and the USAID COVID-19 Strategy religious leaders, teachers, and CSO leaders have to face the COVID-19 pandemic in Nicaragua. URC benefited from the trainings, including how to better developed an RCCE strategy that aligns to global promote healthy practices, such as the use of masks, strategic guidelines and response to the COVID-19 physical distancing from at least two meters, frequent hand pandemic, where official actions are established washing; how to prevent the transmission of COVID-19, regarding comprehensive health measures at the such as staying home and going out only if necessary; how government level and critical activities at the community to care and treatment mild and severe COVID-19 cases; and individual levels. To design the RCCE strategy, the among others. During this quarter, URC developed a series research supported by 26 investigations from secondary of educational material kits for CSOs to promote health sources was vital. Similarly, the strategic orientation and care at the individual and community levels. recommendations for the response to the pandemic and the RCCE framework from international organizations, Stigma and Discrimination: Stigma associated with such as the WHO, PAHO, and the CDC were key. COVID-19 can contribute to spread of the disease, resulting in more severe health problems and difficulties controlling As described above, the COVID-19 Portal is structured it. URC developed an RCCE strategy based on the results in eight sections that facilitate access to relevant links of studies carried out by World Vision, PASMO, and and data on monitoring the pandemic at the global, UNAIDS, which show that the population has suffered regional, and national levels. It also has international discriminatory attitudes in the communities, especially if

50 they have been in another country. Other people refrain economic, social, political and cultural from going to the health unit or have had to go to live – From the design stage, the project used a cross- elsewhere if they have been infected with COVID-19. cutting approach to gender equity, with data Based on these findings, the project emphasized the disaggregation by sex and occupational categories importance for the NGO-led RCCE strategies to be being established in the MEL. implemented actions that would mitigate discrimination – Participation of women’s and transgender CSOs: and stigmatization of people affected by COVID-19. In the initial phase, 19% of the CSOs contacted Through the life of the project, URC ensured that all corresponded to women or transgender women. Of activities were stigma-free and identified other ways to the total number of surveys conducted to ascertain address stigma and discrimination during implementation. needs, 18% were also women or transgender For example, the RCCE campaigns were aimed at not women. After the beneficiary selection process, discriminating or stigmatizing people or families who were 38% of the CSOs were women or trans women. infected with COVID-19. APRODER produced success – Training of CSO leaders: 51% of the people trained stories of people who had been affected by COVID-19 in this category were women. and who had been discriminated. These spots and stories – Training of health personnel: 55.7% of the were shared through the partner organizations’ radio and health personnel trained were women; when Facebook pages to raise awareness about the issue. disaggregated by category, 55% of physicians and Gender: The project’s work plan included a gender 56.4% of community workers were women. analysis in the context of COVID-19. The COVID-19 project – Training according to the use of learning also integrated GESI in its design, implementation, technology: Women had a lower percentage (45%) and evaluation. GESI-related results were not fully of participation in synchronous learning, possibly assessed until the end of the project, which showed that related to their time availability; however, they had a the implementation contributed to the USAID gender higher percentage in asynchronous learning (55%), policy. USAID’s policy provides guidance on pursuing reaching their study certificates. more effective, evidence-based investments in gender – Access to personal protection and infection equality and women’s empowerment and incorporating prevention resources: 65% of health workers who these efforts into core development programming. received PPE and 51% of those who received The following is a brief overview of how project results disinfection kits were women. contributed directly to the policy’s main lines of action: – Participation in the provision of telemedicine • Reducing gender disparities in access, control and services: 69% of telecounselors and service use of resources, wealth, opportunities and services – advisors were women.

51 • Reduce GBV and mitigate its harmful effects on Cultural Sensitivities: This project will take into account people cultural considerations for all interventions where – Training for leaders (51% women) included appropriate, especially in the context of indigenous and information on the issue of violence in the context Miskito communities. URC has considered it essential of the pandemic. The CoVID19 portal, nested in the to incorporate actions to contribute to the improvement virtual platform, provided important informational of knowledge and appropriate practices to prevent and educational resources on the topic of GBV, the transmission of COVID-19, so these issues are mental health and other related resources. Sixty- promoted through community-based CSOs and FBOs. one percent of the people accessing information The organizations that serve and implement RCCE on the portal were women. strategy in indigenous and Miskito communities of the country that have been affected by the pandemic will • Increase the ability of women and girls to realize their develop radio spots and educational materials in both rights, determine their life outcomes and influence English and Miskito. This material included information decision-making in households, communities and on how to promote health, prevent transmission, care for societies vulnerable populations, and when to go to the health unit. – Access to health information, communication and Through the activities implemented by Caritas Nicaragua education: More than 280,000 people benefited and supported by the COVID-19 project, posters were from risk communication campaigns conducted designed in Miskito to educate this population on through traditional media such as radio, television, handwashing, disease symptoms, and caring for people print, educational materials and modern media at home. COMSALUD, located in the RACCS, produced such as social networks, at least half of whom are spots in Miskito and English that talk about masks’ use. women, although there were specific activities These messages have been broadcasted through the targeted for women. 65% of the educational radio and cable TV in the South Caribbean region. materials distributed, The communication campaigns reached indigenous – Access to infection prevention resources: 65% populations and Afro-descendants of six municipalities of the disinfection kits donated to the vulnerable and nine CSOs, including two FBOs (Moravian and population were women. Adventist Church), two CSOs that work with people of – Access to medical services: 64% of the tele- sexual diversity (AMODISEC and MDS), three CSOs that counseling consultations, 53% of the virtual self- work with PLHIV (Future Life, ACCCS, Thesis), and two diagnoses and 61% of the covid19 cases identified CSOs that work on the issue of gender and women’s corresponded to women. Trans women accounted health (Comsalud and Marijn). The project also reached for 3% of the users of the self-diagnosis application. indigenous populations and Afro-descendants using their

52 languages through radio spots, TV spots, and materials received, and other delivery data. Likewise, the process such as posters in both Miskito and English. These documents relevant information from the CSOs that have materials reached 30,000 people in the Autonomous received the kits. The transport company also gets a copy Regions of the Caribbean Coast. The entire campaign of this information. The project created a folder on Google focused on social inclusion with responsive, empathetic, drive to upload relevant information to deliveries such as transparent messages with sensitivity and cultural photographs, videos, and minutes of receipt of materials. relevance. The project also actively promoted social Additionally, the project makes this document available to inclusion through the participation of CSOs from the the USAID AOR, as needed. North and South Caribbean Coast, Miskito communities, URC completed the USAID EMMP evaluation at the end Creoles. Also, Catholic, Adventist, and Moravian of the project, which included a concise description of the populations received kits. activities implemented as mitigation measures, problems Environmental Mitigation Plan and Report: URC encountered and described lessons learned. developed the project’s Environmental Mitigation and Monitoring Plan (EMMP), as required. EMMPs are an important tool for translating applicable IEE conditions and mitigation measures into specific, implementable, and verifiable actions. URC has adjusted the project activities carried out during this period based on the EMMP. The project does not carry out actions with products that generate biological waste as it does not work with biomedical laboratories. All events have been held through the KMVP, and staff have been working from home.

The donated disinfection kits contain 3% chlorine, 70% alcohol, cloth masks, and a bar of soap. Each kit has a printed sheet with instructions for using chlorine and instructions on how to use the masks properly and how to dispose of it in suitable containers to avoid the virus’s spread. Additionally, URC developed a procedure for the delivery of disinfection kits and PPE that documents the name of the person who receives them, their telephone number, the address of the place where the kits are

53 MEL PLAN

The MEL plan plays a crucial role in strengthening project • Since the online health counseling service launch on management. This plan was aligned with the established September 16, 1,610 people have used the service. The objectives, goals, and indicators, facilitating information delay in launching the service, and the dropping of analysis based on decision-making. Based on this plan, positive COVID-19 cases in Nicaragua since August the project developed management tools with feedback 2020, possibly attributable to the guidance provided loops between the donor and the project. This two- by CSOs, medical associations, and independent mass communication created space for the timely identification media, has influenced the result achieved, which is of obstacles and facilitators in implementing the project’s 6.4% compared to the annual target. critical activities toward achieving its objectives. The MEL • Trained a cumulative 669 health workers in COVID-19 plan was endowed with attributes that guarantee the quality case management and IPC, due to the significant of the data and the flexibility and simplicity of obtaining it. participation in the Nicaraguan Medical Association’s Progress toward achieving established targets: Below (AMN’s) national medical congress, “Realities of provides an overview of the activities implemented during COVID-19 in Nicaragua”. Goal of 500, achieving 133%. the life of the project, which are reflected in Annex 1: • Delivered a total of 25,000 disinfection kits acumlative • Strengthened CSO capacities by training a cumulative to 25 CSOs, three FBOs (Caritas, the Morava church, 164 national leaders in COVID-19 pandemic and the Adventist church), 76 medical dispensaries, 26 management and data analysis, achieving 164% of the senior nursing homes, and one Nicaraguan medical annual target (100). unit, reaching 65 municipalities from 17 departments of the country. This represents 100% of the total target • During this performance period reached 280,000 established. The project delivered 1,000 PPEs and 1,000 people through mass media (Facebook, YouTube), disinfection kits to health staff and (CHWs) during this achieving 560%, means that their participation can quarter. The project hired one temporary staffer to be measured accurately, either through digital media receive, organize, distribute, and deliver the kits. reports (e.g., social networks, Google ads, COVID-19 website, marketing emails, delivery of educational • At the end of this reporting period, and as a result material) or another means (e.g., campaigns, of the project’s work, 3,544 people benefitted educational materials, radio and TV). from health and community care services, which represents 76% of the total project target.

54 ANNUAL PLAN COMPLIANCE

Overall, the project completed all its objectives and achieved content was adapted as the pandemic progresses and as most, except for one indicator. In several cases, the project new scientific and technological discoveries emerge. The exceeded its targets. The project exceeded the objectives and COVID-19 Portal is considered a successful experience since goals related to the strengthening, coordination, and response it fulfilled the proposed objective of becoming an interface for of the leaders of CSOs and medical associations working accessing information and promoting project beneficiaries’ in response to the COVID-I9 pandemic. As mentioned participation. Through the portal, innovation and adaptability above, did not fully accomplish the one indicator because it are promoted, being a favorable bet for the project, stimulating estimated that there would be 25,000 consultations, which inclusive participation and a gender perspective. was estimated based on the projections of the specialists The RCEE strategy met its objective of responding to the who expected a second wave of the virus to produce many most pressing needs and gaps, in response to the pandemic, more cases resulting in a larger number of people seeking related to access to accurate and timely information on the support. However, the estimates did not behave that way. transmission and prevention of COVID-19 and timely decision- So, the initial assessment of 25,000 online services was making seeking health care. The design and implementation higher than the actual demand. Additionally, internet access of communication campaigns by community-based CSOs could be a limitation for some people, mainly populations allowed exceeding the estimated results, activating a mega with limited economic resources and who cannot afford community network that ensured citizen participation, and the internet. Despite this, the use of such virtual apps in where young people and women played a leading role, times of health crisis has demonstrated to be a catalyst for thus reaching the 15 departments and the two autonomous higher coverage and a vital tool for access to vulnerable and regions of the country. higher-risk populations. The use of specialized counseling services (by a doctor trained) and reliable information in a The COVID-19 project fully complied with delivering the hostile environment, both for health staff and for the general disinfection kits to vulnerable populations by forming a population, has helped to increase credibility of the tool. network of CSOs, flexibility in the procurement model, distribution, and delivery to vulnerable populations. The Use of ICTs and the creation of a network of 40 CSOs COVID-19 project complied with the delivery of PPE and supported the success of the project. Additionally, the project disinfection kits to health staff and CHWs through Cáritas and developed and implemented live and on-demand courses, UMN, who have a vast network of care services for vulnerable reaching 164 CSO leaders. The project also adapted the and senior populations.

55 ACTIVITIES TO BE COMPLETED FOR PROJECT CLOSURE

• Implement project closout activities. • Finalize gender analysis based on data collected in its different events. • Systematize the overall progress of the project. • Finalize and upload deliverable onto the USAID DEC.

56 FINAL EVALUATION/SYSTEMATIZATION

The project carried out the systematization of the project Methodology. according to the School for Development, to strengthen the capacities of CSOs facing the COVID-19 1991, it contemplated the following stages: pandemic, which was conducted between January 22 • Type of study: Qualitative, prospective and and March 5. The final report describes some results by systematization of data and experiences objectives. A brief summary is described below. • Delimitation of the experience to be systematized: July The systematization of the PrevenCOVID-19 project 1, 2020 to February 28, 2021 was prospective, designed and implemented from the • Location: Throughout the country beginning of the project, and involves the systematic • Sources of information: Primary: stakeholder interviews development of the experience. This study has a and Secondary: Guidelines, Technical Reports, double scope: a) The systematization of information or Scientific Studies, Population Surveys, Project Reports systematization of data, which refers to the ordering and classification of all types of data and information, under • Stages: Delimitation/Description/Records/ certain criteria, categories, relationships, etc. and the Processing/Identify axes of analysis /Discussion/ systematization of experiences referred to experiences Drafting/Redaction/Validation seen as processes that take place in a given period, • Analysis and conclusion: an internal validation was involving different actors, in an economic and social carried out between the evaluation team, URC and context, and within the framework of a given institution. USAID, in order to make a critical review of the results, draw conclusions and recommendations This study answers the following key questions: • Writing: the final product describes and analyzes the 1. What was the initial situation, prior to the intervention? systematized experience and the lessons learned from 2. What objectives were set and what actions were taken it, both for the donor, the implementer and the CSOs to resolve the initial situation? participating in the project 3. What contextual factors hindered the process? More information is described in the final systematization 4. What contextual factors favored the process? report. 5. What were the main stages or moments of the process? 6. What is the current situation, what changes have occurred and what impact have they had? 7. What recommendations emerge for the future?

57 BRANDING AND MARKING

On June 29, URC formally requested a branding and • Printed educational materials, such as brochures and marking exemption from USAID for the IEC materials guides generated by the project, which we are still awaiting • Provision of PPE and disinfection kits response. Due to the socio-political events that occurred • Technical and Direct Assistance to five NGOs in the country in 2018, Nicaraguans’ security has been affected both by the political context and by the lack • Success stories and research results of independent authorities and institutions to exercise • Communication campaign, including ads justice. Since then, there is a high polarization among • Preparation of videos, photos, and interviews of best the population. As the COVID-19 epidemic spreads in practices Nicaragua, the government does not intend to opt for more drastic measures to contain the pandemic. Since • PowerPoint presentations the beginning of the epidemic, they have chosen to hold URC has considered that marking of these materials or sporting events and marches to celebrate “Love in times other activities with USAID logos could put the project’s of COVID,” claiming that “staying home is the path to the technical staff at risk since the selected communities country’s destruction”. are made up of people with diverse opinions and the During the term of the project, the team will be working brand can cause an adverse reaction in them. Given with scientific medical societies and CSOs that have this risk, URC requested the branding waiver based on been leading the response to the epidemic and informing ADS Chapter 320 Branding and Marking, specifically the population about the protection measures, cases, subsections 320.3.2.6 “Waivers to Contract Marking and deaths occurring in the country. In many cases, Requirements.” these actions have resulted in several doctors having been forced to leave their jobs and have been subject to lawsuits. Some of the activities that the project is implementing include: • Training for health and community leaders • Virtual courses and communities of practice

58 MANAGEMENT AND STAFFING

The project is represented by two staff members, the project hired a consultant from October to November Project Director and the Director of Administration/ to support MEL tasks and a consultant in December Finance. Given the nature of the project (emergency), to support the logistics for the delivery of the 10,810 the activities require follow-up, MEL. For this reason, the disinfection kits.

59 FINANCIAL ANALYSIS

PREVENSIDA COVID-19 BUDGET BY QUARTER The total budget for the PrevenSida COVID-19 extension (Strengthen Non-Governmental Capacities to Face COVID-19 Pandemic in Nicaragua project) was $750,000.00, distributed across three quarters starting in Q4 FY20 (July- September 2020) and ending on Q2FY21 in March 31, 2021. For PrevenSida Project, the Total Estimated Cost was $11,967,835, with a Cost Share of $734,017. The Cumulative Obligation was $11,967,835, with Cumulative Expenditure of $11,967,835. The table below summarizes the spending of the USAID-funded PrevenSida Project, with a performance period of September 20, 2010–June 30, 2020.

Cost Categories Approved Budget Expenses as of June 2020 Salaries, Wages, and Fringe $ 3,269,755.00 $ 3,275,711.00 Consultants $ 1,106,494.00 $ 1,098,145.00 Travel $ 304,609.00 $ 305,280.00 Equipment and Supplies $ 155,574.00 $ 155,679.00 Trainings, Activities, and Workshops $ 320,628.00 $ 320,167.98 Allowances Other Direct Costs $ 1,161,012.00 $ 1,158,257.02 Subawards $ 3,096,332.00 $ 3,096,676.00 Indirect Costs $ 1,803,431.00 $ 1,807,919.00 Total Estimated Cost $ 11,217,835 $ 11,217,835.00 Cost Share $ 734,017.00 $ 734,017.00 Total Program Cost $ 11,951,852 $ 11,951,852.00

60 On June 23, 2020, URC signed Modification 22, which granted the 9-month extension PrevenSida COVID-19 extension (Strengthen Non-Governmental Capacities to Face COVID-19 Pandemic in Nicaragua project). The table below summarizes the spending of the extension period only, from July 1, 2020–March 31, 2021. Cost Categories Approved Budget Expenses as of June 2020 Salaries, Wages, and Fringe $ 147,385.59 $ 96,383.80 Consultants $ 160,138.17 $ 131,780.15 Travel $ - Equipment and Supplies $ 177,359.66 $ 227,862.00 Trainings, Activities, and Workshops $ - Allowances $ - Other Direct Costs $ 114,317.27 $ 24,468.39 Subawards $ - Indirect Costs $ 150,799.27 $ 117,231.25 Total Estimated Cost $ 750,000 $ 597,725.59 Cost Share $ $ Total Program Cost $ 750,000 $ 750,000 The final table is consolidated showing the spending of the full PrevenSida Project, from September 20, 2010–March 31, 2021. Cost Categories Approved Budget Expenses as of June 2020 Salaries, Wages, and Fringe $ 3,417,140.59 $ 3,372,094.80 Consultants $ 1,266,632.17 $ 1,229,925.15 Travel $ 304,609.00 $ 305,280.00 Equipment and Supplies $ 332,933.66 $ 383,541.00 Trainings, Activities, and Workshops $ 320,628.00 $ 320,167.98 Allowances $ - $ - Other Direct Costs $ 1,275,329.27 $ 1,182,725.41 Subawards $ 3,096,332.00 $ 3,096,676.00 Indirect Costs $ 1,954,230.27 $ 1,925,150.25 Total Estimated Cost $ 11,967,835 $ 11,815,560.59 Cost Share $ 734,017.00 $ 734,017.00 Total Program Cost $ 12,701,852 $ 12,549,578

* March actuals will be added upon final financial reconciliation. Indirect expenses for FY20 and FY21 are based on the estimated Negotiated Indirect Cost Rate Agreement (NICRA).

61 BUDGET NOTES Listed below are assumptions, major changes, estimations, or issues intended to provide a better understanding of the numbers.

Salaries, Wages, and Fringe This item is made up of salaries, wages, and fringe benefits. Consultants This item is for consultants who strengthened project activities and objectives. Travel This includes the cost of local and regional travel expenses. Equipment and Supplies Included here are items that were purchased for the Ministry of Health’s Information Systems, COVID-19 equipment, and PrevenSida field office support. Trainings, Activities, and Training costs include per diem; training conference rooms; utilization of the virtual platform; and Workshops refreshments for workshops and training sessions. Other Direct Costs These are administrative costs required to implement the project activities, such as rent, utilities, local transportation, IT services, legal fees, outside labors etc. Subawards Sub-awards and FAAs were awarded to local and regional CSOs to implement project activities. Indirect Costs Calculated as per Award conditions. Cost Share The project has reached its cost share requirement and has reported $734,017 [100%] in cost share.

62 ANNEX 1. INDICATOR TABLE

Indicators Baseline Quarter 4 Quarter 1 Quarter 2 Total Actual Total % Achieved Objective 1. Strengthen coordination and response among CSOs leaders and medical associations working on COVID-I9 pandemic response Expected Result 1: Key CSOs and private sector leaders trained on basic aspects of pandemic management, including networking and coordination (Related to WHO’s Pillar 1) Outcome 1.1 Number of CSOs, private sector, 0 108 24 32 164 100 164 medical association and union leaders trained in COVID-19 case coordination, networking, and pandemic management Objective 2. Implement risk communication and community engagement (RCCE) activities focused on most vulnerable populations Expected Result 2: Implemented RCCE strategy addressing key gaps of knowledge and participation, including community monitoring and online health counseling (Related to WHO’s Pillars 2 and 3) Outcome 2.1 A RCCE campaign implemented 0 1 NA NA 1 1 100 and an active RCCE coordination structure for COVID-19 supported through USAID project assistance Outcome 2.2 Number of people reached through 0 0 218,679 61,321 280,000 USAID-supported mass media, including social media (disaggregated by communications channel, sex (where feasible), and age (where feasible) Facebook 0 0 154,199 0 154,199 Youtube 0 0 35.224 53,159 88,388 50,000 560 Educational Materials 0 0 24,010 5990 30,000 Portal COVID-19 (Cummulative) 0 1,645 3,884 5,529 5,529 Web Campaign 0 1,887 0 0 1,887 Radio 0 0 2,806,696 0 2,806,696 Television 0 0 301,250 0 301,250 Outcome 2.3 Number of media outlets participating 0 16 16 16 16 12 133 in the RCCE campaign (Radio and Cable) Outcome 2.4. Number of vulnerable people who 0 6,400 12,610 5,990 25,000 25,000 100 received disinfection kits

63 Indicators Baseline Quarter 4 Quarter 1 Quarter 2 Total Actual Total % Achieved Objective 3. Train human resources on health from CSOs and private sector on IPC and community ease management Expected Result 3: Trained CSOs, private sector human resources, community health leaders and family caregivers on infection, prevention and control and community case management (Related to WHO’s Pillars 6 and 7). Outcome 3.1 Number of health workers trained in 0 176 473 20 669 COVID-19 case management and IPC (disaggregated by: CSOs, private sector, others (community health leaders and family caregivers), and sex) CSOs 0 152 13 NA 165 500 134 Private Sector 0 24 324 7 358 Others 0 136 13 149 Female 0 99 220 12 331 Masculine 0 77 253 8 338 Outcome 3.2 Number of CHW trained in COVID-19 0 187 69 246 502 case management and IPC (disaggregated by: CSOs, private sector, others (community health leaders and family caregivers), and sex) CSOs 0 185 40 133 358 500 102 Private Sector 0 2 15 19 36 Others 0 0 14 98 112 Female 0 103 41 143 287 Masculine 0 84 28 107 219 Outcome 3.3 Number of health workers who 0 0 500 0 500 500 100 received medical grade PPEs and disinfection kits Outcome 3.4 Number of CHW who received 0 0 500 0 500 500 100 medical grade PPEs and disinfection kits Outcome 3.5 Number of online counseling 0 1,108 245 257 1610 25000 6 services implemented

64 ANNEX 2. CSOs PRESENTED WITH THE COVID-19 PROJECT

Organization Name Chronic Patient Organizations 1. ANICP+VIDA 2. ASONVIHSIDA 3. ICW Nicaragua 4. Grupo de Auto ayuda de Occidente (GAO) Health and Development Organizations 5. Asociación para el Progreso y Desarrollo Rural 6. Asociación para el Desarrollo de los Pueblos 7. Alistar 8. Centro de Estudios y Promoción Social 9. CEPRESI 10. FADGANIC 11. Familia Padre Fabretto 12. Ixchen 13. Federación Red Nicasalud 14. Flesnic 15. Freedom House 16. Fundación Amos Salud 17. Fundación Nicaragüense para el Desarrollo Económico y Social 18. Fundación San Lucas 19. Instituto de Promoción Humana de Nicaragua (INPRHU) 20. Plan International

65 21. Prodessa 22. Profamilia 23. Project Concern International 24. Red comunitaria de salud mental 25. Save The Children 26. World Vision Medical Associations 27. Asociación Médica Nicaragüense 28. Unidad Médica Nicaragüense 29. Comité Científico Multidisciplinario FBOs 30. Caritas Nicaragua 31. 7th Day Adventist Church 32. Moravian Church of Bluefields Transgender Organizations 33. ADESENI 34. ANIT USAID Partners 35. Global Communities 36. IntraHeath 37. PASMO

66 ANNEX 3. ORGANIZATIONS LINKED TO PROJECT IMPLEMENTATION

Name of Organization Directed Direct Benefiarcy Coordination and Exchange FBOs CÁRITAS Nicaragua X X X Iglesia Adventista X X Iglesia Morava de Bluefields X X Gender, Health, and Development Red Comunitaria en Salud Mental (COMSALUD) X X X Asociación para el Progreso y Desarrollo Rural (APRODER) X X X Centro de Promoción Asesoría en Investigación y Desarrollo X (Prodessa) Fundación Marijn| X Fundación San Lucas (FSL) X Medical Associations Unidad Médica Nicaragüense (UMN), X X X Asociación Médica Nicaragüense (AMN) X X Comité Científico Multidisciplinario (CCM) X People with HIV Tesis X Campaña Costeña Contra el Sida (ACCCS) X Asociación de Personas que conviven con el VIH/Sida X (ASONVIHSIDA) Grupo de Auto Ayuda de Occidente (GAO) X Asociación Nicaragüense de Personas Positivas Luchando por la X X Vida (ANICP+VIDA) Comunidad Internacional de Mujeres con VIH (ICW Latina) X Grupo de Acción Positiva X Vida Futura X

67 Name of Organization Directed Direct Benefiarcy Coordination and Exchange Transgender People Asociación por los Derechos de la diversidad Sexual Nicaragüenses X X (ADESENI) Organización de Personas Transgénero (ODETRANS) X Asociación de Mujeres Transgéneros de Nicaragüenses X (ADMUTRANS) Sindicato Trans de Trabajadoras Asistentes del Hogar y la Familia X (Sitradotrans) Sexual Diversity Centro para la Educación y Prevención del Sida (CEPRESI) X X Asociación Movimiento de la Diversidad Sexual (MDS) de la Región X Autónoma Costa Caribe Sur (RACCS) Asociación Movimiento de la Diversidad sexual (AMODISEC) Región X Autónoma Costa Caribe Norte (RACCN), Asociación de Mujeres Nicaragüenses (SAFO), X Movimiento de la Diversidad Sexual (MODIVERSEX) Río San Juan. X International Organizations Word Vision X Save The Children X Plan Internacional Proyecto de Prevención Combinada PASMO X Cuidado y Tratamiento (Intrahealth) X Freddom House X Federación Red NicaSalud Centros de Estudios y Promoción Sociales (CEPS) X Asociación Probienestar de la Familia (PROFAMILIA) X Asociación de Personas con Lupus Eritematoso Sistémico (FLESNIC) X Comunicadores Independiente X Representantes de medios de comunicación nacionales (18 X periodistas) Other CSOs Movimientos sociales afectados por la crisis X

68 ANNEX 4. RCCE CAMPAIGN COVERAGE – PEOPLE REACHED

69 ANNEX 5. COVID-19 PORTAL STATISTICS

70 ANNEX 6. COVID-19 CAPACITY BUILDING

71 ANNEX 7. COVID-19 COURSE REGISTRATION AND PARTICIPATION BY TYPE (NICARAGUA)

72 ANNEX 8. ON-DEMAND COURSE REGISTRATION AND COMPLETION

73 ANNEX 9. ONLINE TELEHEALTH COUNSELING

74

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