USAID COMMUNITY CAPACITY FOR HEALTH PROGRAM Mahefa Miaraka Cooperative Agreement No. AID-687-A-16-00001 FY2020 Quarter 2 Progress Report January 1 to March 30, 2020 Re-submitted: September 17, 2020 USAID Community Capacity for Health Program – Mahefa Miaraka FY2020 Quarter 2 Report ii USAID COMMUNITY CAPACITY FOR HEALTH PROGRAM - Mahefa Miaraka FY2020 Quarter 2 Progress Report January 1 to March 30, 2020 Re-submitted: September 17, 2020 Cooperative Agreement No. AID-687-A-16-00001 Submitted to: Dr. Andry Rahajarison, AOR USAID/Madagascar in Antananarivo, Madagascar Prepared by: JSI Research & Training Institute, Inc. USAID Community Capacity for Health Program – Mahefa Miaraka Résidence Lavalley Près Lot IIK 50H Mahatony Alarobia, Antananarivo (101) Tel: 20.22.425.78/ 79 Cover photo: Training of youth peer educators with their coaches, Maintirano Middle School, Melaky Region Photo credit: Mahefa Miaraka Team, Melaky DISCLAIMER: This document is made possible by the support of the American people through the United States Agency for International Development (USAID). The contents of this document are the responsibility of JSI Research & Training Institute, Inc. (JSI) and do not necessarily reflect the views of USAID or the United States Government. Page ii USAID Community Capacity for Health Program – Mahefa Miaraka FY2020 Quarter 2 Report iii Table of Contents Executive Summary of Achievements in Q2 FY2020 ................................................................ 7 Introduction………………………………… .................................................................................... 9 Intervention Area 1 (IA1): Community Engagement and Ownership of Health Services…………………… ........................................................................................... 10 Sub IA 1.1 Increasing CHV Skills and Competencies in Priority Interventions ...........................10 Sub IA 1.2 Sustainability of the CHV Model ..............................................................................28 Sub IA 1.3 Strengthening of Community Structures to Improve Health and Sanitation Planning .................................................................................................28 Sub IA 1.4 Promoting Universal Health Care Access and Coverage, Micro-finance Insurance, and Health Evacuation Activities .......................................................29 Intervention Area 2 (IA2): Behavior Change and Health Promotion .................................... 31 Sub IA 2.1. Community-level Health Promotion and Sensitization to Increase Healthy Behaviors and Uptake of Health Services and Products ..............................................31 Sub IA 2.2 Community-level Health Promotion to Increase Health Behaviors, Update of Health Services and Products, and Advocate for Improved Services ........................33 Sub IA 2.3 Innovations to Promote Adolescent and Youth Health .............................................37 Intervention Area 3 (IA3): Health Service Planning, Management, and Governance .......... 38 Sub IA 3.0 Strengthening of GOM Capacity ..............................................................................38 Sub IA 3.2. Pharmaceutical and Commodity Forecasting ..........................................................40 Sub IA 3.3. Health Data Quality, Management, and Use ...........................................................40 Sub IA 3.4. Referral System Strengthening between CHVs and CSBs .....................................41 Intervention Area 4 (IA4): Monitoring and Evaluation, Learning Management, and Cross-Cutting Issues………….. ............................................................................................ 42 Sub IA 4.1 Program Monitoring, Evaluation, and Performance System .....................................42 Sub IA 4.2 Learning Management .............................................................................................45 Sub IA 4.3 Cross-Cutting Issues ...............................................................................................47 Intervention Area 5 (IA5): Reducing Child Marriage and related Reproductive Morbidity and Mortality among High-Risk and Married Girls in Sofia, Menabe and DIANA regions of Madagascar……………………….. ............................................................................................ 48 Recruitment and Staffing ...........................................................................................................48 Introduction and Orientation with GOM and Community Partners .............................................49 Formative Research ..................................................................................................................50 Challenges and Proposed Solutions for Q2 FY2020 ................................................................. 52 Administrative and Financial Management .............................................................................. 53 Sub IA 0.2 Administration ..........................................................................................................53 Sub IA 0.3 Financial Management ............................................................................................54 Page iii USAID Community Capacity for Health Program – Mahefa Miaraka FY2020 Quarter 2 Report iv List of Tables TABLE 1– NUMBER OF PNSC MEMBERS TRAINED ON COMMUNITY HEALTH, Q2 FY2020 .................................................................11 TABLE 2– READINESS OF CHVS IN THE PROGRAM REGIONS, Q2 FY2020 ............................................................................................11 TABLE 3– CHV REFRESHER CLINICAL TRAINING BY THEME Q1& Q2 FY2020 .....................................................................................13 TABLE 4– CHV REFRESHER TRAINING ON WASH, COMMUNICATION, COMMUNITY MOBILIZATION, AND COMMODITY AND INFORMATION MANAGEMENT, Q1& Q2 FY2020 ........................................................................................................................14 TABLE 5– SUPERVISION OF CHVS BY TYPE OF SUPERVISOR, Q2 FY2020 ...............................................................................................15 TABLE 6 – REFERRAL OF WRA AND CU5 CASES FROM CHVS TO CSBS IN Q2 FY2020 ........................................................................18 TABLE 7– CHV MALARIA SERVICES BY REGIONS IN Q2 FY2020 ............................................................................................................22 TABLE 8 – AVERAGE RATE OF REPORTED STOCKOUTS OF CHILD HEALTH COMMODITIES BY CHVS, Q3 FY2019 – Q2 FY2020 BY PRODUCT TYPE (N = 3,939 FKT) .................................................................................................................................................24 TABLE 9 – AVERAGE RATE OF REPORTED FOKONTANY STOCKOUTS FOR MALARIA PRODUCTS BY REGION, Q2 FY2020 .....................25 TABLE 10- PRESENCE OF FP METHODS POSTER AND CLIENT RIGHTS POSTER, Q2 FY2020 ................................................................26 TABLE 11- OVERVIEW OF BICYCLE SALES PER EBOX COOPERATIVE Q2, FY2020. .................................................................................27 TABLE 12 – NUMBER OF PEOPLE REACHED ON KEY HEALTH AND WASH MESSAGES BY CHVS, Q2 FY2020 ......................................33 TABLE 13 – NUMBER OF PEOPLE REACHED ON KEY HEALTH AND WASH MESSAGES THROUGH RADIO BROADCASTS, Q2 FY2020 ..34 TABLE 14 – PROGRAM PARTICIPATION IN THE HEALTH AND WASH DAYS CELEBRATIONS, Q2 FY2020 .............................................34 TABLE 15 - TRAINING OF TRAINERS RECEIVED BY MOH OFFICIALS, Q2 FY2020 .................................................................................40 TABLE 16: NUMBER OF DQA CONDUCTED BY TYPE OF AUDITOR, Q1 AND Q2 FY2020 .......................................................................43 TABLE 17: TYPE OF CHV MONTHLY REPORT DATA ERRORS ...................................................................................................................43 TABLE 18: TRIANGULATION OF CHV MONTHLY REPORT INDICATORS ..................................................................................................44 TABLE 19 – PROGRAM’S CUMULATIVE EXPENSES AS OF MARCH 31, 2020 ............................................................................................54 List of Figures FIGURE 1- MAHEFA MIARAKA’S REGIONS AND DISTRICTS .......................................................................................................................9 FIGURE 2 - CHVS TRAINED IN CASE MANAGEMENT AND SERVICE DELIVERY TOPICS, Q2 FY2020 .......................................................13 FIGURE 3 - CHVS TRAINED IN SBCC, WASH, COMMODITY AND DATA MANAGEMENT, Q2 FY2020 .................................................14 FIGURE 4- CU5 RECEIVING GROWTH MONITORING SERVICES FROM CHVS: Q1AND Q2 2020 (BY TYPE) ...........................................16 FIGURE 5 - NUMBER OF CU5 CASES DIAGNOSED AND TREATED BY CHVS: Q4 2019 – Q2 FY2020 (BY DISEASE) ...............................17 FIGURE 6 - NUMBER OF GIRLS AND WOMEN USING FAMILY PLANNING SERVICES FROM PROGRAM CHVS, BY AGE GROUP, Q2 FY2020 ...................................................................................................................................................................................19 FIGURE 7 - NEW FAMILY PLANNING USERS IN THE PROGRAM, BY AGE GROUP, Q2 FY2019 COMPARED TO Q2 FY2020 ....................19 FIGURE 8 – TREND IN INJECTABLE CONTRACEPTIVES DISTRIBUTED FROM Q1 2019 TO