FORM #3 Grants Solicitation and Management Quarterly Progress Report Grantee Name: Maternal and Child Survival Program Grant Number: # AID-OAA-A-14-00028 Primary contact person regarding this report: Mira Thompson ([email protected]) Reporting for the quarter Period: Year 3, Quarter 1 (October –December 2018) 1. Briefly describe any significant highlights/accomplishments that took place during this reporting period. Please limit your comments to a maximum of 4 to 6 sentences. During this reporting period, MCSP Zambia: Supported MOH to conduct a data quality assessment to identify and address data quality gaps that some districts have been recording due to inability to correctly interpret data elements in HMIS tools. Some districts lacked the revised registers as well. Collected data on Phase 2 of the TA study looking at the acceptability, level of influence, and results of MCSP’s TA model that supports the G2G granting mechanism. Data collection included interviews with 53 MOH staff from 4 provinces, 20 districts and 20 health facilities. Supported 16 districts in mentorship and service quality assessment (SQA) to support planning and decision-making. In the period under review, MCSP established that multidisciplinary mentorship teams in 10 districts in Luapula Province were functional. Continued with the eIMCI/EPI course orientation in all Provinces. By the end of the quarter under review, in Muchinga 26 HCWs had completed the course, increasing the number of HCWs who improved EPI knowledge and can manage children using IMNCI Guidelines. In Southern Province, 19 mentors from 4 districts were oriented through the electronic EPI/IMNCI interactive learning and had the software installed on their computers. Seventy-eight (78) HCWs were oriented in Southern Province with 19 receiving certificates of completion. The remaining HCWs will complete the course in the subsequent quarter. 2. Briefly describe any unforeseen obstacles or challenges that are having a negative impact on the implementation of the grant activity. For any mentioned, please describe your possible strategy for resolution. The late disbursement of 2018 G2G CoC grants to the districts affected MCSP’s plans to provide TA during implementation of the 2018 district plans. MCSP has been following up with the CoC coordinators to reschedule these activities, and at the same time providing TA during implementation of GRZ-funded activities. 3. Please describe activities to monitor field activities and ensure compliance with USAID family planning and commodity regulations as described in Appendix 2. Activities may include staff training, supervision visits, observation, monitoring of reports, etc. Please indicate whether there are any concerns or questions. All MCSP staff at the national and provincial levels have taken the 2018 version of the US Abortion and FP Compliance and Protecting Life in Global Health Assistance courses on Global Health eLearning Center as required by USAID. The certificates are on file in the MCSP Zambia office. MCSP continues to ensure that all staff are oriented to FP compliance and are trained and certified so that they are able to prevent and look out for any violations. Staff will be reminded to update their certification for the two courses for 2019 in the subsequent reporting period. MCSP has continued to emphasize to MOH at all levels the need for compliance with FP rules and regulations. This TA has also included recommendations for MOH personnel to take the appropriate online courses on Global Health eLearning Center. In provinces where non-USG funds are available together with USG, MCSP has provided TA to MOH personnel to clearly indicate and separate funds that come from other sources to ensure that USG funds are not used for services that may violate these requirements. MCSP staff have been carrying out internal monitoring related to compliance with the mentioned statutes and policies. During the reporting period, no violation of the relevant statutes has been identified. MCSP distributed FP Wall Charts (Do You Know Your Family Planning Choices, 2017) to health care facilities and had them displayed in accessible positions to allow FP clients make more informed family planning choices 4. Briefly comment on the status of the activity as compared with the agreed-to work plan. Mention whether you are behind, basically consistent with, or ahead of the work plan. Objective 1: Provide demand-driven technical assistance for sustainable scale up of RMNCAH&N intervention across the four focus provinces of Zambia. Provided TA for Maternal and Reproductive Health: Followed up on TA offered on the health facilities to admit mothers for 48 hours post- delivery to promote the health of mothers and newborns and prevent perinatal and maternal deaths, which are most likely to occur within 48-72 hours post-delivery. Followed up on TA given to the districts on labor management using a partograph. Mafinga District in Muchinga and Chipata, Nyimba, Katete and Chadiza Districts in Eastern Province have since conducted mentorship on partograph use. 5 staff were mentored in Chipata District and 3 out of 5 partographs at Nyimba District Hospital were correctly completed. Mansa General Hospital staff are now comfortably managing women in labor using the partograph and the gaps identified in the previous TA were addressed. Provided TA on Infection Prevention and Control (IPC) Guidelines and new labor ward at CGH, working closely with the PNO MNCH and the Nursing Officer at Chinsali General Hospital. The IPC practices at the labor ward showed a marked improvement and IP buckets were brought into the delivery room with a new designated IPC corner well labeled for easy identification. This will prevent sepsis in mothers and their newborns. Followed up with Health Facility Labor Ward teams in all four provinces who received TA on the importance of using recommended protocols in the management of obstetric emergencies. In Muchinga Province, 10 health facilities are now holding clinical meetings (32 meetings so far) to improve skills in emergencies. Staff have testified that the meetings are very helpful and meetings provide opportunities for revisions and skill acquisition and strengthening. In Luapula Province, Luamfumu Health Facility procured emergency kits for PPH and eclampsia, and both are well labeled for use in emergencies. Continued to provide technical assistance to MOH to review maternal perinatal deaths and determine how to promptly respond to them. In Southern Province, MCSP supported Kalomo District following 3 maternal deaths that occurred in the district in the 3rd quarter of 2018. Based on MCSP’s guidance and recommendations, Kalomo District has re-oriented 52 health care workers in new maternal referral guidelines, conducted one round of obstetric emergency drills at the district hospital, and installed or repaired resuscitative equipment in two ambulances. In Eastern Province, MCSP supported Nyimba, Katete and Chipata Districts and EPHO during their PNMDSR meetings with appropriate recommendations being made. Supported MOH in conducting DQA in Southern and Luapula Provinces in collaboration with SBH. In Luapula Province, Chipili District reported that ANC < 14 weeks was at 95% in Quarter 3 2018. All facilities visited over reported in HIA2 compared to their facility registers. The actual Quarter 3 2018 data reviewed showed 65% coverage instead of 95%. MCSP guided the district team to ensure that there was close supervision of HF staff in registers updating and used as primary source of data when reporting. Followed up on quality improvement projects identified in QI projects orientation and SQA. Five districts have developed QI projects in maternal health and are at different stages: o Chienge, Luapula Province: Reducing post caesarian infected wounds in postnatal ward at Chienge District Hospital o Milenge, Luapula Province: Increasing capacity among HCWs in infection prevention and control at Milenge East HC o Mwense, Luapula Province: Increasing Access to ANC 1st visit <14 weeks GA at Kalaba RHC o Chembe, Luapula Province: Increasing integrated outreach in FANC services in Chikola RHC o Chadiza, Eastern Province: Increasing institutional deliveries Continued implementing the LNG IUS study in collaboration with SM360+ in Luapula, Eastern and Muchinga Provinces. In Eastern Province, MCSP and SM360+ teams offered TA to Mafuta RHC as the HF is a study site. MCSP oriented Safe Motherhood Action Groups in FP messages to create demand for LARC in the community, to reduce unwanted pregnancies that result in obstetric emergencies. 3 staff from Chipata Central Hospital were offered mentorship at Mwasemphangwe ZHC Provided TA for Essential Newborn Care: Followed up on Technical Assistance visits during implementation of 2018 CoC grants. MCSP conducted TA visits to 6 health facilities in Muchinga and 11 facilities in Eastern province to ascertain levels of compliance to recommendations made during the previous visits. All the visited facilities acted on most of the recommendations, which included infection prevention, creation of resuscitation spaces and KMC. The follow up visits focused on the following areas and technical assistance was provided for gaps identified. o Infection Prevention: Follow up visits were made to TAZARA Clinic, Mpumba RHC, and Mpika Urban Clinic on infection prevention in labor wards. All three facilities procured small IPC buckets for reprocessing and storage of neonatal resuscitation equipment, so