MCHIP Guinea End-of-Project Report October 2010–June 2014 Submitted on: September 15, 2014 Submitted to: United States Agency for International Development under Coooperative Agreement # GHS-A-00-08-00002-000 Submitted by: Yolande Hyjazi, Rachel Waxman and Bethany Arnold 1 The Maternal and Child Health Integrated Program (MCHIP) is the USAID Bureau for Global Health’s flagship maternal, neonatal and child health (MNCH) program. MCHIP supports programming in maternal, newborn and child health, immunization, family planning, malaria, nutrition, and HIV/AIDS, and strongly encourages opportunities for integration. Cross-cutting technical areas include water, sanitation, hygiene, urban health and health systems strengthening. MCHIP brings together a partnership of organizations with demonstrated success in reducing maternal, newborn and child mortality rates and malnutrition. Each partner will take the lead in developing programs around specific technical areas: Jhpiego, as the Prime, will lead maternal health, family planning/reproductive health, and prevention of mother-to-child transmission of HIV (PMTCT); JSI—child health, immunization, and pediatric AIDS; Save the Children—newborn health, community interventions for MNCH, and community mobilization; PATH—nutrition and health technology; JHU/IIP—research and evaluation; Broad Branch—health financing; PSI—social marketing; and ICF International—continues support for the Child Survival and Health Grants Program (CSHGP) and the Malaria Communities Program (MCP). This report was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of the Leader with Associates Cooperative Agreement GHS-A-00-08-00002-00. The contents are the responsibility of the Maternal and Child Health Integrated Program (MCHIP) and do not necessarily reflect the views of USAID or the United States Government. 2 Country Summary: Guinea Selected Health and Demographic Data for Guinea GDP per capita (USD) 440 Total population (millions) 11.1 Maternal mortality ratio (deaths/100,000 live 724 births) Skilled birth attendant coverage 45 Antenatal care, 4+ visits 57 Neonatal mortality rate (deaths/1,000 live 33 births) Infant mortality rate (deaths/1,000 live births) 67 Under-five mortality (deaths/1,000 live births) 123 Treatment for acute respiratory infection 38 Oral rehydration therapy for treatment of 34 diarrhea Diphtheria-pertussis-tetanus vaccine coverage 50 (3 doses) Modern contraceptive prevalence rate 7 Total fertility rate 5.1 Total health expenditure per capita (USD) 32 Sources: World Bank; Ministère Plan 2012; DHSIV. Major Activities by Program . Expand the family planning method mix with long-acting reversible and permanent methods; integrate family planning with postabortion and postpartum care . Integrate the Standards-Based Management and Recognition (SBM-R®) methodology in hospitals and health centers . Strengthen comprehensive emergency obstetric and newborn care and prevention of mother-to-child transmission of HIV services in hospitals and urban health centers . Strengthen community-based health communications and services for family planning, birth planning and complication recognition, management of childhood illness, malaria prevention and treatment, and prevention of postpartum hemorrhage in home deliveries . Update health strategy documents, protocols, and national health management information system indicators and tools . Support pre-service education for the medical faculty and the national midwifery school Program Dates October 2010–June 2014 Total Mission Funding to Family Planning: $3,682,000; Maternal and Child Health: $3,406,000; HIV: Date by Area $999,000; Malaria: $521,879; Incentive Funds for Gender-Based Violence: $400,000 Total Core Funding to Family Planning: $66,108; Date by Area Maternal and Child Health: $156,824 Geographic Coverage No. (%) of 4/8 (50%) No. of 20/38 No. of 234/461 provinces districts (53%) facilities (51%) Country and HQ Contacts Prof. Yolande Hyjazi: [email protected]; Gassim Cisse: [email protected]; Rachel Waxman: [email protected]; Bethany Arnold: [email protected]; Tsigué Pleah: [email protected]; Blami Dao: [email protected]; Serge Raharison: [email protected]; Winifride Mwebesa: [email protected] 3 Table of Contents Country Summary: Guinea .................................................................................................................. 3 Table of Contents .................................................................................................................................. 4 List of Tables and Figures ................................................................................................................... 6 Acronyms and Abbreviations ............................................................................................................... 7 Acknowledgments ................................................................................................................................. 8 Executive Summary: Guinea ............................................................................................................... 9 Introduction ........................................................................................................................................ 15 Major Accomplishments ..................................................................................................................... 18 Family Planning .............................................................................................................................. 18 MCHIP Interventions .................................................................................................................. 18 Improved Access, Utilization and Quality of FP services ......................................................... 21 Challenges, Responses and Lessons ........................................................................................... 23 Maternal and Newborn Health ...................................................................................................... 25 MCHIP Interventions .................................................................................................................. 25 Improved Access, Utilization and Quality of MNH services .................................................... 29 Challenges, Responses and Lessons ........................................................................................... 31 Child Health .................................................................................................................................... 32 MCHIP Interventions .................................................................................................................. 32 Improved Access, Utilization and Quality of Child Health Services ....................................... 35 Challenges, Responses and Lessons ........................................................................................... 36 Community Health ......................................................................................................................... 37 MCHIP Interventions .................................................................................................................. 37 Improved Access, Utilization and Quality of Community-based Health Services ................. 40 Challenges, Responses and Lessons ........................................................................................... 41 Pre-Service Education .................................................................................................................... 42 MCHIP Interventions .................................................................................................................. 42 Improved Functioning and Quality of Pre-service Education .................................................. 44 Challenges, Responses and Lessons ........................................................................................... 46 Malaria (October 2011 to December 2012) .................................................................................... 47 MCHIP Interventions .................................................................................................................. 47 Quality Improvement: The Standards-Based Management and Recognition methodology (SBM-R) ........................................................................................................................................... 49 Outcomes of the focus on quality and standards ...................................................................... 51 Challenges, Responses and Lessons ........................................................................................... 52 Monitoring and evaluation (m&e) strengthening ......................................................................... 55 Data quality improvement .......................................................................................................... 56 4 Challenges, Responses and Lessons ........................................................................................... 56 Infection Prevention ........................................................................................................................ 58 mHealth and mMentoring .............................................................................................................. 60 Prevention,