Mhuri/ Imuli Project Cooperative Agreement Number: 72061318-CA-00008 Baseline report September 2018 Table of Contents Abbreviations ................................................................................................................................ 4 Executive Summary ...................................................................................................................... 5 1.Introduction ................................................................................................................................ 8 Background ............................................................................................................................... 8 Rationale .................................................................................................................................... 9 2. Methods ................................................................................................................................... 10 Design ....................................................................................................................................... 10 Study setting ............................................................................................................................ 11 Data management ................................................................................................................ 12 Data Collection and tools ................................................................................................. 12 Data analysis ........................................................................................................................ 12 Ethical Review ...................................................................................................................... 12 3.Results ........................................................................................................................................ 13 3.1 Percentage of Institutional deliveries ............................................................................. 14 3.2 Proportion of pregnant women booked for 1st ANC before 16 weeks ............... 14 3.3 Percent of pregnant women attending at least 4 ANC visits ............................... 15 3.4 Number and percentage of pregnant women attending ANC who receive Intermittent preventive treatment for malaria ................................................................... 15 3.5 Women giving birth who received uterotonics through USG support ................. 16 3.6 Percentage of newborns not breathing at birth who were resuscitated ............ 16 3.7 Percentage of Low Birth Weight babies initiated on KMC .................................... 16 3.7 Proportion of infants who were breastfed within an hour of birth ....................... 17 3.8 Child Mortality .............................................................................................................. 18 3.9 Neonatal and perinatal mortality ........................................................................... 18 3.10 Increased number of PHC facilities meeting BEmONC standards and referrals for CEmONC .................................................................................................................................. 18 3.11 Number of cases of child diarrhea treated in facilities and/or by community health workers in USG assisted program areas ................................................................... 19 3.12 Contraceptive Prevalence Rate (mCPR) ............................................................. 19 3.13 Proportion of facilities providing post abortion Care (PAC) ..................................... 20 3.14 Proportion of children with fever screened for malaria with RDT at community level ................................................................................................................................................... 21 3.15 Summary of baseline indicator values .................................................................. 21 2 4. Discussion ................................................................................................................................. 26 Limitations ................................................................................................................................ 28 5. Conclusion and Recommendations ............................................................................. 30 Programmatic recommendations ....................................................................................... 30 Research and Data recommendations .............................................................................. 31 References .................................................................................................................................. 32 Appendix 1: Data Collection Tool ............................................................................................ 33 3 Abbreviations ANC Antenatal Care e ARK Absolute Return for Kids BEmONC Basic emergency obstetric and newborn care CEmONC Comprehensive emergency obstetric and newborn care FP Family planning ICDS Inter-censal demographic survey IMNCI Integrated management of childhood illnesses. IPTp Intermittent preventive treatment of malaria in Pregnancy IUCDs Intra-Uterine contraceptive devices KMC Kangaroo mother care LARCs Long-acting reversible contraceptives MCHIP Maternal Child Health Integrated Program MNCH-FP Maternal newborn child health-family planning mCPR Modern contraceptive prevalence rate (mCPR) MoHCC Ministry of Health and Child Care MVA Manual vacuum aspiration PAC Post Abortion Care PIH Pregnancy induced hypertension PPH Postpartum hemorrhage USAID United States Agency for International Development USG United States Government VMAHS Vital Medicines Availability and Health Survey WHO World Health Organization ZNFPC Zimbabwe National Family Planning Council This report is made possible by the support of the U.S. Government and American people through the United States Agency for International Development (USAID). The contents of this report are the responsibility of FHI 360 and do not necessarily reflect the views of USAID or the United States Government. 4 Executive Summary Introduction The Mhuri/Imuli project is a five-year USAID-funded activity (2018 – 2023) aimed at improving maternal, new-born, child health and family planning (MNCH-FP) in Zimbabwe’s Manicaland Province, working in collaboration with the Ministry of Health and Child Care (MOHCC), and the Zimbabwe National Family Planning Council (ZNFPC) for countrywide FP service provision. In Zimbabwe, the maternal mortality ratio of 651 maternal deaths per 100,000 live births is way above global averages and is not on track to meet the Government of Zimbabwe (GOZ) target of 300 maternal deaths per 100,000 live births by 2020. Despite progress made in improving Zimbabwe’s MNCH and FP status, challenges persist. While the use of facility-based services has increased they are not easily accessed by some populations, and cultural and religious beliefs – specifically the apostolic sects- inhibit women from seeking services for themselves and their children. As part of the roll-out of the Mhuri/Imuli project and to facilitate evidence-informed planning, the project conducted a desk review of existing MNCH interventions in Manicaland province and FP activities nationally as a baseline. Methods We developed a data extraction tool to collect information from various sources including national surveys, the national District Health Information System (DHIS2), national strategies, annual MOHCC reports and reports from the Maternal, Newborn and Child Health Integrated Project (MCHIP) which was the predecessor project to Mhuri/Imuli. Data was extracted for maternal, new born, child health and family planning (MNCH-FP) for Manicaland and only for FP in the other provinces. Data for Manicaland MNCH-FP indicators were disaggregated by district wherever possible while FP, impact and outcome level indicators were disaggregated by province where data was available. Data were summarized using frequencies, proportions and presented in graphs and tables generated in Microsoft Excel. There was no ethical clearance required for this desk review as it involved secondary data obtained from published reports. All data sources were acknowledged in the report. 5 Results Manicaland province’s performance is lower than national averages for most MNCH-FP indicators. Manicaland province has the lowest modern contraceptive prevalence rate (mCPR) at 57%. At 37%, the provincial proportion of first ANC visits below 16 weeks is below the national target of 40%. There are seven districts in Manicaland. District comparisons show that among women who seeking antenatal care only 24% register before 16 weeks in Mutare District, which is the lowest in the province (compared to Buhera district in which 58% seek care before they are sixteen weeks pregnant. Only 60% of women in Manicaland attended all four ANC visits and only 53% received the recommend three doses of IPTp, way less than the national average of 81%. Manicaland province has the third highest under five-mortality rate, the second-highest neonatal mortality and the highest peri-natal mortality in Zimbabwe. BEmONC coverage (six signal functions) in the province ranges from 0-6%. There is no data on facilities that provide 5 signal BEmONC functions. Twenty percent of primary health facilities in Manicaland offer post abortion care, with only 6% reported offering manual