TOLIARA REGIONAL EXPANDED IMPACT PROJECT ATSIMO ANDREFANA REGION, MADAGASCAR ANNUAL REPORT FISCAL YEAR 2007 OCTOBER 2006 – SEPTEMBER 2007 MADAGASCAR Cooperative Agreement#: GHS-A-00-06-00007 Submitted: November 29, 2007 Medical Care Development International 8401 Colesville Rd., Suite 425 Silver Spring, MD 20910, USA Telephone: (301) 562-1920 Fax: (301) 562-1921 Internet Electronic Mail: [email protected] World wide web Url: www.mcd.org 1 Contributing Writers and Editors Madagascar Field Office: Josea Ratsirarson, Chief of Party Madagascar (Principal Author) Washington, DC Home Office: Dr. Luis Benavente (Child Survival Coordinator) Dr. Yaikah Jeng-Joof, International Health Program Officer Marie-Louise Orsini, International Health Program Associate Sabriya Linton MPH, International Health Program Associate Patricia High MHS, International Health Program Associate 2 ACRONYMS ACT : Artemisinin-based Combination Therapy AME : Allaitement Maternel Exclusif/ Exclusive Maternal Breastfeeding ARI : Acute Respiratory Infections ASB : Agent de Santé de Base/ Basic Health Agent ASBC : Agent de Service à Base Communautaire/ Community Service Agent AVBC : Agent de Vente à Base Communautaire/ Community Sales Agent BASICS : Basic Support for Institutionalizing Child Survival CCC : Communication pour le Changement de Comportement/ Behavior Change Communication (BCC) CCD : Comité Communal de Développement/ Community Development Committee CCM : Community Case Management CDS : Comité de Développement Social/ Social Development Committee CPN : Consultation PréNatale/ Prenatal Consultation CS : Child Survival CSB : Centre de Santé de Base/ Basic Health Center CSTS : Child Survival Technical Support CRESAN : Crédit pour la Santé (Projet de la Banque Mondiale)/ Health Credit (World Bank Project) DIP : Detailed Implementation Plan DRSPF : Direction Régionale de la Santé du Planning Familial/Regional Management for Family Planning Health DSFA : Direction de la Santé Familiale/Family Health Management EMAD : Equipe de Management du District/ District Management Team FAR : Femme en Age de Reproduction/Women of Reproductive Age (WRA) FAF : Fer Acide Folique/Folic Acid and Iron FDF : Formation des Formateurs/Training of Trainers FF : Flexible Fund 3 FGD : Focus Groupe Dirigé/ Focus Group Discussion FY : Année Fiscale/Fiscal Year HFA : Health Facility Asssessment IEC : Information Education Communication IRA : Infection Respiratoires Aigues/Acute Respiratory Infections ISTs/SIDA : Infection Sexuellement Transmissible/Syndrome d’Immuno Déficience Acquise / Sexually Transmitted Infections/ AIDS JHU : Johns Hopkins University KAP : Knowledge Attitudes Practices – KAP KM : Kominina Mendrika (Commune Championne) KPC : Knowledge, Practice and Coverage MAP : Madagascar Action Plan MCDI : Medical Care Development International MINSANPFPS : Ministère de la Santé du Planning Familial et de la Protection Sociale/ Ministry of Health of Family Planning and Protection OMS : Organisation Mondiale de la Santé/ World Health Organization ONG : Organisation Non Gouvernementale/Non Governmental Organization ONN : Office National de Nutrition/ Office of National Nutrition ORS : Oral Rehydration Solution PCIME : Prise en Charge Intégrée des Maladies des Enfants/ Integrated Management of Childhood Illnesses (IMCI) PCIME-C : Prise en Charge Intégrée des Maladies des Enfants niveau Commun- autaire/ Grassroots Integrated Management of Childhood Illnesses PEV : Programme Elargi de Vaccination/ Expanded Immunization Program PF : Planning Familial/ Family Planning PSI : Population Services International PMI : The President’s Malaria Initiative PNC : Prenatal Consultation QAS : Quality Assurance System RAA : Région Atsimo Andrefana/ Atsimo Andrefana Region RSO : Région Sud Ouest: South West Region 4 SRO : Solution de Réhydratation Orale SSD : Service De Santé de District/ District Health Service SSEA : Service de Santé de l’Enfant et de l’Adolescent/Child and Teen Health Service SSME : Semaine de la Santé de la Mère et Enfant/ Mother and Child Health Week TREIP : Toliara Region Expanded Impact Project TRO : Traitement par Réhydratation Oral/ Oral Rehydration Treatment UNICEF : Fonds des Nations Unies pour l’Enfance/ United Nations Children’s Fund USAID : United States Agency for International Development VEMIMA : Vehivavy Miara-Mandroso VISA : Visiter Identifier Sensibiliser Accompagner/Visit Identify Sensitize and Accompany 5 Table of Contents Introduction................................................................................................................................8 A. Main Accomplishments during FY 2007 ....................................................................... 10 I. Preparation of the Situation Analysis and DIP for Presentation at Mini University 10 i. Health Situation Analyses ..........................................................................10 ii. Preparation of the DIP ................................................................................11 iii. DIP Finalization and Review .....................................................................13 II. Establishment of the Showcase and Demonstration Districts ...............................13 III. Establishment and Start-up of Community Case Management (CCM).................16 IV. Materialization of Partnerships..............................................................................17 i. Contract with SantéNet ..............................................................................17 ii. Collaboration with UNICEF.......................................................................19 iii. Contribution to National Efforts ................................................................20 iv. Collaboration with the Global Fund Round 7.............................................20 v. Continuation of Activities in Previous Districts ..........................................21 V. Factors Contributing to the Success of TREIP Implementation.............................21 VI. Progress Towards Project Scale-Up ......................................................................23 VII. Strategies for Advancing the Scale-Up Process...................................................23 B. Factors Impeding Progress ..............................................................................................53 C. Fields that Required Technical Assistance ....................................................................54 D. Changes to be Made in the DIP ......................................................................................55 E. Monitoring Plan.................................................................................................................55 F. Sustainability Plan.............................................................................................................61 I. Steps to be Taken....................................................................................................61 II. Targets Completed and to be Completed ................................................................61 L. Description of Program Management System ...............................................................62 I. Financial Management System ...............................................................................62 II. Human Resources ...................................................................................................62 i. Expansion of the Office Staff .......................................................................63 ii. Capacity Building of Staff...........................................................................63 III. The System for Communication and Team Building ............................................64 IV. MCDI’s Relationship with Local Partners ...........................................................64 6 V. Coordination and Collaboration in the Country ...................................................65 M. Collaboration with the Mission and its Bilateral Project.............................................67 N. Timeline of Activities (October 2007-September 2008).................................................68 O. Results Highlight...............................................................................................................73 I. Innovative Ideas.......................................................................................................73 i. The Coaching System ....................................................................................73 II. Description of Promising Practices........................................................................73 i. Community Case Management.....................................................................73 ii. Kominina Mendrika......................................................................................77 III. Description of Improvement in Local Institutions Capacity.................................78 R. Annexes .............................................................................................................................79 Annex 1. Methodology for surveys conducted.............................................................79 Annex 2. Main results of household surveys ...............................................................84 Annex 3. Main results of health center surveys ...........................................................89 Annex 4. Answers to DIP Reviewers ...........................................................................92 Annex 5. Publication/presentations ............................................................................136