k Mayer Hashi-II Family Planning Project in Bangladesh (MH-II) QUARTERLY REPORT Reporting Period: October 1–December 31, 2017 Project Year 5, Quarter 1 Submitted to: Office of Population Health, Nutrition and Education United States Agency for International Development USAID/Dhaka By MH-II Project Associate Cooperative Agreement No. AID-388-LA-13-00002 Under Leader Award No. GPO-A-00-08-00007-00 Date of Submission January 31, 2018 1 | Page TABLE OF CONTENTS Table of Contents 2 Acronyms 3 Executive Summary 5 1. Major program results and achievements 7 2. Challenges 13 3. Program management 14 4. Next steps 15 Annex 1. Activity description and achievements in Q1 16 Annex 2. Indicator Tracking Table: Target vs. Achievement for PY5 Q1 46 2 | Page ACRONYMS ADCC Assistant Director, Clinical Contraception AFWO Assistant Family Welfare Officer AHI Assistant Health Inspector ANC Antenatal care AUFPO Assistant Upazilla Family Planning Officer BCO Bangladesh Country Office CC Community clinic CCSDP Clinical Contraceptive Services Delivery Program CHCP Community Health Care Provider CYP Couple-years of protection DDFP Deputy Director Family Planning DDM Data for Decision Making DG Director General DGFP Directorate General of Family Planning DGHS Directorate General of Health Services DHIS District Health Information System DQA Data Quality Assessment EPI Expanded Program on Immunization FP Family planning FPCS-QIT Family Planning Clinical Supervision-Quality Improvement Team FPI Family Planning Inspector FPO Family Planning Office FWA Family Welfare Assistant FWC Family Welfare Center FWV Family Welfare Visitor GOB Government of Bangladesh HI Health Inspector ICT Information communication technology ICV Informed consent and voluntarism iDQA Internal data quality assessment IEC Information, education, communication IPC Interpersonal communication IR Intermediate result IUD Intrauterine device KM Knowledge management LARC Long-acting reversible contraception LD Line Director M&E Monitoring and evaluation MaMoni HSS MaMoni Health Systems Strengthening Project 3 | Page MCH Maternal and child health MCWC Maternity and Child Welfare Center ME&R Monitoring, evaluation, and research MH-II Mayer Hashi II FP Project in Bangladesh MIS Management information system MO Medical Officer MOHFW Ministry of Health and Family Welfare MOU Memorandum of Understanding NGO Nongovernmental organization NSV No-scalpel vasectomy NXT Implanon NXT OGSB Obstetrics and Gynecological Society of Bangladesh OP Operational Plan PHC Primary health care PM Permanent method (of contraception) PNC Postnatal care PPFP Postpartum FP PSA Professional Services Agreement PY5 Project year 5 Q1 Quarter 1 QA Quality assurance QI Quality improvement QIC Quality Improvement Committees QIS Quality Improvement Secretariat RH Reproductive health RTC Regional Training Center SACMO Sub-Assistant Community Medical Officer SBCC Social and behavior change communication SMS Short messaging system SRHR Sexual and reproductive health and rights TA Technical assistance TOT Training of Trainers UFPO Upazilla Family Planning Officer UH&FPO Upazilla Health and Family Planning Officer UHC Upazilla Health Complex UNFPA United Nations Population Fund USAID United States Agency for International Development YPSA Young People in Social Action 4 | Page EXECUTIVE SUMMARY The Mayer Hashi II Project (MH-II), the family planning (FP) project in Bangladesh, successfully completed its fourth year on September 30, 2017. MH-II was initially a four-year project from October 1, 2013—September 30, 2017 under a Leader with Associate Cooperative Agreement awarded by the United States Agency for International Development (USAID). USAID granted a one-year funded extension to MH-II (October 2017—September 2018) with a different strategic approach in specific, targeted geographic areas1 for systems strengthening, working closely with Ministry of Health and Family Welfare (MOH&FW) and local nongovernmental organizations (NGOs). Overall, in project year 5 (PY5), MH-II, still aims to improve the use of reproductive health (RH) and FP services with an emphasis on informed and voluntary use of long-acting reversible contraception (LARC) and permanent methods (PMs). This progress report covers the first reporting quarter (Q1) of PY5, from October 1--December 31, 2017. The total couple-years of protection (CYP) achieved during this period is 130,230, which is 22% of the annual project benchmark (588,189). This slight variation of achieving CYP benchmark is due to the preparatory work undertaken by the project in establishing three districts offices, and downsizing the staffs and the Dhaka office. These preparatory activities delayed our interventions at field level. During this period, MH-II supported 657 health facilities, which is 96% of the annual benchmark (687). The project provided support to the Directorate General of Family Planning (DGFP) in organizing 471 special FP service delivery days by engaging surgeons, mobilizing clients, and providing logistic supports in Q1. The special FP service delivery days served 8,158 LARC and PM clients, which is 14% of the annual benchmark. MH-II projects reaching 60,000 LARC and PM clients through special FP service delivery days over the course of the full PY5. MH-II developed a training plan based on findings from the mapping of training needs for LARC and PM service providers. During Q1, 308 service providers received training through support from the project, which is 4% of the annual training benchmark (8,795). In Q1, four batches of basic LARC and PM training were conducted in three districts in coordination with DGFP Regional Training Centers (RTCs). A total of 20 newly-recruited doctors received the training. The project conducted three batches of refresher training on intrauterine device (IUD) service provision for 38 Family Welfare Assistants (FWAs), Female Sub-Assistant Community Medical Officers (SACMOs), and doctors. To ensure hands-on practice, both the LARC and PM trainings and IUD refresher trainings were linked with special FP service delivery days. DGFP staff conducted these trainings with support from MH-II. Ninety-eight percent of the providers trained were deemed performing to standard on LARC and PM by the end of the training. 1 Mayer Hashi II’s geographic focus for PY5 is in three districts (Sylhet, Khulna, and Comilla) in 38 Upazillas and 37 hard-to-reach Upazillas, totaling 75. 5 | Page To build capacity on training facilitation skills for 14 trainers from the three project-supported districts the project provided a Training of Trainers (TOT) on Training Skills Standardization in Q1. These trainers will facilitate clinical and non-clinical training and orientation on LARC/PMs, rights-based FP counseling, and facilitative supervision. All training will be conducted in project- supported Skills Labs in the three districts. The project provided an additional TOT on rights-based FP counseling for 95 participants (Medical Officers, Maternal and Child Health and Family Planning [MO, MCH-FP], Upazilla Family Planning Officers [UFPOs], and Assistant Upazilla Family Planning Officers [AUFPOs]). The trainers who received this TOT conducted six batches of cascade trainings on rights-based FP counseling for 115 FWAs and FP Inspectors (FPIs) in Sylhet. According to the project’s PY5 workplan, MH-II will help to establish three “Skills Labs” in the three DGFP RTCs in Comilla, Khulna, and Sylhet that provide all clinical and non-clinical training for these districts. In preparation, the project held several advocacy meetings with the Line Director (LD) of the Clinical Contraceptive Services Delivery Program (CCSDP)/DGFP, and equipped two centers (one didactic and one for clinical practice) for each of the three Skills Labs. MH-II procured the majority of the furniture and equipment for these Skills Labs during Q1. In addition, the project completed the facility mapping, developed a list of required items, and provided TOTs to the trainers from the three Skills Labs on training skills standardization, clinical skills standardization, and rights-based FP counselling. The vacancy of 20% of DGFP field worker positions inhibited the project’s demand-side work during Q1. Of primary concern was the limited number of field workers available to conduct home visits to provide quality FP information for potential LARC and PM users. To address this issue, MH-II engaged local NGO partners to conduct demand-generation work and refer potential user to facilities for FP special service delivery days. While Sub-award agreements in Comilla and Khulna were completed during Q1 and Memorandums of Understanding (MOU), the agreement and MOU with the local NGO partner in Sylhet district is expected to be completed in Q2. In Q1, the project revised its monitoring and evaluation (M&E) Plan for PY5, which was submitted to USAID for review. The project also updated its Knowledge Management (KM) Plan to include PY5 activities. To ensure the quality of data collected and reported, MH-II conducted three joint Data Quality Assessments (DQAs) with the DGFP. Based on findings from these DQAs, some client consent forms lack complete data, such as client numbers, phone numbers, and national ID numbers. The project discussed these findings with DGFP local level managers, and advocated for follow-up with the FP service facilities and MH-II district teams followed-up with the providers from respective facilities to ensure the completion of consent forms. 6 | Page 1. MAJOR PROGRAM RESULTS AND ACHIEVEMENTS