Santénet2 REVISED ANNUAL REPORT No. 4 October 2011–September 2012 ©Santénet2/ASOS Central: Community members in village taking patient to CSB of Marofotra commune, Manakara DECEMBER 2012 This publication was produced for review by the United States Agency for International Development. It was prepared by RTI International. REVISED ANNUAL REPORT No. 4 October 2011–September 2012 Contract GHS-1-01-07-00005–00 Prepared for Robert Kolesar, COR USAID/Madagascar Prepared by RTI International 3040 Cornwallis Road Post Office Box 12194 Research Triangle Park, NC 27709-2194 RTI International is one of the leading research institutes in the world and is dedicated to improving human condition by turning knowledge into practice. Its staff of more than 2,800 people provides research and technical services to governments and businesses in over forty countries in the areas of health, pharmaceuticals, education & training, surveys & statistics, advanced technology, democratic governance, economic and social development, energy, and environment. For more information, please visit www.rti.org Table of Contents ACRONYMS ................................................................................................................................................ V INTRODUCTION ............................................................................................................................................... 7 TECHNICAL COMPONENTS ............................................................................................................................. 22 COMPONENT1: COMMUNITY PROGRAMS ..................................................................................................... 22 SPECIFIC ACHIEVEMENTS .................................................................................................................................. 23 Strategic Focus 1. Making tools available to community actors ............................................................... 23 a. Approaches............................................................................................................................................... 23 b. Results ...................................................................................................................................................... 23 Strategic Focus 2. Implementing a mass BCC strategy ............................................................................. 25 a. Approaches ............................................................................................................................................... 25 b. Results ...................................................................................................................................................... 25 c. Challenges and corrective actions .............................................................................................................. 31 Strategic Focus 3. Implementing the new strategy for mutual health insurance schemes ......................... 31 a. Approaches............................................................................................................................................... 31 b. Results ...................................................................................................................................................... 32 c. Challenges and corrective actions .............................................................................................................. 37 COMPONENT 2: STRENGTHENING COMMUNITY HEALTH SYSTEMS ............................................................... 41 SPECIFIC ACHIEVEMENTS .................................................................................................................................. 42 Strategic Focus 1. Engaging the community in improving the quality of health services ........................... 42 a. Approaches............................................................................................................................................... 42 b. Results ...................................................................................................................................................... 42 Strategic focus 2: Ongoing coaching and supervision of CHVs ................................................................. 46 a. Approaches............................................................................................................................................... 46 b. Results ...................................................................................................................................................... 46 Strategic focus 3: Building the analytical and decision-making capacities of the KM salama stakeholders 50 a. Approaches............................................................................................................................................... 50 b. Results ...................................................................................................................................................... 50 Strategic focus 4: Ongoing availability of health products for CHVs ......................................................... 51 a. Approaches............................................................................................................................................... 51 b. Results ...................................................................................................................................................... 51 CHALLENGES AND CORRECTIVE ACTIONS ............................................................................................................... 54 COMPONENT 3: STRATEGIC RESULTS ............................................................................................................. 55 SPECIFIC ACHIEVEMENTS .................................................................................................................................. 57 Strategic focus 1: Providing quality integrated services to improve MCH ................................................. 57 c. Approaches............................................................................................................................................... 58 d. Results ...................................................................................................................................................... 58 Strategic focus 2: Consolidating quality integrated RH/FP service provision ............................................. 66 a. Approaches............................................................................................................................................... 67 b. Results ...................................................................................................................................................... 67 Strategic focus 3: Controlling malaria at the community level ................................................................. 74 a. Approaches............................................................................................................................................... 74 b. Results ...................................................................................................................................................... 74 Strategic focus 4: Increasing most-at-risk populations͛ (MARPs͛) capacity to control STI/HIV/AIDS .......... 81 a. Approaches.................................................................................................................................... 81 b. Results ........................................................................................................................................... 81 Table of Contents iii Strategic focus 5: Involving religious leaders and faith-based organizations in stimulating demand for health services by the population in the communes implementing the KM salama approach ................... 82 a. Approaches.................................................................................................................................... 82 b. Results ........................................................................................................................................... 83 Strategic Focus 6. Setting up a WASH strategy in the communes implementing the KM salama approach .............................................................................................................................................................. 83 a. Approaches............................................................................................................................................... 83 b. Results ...................................................................................................................................................... 83 c. Lessons Learned........................................................................................................................................ 87 CHALLENGES AND CORRECTIVE ACTIONS ............................................................................................................... 87 COORDINATION ............................................................................................................................................. 89 ADMINISTRATION AND FINANCE ................................................................................................................... 96 ANNEX 1: GAP ANALYSIS BY COMPONENT....................................................................................................