ADVANCING PARTNERS & COMMUNITIES POST-EBOLA RECOVERY OF HEALTH SERVICES PROGRAM FINAL REPORT JULY 2015–SEPTEMBER 2017 ADVANCING PARTNERS & COMMUNITIES POST-EBOLA RECOVERY OF HEALTH SERVICES PROGRAM FINAL REPORT JULY 2015–SEPTEMBER 2017 This publication was produced by Advancing Partners & Communities (APC), a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-12-00047, beginning October 1, 2012. The authors' views expressed in this publication do not necessarily reflect the views of the U.S. Agency for International Development or the United States Government. Advancing Partners & Communities Advancing Partners & Communities (APC) is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-12-00047, beginning October 1, 2012. APC is implemented by JSI Research & Training Institute, Inc., in collaboration with FHI 360. The project focuses on advancing and supporting community programs that seek to improve the overall health of communities and achieve other health-related impacts, especially in relationship to family planning. APC provides global leadership for community-based programming, executes and manages small- and medium-sized sub-awards, supports procurement reform by preparing awards for execution by USAID, and builds technical capacity of organizations to implement effective programs. Recommended Citation Advancing Partners & Communities. 2018. Post-Ebola Recovery of Health Services Program Final Report July 2015–September 2017. Arlington, VA: Advancing Partners & Communities. Cover photo: A health worker in Tonkolili district draws water at a newly renovated facility. Photo credit: Joshua Yospyn. JSI RESEARCH & TRAINING INSTITUTE, INC. 1616 Fort Myer Drive, 16th Floor Arlington, VA 22209 USA Phone: 703-528-7474 Fax: 703-528-7480 Email: [email protected] Web: advancingpartners.org TABLE OF CONTENTS TABLE OF CONTENTS .............................................................................................. VI ACRONYMS ................................................................................................................ VII EXECUTIVE SUMMARY .............................................................................................. 1 PROGRAM OVERVIEW ............................................................................................... 2 Country Background ....................................................................................................... 2 Program Background ...................................................................................................... 3 Program Objectives ........................................................................................................ 4 Implementing Partners .................................................................................................... 5 Results Framework ......................................................................................................... 5 Activities & Results ......................................................................................................... 6 CHALLENGES, LESSONS LEARNED, AND RECOMMENDATIONS ................... 17 KNOWLEDGE MANAGEMENT ................................................................................ 18 APPENDIX 1: PERHS COVERAGE BY DISTRICT AND HEALTH FACILITY LOCATIONS ............................................................................................................... 20 APPENDIX 2: FINAL REPORT ON PROGRAM INDICATORS ............................. 33 APPENDIX 3: PERFORMANCE INDICATOR REFERENCE SHEETS ................... 34 APPENDIX 4: SUCCESS STORIES .......................................................................... 58 APPENDIX 5: STUDIES/SURVEYS COMPLETED BY THE PROGRAM ............... 59 APPENDIX 6: DOCUMENTS PRODUCED BY THE PROGRAM .......................... 60 ACRONYMS ADRA Adventist Development Relief Agency APC Advancing Partners & Communities Project BPEHS Basic Package of Essential Health Services CE community engagement CHC Community Health Center CHP Community Health Post CHW Community Health Worker DFID Department for International Development (UK) DHMT District Health Management Team EVD Ebola Virus Disease EVDS Ebola Virus Disease Survivor FMC Facility Management Committee HCD Human-centered Design HSRP Health Sector Recovery Plan iCCM integrated community case management IMC International Medical Corps IMNCI Integrated Management of Newborn and Childhood Illnesses IPC Infection, Prevention, and Control JSI JSI Research & Training Institute, Inc. MCH Maternal and Child Health MCHP Maternal and Child Health Post M&E monitoring and evaluation MOHS Ministry of Health and Sanitation MOWR Ministry of Water and Resources vii POST-EBOLA RECOVERY OF HEALTH SERVICES PROGRAM FINAL REPORT MME Minor Medical Equipment NGO nongovernmental organization PERHS Post-Ebola Recovery of Health Services program PHU Peripheral Health Unit RMNCH Reproductive, Maternal, Neonatal, and Child Health SECHN State-enrolled Community Health Nurse TEC Technical Evaluation Committee USAID United States Agency for International Development WAR Western Area Rural WASH Water, Sanitation, and Hygiene WAU Western Area Urban WHO World Health Organization EXECUTIVE SUMMARY Sierra Leone was among the countries most heavily affected by the Ebola virus outbreak in 2014‒2015, and its already fragile health care system was severely impaired by the resulting crisis. In Sierra Leone, Ebola claimed the lives of more than 200 doctors, nurses, and other health care workers, which further depleted the already short supply of public sector health workers and the availability of health services for patient care. To help the country rebuild health services and the overall health system post-Ebola, the U.S. Agency for International Development (USAID) stepped in with support provided through the Advancing Partners & Communities (APC) project, implemented by JSI Research & Training Institute, Inc. (JSI) and partner, FHI 360. The Post-Ebola Recovery of Health Services program (PERHS) supported the Ministry of Health and Sanitation’s (MOHS) health sector recovery priorities by partnering with United Nations (UN) agencies, and international and local organizations, and providing technical assistance to nongovernmental organizations (NGOs) and the government. Working in the five districts most affected by Ebola—Bombali, Port Loko, Tonkolili, Western Area Rural (WAR) and Western Area Urban (WAU), the program sought to improve access to, and increase quality of, reproductive, maternal, newborn, and child health (RMNCH) services at the health post level. This was accomplished through improved regulatory and policy environments, increased capacity and effectiveness of the health workforce and community platforms, and improved physical and operational conditions at Community Health Posts (CHPs) and Maternal and Child Health Post (MCHPs). The program contributed to review and endorsement of three national-level policies, key among them the new 2016‒2020 Community Health Worker (CHW) policy, which was officially launched in February 2017. The program revised the policy, including all training materials, and conducted roll-out trainings in three districts. To complement USAID’s efforts, other funders including Department for International Development (DFID), the Global Fund, and The World Bank are funding CHW trainings to help complete the program. By the end of 2017, CHWs in all districts are expected to have received training. Other policy work included the Facility Management Committee (FMC) Operational Guidelines and Toolkit for community engagement (CE) that helps FMCs become more vested in improving service delivery at their health facilities, and the 2017 MOHS Standards and Guidelines for WASH Services in Health Facilities in Sierra Leone, which establishes minimum standards for water and sanitation in Peripheral Health Units (PHUs). Program activities in the facilities varied based on need, and three tiers of support were provided. Across the five districts, 305 of 365 PHUs benefited from various levels of support, including improvements to water and sanitation systems; physical facility upgrades; installation of solar powered lighting systems; provision of basic medical equipment; and training for more than 900 health professionals, 1,500 CHWs and peer supervisors, and members of 214 FMCs. Capacity development for PHUs included a quality improvement and capacity-building program covering RMNCH; Integrated Management of Newborn and Childhood Illnesses (IMNCI); and Infection, Prevention, and Control (IPC) topics through a combination of staff training and on-the-job clinical mentorship and supervision. To strengthen ownership, the program collaborated with the District 1 POST-EBOLA RECOVERY OF HEALTH SERVICES PROGRAM FINAL REPORT Health Management Teams (DHMTs) to conduct all training activities using MOHS-approved curricula and training materials. The program’s baseline assessment highlighted the vast number of PHUs that lacked the most basic infrastructure and equipment needed to provide quality health services: water, electricity, delivery kits, beds, etc. In response to dilapidated or non-existent infrastructure for WASH/IPC and waste management, the program rehabilitated 110 Tier I facilities (see Figure 3), improving access to water, installing solar powered lighting systems, and renovating buildings. In 105 of these Tier I