COMMUNITY ACTION ON ZIKA (CAZ) ANNUAL PROGRESS REPORT Y3 USAID ZIKA PROGRAM Period FY3 - October 01, 2018 to September 29, 2019 Submission Date: November 13, 2019 Project: USAID | Community Action on Zika (CAZ) Agreement No.: AID-OAA-A-16-00063 Period of the Agreement: September 30, 2016 — November 29, 2019 Period of the Annual Report: October 1, 2018 — September 29, 2019 Submitted to: United States Agency for International Development USAID/Washington Submitted by: Save the Children Federation, Inc. Date of Submission: November 15, 2019 Contact information: Ariel Habed Project Director USAID | Community Action on Zika City of Knowledge, Building 141 Panama City, Panama Tel: + 507 301-5780 Email: [email protected] Martin Rozenberg Award Manager Save the Children Federation, Inc. 899 North Capitol Street NE, Suite 900 Washington, DC 20002 Tel: +1 202-794-1958 Email: [email protected] This report is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of Save the Children and do not necessarily reflect the views of USAID or the United States Government. CONTENTS ACRONYMS AND ABBREVIATIONS 7 LIST OF TABLES AND FIGURES 8 INTRODUCTION AND BACKGROUND 9 The Community Action on Zika Project 9 The Zika Outbreak - Background and Update 11 Y3 ACTIVITY OVERVIEW 12 Summary Results and Key Achievements in Y3 12 Achievement of Targets by Indicator 14 Progress Narrative 16 Vector Control– Objective 1: Strengthen communities and individuals’ capacity to prevent Zika through community empowerment and mobilization related to vector control 16 El Salvador 16 Honduras 17 Dominican Republic 17 Nicaragua 18 Colombia 18 Social and Behavior Change– Objective 2: Improve capacity of vulnerable populations across key behavior change elements related to personal protection from Zika, and care and support of affected infants, children, and their families 18 El Salvador 19 Honduras 19 Dominican Republic 19 Nicaragua 20 Colombia 20 Community-Based Surveillance - Objective 3: Increase communities’ capacity to participate actively in community surveillance measures 20 El Salvador 21 Honduras 21 Dominican Republic 22 Nicaragua 22 Colombia 22 Implementation Challenges and Modifications Made 22 Internal Challenges 22 External Challenges 23 COLLABORATION 24 LEARNING 27 Lessons Learned During Y3 27 Research and Publications 28 COMMUNICATION AND DISSEMINATION 28 Public Communication and Advocacy 28 Social and Behavior Change 29 SUSTAINABILITY AND EXIT STRATEGY 32 El Salvador 32 Nicaragua 33 Honduras 33 Dominican Republic 33 Colombia 33 ANNEXES 35 Annex IA. Performance Indicator Reporting Sheet 35 Annex II. Success Stories 43 Annex III Training Report 53 Annex V Sub-Grants Under the Activity 63 Annex VI Integration of Cross-cutting Issues 63 (A) Gender Equality and Female Empowerment 63 (B) Environmental Compliance 65 (C) Institutional Strengthening and Local Capacity Building 67 El Salvador 68 Nicaragua 68 Honduras 68 Dominican Republic 68 (D) Youth 68 (E) Security Concerns / Stability 70 (F) Disability 70 El Salvador 70 Nicaragua 70 Honduras 71 Dominican Republic 71 (G) Public Private Partnership (PPP) 71 (H) Science, Technology and Innovation 71 (I) Policy and Regulatory Reform 71 Annex VII Research and Publications 71 Annex VIII Management and Administrative Issues 71 A. Constraints and Critical Issues 71 B. Personnel 71 C. Adaptation of the Activity 72 D. Modifications and Amendments 72 ACRONYMS AND ABBREVIATIONS ASSIST Applying Science to Strengthen and Improve Systems CAZ Community Action on Zika CEA Community Engagement and Accountability CZS Congenital Zika Syndrome IFRC International Federation of Red Cross MCSP Maternal and Child Survival Program MoH Ministry of Health MoE Ministry of Education OAA Office of Acquisitions and Assistance PAHO Pan America Health Organization PHEIC Public Health Emergency of International Concern PPP Public Private Partnership RC Red Cross SC Save the Children SBC Social and Behavior Change Communication USAID United States Agency for International Development WHO World Health Organization Y3 Year Three ZIKV Zika virus 7 | CAZ ANNUAL REPORT Y3 LIST OF TABLES AND FIGURES Table 1. Countries, departments/provinces, and municipalities – CAZ Project Y3 ........................................ 10 Table 2. CAZ reach by target audience and key activity ....................................................................................... 13 Table 3. Summary of Key Achievements during Y3 ................................................................................................ 13 Table 4. Progress in Achieving CAZ project Objectives ....................................................................................... 14 Table 5. Main Collaboration per Work Area – CAZ Project .............................................................................. 24 Table 6. Summary of environmental mitigation strategies ..................................................................................... 66 Table 7. Summary of CAZ staff and locations .......................................................................................................... 72 8 | CAZ ANNUAL REPORT Y3 INTRODUCTION AND BACKGROUND This report documents the activities conducted and the resulting outputs and outcomes of the Community Action on Zika (CAZ) project for year three (Y3), October 2018 to September 2019. This section introduces the CAZ project results framework and offers background and updated information on the Zika epidemic for this period. THE COMMUNITY ACTION ON ZIKA PROJECT The CAZ project responded to Zika epidemic with vector control and surveillance activities through social mobilization, while also instilling social and behavior change that promotes a long-term response to reduce ZIKV transmission and the negative effects of CZS. CAZ was a three-year intervention implemented in Colombia, the Dominican Republic, El Salvador, Honduras, and Nicaragua by a consortium—Save the Children, as prime, with direct implementation in four countries and the International Federation of Red Cross (IFRC)—as a sub-recipient, who supervised the implementation by the National Societies for the Red Cross (RC) in all five countries. The consortium partners relied on their extensive relationships with local government actors and the private sector, community platforms, and technical experience in public health to achieve the project results per the established goals and objectives of the project. The overall goal of the CAZ project is to reduce Zika transmission and minimize the risk of Zika-related microcephaly and other neurological disorders among the most vulnerable populations through community-based prevention strategies in Colombia, the Dominican Republic, El Salvador, Honduras, and Nicaragua. CAZ seeks to attain this goal through its Strategic Objective (SO): Increase adoption of healthy practices and enhance community outbreak response capacity in highly vulnerable communities and populations, with a focus on pregnant women, women of reproductive age, and people living in extreme poverty. CAZ achieves this SO through the following three specific objectives: Objective 1: Strengthen communities and individuals’ capacity to prevent Zika through community empowerment and mobilization related to vector control (by working with community individuals, groups, and organizations to plan, carry out, and evaluate activities on a participatory and sustained basis). Objective 2: Improve capacities of vulnerable populations across key behavior change elements: increased knowledge and community dialogue; essential attitude changes; demand for information and services; reduced stigma and discrimination; changes in key behaviors related to personal protection from Zika; and care and support of affected infants, children, and their families. Objective 3: Increase communities’ capacity to participate actively in community surveillance measures. Principal strategies under objective 1 include household visits and training to raise awareness on the risks of Zika and community organization and mobilization for vector control activities in communities and schools in partnership with local leaders, governments, and supporting institutions. Efforts sought to minimize the impact of disease transmission. The principal strategy under objective 2 was the design and roll-out of the social and behavior change (SBC) strategy for Zika prevention and control. This included, but was not limited to, the development, technical validation, and use of communication materials. In fact, the SBC strategy was a guide that oriented behavior change across all project activities through key messages directed at specific audiences. Also embedded in the project outputs for objective 2 are strategies to increase psychosocial and early childhood and development services for affected families. CAZ developed strategies under the umbrella 9 | CAZ ANNUAL REPORT Y3 of “Care and Support” which included early stimulation circles for children with possible signs of developmental delays and their caregivers and psychosocial support circles for families of children with clear signs of CZS and other Zika-related conditions. The methodology used for the early stimulation circles was developed by SC and was based on early childhood development curriculum and resources used in other programs. The methodology used to offer psychosocial support services was developed by