USAID/Zambia Systems For Better Health Quarterly Progress Report January–March 2018 April 2018 This publication was produced for review by the United States Agency for International Development. It was prepared by Abt Associates for the USAID Systems for Better Health activity. Contract No: AID-OAA-I-14-0003 Order No: AID-611-TO-16-00001 GUC Mechanism Submitted to: William Kanweka Contracting Officer’s Representative USAID Zambia Prepared by: Abt Associates Inc. In collaboration with: American College of Nurse-Midwives Akros Inc. BroadReach Institute for Training and Education Initiatives Inc. Imperial Health Sciences Save the Children DISCLAIMER The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development (USAID) or the United States Government. Contents Acronyms .................................................................................................................................. ii Executive Summary ................................................................................................................. 1 1. Introduction .................................................................................................................. 2 2. Progress by Task .......................................................................................................... 3 2.1 Task One: Design, Implement and Monitor National Level Interventions to Strengthen Health Stewardship by the Ministry of Health ................................................. 3 2.1.1 Sub-Task 1.1: Strengthen Human Resources Planning and Management ......... 3 2.1.2 Sub-Task 1.2: Improve HCF and Public Financial Management .......................... 4 2.1.3 Sub-Task 1.3: Strengthen MOH Capacity to Oversee Delivery of Key Health Programs .......................................................................................................................... 4 2.2 Task Two: Design, Implement, and Monitor Interventions to Strengthen Program Management Capabilities of Provincial and District Teams ................................................ 6 2.2.1 Sub-Task 2.1: Strengthen Program Management Capacity .................................. 7 2.2.2 Sub-Task 2.2: Improve Technical Capacity of Provincial and District Health Teams to Deliver Quality Health Services in Facilities ......................................... 8 2.2.3 Sub-Task 2.3: Improve Districts’ Capacity to Manage G2G Funding for the RMNCAH Continuum of Care Program ................................................................. 9 2.3 Task Three: Support the Government and Community-Based Organizations to Increase the Quality, Availability, and Use of Health Services ......................................... 10 2.3.1 Sub-Task 3.1: Improve the Capacity to Deliver Quality Health Services in the Community .................................................................................................................... 10 2.3.2 Sub-Task 3.2: Strengthen Linkages between the Facility and the Community .......................................................................................................................................... 11 2.4 Cross-Cutting Technical Areas ............................................................................................... 12 2.4.1 Task 4: Grants under Contract ................................................................................ 12 2.4.2 Task 5: Research, Monitoring and Evaluation (RM&E) ....................................... 12 3. Project Management ................................................................................................. 13 3.1 Finance and Administration ...................................................................................................... 13 3.2 Overall Budget and Expenditures ........................................................................................... 13 3.3 Personnel ...................................................................................................................................... 13 4. Success Stories ........................................................................................................... 14 Annex 1: Performance Indicator Tracking Table ....................... Error! Bookmark not defined. i Acronyms AMEP Activity Monitoring and Evaluation Plan ART Antiretroviral Therapy CBO Community-based Organization CBV Community-based Volunteer DHIS2 District Health Information System Version 2 DHO District Health Office FP Family Planning GST Grants Support Team HCC Health Center Committee HCF Health Care Financing HMIS Health Management Information System HP Health Promotion HRH Human Resources for Health HRHSP Human Resources for Health Strategic Plan HRIS Human Resources Information System MOH Ministry of Health MSI Management Systems Inquiry NHC Neighborhood Health Committee NHI National Health Insurance PA/e-PA Performance Assessment/electronic Performance Assessment PHO Provincial Health Office QI Quality Improvement RED/C Reach Every District/Child RMNCAH Reproductive, Maternal, Neonatal, Child and Adolescent Health SBH Systems for Better Health TSS Technical Support Supervision TWG Technical Working Group USAID United States Agency for International Development ZMLA Zambia Management and Leadership Academy ii Executive Summary This Quarterly Progress Report for the United States Agency for International Development Systems for Better Health (SBH) activity covers the period from January 1st through March 31st, 2018. During this first quarter of Year Three, SBH continued providing health systems strengthening assistance to the Zambian Ministry of Health (MOH) at central, provincial, district, facility, and community levels to achieve the project’s goals. At the central level, SBH continued to support the finalization and circulation of important policy documents, including the National Health Insurance Communications Strategy, the Roadmap of Scaling-Up of Injectable Contraception, the National Maternal and Newborn Referral Manual, and most importantly, the 2017-2021 Human Resources for Health Strategic Plan. The project also supported the functioning of key MOH Technical Working Groups, such as family planning, health promotion, and quality improvement. Additionally, SBH helped strengthen materials and systems for nutrition policy through attending relevant events and reviewing national dietary guidelines. Lastly, SBH supported the MOH to review and finalize various community health guidance documents and training materials. Under Task Two, SBH provided ongoing support to provincial and district teams to strengthen their capacity to perform their functions. At the provincial level, the project assisted Provincial Health Offices (PHOs) to conduct Management Systems Inquiries, Provincial Integrated Meetings, and partner coordination meetings. Similarly, at the district level, SBH extensively supported the performance assessment process at multiple District Health Offices (DHOs). To improve service quality, SBH helped PHOs and DHOs to mentor health workers in different roles on quality improvement tools and processes. Further, the project provided training and mentorship on various clinical topics, including malnutrition, essential newborn care, emergency obstetric and neonatal care, long-lasting reversible contraceptives, etc. Lastly, SBH continued implementing the Reproductive, Maternal, Neonatal, Child, and Adolescent Health Continuum of Care program via coordinating with other donors and deploying program personnel. Lastly, at the community level, SBH supported DHOs financially and technically to mentor community volunteers and orient neighborhood health committee (NHC) members. The orientation, along with the capacity assessment tool revised by SBH, will help strengthen NHCs activities in health promotion. Most notably, the project continued implementation of the Kitwe HIV linkages project. These efforts included mentoring on the Pedtrack system; identifying and registering new clients; assessing additional facilities for inclusion; coordinating with partners, and disseminating the results of the baseline study. 1 1. Introduction The five-year United States Agency for International Development (USAID) Systems for Better Health (SBH) activity in Zambia was awarded to Abt Associates, Inc. in October 2015. Abt is implementing SBH in collaboration with partners American College of Nurse-Midwives, Akros, Inc., Broad Reach Institute for Training and Education, Initiatives, Inc., Imperial Health Sciences, and Save the Children. The goal of SBH is to improve health outcomes for Zambians by strengthening systems that underpin the delivery of high-quality health services and increasing the utilization of high-impact health interventions at district and community levels. The expected outcomes of the activity are: 1. More effective national-level health stewardship; 2. Improved capacities of provincial and district health teams to perform program management functions; 3. Increased quality and availability of priority health services at the community level in targeted districts; and, 4. Increased utilization of key public health interventions. During this period, the project had the following specific objectives: • Retention of patients on antiretroviral therapy (ART) increased to at least 85 % in targeted districts; • Couple years of protection increased by 10 % in targeted districts; • The proportion of deliveries with assistance from a medically trained