November 2008

Events in the Life of project AXxes

Strategies to improve activitiesActivities with High performanceActvities with low perfomanceANC, EPI, Assisted births, PSC, Vit A, FP facility based (CYP), LLNIs, Blood safetyMaintain /improve the current approachesFocus on qualityReinforce communicationFP, TPI, Curative care, PMTCT, C-IMCIReinforce the community based approachesCreate and reinforce link with high performance activitiesConcentrate in 200 sites (MNH,PMTCT, FP, care sites)

Reinforce community based approachesComplete relays ( CODESA, mother groups, local associations) training by January and provide tools

Diffuse key messages ( ten commandments) in the community through relays, local FBOs , associations and mass media where possible

Use of CODESA and association members (men) as relays for FP and PMTCT

Support process of integrated micro plan in the community level involving CODESA, association and local leaders

Advocacy at the local level ( leaders)

Sensitization meetings and workshops

Develop community based care sites in 200 Health areas with provision of FP, MNH, PMTCT & GBV counseling and distribution of FP commodities

Outreach FP services by mobile group ( long term methods)

Close supervision and documentation

Create & reinforce link with the high performance activitiesSeize all opportunities to increase client knowledge on FP, PMTCT ( during other preventive activities)

Use community based care sites to provide counseling for FP & PMTCT

Use community based care sites to distribute FP commodities

Distribute cards and diffuse of key messages during ANC , in maternities and during immunization activities. Every attendant in those activities receives counsel card ( one or two pages)

Concentration on 200 sites (health areas) in 40 HZs ( with PMTC, MNH, FP, GBV, PF)

Collaborated with well functioning local organizations for social marketing ( need of training, supervision): Small grant for FP and PMTCT??

Close supervision and documentation

Increased access to, quality of, and demand for curative servicesIndicators and targetsStrategies and activitiesEnsure drug availability

Reduce the cost recovery from 60% to 30%

Encourage episodic payment (at least 70% HCs)

Increase the capacity of community to recognize the danger signs and seek care

Community based care sites ( 5/HZ in average in 40 HZs)

Carry out a care seeking study

Supervision

Utilization rateYear 1 targetYear 1 actualYear2 targetYear2actualYear3target

30%30%35%30%35%

Improved Maternal and New born care servicesIndicators and targetsStrategies and activitiesImprove FANC and reinvigorate link with FP & PMTC especially in 200 sites in 40 HZs

Complete and scale up newborn intervention in 200 sites ( training, provision of material and supplies)

Increase the community knowledge on the benefit of FANC and birth assisted by a skilled personnel

Supervision

Conduct LQAS on the quarterly basis

Set up 10 additional sites for FVR ( training and provision of material , supplies and subsides)

ANC visitsYear 1 targetYear 1 actualYear2 targetYear2actualYear3target204012(70%)141816(49%)256866 (80%)273826(85%)288975(90%)Assisted birthsYear 1 targetYear 1 actualYear2 targetYear2actualYear3target174867(60%)109562 (38%)192650 (60%)204216 (64%)224758 (70%)Newborn receiving essential careYear 1 targetYear 1 actualYear2 targetYear2actualYear3target174867(60%)34811 (12%)192650 (60%)174414 (54%)(90%)192650 (60%)(100%)

Improved Family Planning services Indicators and targetsStrategies and activities

Provide full range of contraceptives to the all 929

Increase knowledge of ANC attendants ( every pregnant women will be informed on PF and receive card, the ANC fees give access to PF services if needed)

Increase mother knowledge in the maternities and during the Post-partum and when utilizing immunization services. To have at least 60% women informed

Increased community in FP services through existing local organizations (CODESA, Associations, FBOs) involvement in FP, GBV & PMTCT activities and by diffusing messages through mass media

CYPYear 1 targetYear 1 actualYear2 targetYear2actualYear3target3000011114400004846160000Individual counseled and received contraceptiveYear 1 targetYear 1 actualYear2 targetYear2actualYear3target5%2( 4) %7%16%20%# Delivery pointsYear 1 targetYear 1 actualYear2 targetYear2actualYear3target581816929864929

Improved Family Planning Services ( cont) Indicators and targetsStrategies and activities

Increase access by communities to FP services by distributing FP commodities to the couples through the community based care sites ( 200 sites are selected)

Reinforce GBV activities ( training, diffusion of key messages through relays, mass media)

Lead the Health zones to have proportion (at least 30%) of women among the village health activists and CODESA/COGE members

Conduct LQAS on individual counseled and on behavior change regarding FP & PMTCT

Work closely with PSI in overlapping HZs

Individual counseledYear 1 targetYear 1 actualYear2 targetYear2actualYear3target60%

Improved child health: ImmunizationIndicators and targetsStrategies and activities Support the Cold Chain with kerosene and installation of 57 additional solar refrigerators

Reinforce/ Integrate DQS and DQA in routine ( in collaboration with JSI)

Conduct Targeted census in the HZ with major problems in denominator

Organize Acceleration activities in HZ with low coverage

Reinforce integrated surveillance including immunization diseases Surveillance system (phonies, supervisions, briefing)

Support polio campaign

DPT3Year 1 targetYear 1 actualYear2 targetYear2actualYear3target178000 (70%)117804 (46%)252131 (90%)241671 (86%)252131 (90%)Measles Year 1 targetYear 1 actualYear2 targetYear2actualYear3target17800 (70%)123638 (49%)252131(90%)216673 (77%)252131 (90%)Drop outYear 1 targetYear 1 actualYear2 targetYear2actualYear3target

Improved child health (cont): Nutrition Indicators and targetsStrategies and activities Participate and Support 2 Vitamin A campaigns in collaboration with HKI

Reinforce the Supervision on nutrition activities

Evaluate routine distribution of Vitamin A program in the 12 HZs

Scale up the routine distribution of Vitamin A in remaining HZs

Children have received vit A during the campaignYear 1 targetYear 1 actualYear2 targetYear2actualYear3target11791981730373125550812107701255508

Children have received vit A in routineYear 1 targetYear 1 actualYear2 targetYear2actualYear3target

Mothers have received vit A during the post partum periodYear 1 targetYear 1 actualYear2 targetYear2actualYear3target60%

Improved child health (cont): Clinic IMCI Indicators and targetsStrategies and activities Supervise correct use of protocols

Provide drugs including Zinc to the new HZs

Set up 200 community based care sites

Children with ARI treated correctlyYear 1 targetYear 1 actualYear2 targetYear2actualYear3target41923291448205277449517Children with diarrhea treated correctlyYear 1 targetYear 1 actualYear2 targetYear2actualYear3target33555291448147187288974

Improved child health (cont): Community IMCI Indicators and targetsStrategies and activitiesSupport Selected relays ( 9260) training and the training by January

Increase Community Awareness of Behaviors Related to Childhood Illnesses through relays (CODESA and mother groups) and through mass media

Conduct LQAS on the adoption of key practices by the community

Use community care sites to key diffuse and disseminate messages

# Population reached by key messages ( ten commandments)Year 1 targetYear 1 actualYear2 targetYear2actualYear3targetAt least 60%# Population adopted key practicesYear 1 targetYear 1 actualYear2 targetYear2actualYear3targetAt least 50%

Improved Water provision & sanitation Indicators and targetsStrategies and activitiesRehabilitate/ construct remaining 114 water sources by January 2009 Promote Construction of incinerators in hospitals and rehabilitated health centers Promote Construction of latrines in health centers (114)Develop and diffuse procedures on Environmental Impact Compliance for HZs Develop and diffuse BCC materials on waste management Provide materials (polybags, waste containers, safe boxes) to the health facilities to improve waste collection

# water sources rehabilitatedYear 1 targetYear 1 actualYear2 targetYear2actualYear3target171122171# Incinerators constructedYear 1 targetYear 1 actualYear2 targetYear2actualYear3target575457# HC rehabilitatedYear 1 targetYear 1 actualYear2 targetYear2actualYear3target17136171222114

Reduced Malaria in targeted populationIndicators and targetsStrategies and activitiesProvide ACT and other malaria drugs to the health facilities and to the community care sites

Promote use of ACT at each HC ( Reduced price, briefing of providers during supervision and monitoring meeting)

Provide IPT as part of FANC to each pregnant women in the HCs

Provide an average of 3500 LLINs/year/HZ that will be sold at subsidized price (0.50 $) to the targeted population ( pregnant women and child under five) at the HC and in the community

# Pregnant women receiving IPT during ANCYear 1 targetYear 1 actualYear2 targetYear2actualYear3target172070(60%)77806(38%)204012(70%)149554(54%)288974(90%)Pregnant received LLINsYear 1 targetYear 1 actualYear2 targetYear2actualYear3target43717259184371734351128433(40%)Children received LLINsYear 1 targetYear 1 actualYear2 targetYear2actualYear3target15628353335915628345241 151975(9%)

Improved TB detection and treatmentIndicators and targetsStrategies and activitiesReinforce the capacity of HZ teams to implement the TB program by training them in supervision within the normal activities of the HZ and DOTS

Provide HZ with PATI 4 (TB protocol)

Promote TB program and ComBased-DOTS through community relays with BCC materials and via radio

Collaborate closely with the national program at the intermediate and central level to identify the cause of high prevalence in Haut Lomami and low prevalence in South Kivu

# Detection rateYear 1 targetYear 1 actualYear2 targetYear2actualYear3target80%134%80%92%70%80%

Establish blood testing and groupingIndicators and targetsStrategies and activitiesPromote safe transfusion at each transfusing service outlet

Supervise HGRs & CSR Lab. Staff in screening for HVI+

Provide HGR and other transfusion outlet services with adequate HBV,RPR and blood group tests, and transfusion supplies

Collaborate with Safe Blood in the provision of HIV tests and promotion of voluntary donors from low-risk population.

% of blood unit trans fused that were screened for HIV and other diseases Year 1 targetYear 1 actualYear2 targetYear2actualYear3target100%100%100%100%100%# transfusion service outlet Year 1 targetYear 1 actualYear2 targetYear2actualYear3target5757114114114

Establish PMTCT (cont)Indicators and targetsStrategies and activitiesHold workshop for revision of PMTCT data tools Identify additional sites for tri therapy in Kasais and prepare providers to integrate the activities Reinforce the community awareness on PMTCT services: keys messages through charts, radio Train providers on PMTCT activities in 30 additional sites in CRS-assisted HZs ( 2sites/HZ/15HZs) Train providers PMTCT tri therapy in 5sites/HZ in 4 HZ in Kasais (Tshikaji, Lubondaie, Lodja and Dibindi)

# PMTCT service outletYear 1 targetYear 1 actualYear2 targetYear2actualYear3target--12093 ( 78%)128# women counseled, tested and receiving resultsYear 1 targetYear 1 actualYear2 targetYear2actualYear3target--440007607 (17%)50688# HIV+ women provided with prophylactic ARVsYear 1 targetYear 1 actualYear2 targetYear2actualYear3target1000112 (11%)811

Establish PMTCT (cont)Indicators and targetsStrategies and activitiesProcure ARV for triple therapy regimen for PMTCT and other PMTCT commodities for FY09

Organize post training follow up (mentorship) in field with the collaboration of UNC

Supervise health care workers trained in management and provision of PMTCT services in health zones and ensure CQI(continue quality improvement) with the collaboration of UNC

Hold quarterly monitoring session at PMTCT sites Provide Post birth follow-up services

# PMTCT service outletYear 1 targetYear 1 actualYear2 targetYear2actualYear3target--12093 ( 78%)120# women counseled, tested and receiving resultsYear 1 targetYear 1 actualYear2 targetYear2actualYear3target--440007607 (17%)50688# HIV+ women provided with prophylactic ARVsYear 1 targetYear 1 actualYear2 targetYear2actualYear3target1000143(14%)811

Component B: Increased Capacity to the health zone and the referral systemReinforce M&E system

Reinforce ManagementProvide all HZs with updated SNIS forms

Support HZ to elaborate development plan & Micro plan

Scale up training for GESIS and SNIS in HZ

Encourage HZMT monthly reviews w/ providers & COGE

Reinforce Surveillance system

Support and encourage HZMTs to ensure Integrated and formative supervisions to each HC every month.

Organize the final KPC Reinforce HZ co management et community participation

Complete inventory/update and mapping of FBO HZ co-management

Encourage and support HZ Admin. Councils

Encourage CODESAs with balanced gender participation

Encourage and follow up the four NGOs selected for PPG

Improve drug Supply Mgmt to reduce stock outs through supervisions Hold Reviews with CDR, PIP, Coordination

Component C: Increased capacity of national health programs and provincial/district offices MOH Intermediate level (provincial & district)MOH Central levelSupport provincial/district technical meetings (CPP,BTP) Support district technical meetings (BTD, CCIA) Support Provincial and district teams to supervise quarterly ( focus on activities with low performance)JHU technical assistance to MOH (4th,5th,7 direction, PNSR) to improve the national M&E systemSupport the supervisions of the MOH intermediate level by the central level selected directions and programs (Pronanut, 4th&5 direction, PEV, PNLP, PNSR, PNSA)

ChallengesContext of poverty

Instability of human resources

Low education among women

Gender issues ( based on culture)

Insecurity in Eastern part of the country

Time (shortness of the project, conflict of agenda with other activities): possibility of non cost extension

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