systems, health and resiliency project

Systems, Health and Resiliency Project Quarterly Report April 2020 to June 2020 Resubmitted December 7, 2020

Systems, Health and Resiliency Project | Quarterly Report 2

Quarterly Report April 1, 2020 to June 30, 2020 Resubmitted December 7, 2020

Cooperative Agreement No. 72027919CA00003 Submitted to: USAID/Yemen Prepared by: John Snow, Inc. (JSI) 44 Farnsworth Street Boston, MA 02210 Tel 617.482.9485 | Fax 617.482.0617 Cover photo: The YFCA team reviews SHARP’s assessment tools in April 2020. Credit: YFCA

DISCLAIMER: This document 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 John Snow, Inc. (JSI) and do not necessarily reflect the views of USAID or the United States Government.


Table of Contents

Acronym List 4

Executive Summary 5

SHARP Background 7

Quarterly Program Highlights 8

Monitoring and Evaluation 11

Challenges, Lessons Learned and Proposed Solutions 12

Priority Activities for Next Quarter 13

Administrative and Financial Progress 14

Annex 1: Progress Against Indicators 16


Acronym List CHV Community Health Volunteer CMW Community Midwife COP Chief of Party F&A Finance & Administration FGD Focus Group Discussion FOSSM Field Office Safety and Security Manual HMIS Health Management Information Systems HR Human Resources IAWG Inter-Agency Working Group on Reproductive Health in Crises IPC Infection Prevention and Control JSI John Snow, Inc. KII Key Informant Interview LHEM Local Hire Employee Manual MEL Monitoring, Evaluation and Learning MELP Monitoring, Evaluation and Learning Plan MoPHP Ministry of Public Health and Population MoPIC Ministry of Planning and International Cooperation MSP Minimum Service Package NYMA National Yemeni Midwives Association PY Project Year QI Quality Improvement RH Reproductive Health RMNCH+N Reproductive, Maternal, Neonatal and Child Health, and Nutrition Search Search for Common Ground SHARP Systems, Health and Resiliency Project UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund USAID United States Agency for International Development YFCA Yemen Family Care Association YF Yamaan Foundation for Health and Social Development WHO World Health Organization


Executive Summary

Since the last reporting period when there were no reported cases, COVID-19 is spreading rapidly across the country and having a significant negative effect on Yemen’s population. According to the World Health Organization (WHO) COVID-19 epidemiological update1, as of June 30, the number of confirmed COVID-19 cases in Yemen stood at 1,262 with 434 recoveries, and 313 COVID-19 related deaths (of which 41 were health workers); men constituted 76 percent of all reported cases. In an effort to support the COVID-19 response by the Ministry of Public Health and Population (MoPHP), the Systems, Health and Resiliency Project (SHARP) has developed communication materials that are in line with existing messaging by the MoPHP, the United Nations Children’s Fund (UNICEF) and the WHO that include posters on 4 topics: i) hand washing, ii) preventing transmission, iii) social distancing, iv) sneezing and coughing etiquette; and, a brochure on transmission and prevention of COVID-19. These messages will be reinforced through radio and social media. Also, trainings on the prevention and identification of COVID-19 symptoms will be given to mediators, community midwives (CMWs), and health providers in the Tuban district of Lahj governorate as well as a scaled-down training on infection prevention and control (IPC) to facility and community providers in all nine of SHARP’s priority districts. Implementation is being planned for the next quarter, upon approval by the United States Agency for International Development (USAID). In alignment with SHARP’s objectives, a second and more comprehensive plan for engagement on COVID-19 was also submitted to USAID which included IPC and supply chain support. The SHARP team continues to make progress in a number of programmatic and operational areas despite the challenging environment in Yemen. On the program side, SHARP:

● Updated the Project Year (PY) 1 work plan and timeline to reflect delays due to COVID-19. ● Formally introduced SHARP to the MoPHP’s Reproductive Health (RH) department

(SHARP’s primary counterpart); SHARP’s Technical Director invited by the MoPHP to serve on the review committee and led the review process for the national referral guidelines.

● Finalized SHARP’s Monitoring & Evaluation (M&E) system matrix; finalized M&E manual. ● Regularly attend the Health Cluster meetings. ● Conducted monthly partner meetings to discuss progress on work plan, challenges, etc.

JSI continues to engage with the Strengthening Family Planning Services project led by Save the Children International (SCI) to identify opportunities for coordination, particularly in a potential subset of 95 facilities (from among 220 facilities that SCI supports) that are operational in SHARP’s priority districts.

USAID formally introduced the SHARP Chief of Party (COP) and Acting COP/Technical Director to Dr. Fawad Khan, WHO’s Health Cluster Coordinator in Yemen; this opened the door for introducing JSI and SHARP to the Health Cluster members. A presentation has been scheduled for July 14.

USAID also facilitated the introduction of the JSI team to Dr. David Wood, Professor of Peace Practice at Seton Hall University. Dr. Wood consults with SHARP partner, Search, and is engaged on conflict sensitivity issues in Yemen, particularly focusing on messaging for COVID-19.

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In the operational area, SHARP has:

● Signed the Project Agreement with the MoPHP on June 14. ● Finalized the selection of office space, and initiated lease negotiation with the landlord. ● Finalized security contracting details with Neptune (JSI’s security provider) for the

management of the safety and security refurbishments for office space, and provision of overarching safety and security management through the life of the project (including intelligence reporting, guard services, car/driver services, staff training, and incident management).

● Developed a working draft of the SHARP Field Office Safety and Security Manual (FOSSM), which will be the governing policy regarding safety and security for all staff.

● Finalized the Security Risk Assessment (with Neptune). ● Developed the procurement plan for office equipment. ● Finalized the salary scale for JSI staff; finalized the local employment contract template,

with the labor lawyer, in Arabic and English; and drafted JSI’s Local Hire Employee Manual (LHEM).

● Successfully completed the remote onboarding of the COP; obtained approval for the Technical Director to continue serving as Acting COP until the COP arrives in Yemen.

● On boarded HR Assistant and Program Assistant; and, finalized recruitment of Security Manager, Finance & Operations Officer, Senior Health Facility Manager, and Health Community Manager.

● Trained three staff on USAID’s vetting portal; developed the SHARP vetting database. ● Conducted procurement training for all SHARP staff on USAID and JSI policies and

procedures. ● Shortlisted two translation firms.

The MoPHP signed the Project Agreement just prior to the close of this quarter, which resulted in a 9-month delay (from the date of award) in officially launching the project and engaging with the health offices at the governorate and district levels.


SHARP Background

SHARP, supported by USAID, is a three-year project led by John Snow, Inc. (JSI) in partnership with the National Yemen Midwives Association (NYMA), Search for Common Ground (Search), and the Yemen Family Care Association (YFCA). The project is being implemented in nine target districts in three priority governorates: Aden: Al Buraiqa, Ash Sheikh Outhman, Dar Sad Lahj: Al Maqatera, Al Musaymir, Tuban Ta’izz: Al Makha, Al Mawasit, Ash Shamayatayn JSI is implementing an integrated approach to reducing maternal and infant mortality focusing on the Minimum Service Package (MSP) with an emphasis on reproductive, maternal, neonatal and child health, and nutrition (RMNCH+N) coupled with appropriate wrap-around support services to address malnutrition, cholera, and diarrhea – all life-threatening challenges for communities. JSI is also assisting in the effective delivery of health services by supporting Yemen’s health management information system (HMIS), as well as exploring and piloting opportunities for innovative financing mechanisms. Finally, the project will foster an enabling environment and strengthen the health system by improving policies, strategies, practices, and local ownership with a focus on i) reducing mortality among women of reproductive age, their newborns, and children under-5, ii) increasing community engagement, and iii) improving health system resiliency across its six objectives:

1. Creating demand for selected components of the MSP; 2. Improving access through a robust referral system and subsidized care and financing; 3. Building capacity of health facility staff to deliver quality care; 4. Revitalizing community-level services by engaging community midwives and volunteers; 5. Improving governance of local authorities in the sustained provision of health care services; and, 6. Strengthening the HMIS to support effective health services management.

To ensure agile, scalable and sustainable programming along the humanitarian aid-peace-development continuum, SHARP’s strategy is based on three pillars: i) integrating program activities, ii) leveraging local institutions, and iii) phasing-in locally appropriate solutions. Given the complexities of working in Yemen resulting from interwoven conflicts, SHARP will ensure that its activities are harmonized with those of other actors engaged in local reconstruction efforts funded under the 2019 Yemen Humanitarian Response Plan, and coordinated with the United Nations agencies and the World Bank.


Quarterly Program Highlights

This section provides a summary of the program highlights this quarter as well as deliverables submitted.

The SHARP team has been guided by the MoPHP’s COVID-19 protocols, and have been working from home to the greatest extent possible; staff do not use public transport. If required to attend meetings, staff wear a mask, maintain physical distance, and wash or sanitize their hands frequently. While trainings and community gatherings have yet to begin, all such events will be conducted in accordance with prevailing guidance. The COVID-19 situation in Yemen (as it is elsewhere) is changing rapidly; and the SHARP team is monitoring the situation closely. As implementation unfolds on the ground, the SHARP team will engage the MoPHP as well as the governorate and district authorities to determine the right course of action, i.e., whether to conduct meetings/trainings/gatherings in-person or virtually. While this may delay implementation of certain activities, the primary consideration driving decisions against which the approach for each intervention will be evaluated is the health of staff and attendees. Objective 1: Create demand for selected components of the MSP

Activity 1.1: Conduct research on client needs

A desk review of the literature on RMNCH+Nutrition was compiled on the basis of which an assessment framework has been developed and survey tools, focus group discussion guides (FGD), and key informant interview (KII) protocols have been drafted. FGD will be held with men and women, youth, and local leaders (village’s sheikh, imam of the mosque), to better understand barriers to accessing health care, perceptions of health care provision in SHARP’s focus interventions. KII will be conducted with community leaders, local civil society organizations, facility level providers, CMWs, and CHVs to better understand availability of quality health services in the community, community perceptions of access to care, prevailing health seeking behaviors, existing community structures to support the provision of health services, and the capacity of stakeholders to deliver quality services that includes access to financial resources, staffing, supplies, and equipment.

Activity 1.5: Adapt the My Village, My Home approach

To better understand the opportunity, as well as challenges and pitfalls of adapting the My Village My Home approach in a fragile setting such as Yemen, the SHARP team initiated discussions of this approach and related tools with JSI’s senior technical advisors who had developed and implemented this methodology in a variety of country contexts (albeit only for immunization services). Since the approach is flexible to a range of country contexts and services, the SHARP team is reviewing and revising the tool for the first round of services that will include immunization, breastfeeding and child nutrition, and the management of low birth weight newborns through the Kangaroo Mother Care approach. With this adaptation, the intervention under SHARP is being renamed “My Community My Home”. Objective 2: Improve access through a robust referral system and subsidized care/financing

Activity 2.1: Map communities and link to available services

Based on data provided by the MoPHP, there are 232 health facilities in SHARP’s nine target districts, of which 169 are public facilities and 63 are private facilities. These facilities are classified by sector (public or private); defined as being either a Health Unit, Health Center, District Hospital or Intra District/Governorate Hospital; and, recognized by the MoPHP as operationally viable. However, there is no reliable data on the current status of these facilities (knowing that 49 percent


of all health facilities in Yemen are non-functional). Consequently, the SHARP team will conduct an assessment in all facilities to determine their level of functionality, and readiness to provide the MSP for RMNCH+N services. The Health Facilities Assessment tool has been finalized, as have the research protocol for this assessment and the terms of reference for the twenty data collectors.

A Community Mapping approach has been drafted for implementation in three steps: i) develop participatory mapping of the catchment area and identify community assets and available health resources related to RMNCH service, ii) conduct orientation sessions to validate the map, orient and sensitize community and households on SHARP’s proposed role for CMWs, start the trust building process and create linkages between community actors, and iii) create individual and household profiles to build rapport between the CMW and households, and better tailor interventions and support. The CMWs will be trained to lead the mapping process through all three steps; the supporting tools and materials are being developed (i.e., discussion tool, facilitation and “map” process, household registers); and, though the composition of the participants will vary in each step, it will include the full range of stakeholders that impact and help to sustain a community’s health decisions and behaviors.

As the lead reviewer appointed by the MoPHP, SHARP’s Technical Director updated the national referral guideline and submitted it to the review committee for approval (expected early in the next quarter). Upon approval, the guideline will be circulated and adopted by SHARP.

Activity: 2.2: Establish a pilot voucher system

The SHARP team held several rounds of discussion with the Yamaan Foundation for Health and Social Development (YF) on the basis of which a comprehensive proposal on a pilot voucher distribution program was submitted by YF. The proposal was reviewed thoroughly, and comments and recommendations were submitted to YF. It is anticipated that SHARP and YF will finalize the technical approach and proposed budget for the pilot program within the next quarter for implementation in PY2. Objective 3: Build capacity of health facility staff to deliver quality care

Activity 3.1: Identify health worker skills gaps

Remote short term technical assistance is being provided to the SHARP team by JSI’s Quality Improvement (QI) expert. This has enabled fast-tracking the review of the MoPHP’s support supervision tools for health centers, health units, and hospitals to identify gaps and propose improvements. In addition, the MoPHP’s supportive supervision checklist for RH is being adapted for use in SHARP’s targeted health facilities. The QI expert will also support the design and implementation of QI interventions in a limited number of facilities to improve identified bottlenecks in service delivery during support supervision visits. These interventions will subsequently be scaled up to all supported facilities. Objective 4: Revitalize community services by engaging community midwives/volunteers

Activity 4.1: Define community level RMNCH+Nutrition services and information

Upon the recommendation of the MoPHP’s RH department, the SHARP team updated the roles and responsibilities of the CMWs. These revisions will be shared with the MoPHP’s technical committee for review and approval in the next reporting period. Upon approval, these will be adopted by SHARP in implementing project activities.

The training guideline and program for the National Community Health and Nutrition Volunteer were updated and endorsed by the MoPHP in 2019; the new topics in the updated training


curriculum include mother-to-mother support group, newborn danger signs, and adolescent health. Upon the MoPHP’s request, SHARP will support printing the updated training manual. Objective 5: Improve governance of local authorities in sustaining health care services

Activity 5.1: Strengthen capacity of local leaders to develop/implement policies and provide oversight

To prepare local leaders for sensitization sessions, the SHARP team drafted the community entry

plan and the criteria for selecting participants from each governorate to attend. Participants will

include the RH Manager, PHC Manager, and the Manager of the Nutrition Health Department from

each of SHARP’s three governorates, as well as the governorate and district health office managers.

Search will submit a letter to the GHOs requesting them to list the training participants based on

the participant’s selection criteria identified.

Deliverables

By the end of this reporting period, the status of the contractual documents was as follows: ● The submitted Project Agreement was approved by the MoPHP and MoPIC on June 14. ● SHARP received USAID’s approval of the EMMP on June 29. ● The SHARP work plan and MEL Plan are pending USAID approval.


Monitoring and Evaluation

During this reporting quarter MEL activities focused on completing several key components of SHARP’s M&E system by developing tools and processes to measure the project`s performance according to the plan (monitoring) and desired results (evaluation). Although it was expected that the data collection tools would be finalized in the previous quarter, this was delayed due to the need for extensive revisions and ensuring all missing tools were accounted for.

Below is a list of major activities conducted during the third quarter of the project:

● Developed the M&E system matrix that aligns project indicators with existing and needed data collection tools, identifies responsible data collection personnel, establishes reporting frequency, and outlines quality control procedures.

● Completed a gap analysis using the M&E system matrix to identify potential challenges with reporting from partners and their reporting/system processes to develop troubleshooting strategies and ensure synergy in the data flow with SHARP’s system.

● Finalized a draft comprehensive M&E manual. The manual is designed as a practical guideline to MEL and program staff on all M&E related processes to ensure the system provides timely and accurate information.

● Developed a training master database that also accounts for the vetting requirements of all trainees.

● Completed the study protocol for the health facilities assessment and currently finalizing the data collection tool for mobile data collection.

● Finalized the community mapping narrative guidelines, including the household profiling tool to be used as part of the community mapping exercise.


Challenges, Lessons Learned and Proposed Solutions

CHALLENGES PROPOSED SOLUTIONS

The MoPHP signed the Project Agreement on June 14, almost five months after the project was registered (and nine months from the date of award). This significantly delayed the official launch of the project at the governorate and district levels, as well as implementation of project activities.

SHARP’s leadership has informally engaged with the MoPHP at the central level to keep them abreast of the project’s proposed activities, developed tools in readiness for MoPHP’s approval prior to program implementation, and participated in Health Cluster meetings to ensure other implementing partners and donors are aware of the project and its mandate.

The intended project kick-off meeting with health authorities in the governorates and target districts could not be held due to COVID-19 related travel restrictions; virtual meetings are also difficult due to limited internet access in some areas.

SHARP is coordinating with the MoPHP to determine if a hybrid option is feasible: virtual where connectivity is not an issue, and face to face meetings with masks, distancing and other COVID-19 restrictions in all other areas.

Signing of the office lease was delayed after conducting security assessments of the selected building. Negotiation with the landlord is taking longer than expected.

Speed up the process with the landlord to review and finalize the office lease to enable the security firm to start the work on the security upgrade.

JSI’s registration with the Tax Authority is still on hold due to delays in establishing an office in Aden.

Upon signing the lease with the landlord, a copy of the lease contract will be given to the Tax Authority - this is the final step in the process.

Recruitment for the F&A Manager position has proven to be difficult in spite of three rounds of advertising.

As a back-up plan, the HR Manager will identify qualified candidates through other recruitment techniques. JSI will extend the contract of our Gaza-based finance consultant who will travel to Yemen, when possible, to support the team.

JSI is yet to be registered with UNHAS to facilitate staff travel between Aden and Sana’a, and to regional destinations.

JSI’s Home Office reached out to WFP headquarters to register with UNHAS-managed flights in Yemen, and was instead advised to connect directly with Yemen UNHAS since all Yemen travel requests are routed through, and registered by, the Yemen UNHAS team. JSI has approached the Yemen WFP/UNHAS through the WFP Humanitarian Booking Hub system to which it has access. JSI is yet to receive confirmation on the likelihood of registering staff for access to UNHAS flights, and continues to follow-up closely.


Priority Activities for Next Quarter Program:

● Finalize the research protocols for the pilot rapid response questionnaire, FGD guide, KII questions; submit to MoPHP for approval.

● Conduct a two-day workshop in each governorate to design and develop key health messages to target communities and health providers, and select appropriate communication channels.

● Finalize the training plan and logistics for the twenty data collectors for the health facility assessment.

● Finalize tools for the community mapping process, identify community catchment areas, train CMW on the tool, and plan the logistics for conducting this assessment.

● Develop an in-service training plan for facility staff using the existing MoPHP curriculum. ● Update the Support Supervision tools and present to the MoPHP for review. ● Finalize missing data collection tools as well SHARP’s master database. ● Engage the WHO and MoPHP on the planned pilot HMIS in Aden governorate. Finance, Administration, Human Resources:

● Sign the office lease. ● Upgrade the office and guest house to ensure staff safety and security. ● Sign contract with Neptune to provide ongoing security services throughout the life of the

project. ● Finalize the FOSSM and ensure all staff are fully trained on security policies and best practices. ● Complete the procurement plan for furnishing the office and guest house. ● Register with the tax and social security authorities in Aden. ● Finalize SHARP’s standard operating procedure for vetting. ● Fully staff the project team and provide comprehensive onboarding and orientation. ● Onboard the Finance Officer and Security Manager, and orient to JSI’s financial policies and

procedures. ● Finalize JSI’s Operations Manual, inclusive of annexes and templates.


Annex 1: Progress Against Indicators

Please see separate excel document.

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