YEAR THREE WORK PLAN SYNTHESIS FY09

1. YEAR THREE WORK PLAN SYNTHESISFY09 November 2008

2. Events in the Life of project AXxes

3. Strategies to improve activities Activities with High performance Actvities with low perfomance • ANC, EPI, Assisted births, PSC, Vit A, FP facility based (CYP), LLNIs, Blood safety • Maintain /improve the current approaches • Focus on quality • Reinforce communication • FP, TPI, Curative care, PMTCT, C-IMCI • Reinforce the community based approaches • Create and reinforce link with high performance activities • Concentrate in 200 sites (MNH,PMTCT, FP, care sites)

4. Reinforce community based approaches • Complete 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

5. Create & reinforce link with the high performance activities • Seize 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

6. Increased access to, quality of, and demand for curative services Indicators and targets Strategies and activities • Ensure 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

7. Improved Maternal and New born care services Indicators and targets Strategies and activities • Improve 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)

8. Improved Family Planning services Indicators and targets Strategies 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

9. Improved Family Planning Services ( cont’) Indicators and targets Strategies 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

10. Improved child health: Immunization Indicators and targets Strategies 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

11. Improved child health (cont’): Nutrition Indicators and targets Strategies 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

12. Improved child health (cont’): Clinic IMCI Indicators and targets Strategies and activities • Supervise correct use of protocols • Provide drugs including Zinc to the new HZs • Set up 200 community based care sites

13. Improved child health (cont’): Community IMCI Indicators and targets Strategies and activities • Support 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

14. Improved Water provision & sanitation Indicators and targets Strategies and activities • Rehabilitate/ 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

15. Reduced Malaria in targeted population Indicators and targets Strategies and activities • Provide 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

16. Improved TB detection and treatment Indicators and targets Strategies and activities • Reinforce 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

17. Establish blood testing and grouping Indicators and targets Strategies and activities • Promote 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.

18. Establish PMTCT (cont’) Indicators and targets Strategies and activities • Hold 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)

19. Establish PMTCT (cont’) Indicators and targets Strategies and activities • Procure 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

20. Component B: Increased Capacity to the health zone and the referral system Reinforce M&E system Reinforce Management • Provide 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

21. Component C: Increased capacity of national health programs and provincial/district offices MOH Intermediate level (provincial & district) MOH Central level • Support 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 system • Support the supervisions of the MOH intermediate level by the central level selected directions and programs (Pronanut, 4th&5 direction, PEV, PNLP, PNSR, PNSA)

22. Challenges • Context 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