HANAN QUARTERLY NARRATIVE REPORT

Reporting Period: July 1, 2006 to September 30, 2006

Submitted to: USAID West Bank/Gaza

Date: September 20, 2006

Table of Contents

I. Overview of Progress and Accomplishments .............................................4

A. Program Highlights.....................................................................................4 B. Major Quarterly Accomplishments by Month..............................................6

II. Constraints....................................................................................................9

III. Major Activities and Outputs ....................................................................10

A. Programmatic & Technical Activities ........................................................10 B. Support Functions ....................................................................................21 C. Finance ....................................................................................................25 D. Administration ..........................................................................................26 E. Major Deviations from Approved Workplan..............................................32

IV. Cumulative List of Tools, Methods, and Publications............................34

V. Expected Activities of the Next Reporting Period ...................................35

Annex I: Quarterly Financial Report................................................................36

Tamam and Hanan Perspective from the Field

My name is Tamam Abu Zaid and I am working as a senior staff nurse at UNRWA-Gaza since 16 years currently in Jabalia Health Sub-Center-Gaza. I am a national trainer on Infection Prevention and Control as I received TOT course with the Maram Project in 2004. My experience with Hanan started in 2005 when the project selected my clinic-at that time “Beit Hanaoun” to work with on improving the quality of MCHN services. I was very impressed with the approach followed by the project in selecting their sites and paying attention to the needs of the community, especially the vulnerability issue. At the beginning, I thought it might be the same as the other projects, working on fragmented pieces and imposing the project agenda on us and sometimes leaving us in the middle of the way limping, not knowing either to continue or to stop. In fact, I am surprised with the degree of involvement the Project maintained during working with us. Hanan staff members were so co-operative with us and asked us about our needs rather than forcing their agenda on us. They taught me how to plan with my staff and how to think comprehensively in order to standardize services. Protocols, equipment, checklists, scorecard and training are all implemented through the Quality Improvement Plan, which we never used before Hanan. Most projects implemented in Gaza were interested in supporting health care providers only, few thought about the community, but Hanan’s focuses on both the health care providers as well as the community at the same time. They held community focus groups in order to assess the needs of the community and started to respond to their needs according to the community perceived priorities. As a senior staff nurse, at the end of each working session at my clinic, I used to check all the antenatal care cards first. Then I used to check the medical issues paying no attention to the client who carries that card, but when Hanan team came to work with us they first ask about the satisfaction of the client so we learned how to critically question ourselves about the care we provide to people; are they satisfied or not? Where are the gaps in our care? We started to assess ourselves, evaluate our work before any one else does that for us and finally try to improve our quality of care by holding regular community meetings, asking clients what they are expecting from us to do for them and what can we do to meet their expectations. We evaluate ourselves after that and we are discovering that our work is not as what others thought; just to give an appointment or to keep your sheet tidy but more importantly to care about people who need the care; what they want and how they want it to be. Of the things I will keep remembering about Hanan, are the many wonderful workshops organized by Hanan. These workshops gave us a lot of information and new perspectives. I was a trainer of one of the training workshops and trainee in many others which installed in me the spirit of sharing knowledge, one time receiving information and the other time giving information. I used Hanan’s approach in implementing IPC training for 41 dentists and staff nurses in my organization using Hanan’s training tools and approach. Uniquely, Hanan doesn’t only provide us with information but also they follow up the application of information in the field. I am very pleased working with Hanan project and my team shares with me this feeling. Many projects came to Gaza but few who left their prints.

Tamam Abu Ziad August 22nd 2006

I. Overview of Progress and Accomplishments

A. Highlights

Program implementation This quarter Hanan returned to full implementation of all clinical, community, and communications and marketing activities. USAID clearance to begin work with new partner clinics in Gaza, Jenin and Hebron districts was received in August. Common objectives and specific areas of Hanan support to the clinics were agreed and on-the-job training and supervision support with the clinics began. This is complemented by the re-launch of Hanan’s formal training program. During the reporting period three trainings – two on Infection Prevention and Control and one on Child Health, Nutrition and Growth Monitoring – were held in September. Hanan is committed to providing MCHN and emergency medical services training to 3080 individuals by the end of the Project. At the end of this quarter, 338 individuals have been trained. During the next quarter clinical program training activities will increase significantly. It is anticipated that 320 individuals will receive formal training and 252 individuals will receive on-the-job training. Additionally, two selected training providers will begin training approximately 400 individuals in Advanced Life Support in Obstetrics and Neonatal Resuscitation, and Pre-hospital Emergency Medical Services. A standardized list of essential MCHN equipment to be procured for the clinics was prepared. Specifications and quantities were established for an initial group of approximately 20 clinics and procurement of the items has started. Additionally, a procurement consultant visited Hanan at the end of September and is currently preparing recommendations for supporting Hanan to accelerate procurement of similar items for the remaining clinics. Hanan also made a significant contribution the emergency and humanitarian response. Approximately $550,000 of critically needed MCHN-related medical equipment and spare parts is now being procured for 9 hospitals in the West Bank and Gaza. The equipment and spare parts will be delivered to the hospitals during October and November. Within the West Bank community program, the Community Mobilizers and Community Health Workers that were hired by our partner Palestinian Medical Relief Society (PMRS) at the end of last quarter began work in 28 communities in Jenin and Hebron Districts. The Health Workers conducted 310 health education sessions, reaching 4152 women of reproductive age. The end-of-project target is 4,000 sessions. This quarter 84 individuals working for Non-Government and Community-Based Organizations have received training, towards a Project target of 300 such individuals. Training topics covered community mobilization and all 18 key MCHN messages (see below) on antenatal care, postnatal care, breast feeding, neonatal care and child health for under 5 year olds. Additionally, these individuals received in-service training on a number of topics, including nutrition for pregnant and lactating women, hygienic food handling and storage, planning a balanced diet for pregnant women and family planning counseling for new mothers.

Topic Key Messages

Importance of early antenatal visit (within 1st

trimester) for fetus and mother, and barriers to early registration

Understanding danger signs and potential complications during pregnancy, and the early identification of risks and emergency response

Importance of preventing anemia for fetus and mother, and what to do about it – iron and folic acid supplementation for at least 6 months during pregnancy and for 3 months postpartum

Ante-Natal Care

Signs of labor, planning for delivery, importance of physical and psychological support by husband and family (m-in-l, mother) during pregnancy and postpartum

Importance of postnatal care (for baby and mother) within 6 hours, 6 days and 6 weeks of delivery, and barriers to seeking early postnatal care

Understanding danger signs during 1st

6 days of delivery for the neonate and mother, early identification of risks and complications during this period, and emergency response

Post Natal Care

Importance of appropriate care for neonates (hygiene, bathing, wrapping/clothing, warming, eye care, care of umbilical cord)

Importance and benefits of early initiation of breast feeding – within one hour of delivery, night feeding, and feeding on-demand

Correct technique for breastfeeding

Importance of breast feeding exclusively for 6 months, and overcoming barriers

Breast Feeding

Importance of breast feeding for 2 years, and overcoming barriers

Timing and type of liquids/solids in baby’s diet after 6 months

Importance of healthy weaning practices at 2 years

Child Health U2

Importance of anemia prevention – iron supplementation, and Vit A&D drops

Prevention, early detection, home management, referral of children with ARI

Prevention, early detection, home management, referral of children with DD

Prevention of anemia – iron supplementation, nutrition

Child Health U5

Importance of growth monitoring and promotion after vaccination schedule completed

Hanan’s MCHN messages Individuals trained are now sharing new skills and knowledge with other mothers and their families in the communities where Hanan works. This is happening through a variety of community events, including topical discussions with small groups of pregnant women and larger scale community campaigns. For example, this quarter ‘Community Clean-up’ campaigns were held in 7 towns in Jenin and Hebron districts. Campaign messages were linked to diarrhea prevention and home management for children under 5, as well as the importance of continued and increased breastfeeding. Community Coalitions were established in 18 communities in Jenin district and 7 communities in Hebron district. Each Coalition is now implementing an action plan for supporting women’s and children’s health in its community. Next month selected staff of Community Based Organizations and members of Community Coalitions will receive comprehensive training in communications including listening skills, negotiation, conflict resolution, and networking. These trainings will help them to effectively advocate for and take action to meet women’s and children’s health priorities and needs. With support from Hanan, this quarter the Palestinian Center for Human Resource Development (PCHRD) took the first steps to establish a similar community program for

Gaza. Twenty-nine Community Mobilizers and Community Health Workers are currently being recruited for this program and it is anticipated that they will be working in 36 neighborhoods across North Gaza and Gaza City by the end of October. Plans for forming Community Coalitions in Gaza are also now under way. Hanan’s communications and marketing program was launched this quarter. Sama Productions developed the creative content of communications products and this content will be pre-tested with Project beneficiaries next quarter. Education and promotion materials, radio plays, original songs and theatre performances featuring the MCHN messages are now being prepared and will be delivered to the communities where Hanan works, also during the next quarter. All of the preparations were made for the Community College of Applied Science and Technology (CCAST) – Gaza to carry out this year’s household baseline survey, addressing 14 outcome indicators in the Project Performance Management Plan (PMP). The survey will begin in October, to be completed by the end of November. Additionally, routine project performance monitoring and evaluation reporting was resumed to address the remaining process and output indicators in the PMP. The Centre for Development of Primary Health Care (CDPHC) at Al Quds University initiated a first applied research study supported by Hanan, on complementary feeding practices. A second research study, on traditional home practices, has also been awarded to CDPHC through an open tender process. This latter study is scheduled to begin next quarter. Program expansion This quarter Hanan’s plans for expanding its work with clinics and communities to new geographic areas were finalized. In particular, approximately 55 potential new clinic partners, encompassing new districts of Bethlehem, Ramallah, Jerusalem, Toulkarem and Salfeet in the West Bank and Gaza Middle and Gaza Southern areas, were mapped. Preliminary assessments to verify the willingness and potential of these clinics to receive support from Hanan are now being conducted. It is anticipated that the potential new partner clinics will be vetted and selected by the end of this year. At the same time, approximately 27 new communities to be reached through the West Bank community program have been identified. Once the current community program has been launched in Gaza City and Gaza North, Hanan will also begin identifying additional communities throughout Gaza to be reached.

B. Major Quarterly Accomplishments by Month

July

• On July 16, received pre-award authorization from USAID to continue with Project implementation in specified areas.

• In anticipation of the release of clinic vetting results from USAID, prepared a rapid assessment tool, as a reference for agreeing with each clinic common objectives and support requirements for improving service quality.

• Prepared presentations for clinics on ‘Epidemiologic data underlying Hanan’s choice of interventions’ and ‘Hanan’s Quality Improvement Strategy’.

• Prepared 3 new supervision checklists – on preparation of normal delivery, normal delivery and equipment needed for delivery – to be used with clinic partners.

• Duplicated Maternal Child Health and Nutrition (MCHN) protocols for distribution to Hanan’s designated clinics.

• Completed an emergency procurement assessment to identify MCHN-related medical equipment and spare parts urgently needed by 9 NGO hospitals in the West Bank (6) and Gaza (3).

• Upon receiving vetting results from USAID, initiated the emergency procurement for the 3 hospitals in Gaza.

• Jointly with Palestinian Medical Relief Society (PMRS), conducted the second health workers training module entitled ‘From first antenatal care visit through Breastfeeding’.

• Conducted a health worker in-service training. Topics covered include planning a balanced diet for pregnant and lactating women; preparing a balanced meal from available and affordable produce; and hygienic food handling and storage.

• With support from PMRS, Community Coalitions in 15 communities in Jenin district and 7 communities in Hebron district completed action plans for responding to mothers’ and children’s health priorities and needs. All 28 communities in Jenin and Hebron districts in which Hanan is working have formed coalitions, some of which are strong and active in their communities.

• With support from Hanan, the Center for the Development of Primary Health Care (CDPHC)/Al-Quds University initiated a research study on Complementary Feeding Practices.

August

• On August 4, received vetting results for suggested clinic partners. • Completed rapid assessments to agree objectives and areas of support with 8

clinics in the West Bank and 10 clinics in Gaza. Rapid assessment findings and recommendations are captured in a Quality Improvement Plan, which can be feasibly implemented over a 9-12 month period.

• In Gaza, conducted an introductory workshop to introduce all partner clinic staff members and the senior management of their organizations to Hanan’s clinic support strategy and agree next steps.

• For procurement planning, prepared a standardized list of equipment, pharmaceuticals and disposables for Hanan clinics.

• To prepare for Project expansion, completed a mapping of potential new clinic partners and communities in Middle and Southern Gaza and Northern, Southern and Middle West Bank.

• Prepared a training plan and schedule for clinic partners. • Completed Antenatal Care Guidelines for distribution to clinics. The guidelines are

based on the Antenatal Care Curriculum developed by Hanan in collaboration with UNFPA, PMRS, and WHO.

• On August 4, received vetting results for the 6 West Bank NGO Hospitals to receive an emergency procurement.

• On August 22, submitted to USAID the proposed list of equipment and spare parts to be procured for the 6 hospitals. Approval was received the next day and the procurement was initiated.

• PMRS’ community health workers in Zbuba, Jenin district facilitated a discussion with pregnant women on healthy nutrition, with a particular focus on sources of iron.

• Conducted an in-service training for community health workers in Hebron district on how to plan a balanced diet for pregnant women.

• Conducted an in-service training for community health workers in Jenin district on how to plan special community events on Hanan’s key MCHN messages.

• Conducted an in-service training for community health workers in Jenin and Hebron, to prepare them to address family planning issues that they would normally encounter during home visits and group education sessions.

• In six towns in Jenin district and two towns in Hebron district, conducted ‘Community Clean-Up’ campaigns.

• Sama Productions began developing the creative content, including characters, tag lines and materials designs, for MCHN communications products.

• Sama Production submitted a proposed media plan for internal review and discussion, prior to submission to USAID.

• Drafted RFA for pre-testing of communications products. • Received USAID approval of subcontract for Hanan’s Gaza community program

partner, the Palestinian Coalition for Human Resource Development. • Initiated recruitment of PCHRD team members, including 25 community health

workers for Gaza. • Submitted monthly Humanitarian Monitoring Unit report to USAID. The report

presents results for 6 clinics with regard to indicators of service access and availability and maternal and child health.

• Through a tender process, selected the Community College of Applied Science and Technology (CCAST) Gaza to conduct this year’s household baseline survey.

September

• Completed rapid assessments with an additional 3 clinics in Gaza and an additional 7 clinics in the West Bank. Thus, objectives and areas for support, set out in Quality Improvement Plans, have been agreed with all 28 current clinic partners.

• Collected specifications and quantities estimates for Hanan’s list of equipment to be procured for clinics.

• Submitted to USAID a subcontract with Juzoor Foundation for Health and Social Development to provide Advanced Life Support in Obstetrics (ALSO) and Neonatal Resuscitation training in the West Bank and Gaza. 180 health providers will benefit from this training and receive follow on support to help them apply training concepts in practice.

• Prepared guidelines for conducting on-the-job training by Hanan staff and by partners. On-the-job training will be implemented at facilities to improve service quality and reinforce knowledge and skills received during formal training.

• Prepared concept papers clarifying Hanan’s approaches to providing training and follow on support in the areas of child health, nutrition and growth monitoring and management of diarrheal disease and acute respiratory infection.

• Conducted a training course in ‘Child Health, Nutrition and Growth Monitoring’ in Gaza.

• Conducted training courses in ‘Infection Prevention and Control’ in Gaza and Hebron.

• Initiated procurement of 450 emergency kits to be distributed to qualified health providers in the West Bank and Gaza.

• Received 7 applications in response to an RFA for pre-hospital emergency services training. The applications will now be reviewed by a tender committee and it is hoped that the selected partner can begin implementation in October.

• Al Kasaba began scripting 10 radio plays to be broadcast on stations covering areas where Hanan works and reaching Project beneficiaries.

• Studio 1 began producing a CD of original songs featuring Hanan’s MCHN messages. The CD will be distributed in communities where Hanan works.

• Heart to Heart International began preparations to conduct 50 live theatre performances on MCHN-related themes in the communities where Hanan works.

• Finalized a purchase order with New Vision for conducting 10 trainings on “Communications” which include topics on listening skills, negotiations, conflict resolution and networking.

• Finalized contents of proposed MCHN educational booklets for Hanan. • An RFA on pre-testing Hanan communications products was sent to the four short-

listed market research firms for proposal submission. • Hosted regional meetings of Community Coalitions in Jenin and Hebron districts.

The purpose of the meetings is to share learning across Coalitions about successful approaches to mobilizing communities for MCHN.

• Conducted in-service trainings for Community Health Workers on identifying barriers to early ante-natal and post-natal care and supporting women and families to overcome them, and on ensuring adequate iron and folic acid consumption during pregnancy and after delivery.

• Jointly with PCHRD, Hanan’s community program partner in Gaza, developed recruitment plan for hiring field staff to be based in Gaza City and Beit Lahia.

• Recruitment ads were placed by PCHRD in newspapers and posted in community based organizations inviting CVs for all 29 positions; interviews were conducted jointly in PCHRD’s offices.

• The PCHRD Project Manager for the community program was given an orientation on Community Mobilization, Hanan’s 1st training module.

• Resumed Project monthly monitoring and evaluation reporting. • Trained CCAST researchers in LQAS methodology for the HBLS. • Participated in USAID’s GIS audit. This audit focuses on how USAID projects use

the USAID GIS database and comply with related reporting requirements.

II. Constraints Clinic vetting requests submitted in mid-June were not cleared by USAID, the Consulate and the Embassy until early August. With the learning that it takes approximately 2 months to obtain clinic vetting results, Hanan is working now to identify potential new clinic partners. The remaining 52 clinics will need to be identified in September and October, in order to be vetted by the end of this year, so that they can receive Hanan support for an adequate period of time to achieve service quality improvement results by the end of the Project. Many of the clinic partners are experiencing tremendous financial difficulties in meeting operating and salary costs. This hinders their potential to achieve agreed service quality improvement objectives. Hanan has begun inviting partners in this situation to submit proposals to receive short term grant support to bridge financial gaps. Once these proposals have been received, Hanan and USAID will jointly decide which proposals to support. The doctors’ strike, which began at the end of August, has significantly affected both public and private hospital and clinic service delivery to communities where Hanan works. The Project is receiving reports of clinics and hospitals not functioning because no doctors are available; women delivering babies on hospital floors; complications during pregnancy not

being attended to; and high risk cases not being treated. Additionally, the Project has heard a number of stories, from Jenin district in particular, of women dying during child birth and of babies being born dead. Palestinian team members were prohibited from traveling to and from Gaza from the end of June until the end of September. Opportunities for sharing and learning amongst colleagues have been lost and this has set back earlier accomplishments to build team work across regions. Additionally, this has delayed progress in implementing the Gaza community program, as the team members with responsibility for this activity are based in Ramallah. The latter problem is currently being addressed through the recruitment of a Community Program Supervisor to be based in Gaza. Access to Jenin is increasingly restricted and team members traveling to Jenin from Ramallah have routinely experienced long delays at checkpoints along the way. This has hindered the ability of Ramallah-based team members to participate as fully as they might have in clinic and community activities.

III. Major Activities and Outputs

A. Programmatic & Technical Activities

1. Clinical Services Strengthening

Hanan’s new clinic partners In August new clinic partners were selected. As indicated by District in Table 1 below, the partners represent the diversity of responses within the Palestinian non-government sector, ranging from large organizations with substantial clinic networks to smaller organizations providing needed services to specific, local communities. Some of the organizations have a health mandate, whilst others also serve community needs more broadly. All of them have strong traditions of working with local communities. Developing Quality Improvement Plans with Hanan clinic partners This quarter Hanan began developing a Quality Improvement Plan with each of its new clinic partners. The plan constitutes an agreed upon framework for Hanan’s supportive interventions to the clinic. It outlines the context in which the clinic is working and broad objectives for improving the quality of the clinic’s MCHN services. In relation to this, specific priorities for technical and managerial training and MCHN-related equipment, disposables and drugs are identified. MCHN intervention areas in which the project is interested and the clinic’s perceptions about areas that require priority attention are both incorporated into the plan. Throughout August and early September, rapid assessments, which form the basis for the Quality Improvement Plans, were completed for all of Hanan’s 28 partner clinics. To inform the assessment process, Hanan presented its intervention support package, quality improvement approach and training agenda to the clinics. This was done individually with clinics in the West Bank and for all clinics in Gaza through a large start-up meeting By the end of this reporting period, the plans will be produced. Draft plans are currently being shared with the clinics’ mother organizations for their endorsement, prior to the official signing of them. In its final form, each clinic’s Quality Improvement Plan will include:

• Three to five MCHN technical areas, as perceived by the clinic staff and agreed by

Hanan, to focus on during the course of 9-12 month’s work with the clinic. An example of a MCHN focus area is ‘Improving pregnant women’s compliance with iron supplementation’.

• Three to five management areas to focus on during the course of work. An example of a management focus area is ‘Improving documentation and reporting practices’.

• A list of MCHN-related equipment and supplies, to be provided directly by Hanan, and pharmaceuticals and disposables, to be provided through Care International’s EMAP III Project, to the clinic.

• The clinic’s requests for technical and management training and the training plan for each clinic. The training plan allows the project to immediately organize additional training courses and to recruit training participants from clinics.

• Time bound next steps to be taken, by both Hanan and the clinic, in order to introduce the required improvements in each focus area.

Table 1: Hanan clinic partners by District* No. Area District Organization name Ownership

1. Al-Amal Health Center Patient’s Friends Society 2. Misilya Clinic Patient’s Friends Society 3. Arraneh Clinic Patient’s Friends Society 4. Qabatia Clinic Patient’s Friends Society 5. Rumana Clinic Patient’s Friends Society 6. Seilat Al -Harthia Clinic PMRS 7. Zababdah Clinic PMRS 8. Kuf Rae Clinic PMRS 9.

Jenin

Qabatia Al-Aksa Clinic NGO 10. Biet Awwa Emergency

Center Biet Awwa Municipality

11. Yatta Clinic Yatta Charitable Organization 12. Alreheya Clinic Alreheya Charitable Society 13. Dahria Medical Center Dahria Municipality 14. Idna Clinic PMRS 15.

West Bank

Hebron

Al Hajj Musbah Clinic PMRS 16. Ard El-Insan Clinic Ard El-Insan Society 17. Patient’s Friends

Benevolent Society Clinic

Patient’s Friends Benevolent Society

18. Caritas Clinic Caritas-Jerusalem 19. Shejaiya Clinic Near East Council of Churches

Committees 20. Darraj Clinic Near East Council of Churches

Committees 21. Red Crescent Society –

Central Red Crescent Society for Gaza Strip

22. El Moghraqa Medical Center

Mother & Child Health –El Moghraqa Society

23. Al Rimal Health Center UNRWA 24. Zaytoon Health Center UNRWA 25.

Gaza

Gaza Town Health Center UNRWA 26. Jablia Women Health

Center

Red Crescent Society for Gaza Strip

27. Fakhoura Sub-Center UNRWA 28.

Gaza

North Gaza

Beit Hanoun Health Center UNRWA * An additional 3 clinic partners have provisionally been selected, pending final clearance from USAID. 2 clinics were dropped from the original list of 33 vetted clinics.

Training Hanan clinic partners Through developing Quality Improvement Plans with the clinics, Hanan has already identified its clinic partners’ MCHN and clinic management training needs and jointly with them developed training plans. Next quarter Hanan plans to hold approximately 15 training courses for clinic partners in the areas of antenatal care, postnatal care, newborn care and in clinic management topics. This quarter Hanan held a training course on child health, nutrition and growth monitoring that was attended by 26 participants from partner clinics in Gaza. This was the first time a course on this combined topic had been organized in Gaza. During his closing remarks at the training, Dr Ayoub El Alem, the Director of UNRWA Health Program in Gaza stated that “The quality of this training in terms of organization, quality of the content and training methodology, especially the role play, is much better than the training I received myself in this regard abroad”. Hanan also organized two Infection Prevention and Control training courses, in Gaza and Hebron, with 43 participating.

Role play at Hanan training on Child health, nutrition and growth monitoring in Gaza

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To further scale up the training activities, Hanan prepared an RFA to outsource a mother health - encompassing antenatal, postnatal and newborn care – training package. This RFA is ready for release. In the meantime, a consortium of organizations approached Hanan to express its interest in organizing and implementing this training package and provide needed follow on support to trainees in their work places. Hanan is currently awaiting a more defined proposal in order to determine if there is an adequate sole source justification for awarding this training package to the consortium. If there is not adequate justification, Hanan will release the RFA. Additionally, Hanan is currently selecting, from amongst 7 tender applicants, an organization to provide pre-hospital emergency medical services to 300 health and non-health providers. A subcontract has been prepared for Juzoor Foundation for Health and Social Development to train 180 health providers in Advanced Life Support in Obstetrics and Neonatal Resuscitation. The subcontract is currently with USAID for review and approval. Any remaining preparations for intensively scaling up training activities next quarter were completed. For example, the team prepared concept papers clarifying Hanan’s approaches to training and follow on support in the areas of child health, nutrition and growth monitoring, and management of diarrheal diseases and acute respiratory infections. All MCHN and Infection Prevention and Control protocols were duplicated and are now ready for distribution to partner clinics. Materials to support management training on topics such as supervision, documentation and reporting, and communications, were finalized and are now available for use. To structure planned on-the-job training for clinic partners, guidelines on this topic were prepared for Hanan team and staff of partner organizations. Producing and distributing supportive tools for clinics Hanan continued to develop and disseminate to partner clinics supportive tools for improving MCHN service quality. To increase ownership, these tools have been shared with clinics and their mother organizations prior to their dissemination or use. This quarter 1408 copies of the MCHN protocols were duplicated. Dissemination has started in accordance with a prepared dissemination plan. During regular supervisory visits, Hanan will monitor the availability and use of these protocols at the clinics and will disseminate more copies as needed. Previously developed supervisory checklists were simplified, using a decimal and binary approach. The strategy for checklists use, along with Hanan’s balanced scorecard tool and strategy, were revised to reflect the new Project Description. Job aides were also revised accordingly and will be produced and disseminated next quarter.

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The 15 checklists and balanced scorecard tools and strategies have been shared with clinic partners. Additionally, new checklists on emergency preparedness and on hospital- and centre- based delivery (normal delivery, preparations for normal delivery and equipment needed for delivery) were prepared in support of the Project’s new humanitarian assistance orientation. In conjunction with any checklists that the clinics already use, the Hanan checklists and balanced scorecard will be applied jointly with clinic staff members next quarter. The purpose is for monitoring and developing where desired the quality of different services. Approaches for applying the checklists and the scorecard were discussed and agreed in advance with clinic partners during the quality improvement planning process. Already the checklists have been applied with clinic partners in order to take preliminary readings. By the end of this quarter, balanced scorecard baseline readings will also be available for the participating clinics.

2. Emergency and Humanitarian Assistance

Emergency procurement of MCHN-related medical equipment and spare parts This quarter Hanan carried out its first emergency procurement of urgently needed medical equipment and spare parts. The estimated procurement value is $550,000, drawing on the Project’s new emergency fund. The following nine non-government hospitals, six in the West Bank and three in Gaza, will receive the procurement as soon as the items are delivered during October and November: • Al Ahli Hospital - Hebron • Al Aljili Hospital - Nablus • Al Ittihad Hospital - Nablus • Al Makassed Hospital - Jerusalem • Augusta Victoria Hospital – Jerusalem • Sheik Zayed Hospital - Ramallah • Al Ahli Hospital – Gaza • Al Amal – Palestinian Red Crescent Society – Gaza • Al Quds – Palestinian Red Crescent Society – Gaza The items to be procured for each hospital were determined jointly and on site with the Hanan team and hospital management, clinical and engineering staff. The Hanan teams completed detailed assessments of the needs for equipment and spare parts, and worked with hospital teams to prioritize those needs in line with the Project’s maternal and child health mandate.

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In the current difficult humanitarian and financial situation, all of the hospitals are facing increased demands on their services and they lack physical resources to effectively support this. The urgent needs largely encompassed: • Basic equipment to replace failing or absent infrastructure or furniture such as

hospital beds, examination tables and trolley, and • Instruments or technical installations to investigate or treat medical or

obstetric conditions, including laboratory, intensive care and surgical equipment.

In some cases the ability of the hospital to produce its own oxygen supply and to remain independent from potentially life threatening disruptions in electricity supply was also addressed. Urgent needs for spare parts were equally varied. Some hospitals needed essential items that are required for regular maintenance of equipment but that they cannot afford in their current financial situation. Others needed replacement parts or repair kits for different types of equipment, ranging from minor examination, surgical or obstetric equipment to sophisticated laboratory or resuscitation equipment. The assessment process was carried out together with Care International, USAID’s Health and Humanitarian Assistance partner responsible for the emergency procurement of pharmaceuticals and disposables. Hanan and Care harmonized their methodologies and schedules for the assessment in order to minimize the time and logistics burden placed on the hospitals. Pediatric Advanced Life Support, Neonatal Resuscitation and Advanced Cardiac Life Support Training Courses Over the past five years, Juzoor "Foundation for Health and Social Development” has been systemically aiming at building the capacity of health professionals in Palestine. Juzoor sees the introduction of internationally accredited programs of training as one way of achieving its aim. The advantage of such programs is the facts that they standardize practice as well as introduce evidence based knowledge and skills and most importantly, when delivered with the same international standard locally as abroad, provide a quality and an incentive for trainees to read and learn. This quarter Hanan joined the National Arab American Medical Association (NAAMA) and Physicians for Peace in supporting Juzoor to hold a series of trainings, to international standard, on childhood and maternal emergencies. In particular, the topics of Pediatric Advanced Life Support (PALS), Neonatal Resuscitation, and Advanced Cardiac Life Support were addressed. 59 individuals participated in the trainings and of those 53 successfully completed them.

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NAAMA and Physicians for Peace professionals exchanged their experience and provided lectures and hands-on training and their organizations also provided the books and mannequins needed for the training. Hanan mobilized additional financial and logistics resources to support the event. A follow up day for the trainees will be held four months following the training. This is part of Juzoor’s methodology. During those follow up days, participants will present case studies reflecting how they put their training to practice. Updates will be reviewed as well as major practice changes. Some lessons learned from the training meetings are:

• There is a great need for quality

international standard courses, people were calling throughout the preparation phase asking to attend the courses once they heard of them and we could not accommodate more numbers. Juzoor maintains a waiting list for future courses. People are willing to travel for long distances and study in order to attend courses that are of international standard.

• The expertise and experience among candidates varies significantly and

trainings must be tailored accordingly. English language presents an issue for some candidates who have done their studies in countries that do not teach medicine in English.

• The fact that the trainers were Palestinian in origin made them empathies

with the participants on the professional and social level. Maintaining Nutrition in Emergency Situations Conference, Amman, Jordan Hanan participated in the ‘Maintaining Nutrition in Emergency Conditions’ conference in Amman, Jordan. The Project Director presented on Hanan’s nutrition approaches, program activities and partners. As well, the Project Director and the Director of Community Mobilization/Communications and Marketing participated in plenary and in small group work on ‘Coordination of nutrition responses’ and on ‘Enhancing current nutrition responses across

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sectors’, respectively. The conference gave an update on the nutritional status of Palestinian women and children and other groups and on current agency responses. It also provided an opportunity to explore ways to strengthen coordination of Hanan’s nutrition response with that of other USAID Health and Humanitarian Assistance partners and of other UN and non-government agencies. Hanan will play an active role as appropriate in taking forward the conference recommendations and next steps.

3. Community Mobilization/Communications and Marketing Gaza community program A first meeting with Hanan’s new community program partner in Gaza was held in late August, soon after official approval of their subcontract was received from USAID. PCHRD’s new Project Manager for the program started his duties on 10 September and with him a recruitment plan for hiring 29 Community Health Workers, Community Mobilizers and Community Mobilization Officers was developed. Recruitment advertisements were placed by PCHRD in newspapers as well as posted in community based organizations. Interviews for all positions will be conducted jointly by Hanan and PCHRD from 25 September onwards. An orientation of the first training module on Community Mobilization was given to PCHRD’s Project Manager and it is anticipated that the first training of the field staff will be carried out next month. West Bank community health workers training The planned formal trainings of West Bank community health workers working in the first round of 28 communities have been completed. Training topics covered include Community Mobilization (Module 1); Maternal Health and Nutrition (Module 2) and Child Health and Nutrition (Module 3). With a view to ensuring that health workers are also engaged in continuous learning that practically addresses the issues they face in carrying out their work, PMRS and Hanan have organized a series of short, one hour ‘in-service’ trainings on a variety of topics. The topics either expand on or complement Hanan’s key MCHN messages. In service trainings are held monthly during regularly scheduled weekly meetings held in Jenin and Hebron. Topics covered this quarter include planning a balanced diet for pregnant and lactating women; preparing a balanced meal from available and affordable produce; hygienic food handling and storage; how to plan for community events; and family planning issues commonly raised by recently delivered women.

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Community Health Worker counseling mothers, Reeheya, Hebron Community Coalitions Coalitions have been formed in all 28 communities in Hebron and Jenin districts. These Coalitions typically comprise of community leaders, community based organizations, professionals such as doctors and teachers, as well as target beneficiaries. The Coalitions, with support from the health workers, have identified the MCHN areas in which their communities are most in need of assistance and on the basis of which action plans have been developed. The action plans are guides for the health workers and coalitions on interventions that will be undertaken to best address the MCHN needs of the communities they serve, focusing on those believed most likely to have impact. Responsibility for implementing the action plans presently rests jointly with the health workers and the coalitions. The expectation is that updating these plans and ensuring that they are implemented and the results tracked in terms of beneficiary and household behaviors will become the sole responsibility of the coalitions – not only to impact Hanan’s 18 key MCHN messages, but also to broaden the agenda to include a range of health and other concerns of importance to the community.

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Community Coalition meeting Dhahariya, Hebron Community Events While one-on-one education sessions, during home visits, and group education sessions are most often the means of educating women and their families, special events have been embraced by several Coalitions in Jenin and Hebron districts as a catalyst for bringing families and communities together on a health issue of common concern. This quarter, eight Coalitions with support from the health workers, organized clean-up campaigns as a vehicle through which their communities – women, children and men - actively participated in a drive to remove garbage and debris, sweep the streets, and install permanent garbage cans in the neighborhoods. As an integral part of the campaigns, sessions were held on diarrhea prevention in children under 5, on the importance of ensuring breastfed babies are given their mother’s milk even more frequently if they have diarrhea, and on breast milk as a natural protection against childhood diseases. In all these communities participation extended beyond volunteering time by families, which was significant. It also included supermarkets and local businesses that made in-kind contributions in the form of garbage bags, garbage

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cans, brooms and pans, and equipment for removing large debris and disposing of the collected garbage.

Children participating in community clean-up campaign, Reeheya, Hebron In each community the clean-up days concluded with a celebration that included the performance of puppet shows, songs, and skits by children, as well as quiz shows in which adults participated enthusiastically, jousting with each other to demonstrate how well they had understood the importance of a clean environment on the health and well-being of their families. The events were attended by local leaders and presents (donated by local stores) were given to all volunteers – children and adults – as a token of thanks. A coalition member in one Jenin community remarked publicly that while many donors and projects had come through his town he had never before witnessed a program that brought residents together to act in support of their own needs. Others agreed that prior to the event no one could have imagined that their townspeople were capable of such working together for a common cause. The coalition and the residents expressed a desire to keep the town clean every day, not just during the clean-up days. In Hebron district, a community that was earlier considered too conservative to allow its men and women to work together, let alone sit in the same room, found themselves working side by side during the clean up days. Two Imams were overhead talking as they were leaving the hall after the celebrations marking the end of the clean-up days. One Imam said that he was not convinced of the merit

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of this effort and that he would not allow his wife and daughters to participate; the other Imam advised him that what he does is his business but to not dictate to the rest of them, as the event clearly proved that people want to come together and only good can come from their interest and participation. Launch of Communications and Marketing plans Hanan’s Communications and Marketing partners are in the process of developing plans for the proposed communications campaign. Theater performances will be launched in October in selected communities by Heart to Heart International and a total of 50 community performances will be held by the end of the year. A media plan has been proposed by Sama Productions that includes programs on radio, as well as concepts for Hanan’s brochures, “taglines” covering the 18 key messages, and sketches of the Hanan characters for use in printed materials. Taking advantage of the presence of health workers attending Module 3 training in Ramallah, Hanan’s Communications and Marketing partners presented their plans for supporting field activities. Heart to Heart International gave an overview of the 50-60 minute sketch of their proposed show and shared a sample of the coloring books that they will be updating to include Hanan’s health messages for distribution to children in the audience. Al Kasaba outlined the radio plays that they have started scripting and explained how the messages in these plays will be linked to and support the work that the field team is promoting. Studio 1 discussed the songs that they are writing the lyrics and music for. The songs will be drawn from well-known Palestinian lullabies and the lyrics will reflect Hanan’s messages in a tasteful way. The songs will be distributed in CD format to communities and made available for use by Heart to Heart International in performances planned for early Spring 2007. Sama Productions shared the overall plan of the communications campaign, including concepts for the two radio shows – a Health Magazine and Radio Stories – that they are currently developing. The overall plan for Hanan’s brochures and “taglines” were also presented, as well as the media plan. The health workers were enthusiastic in their support for the plans and made some useful suggestions that will be incorporated into the development of the campaign.

B. Support Functions

1. Monitoring and Evaluation

During the third quarter of 2006, the Monitoring and Evaluation team carried out the following activities:

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Finalization of the Program Management Plan (PMP) and USAID GIS Performance Indicators Data reporting forms and the database system were modified to correspond with the revised PMP submitted to USAID at the end of June. Team members were trained on how to use the new reporting forms and provision was made for new data storage requirements. In order to facilitate efficient and accurate data collection, a number of these forms have been developed on pocket computers and relevant team members have been trained to use them. Complementary performance indicators to be reported on through USAID’s GIS were developed. USAID has approved these indicators and included them in its database. Hanan began reporting on them for activities taking place this quarter. At present, Project reporting on USAID GIS performance indicators is up to date. The Complementary Feeding Practices Study CDPHC, Al-Quds University is carrying out this study with support from Hanan. Its aim is to recommend clinic and community program interventions that can support mothers to adopt positive complementary feeding practices.

The first deliverable, the research methodology and instruments, has been received and the CDPHC research team is currently conducting focus group discussions with mothers in Jenin, Hebron, North Gaza and Gaza districts. In-depth interviews will follow and build on the results of the focus group discussions.

Annual Household Baseline Survey In preparation for this year’s HBLS, Hanan staff revised the survey questionnaire in line with the new Project Description and revised PMP; defined for measurement all composite indicators and LQAS tabulations; and developed all relevant dummy tables. The 36 Project cluster sites in Jenin, Hebron, Gaza and North Gaza districts where the survey will be conducted were identified. Hanan is working with clinics and/or communities in these sites. The survey data collected from these sites will address fourteen PMP outcome indicators, focusing on the health and nutrition status of women of reproductive age and children under five years, as well as care seeking practices and positive health behaviors carried out at the household level. In response to an RFA, Hanan received applications from five research institutes interested in carrying out the survey. A tender committee reviewed and assessed all applications and selected the Community College of Applied Science and Technology (CCAST), based in Gaza, as the winning candidate.

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This month the JSI Boston Monitoring and Evaluation Adviser will train the CCAST research team on the lot quality assurance sampling methodology to be used in the survey. Data collection will begin in early October. It is anticipated that the survey will be completed by the end of December 2006. Monitoring and Measurement of Project Results While the HBLS addresses 14 outcome indicators, Hanan’s routine data collection forms address the remaining 14 process and output indicators in the PMP. Depending on the indicator in question, data are collected on a monthly, quarterly, semi-annual or ‘as achieved’ basis. Monthly performance monitoring reports address 7 process and output indicators. Production of these reports was resumed this quarter. The first report, for the month of August, was completed by September 15. An analytical account of all data collected in the monthly monitoring report as well as an additional two process indicators and four output indicators will be produced on a quarterly basis. This report also reflects cumulative measurements of Hanan’s performance in relation to PMP targets. The first report, also covering the third quarter of this year, will be submitted separately to USAID by October 15. In future, quarterly performance analysis reports will be incorporated into this narrative report. Humanitarian Monitoring In July, August and September, monthly humanitarian monitoring reports on indicators of service accessibility and availability and maternal and child health status for 6 partner clinics were submitted to USAID, as requested. At the end of September, data will be collected from an additional 22 Hanan partner clinics. The first three months of humanitarian monitoring was conducted as a pilot. After the September report has been submitted to the USAID Humanitarian Monitoring Unit (HMU), Hanan will request a meeting with the HMU in order to examine the usefulness of the data and assess the resources required to collect it from a greater number of clinics.

2. Policy and Advocacy

There have been no policy or advocacy activities during this reporting period. Work in this area will be taken forward during the next project year, at which time it is anticipated that a number of specific and clear policy and advocacy issues have emerged from project implementation.

3. External relations and strategic partnerships

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During this quarter, the Hanan team met with different Palestinian and international partner organizations. These meetings served to clarify areas of strategic collaboration and working relationships with regard to the new Project Description. Care International- EMAPIII Hanan and EMAP III worked out management arrangements and practical steps, by which EMAP III would provide MCHN-related pharmaceuticals and rational drug use training to Hanan partner clinics. EMAP III is now ready to respond to Hanan’s request for support to specific clinics. A first step for EMAP III will be to conduct an on-site assessment. The assessment findings and recommendations will then be shared with Hanan and USAID, as a basis for deciding what support will be provided. Palestinian Medical Relief Society (PMRS) As an outcome of several meetings, Hanan and PMRS management agreed a collaborative framework for implementing Hanan’s clinic program activities. Approximately 18-20 vetted PMRS clinics in the West Bank and Gaza will benefit from Hanan support. Hanan will work closely with PMRS at headquarters and district level to tailor this support to fit PMRS’ organizational objectives, culture and systems, as well as each clinic’s needs and priorities. To this end, clinic rapid assessments and subsequent quality improvement plans will be carried out jointly by Hanan and PMRS. Hanan and PMRS headquarters will sign a Memorandum of Understanding (MOU), which will complement quality improvement plans agreed for each clinic. The MOU will specify the overall program and time-bound plan of support to PMRS clinics, measurement of progress, and agreed inputs or obligations of each partner. Palestinian Family Planning and Protection Association Hanan and the Palestinian Family Planning and Protection Association (PFPPA) are mutually interested to work together. In particular, PFPPA would like Hanan to provide support to four of its clinics, three in the West Bank (Halhoul, Hebron City, and Bethlehem) and one in Gaza City. In particular, Hanan would provide in-kind assistance relating to maternal nutrition, newborn care, preventative and curative child health, infant and child nutrition, infection prevention and control, and pre-hospital emergency training. The in-kind assistance would include training; provision of tools and reference materials; procuring medical equipment and supplies; and in coordination with Care, supplying pharmaceuticals and disposables, as related to the above

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intervention areas. In addition, supervision checklists on the topics would be administered jointly with PFPPA clinic staff. PFPPA would be responsible for securing the needed staff to provide child services in the four clinics. Because PFPPA provides family planning services and in light of the Hanan cooperative agreement special provisions related to how such services must be provided, Hanan consulted closely with USAID West Bank/Gaza and USAID Washington to develop the above proposal for collaboration with PFPPA. Hanan is now awaiting final approval of the proposal from USAID. Community Housing and Finance (CHF) Hanan has had several meetings with CHF in order to share experiences and learning in working with communities. Possibilities for how the involvement of CHF’s community committees could enhance the impact of Hanan’s mobilization activities with current and potential target communities in Gaza are being explored. Opportunities are also being explored to link CHF’s World Food Program-mandated requirement of ensuring communities are trained in nutrition and health, as a prerequisite for receiving food, with Hanan’s community education work in Jenin district. Hanan communications

During this reporting period a new communications plan for Hanan was finalized and shared with JSI and USAID. The plan specifies key messages, target audiences, specific communications activities and team member responsibilities for completing them.

In September the new content of the Hanan brochure and website were finalized. The brochure content was approved by USAID and the design is currently being developed. The website will be launched during October.

D. Finance

Budget vs. Expenditure: Summary and Analysis Since USAID approved Hanan’s first budget modification of December 23, 2005, the year-to-date expenditures have been on track or within a reasonable deviation of the budgeted limitation for each line item, except for the program costs line item as explained below. We expect that this deviation will be further corrected once Hanan’s second budget modification request, which was submitted to USAID for approval on June 20, 2006, is approved by the Mission. The total estimated project expenditures (actual expenditures as of August 31, 2006 are $5,509,893 and the estimated expenditures for September 2006 are $644,023) are well within the currently obligated amount of $19,186,044.

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For further detail, please see Annex I: Third Quarter Financial Report (July – September 2006). Please note that the expected expenditures for September 2006 are higher than estimates previously shared with USAID. This is due to the expectation of receiving a quarterly invoice from ANERA for approximately $315,000. To-date, the project has spent on the cash basis an estimated total of $6,153,916 representing 29% of the total budget for 55% time passed. Due to delays and then a temporary suspension in implementing program activities and subsequent challenges encountered in finding program partners that can work within the policies and procedures applied to Hanan, the level of expenditures of program costs is lower than expected and budgeted. However, this discrepancy will soon be reduced or eliminated with the resumption of full implementation and the signing of a number of subcontracts and purchase orders with new partners, as outlined in Table 1 below. Cost Sharing During this reporting period, Hanan calculated the cost share contribution made by participants who have attended Project training courses or workshops. This contribution, which has now been registered in the Project accounting system, is approximately $40,000. Additionally, ANERA’s cost share contribution made in 2005 has been calculated at $5,905,687. This is in the form of in-kind contributions of MCHN-related medical supplies and pharmaceuticals to clinics, organizations and communities in the areas where Hanan works. The value of ANERA’s in-kind contribution for the period January through March 2006 (the period before the policy of no contact with the Palestinian Authority came into effect) is now being determined. Most of the necessary steps have been taken and at this point the figure can be closely estimated at $2,312,636. The final figure will be reported in the Project accounting system during the next quarter. ANERA’s cost share contribution for the remainder of 2006 will then be calculated. Cost share plans have now been established with most of our subcontractors. For example, Hanan has established a detailed cost share plan with PMRS and entered into cost share agreements with PCHRD and Heart to Heart.

E. Administration

Facilities and Equipment Several security-related equipment items were procured for the Ramallah office. These include a security camera and multi-lock reinforced door for the office

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entrance and a television satellite receiver to allow for monitoring of television news alerts. Program subcontracts

Table 2 below summarizes the current status of all Project sub-contracts. Table 2: Status of Program subcontracts Organization Project Component Type of

contract Current Status Amount

Juzoor Foundation Public Health Sub-contract With USAID for review

180,950

PMRS Community Mobilization Sub-Contract Implementation 297,436

PCHRD Community Mobilization Sub-Contract Implementation 229,438

Sama Productions Communications and Marketing

Sub-Contract Implementation 220,000

Al Kasaba Communications and Marketing

Purchase Order Implementation 18,500

Studio 1 Communications and Marketing

Purchase Order Implementation 17,180

Studio 1 Communications and Marketing

Purchase Order Implementation 45,500

Heart-to-Heart International

Communications and Marketing

Purchase Order Implementation 93,544

CCAST Research/ Monitoring and Evaluation

Purchase Order Implementation 99,730

CDPHC Research/ Monitoring and Evaluation

Purchase Order Implementation 78,014

Total 1,280,292

Subcontractor procurement Hanan procured approximately $16,500 worth of office equipment and supplies for PCHRD to support the work of PCHRD. These are needed to enable PCHRD to carry out its work on the community program in Gaza. Clinical and emergency equipment and spare parts procurement A waiver request for the procurement of 450 emergency medical kits is under review by USAID. Once this is approved this procurement will proceed to purchasing. The Public Health team is currently identifying specifications and quantities of delivery kits, to be procured for health providers, and of essential MCHN

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equipment and supplies, to be procured for approximately 20 PMRS clinic partners. For the emergency procurement of medical equipment and spare parts for 9 hospitals in the West Bank and Gaza, waiver requests are under review by USAID. Visitors and Consultants Table 3 below summarizes the visitors and consultants to the Project during the reporting period, and the purpose of their visits. Table 3: Visitors and consultants during the reporting period Name Area Period SOW

Yousri Aclimandos Procurement September 19-27, 2006 • To conduct an assessment of Hanan’s needs to support implementation of planned procurement

Deidre Rogers Monitoring and Evaluation

September 24-October 5, 2006

• To develop a monitoring and evaluation plan for capturing and presenting Hanan’s progress and results

• To provide LQAS training to CCAST

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Level of Effort Table 4 below details the current level of effort on the Project. Table 4: Level of Effort on the Project Name Position Status Employer Office Start Date on Project Level of Effort

Anne Scott Project Director Full-time JSI Ramallah January 9, 2006 100% Nadira Sansour Training Specialist Full-time JSI Ramallah January 13, 2005 100% George Shoufani Director of Finance Full-time JSI Ramallah January 17, 2005 100% Bassam Abu Hamad

Deputy Project Director

Part-time ANERA Gaza January 18, 2005 100%

Rand Salman Deputy Director for Public Health

Full-time ANERA Ramallah January 18, 2005 100%

Hassna Dajani Director of Administration

Full-time ANERA Ramallah January 25, 2005 100%

Mahmoud Abu Radaha

Management Specialist

Full-time EMG Ramallah January 28, 2005 100%

Emad Khoury Driver Full-time JSI Ramallah February 1, 2005 100% Hisham Al Haj Driver Full-time JSI Gaza February 6, 2005 100%

Peter Eerens Director of Public Health

Full-time JSI Ramallah February 22, 2006 100%

Nancy O’Rourke Director of Monitoring and Evaluation

Full-time JSI Ramallah March 7, 2005 100%

Sana Abu Mazyad

Administrative Assistant

Full-time JSI Gaza March 23, 2005 100%

Maher Saqqa Finance and Administration Manager – Gaza

Full-time JSI Gaza March 26, 2005 100%

Rola Tahboub Senior Finance Advisor

Full-time JSI Ramallah April 11, 2005 100%

Nuha Judeh Cleaner/Hostess Full-time JSI Ramallah April 11, 2005 100%

Haya Mousleh Administrative Assistant

Full-time JSI Ramallah April 13, 2005 100%

Salwa Wishah Cleaner/Hostess Full-time JSI Gaza June 1, 2006 100% Essa Khoury Driver Full-time JSI Ramallah June 1, 2006 100% Abdallah Abu Dayyah

Capacity Building Specialist

Full-time EMG Gaza June 6, 2005 100%

Dina Husary M&E Specialist Full-time JSI Ramallah July 09, 2006 100%

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Saeda Abu Ramadan

Administrative Assistant

Full-time JSI Gaza June 13, 2005 100%

Randa Bani Odeh

Associate Director for Community Mobilization

Full-time JSI Ramallah June 13, 2005 100%

Kumkum Amin

Director of Community Mobilization/ Communications and Marketing

Full-time JSI Ramallah July 15, 2005 100%

Daoud Abdeen Associate Director for Capacity Building

Full-time EMG Ramallah July 18, 2005 100%

Majed Al Bakri IT Manager Full-time JSI Ramallah August 1, 2005 100%

Sahar Mukhaimer

Community Mobilization/Communications and Marketing Coordinator

Full-time ANERA Gaza August 1, 2005 100%

Samar Sharif Administrative Assistant

Part-time ANERA Hebron August 1, 2005 50%

Abdel Nasser Soboh

Team Leader Full Time ANERA Gaza August 1, 2006 % 100

Jasem Humeid Training Specialist Full Time JSI Gaza

August 6, 2006 % 100

Lubna Sharif Mentoring & Evaluation Specialist

Full Time JSI Gaza August 15, 2006 % 100

Diane Abraham Team Leader Full-time ANERA Hebron August 18, 2005 100% Sahar Abu Samra

Team Leader Full-time ANERA Gaza September 1, 2005 100%

Essa Khoury Driver Full-time JSI Ramallah September 1, 2006 100% Tharaa Nasser Accountant Full-time JSI Ramallah September 6, 2005 100%

Nadera Shibly Procurement / Contracting Manager

Full-time ANERA Ramallah September 12, 2005 100%

Rula Abu Nimreh Receptionist / Admin. Assistant

Full-time JSI Ramallah September 15, 2005 100%

Nihad Karajah Public Health Officer Full-time JSI Hebron October 15, 2005 100 %

Hanan Awartani Receptionist/ Admin. Assistant

Full-time JSI Jenin November 1, 2005 100 %

Najah Hamarshi Public Health Officer Full-time JSI Jenin November 1, 2005 100 %

Firas Khalaf Communication & Marketing Specialist

Full-time JSI Ramallah November 6, 2005 100%

Fuad Hudali Database Manager Full-time JSI Ramallah November 7, 2005 100%

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Current Staffing Overview

The following employees and consultants left the Project during the reporting period:

• Ya’qoub Habash’s employment as a Driver based In Ramallah was terminated as of September 1, 2006.

• Nihad Karaja began a leave of absence without pay for two months beginning August 20. Her position will be temporarily filled by consultant Wisal Karaja.

• Raja’ Zyoud, Jenin satellite office Team Leader, submitted her resignation on September 4, 2006. Recruitment to replace her has begun.

The following employees and consultants joined or returned to the Project during this reporting period:

• Dina Husary replaced Riham Al Faqih as Monitoring and Evaluation Specialist in the Ramallah office. Dina took up her position on July 9.

• On August 1, Abdel Nasser Soboh took up the position of Satellite Team Leader in the Gaza office.

• Jasem Humeid joined the Project as Training Specialist in the Gaza office on August 6. He had previously filled this position and successfully completed for it again.

• Lubna Sharif began work as Monitoring and Evaluation Specialist in the Gaza office on August 15.

• Sahar Abu Samra returned to the Project on August 28, after a leave of absence without pay.

• Essa Khoury, a temporary Driver based in the Ramallah office, accepted to stay on as a full-time employee, starting September 1.

• Alaa Ahmad Al Shorafa’s consultant contract to provide IT support services to the Gaza office was re-activated on September 4.

The Project is currently recruiting to fill a number of vacancies, as summarized in Table 5 below.

Table 5: Hanan recruitment currently underway Position Number of

Applicants Status

Program Officers – Gaza 20 Interviewing

Program Officer – Ramallah 22 Interviewing

Program Officer – Jenin 16 Interviewing

Program Officer – Hebron 11 Interviewing

Filed Coordinator 59 Interviewing

Community Program Supervisor – Gaza

- Advertising

Community Program Supervisor – Ramallah

- Advertising

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F. Major Deviations from Approved Workplan

Five activities scheduled for this quarter are slightly delayed, for the reasons outlined below. With the exception of the traditional home practices study, all of the activities are on track for implementation during the next reporting period.

Procurement of essential equipment for clinic partners The Public Health team developed a standardized list of essential equipment for clinic partners, but encountered some difficulty in making procurement resource allocation decisions; planning for procurement; and determining specifications and quantities of equipment to be procured. This is because the team does not have significant previous experience of and expertise in these aspects of procurement and because they have limited time to dedicate to such a big activity. To address this, a consultant with specialist expertise in procurement was contracted to provide immediate support to the team on this activity and to identify how best to meet any ongoing support needs. The consultant visited Hanan at the end of September and will present his findings in early October. On the job training and supervision support August and September have been devoted to agreeing common objectives and areas of support with clinic partners. Although the Public Health team developed a rapid assessment methodology to focus and guide this process, it has still proved to be time consuming. The time it took to receive USAID vetting clearance for the clinics also contributed to the delay. This has pushed back by a month or two the initiation of on the job training and supervision support visits with clinic partners. However, the investment made in agreeing clear frameworks for support and management arrangements and in building relationships based on trust has been extremely worthwhile and should facilitate implementation in the future. ‘Consultants’ budget line item The time needed to recruit and contract program staff and short-term technical consultants, whose costs are covered within the ‘Consultants’ budget line item for each team, was underestimated. However, as at the end of September, the recruitment process is at the interview or advertising stage for all program staff identified in the annual implementation plan. Strong applications have been received thus far and it is likely that appointments to these positions will be made in early October. Additionally, 4 Palestinian consultants and 2 international consultants were contracted to begin short-term work, in a variety of areas ranging from clinic service quality assurance to procurement to monitoring and evaluation, before the end of the month. 2 of the Palestinian consultants will be assisting in identifying potential new clinic partners in new geographic areas in the West Bank and Gaza.

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Theater performances and radio plays Some time was taken between May and July of this year, whilst it was determined with USAID that the candidates, ranked first and second through a tendering process, could not meet subcontracting requirements. Neither of the candidates was willing to sign the required subcontract mandatory clauses. During July and August, alternative candidates for carrying out these activities were identified through a limited competition process that was carried out in consultation with USAID. Contracts with each of these candidates have now been prepared and they began implementation at the end of September. Therefore this activity is now on track again. Community based organizations training Training of community based organizations that will be involved in Hanan’s community program was due to be carried out during this reporting period. The purpose of the training program is to build skills of organization staff members in communication, so that they can advocate actively and effectively on behalf of women and children within their communities. The tendering process to find a training provider took longer than anticipated, but the provider has been selected from amongst the applicants and preparation of the purchase order is almost complete. The training program will be implemented starting October. Traditional home practices study Through an open tendering process, CDPHC Al-Quds University was selected as the candidate to carry out this study. However, CDPHC is currently occupied with the complementary feeding practices study. To prevent the management and research team, which was proposed for both studies, from becoming over-extended, the Center agreed to first establish complementary feeding practices study before starting the traditional home practices study later this year.

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IV. Cumulative List of Tools, Methods, and Publications Table 6 below presents a cumulative list of tools, methodologies and publications developed by Hanan. The items appearing in italics were produced during this reporting period. Table 6: Cumulative list of Hanan tools, methods and publications

Tools and methodologies Publications/Reports

• Vulnerability assessment methodology • Health Facility Assessment methodology • Training Manual for Community Mobilizers and Community

Health Workers • Guidelines for forming Community Coalitions • Job Aids: Neonatal resuscitation desk calendar, infection

prevention and control job aid, ARI and DD job aids (reprints from UNICEF, PMRS and WHO)

• Checklists for: ARI, DD, Management, Infection Prevention and Control, Growth Monitoring, Antenatal Care, Postnatal Care, Emergency Preparedness, Preparation for Normal Delivery, Normal Delivery, and Equipment Needed for Delivery

• Clinic Management Menu • Clinic rapid assessment methodology and Quality

Improvement Plan • Guidelines for on-the-job training in clinics

• HBLS questionnaire and LQAS tabulations • Reporting forms for combined USAID and Hanan data

collection of PMP indicators • Monitoring and Evaluation query forms • Prototype database for measuring compliance indicators • Stakeholders meetings log

Technical Papers and Reports: Hanan Household Baseline Survey: Maternal and Child Health and Nutrition Indicators at the Household Level in the West Bank and Gaza Hanan Baseline Health Facility Assessment for Maternal and Child Health and Nutrition Services: First Cohort Clinics in the West Bank and Gaza Women’s Perspectives on Maternal and Child Health and Nutrition: Findings from Hanan Focus Groups Community Capacity Assessments: West Bank & Gaza Training Report: Community Mobilization for Community Health Workers

Technical Tools: Supervisory Checklists: Standardizing High Quality Maternal and Child Health and Nutrition Services in Primary Care Settings

The Hanan Model Clinic: Criteria for the Organization and Delivery of Essential Maternal and Child, Health and Nutrition Services Hanan’s approaches to providing training and follow on support: child health, nutrition and growth monitoring and management of diarrheal disease and acute respiratory infection Technical Briefs: Empowering Communities, Sustaining Social Change: Community Mobilization in the West Bank and Gaza Presentations: Epidemiologic data underlying Hanan’s choice of interventions Hanan’s Quality Improvement Strategy Overview of Hanan Nutrition Activities Other: Hanan Brochure Hanan Communications Plan

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V. Expected Activities of the Next Reporting Period Some highlights of the work plan for October, November and December are as follows. For the Public Health team: • Initiation of on the job training with clinic partners • Initiation of supervisory support visits with the clinic partners, referring to

Hanan’s supervisory checklists • Continuation of formal training for the clinic partners on topics in maternal and

child health; nutrition; infection prevention and control; and clinic management.

• Production and distribution to clinic partners of relevant curricula and job aides

• Procurement of essential equipment for clinic partners • With USAID, review and approval of emergency support requests from clinic

partners • Distribution of procured emergency medical kits for health and non health

providers • Procurement of delivery kits for medical professionals • Initiation of advanced life support, neonatal resuscitation and pre-hospital

emergency services training for health providers and non-health providers • Identification of 52 potential new clinic partners, to reach the target of 80 For the Communications and Marketing team:

• Pre-testing in Hanan communities of MCHN communications products • Theater performances in 50 communities where Hanan works • Production and airing of radio plays • Production and distribution of health education and promotion materials • Production and distribution of CD of songs on MCHN themes • Design and installation of clinic signage and displays For the Community Mobilization team: • Launch of Gaza community program by health workers • Continued implementation of West Bank community program by health

workers • Community events and Community Coalition meetings • Training and procurement for Community Based Organization partners • Initiating applied research on Traditional Home Practices For the Monitoring and Evaluation team:

• Conducting annual household baseline survey • Conducting complementary feeding practices research study

------------------------------------------ Anne Scott Hanan Project Director September 20, 2006

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Annex I: Third Quarter Financial Report (July-September 2006)

QUARTERLY FINANCIAL REPORT

JSI RESEARCH & TRAINING INSTITUTE, INC.

THE HANAN PROJECT

USAID 3rd Actual Actual Estimated Total Remaining Percentage

Contribution Quarter EXPENSES EXPENSES EXPENSES Expenditures Funds Funds

LINE ITEM Federal Funds 7/06 - 9/06 July '06 Aug '06 Sept '06 & Projections Expended

SALARIES 3,711,215 307,529 99,474 97,153 110,902 1,681,901 2,029,314 45%

ALLOWANCES 1,347,866 128,449 49,341 30,971 48,137 678,159 669,707 50%

CONSULTANTS 38,015 0 0 0 0 13,558 24,458 36%

OTHER DIRECT COSTS / TRAVEL / EQUIPMENT 2,140,063 131,828 24,636 86,594 20,598 1,030,344 1,109,719 48%

INDIRECT COSTS / OVERHEAD 1,462,309 146,871 44,678 51,065 51,129 857,920 604,389 59%

PROGRAM COSTS 8,825,614 138,206 11,591 57,507 69,108 628,483 8,197,131 7%

SUB-RECIPIENTS 3,381,224 387,670 43,521 0 344,149 1,263,551 2,117,673 37%

TOTAL 20,906,306 1,240,555 273,241 323,290 644,023 6,153,916 14,752,390 29%

Current Amount of Obligated Federal Funds 19,186,044

Estimated Remaining Obligated Federal Funds 13,032,128