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Maternal and Child Health Integrated Program

MCHIP

YEAR TWO

ANNUAL IMPLEMENTATION PLAN – PART A

REVISED (Submitted 23 October 2009)

1 October 2009–30 September 2010

Submitted to: United States Agency for International Development

under Cooperative Agreement # GHS-A-00-08-00002-000

Submitted by: Jhpiego, in collaboration with:

Save the Children John Snow Inc.

ICF Macro PATH

Institute of International Programs/Johns Hopkins University Broad Branch Associates

Population Services International

Final submitted October 23, 2009

MCHIP Year 2 Annual Implementation Plan iii

TABLE OF CONTENTS ABBREVIATIONS ........................................................................................................................................ v

OVERVIEW OF WORKPLAN....................................................................................................................... 1 A Strategic Approach to Impact at Scale ................................................................................................ 1 Monitoring, Evaluation and Research .................................................................................................. 10

TECHNICAL ELEMENTS ........................................................................................................................... 13 Maternal Health (including nutrition) ..................................................................................................... 13 Newborn Health .................................................................................................................................... 19 Child Health .......................................................................................................................................... 24 Cross-Cutting ........................................................................................................................................ 34

Integration of water, sanitation and hygiene with MNCH for improved newborn and child health ........................................................................... 34

HIV/PMTCT-MNCH integration ...................................................................................................... 36 Health systems to enhance maternal, newborn and child survival ................................................ 37 Maternal and child urban health ..................................................................................................... 38

PVO/NGO Support ............................................................................................................................... 39 CSHGP Support ................................................................................................................................... 39 Family Planning .................................................................................................................................... 41 Malaria .................................................................................................................................................. 44

REGIONAL BUREAU FUNDING ............................................................................................................... 52 Africa/SD ............................................................................................................................................... 52 Latin America and Caribbean ............................................................................................................... 57

MCHIP MANAGEMENT ............................................................................................................................. 60

ANNEX 1: FINANCIAL OVERVIEW .......................................................................................................... 64

ANNEX 2: INTERNATIONAL TRAVEL ..................................................................................................... 67

ANNEX 3: SUMMARY OF EXPECTED RESULTS FOR MNCH ............................................................... 68

ANNEX 4: MCHIP COUNTRY INVESTMENT TABLE .............................................................................. 76


MCHIP Year 2 Annual Implementation Plan iv

TABLES AND FIGURES

Table 1. Proposed MCHIP Program Year 2 Intensive Focus Countries ....................................................... 4

Table 2. MCHIP’s Approach to Reaching Every Country ............................................................................. 5

Table 3. MCHIP Expected Results for Introduction and Scale-Up: Maternal Health .................................. 15

Table 4. MCHIP Expected Results for Introduction and Scale-Up: Newborn Health ................................. 21

Table 5. MCHIP Expected Results for Introduction and Scale-Up: Child Health ........................................ 26

Table 6. MCHIP Expected Results for Introduction and Scale-up: Immunization ...................................... 32

Table 7. MCHIP Expected Results for Introduction and Scale-Up: Family Planning .................................. 43

Table 8. MCHIP Expected Results for Introduction and Scale-Up: Malaria ............................................... 46

Table 9. MCHIP Headquarters Technical Backstop ................................................................................... 62

Table 10. MCHIP Country Support Management ....................................................................................... 63

Table 11. Summary of Funding Available for Year Two ............................................................................. 64

Table 12. Summary of Core Year Two Workplan Budget ........................................................................... 65

Table 13. Level of Effort for MCHIP Management and Key Technical Staff ............................................... 64

Figure 1. MCHIP Approach to Supporting High-Impact Interventions .......................................................... 2

Figure 2. MCHIP Knowledge Management Components ............................................................................. 8

Figure 3. MCHIP Results Framework ......................................................................................................... 11

Figure 4. MCHIP Partner Roles .................................................................................................................. 60

Figure 5. MCHIP Organizational Structure ................................................................................................. 61

ATTACHMENT Attachment 1: MCHIP Year 2 Core Activity Matrix Attachment 2: MCHIP PY1 Illustrative Funding Matrix with Sub-elements


MCHIP Year 2 Annual Implementation Plan v

ABBREVIATIONS TECHNICAL AAP American Association of Pediatrics AIDS Acquired Immune Deficiency Syndrome AMTSL Active Management of the Third Stage of Labor ANC Antenatal Care CCM Community Case Management CHW Community Health Worker CSHGP Child Survival and Health Grants Program EmONC Emergency Obstetric and Newborn Care ENC Essential Newborn Care FP Family Planning HIV Human Immunodeficiency Virus HTSP Healthy Timing and Spacing of Pregnancy IMaD Improving Malaria Diagnostics Project IPTp Intermittent Preventive Treatment for Malaria in Pregnancy ITN Insecticide Treated Net KM Knowledge Management KMC Kangaroo Mother Care LAM Lactational Amenorrhea Method LAPM Long-Acting and Permanent Methods LBW Low Birth Weight LiST Lives Saved Tool MDG Millennium Development Goal MIP Malaria in Pregnancy MNC Maternal and Newborn Care MNCH Maternal, Newborn and Child Health PAC Post Abortion Care PMP Performance Monitoring Plan PMTCT Prevention of Mother-to-Child Transmission of HIV PNC Postnatal Care PPFP Postpartum Family Planning PPH Postpartum Hemorrhage PPIUD Postpartum Intrauterine Contraceptive Device RED Reaching Every District TB Tuberculosis


MCHIP Year 2 Annual Implementation Plan vi

DONORS, PROGRAMS, ORGANIZATIONS ACCESS Access to Clinical and Community Maternal, Neonatal and Women’s Health Services

Program ACNM American College of Nurses and Midwives AED Academy for Educational Development AFR/SD USAID Africa Bureau, Office of Sustainable Development BASICS Basic Support for Institutionalizing Child Survival CI Catalytic Initiative CIDA Canadian International Development Agency CHAK Christian Health Association of Kenya CHNRI Child Health and Nutrition Research Initiative CREDOS Child Survival Research and Documentation Center, Mali ECSA East, Central and Southern Africa Health Secretariat GAPPS Global Alliance for Prevention of Prematurity and Stillbirths GAVI GAVI Alliance (formerly the Global Alliance for Vaccines and Immunization) HIDN/MH Health, Infectious Disease and Nutrition/Maternal Health HPN Health, Population and Nutrition IIP Institute of International Programs IMMbasics IMMUNIZATIONbasics JHU Johns Hopkins University JSI John Snow Inc. LAC Latin America and the Caribbean MIPESA Malaria in Pregnancy East and Southern Africa MoHFW Ministry of Health and Family Welfare MVP Meningitis Vaccine Project NGO Nongovernmental Organization POPPHI Prevention of Postpartum Hemorrhage Initiative PMNCH Partnership for Maternal, Newborn and Child Health OP Operational Plan SC Save the Children SNL Saving Newborn Lives UN United Nations UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund USAID United States Agency for International Development WHO World Health Organization WHO/AFRO World Health Organization/Regional Office for Africa WHO/SEARO World Health Organization/Regional Office for South-East Asia WRA White Ribbon Alliance


MCHIP Year 2 Annual Implementation Plan 1

OVERVIEW OF WORKPLAN The MCHIP Program Year 2 (PY02) workplan aims to accelerate progress in 14 Results Pathways1 and builds on activities and partnerships at the county, regional and global levels to improve the enabling environment, scale up proven interventions and initiate country-level activities. MCHIP will continue to introduce and scale up evidence-based maternal, newborn and child interventions that can be effectively provided in the home, community and peripheral health facilities. This document represents the MCHIP PY02 Annual Implementation Plan for the period of 1 October 2009–30 September 2010. It begins with an overview of the MCHIP strategic approach, including strategy for scaling up high-impact evidence-based interventions in USAID’s 30 priority maternal and child health (MCH) countries over the life of the Program. The strategy emphasizes MCHIP’s catalytic role at the global, regional and national levels, leveraging funds from USAID partners and other donor agencies while working in full partnership with governments. This is followed by an overview of the technical components of the workplan for core and regional bureau (AFR/SD and LAC) funded activities. Each technical section addresses global leadership, describes long-term strategy and lists Year 2 expected results. Attachment 1 provides the MCHIP Year 2 Core Activity Matrix.

A Strategic Approach to Impact at Scale MCHIP’s overall strategic approach to reaching its projected end of Program results is guided by five interrelated principles, each of which are discussed in greater detail below:

Scaling up proven interventions

Maximizing the use of core and mission resources with a phased-country approach to achieve integrated programming, where feasible

Building on existing efforts of bilaterals, national programs, and global and regional partners

Ensuring a focus on evidence generation through program learning and knowledge management

Taking a global leadership role in areas where MCHIP occupies a unique niche in the global community

Scaling up proven interventions

The MCHIP Program will support high-impact interventions that have a demonstrable impact on mortality, have shown an increase in coverage and hold the greatest promise for scaling up. Figure 1 on the next page illustrates the intervention areas where MCHIP can support country-level strategies, and how the different elements of the MCHIP Program will reinforce these efforts. USAID’s “Acceleration Framework” is one example of a model that seeks to identify and prioritize these interventions for maternal and newborn health, and proposes a phased approach to adding interventions in the short, medium and long term, based on the country context. This type of thinking will guide MCHIP’s efforts to ensure that the appropriate interventions are highlighted across the household-to-facility continuum, including addressing the health system strengthening needs at the community or facility level. Targeting interventions to different epidemiology and socioeconomic scenarios for improved program efficiency and effectiveness is important to get the

1 The USAID Results Pathways are: Skilled Care at Delivery; Prevention and Treatment of Postpartum Hemhorrage; Eclampsia; Newborn Care; Immunization; ARI; ORT; Zinc (child illness and nutrition); HIV Integration; Nutrition; Hygiene Improvement; Urban Health; PVO/NGO Strengthening; and Polio.



appropriate mix of household/community and facility-based services. Equity and health strengthening systems are key lenses through which programming will occur. MCHIP plans to engage in activities to advance these interventions through cross-cutting health systems activities such as community-based interventions, community mobilization and expansion of Reaching Every District (RED) approach in new countries to apply to other health services, performance-based financing, private sector work and urban health. CSHGP activities offer an opportunity for a learning lab for innovative delivery strategies to inform country scale-up. Figure 1. MCHIP Approach to Supporting High-Impact Interventions

Maximizing the use of core and mission resources with a phased-country approach to achieve integrated programming, where feasible

USAID has established a strategic approach for advancing MCH, which focused on the identification of “Maternal and Child Health priority countries.” These countries have a well-documented magnitude and severity of need, established presence of USAID Missions and the capacity to implement expanded MCH programming. MCHIP will use core funds strategically to 1) introduce and/or improve and expand implementation of high-impact interventions through local implementing partners (Ministries of Health, NGOs and donor-funded projects); 2) provide global leadership through advancing implementation research; 3) contribute and disseminate program learning on service delivery approaches for high-impact interventions for MNCH; and 4) provide technical assistance to share SOTA practices along the MNCH and household-to-hospital continuum of care.



Countries of Intensive Focus MCHIP will influence both USAID’s priority MCH countries and the 68 Countdown countries with the highest burden of maternal and child mortality—both directly and indirectly through three distinct strategies. While the intensive focus countries represent the greatest opportunity to achieve impact at scale, all 30 MCH priority countries will receive MCHIP support depending on where they are operating within USAID’S Acceleration Framework. For example, MCHIP will implement MNCH activities in the focus countries and, in the other MCH priority countries, MCHIP will contribute process documentation and share experiences scaling up MNCH interventions to ensure that valuable implementation information is not lost. First, MCHIP and USAID have agreed that MCHIP will have six to eight focus countries (see Table 2 page 5). If resources and interventions from core and field are strategically focused and continue for at least three to five years, these countries have the potential to achieve measurable impact on maternal, newborn and child mortality at the national level by the end of the MCHIP implementation period. These MCHIP programs will have integrated maternal, newborn and child health activities across the household-to-hospital continuum of care. Through a participatory process with USAID/W, the USAID mission and the government, MCHIP will develop a clear pathway for each focus country for achieving this vision through systematic assessment and analysis of the enabling environment, stakeholder implementation capacities and challenges related to supply and demand for high-quality MNCH care services. This includes strategic focus on scale-up and key MNCH priority areas and interventions, identification of barriers and opportunities, leveraging of strategic alliances and partners, and re-prioritization and allocation of resources. In these countries, MCHIP will assess changes in the quality and coverage of service delivery and document program implementation. Countries for intensive MCHIP focus will require multi-year commitments of support. Using a combination of field and core support in most cases, MCHIP will leverage significant government and partner investment, and catalyze coordinated action toward the expansion and scale-up of high-impact, evidence-based MNCH interventions. Second Phase Countries MCHIP will also work catalytically in other countries to expand high-impact MNCH interventions. In these “second phase” countries, MCHIP will strategically use more limited core and/or field funding in partnership with other USAID-funded programs or other partners, such as UNICEF, WHO, PMNCH, Catalytic Initiative, among others, to leverage these programs to expand high-impact MNCH interventions. With limited funding and role in country, MCHIP will have limited control over programs, but will strategically use TA support to influence government programs and policies. In these second phase countries, MCHIP will encourage and galvanize MCHIP involvement, with the intent of facilitating movement of some second phase countries to focus countries.

Third Phase Countries In the remaining “third phase” countries, MCHIP’s role will be more indirect and will advance dissemination of evidence-based best practices. This will happen through influencing the agenda of global partners and timely and actionable dissemination of common protocols, standardized indicators and measurement tools, and information about proven interventions.

4 MCHIP Year 2 Annual Implementation Plan

Table 1. Proposed MCHIP Program Year 2 Intensive Focus Countries Bangladesh MCHIP was recently awarded an Associate Award, MA-MONI, to implement integrated maternal, newborn and family planning services

through the public sector. MCHIP will use a mix of core and field funds to influence national policy on MNCH and strengthen evidence-based interventions, including: breastfeeding, handwashing and hygiene for newborn health; management of low birth weight (LBW) babies; and essential maternal and newborn health services and practices. USAID/Bangladesh is also using field funds to support national advocacy on maternal health through the White Ribbon Alliance and to support OR on neonatal resuscitation. The opportunity exists in Year 2, with core funding, to work on a multi-partner national effort to promote handwashing for newborn health, to document CKMC, and, in future years, to work with partners to refine and expand CCM and to expand community-based MNH to urban settings. MCHIP, using the MA-MONI platform, is well-positioned to inform and influence national policy by demonstrating comprehensive district-based approaches that can be scaled up in other districts. At the national, district and local levels, MA-MONI will galvanize stakeholders around priority interventions, collaborate with them to scale up programs, and apply effective, innovative approaches that will accelerate delivery of MNH/FP services.

Democratic Republic of Congo

MCHIP proposes to use a combination of Mission field funding and core funding (MCH, malaria and family planning) to continue work with the DRC/MOH, the USAID bilateral project (AXxes), UNICEF and other partners. In Year 2, MCHIP will invest in documenting the scale-up of the integrated community case management (iCCM), and work with partners to refine and expand CCM, and institutionalize the necessary training and support functions at health zone, provincial and national levels. MCHIP will also invest in a multi-partner, national effort to revitalize ORT and introduce zinc in diarrhea case management; work with the national immunization program and its partners to revitalize and expand the RED approach to include other MNCH interventions; and use mission and core funding to assist the MOH, AXxes and the other partners who are currently expanding the coverage of a package of community- and facility-based AMTSL and ENC interventions.

Kenya MCHIP proposes Kenya for intensive focus because of the country’s declining or stagnating public health indicators, especially ORT use, and the opportunities that exist, by investing strategically, to reverse this trend. With a combination of field and core funding in Year 2, MCHIP will upgrade the management, supervisory and M&E capacity of three key Ministry of Health divisions—Child and Adolescent Health, Nutrition, and Immunization. We will also strengthen critical child health, nutrition and immunization services in three USAID-assisted APHIA areas; work with partners at the national level to revitalize ORT and increase the use of zinc in managing diarrheal disease; conduct the first MCHIP maternal/newborn Quality of Care survey, support an important neonatal asphyxia study that is being conducted by Moi University; and document the impact of USAID’s CSHGP grants on the government and other partners in Kenya. The opportunity also exists in Year 2, with core funding (and potentially water and sanitation funding from the Mission), to document the more comprehensive approach to diarrheal disease control (including prevention and treatment) piloted by PATH. The potential exists for a truly integrated package of MCHIP support that could have significant impact on Kenya’s public health outcomes in the years ahead. In addition, potential opportunities exist to scale up AMTSL as a national strategy and expand ENC and newborn resuscitation.

Malawi MCHIP proposes Malawi for intensive focus because opportunities exist, by investing strategically, to effect improvements in those maternal and newborn health indicators. With a combination of field and core funding in Year 2, MCHIP will improve FP pre-service education, expand community KMC and strengthen health systems. MCHIP will collaborate with the MoH and bilateral partners to strengthen and harmonize in-service and pre-service curricula content in postpartum and postabortion FP, which includes assessing current curricular content, holding stakeholders meetings to identify gaps, updating content to reflect evidence-based global guidelines and updating the FP modules of the curricula that will be disseminated to training institutions. Core investments will also support KMC, which will provide lessons learned for expansion in Malawi as well as application as CKMC is introduced in other countries. The MCHIP/Malawi field program has many program elements that could benefit from core investment such as: the identification of strategic areas to support health systems strengthening using the LiST tool; piloting ambulatory and community KMC; and supporting Malawi in the early stages of developing a P4P initiative.



Table 2. MCHIP’s Approach to Reaching Every Country MCHIP Level of Engagement Countries2

Intensive Focus Countries

• Multi-year core and field funds • Integrated MNCH work • Close partnership with USAID Mission, bilateral projects, MOH

and other key partners • Demonstrable change in coverage of package of interventions • Significant scope (either directly or through partners) to impact

national outcomes (or state outcomes if a large country) • Strong evaluation component

Bangladesh, DRC, Kenya, Malawi and potentially Nepal, Mozambique, Indonesia, Mali and Rwanda

2nd Phase Countries

• Limited core or field funding; limited timeframe • One or two interventions only • Targeted TA to support USAID bilateral or other partner programs • Assessment, policy, strategy and plan development, includes

program reviews and evaluations • Dissemination of common protocols, and standardized indicators

and measurement tools • Sharing information about proven interventions • MCHIP/USAID to galvanize support to facilitate movement of

some countries to focus country status

Benin, Nigeria, Madagascar, Liberia, Ethiopia, Burkina Faso, Bolivia and India

3rd Phase Countries

• Program learning/OR focus to influence the national agenda on MNCH

• One-off technical assistance or support for events • Dissemination of common protocols, and standardized indicators

and measurement tools • Sharing information about proven interventions

Azerbaijan, Zambia, S. Sudan, Rwanda, Senegal, Uganda, Ghana, Tanzania, Peru, Dominican Republic, Nicaragua, Lesotho, Paraguay, Guatemala, Haiti, Cambodia, Philippines, Afghanistan, Tajikistan and Pakistan

Building on existing efforts of bilaterals, national programs and global partners

To achieve rapid implementation of program interventions in DRC and India, MCHIP will build upon existing global and bilateral programs, ensuring that the best results from existing programs are captured and enhanced. In Malawi, for instance, building on the existing platform of pre-service education established under ACCESS, MCHIP added postpartum family planning as an essential component of BEmONC. In Mali, work done under POPPHI and BASICS in AMTSL and newborn health was expanded, and a family planning component was added. In DRC, to achieve national level scale-up, MCHIP continued the expansion of national-level support and technical assistance to the bilateral program, AXxes, MOH, UNICEF and other partners in the areas of CCM, AMTSL and newborn care.

2 These countries may shift categories over the course of MCHIP as field funding comes in.



Ensuring a focus on evidence-generation through program learning and knowledge management

Program learning strategic approach

Program learning and research, including documenting and promoting processes and results of evidence-based maternal, newborn and child health care services and practices at scale, are central to the achievement of MCHIP objectives. This includes both research conducted by others and research or program learning that MCHIP conducts itself in collaboration with governments and other country partners. In Year 1, the CSHGP program continued and strengthened the operational research component of their program, and convened a virtual meeting of their Technical Advisory Group to review and update their program evaluation guidelines for grantees. Other research activities started in Year 1 included: development of a survey to assess quality of care for complications during labor and delivery (including PE/E); a consultation meeting to develop a strategy to evaluate and document community KMC; early application and documentation of LiST in Ghana, Malawi and Mozambique; documentation of the integration of PMTCT and MNCH services in Malawi; and formative research on handwashing and newborn health in India. In Year 2, MCHIP plans to develop a more systematic approach to research, using the limited core funds available on highly focused work in the following areas: Program learning and documentation of program experience. Ideally, MCHIP would develop and apply a systematic set of guidelines leading to documentation of Program experience. Although capacity exists to do this within partner institutions, it requires a greater commitment of personnel than MCHIP can afford at this time. Therefore, MCHIP proposes to begin in Year 2 with high-priority documentation activities focused on the assessment of CCM at scale in three countries and piloting of community-based neonatal resuscitation in Kenya and Bangladesh.3 MCHIP also will begin work in Ethiopia to examine the urban-based community health worker. Development of common metrics for facility-based maternal care. A priority activity started in Year 1 is the development, testing and broader implementation of a health facility survey tool to assess the quality of delivery care, and specifically care for PE/E. MCHIP will use rapid facility assessments as well as work on simplifying other tools that come out of the survey, which can assist countries in assessing services. CHSGP also has tools that will be available for MCHIP work. This activity fills a widely recognized gap in available methodologies for monitoring, evaluation and program strengthening. The early use of this tool puts MCHIP in a unique position to assess the validity and feasibility of alternative indicators of the quality of delivery care, and to play a leadership role globally in this area, if funds are available. A second proposed activity, to be supported where opportunities arise through mission buy-ins from focus countries, would be to support the use of a new tool for assessing the quality of community case management for childhood illness. This tool has been developed and field tested in Malawi with technical inputs from IIP-JHU and support from the Bill & Melinda Gates Foundation under the Catalytic Initiative (CI). Operational research. MCHIP has adopted a working definition of operational research (OR) as small-scale studies and/or formative research intended to inform decisions about how best to scale up MNCH programs in low-income countries. All MCHIP operational research, including that supported through CSHGP, is conducted in collaboration with local partners and is designed and carried out in ways that encourage local commitment and the uptake of results, while using rigorous quantitative and/or qualitative designs, which are sufficiently rigorous to produce results that can be

3 Pilots in Kenya and Bangladesh will be carried out in collaboration with Moi University in Kenya and with Prof. Mohammod Shahidullah at Bangabandhu Sheikh Mujib Medical University in Bangladesh.



used in decision-making. MCHIP will discuss and get agreement from USAID for all operational research. In India, MCHIP is partnering with Unilever to conduct formative research on handwashing for newborn health. The OR conducted as an integral part of CSHGP will continue, and special efforts will be made to disseminate the lessons learned in ways that inform the scale-up efforts of governments and USAID missions. Another area of importance is to assess strategies for management of newborn sepsis in communities. As an initial step, MCHIP will collaborate with SNL on a Working Group on Delivery Strategies for Community Management of Newborn Infections. Program evaluations in MCHIP focus countries. MCHIP believes that systematic assessments of USAID-supported approaches for accelerating coverage for MNC interventions, including the “Acceleration Framework,” should be a priority for MCHIP. These evaluations would focus on assessments of service quality, intervention coverage, and cost and equity. Where possible, they would either model the impact on mortality and nutritional status using LiST, or coordinate with large-scale household surveys supported from other sources (e.g., MICS or DHS) to measure impact. Each program evaluation would also need to include a strong documentation component to ensure that full descriptions of program implementation and contextual factors are available as a basis for interpreting the results. Program evaluations are best designed at the start of a program, and carried out by in-country research partners who are independent of program implementation. The financial commitment needed to conduct a program evaluation is estimated as a minimum of USD 300,000 over the life of the Program, assuming a geographic scope of one or a few districts and the need to establish a national or subnational evaluation platform to support dose-response analyses of the “value added” through USAID/MCHIP program approaches. MCHIP core funds cannot be stretched to cover this commitment, but we hope that plans for program evaluations can be developed with Missions in the MCHIP focus countries and, where possible, MCHIP will collaborate with other partners (such as CI, UNICEF and others) in this evaluation work. Knowledge management MCHIP’s knowledge management (KM) strategy (see Figure 2 on the next page) builds upon USAID’s overall approach to KM, and addresses the issues of how field-based evidence on proven MCHIP interventions can: 1) inform program learning and implementation at the field level; 2) influence national policy and decision-making on global health issues; and 3) influence decisions made at the international level by deliberating bodies and the larger donor community. Our vision for knowledge management (KM) is for key stakeholders in MCHIP at all levels—from country-level practitioners to USAID and other global actors—to access and put in use MCHIP-generated learning on a routine basis. MCHIP’s KM strategy is based on the following key principles:

Alignment with country processes, building upon national processes that countries have established to monitor and evaluate progress in the implementation of national plans

Generation, documentation and sharing of knowledge about how to scale up, assess costs, set indicators and monitor scale-up progress

Harmonization of approaches using common protocols, standardized outcome indicators and measurement tools with appropriate country adaptations

Capacity building and health information system strengthening through the systematic involvement of country institutions



Timely, accurate and actionable dissemination of information about proven interventions and lessons learned at the national and global levels

Provision of opportunities for MCHIP country programs to share lessons learned, identify key missing interventions and develop plans to integrate high-impact interventions in their program of work

Figure 2. MCHIP Knowledge Management Components

Improving programs

through better evidence

OR and program learning

M&E of MCHIP

Year 1 Progress: Laying the Foundation for KM. In Year 1, MCHIP followed the guiding principles outlined above to establish the systems needed for project activities to generate program learning in a way that informs global learning and country-level program design and implementation. Specifically, MCHIP:

Strategically linked MCHIP workplan activities to HIDN Results Pathways to ensure that activities were positioned to make the maximum contribution to informing learning about scaling up proven interventions.

Created a Performance Monitoring Plan guided by the Common Evaluation Framework to direct the work of countries and initiatives seeking to accelerate the achievements of MDGs 4 and 5, and which has been adopted by the International Health Partnership, the Catalytic Initiative and others.

Initiated a framework for MCHIP’s Research Agenda, which is tied to HIDN’s Results Pathways and the RTU Continuum, and which features components related to program learning, planning and evaluation; common metrics; and formative/systems/operational research related to program scale-up.

Identified phases of focus countries (discussed previously) in which opportunities for integration will be prioritized. These countries will provide a lens through which MCHIP’s KM activities can focus. While we anticipate that much of the learning generated through MCHIP activities will be applicable in different contexts, the opportunity to focus efforts in specific countries will



allow us to more deeply explore contextual and cultural factors that may influence the success or failure of specific strategies.

Developed a conceptual framework for information management architecture for MCHIP that will facilitate the generation, accessibility and diffusion of key learning from MCHIP across a wide range of stakeholders. MCHIP.net was launched as the Program’s public site, with the intent that it will be adapted to incorporate key elements of the information management framework once the PMP and Research Agenda priorities are finalized.

Initiated activities to generate important learning that will benefit the wider global health community, including the pilot testing of the PE/E Quality of Care Survey; an initiative on newborn handwashing in India; and working groups on Community KMC, neonatal sepsis and CMM.

Year 2: Operationalizing Knowledge Management. In Year 2, MCHIP will continue to move its KM activities from the conceptual to the practical, while ensuring that the learning emerging from key initiatives is tracked, documented and disseminated widely through the MCHIP Web site, MCHIP annual meetings for country program staff, professional conferences and peer review journals. MCHIP will also develop an e-newsletter to enhance dissemination of key information beyond MCHIP countries and to influence the global agenda. All of the activities in MCHIP’s workplan are designed to build evidence for promising approaches (e.g., KMC, CCM); scale up proven interventions (e.g., essential newborn care, handwashing for newborn health); adapt proven strategies to new contexts (e.g., RED); or integrate proven interventions into national programs (e.g., PPH prevention and treatment, ORT revitalization). Innovations tested through CSHGP grants cut across these categories and are being implemented in countries that overlap with USAID’s MCH focus countries and MCHIP priority countries. Working with Projects like AIM, MH Taskforce and others, MCHIP will ensure collaboration, enhance dissemination and prevent duplication of efforts.

Taking a global leadership role in areas where MCHIP occupies a unique niche in the global community

MCHIP will build on existing platforms and partnerships to increase global and national attention to maternal, newborn and child health. Key elements of this global leadership are to:

Channel high-impact interventions, building on existing platforms

Develop consensus around evidence-based, high-impact interventions and document results and implementation research

Leverage MCHIP’s impact through strategic alliances at global and national levels to mobilize commitment and resources to achieve impact at scale

Global leadership roles for MCHIP are outlined in each area of the workplan. In adherence to the Program’s guiding principles for KM (discussed previously), MCHIP will ensure that the learning emerging from its efforts are presented in fora that offer the best opportunities for influencing the global dialogue and policy in key areas. MCHIP team members already represent USAID in a variety of international policy settings, advocacy initiatives, working groups and global movements, and are therefore well-positioned to transition those roles into their MCHIP responsibilities. For instance, MCHIP’s Global Technical Team Leader, Steve Hodgins, will attend the Countdown Meeting in September 2009. MCHIP will support USAID in influencing how resources are spent by international partners, global alliances and bilateral projects, and will serve as a vehicle for USAID to strengthen and reinforce its vision to ensure that MNCH services remain strong in the midst of competing needs. In focus countries, MCHIP will use the LiST tool to identify key MNCH



interventions to scale up through existing health systems. USAID’s strategy of combining country-level implementation, scale-up, and program-based learning, documented through OR and strong M&E, will position MCHIP to translate its experience into international advocacy, policy, tools and guidance, and in turn influence country programs and accelerate progress toward MDGs. Likewise, MCHIP can provide important capacity building and technical support to: NGO/PVO and MCP grantees; CORE and other network partners; other in-country institutions such as FBO health systems, researchers and institutions conducting OR and evaluation; and other non-USAID funded programs and implementing partners. Such indirect assistance from MCHIP offers an opportunity to coordinate efforts and leverage resources. However, this opportunity must be strategically focused to achieve larger-scale MNCH impact and maximize the number of maternal, newborn and child lives saved. MCHIP partners are extremely well-positioned to leverage non-USAID donor funds to enhance knowledge and learning in key areas of interest to MCHIP. For instance, JSI is in negotiations with the Bill & Melinda Gates Foundation (BMGF) for a learning grant that will study evidence-based innovations and strategies for strengthening routine immunization (RI)systems in the Africa region, while also stimulating the development of “out of the box” solutions to persistent RI problems. Jhpiego is in dialogue with the BMGF to ensure that PE/E is a focus for it and to leverage support for global meetings and task forces. PATH will receive funding to advance PPH prevention though testing oxytocin in Uniject. Save the Children, through SNL, is advancing the field of newborn health in the management of low birth weight, birth asphyxia, and the management and treatment of neonatal infection.

Monitoring, Evaluation and Research As USAID’s flagship global program in MNCH, MCHIP has the opportunity and responsibility to promote and apply M&E best practices and the use of standardized indicators for measuring MNCH results. The Program’s M&E approach will keep with the evaluation framework that will guide the work of countries and initiatives seeking to accelerate the achievement of MDGs 4 and 5. As country programs develop their own M&E plans, they will abide by these principles and ensure that their objectives, planned results and core indicators are aligned with the local USAID Mission’s Strategic Plan, MOH priorities and systems, as well as MCHIP global objectives and expected results. The design of the M&E systems will meet the multiple needs and objectives of MCHIP to generate high-quality data to inform programmatic decision-making and report progress to stakeholders, build capacity of in-country partners and contribute to the MNCH evidence base. M&E systems will rely on existing information systems and MCHIP will engage appropriate in-country stakeholders to strengthen and improve those systems. MCHIP will measure coverage of high-impact MNCH interventions indirectly by drawing on existing population-based surveys or through rigorous M&E efforts of in-country implementing partners and PVO/NGO grantees. When MCHIP receives the mandate and funding from USAID Missions to conduct population-based surveys, MCHIP will measure coverage directly. MCHIP can conduct annual outcome monitoring if requested by Missions. The MCHIP partnership’s experience working with CSHGP grantees to collect similar indicators shows that MCHIP would be an effective mechanism for this type of monitoring. In addition, MCHIP will participate in ongoing efforts to review MNCH indicators used in nationally representative household surveys, such as USAID’s Demographic and Health Surveys (DHS) and the UNICEF-supported Multiple-Indicator Cluster Surveys and Malaria Indicator



Surveys, and help provide recommendations for improving them and testing new indicators as appropriate. These surveys have been revised to ensure that coverage indicators in the common evaluation framework are measured and reported accurately, and this harmonization will continue as methods and indicators evolve over the life of MCHIP. Attribution of national-level outcome and impact-level results to MCHIP will, in many cases, reflect MCHIP’s contribution to collective efforts to scale up MNCH interventions in target countries. MCHIP will obtain the best possible evidence of program impact, including measurable progress toward MDGs 4 and 5, by using and contributing to efforts to monitor mortality on a continuous basis and by working within a conceptual framework that supports modeling of mortality reductions based on increases in coverage. DHS surveys in the years after MCHIP could also provide evidence of health impact. MCHIP proposes to work with USAID and partners to educate policymakers about the importance of using intermediate results to estimate the potential impact of Program activities and the need for longer time frames in program implementation and evaluation.

Results framework and expected life of program results

The Results Framework on the next page (Figure 3) illustrates the type and level of results MCHIP aims to achieve globally with core and field funding. The framework includes the three Program sub-objectives that will lead to improved MNCH health outcomes over the long term. Indicators in the global MCHIP M&E framework are also organized by this global results framework. In addition, each MCHIP country or regional program with at least USD 500,000 of annual funding will develop its own results framework and PMP that will be approved by the local USAID Mission or Regional Office. The country results frameworks and PMPs will be included as part of the MCHIP field workplans. Figure 3. MCHIP Results Framework

Sub Objective 3: Innovative, effective and

scalable community-oriented strategies that deliver integrated high-impact interventions to vulnerable populations designed, implemented

and evaluated by PVOs/NGOs

Sub Objective 2: Global leadership in

MNCH, including further development and

promotion of improved approaches

Sub Objective 1: Increased availability

and use of appropriate high-impact MNCH

interventions, including supportive family

planning interventions

STRATEGIC OBJECTIVE: Increased use/coverage of high-impact MNCH interventions

GOAL: Reductions in under-five and maternal mortality and morbidity/accelerated progress

toward reaching MDGs 4 and 5



Program Year 1 MCHIP’s Year 1 was envisioned as a transition year, ensuring continuity in projects whose end coincided with MCHIP startup (i.e., CSTS+) while providing a bridge between the final year of other projects and MCHIP’s startup year (i.e., ACCESS, POPPHI, Immunization BASICS and BASICS). Year 1 featured intensive discussions with USAID staff and other key stakeholders to build consensus around the MCHIP strategy outlined above, while at the same time launching work at the country level. In Year 1, MCHIP worked with core and/or field funds in 13 countries: Kenya, Mali, Mozambique, India, S. Sudan, Nigeria, DRC, Swaziland, South Africa, Burkina Faso, Ghana, Malawi and Bangladesh (see Annex 4). In some countries, such as Nigeria, DRC, S. Sudan and Mali, this work continues and is a transition from previous work by ACCESS, BASICS, Immunization BASICS and POPPHI, respectively. In Kenya, MCHIP is building upon work in maternal health but expanding this to provide technical assistance on supportive supervision and on M&E within other divisions of the MOH. The Mission in Mozambique has asked MCHIP to strengthen MNH and key preventive FP/RH services. In India, MCHIP is continuing work on immunization and will add maternal and newborn care and handwashing for newborn health. MCHIP has also received field support for male circumcision in Swaziland, Lesotho, Tanzania and South Africa. In addition, the PVO/NGO components supported 66 grants in 29 countries.4 Program Year 2 and beyond MCHIP expects to help increase the use of key MNCH and nutrition services through both field-based interventions and global leadership activities. The major expected Life of Program results are:

Contribute to reductions in maternal and under-five child mortality in 20 countries

Contribute to an estimated 118,000 mothers and 7.2 million children under-five saved in 20 high-burden mortality countries

Assist 20 countries to demonstrate improved coverage of MNCH services, with five of these benefiting from an integrated package of high-impact MNCH interventions

Help five countries to demonstrate greater equity in coverage of MNCH services

Have all 68 MDG countdown countries benefitting from MCHIP-promoted learning tools and approaches

The following technical narratives present MCHIP approaches for attaining impact at scale through global leadership and country level interventions for maternal, newborn and child health, as well as the key cross-cutting areas. MCHIP intends to support the USAID MNCH Results Pathways through focusing on high-impact interventions in MNCH. Each of the major sections presents the strategic approach for the technical area, summary of Year 1 achievements, and Year 2 and LOP expected results.

4 CSHGP has 53 active grants in 26 countries. MCP has 13 grants in eight countries, and five of those countries overlap with CSHGP countries. At least two CSHGP grants are operating in each of the proposed Phase 1 countries, with three grants in Kenya and four in Malawi.



TECHNICAL ELEMENTS MCHIP is contributing to a large cross section of technical areas in the MNCH field, and will design its field programs and invest core resources in as integrated a method as possible to take advantage of overlaps among technical areas and explore new links that could prove effective in addressing MNCH problems. MCHIP is also developing strategies through both global leadership and country-level activities for each technical area to advance USAID/HIDN’s Results Pathways. MCHIP’s broad technical areas are described in detail below:

Maternal Health

Newborn Health

Child Health

Immunization

Crosscutting, including:

Integration of water, sanitation and hygiene across MNCH

HIV/PMTCT-MNCH Integration

Urban Health

Health Systems Strengthening

PVO/NGO Strengthening

Family Planning

Malaria (includes malaria in pregnancy, community case management of malaria and Malaria Communities Program)

Maternal Health Worldwide, maternal mortality remains high and essentially unchanged over the past 15 years, with a maternal mortality rate (MMR) of 400/100,000 live births (or more than 500,000 deaths each year). The lifetime risk of maternal death in sub-Saharan Africa is more than 200 times greater than in the United States. The major causes of maternal mortality are postpartum hemorrhage and pre-eclampsia/ eclampsia—which alone account for more than 40% of maternal mortality—as well as puerperal infection, obstructed labor and complications of abortion. Anemia and infections, such as malaria and HIV, also contribute to maternal mortality. Maternal morbidity and disability are poorly documented but are estimated to affect millions of women each year. Efforts to decrease maternal morbidity and mortality over the past two decades have led to the development of a number of evidence-based high-impact interventions appropriate for use in low-resource settings at both the facility and community levels. MCHIP partners have implemented many of these interventions through initiatives at global and country levels, through policy and advocacy work, program implementation in facilities and communities, M&E efforts at country and regional levels, and the sharing of results and knowledge.

Strategy for Maternal Health

MCHIP’s approach is well-aligned with USAID’s Maternal Health Results Pathways, and will help reduce the global burden of maternal mortality and be a key contributor to USAID’s goal to reduce maternal mortality by 25% by 2013 in 20 priority countries with high disease burden. MCHIP will



focus on three main areas to contribute to this reduction in mortality—preventing postpartum hemorrhage (PPH), preventing and treating pre-eclampsia/eclampsia (PE/E) and ensuring meaningful skilled attendance at birth—by:

Providing catalytic inputs to develop effective, evidence-based maternal care interventions and scaling them up;

Supporting activities that aim to increase coverage and use of services/practices to prevent and treat conditions that cause high mortality, such as active management of third stage of labor (AMTSL); community-based distribution of misoprostol; use of magnesium sulfate for pre-eclampsia/eclampsia; infection prevention; use of the partograph; and improved availability and quality of care given by skilled providers;

Scaling up evidence-based approaches to improve maternal health by focusing on 20 priority MCH countries and applying core investments in selected scale-up efforts for the six focus countries selected jointly by MCHIP and USAID;

Supporting the integration of FP, PMTCT with MNCH services where appropriate;

Conducting program research and documenting evidence-based maternal care programs;

Providing technical leadership in maternal health globally; and

Strengthening and supporting strategic alliances that support implementation of maternal health programs at scale.

As appropriate, the focus of MCHIP’s interventions will be the household-to-hospital continuum of care, depending on the context. Based on the MCHIP strategic approach and the Acceleration Framework, MCHIP will promote high-impact interventions at the community, facility and national levels. In all cases, MCHIP’s limited core funds will be used to leverage resources from existing partners on the ground to achieve impact at scale. MCHIP will ensure accurate and global measurement of key indicators that provide evidence of use of interventions that can impact maternal mortality. Table 3 provides an overview of MCHIP’s expected results for maternal health.



Table 3. MCHIP Expected Results for Introduction and Scale-Up: Maternal Health

Expected Result PY 1 PY 2 LOP Year 5 (# of countries)

PPH Expansion of PPH prevention programs

Mali, DRC Kenya, DRC, Mozambique, Madagascar, Liberia, India, Nigeria and Malawi

20 countries—field and core

Introduction of PPH treatment

Mali, Kenya, DRC, Malawi, Mozambique, Madagascar, Liberia, India and Nigeria


PE/E Advocacy and global awareness

PE/E Technical Working Group and Task Forces established

Terms of reference for both groups established at meeting in November, 2009


Quality of Care Assessment Tool developed and assessments conducted

Pilot assessments begun in Kenya and Ethiopia

Tools finalized Assessments carried out in at least five total countries (including Kenya and Ethiopia)

Up to 8 countries; additional countries as funding allows

Program model for prevention and management of PE/E developed and introduced

Kenya and Ethiopia following results of pilot assessments


Expansion of PE/E prevention and management

Tanzania, Malawi, India, Mozambique Nigeria, Nepal

TBD

SBA Global effort to update clinical guidelines with WHO

Collaborate with WHO to complete first draft of revision of Managing Complications in Pregnancy and Childbirth

Revision of MCPC completed

Improving delivery of high-impact interventions by SBA skills

Mozambique Malawi, Kenya, Madagascar, India, Liberia, Mali, Lesotho and DRC


Postpartum care (community- and facility-based, including supportive supervision of CHW)

Mali, Malawi, India, Mozambique, Liberia and Madagascar


Increased knowledge of what has worked to improve maternal and neonatal health results in two countries in Africa with relevant lessons for other contexts.



Expected Result PY 1 PY 2 LOP Year 5 (# of countries)

Maternal anemia

Identification of country-level barriers and facilitators for successful maternal anemia control programs through a national consultation in at least two countries

Bangladesh and Indonesia

5

Creation of a national strategic plan for addressing maternal anemia in at least two countries

Bangladesh and Indonesia

5

Development of new or strengthened maternal anemia control activities in one country

Bangladesh or Indonesia

5

Participation in an international consultation on maternal anemia (led by A2Z)

Maternal anemia

Maternal anemia, even moderate cases, increases the risk of dying during delivery. The recent Lancet series on maternal and child undernutrition estimated that 20% of maternal deaths are due to maternal anemia and stunting in women. Moreover, maternal iron deficiency anemia adds 115,000 deaths to the total maternal deaths from obstetric complications annually. Despite the consequences of maternal anemia, there is little attention given at global and country levels to the problem. Maternal anemia control programs are the primary maternal nutrition program worldwide; however, these programs are not well-funded and have therefore failed to significantly reduce maternal anemia in developing countries. MCHIP will work at the country level to integrate actions into its maternal health initiatives to identify the barriers (e.g., supply and demand problems) to and improve maternal anemia control programs and reduce maternal anemia. To improve programming in these areas, MCHIP will use innovative strategies to solve supply and demand barriers to successful programs such as pay-for-performance for increasing the number of women receiving iron-folic acid supplements from health workers, and using cell phones to remind women to take their iron-folic acid supplements. MCHIP will not take the lead at the global level to improve the global response to maternal anemia but will participate as needed with the A2Z Project on these issues.

Global Leadership

To create synergies and accelerate progress toward MDGs 4, 5 and 6, MCHIP will work closely with WHO, PMNCH, the Maternal Health Thematic Fund, the Maternal Health Task Force, FIGO,



ICM, WRA and other global organizations. These ongoing collaborations will also advance advocacy and strategy development to ensure implementation of evidence-based MNCH interventions in MCHIP focus countries and as many other USAID/HIDN countries as possible. In addition, MCHIP will draw on the expertise from within the partnership as well as from colleagues in other organizations to advocate that critical components of maternal health maintain visibility in the global arena. For example, MCHIP is striving to ensure that momentum is maintained in the areas of prevention and treatment of pre-eclampsia/eclampsia and postpartum hemorrhage through sponsorship of and participation in global meetings, attending WHO consultations, and disseminating new learning to regional and country programs. MCHIP will also provide technical assistance to other global and bilateral programs as requested to foster use of evidence-based approaches in the formulation and evaluation of maternal health strategies, guidelines and programs. Year 1 achievements

Postpartum hemorrhage 1. Development of an MCHIP Strategy for Accelerating Scale-Up of Interventions to Prevent and

Treat PPH developed to sustain and expand gains made in PPH prevention through USAID partners. This includes: a transition plan to integrate key POPPHI and ACCESS activities into MCHIP work, encompassing country-level AMTSL work in DRC, Mali and Latin America; collaboration with FIGO and ICM; and the UNFPA/ICM midwifery capacity-building initiative.

2. Creation of an MCHIP Plan for systematic dissemination of WHO PPH Treatment Guidelines.

3. Development of a Quality of Care assessment tool that includes use of AMTSL.

4. Expansion of AMTSL activities in Mali and DRC as part of the Program definition.

Pre-eclampsia/eclampsia 1. Formation of a Technical Working Group and five PE/E Task Forces and drafting of Terms

and Reference, which will be finalized at the second meeting in November, 2009.

2. Formulation of a Quality of Care assessment tool based on the POPPHI model, and preparation for a pilot test of QOC Assessment to be carried out in Ethiopia and Kenya.

3. Determination of countries and strategy for demonstration of loading dose of MgSO4 by SBAs at the community level.

Skilled birth attendance 1. Advancement of knowledge about prevention and treatment of pre-eclampsia/eclampsia

(PE/E) and postpartum hemorrhage (PPH) through collaboration with WHO, FIGO, ICM, the Maternal Health Task Force and others. Stakeholder meeting held, including formation of and meeting with the Technical Working Group and Task Forces for PE/E; development of a set of survey tools to assess the quality of care for PE/E, prevention of PPH, essential newborn care, and infection prevention; and strengthening of midwives in ICM focus countries.

2. Identification of countries and determination of approach to document lessons learned on health system elements that improve maternal and newborn health.

3. Review of Impact tools and recommendations made for their use of specific modules as appropriate when carrying out assessments in MCHIP countries.



4. Participation at WHO/Geneva technical consultation on postpartum/postnatal care and input given on draft report of meeting.

5. Drafting of MCHIP PPC/PNC facility- and community-based guidelines based on WHO/ UNICEF Joint Statement as well as existing maternal and newborn care guidelines from WHO, for use by MCHIP programs and others as applicable until revised WHO guidelines are available.

Year 2 expected results

MCHIP will build on the activities initiated in Year 1 in countries highlighted for investments as focus countries. Expected results include: Global leadership (Activity 2.1.1)

Assessment of elements of quality of care associated with prevention and management of PE/E, use of the partograph, PPH prevention, infection prevention and normal newborn care.

Identification of health systems elements that yield positive outcomes in maternal health.

Testing and documentation of use of Reaching Every District (RED) approach for delivering an integrated set of community-based maternal and newborn interventions.

Formulation and implementation of a coordinated agenda of collaboration with WHO, ICM, FIGO, PMNCH, the Catalytic Initiative, the Maternal Health Thematic Fund, and the Maternal Health Task Force to advance work in PPC/PNC, PE/E and in MCHIP focus countries and globally.

Harmonization across multiple USAID programs of quality of care approaches to achieve maximum impact.

Skilled birth attendance Dissemination and utilization of harmonized guidelines on components and timing of

postpartum/postnatal at community and facility levels by skilled birth attendants and community health workers. (Activity 2.2.1)

Updating of regional and country midwifery advisors in evidence-based approaches through technical assistance provided to the ICM/UNFPA midwifery strengthening initiative in the areas of PPH, PE/E, PPC/PNC, FP and ENC. (Activity 2.2.5)

Use of Immpact toolkit and learning to guide MCHIP programs. (Activity 2.2.6) Increase access to quality maternal, newborn and child health in India. (Activity 2.2.3) Case studies to document lesson learned that improve maternal health in two countries in Africa.

(Activity 2.2.7) Definition and adaptation of community-based package of preventive MNCH/FP care linked with

health facility and piloting of package as part of ongoing field-funded interventions. (Activity 2.2.2) Document scale-up of maternal and newborn health in Senegal. (Activity 2.2.4) Documentation of lessons learned for scaling up maternal health (Activity 2.2.7)

Postpartum hemorrhage Implementation of MCHIP’s Strategy for Accelerating Expansion of Interventions to Prevent

and Treat PPH in Mali and DRC in collaboration with bilateral programs and other partners/donors. (Activity 2.3.1)



Continued support to PPH Working Group initiated by POPPHI; the specific terms of this support and the group’s agenda will be defined in November, 2009. (Activity 2.4.1)

Development of strategy for expansion of PPH prevention in Mali and implementation begun through MOH and bilateral partners. (Activity 2.3.3)

Review progress of AMTSL in MCHIP countries. (Activity 2.2.2) Pre-Eclampsia/Eclampsia

Carrying out of Quality of Care assessments in five MCHIP countries and dissemination of related results. (Activities 2.4.1 & 2.4.2)

Completion of PE/E Task Forces’ Year 1–2 TORs, to be finalized in November, 2009 meeting. (Activity 2.4.1)

Planning and initiation of operations research intervention in one country on use of MgSO4 at the community level by SBAs. This OR will be discussed and agreed upon with USAID. (Activity 2.4.1)

Maternal anemia (Activity 2.5.1) Identification of country-level barriers and facilitators for a successful maternal anemia control

program through a national consultation in at least two countries.

Creation of strategic plan for addressing maternal anemia in at least two countries.

Development of new or strengthened maternal anemia control activities in one country.

Participation in an international consultation on maternal anemia (with A2Z).

Newborn Health Of the 9.7 million children who die every year before reaching their fifth birthday, about 3.7 million are newborns who do not survive their first four weeks of life. The majority of these newborns live in developing countries and most die at home. Up to two-thirds of these deaths can be prevented if mothers and newborns receive known, effective interventions during pregnancy, childbirth and in the first hours and days after birth. A strategy that promotes universal access to antenatal care, skilled birth attendance and early postnatal care will contribute to sustained reduction in maternal and neonatal mortality Three causes—infections, birth asphyxia and preterm/low birth weight—account for 86% of neonatal deaths. While much is known about what to do to address these causes of mortality, less is known about how to deliver life-saving interventions in low-resource settings, especially in the poorest communities, where most of these deaths occur. MCHIP will apply a systematic effort to introduce and scale-up interventions (and combinations of interventions) that are feasible, affordable and effective in these settings, and support the integration of these interventions into large-scale maternal and child health systems and programs to achieve high coverage. The Lancet series on newborn health identified key interventions for the prevention and treatment of the three major causes of neonatal deaths listed above. Included are the four main evidence-based interventions that MCHIP will support for the introduction and expansion of newborn interventions. These include essential newborn care (including hygienic cord care, maintenance of warmth, and immediate and exclusive breastfeeding), extra care for low birth weight babies including KMC, neonatal resuscitation and sepsis management. These are all interventions that have been



around for many years. However, in most developing countries the coverage is very low or non-existent. Essential newborn care practices continue to be low, and care for asphyxiated or sick newborn infants including premature/low birth weight babies, and those with infections is limited to a few tertiary and/or secondary health facilities. In addition to these post-delivery interventions, antenatal and intrapartum interventions mentioned in the maternal section such as skilled birth attendance and improved care PE/E will contribute to the reduction of neonatal mortality. MCHIP’s goal is to support the reduction in the global burden of neonatal mortality and by so doing contribute to the reduction in MDG 4. MCHIP will be a key contributor to USAID’s goal to reduce under-five mortality by 25% by 2013 in 30 priority countries, and to its pathway for the introduction and expansion of newborn interventions. MCHIP will focus on the three main causes of death and support the introduction and scale-up of evidence-based prevention and treatment interventions.

Strategy for newborn health

The MCHIP strategy for newborn health will:

Follow the Paris Principles and work with partners including UNICEF, WHO and SNL to provide catalytic inputs to support the introduction and expansion of evidence-based newborn care interventions,5

Scale up evidence-based approaches to improve newborn health by focusing on 20 priority MCH countries;

Support integration of ENC packages into MCH systems;

Assure that evidence-based ENC programs are documented and promoted at scale;

Provide technical leadership in newborn health globally; and

Strengthen and support strategic alliances that support implementation of newborn health programs at scale.

MCHIP will expand proven, evidence-based interventions, including ENC, into country-level MCH systems through its programs and those of partners. MCHIP will also address key “how” questions related to the delivery of these interventions. For example, there is limited data on the use of KMC for community-based management of the neonate, and because mothers using KMC are released early from the hospital, MCHIP will include testing and evaluating the feasibility of community-based KMC. MCHIP will also examine approaches and timing for postnatal care, and learning more about the combinations of newborn health intervention packages, including management of infection and birth asphyxia in the community. The current community-based injectable antibiotic treatment strategies are associated with major challenges (e.g., community acceptance, feasibility of implementation). Testing and development of these strategies for high mortality settings are issues that MCHIP and its partners can contribute to program learning. At the country level, MCHIP will promote the adoption and implementation of high-impact evidence-based interventions into ongoing MCH programs. MCHIP’s work will focus on the most vulnerable part of the neonatal period—the first week of life—as well as on community-based care and linking communities to facilities.

5 MCHIP will support activities that aim at increasing coverage and use of service/practices for ENC, community-based infection management, kangaroo mother care to manage low birth weight babies and management of birth asphyxia in the home.



Table 4. MCHIP Expected Results for Introduction and Scale-Up: Newborn Health

Expected Results PY 1 PY 2 Life of Program—FY13

Essential newborn care (and postnatal for mother)

Postnatal/essential newborn care introduced (<3 districts)

India, Malawi, Mali and Nigeria (plus 3 in LAC)

15

PNC/ENC expanded (>3 districts)

Bangladesh 10

Disseminate/launch UN Joint statement

Joint UN Statement on community-based newborn care launched and implemented in 6 countries

Bangladesh, India Kenya, Mali and Nigeria

15

Kangaroo mother care (facility and community)

KMC introduced and expanded

Malawi, Bangladesh, Nigeria, DRC and Mali

15

Community Kangaroo Mother Care programs

Bangladesh Bangladesh and Malawi

8

Community-based infection prevention and management

Newborn infection management introduced

Bangladesh and Nigeria (plus 3 in LAC)

8

Newborn handwash-ing promoted through public and private sector alliance

India, Indonesia and Bangladesh

8

Management of asphyxia

Introduce management of asphyxia in home and facility settings

Kenya and Bangladesh

8

Global leadership

MCHIP will support global learning through technical consultations on critical technical areas including: community KMC; postnatal care; community-based management of birth asphyxia; handwashing for newborn survival; and preterm birth. MCHIP will maintain a leadership function with strategic partners and alliances to advance global learning and advocacy aimed at increasing and leveraging resources from governments, donors and NGOs for newborn health programming. These alliances include UNICEF, WHO (Child and Adolescent Health and Making Pregnancy Safer), Saving Newborn Lives/SC, DIFID, International Pediatric Association, PMNCH, Countdown to 2015, ICDDR,B, CHNRI, the Bill & Melinda Gates Foundation, the Global Alliance for Prevention of Prematurity and Stillbirths (GAPPS) and the American Association of Pediatrics (AAP). ENC and KMC

In Year 2, working with the CKMC TWG, MCHIP will improve the quality, monitoring and evaluation of CKMC programs initiated by the ACCESS Program in Malawi and Bangladesh. Work



will continue to expand ENC in India and Mali,6 and ENC will be scaled up to two additional countries. Scale-up will be done using the recently released joint statement by WHO/UNICEF and supported by USAID and STC as the focal point for conducting one to two regional meetings to disseminate the statement in Africa. This activity will be done in collaboration with WHO, UNICEF and other regional organizations in Sub Saharan Africa and Asia. Newborn sepsis

MCHIP and its global partners will support the establishment of a technical working group on neonatal sepsis management that would assist in defining a global strategy for the introduction and expansion of community-based infection management of neonatal sepsis (CBIMNS). This will include the mapping of neonatal sepsis management at the community level in sub Saharan Africa and Southeast Asia. MCHIP will use Africa Bureau funds in Nigeria to implement community-based management of neonatal sepsis, and will work with LAC funds in three Latin American countries to develop strategies to implement prevention and treatment of newborn sepsis. To facilitate program learning, awareness creation and mobilization of resources to scale up this intervention, process documentation will be completed for all the newborn sepsis management programs.

Neonatal resuscitation

MCHIP’s strategy for the prevention of preterm births is to ensure proven interventions known to reduce the incidence of preterm births are included in all its focus antenatal care programs. The interventions will be context specific and include: syphilis screening and treatment; reproductive and urinary tract infection screening and treatment; presumptive treatment of malaria; iron/folate; and antenatal steroids for pregnant women where appropriate. MCHIP will also continue its work with AAP to scale up neonatal resuscitation. In Year 2, working with the Principal Investigators conducting studies on AAP’s HBB training manual and associated job aids, MCHIP will support the field testing, implementation and development of neonatal resuscitation strategies for Kenya and Bangladesh. Handwashing with soap for newborn health

Using the results of the formative research conducted in Year 1, MCHIP, in collaboration with Unilever, will develop behavior change communication materials and training manuals and initiate a handwashing campaign in two states in India. In addition to the state-wide campaign, MCHIP will work with the Ministry of Health to address gaps identified in handwashing practices by health workers at all levels of the health care system. Handwashing will also be integrated into the community activities for ENC, and opportunities to work with partners in urban settings will be explored. In Year 2, MCHIP will expand its handwashing activities in Bangladesh. It will support the formation of a handwashing alliance and conduct formative research to identify the barriers and enhancers to handwashing by caretakers of newborns including health service providers. MCHIP’s newborn activities primarily contribute to the USAID Newborn Health Results Pathway and, in addition, advance the achievement in the Skilled Birth Attendant Results Pathway through the strategy of home visits by community health workers. Year 1 activities

To move the implementation of KMC forward for LBW newborns, MCHIP established a community KMC technical working group (CKMC TWG) to assist it to strengthen the KMC component of ongoing community-based maternal and newborn projects under the ACCESS

6 Assuming approval is obtained in Year 1.



Program in Malawi and Bangladesh. The CKMC TWG is in the process of defining and developing tools to ensure the quality, and appropriate monitoring and evaluation of ongoing CKMC programs in Malawi and Bangladesh.

MCHIP selected two countries to support the scale-up of essential newborn care services in Mali and Ghana. Ghana was not approved and was replaced by India. Concept papers describing MCHIP-proposed activities in the two countries have been written, and are awaiting approval from the respective USAID mission for on the ground implementation to begin.

Supporting program learning on prevention of preterm births. MCHIP provided partial funding to GAPPS to support the global conference on prevention of preterm births and stillbirths, during which KMC was endorsed for scale-up in developing countries. MCHIP’s strategy on the issue of preterm birth would include strengthening its focus on antenatal care to ensure, where appropriate, pregnant women are screened and treated for syphilis, and receive presumptive treatment of malaria, iron/folate and antenatal steroids. Various potential operational research topics are also identified. However, the conference report, including the prioritized research topics, has not yet been finalized and disseminated by the GAPPS (the conference organizers).

To support the scaling-up of newborn resuscitation, MCHIP has been working with the American Association of Pediatrics (AAP) on finalizing, field testing and implementation of its Helping Babies Breathe (HBB) approach. MCHIP participated in the review of the HBB training materials and associated job aids. MCHIP reviewed and accepted to support two of the proposals submitted to AAP by investigators in Kenya and Bangladesh. MCHIP is in dialogue with the investigators to make various adjustments to their proposed study including the shortening of the study period, and adding a community component (Bangladesh only) and a phase III that would develop a national strategy for the scale-up of neonatal resuscitation in the two countries.

Survey tools for assessment of the health systems readiness for newborn care focusing on essential newborn care and neonatal resuscitation were developed as part of the PE/E survey.

MCHIP in collaboration with Unilever and other stakeholders initiated its “handwashing for newborn survival” activity in India. A concept paper describing proposed activities under this intervention was also completed. A local firm to conduct the formative research associated with this work has been identified and discussions are underway to finalize the research methodology.

MCHIP worked to transition and build on ACCESS and BASICS newborn health work in selected countries.

In Year 2, MCHIP will continue to build on work initiated in Year 1 through the following activities:

Year 2 expected results During Year 2, the following activities will define the key technological, operational and policy-related constraints or barriers to addressing knowledge gaps, and introduce and replicate ENC and community-based infection management in varied and multiple settings in select countries:

Moving implementation of KMC forward for LBW newborns in three countries (India, DRC and Malawi) (Activity 3.2.1)

Scaling up essential newborn care in Mali, India and two other countries (Activity 3.2.2) Supporting the introduction of community-based infection management of neonatal sepsis in

Nigeria (Activity 3.2.3)



Strengthening prevention of preterm births by ensuring, where appropriate: syphilis screening and treatment; presumptive treatment of malaria; iron/folate; screening and treatment of reproductive and urinary tract infections; and antenatal steroids provision for pregnant women during antenatal care (Activity 3.2.4)

Supporting the improvement and scaling-up of newborn resuscitation in Kenya and Bangladesh (Activity 3.2.5)

Conducting the Quality of Maternal and Newborn Care Assessment (Activity 3.2.6) Supporting the scale-up of handwashing for newborn survival in India, Bangladesh and

Indonesia (Activity 3.2.7)

Child Health Child mortality remains high in most developing countries and, as mentioned previously, 9.7 million children under-five still die each year, despite being only six years away from the target date for reaching the MDG goals. Nearly two-thirds of child deaths could be prevented though an integrated package of simple, inexpensive, cost-effective interventions that combine effective preventive actions including prevention of malnutrition, which is an underlying factor in at least 30 percent of childhood deaths, and case management of illnesses. However, reaching children in the poorest communities of the poorest countries remains a challenge. Children in the poorest households receive less health care and have higher mortality rates than children from the richest households. Lack of access to treatment and other services contributes to high mortality. Actors outside of the formal health system, such as community health workers (CHWs), can facilitate access to illness treatment and other services. Some countries do not support delivery of services by CHWs, or restrict the services they can deliver, such as antibiotics for pneumonia. Most countries lack, or struggle to provide, the support systems necessary to achieve high-quality delivery at scale of community-based illness treatment. Uninterrupted supply of essential health products and regular supportive supervision are critical health systems supports required for effective community case management. Despite strong evidence of impact and official endorsement by WHO, progress in the scale-up of the results pathway for community treatment of pneumonia has stalled in the “introduction” phase. Some countries have adopted the policy and are now beginning to implement community case management (CCM) for pneumonia and other child illnesses—including malaria and diarrhea—at scale (e.g., DRC, Rwanda, Malawi and Senegal). In other countries, strategies for accelerating policy change at the national level are underway. For example, the MOH and partners in Mali are in the early stages of planning for the deployment of integrated CCM (iCCM) within national programming. In a few countries, notably Ethiopia, governments have been reluctant to authorize CCM for pneumonia, despite repeated efforts to engage policy and decision makers. The entry of rapid diagnostic tests (RDTs) is changing the face of malaria treatment. The introduction of ACTs and, in some cases RDTs, adds complexity to algorithms and support systems (e.g., continuous supplies of drugs and test kits). Although PMI does not promote the use of RDTs at the community level, in some countries the national policy supports the use of RDTs at this level. In these countries, PMI, through malaria operational plans (MOPs), will assist the MOH to expand iCCM using RDTs. During documentation of countries’ experiences implementing iCCM, MCHIP will assess whether RDTs are being correctly used and if appropriate treatment is provided. The entry of RDTs increasingly heightens the urgency for iCCM so that CHWs are equipped to assess and treat fever in children for pneumonia when an RDT proves negative for malaria. Policy revision, as well as a continuous supply of respiratory timers and antibiotics, is urgently needed. In several



countries, there is evidence that money and lives are wasted when community workers continue to use expensive ACTs despite negative RDTs. This is largely because countries have no antibiotics or policy to support treating these children for pneumonia, who are presenting with fever and negative RDT results for malaria. The President’s Malaria Initiative (PMI), together with the Obama administration’s Global Health Initiative guidance to integrate MCH programs, provides unique opportunities for the USG to contribute substantially to the rapid expansion of iCCM globally. Both USG financial resources and technical assistance are poised to assist countries to surpass their previous horizons to impact mortality, expanding impact from malaria-specific mortality reduction to reducing all three of the major causes of childhood deaths worldwide: diarrhea, pneumonia and malaria. Correct management of diarrhea has stagnated or declined in many countries, despite the widespread introduction and promotion of life-saving ORT/ORS over 20 years ago. Many countries are now introducing zinc treatment in association with ORT/ORS to enhance the management of childhood diarrhea. These interventions will be combined with existing twice-yearly vitamin A supplementation, which mitigates the effects of diarrhea and reduces under-five mortality. Reaching high coverage levels for correct management of diarrhea will require multiple delivery strategies, including public health facilities, the private sector and community-based delivery. Advocacy efforts are needed at global, regional, country and district levels—as well as in pre-service medical, nursing and paramedical schools—to reposition ORT/ORS and introduce zinc. However, management of diarrhea is not enough. MCHIP will work to integrate evidence-based preventative interventions—such as optimal breast-feeding, appropriate complementary feeding and water/sanitation/hygiene interventions, including handwashing—with management of diarrheal disease. This combination is essential to effectively decreasing diarrhea morbidity and mortality. MCHIP is committed to the MDG 4 goal of reducing child mortality by two-thirds. We will work with partners at the global, national and local levels to expand access to case management and preventative interventions aimed at saving children’s lives.

Strategy for child health

The MCHIP five-year LOP strategy for child health will:

Follow the Paris Principles and work to leverage global and country partners, with special emphasis on collaboration with PMI, UNICEF and the Catalytic Initiative, to support rapid scale-up of priority child health interventions.

Raise awareness and resources for pneumonia and diarrheal disease within an integrated vision and create conditions that will facilitate collaboration and coordination in the field, especially at the country level.

Rapidly accelerate the introduction and expansion of integrated child health programming and learning at the global and country levels for iCCM, ORT revitalization including addition of zinc, optimal infant and young child feeding/nutrition before, during and after illness, and water/sanitation/hygiene interventions, e.g., handwashing, and specific approaches for urban child health.

Link program implementation with operational research to identify evidence-based solutions to challenges in the field (quality as well as increased coverage of iCCM, task sharing, etc.).



MCHIP will strategically use core funding to closely collaborate with key global partners such as PMI, UNICEF and Catalytic Initiative to advance the USAID results pathways for pneumonia, ORT and zinc primarily through integrated CCM, increasing access to treatment for pneumonia, diarrhea and malaria to those outside the reach of current health services. Table 5 below summarizes MCHIP targets for introduction and expansion of iCCM, ORT revitalization and zinc introduction. Table 5. MCHIP Expected Results for Introduction and Scale-Up: Child Health


Analysis to determine potential mortality impact of improving diarrhea-related indicators in 30 MCH priority countries using LIST tool

Analysis initiated

10 country analyses completed

30

Programmatic analyses and findings provide further evidence for effective introduction and scale-up of integrated CCM and ORT revitalization programs

Country case studies completed in 3 PMI countries

5

Joint advocacy and technical support for integrated CCM carried out with Catalytic Initiative/ ACSD and Global Action Plan for Pneumonia (GAPP)

To be coordinated jointly with USAID, UNICEF and implementing partners

TBD 3+

Number of countries with integrated CCM or pneumonia control programs

Introduction DRC Uganda, Mali, plus1

10–5

Expansion DRC, Rwanda, plus1–2

8

Joint advocacy and technical support for ORT revitalization carried out with Catalytic Initiative/ACSD, CIFF ORT/Zn and ZTFF

7


Kenya, plus1 3 or more

Number of countries with revitalization of ORT and introduction of zinc activities

Introduction DRC and Mali Kenya plus 1–2 selected countries among 5 Africa 2010/AFRO assessments

13

Expansion DRC and Mali 6

7 CIFF countries: Kenya, Nigeria, India, Ethiopia * implemented under ongoing BASICS TOs



MCHIP will engage in opportunities for child health programming within cross-cutting health systems areas such as quality of care, social marketing, performance-based financing, urban health and private sector work. MCHIP will work with other USAID-funded health systems projects (e.g., HCI, HS 2020, Africa 2010, etc.) to identify countries where collaborative efforts could be undertaken.

Program learning opportunities

Documenting the lessons learned by countries that have taken CCM to scale is an important aspect of MCHIP’s long-term Child Health strategy. In Year 2, MCHIP will conduct country case studies toward this purpose in two francophone (Senegal, DRC) and one anglophone (TBD) African country. Protocols for country data collection will be finalized during the first quarter of Year 2 and cleared with USAID/GHB prior to the start of field work. Participation in country assessment exercises by key stakeholders, such as UNICEF and WHO, in addition to MCHIP and USAID staff, will enrich and increase the multi-agency buy-in to case study findings and recommendations. These three CCM country studies, together with MCHIP’s on-going review of CSHGP experience in CCM, will inform the design of programs and evaluations during the anticipated expansion of iCCM in priority MCH and PMI countries. Building upon the ORT assessments by Africa 2010/AFRO in five countries (Benin, Senegal, Mali, Ethiopia and Zambia), MCHIP will also consult with USAID to identify one to two countries needing technical assistance to address gaps and document progress. Using core and country resources for child health and water, MCHIP will make Kenya a focus country for a visible, well-documented combined prevention and treatment approach to diarrheal disease including improving infant and young child feeding/nutrition. The Ministry of Health, NGO partners and donors such as USAID, CDC and UNICEF have supported diarrhea prevention through hygiene promotion campaigns and a diversity of point-of-use water treatment projects and evaluations over the last few years. Diarrhea prevention has generated significant awareness at the national and provincial levels, although diarrhea treatment lags behind. MCHIP will assist Kenya’s MOH to review the evidence of a pilot comprehensive diarrhea control program and adapt it for scale-up in the three provinces designated for USAID MCH plus results.

Leveraging global partners

With the challenges of meeting MDG 4, no one donor’s resources are sufficient. It is imperative that partners collaborate closely to harmonize their efforts to assist countries to reach their objectives. MCHIP will actively engage development partners with a demonstrated commitment to iCCM and diarrhea management (including UNICEF, the Catalytic Initiative and CIFF) to harmonize activities and leverage potential resources for programming CCM and diarrhea management at the country level. Through active participation in global partnerships, MCHIP will contribute to advancing the global agenda and harmonizing global program learning while advancing USAID positions on pneumonia, malaria, ORT/ORS and zinc. MCHIP will engage with the following global groups: 1) the Global Action Plan for the Prevention and Control of Pneumonia (GAPP) to raise interest and funds for pneumonia; 2) PMI and the CCM Task Force to raise interest and funds for CCM specifically, and to prioritize and coordinate operational research (CCM.ORG working group); and 3) the Zinc Task Force (ZTF) to address diarrheal disease control. Special emphasis will be placed on collaboration and joint workplans with PMI and UNICEF at the headquarters and country level to leverage broader impact across MCH and PMI priority countries.



Advocacy to global malaria partners to support the integrated package under iCCM will be an important strategy to rebalance attention to address the three diseases contributing most to the global burden of childhood mortality. In the context of child health, MCHIP will work at global, regional and country levels as described below to contribute to the mortality reduction in 20 priority countries over the LOP.

Year 1 achievements An iCCM working group was formed, composed of members across MCHIP partners. The first

task of the group was to develop a matrix of countries showing the status, interest and number of implementing partners for CCM to help MCHIP identify opportunities for implementation in Year 2.

Regular meetings with PMI (including the quarterly PMI/MCH Partners Coordinating meetings), AFR/SD and MCH were held to garner support and achieve consensus on priority countries for scale-up of iCCM with MCHIP support. MCHIP worked with Global MCH and PMI to develop a CCM pathway, create a framework, identify components/benchmarks and compile CCM tools. This effort across USG partners looks for opportunities to collaborate to increase efficiency in the field.

With a view to harmonize, leverage and accelerate iCCM across countries, MCHIP participated with global partners in CCM Task Force/CCM.ORG in the development of common metrics for the assessment and evaluation of integrated CCM programming.

MCHIP developed a draft strategic CCM paper with Africa 2010, continuing work initiated under BASICS, that recommends areas for future USAID investment.

An MCHIP review of CCM approaches is underway that includes their associations with quality of care, coverage and equity of services. Gaps in CCM evidence are being identified, with proposals for evaluation and research activities to address these gaps. Dissemination is planned for Year 2.

An MCHIP ORT/Zinc working group began and later merged with the iCCM working group to effectively create the MCHIP Child Health Team. The strengths and diversity of child health experience across MCHIP partners is a tremendous asset that will be used to full advantage.

MCHIP core funds were creatively programmed in Kenya to complement the mission’s initial buy-in. In addition to ORT revitalization and the inclusion of zinc in treatment, in-country MCHIP partners will collaborate on a more comprehensive approach to control diarrheal diseases by promoting a package of evidence-based preventive interventions (water, sanitation and hygiene/handwashing, infant and young child feeding/nutrition, and immunization).

MCHIP worked to transition and build on BASICS child health efforts in selected countries. For example, in addition to its bilateral support to AXxes project, the DRC/USAID Mission is now supporting the scale-up of CCM and continued work in ORT and immunization through a buy-in to MCHIP. BASICS local staff transitioned to MCHIP on April 1, making DRC the first MCHIP field office.

MCHIP/DRC established two working groups, one on product and logistics and the other on communication and resource mobilization, to support the launch of its National Day for Revitalization of Diarrheal Disease Control activities.




Co-sponsored the fourth Africa regional CCM implementers’ experience exchange and program update meeting to leverage existing learning on iCCM, and to expand iCCM in-country and to other countries (e.g., Anglophone countries and non-African countries), working in close collaboration with USAID (Activity 4.1.1)

Finalized and disseminated review of existing analyses/assessments of CCM (Activity 4.2.2) Completed lessons learned/evaluation of the scale-up of CCM in two francophone countries

(Senegal, DRC) and one anglophone African country (TBD) to inform the introduction and expansion of iCCM in new countries (Activity 4.2.2)

Completed mapping of CSHGP grantees and their activities in CCM (Activity 4.2.2) Developed and made available an iCCM toolbox of good practices identified in the

consolidation of iCCM tools currently being done by USAID (Activity 4.2.2 & 8.4) Introduced iCCM in three to four PMI and/or non-PMI countries (Activity 4.2.2 & 8.4) Participated in and supported USAID’s coordination with UNICEF at global and country levels

(Activity 4.1.2) Completed synthesis of existing reviews on ORT use/non-use and brought to global fora in

collaboration with Africa 2010 and UNICEF (Activity 4.3.1) Accelerated ORT revitalization and zinc introduction in at least three selected MCH priority

countries, including one country in collaboration with Africa 2010, where it has completed a study that identifies bottlenecks in ORT decline (DRC, Kenya and one Africa 2010 country) (Activity 4.3.2)

Scaled up well-documented and visible comprehensive diarrhea prevention and treatment program in three MCH plus provinces of Kenya (core plus country funding) (Activity 4.4.2)

Developed structured collaboration with other ORT/zinc partners (CIFF, ZTF)(Activity 4.1.2 & 4.4.2)

Defined MCHIP role for advancing lessons learned from POUZN’s zinc introduction to date (Activity 4.4.1)

Developed protocols and carried out further CCM and diarrhea management documentation and assessment to address gaps in the evidence base and identify innovative approaches to community-based programming for testing and evaluation in Year Three.(Activity 4.2.2)

Identified a package of preventive actions to complement iCCM in one country (DRC) and support operationalization through partners including the Mission bilateral (AXxes) (Activity 4.5.1& 4.5.2)

Immunization

Vaccination programs prevent approximately 4 million deaths each year and a quarter of the remaining 9.7 million child deaths could be prevented through vaccines that are currently used or soon to be introduced in developing countries. USAID provides considerable financial support to the GAVI Alliance and polio eradication efforts. Disease control initiatives against polio, measles and tetanus similarly attract sizable resources from the donor community. However, the availability of these resources has exposed the relative lack of technical support being provided by partners to strengthen the capacity of MOHs to develop and implement their routine immunization programs.



USAID, through its contracts, has partially filled this niche over the years to complement the efforts of other global partners.

Strategy for immunization

MCHIP will continue USAID’s strategy of combining technical support to MOHs and partners at national and sub-national levels with technical leadership at global and regional levels. Working with global and regional partners (including WHO, CDC, GAVI, the Bill & Melinda Gates Foundation and others) and directly with USAID Missions and partners at the country level, MCHIP will advance the immunization pathway goals of: 1) increasing sustainable immunization coverage with all appropriate vaccines and reducing child mortality from vaccine-preventable diseases; and 2) supporting the effective and sustainable introduction of affordable, safe, high-quality new and/or underutilized vaccines and innovative technologies. In most of its activities, MCHIP will continue the strong contributions IMMUNIZATIONbasics (IMMbasics) and earlier USAID global immunization projects have already made at global, regional and country levels. By their nature, immunization programs are designed to achieve public health impact at scale, but clearly some are stronger and more effective than others. IMMbasics and MCHIP started a strategic review of coverage trends and other immunization indicators in the 30 MCH priority countries in 2009. That review will be updated with 2008 data, finalized and then used in targeting a subset of countries with low or faltering coverage for the strategic investment of core MCH resources and increased advocacy with USAID Missions and their partners. The Reaching Every District (RED) approach—originally designed by WHO, UNICEF and USAID—will be a key feature of MCHIP country support. RED is a package of immunization “best practices” that can be introduced to increase and sustain high levels of immunization coverage. RED focuses at the district and health facility level to:

1. Improve the planning and management of available immunization resources by, among other things, targeting districts and health facilities with large numbers of unimmunized children for special attention;

2. Select and use an appropriate mix of service delivery approaches to ensure that all children have at least four appropriately spaced immunization contacts before 12 months;

3. Strengthen the linkages between health facilities and the communities they serve, encouraging community involvement in the tracking of pregnant women, infants and vaccination defaulters, and other activities;

4. Ensure regular support supervision and on-the-job training for those who deliver and manage immunization services; and

5. Use data for the active monitoring and management of routine immunization services over time. Application of this systematic approach has been associated with improved coverage in many countries. However, one of the original goals of the RED approach—targeting districts and catchment areas with large numbers of children who are either completely or partially missed by existing immunization services—was all but lost as most countries took advantage of GAVI Alliance resources after 2005 to take the RED approach to scale. It is for this reason that MCHIP’s forerunner, IMMbasics, has been working with WHO and several countries in the Africa Region to more fully operationalize and revitalize, where needed, the RED approach. An important part of RED revitalization entails encouraging countries to once again target for special attention those districts and health facilities with large numbers of unimmunized and partially immunized children and then to use



appropriate combinations of service delivery strategies—fixed, outreach and periodic intensification—to reach them by 12 months of age with the full infant immunization series. MCHIP will continue the work started by IMMbasics to revitalize RED in the Africa region and also use RED and RED-like approaches at the country level to strengthen immunization services and increase coverage in areas of low performance. MCHIP will also begin work, again with WHO/AFRO, to adapt and test the use of the RED approach to manage an expanded package of MNCH/FP/HIV/AIDS interventions, either singly or in combination as integrated approaches. To ensure that USAID MCH priority countries are ready to incorporate new vaccines and that those with low or faltering immunization coverage are strengthened, in addition to support for RED, MCHIP will also provide technical assistance to the USAID MCH priority countries for: multi-agency EPI reviews and coverage surveys; comprehensive multi-year plans (cMYP) and annual workplanning; cold chain and vaccine management assessments and capacity building; data quality audits and data quality self-assessments; development of vaccine introduction plans and technical support for smooth introduction of the new vaccines; and preparation of GAVI applications and supporting documents (including cMYPs) for all types of funding, including funding for new vaccines.

Year 1 achievements MCHIP’s first year has also been the final year of the IMMUNIZATIONbasics project. Staff time has been shared between the two projects and to a large degree it is difficult to say where IMMUNIZATIONbasics support has stopped and MCHIP’s has begun. Year 1 results are thus shared by both projects, and include:

1. Drafted summaries for 30 MCH priority countries and conducted analysis

2. Began epidemiological analysis of un-/under- immunized children

3. Disseminated revised RED guide and monitoring tools in English, French and Portuguese

4. Conducted a regional RED adaptation workshop with WHO/AFRO

5. Assisted four high-burden countries (India, Nigeria, S. Sudan and Timor-Leste) and one country with low performing regions (Madagascar) in applying RED or RED-like strategies

6. Completed literature review on integrated outreach

7. Drafted WHO guidance to national policy makers on immunization schedules

8. Provided technical input to global policies, including generic preferred product presentation, multi-dose vial policy and visual cues designed to inform health workers whether vial can be kept after opening

9. Leveraged partner resources for country support

10. Provided pneumonia vaccine introduction assistance to Rwanda

11. Field tested evaluation protocols for new vaccine (post-introduction)

12. Drafted protocol for assessing HCWM systems before and after new vaccine introduction

13. Carried out country and cross country TAGs and rapid assessments in polio endemic countries

14. Gave continuous input to polio and RI knowledge management network



Table 6. MCHIP Expected Results for Introduction and Scale-up: Immunization

Expected Results PY 1

IMMbasics and MCHIP

PY 2 Life of Program—FY13

Analysis of immunization in high-burden countries

Expansion and improvement

Analysis conducted Country summaries updated and used with USAID Missions Literature review on unvaccinated child

All MCH priority countries

RI coverage increased by 1 year of age in areas receiving MCHIP TA


DRC, India, Madagascar, Nigeria and S. Sudan

Benin, DRC, India and Kenya

6–7 countries

Resources leveraged toward implementation of coordinated RI improvement plans


Benin, DRC, India, Madagascar, Timor-Leste, and S. Sudan

Benin, DRC, Kenya India and S. Sudan

6–7 countries

RI planning and management capacity at district level improved


1 regional RED adaptation workshop conducted with WHO/AFRO India, Nigeria, S. Sudan Madagascar and Timor-Leste

1–2 regional RED adaptation workshops conducted Benin, DRC, India and Kenya

TBD

RED+ Selected MNCH/FP interventions added to RI and RED

Action research/ introduction

Literature review on integrated outreach 1 country selected with WHO/AFRO for RED+ design and testing

2–3 countries (e.g., DRC, Kenya, Malawi, Liberia, Nigeria and Zambia)

3 countries

MCHIP technical input given related to new vaccine introduction

Introduction and expansion

WHO guidance to national policymakers on immunization schedules drafted Technical input provided to multiple global policies

Global policies and strategies finalized with MCHIP input

7+ key global and/or regional policies

New vaccines and innovative technologies introduced


Rwanda (pneumococcal vaccine) Drafted protocol for assessing HCWM pre and post new vaccine introduction

2–3 countries

4–6 countries

Routine Introduction 4 polio endemic 5+ countries 5–7 endemic



Expected Results PY 1

IMMbasics and MCHIP

PY 2 Life of Program—FY13

immunization and polio eradication strategies used to mutually strengthen each other

and expansion

countries and re-importation countries

Global partnerships

Continuing with current IMMbasics activities, MCHIP will provide global technical leadership to a variety of immunization-specific entities, including: WHO’s Strategic Advisory Group of Experts (SAGE) and Technologies and Logistics Advisory Committee (TLAC); the GAVI Alliance’s Civil Society Task Team (CSTT) and Vaccine Presentation and Packaging Advisory Group (VPPAG); UNICEF and the UNICEF Catalytic Initiative; CDC’s global immunization research panel of experts; BMGF’s learning grant on improving the performance of routine immunization systems in Africa; and others. At the regional level, the Program will continue providing support to WHO regional offices, with particular attention given to the Africa Regional Office (AFRO), its subregional Inter-Country Support Team (IST) offices, and the Task Force on Immunization (TFI) in Africa. Furthermore, MCHIP will seek opportunities to contribute its expertise and field experience to the continuing global dialogue on: better linking of immunization with other health interventions; engaging civil society; strengthening the relatively weak link between health services and communities to increase birth and subsequent vaccine doses; identifying reasons for non-immunization; preparing guidance to national managers on revision of their immunization schedules; using routine immunization outreach as a platform for other health interventions; and capitalizing on routine immunization contacts—whether in static facilities or through outreach—to add birth spacing messages.

Opportunities for program learning

Through MCHIP, USAID will have an ally in marshalling and managing knowledge and disseminating experience that has been accumulated over many years of consistent USAID support for routine immunization and polio eradication. In addition to the documentation efforts mentioned above (e.g., evaluation of new vaccine introduction, documentation of RED+ approaches, etc.), MCHIP also has the opportunity to link to an exciting new BMGF learning grant that will systematically identify, document and make information available about strategies in the Africa region that work when it comes to strengthening routine immunization systems and sustaining high levels of coverage. This grant, which is being awarded to JSI, MCHIP’s lead organization for child health and immunization, will get underway early in Year 2.

Expected results for Year 2

Transitioning and building on relevant activities from IMMbasics, MCHIP will use global support to:

Participate with USAID and partners in global/regional advocacy and planning to mobilize resources and coordinate support for implementation at the country level. (Activity 4.6.1)

Finalize a strategic review of immunization status in the 30 MCH priority countries in order to identify gaps in coverage and support. (Activity 4.6.2)



Support the development and implementation of strategies to reach unimmunized and partially immunized children with life-saving vaccines in MCH priority countries with fragile or ineffective immunization systems. (Activity 4.6.3)

Support the introduction of new vaccines by working with countries on national introduction plans and GAVI applications; strengthening routine immunization systems; building the capacity of health workers and managers; and monitoring and evaluating the introduction process. (Activity 4.6.4).

Utilize routine immunization and polio eradication strategies to strengthen each other and guide integration efforts (i.e., link polio and routine immunization data and decision-making more effectively; compile and disseminate lessons learned; identify and help to address issues with integration). (Activity 4.6.6).

Continue working with WHO/AFRO to add selective MNCH/FP interventions to the existing routine immunization platform and simultaneously expanding the RED approach to support multiple interventions. (This will include testing the use of adapted RED approach to improve coverage and continuity of some aspect of MNCH/FP.)(Activity 4.6.7–4.6.9)

Finalize a review of the experience using routine outreach—a mainstay of immunization programs around the world—as a platform on which to add other interventions. (Activity 4.6.7–4.6.9)

Promote birth spacing and increase access to FP services using immunization contacts. (Activity 4.6.5).

Collaborate with BMGF-supported learning grant activities to identify and document innovations and other successful approaches to RI strengthening in Africa. (Activity 4.6.5)

Core-supported immunization activities are also included in other pathways and strategies, including those focused on maternal/neonatal health and family planning, and in the country strategies for DRC, Kenya and India. With support from USAID’s Reproductive Health and Family Planning Division, MCHIP will further document and explore how routine vaccination contacts can be used systematically to counsel mothers about healthy timing and spacing of pregnancy and provide family planning services.

Cross-Cutting The cross-cutting technical areas are those with affects across the specific MNCH technical areas described above.

Integration of water, sanitation and hygiene with MNCH for improved newborn and child health

MCHIP will address the behavioral aspects of all three components of WASH (clean water, sanitation and handwashing) and serve as a platform to integrate WASH with other MNCH activities as appropriate. Handwashing, safe water treatment and handling and safe storage at point of use and the safe disposal of feces, form the pillars of hygiene improvement interventions that can interrupt the transmission of many pathogens, including those that cause diarrhea and neonatal sepsis. Diarrhea is a common cause of morbidity and a leading cause of death among children under 5 in low-income countries.



About 3.7 million newborns die every year in developing countries, and almost one-third of these deaths are due to infections. Evidence from studies in India, Pakistan, Bangladesh and Nepal has shown that infection prevention and management interventions can reduce death rates significantly among newborns. A recent study in Nepal by Johns Hopkins University and the Nepal Nutrition Intervention Project found that birth attendant and maternal handwashing with soap and water were associated with a 41% lower mortality rate for newborns exposed to handwashing. These results indicate that measures to improve or promote birth attendant and maternal handwashing could improve neonatal survival rates. To maximize benefits of hygiene promotion, MCHIP will integrate messages on safe disposal of feces, consumption of safe drinking water and handwashing into MCH programs. In some settings a lack of adequate sanitation facilities and access to safe water may create a barrier to improved practices and health outcomes. In these situations, MCHIP will include a focus on increasing access to hygienic latrines as well as promotion of point-of-use water treatment and safe storage. While the importance of handwashing, safe disposal of feces and safe drinking water and their potential for significantly reducing newborn and child mortality are recognized, challenges around implementing and scaling up activities for child and newborn health remain. MCHIP has identified the lack of clear and practical messages around the critical moments for handwashing by new mothers as an area of importance, and MCHIP will facilitate activities to help answer this question. Through its work in India and Bangladesh, MCHIP will also define and test strategies for integrating handwashing messages and activities into broader newborn and child health programs to have impact at scale. While developing these approaches, MCHIP will look for opportunities to target interventions to improve handwashing practices and reduce neonatal mortality among the urban poor. Informal urban settlements present unique challenges, which may require specialized solutions. MCHIP will look for opportunities to include a focus on handwashing in broader urban health programs.

Year 1 activities Worked with USAID/W and USAID/India to collaborate with HIP, USAID/India’s Market

Based Partnership bilateral project and Unilever to initiate development of a handwashing for newborn survival activity in India.

Submitted a concept note describing potential handwashing activities in India.

Supported Unilever in design of formative research that is currently being finalized and will be carried out in two states of India.

Identified Bangladesh as a second country for MCHIP to support implementation of handwashing for newborn health.

Year 2 expected results Hold a technical consultation of individuals and agencies with expertise in handwashing

promotion and newborn health to identify specific messages around appropriate timing for handwashing to improve newborn health. (Activity 5.1.2)

Collaborate with Unilever, USAID/I, HIP, MBP and other bilateral projects to implement a handwashing program in India, potentially in two states. MCHIP will play a catalytic role by providing technical support in message development and supporting state-level training of



trainers. MCHIP will also identify existing platforms and partners through which the handwashing work can be linked to Essential Newborn Care and scaled up. (Activity 5.1.2)

Document water/sanitation activities in Indonesia to inform development of a handwashing strategy to improve newborn health. (Activity 5.1.4)

Collaborate with public and private sector partners and MaMoni bilateral program to develop a national handwashing strategy for Bangladesh. This may include providing support for formative research in Bangladesh to inform strategy development and technical support for revision or creation of appropriate materials. (Activity 5.1.2)

Explore the GDA mechanism as a means of providing complementary support to private sector funding for handwashing. Increasing handwashing represents a convergence of interests of the public and private sectors. MCHIP will continue to engage with both public and private partners to maximize the reach and impact of handwashing interventions. (Activity 5.1.2)

Integrate water and hygiene improvement for prevention of diarrhea in MNCH platform. (Activity 5.1.1)

HIV/PMTCT-MNCH integration

Ensure integrated implementation of four prongs of PMTCT The failure to prevent transmission of HIV from mothers to their infants is undermining other gains being made in maternal and child health. MCHIP will address this issue by planning and implementing integrated programs wherever possible, building on the well-established platforms of maternal and child health services. MCHIP will explore appropriate entry points for PMTCT, pediatric HIV and other reproductive health services for HIV+ women within the MNCH continuum—including during antenatal care, labor and delivery, postpartum/postnatal care, family planning, well and sick baby visits, and immunization contacts. Traditionally, PMTCT and pediatric HIV/AIDS services have been delivered in a facility setting, but there is both a need and an opportunity to engage communities in the process. Using lessons learned from ACCESS, BASICS and other partners, and adapting elements of the successful RED approach to strengthening district planning and management of immunization services, MCHIP will develop strategies to improve the quality and coverage of PMTCT, strengthen the referral process within facilities, and explore approaches to delivering appropriate services to both women and children at the community level. WHO and others are presently revising Pediatric HIV guidelines, which are expected to be issued in November. Once these are available, MCHIP will hold a technical consultation on pediatric HIV with USAID and other partners to define MCHIP’s role in pediatric HIV.

Year 1 achievements 1. Held PMTCT/MNCH/FP Integration meeting on 25 June 2009 with over 30 participants from

USAID and collaborating partners.

2. Established dialogue with USAID and partners about MCHIP’s role in planning and implementing integrated programs that include PMTCT, MNCH and FP.

Year 2 expected results 1. USAID PMTCT strategy implemented in one country, potentially Zambia or Malawi (and other

countries as feasible)—including integration of PMTCT into the continuum of maternal, newborn, family planning and child health services—in collaboration with existing bilateral programs. (Activity 5.2.1)



2. RED approach adapted and field tested in at least MCHIP-supported country to determine effects on PMTCT coverage and continuity of care. (Activity 5.2.1)

3. Lessons learned from countries where integration of PMTCT into other health services has occurred compiled and disseminated globally. (Activity 5.2.2)

4. Once the new WHO Pediatric HIV Guidelines are available, a technical consultation on pediatric HIV held with USAID and other partners to define MCHIP’s role in pediatric HIV. (Activity 5.2.3)

5. MCHIP’s Pediatric HIV strategy developed and planning underway to increase the coverage and effectiveness of pediatric HIV care in two additional countries in Year 3. (Activity 5.2.3, contingent upon new funding)

Health systems to enhance maternal, newborn and child survival

While there is broad agreement that strong and responsive health systems that deliver quality services are essential for enhancing MNCH and improving survival, there is little clarity about the elements that are most important and where countries and the donors that support them should focus health systems strengthening investments. While interest is growing in understanding what comprises a strong health system and how to strengthen systems, the discussion is not usually grounded in the ultimate measures of effective health systems—namely, saving lives and improving health. In Year 2, MCHIP will build on existing frameworks, and will consult with technical partners and the CORE group to develop guidance on health systems elements that are essential to deliver MNCH services and the linkages and dynamics that determine how health systems elements interact. The intention of this conceptual framework is to guide priorities for technical assistance in MCHIP programs, not to provide global leadership on health systems strengthening as is provided by the USAID-funded HS20/20 project. This conceptual framework will be used in MCHIP country programs to guide priorities for technical assistance so that health results are achieved at scale. At the country level, this framework will complement information gained from application of the LIST tool by providing information about the elements of the system that need to be strengthened so that priority services reach beneficiaries. Part of this will likely include building on the RED approach by strengthening management of health and utilization of priority services at the community level. It will also link to the MCHIP Performance Based Incentives strategy that will be developed in the coming year to guide MCHIP support to countries that are introducing new incentive approaches for both patients and providers to improve MNCH outcomes. By examining needs and complementary initiatives, MCHIP will be able to identify priorities for high-impact assistance that builds on MCHIP skills and complements resources of other USAID and non-USAID partners. MCHIP is collaborating with URC and other partners to distill the key and essential elements of quality improvements based on existing USAID-funded program approaches. MCHIP already has a broad platform of QI initiatives (e.g., Afghanistan, India, Nepal, Malawi, Tanzania, South Africa and Ethiopia), where MCHIP can immediately integrate these best practices to further strengthen the health outcomes. In addition, MCHIP will contribute to developing a framework that links QI initiatives to health system framework to communicate this to various audiences. Performance-based incentives, if carefully designed and implemented, are one tool in the arsenal of health systems interventions that shows promise for improving utilization of priority services at scale. By recognizing the incentives confronting providers and users and considering adding new ones to



counteract dysfunctional incentives, the many actors in health systems can be catalyzed to alter behaviors so that better health results are achieved. MCHIP’s approach to the application of performance-based incentives will be to identify opportunities in MCHIP field programs, where responsible application of performance-based incentives will complement other MCHIP technical assistance and contribute to achieving MNCH results at scale. For example, in Year 2, MCHIP will provide technical assistance to the government of Malawi using mission funding to support the design of performance-based financing, complementing and leverage funding from Norway and Germany for performance-based financing to improve maternal health. Of the 21 countries that have received mission buy-ins to MCHIP, we know of 15 that have a performance-based financing program in the design stage (e.g., Burkina Faso and Malawi), in the early phases of implementation (e.g., Liberia and Kenya) or more mature programs (e.g., India and Rwanda). These countries contain a rich combination of approaches with voucher schemes for reproductive health (e.g., Bangladesh and Nepal), supply side schemes in the public sector (e.g., Rwanda and Tanzania) and approaches that contract NGOs to deliver services and pay based on results (e.g., DRC and Liberia). The MCHIP strategy will be to identify opportunities where technical assistance on performance-based incentives will complement the goals of specific country programs and contribute to achieving results at scale.

Year 1 results Completed preliminary assessment of existing HSS frameworks.

Year 2 expected results Enhance global understanding regarding how health systems elements interact and contribute to

MNCH. (Activity 5.3.1) HSS framework developed that identifies major health system linkages and requirements with

key MNCH services outcomes. (Activity 5.3.1) MCHIP country planning integrates elements of health systems necessary to ensure that priority

interventions that save lives actually reach beneficiaries. (Activity 5.3.2) Quality Improvement approaches inform MCHIP program implementation. (Activity 5.3.2)

Maternal and child urban health

USAID aims to reduce under-five mortality by 25% by 2013 in 30 priority countries. Over the next two decades, each of these countries is likely to see for the first time the majority of its children living in cities—a turning point that the world population reached in 2007—and the MCH challenges among urban populations are different. Unlike the relatively homogeneous needs among rural populations, the poor, at-risk populations in cities live in slum clusters or disperse areas and identifying and reaching them requires innovative strategies. The disease profiles and health risks also vary between rural and urban populations. Some of these differences are very visible, such as the heightened sanitation and hygiene concerns among urban populations living in cramped and dense housing. MCHIP will work with USAID and partners on the new urban health pathway to better understand the issue of MNCH in urban settings and begin to test and evaluate the best practices to adapt proven community-based MCH interventions to address them.



Year 2 Expected Results In Year 2, MCHIP proposes to develop an MCHIP agenda for community-based urban maternal, newborn and child health and support USAID’s urban health pathway in several ways:

MCHIP will support the development of urban health leaders and champions: MCHIP will provide a sub grant to the African Population and Health Research Center (APHRC) for support of the Urban Health Champions Forum in October 2009. MCHIP staff will also participate in this forum as well as the International Conference on Urban Health, where they will engage with policymakers and practitioners to identify opportunities for partnering in community-based MNCH activities. MCHIP will also host an expert consultation in Washington, DC, with USAID and its partners to define the community-based MNCH agenda for MCHIP. (Activity 5.4.1)

Development of metrics for community-based urban health: The identification of feasible indicators for measuring community-based maternal, newborn and child health in urban settings will begin in Year 2. (Activity 5.4.2)

Support implementation of MC-UH program experience: MCHIP will work with USAID’s urban health project in Ethiopia to expand MNCH impact in urban areas and document this experience. (Activity 5.4.3)

Integrate handwashing for newborn health in urban settings: MCHIP is working in India and Bangladesh to integrate handwashing into ENC activities. Formative research is being done in collaboration with Unilever. Work in both countries can be done to add synergy to apply this to urban settings. (Activity 5.4.4)

PVO/NGO Support Overview

MCHIP’s PVO/NGO Support Team assists USAID’s Child Survival and Health Grants Program (CSHGP) and the President’s Malaria Initiative’s Malaria Communities Program (MCP) to maintain a consistent level of quality across their portfolios of grants, thus providing a mechanism to ensure that PVOs and NGOs play a critical role in advancing USAID’s MCH and malaria priorities. CSHGP projects are uniquely positioned in MCHIP focus countries to be part of an integrated approach through MCHIP partners in country. MCP grantees are uniquely positioned as key in-country partners in PMI Malaria priority Countries. MCHIP’s support to the CSHGP is outlined in greater detail below. The narrative regarding the MCP support activities are included in the Malaria section of the workplan.

CSHGP Support Background

The CSHGP presently consists of 53 grantees operating in 28 countries, reaching over ten million women of reproductive age and children under 5. The CSHGP’s unique partnership model combines global implementation with technical leadership, rigor, and collaborative learning and action. CSHGP’s program model is responsive to the priorities and mandates of the Global Health Bureau and contributes significantly to USAID’s leadership role in innovative community-oriented programming. CSHGP grantees have consistently increased coverage in key interventions over the national average from baseline to end of project, and have demonstrated average estimated mortality reductions of 22% for children under-five. The objectives of the CSHGP are to:



Pilot and analyze new approaches to introduce and scale up high-impact interventions in diverse communities, including urban and post-conflict settings.

Contribute to the solution to key operational barriers to scaling up delivery of these interventions through the provision of technical leadership and specialized technical resources.

Disseminate evidence and lessons of proven models for the delivery of high-impact integrated interventions.

Strategy

MCHIP’s vision is to maximize the inclusion of PVO and NGO contributions in scale-up of proven interventions at the country level. MCHIP assists the CSHGP to further its objectives through strategic analysis and dissemination of CSHGP portfolio data; targeted technical support to the active portfolio of CSHGP grantees; and support to existing CSHGP management systems that are utilized to guide, organize, collect, and diffuse portfolio level data. Progress and activities specific to CSHGP support are outlined below.

Year 1 Achievements In Year 1, MCHIP laid the groundwork for its 5-year vision. The MCHIP team worked with the CSHGP to position its program to both inform and benefit from MCHIP global leadership and country activities. Specifically:

The CSHGP Portfolio was mapped against technical and cross-cutting intervention areas in MCHIP’s Year 1 workplan, to assist the wider MCHIP team to plan for utilizing lessons from these projects into country programs and global leadership efforts.

The CSHGP’s information management system was redesigned to ensure that the information that is regularly tracked at the CSHGP portfolio level is aligned with USAID’s MCH Strategy and MCHIP’s priority technical areas.

MCHIP advanced a framework for innovations mapping that will serve as a tool for communicating with Missions and other global stakeholders about the relevance and progress of strategies that are being tested in the CSHGP Innovation Grant category.

MCHIP participated in discussions and offered recommendations on how to best leverage learning from the CSHGP portfolio into MCHIP activities, conducting review and revision of CSHGP program guidelines, and offering recommendations for future CSHGP RFAs.

Potential areas of synergy with family planning were identified through a review of the CSHGP portfolio against PRH’s Global and Technical Leadership Priority Areas.

CSHGP’s Rapid Health Facility Assessment tool informed the design of the PE/E survey that was pilot tested in September 2009.

Team members from the wider MCHIP consortium participated in DIP reviews, a Technical Advisory Group that informed the CSHGP’s overall evaluation strengthening efforts, and served as reviewers for Technical Reference Materials that were updated in Year 1.

Staff from the PVO/NGO support team of MCHIP participated in the design of the PE/E tool that was pilot tested near the end of the fiscal year, the development of the MCHIP Performance Monitoring Plan, and in MCHIP technical working groups that met to discuss program implementation and Year 2 workplanning.

MCHIP’s PVO/NGO support team was built into the MCHIP Bangladesh Associate Award.



Year 2 Expected Results In Year 2, MCHIP’s PVO/NGO support efforts will build upon the synergies established in Year 1. CSHGP-related activities will continue to focus on supporting existing CSHGP management systems, and ensuring technically rigorous programs that best position grantees to contribute to country-level scale-up efforts. An increased focus in Year 2 will be on strategic analysis and dissemination of CSHGP portfolio-level data, for the purpose of informing practitioners, global stakeholders and other MCHIP country-level efforts. The specific expected results for Year 2 will include:

CSHGP Guidelines maintained with clear linkages to MCHIP priority activities;(Activity 6.1) At least 50% of FY10 applications recommended for funding align with MCHIP priority

technical areas and/or focus countries; (Activity 6.1) Annual program results generated for CSHGP program/portfolio review, including Report to

Congress; (Activity 6.1) Management data on CSHGP grantees maintained; (Activity 6.1) Technically sound and rigorous Detailed Implementation Plans for eight newly funded projects

in Ecuador, Mozambique, Nepal, Zambia, Niger, Bangladesh, Honduras and Uganda; (Activity 6.2)

Technically sound and rigorous operations research designs for six innovation grantees; (Activity 6.2)

Ten evidence-based, project-specific results highlights (as reported in Final/Mid-Term Evaluations, documented and diffused through MCHIP information system; (Activity 6.3)

CSHGP results diffused through professional conferences, journal articles and MCHIP technical update meetings; (Activity 6.3)

GH/W and Mission Stakeholders Oriented to CSHGP data uses and resources; (Activity 6.3) CSHGP-generated tools/resources inform S01/SO2 activities; (Activity 6.3) Uptake of CSHGP strategies documented in Kenya; and (Activity 6.3) Opportunities for wider application of CSHGP grantee experience documented in Burundi.

(Activity 6.3) To the extent feasible, MCHIP will continue efforts to link CSHGP grantees to MCHIP country activities to facilitate linkages between CSHGP grantees and other non-MCHIP programs led by MCHIP consortia members in-country.

Family Planning Family Planning (FP) is a lifesaving intervention for woman, newborns and infants, and the ultimate goal of MCHIP FP activities is to advance FP-MNCH integration to help women delay, space and limit pregnancies, and contribute to mortality and morbidity reduction. MCHIP will work to advance understanding of FP’s role in ensuring that desired pregnancies occur at the healthiest times of women’s lives to achieve healthy outcomes. MCHIP will do this by ensuring that FP counseling and/or services are routinely provided as a part of MNCH at both community and facility levels, with a focus on women with children less than two years of age. According to analysis of DHS in multiple countries, the vast majority of women during the first year after childbirth want to avoid another pregnancy, yet only a small percentage are using modern



contraception. The unmet need among postpartum women during the first year is two and three times as great as among all women of reproductive age. Ross and Stover have recently published a study that looked at multiple global surveys and reported that family planning could reduce maternal mortality by reducing the numbers of pregnancies at risk, not only those pregnancies spaced too closely, but also those pregnancies among multiparous women greater than four pregnancies and women older than 35 years. The authors state “as countries transition from a very low CPR to a high CPR, the percentage of births at risk can be expected to drop from 75% to nearly 35%. As a result of this change in the percentage of births at high risk, the MMR can be expected to drop by about 450 points a change due to entirely to the effects of contraceptive use.”8

Program strategy for family planning

The five-year LOP strategy for family planning will:

Systematically integrate FP in maternal and newborn care, with an emphasis on linking immediate and exclusive breastfeeding with the lactational amenorrhea method and other key messages, and providing immediate postpartum family methods such as tubal ligation and IUD. The program will assess ways to increase the number of women who transition appropriately from LAM to another modern method, continuing the efforts that ACCESS-FP has initiated for a seamless transition from ACCESS-FP to MCHIP.

Ensure that family planning counseling and provision of commodities are strengthened as an integral component of postabortion care (PAC), and that PAC becomes a component of all emergency obstetric and newborn care (EmONC). Long-term and/or permanent methods such as IUDs, implants and tubal ligation should be available for women wanting to space or limit pregnancies.

Systematically integrate FP services into contacts for both well and sick infants and children, including immunization, nutrition and other services.

Develop and apply community-based models for FP integrated within the MNCH continuum of care.

MCHIP anticipates providing significant learning about effective program integration in these four areas. It will use global fora to present findings such as ECSA-HC, the Regional Family Planning Conference in Uganda, Global Health Council as well as on-line forums to continue the interest in PPFP generated by ACCESS-FP, but will also cast a wider net to include infant and young children nutrition and immunization. In addition, MCHIP FP activities will link with the PVO/NGO strengthening activities to include FP content and technical assistance as appropriate to the CSHGP grantees. In Year 2, MCHIP will continue to ensure that CSHGP grantees have access to the most relevant technical resources generated through the PRH office. MCHIP will strategically use core funds to work with Ministries of Health, Education and implementing bilaterals to promote and scale up evidence-based best practices of family planning so that couples can achieve the healthiest outcome for their pregnancies, babies children, mothers and communities.

8 Ross J, Stover J,How Increased Contraceptive Use Has Reduced Maternal Mortality, Maternal Child Health Journal; July 2009 Published on-line



Table 7. MCHIP Expected Results for Introduction and Scale-Up: Family Planning


Expanded community of practice on PPFP and PAC to include those working in maternal and infant nutrition, HIV/PMTCT, immunization and other MNCH services as part of global learning

Co-chair PAC Consortium FP WG PPFP integrated into technical resource materials for CSHGP

3 global fora where experts from immunization, infant and young child nutrition, UNICEF and UNFPA, and PPFP participate Continuation of LAM WG expand to include IYCN and child survival experts PPFP integrated into active profile of CSHG Explore and develop PPFP concept to expand to FP for at least 24 months to achieve HTSP Provide TA to ECSA-HC and Africa 2010 (see matrix 7.3)

TBD

Supported MOH and MOE to strengthen national FP standards. Capacity of midwifery pre-service education updated in Malawi and Ghana, including curricula, in-service materials tutors, and LAPM and PAC

PPFP Assessment visit in Ghana

Strengthened national FP standards, pre-curricula and in-service materials in Ghana and Malawi

15 countries field and core

Strengthened PPFP services in a community-based package of integrated services

With partners, develop integrated package AMSTL ENC and PPFP

Assessment visit to and program developed in Mali for PPFP strengthening with MOH, partners and bilateral for a continuum of care at the home and health facility


Demonstrated programmatic implementation on integrating PPFP, immunization and infant nutrition (American Association of Pediatrics [AAP]).

Literature review include IYCN interventions, NGO/PVO CSHGP lessons learned

Co-host consultative meeting Select one country with WHO/AFRO for RED + design and testing in one country

Malawi, Nigeria, Liberia, Zambia



Year 1 achievements

MCHIP submitted two concept papers to USAID on pre-service strengthening of FP through PPFP and PAC to Malawi and Ghana, working with bilaterals and the MOH. Both concept papers have been accepted. Additionally, MCHIP’s concept paper on an integrated package of postpartum and postnatal care to include AMTSL, ENC and PPFP in Mali has been accepted. The integrated package is directed at the matrones who work at the community level and are responsible for the majority of deleveries in Mali.

Initiated assessments in midwifery curricula/training sites, and built a strategy to enhance PPFP and emphasize FP in PAC.


MCHIP and ACCESS-FP work closely to provide a seamless transition from ACCESS-FP to MCHIP in the community of practice, on-line forums and working groups such as LAM and PPIUD and FP strengthening in PAC. (Activity 7.1)

Expanded concept of PPFP to include at least another year that couples need to continue family planning so that between conceptions mother and baby can grow healthy and strong for the healthiest outcome for the entire family and community. (Activity 7.1.)

MCHIP provides TA to ECSA-HC Africa’s Health 2010. (Activity 7.3) CSHGP included FP indicator (LAM and transition) for in PVO/NGO globally. (Activity 7.4) Strengthen pre-service training materials to include family planning. (Activity 7.3) Strengthened postpartum family planning and FP component of PAC into pre-service training

materials, national tutors and clinical training sites at the national level standards, pre-service curricula, tutors and clinical preceptor sites and in-service materials in Malawi and Ghana. (Activity 7.3)

• Integrated package of Continuum of Care through the MOH and implementing partners, and provided TA to include PPFP into an integrated package of services (AMTSL ENC and PPFP) that the auxiliary midwife provides and TA to support CHWs to create demand generation in Mali and possibly DRC. (Activity 7.3)

• Provide TA for PPIUD training. (Activity 7.8)

• Promoted healthy pregnancy spacing by increasing access to FP services using immunization contacts. (Activity 4.6.5 same as 7.4)

Malaria Today, approximately 40% of the world's population—mostly those living in the world’s poorest countries—are at risk of malaria. Malaria is found throughout the tropical and sub-tropical regions of the world and causes more than 250 million acute illnesses and at least one million deaths annually. Eighty-six percent of deaths due to malaria occur in Africa, south of the Sahara, mostly among young children. Malaria kills an African child every 30 seconds. Many children who survive an episode of severe malaria may suffer from learning impairments or brain damage. Pregnant women and their unborn children are also particularly vulnerable to malaria, which is a major cause of perinatal mortality, low birth weight, and maternal anemia. Malaria, together with HIV/AIDS and TB, is one of the major public health challenges undermining development in the poorest countries in the world.



One of MCHIP’s goals is to support a reduction in the global burden of malaria morbidity and mortality. MCHIP will be a key contributor to the President’s Malaria Initiative (PMI) goal to reduce malaria deaths by half in 15 target countries by reaching 85 percent of the most vulnerable groups—children under-five years of age and pregnant women—with proven and effective malaria prevention and treatment measures such as: insecticide-treated mosquito nets (ITNs), indoor residual spraying, rapid diagnostic tests (RDT), new lifesaving anti-malarial drugs for children, and treatment to prevent malaria in pregnant women. MCHIP will apply successful approaches to integrate malaria prevention and treatment comprehensively in all its malaria programming efforts including: capacity development, quality assurance, and community outreach. MCHIP brings stellar leadership and technical experience to help countries address and scale up prevention and treatment of malaria based on our collective work through access to maternal, neonatal, and women’s health services (ACCESS), basic support for institutionalizing child survival (BASICS), and child survival and technical support plus (CSTS+) programs. ACCESS and BASICS end in September 2009; CSTS+ ended in September 2008. MCHIP will work in close collaboration with the PMI team at the country level and headquarters, as well as with ministries of health to “scale up for impact” proven malaria interventions.

How MCHIP will do this

MCHIP will build national and local (community, nongovernmental organization [NGO], and facility) capacities and strengthen health systems to accelerate scale-up for prevention and treatment programs addressing malaria in pregnancy (MIP) and in children under-five. MCHIP will afford countries holistic support that addresses malaria across the health continuum of care—from household to community to facility and, finally, at policy level. Specifically, MCHIP will: 1) strengthen MIP control services, and 2) promote community case management of malaria in children under-five. In year 1, MCHIP implemented a number of activities that set the stage for malaria programming growth and support at the global, regional, country levels.

Malaria in pregnancy

Malaria in Pregnancy programs are at a crossroad. While many countries have made important strides in achieving their goals, most African countries are still far from achieving the Roll Back Malaria Initiative goal (80%) and the President’s Malaria Initiative (PMI) goal (85%) for intermittent preventive treatment (IPTp) uptake and insecticide treated bed-net (ITN) use. As countries expand their MIP programs and work toward scale-up, there are critical lessons learned, as well as best practices, that should be considered, adopted and applied based on the contextual needs of each country. MCHIP, in close collaboration with PMI, will build on MIP best practices, existing tools and lessons learned to support countries in their efforts to rapidly expand MIP prevention and control. MCHIP is well positioned through on the ground presence in PMI countries as well as Nigeria, to provide the necessary technical guidance and support countries need to move MIP programs to the next level.



Table 8. MCHIP Expected Results for Introduction and Scale-Up: Malaria


Malaria in Pregnancy

Technical leadership in MIP at the global and sub-regional levels.

RBM MIP working group

RBM MIP working group, MIPESA, RAOPAG, EARN, WARN


Key resources and tools (e.g., Malaria Resource Package) introduced in priorities countries.

PMI Country Teams

MIPESA, RAOPAG, EARN, WARN, MIM, MIP working group

PMI, USAID malaria focus, and MCH priority countries

Documentation and dissemination of MIP best practices and lessons learned.

Zambia Malawi (desk review), Senegal, Zambia


MIP service delivery bottlenecks addressed through innovative approaches.

Nigeria Up to 5 PMI focus countries


Community Case Management

Technical leadership in CCM at global, sub-regional, and country level.

CCM Task Force, CCM.ORG

CCM Task Force, CCM Operations Research Group, RBM East/ West Network

CCM Task Force, CCM Operations Research Group, RBM East/West Networks

Key resources and tools introduced in priorities countries

DRC, Senegal 2–3 PMI countries and 2 MCH/non-PMI countries

DRC, Rwanda, Benin, Kenya, Cambodia, Ethiopia Madagascar, Mali

Documentation and dissemination of CCM best practices and lessons learned.

Senegal Senegal, DRC, plus1 Anglophone country

PMI and MCH priority countries

CCM service delivery bottlenecks addressed through innovative approaches.

DRC 2–3 PMI countries and 2 MCH countries

10–15 PMI and MCH priority countries

MCP Support Technically sound community-based malaria projects contribute to the respective Country Malaria Operational Plans.

Uganda (2), Tanzania (2), Angola (2), Malawi (2), Liberia (2), Ethiopia, Senegal and Ghana

PY1 Grantees plus 8 new grantees in PMI countries TBD

# of grantees TBD in PMI countries



Year 1 activities In collaboration with the RBM MIP working group, contribution to the development of a

regional MIP strategy for Asia.

MCHIP provided technical assistance to help Nigeria accelerate implementation for MIP programming. The program supported efforts to strengthen the partnerships between reproductive health and malaria control at the State level, which resulted in prioritization of MIP programming in two States.

Key malaria resources including the ‘Malaria Resource Package’ and Malaria in Pregnancy Implementation Guide were disseminated to PMI country teams.

Participation in the Malaria in Pregnancy Consortium (MIPc) meeting; Dakar, Senegal to promote linkages between the research agenda and MIP programming.

In collaboration with PMI, start up of documentation of best practices, lessons learned, and bottlenecks address initiated in Zambia.

Technical guidance to support launching of USAID Burkina Faso malaria program. This program will help support Burkina Faso in the implementation and scale-up of MIP programming. MCHIP will work in close coordination with the DELIVER project as well as the USAID regional (Ghana) and USAID Washington as well as the Burkina Faso USAID Advisor (TBD).

Year 2 expected results Participate in at least 1 global and/or regional meeting(s):

MCHIP is committed to supporting the global and regional MIP agenda through the RBM MIP working group and regional networks including MIPESA, RAOPAG, EARN and WARN to promote scale-up. MCHIP will participate in one regional or global meeting to support this effort.(Activity 8.2)

Disseminate Global MIP key resources and lessons learned in at least one global and/or regional meeting: Jhpiego, in partnership with the World Health Organization, the Centers for Disease Control and Prevention, and Management Sciences for Health, through the USAID Malaria Action Coalition developed a MIP Implementation Guide and Jhpiego updated the Malaria Resource Package (MRP) to support countries in their efforts to scale up MIP programming. The implementation guide outlines a step-by-step process to address the seven key elements of MIP programming, based on the WHO MIP Strategic Framework and includes country case studies and lessons learned. The MRP is a compilation of tools and resources including: training materials, MIP Implementation Guide, job aids, communication strategies, and key articles that serve to support country efforts to expand MIP programming. MCHIP will disseminate these tools through its participation in global and/or regional events (e.g., MIPESA, RAOPAG WARN, EARN, and/or MIP Working Group). Additionally country teams can request copies of the key resources through their programs. MCHIP core will support the cost of the materials reproduction and shipment and country programs will be expected to support dissemination costs. (Activity 8.3)

Documentation of MIP best practices and lessons learned in one francophone country: In Year 1, MCHIP supported an MIP assessment in Zambia that assessed: 1) best practices/ strategies that have supported MIP programming success in these countries; and 2) existing bottlenecks in MIP program implementation and how these could be overcome. In Year 2, MCHIP will conduct a similar assessment in Senegal. The assessment(s) will identify key



elements for successful MIP prevention and control9,10, building upon what is already known, and further determine countries’ best practices, gaps in achieving MIP targets, and lessons learned. Additionally, the country assessment process will contribute to the development of a MIP analysis framework that countries can utilize to collect and synthesize MIP data. Additionally, MCHIP will conduct a desk review in Malawi using the MIP analysis framework. Although funds do not exist to support a full assessment in Malawi, the desk review will provide further insight into common best practices, lessons learned and bottlenecks faced in MIP programming.(Activity 8.4)

Address MIP service delivery bottlenecks at a regional level in up to 5 countries. *Based on documentation of best practices and lessons learned: Based on the documentation of best practices and lessons learned (#3), MCHIP will address common MIP service delivery bottlenecks countries are facing through a regional and/or global forum (e.g., MIPESA, RAOPAG MIP Working Group). Depending on the bottleneck(s) addressed, MCHIP will determine the most advantageous method to address the bottleneck with countries. (Activity 8.3)

Community case management

The new administration’s Global Health Initiative places new emphasis on integration, bringing important implications for CCM. In Year 2, as PMI pushes to accelerate introduction and expansion of iCCM in all PMI countries, MCHIP will work very closely with PMI to address bottlenecks with innovative approaches as PMI countries are sequenced for iCCM introduction/acceleration. The President’s Malaria Initiative (PMI), together with the new administration’s Global Health Initiative guidance to integrate MCH programs, provides unique opportunities for USG to contribute substantially to the rapid expansion of iCCM globally. Both USG financial resources and technical assistance are poised to assist countries to surpass their previous horizons to impact mortality, expanding impact from malaria-specific mortality reduction to reducing all three of the remaining top causes of childhood deaths world-wide: diarrhea, pneumonia and malaria. The entry of RDT is changing the face of malaria treatment. The introduction of ACTs and, in some cases RDTs, adds complexity to algorithms and support systems (e.g., continuous supplies of drugs and test kits). Although PMI does not promote the use of RDT at the community level, in some countries the national policy supports the use of RDT at this level. In these countries, PMI, through malaria operational plans (MOPs) will assist the MOH to expand iCCM using RDTs. During documentation of countries experiences implementing iCCM, MCHIP will assess whether RDTs are being correctly used and if appropriate treatment is provided. The entry of RDTs increasingly heightens the urgency for iCCM so that CHWs are equipped to assess and treat fever in children for pneumonia when RDT proves negative for malaria. Policy revision as well as a continuous supply of respiratory timers and antibiotics is urgently needed. In several countries, there is evidence that money and lives are wasted when community workers continue to use expensive ACTs despite negative RDTs. This is largely because countries have no antibiotics or policy to support treating these children for pneumonia, who are presenting with fever and negative RDT results for malaria. MCHIP will finalize review of CCM and documentation of CCM lessons learned in two francophone (Senegal, DRC) and one anglophone (TBD) African countries in Year 2. These lessons will be shared at global CCM fora such as GAPP and CCM.ORG. Based on a better understanding 9 Jhpiego: Scaling up Malaria in Pregnancy Programs: What it Takes! 2008. 10 Roman E, et al. Malaria in Pregnancy: The Dynamic Relationship Between Policy and Program Implementation. Harvard Health Policy Review. Vol. 9, N. 1, 2008.



of innovative approaches to CCM programming (training, supervision, worker motivation, drug logistics and monitoring), MCHIP will design innovative CCM programs to introduce in Year 3 in newly identified countries as well as design evaluation frameworks to capture their experience.

Year 1 activities A CCM working group made up of members across MCHIP partners developed a matrix of

countries showing the status, interest, and number of implementing partners for CCM to help MCHIP identify opportunities implementation in Year 2.

Meetings with PMI, AFR/SD and MCH were held to garner support and achieve consensus on priority countries for scale-up of iCCM with MCHIP support. MCHIP worked with PMI and USAID/MCH to develop a CCM pathway, identify components/benchmarks and compile CCM tools. This effort across USG partners looks for opportunities to collaborate to increase efficiency in the field.

With a view to harmonize, leverage and accelerate CCM across countries, MCHIP participated with global partners in CCM Task Force/CCM.ORG in the development of common metrics for the assessment and evaluation of integrated CCM programming.

MCHIP developed a draft CCM strategic paper with Africa 2010, continuing work initiated under BASICS, that recommends areas for future USAID investment.

A MCHIP review of CCM approaches is underway that includes their associations with quality of care, coverage and equity of services. Gaps in CCM evidence are being identified, with proposals for evaluation and research activities to address these gaps. Dissemination is planned for Year 2.

MCHIP worked to transition and build on BASICS child health efforts in selected countries. For example, the DRC/USAID Mission is now supporting the scale-up of CCM and continued work in ORT and immunization through a buy-in to MCHIP in addition to its bilateral support to AXxes project. BASICS local staff transitioned to MCHIP on April 1, making DRC the first MCHIP field office.

Year 2 programming will build on the achievements from Year 1, with an aim to ensure that malaria programming is supporting rapid implementation and scale up through the platform of maternal and child health services.

Year 2 expected results Participate in at least one global meeting or regional meeting of CCM Task Force and/or RBM meeting:

MCHIP is committed to continuing its global leadership role in iCCM. Participation in key international meetings provides a forum for MCHIP to assure that shared USAID perspectives on best practices, bottlenecks and, sometimes, controversial issues (e.g., Use of RDT at community level) surrounding iCCM are discussed at the global table. (Activity 8.4)

Finalize review of global iCCM experience and documentation of iCCM in 2 BASICS supported African (francophone) countries and 1 Anglophone country with integrated CCM including malaria: In Year 1, a global review of iCCM experience was undertaken with MCH funding and is near completion. Documentation of 3 countries in Africa is just beginning and will be completed in Year 2. These two activities are complementary and will make an important contribution to better understanding of this still nascent approach. (Activity 8.4)



Disseminate global review and 3 country documentation of iCCM: Lessons learned from the global review and 3 country documentation, including bottlenecks identified as well as promising practices, will be shared in international fora including GAPP, CCM Task Force, RBM meetings and CCM.ORG. (Activity 8.4)

Key tools, learning and resources applied when planning iCCM introduction in 2–3 PMI countries and 2 MCH countries: MCHIP will work very closely with PMI and UNICEF/Catalytic Initiative as they plan the rapid scale-up of iCCM. MCHIP will assist in iCCM planning and introduction as requested by PMI countries in their MOPs. MCHIP will share the lessons learned from documentation in 3 iCCM countries on bottlenecks and best practices to enable new countries to build on this experience. Innovations for programming in training, supervision, monitoring, CHW incentives and logistics will suggested as they design their new iCCM programs. (Activity 8.4)

Malaria Communities Program Support

Background The Malaria Communities Program (MCP) is an initiative created under the PMI to support the efforts of communities in PMI focus countries to combat malaria. The program provides small grants to US, international and local non-governmental organizations to carry out malaria prevention and treatment activities and to build local ownership of malaria control for the long-term. MCP grantees work with in-country partners and with other donor organizations working in-country, and operate within respective PMI country strategies, which have been developed in collaboration with each country’s Ministry of Health and National Malaria Control Program. In October 2007 USAID announced the first 5 organizations to receive grants under the MCP. In September 2008 USAID announced 8 additional organizations receiving MCP awards. It is anticipated that by the end of September 2009, USAID will announce the final 7 organizations to receive MCP grants under this program. Similar to support provided to USAID’s CSHGP, MCHIP supports the administration of PMI’s MCP as well as the grantees in the program by providing technical resources and ongoing advice to strengthen project design, implementation, monitoring and evaluation.

Strategy MCHIP’s 5-year vision for MCP is that all MCP grantees implement sound community-based malaria projects that contribute to the respective Country Malaria Operational Plans, and that lessons learned regarding community-oriented malaria prevention and treatment inform overall country malaria strategies. The USAID PMI team and in-country partners are important players to supporting this overall vision. Within MCHIP, the MCP support function falls under the rubric of the PVO/NGO Support team, but coordinates closely with other MCHIP Malaria team members to ensure congruence with the project’s Malaria in Pregnancy and Malaria CCM efforts. MCHIP thereby draws upon a wealth of technical knowledge and capacity to provide support in two main areas: Support to MCP Administration and Support to MCP Grantees. Support to MCP Administration includes updating work plan and reporting guidance, reviewing annual reports and workplans, creating Technical Assistance plans with individual grantees when needed, and providing information for USAID and PMI reports. Support to MCP Grantees includes responding to ad-hoc requests for assistance, providing on-site TA, documenting and sharing promising practices, and updating and disseminating technical resources. MCHIP also organizes



training events and meetings, at PMI/MCP’s request, to provide additional opportunities for grantee capacity-building and project strengthening.

Year 1 Achievements Reviewed 5 annual reports and 13 workplans, and provided feedback to grantees for the purpose

of strengthening their program’s contributions to the country operational plans; Provided on-site technical assistance to grantees in Tanzania, Ghana, and Angola; Provided ad-hoc technical assistance via phone and email to grantees in Tanzania, Ghana,

Angola, Malawi, Senegal, Uganda, and Liberia; Organized and attended a national workshop in Benin, designed to strengthen the dialogue

between partners, actors and stakeholders involved in community-based interventions against malaria;

Assisted with logistics for, and attended a national workshop in Angola; provided planning assistance for national workshop in Uganda Designed and delivered two distance-learning sessions via Elluminate about planning for

sustainability in community-based malaria projects, which were attended by at least 5 grantees and are available to be downloaded by anyone at anytime.

Adapted curricula, coordinated logistics, and led other key planning efforts in preparation for October Kenya Regional Training for MCP grantees on Program Design, Monitoring and Evaluation (PDME) and Behavior Change (BC)

Updated USAID/GH/HIDN/CSHGP Malaria Technical Reference Module to ensure that it reflects standard practice for malaria control and prevention, and disseminated it.

Disseminated MCP RFA; Prepared grantee information packages for new grantees; Revised workplan guidance for grantees; Created Google Group and issued two discussion topics: Malaria in Pregnancy and Rapid

Diagnostic Tests.

Year 2 Expected Results 13 annual reports and 20 workplans reviewed, and feedback provided to ensure that design and

implementation plan is sound and consistent with country plans; (Activity 8.1) 20 grantees trained in PDME and BC through Kenya Regional MCP Grantee Workshop;

(Activity 8.2) Ad-hoc TA via email and phone provided at grantee request; (Activity 8.2) 7 new grantees oriented to MCP; (Activity 8.2) In-country TA provided (schedule to be determined with PMI/MCP and grantees after review

of workplans and annual reports); (Activity 8.2) Grantee contributions to PMI Annual Report facilitated; (Activity 8.1) Annual report and workplan guidance updated; (Activity 8.1) Promising practices documented and shared, as appropriate. (Activity 8.1)



REGIONAL BUREAU FUNDING Africa/SD MCHIP will combine Africa/SD, core MCH and malaria funding with available Mission field support in the Africa Region to:

Democratic Republic of Congo: Continue working with AXxes, UNICEF and others to increase the coverage and quality of iCCM, ORT/Zinc, AMTSL, ENC and immunization.

RED+: Adapt and use the RED approach to improve the coverage of select MNH interventions in one country (Nigeria is proposed).

Immunization: Improve regional coordination and support to 2–3 high-burden countries (in addition to DRC) in reaching their unimmunized and partially immunized populations with routine immunization services and new vaccines.

iCCM, including Malaria: Build the evidence base and support to at least two new countries to introduce and expand iCCM, including malaria.

Newborn sepsis: Introduce neonatal sepsis control in Nigeria.

Strengthen family planning knowledge of midwifery tutors: Support ECSA-HC and Africa’s Health in 2010 in the second regional workshop on family planning for midwifery tutors.

Maternal and Newborn Quality of Care Assessment (FMN QoCA): Conduct an FMN QoCA in one African country with AFR/SD support.

The activities proposed in Year 2 toward these results are described below and in the Core Activity Matrix, Attachment 1.

Democratic Republic of Congo

Continue increasing the coverage and quality of iCCM, ORT/Zinc, AMTSL, ENC and routine immunization. (Through Dec 2009 only) MCHIP has been working hand in hand with the USAID bilateral project (AXxes), the MOH, WHO, UNICEF and other NGO partners in DRC since 1 April 2008 on: the introduction and expansion of a CCM package that includes treatment for pneumonia, malaria and diarrhea, as well as screening for malnutrition; the introduction of zinc and the revitalization of ORT nationally; and the training and supervision of birth attendants in AMTSL and essential newborn care at the facility level and of community health volunteers in essential newborn care. Once IMMUNIZATIONbasics ends (September 2009), MCHIP will take over the provision of periodic technical support to the national immunization program, primarily for program reviews, planning and RED revitalization. USAID/Kinshasa will provide partial support for continuation of MCHIP work with the AXxes project and the other partners in Year 2. MCHIP will combine this field support with core MCH, AFR/SD and malaria funding to continue the expansion and improve the effectiveness of iCCM activities in 80 health zones with AXxes, UNICEF and other partners. MCHIP will also document the iCCM scale-up experience and results and continue working with the partner group to ensure that the necessary policies, strategies, training capacity, and supply and information systems are in place to sustain iCCM over time. As suggested by AFR/SD, MCHIP will also explore, with the partners, the development of a multi-year operational plan for iCCM expansion, similar to the operational plans developed by PMI in its focus countries.



MCHIP will also continue on-going work with partners on a national ORT revitalization campaign, which will be launched with UNICEF and others in September/October 2009, and with the USAID SPS project and others to address serious supply issues that will ultimately undermine widespread introduction of zinc in diarrhea case management if they are not effectively addressed. Findings and recommendations from an MCHIP assessment in August 2009 of the combined AMSTL/newborn training and supervision (begun with BASICS and POPPHI technical assistance) will guide MCHIP’s plans for further expansion and improvement of the results of these interventions, again with AXxes, the MOH and other partners. MCHIP will support a national EPI review in autumn 2009 and then work with the MOH to disseminate and use the findings and recommendations from this multi-agency external review in national planning and in our own planning for MCHIP’s technical support. At a minimum, MCHIP immunization support will include participation in a semi-annual EPI review and planning meetings and, during the drafting of the annual Memo of Understanding, defining government and donor commitments to the national immunization program. DRC is also a candidate for the revitalization of the RED approach, and for the possible expansion of RED to support the delivery of an integrated MNCH package of interventions during outreach visits. MCHIP will explore these options with the national immunization program and support them technically if they proceed. The AXxes project has requested MCHIP support to improve family planning counseling and services in its health zones. This is an important area of work for MCHIP overall, and we welcome the opportunity to become involved with AXxes and the other partners in DRC. With approval from USAID/Kinshasa and USAID/G/RH/FP, MCHIP will use population funding to support an assessment of family planning needs and resources, and develop a joint AXxes/MCHIP plan to improve family planning counseling and services in AXxes-supported health zones. Although this activity will not be AFR/SD funded, we include it here to complete the MCHIP proposal for its support to DRC in Year 2.

RED+

Adapt and use the RED approach to improve the coverage of select MNH interventions in one country (Nigeria is proposed). (Activity 4.6.9) The RED approach is a package of immunization “best practices” that can be introduced to increase and sustain high levels of immunization coverage. RED focuses at the district and health facility level on: improving the planning and management of available resources and targeting children who are not being reached with vaccination services for outreach and other service delivery strategies; encouraging the use of an appropriate mix of service delivery approaches—fixed, outreach, periodic intensification; building stronger linkages between health facilities and communities; ensuring regular support supervision and on-the-job training for health providers; and promoting the use of data for the active monitoring and management of immunization services over time. To date, the RED approach has been used almost exclusively to improve immunization coverage. In Year 2, MCHIP will begin work with WHO/AFRO in at least two countries to adapt and test the use of an adapted RED approach to improving the coverage and quality of other, non-immunization MNCH and HIV/AIDS interventions. With Africa Bureau support, MCHIP will focus on one country, Nigeria, where the project is already working in two states—Kano and Zamfara—to improve maternal and newborn health. In adapting the RED approach for MNH, we will focus on a few interventions that are appropriate for outreach, such as misoprostol, family planning and/or iron folic acid. We will then engage someone from the recently closed IMMBASICS/Nigeria project



to assist the MCHIP/Nigeria team in adapting the revised RED guidelines and monitoring tools for use with these interventions. In Nigeria, MCHIP will also engage WHO, UNICEF, the National Primary Health Care Agency and the State Health Department during the RED adaptation process. Once the adapted RED approach is developed, MCHIP will support its introduction in one or two Local Government Areas (Nigeria’s district equivalent) and also monitor changes in intervention coverage. The expected result will be improved coverage and quality of the selected MNH interventions in the demonstration area. Immunization

Coordinated action with WHO/AFRO and UNICEF to revitalize RED across the region, and direct support to two to three countries to reach unimmunized and partially immunized populations with routine services and new vaccines. (Activity 4.6.1 and 4.6.3) One of the original goals of the RED approach—targeting districts and catchment areas with large numbers of unimmunized or partially immunized children—was all but lost after 2005, when countries started taking advantage of GAVI Alliance resources to rapidly scale it up. MCHIP’s forerunner, IMMbasics, has been working with WHO/AFRO and several countries in the Africa Region to more fully operationalize and revitalize the RED approach. In Year 1, we worked with WHO/AFRO to finalize, translate into French and Portuguese, produce and disseminate a revised RED guide and monitoring tool. Recently, our staff also participated with WHO/AFRO in subregional RED adaptation workshops. The third of these subregional RED adaptation/revitalization workshops will be conducted with WHO/AFRO and UNICEF in Year 2. Also in Year 2, MCHIP will offer direct technical support to countries to revitalize and expand RED and other RED-like approaches toward improved coverage in areas of low performance. Using a combination of core MCH and AFR/SD support, MCHIP immunization advisors will contribute to regional technical advisory groups, task teams and working groups. We will also participate with USAID in coordination and technical updates, and carry out joint activities with WHO/AFRO and others, including Africa 2010. AFR/SD funding will make this work possible and enable MCHIP immunization team members to participate in important regional immunization partnership meetings, including TFI, WHO’s Regional Working Groups and Managers’ Meetings, GAVI Technical Working Groups, etc. USAID’s direct immunization support to two to three countries in the Africa region will be carefully coordinated with WHO, UNICEF, CDC and others. In MCH’s intensive focus countries, particularly those with fragile or underperforming immunization systems, MCHIP will use AFR/SD support for staff participation in EPI reviews, assessments and planning missions. We will also work directly with country counterparts to develop and support their implementations of strategies for reaching unimmunized and partially immunized children. We expect that at least two countries will complete formal assessments, EPI reviews and/or country planning exercises with MCHIP input and that workplans targeting the unimmunized and partially immunized children will be developed and implemented in two African countries with partial AFR/SD support. Candidates for direct technical support, in addition to DRC, include Benin, S. Sudan and Nigeria.



Integrated Community Case Management (iCCM), including malaria

Build the evidence base and support at least two new countries to introduce and expand iCCM. (Activity 4.2.1 and 4.2.2) Nearly two-thirds of child deaths could be prevented though an integrated package of simple, cost-effective, low-cost interventions that combine effective preventive actions and case management of illnesses. Lack of access to treatment and preventive interventions contributes to high mortality and affects the poorest families in all countries in the region disproportionately. Community health workers (CHWs) can facilitate access to the treatment of childhood illnesses and other services, but many countries still restrict the services that CHWs are allowed to deliver—such as antibiotics for pneumonia. As a result, community pneumonia treatment has stalled in the “introduction” phase (despite strong evidence of impact and official endorsement by WHO). Nonetheless, there has been significant progress in community-based malaria treatment in a number of countries and several countries have enacted national policies and are moving to implement iCCM at scale, including Rwanda, Malawi and Senegal. Other countries are moving toward policy change at the national level; the MOH and partners in Mali, for example, are in the early stages of planning for the deployment of iCCM within the national health program. The entry of rapid diagnostic tests (RDTs) are changing the face of malaria treatment, The move from previous first-line treatments for malaria to ACTs has introduced complexity and confusion in some countries due to the availability of rapid diagnostic tests. In several countries, there is evidence that money as well as lives are wasted when community workers continue to use expensive ACT despite negative RDT. This is largely because they have no antibiotics or policy to support treating these children with fever and negative RDT for pneumonia. The President’s Malaria Initiative (PMI), together with the Obama administration’s Global Health Initiative guidance to integrate MCH programs, will contribute substantially to the rapid expansion of iCCM in the Africa Region. MCHIP is poised to assist countries in reducing the three remaining major causes of childhood deaths in all regions: diarrhea, pneumonia and malaria. MCHIP will invest a combination of core MCH, Malaria and Africa SD funding in Year 2 to:

Document in three African countries (two Francophone and one Anglophone) the lessons learned about integrated CCM scale-up and community linkages: MCHIP will use a combination of core Malaria and AFR/SD funding for these documentation exercises. Lessons will be shared in international fora including GAPP and CCM.ORG. Based on lessons learned, innovations in training, supervision, monitoring, CHW incentives and logistics will be used with PMI, in particular, to design new and more effective iCCM programs.

Leverage global malaria partners to support the simultaneous introduction of CCM of malaria and pneumonia: Work closely with PMI, Global Fund and UNICEF/Catalytic Initiative to integrate RDT (and antibiotics for cases of fever with negative RDT) in large-scale CCM country programs. Assist in the development of systems to monitor the use of RDT and appropriate treatment. Data will add to the evidence needed to change pneumonia policy so that malaria and pneumonia CCM are introduced together.

Introduce CCM in two to three PMI countries and two MCH countries: Work closely with PMI and UNICEF/Catalytic Initiative to plan and provide technical support as they rapidly assist priority PMI and MCH countries to accelerate introduction of iCCM.

Increase community mobilization and participation to prevent malaria by the appropriate use of ITNs by pregnant women and under-five children.



Newborn sepsis

Introduce neonatal sepsis control in Nigeria. (Activity 3.2.3) Of the 9.7 million children who die every year before reaching their fifth birthday, about 3.7 million are newborns, babies not surviving their first four weeks of life. The majority of these newborns live in developing countries and most die at home. Three causes—infections, birth asphyxia and preterm/low birth weight—account for 86% of neonatal deaths. While much, but not all, is known about what to do to address these causes of mortality, much less is known about how to deliver life-saving interventions in low-resource settings, especially in the poorest communities, where most of these deaths occur. Working with global partners, including Saving Newborn Lives, interested in the scaling-up of community-based infection management of neonatal sepsis (CBIMNS), MCHIP will support the establishment of a technical working group on neonatal sepsis management that would assist in defining a global strategy for introduction and expansion of CBIMNS. This will include the mapping of neonatal sepsis management at community level in sub-Saharan Africa and Southeast Asia. With support from AFR/SD, MCHIP will also support the Nigeria Society of Neonatal Medicine (NISONM) to introduce neonatal sepsis management, on a pilot basis, at the primary health care centers and within the community using government paid Community Health Extension Workers. Strengthen family planning knowledge of midwifery tutors Support ECSA-HC and Africa’s Health in 2010 in the second regional workshop on family planning for midwifery tutors. (See Activity 7.3) Evidence demonstrates that healthy spacing of pregnancies can reduce maternal, infant and child mortality.11 Most sub-Saharan Africa countries have high unmet need for planning and the specific unmet need for women during the first year after delivery is assumed to be much higher. Given this background the East, Central and Southern Africa Health Community (ECSA-HC), in collaboration with Africa’s Health in 2010, organized in 2008 a regional workshop for updating the knowledge of midwifery tutors in family planning. The workshop was highly rated by participants, and ECSA-HC is thus planning a second regional workshop to be held in early 2010, also in conjunction with Africa’s Health in 2010. These organizations have expressed special interest in MCHIP’s support to strengthen the postpartum family planning and postpartum IUD components of the curriculum, and to teach these sessions of the workshop. Ideally, MCHIP would also support follow-up of workshop participants after they return to their countries.

Maternal and newborn quality of care assessment (FMN QoCA)

Conduct a FMN QoCA in one African country with AFR/SD support. (See Activity 2.4.2)

Building on the successful model of the POPPHI surveys on AMTSL conducted in 10 countries, this survey is designed to address another frequent direct cause of maternal death—pre-eclampsia/eclampsia (PE/E)—identified by USAID as a priority area of intervention to address maternal mortality reduction. The purpose of the assessment is to guide QoC improvement activities in facilities, and guide district and national QoC by means of policy development and implementation. The assessment will document the prevalence of use, quality of implementation and barriers to performance of key preventive, screening and treatment interventions during maternal and newborn care. It will achieve this by providing a multi-country baseline of PE/E QoC and labor 11 Rutstein 2008; DeVanzo 2007; Conde-Agudelo 2006



and delivery management and enabling the development of indicators and tools that can be used in multiple countries. Data about the screening and treatment of severe pre-eclampsia/eclampsia; the prevention of postpartum hemorrhage, obstructed labor and puerperal sepsis; and essential newborn care and resuscitation practices will be collected. MCHIP is testing the assessment protocols in Ethiopia and Kenya with MCHP core support. Protocols and tools will be revised based on findings of the pilot tests and IRB approval will be secured in an additional one to two countries in Year 2. MCHIP proposes to use AFR/SD support to carry out the final assessment in at least one of these countries, with data analysis and draft report completed, and results disseminated by the end of the year.

Latin America and Caribbean Maternal health

In Latin American and the Caribbean (LAC), every year, more than 22,000 women die from complications due to pregnancy and childbirth, with an estimated rate of 194 maternal deaths per 100,000 live births. If appropriate care and interventions had been available throughout pregnancy, childbirth and the postnatal period, many of these deaths could have been prevented. Within the LAC countries, there is striking evidence of health inequality with the highest prevalence in maternal and child health. Most maternal deaths involve indigenous women which is a result of strained economic conditions, higher fertility rates, and decreased health care quality and availability. Guatemala displays one of the highest prevalence of health inequalities, particularly within maternal health. In 2000, the MMR was 154 deaths per 100,000 live births. By looking at the cause of death breakdown, over half of all maternal death was due to hemorrhage, with 66.5% of all maternal deaths occurring in women without a formal education. Honduras shows significant health care challenges for indigenous people with a national rate of 147 maternal deaths per 100,000 live births, while the statistics within indigenous regions fluctuates between 225 and 190 deaths per 100,000 live births. Paraguay has experienced an increase in MMR rates as reporting tools have become more essential to proper health care, leading to the assumption that underreporting has been a large problem in the past. The MMR rate in Paraguay in 2003 was 174 deaths per 100,000 live births. Peru is another country that suffers from large differences in health quality, with disadvantaged regions fairing poorly. In 2001, Peru experienced staggering MMR rates in its poorer regions with 300 deaths per 100,000 live births. At the core of maternal and child survival within this region are persistent inequalities in access to health resources and services. Those individuals who are socioeconomically disadvantaged have higher health risks because of limited availability of physicians, limited deliveries attended by skilled professionals and low birth weight prevalence. The mortality statistics among these population groups are unacceptably high, with the high maternal and infant mortality rates due primarily to high rates of adolescent pregnancies, decreased levels of maternal education, limited access to services, poor sanitation and drinking water, and child malnutrition. POPPHI is providing technical assistance to a number of countries based on their particular needs and requests. The 12 country LAC PPH prevention conference held in April 2008 significantly increased interest in working on PPH prevention and the activities listed below were directly either catalyzed or increased from the conference. Honduras and Guatemala have requested an oxytocin in Uniject pilot project and POPPHI will complete the pilot in Guatemala by the end of 2009. POPPHI and Health Tech have collaborated to: get the product registered in Guatemala, get



approval from PATH and Guatemala’s ethics committees for the pilot, provide a grant to the ob/gyn association to conduct the trainings and support monitoring activities, and provide technical assistance to the project. The activities in Year 2 of MCHIP will support, monitor and assist in scale-up of the pilot to a national program. The time-line of the Honduras oxytocin in Uniject pilot was just behind Guatemala but the political situation has limited activity in Honduras. POPPHI anticipates one trip to initiate the project before the end of the project but has rolled over the majority of the pilot activities into MCHIP. The activities in Paraguay and Peru are strengthening midwifery education programs to include AMTSL in both the didactic and clinical components of the curriculum. POPPHI has been working with the midwifery association(s) through a small grant and the schools in Peru and will provide updates to their tutors during the last months of POPPHI. During 2008, POPPHI also supported Gloria Metcalfe to present at a large conference in Paraguay and then to provide technical assistance to their five midwifery schools, including childbirth anatomical models to all five. The work in Year 2 of MCHIP will build on these POPPHI activities and will support Strengthening Midwifery Services in Paraguay and Peru through a south-to-south exchange with the Paraguay midwifery instructors—learning from the Peru model of midwifery education, dissemination results from the oxytocin in Uniject pilot and scale-up initiated in Guatemala, and CAMBIO intervention (Changing AMTSL Behavior in Obstetrics) replicated in one LAC country. Year 2 expected results 1. Evaluation carried out of integration of AMTSL into the Paraguay midwifery curriculum begun

under POPPHI. (Activity 10.1) 2. Best practices and competency-based methodology incorporated into Paraguayan midwifery

curriculum (Activity 10.1) 3. Best practices from the Peru model curriculum incorporated into Paraguayan midwifery schools.

(Activity 10.1) 4. Dissemination of oxytocin in Uniject pilot in Guatemala completed and scale-up activities

initiated and monitored, and completion of Uniject pilot in Honduras. (Activity 10.3) 5. CAMBIO intervention (Changing AMTSL Behavior in Obstetrics) replicated in one LAC

country. (Activity 10.2)

Newborn health

In Latin American and the Caribbean (LAC), 180,000 newborns die (NMR 15/1,000 live births), and 22,000 women succumb to complications (MMR 150/100,000 live births) related to pregnancy and childbirth every year. Nevertheless there is great variability throughout the region, where some countries have an NMR as high as 31/1,000 live births (Haiti), and some as low as 5/1,000 live births (Cuba and Chile). There is also an inverse correlation between NMR and skilled birth attendance (SBA) in the region, with the exception of a few countries such as the Dominican Republic, where SBA is 98% but the NMR continues to be high at 22/1,000 live births. Some countries with a high number of rural and indigenous populations and low SBA due to lack of access and/or cultural barriers have the highest mortalities (i.e. Haiti, Bolivia, and Guatemala). One of the region’s biggest inequities relates to income quintiles; where the NMR of the poorest quintile is double that of the richest one. The three main causes of newborn deaths are consistent with the global situation, but there are increasing numbers of premature births and an increase in deaths from related complications.



Since 2004, USAID and its partners have supported the LAC Neonatal Alliance —which includes USAID’s LAC Bureau, the Pan American Health Organization (PAHO), the CORE Group, the Access to Clinical and Community Maternal, Neonatal, and Women’s Health Services Program (ACCESS), Save the Children’s SNL (Saving Newborn Lives), the Health Care Improvement project (HCI), the United Nations Children’s Fund (UNICEF), and the Basic Support for Institutionalizing Child Survival Project (BASICS)—and have worked to foster consensus among countries in the region on essential actions for newborn health through the establishment of a regional strategy and the development of a regional action plan to promote newborn health. This plan was approved by PAHO’s Directing Council in September of 2008. The Alliance members continue to work in the strengthening of country plans of action to reduce neonatal mortality in the region, and in the implementation of initiatives to address some of the causes of newborn mortality in LAC. For example, an initiative implemented by BASICS from 2006 to 2009 operationalizes with partners an important element of the LAC regional strategy: the prevention and treatment of neonatal sepsis. The project incorporated distance learning methodologies with in-country support and elements of collaborative models for quality improvement. El Salvador and the Dominican Republic focused on the prevention and treatment of neonatal sepsis at the hospital level and Honduras implemented at the community level. This initiative contributed to the reduction of admissions to nurseries due to suspected nosocomial infections by up to 30% in some hospitals and to an increase in newborn babies evaluated by the third day of life by 50% in some communities in Honduras. This proposed MCHIP work will continue to support the activities of the Alliance and the implementation of the regional action plan at country levels, thereby supporting the USAID LAC Bureau objectives to reduce newborn morbidity and mortality in the region.

Year 2 expected results Survey on postnatal care legislation and policies carried out in six countries and results and

recommendations disseminated. (Activity 10.4) Assistance to countries initiated for implementation and/or strengthening of postnatal care

practices based on the results and recommendations of the survey. (Activity 10.4) Technical oversight and assistance provided for dissemination of best practices and information

exchanges on newborn health in the LAC. (Activity 10.5) Technical support contributed for the implementation/strengthening of national action plans for

newborn health in two countries. (Activity 10.5) In-country improvement of prevention and treatment of newborn sepsis initiated at facility

and/or community levels in three countries. (Activity 10.6)



MCHIP MANAGEMENT MCHIP is structured at the central and the field level to optimally utilize the strengths across the partnership while retaining a leadership role of each partner in different technical areas. Figure 4 below displays partner roles and responsibilities within MCHIP. While each partner is assigned a technical leadership role, MCHIP will engage technical experts as needed from all MCHIP partners to enrich the technical resource pool. Figure 4. MCHIP Partner Roles

Jhpiego Strategic Leadership and Management Cross-cutting

support for M&E, scale-up, and information dissemination

Maternal Health, RH/FP, PMTCT, MIP

For day to day management decisions and functioning of the MCHIP program, the MCHIP Executive Management Team (EMT) liaises with USAID and the broader partnership. The MCHIP EMT is responsible for the ensuring strategic direction and long term vision of the program. The EMT also is accountable for the timely submission and approval of the workplan. This team consists of Koki Agarwal, Pat Daly, Steve Hodgins (replacing Mary Carnell in October), Pat Taylor, Leo Ryan, and Terry Padgett. There is also a Core Management Team (CMT) that meets to discuss management and technical issues. The CMT, which will meet on a regular basis to oversee the Program’s needs, is comprised of the individuals/organizations listed in the box at right.

CORE MANAGEMENT TEAM (CMT) Koki Agarwal Jhpiego Pat Daly Save the Children Steve Hodgins JSI Pat Taylor JSI Leo Ryan ICF Macro Terry Padgett Jhpiego Michel Pacqué ICF Macro Linda Bartlett IIP/JHU Rae Galloway PATH Barbara Rawlins Jhpiego Rena Eichler Broad Branch Associates Megan Wilson PSI

JHU/IIP Research and analysis, M&E, Priority setting

Technical and programmatic leadership for high-impact MNCH interventions

Macro PVO/NGO capacity building,

Knowledge management

SC Newborn health,

Community MNCH, Community mobilization

JSI Child health,

Immunization, Pediatric HIV

PATH Infant/child nutrition, New technologies,

BCC

PSI Social marketing

Broad Branch Associates Innovative financing schemes

Collaborating Organizations and Technical Advisors (Various)



CMT FUNCTIONS

• Meet regularly to discuss management and technical issues • Develop and maintain a common program vision and integrated strategy • Carry out strategic planning with USAID • Policy development and implementation • Support enabling environment for MCHIP • Global and regional strategic alliance development • Lead technical and operational planning • Ensure synergies and integration and consensus in programming • Prepare annual workplans and reports • Prepare and disseminate program learning

The MCHIP team will also benefit from the guidance and support of the Corporate Representative Team (CRT), comprised of one senior corporate representative from each MCHIP partner, as shown at left. The CRT will ensure a smooth and well functioning partnership, resolve conflicts, ensure appropriate staffing and funding, maintain cost share, and provide strategic guidance to the Program. The CRT will meet quarterly during the first year and then transition to meeting twice a

year.

CORPORATE REPRESENTATIVE TEAM (CRT)

Jhpiego Alain Damiba Save the Children David Oot JSI Carrie Hessler-Radelet ICF Macro Leo Ryan IIP/JHU Jennifer Bryce PATH Catharine Taylor Broad Branch Rena Eichler PSI Megan Wilson

Figure 5 on the next page depicts the MCHIP organizational structure. The reporting structure is flexible. In most instances, Koki Agarwal and Pat Daly will communicate with the USAID AOTRs regarding management, strategic planning and resource allocation. When specific country or global leadership issues are discussed, Pat Taylor and Steve Hodgins will be the main point of contact. The PVO/NGO support team—through Team Leader Leo Ryan—will communicate directly with Nazo Kureshy at USAID and will copy USAID AOTRs and the MCHIP management staff for broader workplan and management issues. The MCHIP management team will engage various representatives from country or technical teams as necessary. MCHIP’s technical backstopping team is depicted in Table 9. As country activities expand, MCHIP will have a backstop plan that includes a more complete HQ support team for technical, operational and financial support for field activities and country management. The technical teams will support evidence generation (synthesis and coordination), application of evidence and dissemination, technical assistance in priority areas, and facilitation of south-to-south transfer. MCHIP has proposed technical team leads for each of the areas. The Team Leaders report to the Global Leadership Team Leader. During Year 1, MCHIP will continue to have series of technical meetings on “hot topics” such as PPH, pre-eclampsia, Urban Health, Quality of Care, Postpartum Family Planning, Innovative Financing, Community Mobilization, community-based management of neonatal sepsis, and others to strengthen cross learning and to disseminate evidence-based practices to MCHIP staff and partners.



Figure 5. MCHIP Organizational Structure

Director Koki Agarwal

Deputy Director Pat Daly

Global Leadership Team Leader Mary Carnell/

Steve Hodgins

Country Support Team Leader

Pat Taylor

PVO/NGO support team leader

Leo Ryan

Associate Director, Finance Terry Padgett

Technical TeamsCountry Teams PVO/NGO support team

Monitoring and Evaluation

Table 9. MCHIP Headquarters Technical Backstop12

Technical Teams Team Leaders PVO/NGO Support Leo Ryan Maternal Health Patricia Gomez Newborn Health Joseph de Graft-Johnson Child Health Emmanuel Wansi Immunizations Robert Steinglass Family Planning Holly Blanchard Health Systems Strengthening Rena Eichler Community Interventions / Social Mobilization Joseph de Graft-Johnson Nutrition Rae Galloway Research Jennifer Bryce M&E Barbara Rawlins Pediatric HIV Carrie Hessler-Radelet PMTCT Patricia Gomez Malaria Elaine Roman/Jennifer Yourkavitch (MCP) Water and Sanitation Dan Abbott/ Mary Carnell Urban Health Pat Daly

12 As MCHIP’s field presence grows in Year 2 and beyond, the MCHIP team will develop a backstop plan for field activities and country management and share with the USAID.



Table 10. MCHIP Country Support Management Africa Region Benin Pat Daly DR Congo Pat Taylor Ethiopia Mary Carnell Ghana Mary Carnell Kenya Koki Agarwal Liberia Pat Taylor Madagascar Pat Taylor Malawi Pat Daly Mali Pat Daly Mozambique Pat Taylor Nigeria Koki Agarwal Rwanda Koki Agarwal Senegal Pat Daly Sudan Pat Taylor Tanzania Koki Agarwal Uganda Mary Carnell/Steve Hodgins Zambia Mary Carnell/Steve Hodgins Asia Region Afghanistan Koki Agarwal Bangladesh Pat Daly Cambodia Pat Daly India Koki Agarwal Indonesia Pat Daly Nepal Steve Hodgins Pakistan Pat Taylor Philippines Pat Taylor Tajikistan Mary Carnell Europe & Eurasia Region Azerbaijan Pat Taylor LAC Region Bolivia Pat Daly Guatemala Mary Carnell Haiti Koki Agarwal

66 MCHIP Year 2 Annual Implementation Plan Final submitted October 23, 2009

Table 13. Level of Effort for MCHIP Management and Key Technical Staff Key Positions Director, Koki Agarwal (refer to note 1 below) 80% Deputy Director, Pat Daly 90% Global Support Team Leader, Steve Hodgins 90% Country Support Team Leader, Pat Taylor 60% PVO/NGO Support Team Leader, Leo Ryan 80% Senior NGO Advisor, Michel Pacque 80% Finance Manager, Terry Padgett 60% Senior Technical Advisors MH Team Leader, Patricia Gomez 80% FP Team Leader, Holly Blanchard 100% Malaria Team Leader, Elaine Roman 50% Community Advisor, Joseph DeGraft Johnson 75% Immunization Team Leader, Robert Steinglass 80% Child Health Team Leader, Emmanuel Wansi 85% Monitoring & Evaluation, Barbara Rawlins 100% Other Technical Resources Maternal Health CMT Representative, Linda Bartlett 50% Child Health, CCM, Kate Gilroy 30% Maternal Anemia, Rae Galloway 34% Health Systems Strengthening, Rena Eichler 40% Water and Sanitation, Dan Abbott 30% CSHGP Sr. PVO/NGO M&E Advisor, Jennifer Luna 93% CSHGP Sustainability Planning Advisor, Jim Ricca 65% CSHGP HMIS Advisor, David Cantor 34% PMI/MCP Advisor, Jennifer Yourkavitch 100% Pooled Maternal health (Marge, Sushie and Deb) Est 30% Pooled Newborn Health (Indira, Goldy, Stella) Est 15% Program and Administrative Support Core Program Officer, Carmen Crow 100% Field Program Officer, TBD 100% Core Program Officer, Communications & M & E TBD 100% Finance Support (two full positions) 100% Program Coordinator 100% Administrative Assistant 100% PVO/NGO M&E Advisor 100% SO3 Program Assistant 35%

Note 1: A portion of the MCHIP Director’s time is budgeted under Associate Awards for the ACCESS and MCHIP programs.


ANNEX 2: INTERNATIONAL TRAVEL

ACTIVITIES US TO AFRICA

US TO ASIA

US TO GENEVA/

BRUSSELS US TO LAC

LAC TO LAC TOTAL

Global Leadership and Learning

3 1 4

Maternal Health 11 5 2 1 19 Newborn Health 9 4 13 Child Health/Immunization 51 1 2 54* Crosscutting Interventions 2 2 PVO/NGO Strengthening 3 1 4 Family Planning 11 1 12 Malaria 4 4 M&E 2 2 LAC Bureau Funds 3 15 18 Total International Travel 132

* Some of the international travel under Child Health/Immunization will be co-funded or paid for using AFR/SD funds.


ANNEX 3: SUMMARY OF EXPECTED RESULTS FOR MNCH

Expected Result PY 1 PY 2 LOP Year 5 (# of countries) MATERNAL HEALTH

PPH Expansion of PPH prevention programs

Mali, DRC Mali, Kenya, DRC, Mozambique, Madagascar, Liberia, India, Nigeria and Malawi


Introduction of PPH treatment Mali, Kenya, DRC, Malawi, Mozambique, Madagascar, Liberia, India and Nigeria


PE/E Advocacy and global awareness PE/E Technical Working Group and Task Forces established

Terms of reference for both groups established at meeting in November, 2009

10 countries—field and core (who use materials/products developed by small groups)

Quality of Care Assessment Tool developed and assessments conducted

Pilot assessments begun in Kenya and Ethiopia

Tools finalized Assessments carried out in at least five total countries (including Kenya and Ethiopia)


Program model for prevention and management of PE/E developed and introduced

Kenya and Ethiopia following results of pilot assessments


Expansion of PE/E prevention and management

Tanzania, Malawi, India, Mozambique Nigeria, Nepal

TBD


Expected Result PY 1 PY 2 LOP Year 5 (# of countries) SBA Global effort to update clinical

guidelines with WHO

Collaborate with WHO to complete first draft of revision of Managing Complications in Pregnancy and Childbirth

Revision of MCPC completed

Improving delivery of high-impact interventions by SBA skills

Mozambique Malawi, Kenya, Madagascar, India, Liberia, Mali and DRC


Postpartum care (community- and facility-based, including supportive supervision of CHW)

Mali, Malawi, India, Mozambique, Liberia and Madagascar


Increased knowledge of what has worked to improve maternal and neonatal health results in two countries in Africa with relevant lessons for other contexts

Maternal anemia Identification of country-level barriers and facilitators for successful maternal anemia control programs through a national consultation in at least two countries

Bangladesh and Indonesia 5

Creation of a national strategic plan for addressing maternal anemia in at least two countries

Bangladesh and Indonesia 5

Development of new or strengthened maternal anemia control activities in one country

Bangladesh or Indonesia 5

Participation in an international consultation on maternal anemia (led by A2Z)


Expected Result PY 1 PY 2 LOP Year 5 (# of countries) NEWBORN HEALTH

Essential newborn care (and postnatal for mother)

Postnatal/essential newborn care introduced (<3 districts)

India, Malawi, Mali and Nigeria (plus 3 in LAC)

15

PNC/ENC expanded (>3 districts)

Bangladesh 10

Disseminate/launch UN Joint statement

Joint UN Statement on community-based newborn care launched and implemented in 6 countries

Bangladesh, India Kenya, Mali and Nigeria

15

Kangaroo mother care (facility and community)

KMC introduced and expanded Malawi, Bangladesh, Nigeria, DRC and Mali

15

Community Kangaroo Mother Care programs

Bangladesh Bangladesh and Malawi 8

Community-based infection prevention and management

Newborn infection management introduced

Bangladesh and Nigeria (plus 3 in LAC)

8

Newborn handwashing promoted through public and private sector alliance

India, Indonesia and Bangladesh 8

Management of asphyxia Introduce management of asphyxia in home and facility settings

Kenya and Bangladesh 8


Expected Result PY 1 PY 2 LOP Year 5 (# of countries) CHILD HEALTH

Analysis to determine potential mortality impact of improving diarrhea-related indicators in 30 MCH priority countries using LIST tool

Analysis initiated 10 country analyses completed 30

Programmatic analyses and findings provide further evidence for effective introduction and scale-up of integrated CCM and ORT revitalization programs

Country case studies completed in 3 PMI countries

5

Joint advocacy and technical support for integrated CCM carried out with Catalytic Initiative/ACSD and Global Action Plan for Pneumonia (GAPP)


TBD 3+

Number of countries with integrated CCM or pneumonia control programs

Introduction DRC Uganda, Mali, plus1 10–5 Expansion DRC, Rwanda, plus1–2 8

Joint advocacy and technical support for ORT revitalization carried out with Catalytic Initiative/ACSD, CIFF ORT/Zn and ZTF13


Kenya, plus1 3 or more

Number of countries with revitalization of ORT and introduction of zinc activities

Introduction DRC and Mali Kenya plus 1–2 selected countries among 5 Africa 2010/AFRO assessments

13

Expansion DRC and Mali 6

13 CIFF countries: Kenya, Nigeria, India, Ethiopia * implemented under ongoing BASICS TOs


Expected Result PY 1 PY 2 LOP Year 5 (# of countries) IMMUNIZATION

Analysis of immunization in high-burden countries

Expansion and improvement Analysis conducted Country summaries updated and used with USAID Missions Literature review on unvaccinated child

All MCH priority countries

RI coverage increased by 1 year of age in areas receiving MCHIP TA

Expansion and improvement DRC, India, Madagascar, Nigeria and S. Sudan

Benin, DRC, India and Kenya 6–7 countries

Resources leveraged toward implementation of coordinated RI improvement plans

Expansion and improvement Benin, DRC, India, Madagascar, Timor-Leste, and S. Sudan

Benin, DRC, Kenya India and S. Sudan

6–7 countries

RI planning and management capacity at district level improved

Expansion and improvement 1 regional RED adaptation workshop conducted with WHO/AFRO India, Nigeria, S. Sudan Madagascar and Timor-Leste

1–2 regional RED adaptation workshops conducted Benin, DRC, India and Kenya

TBD

RED+ Selected MNCH/FP interventions added to RI and RED

Action research/ introduction

Literature review on integrated outreach 1 country selected with WHO/AFRO for RED+ design and testing

2–3 countries (e.g., DRC, Kenya, Malawi, Liberia, Nigeria and Zambia)

3 countries


Expected Result PY 1 PY 2 LOP Year 5 (# of countries) MCHIP technical input given related to new vaccine introduction


WHO guidance to national policymakers on immunization schedules drafted Technical input provided to multiple global policies

Global policies and strategies finalized with MCHIP input

7+ key global and/or regional policies

New vaccines and innovative technologies introduced


Rwanda (pneumococcal vaccine) Drafted protocol for assessing HCWM pre and post new vaccine introduction

2–3 countries

4–6 countries


Expected Result PY 1 PY 2 LOP Year 5 (# of countries) FAMILY PLANNING

Expanded community of practice on PPFP and PAC to include those working in maternal and infant nutrition, HIV/PMTCT, immunization and other MNCH services as part of global learning

Co-chair PAC Consortium FP WG PPFP integrated into technical resource materials for CSHGP

3 global fora where experts from immunization, infant and young child nutrition, UNICEF and UNFPA, and PPFP participate Continuation of LAM WG expand to include IYCN and child survival experts PPFP integrated into active profile of CSHG Explore and develop PPFP concept to expand to FP for at least 24 months to achieve HTSP Provide TA to ECSA-HC and Africa 2010 (see matrix 7.3)

TBD

Supported MOH and MOE to strengthen national FP standards. Capacity of midwifery pre-service education updated in Malawi and Ghana, including curricula, in-service materials tutors, and LAPM and PAC

PPFP Assessment visit in Ghana

Strengthened national FP standards, pre-curricula and in-service materials in Ghana and Malawi


Strengthened PPFP services in a community-based package of integrated services

With partners, develop integrated package AMSTL ENC and PPFP

Assessment visit to and program developed in Mali for PPFP strengthening with MOH, partners and bilateral for a continuum of care at the home and health facility


Demonstrated programmatic implementation on integrating PPFP, immunization and infant nutrition (American Association of Pediatrics [AAP]).

Literature review include IYCN interventions, NGO/PVO CSHGP lessons learned

Co-host consultative meeting Select one country with WHO/AFRO for RED + design and testing in one country

Malawi, Nigeria, Liberia, Zambia


Expected Result PY 1 PY 2 LOP Year 5 (# of countries) MALARIA

MIP Technical leadership in MIP at the global and sub-regional levels.

RBM MIP working group



Key resources and tools (e.g., Malaria Resource Package) introduced in priorities countries.

PMI Country Teams MIPESA, RAOPAG, EARN, WARN, MIM, MIP working group


Documentation and dissemination of MIP best practices and lessons learned.

Zambia Malawi (desk review), Senegal, Zambia


MIP service delivery bottlenecks addressed through innovative approaches.

Nigeria Up to 5 PMI focus countries


Community Case Management

Technical leadership in CCM at global, sub-regional, and country level.

CCM Task Force, CCM.ORG

CCM Task Force, CCM Operations Research Group, RBM East/ West Network

CCM Task Force, CCM Operations Research Group, RBM East/West Networks

Key resources and tools introduced in priorities countries

DRC, Senegal 2–3 PMI countries and 2 MCH/non-PMI countries

DRC, Rwanda, Benin, Kenya, Cambodia, Ethiopia Madagascar, Mali

Documentation and dissemination of CCM best practices and lessons learned.

Senegal Senegal, DRC, plus1 Anglophone country

PMI and MCH priority countries

CCM service delivery bottlenecks addressed through innovative approaches.

DRC 2–3 PMI countries and 2 MCH countries

10–15 PMI and MCH priority countries

MCP Support Technically sound community-based malaria projects contribute to the respective Country Malaria Operational Plans.

Uganda (2), Tanzania (2), Angola (2), Malawi (2), Liberia (2), Ethiopia, Senegal and Ghana

PY1 Grantees plus 8 new grantees in PMI countries TBD

# of grantees TBD in PMI countries


ATTACHMENT 1: MCHIP YEAR 2 CORE ACTIVITY MATRIX MCHIP’s workplan is framed along HIDN’s Results Pathways. The column entitled “Other Contributing Results Pathways” lists other HIDN pathway to which that activity contributes. For example, Activity 2.4 Pre-Eclampsia/Eclampsia reflects all activities making major contributions to HIDN’s PE/E RP. All subactivities under 2.4 are placed along the PE/E RP and contributions of those activities to other RPs are listed under “Other Contributing Results Pathways” column.

ACTIVITY TITLE EXPECTED RESULTS

1 October 2009 – 30 September 2010

KEY TASKS OTHER RESULT

PATHWAYS CONTRIBUTION

CONTRIBUTING MCH

SUBELEMENT MATERNAL HEALTH

1 Global Strategy and Management 1.1 Finalize five-year

strategy development MCHIP five-year strategy

1. Based on planning meeting with MCHIP and USAID, MCHIP to develop overall 5-year strategy as well as specific strategies for each technical area and Results Pathway

All1 1.6.1, 1.6.2, 1.6.4, 1.6.6, 1.6.7,

1.2 Participate in global/ regional advocacy and planning (see under separate technical areas)

Details on MCHIP’s global Leadership activities are included in each technical component: (See Activities 2.1.1, 2.1.2, 3.1.1, 4.1.1, 4.1.2, 4.1.3, 4.6.1, 7.1 )

1. Work with the “Countdown to the MDGs.” All

1.3 Consultation with key stakeholders to define MCHIP research and evaluation process to support achievement of MDGs 4 and 5

1. Finalized MCHIP research agenda, including program planning and evaluation, development and use of common metrics, and formative or operational research.

2. Expert consultation with partners on a common implementation research and evaluation agenda. • HRCD • HRCI

1. Apply the research prioritization process developed by the Child Health and Nutrition Research Initiative (CHNRI) in collaboration with USAID staff

2. Meet with partners including HRCD and HRCI to agree on priority topics for implementation research and evaluation, and finalize MCHIP program learning/ evaluation agenda. Prepare a report of the meeting

3. Participate in MCHIP contributions to research priority setting (consultant Igor Rudan) through application of the research prioritization process developed by the Child Health and Nutrition Research Initiative (CHNRI)2 in collaboration with USAID staff

4. Complete MCHIP core program research activities as per program workplan

All 1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6, 1.6.7,

1 All results pathways include: SBA, PPH, PE/E, Newborn Care, Immunization, ARI, ORT, Zinc, HIV Integration, Nutrition, Hygiene Improvement/Handwashing, Urban Health, PVO/NGO Strengthening, and Polio. 2 Rudan S, El Arifeen S, Black RE, Campbell H. Childhood pneumonia and diarrhea: setting our priorities right Lancet Infectious Diseases 2003; 7(1): 56 – 61.






CONTRIBUTING MCH

SUBELEMENT 1.4 Using LiST for planning

and advocacy in countries

1. LiST results, national and district level, in Malawi and Bangladesh that reflect the reductions of under-five mortality that can be expected if national plans are fully implemented and coverage targets are met

2. National plans in one priority country where MCHIP works reflect focus on high-impact interventions to reduce mortality and improve nutrition among mothers, newborns and children

3. List results for 30 priority countries with a country-specific report for each.

4. MCHIP staff and others are competent in the use of LiST tool.

1. Build capacity applying country-specific LiST results in ways that stimulate policy dialogue at country level.

2. LiST results for 10 priority countries that reflect the reductions of under-five mortality that can be expected if national plans are fully implemented and coverage targets are met.

3. Apply LiST in select MCHIP priority countries to inform policy and programs on high-impact interventions to reduce mortality and improve nutrition among mothers, newborns and children.

4. Assess MCHIP focus country and core work plans for areas where community based interventions are being/can be planned that would be suitable for operational research or an evaluation where the coverage, equity and quality of the intervention package can be assessed (and explore assessment of impact of the intervention/s through either modeling with the LiST tool (or in Malawi or Mali (where the Catalytic Initiative is funding Rapid Mortality Monitoring).

All 1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6, 1.6.7,

1.5 Contribute to Global Dialogue on Program Learning on Community Based Interventions, the Role of Community Health Worker, and CHW Task Shifting.

1. MCHIP contributes to learning on community-based MNCH and the “functional” community health worker

1. Collaborate with USAID, HCI and others key partners to discuss opportunities and approaches for community health workers in MNCH

2. Assure review of MCHIP country strategies and programs for community-based work

All 1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6, 1.6.7,

1.6 MCHIP Information Management System Co-funded with FP

1. MCHIP.net Public Website active and functioning

2. MCHIP internal knowledge management system

3. Extranet

1. Identify priority functions and content for MHCIP internal information management system and external website.

2. Develop beta sites for review and feedback. 3. Launch MCHIP public and internal sites. 4. Link resources from internal knowledge management

system

All 1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6, 1.6.7,






CONTRIBUTING MCH

SUBELEMENT 2 MATERNAL HEALTH 2.1 Global Leadership for Maternal Health 2.1.1 Global technical

leadership: Participate in global/regional advocacy and planning with USAID and other partners to mobilize resources and create synergies to support implementation and scale-up

1. Coordinated agenda with the PMNCH, the Catalytic Initiative, FIGO, ICM, UNFPA/Maternal Health Thematic Fund, AAP, and the Maternal Health Task Force formulated and implemented to advance work in PPC/PNC, PE/E and PPH globally and in MCHIP focus countries.

2. Regional and country midwifery advisors updated in evidence-based approaches through technical assistance provided to the ICM/UNFPA midwifery strengthening initiative in the areas of PPH, PE/E, PPC/PNC, FP, and ENC.

3. Technical assistance provided to WHO/MPS department to finalize the PPC/PNC guidelines (linked with 2.2.4); and to revise the MCPC.

4. Collaboration established with FIGO and ICM to build on global and regional work by POPPHI, to promote use of evidence-based interventions for PPH and PE/E.

1. Collaborate with other global MNH organizations to identify synergies.

2. Participate in ICM/UNFPA technical meetings and activities to advance access to midwifery care in key countries. Link other global/country activities below to this initiative to the extent possible to ensure advocacy for and scale-up of evidence-based interventions.

3. Participate in WHO technical consultations on PPC/PNC, PPH, PE/E, MCPC revision, newborn resuscitation and other technical areas; develop global dissemination plan to assure wide knowledge and use of updated information.

4. Establish workplan with FIGO and ICM and agree on global and regional activities.

SBA, PPH, PE/E and Newborn

1.6.1, 1.6.2,

2.2 Skilled Birth Attendance 2.2.1 Harmonized

Postpartum/ Postnatal Care Guidelines Linked with Activity 3.2.6

1. Participation in WHO/MPS consultations on PPC/PNC and reviewed resulting documents.

2. MCHIP draft guidelines for PPC/PNC in facilities and communities reviewed, finalized, and disseminated.

1. Continue participation in WHO/MPS consultative process on PPC/PNC.

2. Undertake review, revision and finalization of MCHIP PPC/PNC guidelines and develop dissemination plan.

SBA, Newborn 1.6.1, 1.6.2






CONTRIBUTING MCH

SUBELEMENT 2.2.2 Community-based

package of preventive MNCH/FP care

1. One to two MCHIP focus countries identified to build on existing bilateral or other program efforts in under-served settings and communities where health systems are weak using core funds to achieve as complete a package as possible across the continuum of care from community to facility where BEmONC services are offered.

2. Assessment carried out in one to two focus countries to determine gaps in community and facility-based maternal and newborn care, and strategy formulated to strengthen existing cadres and systems to implement all or part of comprehensive package at community and facility levels.

3. Advocacy/expert meetings carried out to determine components of community-based package of preventive MNCH and FP care; and to identify barriers to and strategies to increase use of BEmONC at peripheral levels.

4. Two countries identified to pilot strategies defined in advocacy meeting.

1. Assess at country level community-based packages in use, identify gaps, and determine how they can be strengthened under existing programs, to include use of TT, IFA, MIP, BP/CR, PE/E prevention and treatment, misoprostol, ENC, counseling on PPFP/LAM and CBD of contraceptives, etc.

2. Assess at country level major barriers and bottlenecks to BEmONC, prioritize gaps, and identify approaches to overcome them in underserved settings and communities.

3. Form advocacy group/expert group in country to formulate strategies leading to phasing in of some or all of these approaches.

4. Liaise with other initiatives/donors to support country-level operations research to determine effective approaches

5. Plan implementation in 2 countries; begin implementation late in Year Two.

SBA, PPH, PE/E, Newborn

1.6.1, 1.6.2

2.2.3 Increase access to quality maternal, newborn and child health in two states in India

1. Building on outcome of maternal/newborn health desk review and assessment in Year One, strategy developed in collaboration with MOH and other partners to improve maternal, newborn and child health in two states in India.

1. Finalize and disseminate findings from desk review and maternal/newborn health assessment done in Year One.

2. With mission and other partners, develop strategy in two Indian states leading to improved maternal, newborn and child health.

3. Implement approved integrated MNCH strategy in 2 states


1.6.1, 1.6.2, 1.6.3






CONTRIBUTING MCH

SUBELEMENT 2.2.4 Document scale-up of

MNH in Senegal Linked with Activity 2.2.3 and 3.2.2

1. Review completed and report development of elements that led to scale-up of maternal and newborn health activities in Senegal.

1. Hire local consultant to carry out desk review of MNH programs/activities over last 5 years.

2. Interview key informants and conduct visits to key sites to assess current status of MNH.

3. Develop report describing factors that led to scale-up of key MNH interventions in Senegal.


1.6.1, 1.6.2, 1.6.3

2.2.5 Contribute to USAID assessment of preservice Investments

1. Provided technical assistance to GH Tech-led assessment of past USAID investments in preservice education including the ACCESS Africa Regional Preservice Initiative in Ethiopia, Ghana, Malawi, and Tanzania

1. Participate in working group meetings with GH Tech as appropriate to provide input on assessment strategy, indicators, and tools.

2. Coordinate with field programs as necessary to collect data.


16.1, 1.6.3

2.2.6 Use of Immpact toolkit and learning to guide MCHIP’s evaluation of maternal health programs

1. Based on review and recommendations made in Year One to utilize specific modules as applicable in MCHIP country assessments, toolkit utilized to evaluate current maternal health situation as appropriate in MCHIP country programs, and information used in program planning and implementation to assist countries to achieve their goals.

1. Select as appropriate MCHIP country programs and utilize appropriate portions of toolkit for evaluation/planning of maternal health programs.


16.1, 1.6.3

2.2.7 Finalize case studies: documenting lessons learned on elements that improve maternal health in countries where progress has been achieved. Co-funded with FP

1. Increased knowledge of what has worked to improve maternal and neonatal health results in two countries in Africa with relevant lessons for other contexts.

[HSS framework referenced from narrative]

1. Finalize country selection (e.g., Mali, Rwanda, Senegal).

2. Conduct case study data collection. 3. Prepare case study reports. 4. Refine and strengthen HSS framework.


1.6.1, 1.6.2






CONTRIBUTING MCH

SUBELEMENT 2.3 PPH 2.3.1 Support expansion of

PPH prevention and treatment activities at global, regional and country levels.

1. MCHIP Strategy for Accelerating Scale-up of Interventions to Prevent and Treat Postpartum Hemorrhage applied in at least two MCHIP countries (Mali and DRC) in collaboration with bilaterals and other partners/donors.

2. WHO PPH treatment guidelines disseminated in all MCHIP countries.

3. SOW developed with FIGO and ICM for their support of PPH expansion at global and country levels.

4. ICM and FIGO participation in PPH working group meeting to maintain momentum in PPH supported in conjunction with PE/E TWG meeting.

1. Work with USAID/W, country missions and other partners to identify countries where core funding can be used as a catalyst to expand PPH prevention and treatment activities; provide TA in these countries for development of short and medium-term expansion strategy.

2. Collaborate with MCHIP country programs and with partners in non-MCHIP countries to identify regional and country-level meetings where PPH treatment guidelines will be disseminated.

3. Meet with FIGO and ICM to determine their SOW for MCHIP Year Two activities, building on previous work in PPH (and PE/E).

4. With FIGO and ICM convene targeted PPH working group as component of PE/E TWG meeting to inform and continue support of PPH work.

SBA, PPH 1.6.1, 1.6.2

2.3.2 Identification of progress of AMTSL in MCHIP countries

1. Successes and challenges in scaling up AMTSL identified in one country (Ethiopia)

2. Comparison of QOC assessment results with previous POPPHI survey

3. Reporting on AMSTL scale-up in five focus countries

1. Engage USAID missions, bilaterals, UNICEF, UNFPA, FIGO, ICM, and other partners/donors to contribute to QOC assessment in countries where POPPHI surveys have been done.

2. Ensure analysis of results of QOC assessments and include comparison of initial POPPHI survey results and recommendations for further activities in each country leading to scale-up of PPH prevention activities.

SBA, PPH 1.6.1, 1.6.2

2.3.3 Scaling up AMTSL in Mali as part of an integrated package of maternal and newborn care Co-funded with Newborn Health and FP

1. Strategy for PPH expansion in Mali developed and implemented as part of integrated program to scale up PPH prevention and treatment (including Uniject), essential newborn care, and PPFP.

1. Based on strategy developed in Program Year One support partners in scale-up of AMTSL through TA for training of trainers, training of supervisors, and data collection to monitor successes, challenges, and define next steps.

SBA, PPH 1.6.1, 1.6.2






CONTRIBUTING MCH

SUBELEMENT 2.4 Pre-Eclampsia/Eclampsia 2.4.1

PE/E Strategy Development

1. Activities planned by each PE/E Task Force for Year One/Two (during November 2009 PE/E meeting) completed.

2. Second PE/E TWG meeting held; TORs for PY 2–3 developed by Task Forces.

3. QOC Assessment results from field tests and assessment in 1–2 other countries tabulated and used to inform comprehensive programming for PE/E.

4. Application of PE/E program scale-up in two MCHIP countries

5. Consideration given to OR in one country on use of loading dose of MgSO4 per the Bangladesh experience.

1. Continue coordination of PE/E Task Force activities. 2. Plan second PE/E Technical Working Group meeting

and develop Task Force workplans. 3. Collaborate with USAID/W and missions, as well as

other partners, to plan and begin implementation of comprehensive PE/E prevention and treatment demonstration in 1–2 countries based on results of QOC assessments.

4. With partners develop and begin implementation of MCHIP PE/E Prevention and Treatment Acceleration Strategy in two countries.

5. In discussions with USAID/W and regional/country missions consider development of OR on use of MgSO4 loading dose at community level by SBA.

SBA, PE/E, Newborn

1.6.1, 1.6.2

2.4.2 Quality of Maternal and Newborn Care Assessment (FMN QoCA)

1. Pilot tests completed in Ethiopia and Kenya.

2. Protocol and tools revised based on findings during pilot test in Year One.

3. IRB approval in additional 1–2 countries obtained.

4. Assessment completed in 1–2 countries.

5. Data analysis and draft report completed and results disseminated.

1. Revise assessment protocol and tools. 2. Obtain IRB approval in target countries. 3. Contract with appropriate research firms to manage

data collection. 4. Draft report and disseminate.


1.6.1, 1.6.2






CONTRIBUTING MCH

SUBELEMENT 2.5 Maternal Anemia 2.5.1 Support improvement

of maternal anemia 1. National consultation held in at

least two countries to identify country-level barriers and facilitators for a successful maternal anemia control program. (Indonesia /Bangladesh)

2. Strategic plan for addressing maternal anemia in at least two countries.

3. New or strengthened maternal anemia control activities implemented in one country.

4. Participate in an international consultation/meeting on maternal anemia led by A2Z.

1. Convene consultations in at least two MCHIP countries to identify barriers and facilitators for a success maternal anemia control program/package;

2. Help develop guidelines and/or a strategic plan for addressing maternal anemia in at least two countries.

3. Design and give technical assistance to the implementation of a new or strengthened anemia control program in one country.

4. Participate in an international meeting on maternal anemia controlled by A2Z.

PPH, nutrition 1.6.1, 1.6.6

3 NEWBORN HEALTH 3.1 Global Leadership for Newborn Health 3.1.1 Participate in

global/regional advocacy and planning with USAID to mobilize resources and coordinate partner support for implementation

1. Collaboration with global and regional partners in neonatal infection, birth asphyxia, management of low birth weight babies (LBW) with Kangaroo Mothercare (KMC), and postnatal care.

2. Global partners recognize MCHIP as a leader/convener for newborn health.

3. Continued engagement with Global alliance for MNH in LAC region

4. Acceleration Strategy: Sequencing high impact MNH interventions and strengthening systems finalized with USAID

1. Continue MCHIP engagement with global partners in newborn health, including PMNCH, GAPPS, WHO, UNICEF, AAP, and others.

2. Collaborate with UNICEF-Catalytic Initiative, GAPP as well as USAID partners/partnerships such as BASICS, CORE/CSHGP, and SPS.

3. Exchange technical information, disseminate findings and/or develop joint action plans in identified countries.

Newborn, SBA 1.6.3






CONTRIBUTING MCH

SUBELEMENT 3.2 Newborn Care 3.2.1 Moving implementation

of KMC forward for LBW Newborns

1. KMC services in Mali and other countries expanded

2. Community Kangaroo Mothercare (CKMC) introduced one country

3. CKMC evaluated in Malawi

1. Provide technical assistance and financial support to establish KMC centers in one country (complements field funds)

2. Provide technical assistance and financial support to establish KMC centers in Mali

3. Provide technical assistance and financial support to establish at least 2 KMC centers in DRC

4. Operationalize the elements of “special care” for LBW/preterm babies

5. Provide technical assistance and financial support to strengthen CKMC in one country

6. Provide technical assistance and financial support to strengthen CKMC activities in Malawi

Newborn, SBA 1.6.1, 1.6.3

3.2.2 Scaling-up essential newborn care Linked with Activities 2.2.3 and 2.2.5

1. Scale-up of maternal and newborn health care (both facility and community) in Senegal documented

2. ENC scaled-up in 1–2 states in India

3. ENC scaled-up in 1–2 districts in Mali (including introduction of structured PNC home visits)

4. WHO/UNICEF PNC home visits statement disseminated and adopted in sub-Sahara Africa and S. East Asia

1. Develop SOW for documentation of MNH scale-up in Senegal

2. Provide technical and financial support to document MNH scale-up in Senegal

3. Provide technical assistance and training of health workers and community volunteers on ENC in 1–2 states in India

4. Provide technical assistance, development of complementary training materials, and training of health workers and community volunteers

5. Co-organize 1–2 regional meetings to disseminate the WHO/UNICEF PNC statement in Africa (in collaboration with Africa 2010, SNL, UNICEF and WHO)

6. Provide technical support to selected African countries to develop strategy to introduce PNC home visits based on the WHO/UNICEF statement

7. Support the dissemination of the WHO/UNICEF PNC statement through upcoming global/regional meetings







CONTRIBUTING MCH

SUBELEMENT 3.2.3 Community-based

infection management for newborn

1. Engaged in global strategy for scaling-up community-based management of neonatal sepsis

2. Community-based management of neonatal sepsis introduced in Nigeria

3. Documentation of Community Case Management (CCM) of neonatal sepsis in select countries completed

1. Map status of neonatal sepsis management at community level in sub-Saharan Africa and Southeast Asia

2. Co-organize an expert consultation on global strategy for introduction and expansion of community-based management of neonatal sepsis

3. Provide technical support to the Nigerian Society of Neonatal Medicine (NISONM) to develop a strategic framework for community-based newborn care

4. Provide technical and financial support to NISONM to introduce community-based management of neonatal sepsis in one selected sub-district


3.2.4 Prevention of preterm births

1. MCHIP prevention of preterm strategy developed to be applied in MCHIP countries in YR 3

1. Strengthen antenatal elements (Package of interventions to reduce preterm and low birth weight births) that prevent preterm deliveries: • Syphilis screening and treatment • IPTp • Antenatal steroids use • Screening and treatment of URTI and RTI • Iron/folate use

Newborn, SBA, nutrition

1.6.1, 1.6.3

3.2.5 Scaling up newborn resuscitation

1. Collaborate with AAP and USAID missions on field testing supported for Helping Babies Breath (HBB) manual in Bangladesh and/or Kenya

2. Documentation of community-based neonatal resuscitation conducted in one country (may be linked to HBB field-test)

1. Provide technical and financial support to revise Bangladesh birth asphyxia study to link to Sylhet program

2. Support national dissemination of results of the birth asphyxia study, and development of strategy to improve neonatal resuscitation

3. Provide technical and financial support to Kenya birth asphyxia study

4. Identify a country to field test community-based neonatal resuscitation, and develop an operations research protocol

5. Initiate preparatory phase of the community-based neonatal resuscitation OR.


3.2.6 Quality of Maternal and Newborn Care Assessment (FMN QoCA Linked with Activity 2.4.2

1. Ongoing from Year One—link to PE/E surveys

1. Support national dissemination of findings from the QoCA for ENC and neonatal resuscitation in 1–2 countries (Kenya, Ethiopia)

2. Support development of national strategy to improve ENC and neonatal resuscitation in 1–2 countries







CONTRIBUTING MCH

SUBELEMENT 3.2.7 Handwashing for

newborn survival Linked with Activity 5.1.2

1. Hand washing technical consultation held to share most recent data and define appropriate messages for timing of hand washing for newborn health.

2. Hand washing work in India is continued

3. Initiate national level hand washing work in Bangladesh

4. Explore potential for national level hand washing work in one African country(e.g. Malawi)

1. Hold consultative meeting with hand washing experts 2. Explore use of GDA mechanism to provide

complementary support to private sector funding for newborn hand washing globally.

India: 1. Support development of BCC campaign for hand

washing for newborn health with private sector partners in India

2. Support design of integrating hand washing into newborn survival implementation

3. Provide technical assistance and training of health workers and community volunteers on hand washing as part of ENC in 1–2 states in India (done as part of ENC training described in Activity 3.2.2)

Bangladesh: 1. Collaborate with public and private sector partners and

ISMNC-FP program to develop national hand washing strategy for Bangladesh

2. Identify formative research needed to develop messages around hand washing timing for new mothers (Bangladesh, Indonesia)

Newborn 1.6.1, 1.6.3






CONTRIBUTING MCH

SUBELEMENT 4 CHILD HEALTH 4.1 Global Leadership for Child Health 4.1.1 GTL—Community-

based Treatment of Pneumonia Participate in global/regional advocacy and planning with USAID to mobilize resources and leverage partner support for implementation of Community-based Case Management

1. Package of resources for MCHIP-supported CB-pneumonia programs defined

2. Common CCM indicators developed (including quality indicators)

3. Supported USAID’s coordination with UNICEF

4. Coordinated iCCM planning conducted with PMI and additional partners

5. Co-sponsored 4th Africa regional CCM implementers experience exchange and program update meeting to leverage existing learning on iCCM and to expand iCCM in-country and to other countries (e.g., Anglophone and non-African countries)

6. Global Malaria partners support integration of pneumonia, diarrhea and malaria CCM

1. Strategically identify fora in which to participate and create a matrix to pinpoint and track MCHIP participation.

2. Leverage Malaria partners to include pneumonia including MCHIP participation in World Pneumonia Day.

3. Participate and support USAID’s coordination with UNICEF at global and country levels

4. Establish a joint USAID/MCHIP planning committee in coordination with global partners for the 4th Africa regional CCM implementers meeting

4a. Continue on-going collaboration and coordination on iCCM to promote global learning with UNICEF-Catalytic Initiative, GAPP, CCM Task Force/CCM.OR Group, ZTF, as well as USAID partners/ partnerships such as, CORE/ CSHGP, DELIVIER, SPS, the new BMGF-funded CCM logistics project, and others as appropriate.

5. Adapt and implement a cost model at the outset of program start up

ORT revitalization, Zinc in diarrhea case management, Malaria

1.6.7

4.1.2 GTL—ORT Revitalization/Zinc Participate in global/regional advocacy and planning with USAID to mobilize resources and leverage partner support for implementation

1. Package of resources defined for MCHIP-supported ORT revitalization/Zinc efforts and shared at global fora

2. Common ORT/Zinc indicators developed (including quality indicators)

1. Collaborate with UNICEF-Catalytic Initiative, WHO, CIFF and USAID partners/partnerships such as, CSHGP and Africa 2010

2. Exchange technical information and, disseminate findings in 3 countries

Zinc in diarrhea case mgt, hygiene improvement for the prevention of diarrhea, nutrition

1.6.7






CONTRIBUTING MCH

SUBELEMENT 4.2 Community-Based Treatment of Pneumonia 4.2.1 Country support for

introduction and expansion of CCM Implement strategies in select MCH focus countries to introduce/expand community treatment of pneumonia Co-funded with malaria and AFR/SD

1. CB-pneumonia treatment introduced in 2–3 new countries, including an urban setting.

2. Efforts advanced in 2–3 countries transitioning from BASICS support into actual program.

3. Package developed of iCCM priority preventive interventions (e.g., breast-feeding, complementary feeding, water/sanitation/hygiene, ITN and good practice tools)

1. Continue providing technical support to CCM country programs started by BASICS, including DRC (see below) and 1 other country ,

2. Based on the analyses below, identify 2–3 new countries with USAID to initiate activities (Mali, Uganda, +1)

3. Collaborate with and leverage SPS and the BMGF CCM Logistics project in countries where they are working to strengthen drug logistics and availability in support of community treatment programs

4. Document prevention practices currently implemented, and develop package of priority prevention actions to complement CCM

Community-based Treatment of Pneumonia, ORT in diarrhea case management, Zinc in diarrhea case mgt, hygiene improvement for the prevention of diarrhea,

1.6.7

4.2.2 Build evidence base for implementation and scale-up of CCM Co-funded with Malaria and AFR/SD

1. Review of existing analyses/ assessments of CB-pneumonia treatment finalized and published in peer-review journal.

2. Document in 3 countries lessons learned on CCM and explore community linkages (see also 8.4)

3. One CCM.ORG assessment module tested and validated

4. Innovative approaches and evaluation designs for iCCM programming identified for testing in Year 3.

5. CSHGP experience in CCM, including CORE CCM Essentials Guide, used to inform introduction and expansion.

1. Finalize review of existing literature/studies/ analyses to identify lessons learned and evidence gaps for CCM scale-up

2. Work closely with PMI to support use of their framework when assessing countries for CCM introduction

3. Carry out country case studies in 3 countries with PMI to document lessons learned with scale-up of CCM (See Activity 8.4)

4. Document and assess selected CCM program components based on proposed CCM.ORG modules in at least two countries.

5. Through documentation/ assessment, identify innovative approaches to training, supervision, motivation, monitoring or drug supply to be tested in Year 3.

6. With MCHIP partners, design evaluation of innovative approaches to support iCCM programming.

7. Use LiST to estimate potential mortality impact of adding CCM/pneumonia in 30 MCH priority countries to reach MDG 4.

Community-based Treatment of Pneumonia, ORT in diarrhea case management, Zinc in diarrhea case mgt, hygiene improvement for the prevention of diarrhea, nutrition, newborn

1.6.7






CONTRIBUTING MCH

SUBELEMENT 4.3 ORT in Diarrhea Case Management 4.3.1 Desk analyses to

identify factors contributing to low or declining ORT use

1. Results of analyses/ assessments are synthesized, shared globally and used to inform MCHIP ORT revitalization efforts

2. Additional countries identified for assessment and support to address bottleneck of ORT use

3. LiST used to inform potential mortality impact of adding diarrhea related interventions in 10 priority countries.

(See Activity 1.4.)

1. Finalize synthesis of the review of existing literature, analyses and assessments for lessons learned including WHO AFRO and AFRICA 2010 joint analyses of determinants of ORT use/non-use, previous BASICS and A2Z Zinc/ORT assessments, CDC/Kemri analyses in Kenya, DHS analyses, etc.

2. Collaborate with Africa 2010, AFRO and UNICEF to share synthesis document globally.

3. Based on above, design additional in-country analyses as needed, utilizing other partner resources where feasible

4. Apply LiST to 10 priority countries to determine potential mortality impact of improving diarrhea disease control

ORT in Diarrhea Case Management, Zinc in diarrhea case mgt, hygiene improvement for the prevention of diarrhea, nutrition

1.6.7

4.3.2 Support to selected countries for ORT revitalization

1. ORT revitalization efforts initiated or continued in at least 3 countries.

2. Health worker performance improvement models to increase ORT rates identified and tested in 3 of above countries.

1. Based on the analyses above, initiate or continue activities in at least 3 countries (Kenya, DRC and at least one Africa 2010 country)

2. Leverage USAID core MCH resources with UNICEF, Catalytic Initiative, CIFF and local resources to assess, supply and launch efforts in same 3countries

3. Develop and test alternatives to traditional in-service health worker training approaches to improve performance in ORT in 2 of above countries.

ORT in Diarrhea Case Management, Nutrition, hygiene

1.6.7

4.4 Zinc in Diarrhea Case Management 4.4.1 Documentation of

lessons learned with zinc introduction

1. Zinc included in revitalization of ORT efforts at global, regional and country levels, described above

2. Country readiness for introduction of zinc assessed in 2 countries. (Kenya, DRC)

3. Existing analysis/ assessment reviewed

1. Participate in discussions/key forums (e.g., Zinc Task Force) to identify program gaps/needs and opportunities to strengthen country implementation.

2. Review lessons learned from POUZN and others to identify factors contributing to zinc introduction

3. Contribute to the introduction of zinc in the context and scale-up of diarrhea disease case management

Zinc in Diarrhea Case Management, ORT in diarrhea case management, hygiene improvement for the prevention of diarrhea, nutrition

1.6.7






CONTRIBUTING MCH

SUBELEMENT 4.4.2 Support countries to

introduce or expand Zinc use in diarrheal disease case management

1. Zinc introduced and/or expanded into ORT activities in 2 countries

1. Continue technical support efforts in 2 existing countries transitioning from BASICS (e.g., Indonesia, Kenya, DRC)

2. Initiate activities in 1-2 new countries leveraging Catalytic Initiative, CIFF and local resources committed to this effort together with USAID core funds + available field support)

Zinc in Diarrhea Case Management, ORT in diarrhea case management, hygiene improve-ment for the prevention of diarrhea, nutrition

1.6.7

4.5 Crosscutting Child Health Interventions 4.5.1 Through Dec 2009 only

Democratic Republic of Congo Ensure continued quality and expansion of CCM, ORT/Zinc, AMSTL, Newborn and Immunization interventions until a new USAID TA mechanism is in place Co-funded with Mission FS and AFR/SD

1. Leveraged UNICEF, USAID/AXxes, and other partners to expand high-quality CCM activities in 100 health zones

2. Necessary policies, strategies and training capacity in place to continue CCM expansion

3. ORT revitalization campaign launched successfully with UNICEF and other partners

4. Findings and recommendations of the assessment of AMSTL/Newborn training and supervision used to develop a plan for further expanding and improving the results of these interventions

5. National EPI review completed (IMMbasics) and findings and recommendations disseminated (MCHIP) and used in planning.

6. EPI Review recommendations implemented with MCHIP technical support.

7. Annual Memo of Understanding for the national immunization program defines government and donor commitments in 2010

8. USAID long-term MNCH strategy developed

Transition CCM in-country work of BASICS to MCHIP CCM 1 Provide technical support and leverage support for the

expansion of CCM 2. Lobby and take other steps to ensure that CCM policies

and resources are in place 3. Monitor the progress and quality of CCM training and

expansion 4. Document CCM results 5. Develop a plan for institutionalizing CCM training

capacity 6. Leverage support to carry it out ORT revitalization 1. Support final preparations/materials for the launch AMSTL/Newborn 1. Continue support to AXxes for training and support

supervision and support the implementation of a plan to improve quality and effectiveness of the intervention

2. With MOH and partners, develop and support the implementation of a plan to improve quality and effectiveness of the intervention

3. Advocate for policy change if that is required Immunization 1. Continue to provide direct technical support to AXxes,

GAVI CSO recipients and MOH to improve immunization coverage in targeted health zones

2. Participate in the national EPI review (IMMbasics) 3. Facilitate use of the national EPI review findings in

planning 4. Participate in the annual EPI planning meeting and

development of macro EPI plan for 2010 5. Assist in drafting the annual MOU that defines partner

commitments 6. Continue GAVI HSS tracking study through Sept 2009

Pneumonia, ORT, Zinc, nutrition, newborn, PPH, SBA, Immunization

1.6.7






CONTRIBUTING MCH

SUBELEMENT (GAVI funded cost-share)

7. Work closely with USAID Mission to develop long-term MNCH strategy to expand and sustain CCM, ORT, AMSTL/ Newborn and immunization investments

4.5.2 Essential community child health package in DRC Identify an essential package for CHWs and communities to address prevention and treatment aspects of malaria, pneumonia and diarrhea Co-funded with Mission FS

1. Communities, community human resources and community linkages identified.

2. Package of essential CCM plus preventive messages identified.

1. Define priority preventive actions/messages necessary to complement CCM treatment without overwhelming the package.

2. Provide TA to MOH and partners for implementation of the package

ORT revitalization, Zinc in diarrhea case management, Malaria

1.6.7






CONTRIBUTING MCH

SUBELEMENT 4.6 Immunization 4.6.1 Global Technical

Leadership - Immunization Activities in Africa Region co-funded with AFR/SD

1. Global policies on new vaccine presentation, packaging, and financing reflect country needs—generic preferred product presentation finalized (VPPAG); new vaccine post-introduction evaluation finalized (WHO)

2. New immunization policies and guidelines are in place—new Multi-dose vial policy (TLAC), visual cues to inform health workers whether each vial can be kept after opening designed (TLAC); policies on use of vaccines out of the cold chain formulated (TLAC); guidance (“companion piece”) to national policymakers on revised immunization schedules finalized (WHO)

3. USAID immunization support to countries leveraged and well coordinated with WHO, UNICEF and others—CDC research agenda finalized with MCHIP input (CDC); epidemiology of unimmunized informs SAGE (WHO)

4. GAVI CSO support is re-designed (GAVI CSTT) and USAID CSHG grantees increase activities in support of immunization

1. Contribute to global and regional technical advisory groups, task teams and working groups, including GAVI CSO Task Team, WHO SAGE, TLAC, and Optimise.

2. Participate with USAID in coordination and technical update meetings and definition of research agenda with WHO, CDC and others.

3. Participate in immunization partnership teleconferences and meetings (i.e., SAGE, GIM, TFI, WHO Regional WGs and Managers Meetings, GAVI Technical WGs, NUVI, MCC, and VPPAG, AFRO/Africa Bureau collaboration)

4. Support CSHGP to identify opportunities for improving immunization as part of CSHGP activities

Immunization 1.6.4






CONTRIBUTING MCH

SUBELEMENT 4.6.2 Strategic planning/

advocacy for routine immunization with USAID missions and partners Conduct strategic review of immunization program status to identify gaps in 30 USAID MCH priority countries

1. Report on epidemiology of non-immunized from grey literature (started under IMMbasics, may be completed under MCHIP)

2. Analysis of coverage trends and other EPI indicators in 30 MCH Priority Countries completed (started by IMMbasics)

3. Recommendations to guide advocacy with USAID Missions and partners produced

4. Country fact sheets and other advocacy materials sent to priority missions and followed up by MCHIP staff

1. Review grey literature and document the epidemiology of non-immunized women and children (IMMbasics funded as part of broader WHO-led effort; will be completed under MCHIP in Year 2)

2. Finalize country summaries of coverage trends and program indicators

3. Work with USAID to determine the strategy for approaching missions and partners in high-burden and/or low-performing priority countries

4. Send advocacy packets to missions and partners in priority to identify additional countries for MCHIP immunization support

5. Further analyze immunization trends in the 30 MCH priority countries, using official country estimates, WHO/UNICEF estimates, JRFs, Annual Progress Reports to GAVI and population-based survey data

Immunization 1.6.4

4.6.3 Reaching unreached populations with routine immunization In MCH priority countries with fragile or underperforming immunization systems, support the development and implementation of strategies to reach unimmunized and partially immunized children with life-saving vaccines Co-funded with AFR/SD

1 Two subregional RED adaptation/revitalization workshops conducted with WHO/AFRO and UNICEF

2. At least two countries complete formal assessments, EPI reviews and/or country planning exercises with MCHIP core input

3. In 4 MCHIP countries, workplans targeting the unreached and partially immunized are implemented as planned using MCHIP core and field support (DRC, India, Kenya and S. Sudan)

4. In 2–3 new countries, MCHIP technical support initiated to increase coverage among unreached and partially immunized women and children

1. Facilitate subregional RED adaptation/revitalization workshops for Anglophone and Lusophone countries with WHO/AFRO and UNICEF

2. Couple Field Support and Global MCH funding in 4 countries for innovation, advocacy, leveraging, and expansion of proven approaches, including RED and other RED-like approaches in DRC, India, Kenya, S. Sudan, and Bangladesh (see DRC plan)

3. Plan with USAID Missions, WHO and UNICEF for immunization activities in 2–3 new countries under MCHIP

4. Provide technical support to countries above to uncover the causes of low coverage and underperformance. This may include technical support for rapid assessments; coverage surveys; multi-agency EPI reviews (e.g., DRC, Kenya); rapid cold chain, vaccine management assessments; immunization program and data quality assessments; comprehensive Multi-Year Planning; and annual work planning

Immunization, ANC, Family Planning

1.6.4

4.6.4 New vaccine introduction Support countries to introduce and evaluate the introduction of new vaccines

1. At least 2 countries complete a GAVI application with MCHIP support and/or are assisted during planning, preparations for and/or the evaluation of new vaccine introduction

1. Provide technical support to 2–3 countries for the preparation of plans and applications to GAVI for new vaccine introduction and other forms of GAVI and government support (i.e., HSS, ISS)

2. Provide technical support to 2–3 countries during preparations, implementation and/or monitoring/evaluation of new vaccine introduction

All child health 1.6.4






CONTRIBUTING MCH

SUBELEMENT 4.6.5 Integration of

immunization and family planning interventions Use immunization contacts to promote birth spacing and increase access to FP services (Funded with FP)

This activity is the same as FP Activity 7.4. 1. Literature review and key

informant interviews used to produce summary document

2. Analytic or conceptual framework developed to guide design of interventions

3. Plan for developing and testing immunization/FP interventions with countries in place

1. Co-host a consultative meeting with ACCESS/FP, to include CAs and other agencies and NGO partners to share implementation experience to date on integrating FP with immunization

2. Prepare a document analyzing and reviewing experience in linking FP and immunization services including programmatic tools

3. Select sites for pilot implementation and make site visits4. Secure funding and obtain agreement from MOHs and

partner agencies to participate in implementation in Year 2

Immunization, ANC

4.6.6 Utilize polio eradication and routine immunization strategies to mutually strengthen each other and guide integration opportunities."

1. Polio and routine immunization data linked more effectively for addressing the unimmunized in at least 2 countries.

2. Polio and immunization communication lessons documented and recommendations applied in regional and country reviews

1. Participate as technical advisors in select polio priority country and regional (e.g., Horn of Africa, India, Nigeria, Pakistan, Afghanistan) polio and immunization communication TAGs and/or surveillance reviews

2. Provide technical guidance for linking polio and routine immunization activities (e.g., RED, improved newborn tracking and vaccination) in MCHIP countries with WPV re-importations, such as DRC, Kenya, Benin

3. Contribute to finalization of communication articles in Journal of Health Education and operations research on improving immunization communication conducted by partners (e.g., Gates Foundation and WHO)

4. Support to Communications Initiative for Polio

Immunization, ANC, MNCH integration

1.6.4






CONTRIBUTING MCH

SUBELEMENT 4.6.7 RED+ - delivering other

MNCH interventions on the immunization platform Use the routine immunization platform to add selective MNCH/FP interventions and expand the RED approach (Co-funded with AFR/SD)

1. Conceptual framework developed to guide the expansion of the RED approach

2. RED guidelines and tools expanded and used with 2 countries in planning to deliver integrated RI and selected MNCH interventions

3. At least 2 countries, including Kenya, selected and country plans developed with WHO and UNICEF for development and testing of RED+ approach

4. Implementation underway in two countries, with agreed upon indicators and tracking process in place

5. Implementation and process monitoring plans in place for Year 3

1. Use findings of IMMbasics literature review to develop a framework for expanding the immunization specific RED approach

2. Meet with WHO/AFRO, UNICEF, CDC, and others in the Africa region for joint activity planning, country selection and initial work on expansion of RED guide and tools to support an integrated package of services

3. Expand the RED guide and tools for use in selected countries in collaboration with UNICEF/WHO

4. Leverage funding from USAID Missions, WHO, UNICEF and others for country implementation.

5. Work with stakeholders in each country to develop an appropriate package of interventions and a work plan for introducing and testing the integrated RED approach

6. Support the implementation and process monitoring of an integrated package of RI and MNCH services

7. Evaluate and document lessons learned with the expanded RED approach (Year 3)

ANC, Family Planning, HIV/PMTCT-MNCH Integration, nutrition, ORT

1.6.4

4.6.8 Adapting RED to strengthen other MNCH interventions PMTCT: Test the use of an adapted RED approach to improve coverage and continuity of PMTCT care for mothers and newborns See Activity 5.2.1 (Co-funded with HIV/HOP)

1. Adaptation of RED approach developed, being implemented and monitored in one country to improve the coverage and continuity of PMTCT care

Same process for both activities 1. Identify one country with interest in adapting RED

approach to improve coverage and continuity of PMTCT prong 2 and 3 care for affected women and newborns(Zambia, Malawi);

2. Revise RED guide, reference materials and monitoring tools for use in planning, organizing and monitoring PMTCT services, with focus on immediate post-partum/post-natal period

3. Work with country stakeholders to develop a demonstration activity in 1-2 districts (both)

4. Leverage USAID, UNICEF, WHO and other sources of support for demonstration activities

5. Monitor and document process and results during implementation

PMTCT

1.6.4






CONTRIBUTING MCH

SUBELEMENT 4.6.9 Adapting RED to

strengthen other MNCH interventions MNCH/FP: Test the use of an adapted RED approach to improve coverage and continuity of some aspect of MNCH/FP care See ARF/SD activity Co-funded with AFR/SD

1. Adaptation of RED approach developed, being implemented and monitored in one country to improve the coverage and continuity of selected elements of MNCH care

1. Identify one country with interest in adapting RED approach to improve coverage and continuity of selected elements of MNCH care (Nigeria, Liberia)

2. Revise RED guide, reference materials and monitoring tools for use in planning, organizing and monitoring MNH services for non-HIV positive women and newborns.


4. Monitor and document process and results during implementation

SBA, Newborn, revitalization, Zinc in diarrhea case management, Malaria

1.6.4

5 CROSSCUTTING INTERVENTIONS 5.1 Water and Sanitation 5.1.1 Water and hygiene

improvement for prevention of diarrhea Co-funded with AFR/SD

1. Use of MNCH platform to initiate water, sanitation and hygiene improvement activities, in 1–2 MCHIP countries in context of integrated diarrhea disease control program (Kenya, DRC)

1. Meet with HIP, POUZN and other water, sanitation and hygiene projects to review their tools and experience and brainstorm the possible strategic integration with ORT.

2. Identify 1–2 countries for collaboration with HIP, POUZN and other water/sanitation/hygiene partners

Zinc, Urban Health 1.6.8






CONTRIBUTING MCH

SUBELEMENT 5.1.2 Handwashing for

newborn survival (Repeated from Newborn Activity 3.2.7)

1. Hand washing technical consultation held to share most recent data and define appropriate messages for timing of hand washing for newborn health.

2. Hand washing work in India is continued

3. Initiate national level hand washing work in Bangladesh

4. Initiate national level hand washing work in one or two African countries (e.g.Malawi)

1. Hold consultative meeting with hand washing experts 2. Explore use of GDA mechanism to provide

complementary support to private sector funding for newborn hand washing globally.

India 3. Support development of BCC campaign for hand

washing for newborn health with private sector partners in India

4. Support design of integrating hand washing into newborn survival implementation

5. Provide technical assistance and training of health workers and community volunteers on hand washing as part of ENC in 1–2 states in India (done as part of ENC training described in Activity 3.2.2)

Bangladesh 6. Collaborate with public and private sector partners and

ISMNC-FP program to develop national hand washing strategy for Bangladesh

7. Identify formative research needed to develop messages around hand washing timing for new mothers (Bangladesh, Indonesia)

Newborn 1.6.8

5.1.3 Hygiene improvement for HIV/PMTCT-MNCH Integration

1. Infection prevention practices in MNCH facilities reinforced

(See Activity 5.2.1)

1. Assess facilities for presence for adequate infection prevention, equipment ,and supplies

2. Work with partners/stakeholders to improve logistics to ensure adequate equipment and supplies

Maternal, newborn, child health, ANC, SBA

1.6.8

5.1.4 Document water/sanitation activities in Indonesia

1. Lessons learned on successful implementation strategies on water and hygiene documented

1. CCP will work with a consultant/ staff to document what worked in achieving results in water in hygiene.

CH 1.6.8






CONTRIBUTING MCH

SUBELEMENT 5.2 HIV/PMTCT-MNCH Integration 5.2.1 Implement USAID

PMTCT-MNCH strategy in collaboration with existing bilateral programs.

1. USAID’s integrated PMTCT strategy (4 prongs) implemented in one country, including integration of PMTCT into the continuum of maternal, newborn, family planning and child health services.

2. RED approach adapted and field tested to improve PMTCT coverage and effectiveness

3. Results (of integration and adapted RED approach) documented

1. Identify at least one country for implementation of PMTCT integrated approach with existing programs/partners (e.g., Tanzania, Zambia, Malawi)

2. Provide TA to bilateral partner for integrated PMTCT-MNCH interventions

3. Adapt and test the RED approach to increase the coverage and continuity of the four prongs of PMTCT

4. Document the integration process and results of this work

ANC, newborn, SBA, CH

1.6.1, 1.6.2, 1.6.3

5.2.2 Implement learning from PMTCT/MNCH integration in countries

1. Learning from countries compiled and disseminated globally

1. Develop report based on data gathered and lessons learned

2. Disseminate report in global forum

ANC, newborn, SBA, CH

1.6.1, 1.6.2, 1.6.3

5.2.3 Develop and implement MCHIP’s pediatric HIV strategy

1. Pediatric HIV consultation held with USAID and other partners using new WHO Pediatric HIV Guidelines

2. MCHIP’s pediatric HIV strategy developed and planning underway for activities to increase coverage and quality of pediatric HIV care in two additional countries in Year 3 (new funding required)

1. Once the new WHO Pediatric HIV Guidelines are available, organize and host a technical consultation on pediatric HIV with USAID and other partners

2. Define MCHIP’s role in pediatric HIV and develop project strategy

3. Identify and plan for activities to increase the coverage and quality of pediatric HIV care in at least two additional countries (new funding required)

Newborn, CH 1.6.3, 1.6.7






CONTRIBUTING MCH

SUBELEMENT 5.3 Health Systems Strengthening 5.3.1

Strong Health Systems Enhance MNCH Survival

1. Enhance global understanding regarding how health systems elements interact and contribute to MNCH.

2. HSS framework developed that identifies major health system linkages and requirements with key MNCH services outcomes.

1. Critically review existing HSS frameworks with focus on what works for MNCH.

2. Develop Performance-Based Incentives Strategy to guide technical assistance in MCHIP country programs, building on concrete opportunities in Malawi and possibly others.

3. Contribute HSS and PBI input to the strategy for RED Plus and how it is operationalized in field programs.

4. Develop conceptual framework for HSS for MNCH that incorporates the elements of health systems that are important and their interactions that contribute to health outcomes.

5. Carry out consultative meeting with key stakeholders and technical leaders in MNCH and HSS to obtain feedback on framework and generate buy in.

6. Develop HSS strategy that can guide MCHIP field programs and global leadership.

All 1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6, 1.6.7, 1.6.8

5.3.2

Expert review of health systems and quality improvement approaches to guide MCHIP’s strategic approach to maternal, newborn and child health

1. Quality Improvement approaches inform MCHIP program implementation.

2. MCHIP country planning integrates elements of health systems necessary to ensure that priority interventions that save lives actually reach beneficiaries.

1. MCHIP participation in quality improvement working group maintained.

2 TA provided to countries implementing QI activities, based on output of expert group and country’s needs

3. Data collection carried out on use and results of various models of QI to identify best practices.

4. Results of #3 above disseminated to MCHIP partners and other collaborators.

All 1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6, 1.6.7, 1.6.8

5.4 Urban Health 5.4.1

Urban Health Champions Forum (co-funded with AFR/SD)

1. Increased commitment and awareness of country level urban health champions in Africa

2. Identified opportunities to strengthen MNCH best practices in urban areas.

1. Provide support to the African Population and Health Research Center (APHRC) to espouse the Urban Health Champions Forum on October 19, 2009.

2. 3–4 MCHIP staff participate in the International Conference on Urban Health.

3. Engage with Urban Health Champions to identify opportunities to program MNCH best practices in urban areas.

CH, MH, Newborn 1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6






CONTRIBUTING MCH

SUBELEMENT 5.4.2 Strategic Analysis and

Planning for community-based MNCH urban health

1. MCHIP community-based strategy for urban health is defined.

2. Metrics for monitoring and evaluating progress in achieving sustainable and equitable MNCH in urban areas are defined.

1. Consult with Urban Health partners on a common community-based MNCH implementation agenda.

2. Plan for MCHIP strategy to for “best bet” opportunities for achieving high, sustained and equitable coverage for proven MNCH interventions in urban areas.

3. Identify metrics for community-base urban health.

All 1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6

5.4.3 Leverage USAID Urban Health project in Ethiopia for expanded MNCH impact in urban areas

1. MCHIP strategy and workplan to complement USAID’s Urban Health project in Ethiopia defined.

2. Technical assistance provided to identify activities.

1. Participate as a partner in USAID/Ethiopia Urban Health project strategic planning exercise.

2. Define MCHIP’s comparative advantage to add synergy and SOTA approaches to increase MNCH impact in project cities.

3. Develop joint MCHIP/Urban Health Project workplan for Year Two with vision for LOP of MCHIP.

All 1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6

5.4.4 Integrating hand washing for newborn survival Into Urban Health

1. Formative research on hand washing in newborn health in India is shared with urban health programs in India and Bangladesh

2. National level hand washing work in India and/or Bangladesh incorporates strategies for urban settings.

3. Initiate national level hand washing work in urban settings in India

1. Hold consultative meeting with urban health and hand washing experts

2. Support design of integrating hand washing into newborn survival in urban settings with partners in India

3. In Bangladesh, collaborate with public and private sector partners and MAMONI program to include urban settings in national hand washing strategy

4. Identify formative research needed to develop messages around hand washing timing for urban settings

Newborn, CH 1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6






CONTRIBUTING MCH

SUBELEMENT 6 PVO/NGO STRENGTHENING 6.1 Support to existing

CSHGP Management Systems

1. CSHGP Guidelines maintained with clear linkages to MCHIP priority activities

2. At least 50% of FY10 applications recommended for funding align with MCHIP priority technical areas and/or focus countries

3. Annual program results

generated for CSHGP program review and Report to Congress

4. Management data on CSHGP

grantees maintained

1. Review and recommend modifications to CSHGP RFA, DIP Guidelines, and Annual Reporting Guidelines (including FE and MTE guidelines) to ensure that they are consistent with the direction of the CSHGP and connected to MCHIP priority areas of focus

2. Conduct Orientation on CSHGP Guidelines for evaluators and practitioners

3. Coordinate external review of CSHGP applications in innovation category only.

4. Calculate lives saved, beneficiaries reached, etc. for CSHGP Program Review

5. Maintain and monitor quality of grantee project data 6. Respond to ad-hoc requests for portfolio-level grantee

data 7. Maintain CSHGP Extranet and PVO/NGO Support arm

of MCHIP.net

1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6, 1.6.7, 1.6.8

6.2 Technical Support to Active Portfolio of CSHGP Grantees

1. Technically sound and rigorous Detailed Implementation Plans for 8 newly-funded projects in Ecuador, Mozambique, Nepal, Zambia, Niger, Bangladesh, Honduras, Uganda

2. Technically sound and rigorous OR designs for 6 innovation grantees

1. Coordinate New Grantee Orientation Event 2. DIP Backstop Check-ins 3. Support DIP Review process 4. OR Backstop Check-ins 5. Plan and conduct OR workshop for Innovation grantees

1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6, 1.6.7, 1.6.8






CONTRIBUTING MCH

SUBELEMENT 6.3 Strategic Analysis and

Dissemination of CSHGP Portfolio Data

1. 10 evidence-based, project-specific results highlights (as reported in Final/Mid-term Evaluations, documented and diffused through MCHIP Info System

2. CSHGP results diffused through

professional conferences, journal articles and MCHIP technical update meetings

3. GH/W and Mission

Stakeholders oriented to CSHGP data uses and resources

4. CSHGP-generated

tools/resources inform S01/SO2 activities

5. Uptake of CSHGP strategies

1. Review 20 CSHGP Final Evaluation and 8 Mid-term Evaluations to identify priority results that relate to MCHIP focus areas/countries

2. Post Results Highlights from priority results on SO3 website

3. Panel discussion at APHA: USAID’s Child Survival and

Health Grants Program Improves EBF, ORT, and Handwashing Practices

4. Present updates on Equity TAG and Innovation Mapping at CORE Fall meeting;

5. Program-level highlights from CSHGP portfolio documented in 10–15 page paper.

6. Develop Working Paper on CHW performance (in collaboration with CORE)

7. Practitioner Experience and Resources for C-IMCI framework diffused through expert consultation meeting;

8. Facilitate MCHIP Brown-bag on CSHGP data and

information management systems; 9. Develop briefing paper for Missions and GH staff on

how to access and utilize CSHGP data and resources. 10. RHFA informs PE/E pilot in Ethiopia; 11. MCHIP HSS framework informed by NGO practitioner

advisory group to ensure inclusion of community health systems perspective;

12. Develop guidelines on Equity for CSHGP and MCHIP programming, based on Equity TAG recommendations;

13. Finalize Global Health Policy Brief on Community Based Primary Health Care;

14. Experience from CSHGP portfolio reviewed as appropriate to inform MCHIP activities in technical areas including CCM, Newborn Health, PPH, and PPFP

15. CORE CCM Essentials Guide diffused widely to complement overall MCHIP CCM focus.

16. Review CSHGP Portfolio in Kenya to identify key areas

of uptake 17. Convene in-country partners meeting with Bi-lateral,

1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6, 1.6.7, 1.6.8






CONTRIBUTING MCH

SUBELEMENT documented in Kenya

6. Opportunities for wider

application of CSHGP grantee experience documented in Burundi

CSHGP grantees, USAID Mission, other key stakeholders

18. Document meeting and recommendations for maximizing uptake of CSHGP strategies

19. TA visit to Burundi Innovations Project 20. Convene Partners meeting with Mission, FANTA, CWI,

WRC and other relevant partners; 21. Identify opportunities and follow-up steps for greater in-

country collaboration, and potential wider applications of CSHGP grantee experience.

7 FAMILY PLANNING 7.1 Global Leadership and

Program Learning 1. Co-hosted annual community of

practice meeting with ACCESS-FP on integration of FP into MNCH activities

2. Supported presentations on PPFP in Uganda International FP conference

3. Held PPIUD on-line forum with ACCESS-FP

4. Abstract based on results of PPIUD analysis in Paraguay submitted to international FP journal (i.e., Contraception) and for presentation at GHC

5. EBF-LAM ,complimentary feeding, and immunization Consultative meeting held with participation of UNICEF, UNFPA and other partners

1. Co-host a consultative meeting with ACCESS/FP, to include CAs and other agencies and NGO partners to share implementation experience to date on integrating FP with immunization linking child survival to HTSP through FP

2. Support ACCESS-FP on PPFP auxiliary workshop to demonstrate seamless transition from ACCESS-FP to MCHIP in FP conference in Uganda

3. Establish and lead WG on PPIUD 4. Support analysis for PIUCD 10,000 cases in Paraguay 5. Support/host LAM WG meeting in last quarter include

IYCN and child survival experts 6. Co-lead PAC FP WG in PAC Consortium with

Intrahealth -09






CONTRIBUTING MCH

SUBELEMENT 7.2

Integrate PPFP into MNCH services Postpartum/ Interconceptional FP Program in Mali

1. Through MOH and implementing partners provided TA to include PPFP in an integrated package AMSTL, ENC and PPFP through auxiliary midwives (matrones) and demand generation through CHWs (relais) (multi-year activity)

1. Work with TWG in Mali and partners on integrated PPC/PNC package

2. NGO/PVO/FBO in Mali, conduct formative research to inform design of community component

3. With MOH and existing implementing partners, complete the contents of an essential postpartum/interconceptional package for strengthening PP/IC interventions through their programs

4. With MOH TWG and implementing partners modify norms/protocols/ guidelines to ensure PPFP is appropriately integrated based on approaches from ACCESS-FP that have been adapted to Mali

5. Identify districts to implement activities 6. Identify existing community-based interventions on

which PPFP/ and continue to FP can be integrated 7. Identify facilities where existing MNCH activities can be

strengthened to include provision of FP counseling and services

8. Identify technical assistance needs of existing implementing partners and develop joint plans

PPH Postpartum/postnatal care






CONTRIBUTING MCH

SUBELEMENT 7.3 Strengthening Family

Planning Content in Midwifery Preservice Education in Malawi and Ghana

1. Strengthened capacity of midwifery preservice education modules/training materials in PPFP and the FP component of PAC

2. Reviewed and updated national standards to include PPFP and the FP component of PAC

3. Strengthened capacity of service delivery sites in selected areas (multi year activity)

1. Continue working with and supporting TWG as they develop assessment tools for preservice midwifery education on PPFP and support them to assess preservice midwifery education, clinical sites, tutors and national policies on PPFP and FP activities.

2. Support MOH on National guidelines that include PPFP, updated FP and permit midwives to provide FP inclusive of Implants and IUDs

3. Revise syllabus as appropriate to ensure competency of graduates in counseling and provision of FP services, including immediate postpartum and emphasize the FP component of PAC interval IUD insertion and insertion of implants services)

4. Update core group of midwifery tutors and clinical preceptors on PPFP and emphasize FP in PAC.

5. Harmonize with bilaterals on pre-service/in-service FP training content to include PPFP and emphasize FP in PAC. Strengthen at least one clinical site per school to ensure that midwifery students have the opportunity to integrate FP into MNCH services that they provide

6. Assess readiness to initiate PPIUCDs and PPTL training and strengthen clinical site

7. Provide TA to ECSA-HC and Africa 2010 (same activity listed in Africa/SD narrative page 52 and matrix page 40)

7.4 Integration of immunization and family planning interventions Use immunization contacts to promote birth spacing and increase access to FP services Co-funded with FP

This activity is the same as Immunization Activity 4.6.5. 1. Literature review and key

informant interviews used to produce summary document included are identifying which bilateral or PVO/NGO programs are doing this, how, and what results are

2. Analytic or conceptual framework developed to guide design of interventions

3. Plan for developing and testing immunization/FP interventions with countries in place

1. Co-host a consultative meeting with ACCESS/FP, to include CAs and other agencies and NGO partners to share implementation experience to date on integrating FP with immunization

2. Prepare a document analyzing and reviewing experience in linking FP and immunization services including programmatic tools

3. Select sites for pilot implementation and make site visits

4. Secure funding and obtain agreement from MOHs and partner agencies to participate in implementation in Year 2

Immunization, ANC

7.5 Use the LiST tool to demonstrate the role of FP

(same as Activity 1.4) 1. Team evaluation of MCHIP work in LiST tool to decide how best to incorporate LiST tool






CONTRIBUTING MCH

SUBELEMENT 7.6 Case studies

documenting lessons learned on health systems elements that improve maternal and neonatal health (See Activity 2.2.7)

1. Case study completed that includes good examples of PPFP/FP integration

(same as Activity 2.2.7) SBA

7.7 Bangladesh Health Fertility Study (HFS)

1. Report on operational research findings for women at three and six months

1 Shift management of HFS sub-contracts to MCHIP technical role played by ACCESS-FP shifted to MCHIP

Newborn

7.8 PPIUD training 1. In conjunction with FHI report on PPIUD feasibility in Rwanda

2. Support t the analysis of the PPIUD data from Paraguay

1. Support TA for PPIUCD training SBA

8 MALARIA 8.1 Support to MCP Team 1. 13 grantee annual reports

reviewed 2. 20 grantee workplans reviewed 3. Annual report and workplan

guidance updated 4. Contributions to PMI annual

report and other reports made

1. Review annual reports from MCP grantees 2. Review workplans for all MCP grantees 3. Update annual report and workplan guidance 4. Assist grantees with preparing stories for the PMI

annual report, and other reports, as needed

8.2 Support to MCP Grantees

1. PDME and Behavior Change Event for MCP Grantees organized and conducted

2. 3 field visits to MCP grantees

conducted

1. Finalize planning and preparation for PDME and BC Training Event that was initiated in FY09

2. Conduct PDME and BC Event in Nairobi, Kenya 3. Provide in-country support to grantees, as needed






CONTRIBUTING MCH

SUBELEMENT 8.3 Malaria in Pregnancy

Co-funded with MCH

1. MCHIP participation in global and/or regional meetings.

2. Global MIP key resources and lessons learned disseminated at one regional and/or global meeting.

3. MIP service delivery bottlenecks addressed in up to 5 countries. *Based on documentation of best practices and lessons learned.

4. Documentation of MIP best practices and lessons learned in Senegal.

5. MIP service delivery bottlenecks addressed in up to 5 countries. *Based on documentation of best practices and lessons learned.

1 Participate in RBM MIP Working Group Meeting, participate in MIM, and participate in MIPESA and/or RAOPAG meetings

2. Present and disseminate MIP Implementation Guide and/or Malaria Resource Package at RBM MIP working group meeting at relevant regional and/or global meetings.

3. Conduct desk review of key articles and references for MIP prevention and control in Senegal.

4. Qualitative interviews with MIP stakeholders in Senegal.

5. Develop and write final report. 6. Conduct technical workshop/ module addressing

common MIP bottlenecks (determined through assessment Yr. 1) developed.

7. Implementation through regional and/or global workshop (e.g., MIPESA, RAOPAG and/or MIP working group).






CONTRIBUTING MCH

SUBELEMENT 8.4 (See Activity 4.2.2)

Malaria Community Case Management (CCM) Co-funded with MCH

1. MCHIP participation in global events on home based treatment or CCM of malaria

2. CCM documentation finalized in 2 BASICS and one Anglophone African countries

3. MCHIP CCM service delivery bottlenecks addressed with tools and best practices documentation completed and disseminated through global events

4. iCCM introduced in 3–4 PMI countries and/or non-PMI countries.

1. Actively participate in global and regional policy and program discussions on home and community management of malaria (CCM) including GAPP, CCM Task Force and CCM.ORG

2. Finalize documentation of CCM in 2 BASICS supported countries and an Anglophone country with integrated CCM including malaria

3. Presentation of CCM documentation in GAPP, CORE and other global events

4. Assist in the data-gathering and analysis by PMI country of CCM status (policy, geographic coverage, definition of CHW, etc.)

5. Collaborate with other USAID funded health systems projects involved in malaria issues such as DELIVER, SPS, IMaD and HCI

6. Refine CCM training and supervisory guidelines and tools to include indicators of quality in pay for performance settings

7. Introduce CCM in 3-4 PMI and /or non-PMI countries 8. Increase community mobilization and participation to

prevent malaria by the appropriate use of ITNs by pregnant women and under five children

9. Transition selected CCM countries supported under BASICS to MCHIP assistance or other partners to continue to address issues of scale-up and sustainability.

9 MONITORING AND EVALUATION 9.1 Develop M&E

conceptual models and guidance

1. Improved understanding for the pathways to reducing maternal and newborn mortality

2. Standardized approach to M&E applied across MCHIP country programs. High quality data provided to USAID and other program stakeholders to understand program results and inform program implementation

1. Collaborate with MCHIP Research, Analysis and Evaluation team and stakeholders to develop a MCH-specific conceptual framework as part of the Common Evaluation Framework for the Scale-up to Achieve the Health MDGs

2. Continue preparation of M&E guidance for country programs that buy into MCHIP with field support funds including: M&E plan template; expectations for M&E workplan and budgeting based on program size and scope; and guidance on data quality control and M&E capacity assessments

All 1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6, 1.6.7, 1.6.8






CONTRIBUTING MCH

SUBELEMENT 9.2 Review and revise

MNCH indicators and tools

1. MNCH indicators reviewed and recommendations made for modifications and field testing. A new menu of MNCH indicators for use in performance based incentive programs developed, which are more clearly linked to the provision of high quality and high impact maternal, newborn and child services (ongoing)

2. Standardized data collection tools tailored to MCHIP program needs available and used by country programs (both MCHIP led and others) to generate standardized high quality data for program planning and reporting

1. Participate in ongoing efforts to review MNCH indicators (pneumonia/CCM, water and sanitation, pay for performance-related, etc.) and help provide recommendations for improving them and testing them as appropriate (ongoing)

2. Review standardized MCH data collection tools developed by Macro International and other organizations and adapt to MCHIP's needs

All 1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6, 1.6.7, 1.6.8

9.3 Prepare results reports for USAID Washington

1. MCHIP program results synthesized and disseminated to stakeholders

1. Prepare quarterly, semi-annual and annual results reports for USAID

All 1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6, 1.6.7, 1.6.8

9.4 Participate in M&E working groups

1. Standardized approach to M&E ensured across MCHIP S.O.s and implementing partners.

2. MCHIP up to date on, and applying, M&E best practices

3. MCHIP disseminates information on the LiST and other M&E approaches used by MCHIP to other CAs

1. Attend key M&E working group meetings (including the USAID/MEASURE Evaluation Global Bureau of Health’s M&E working group, and the CORE Group M&E working group, and MCHIP internal M&E working group).

All 1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6, 1.6.7, 1.6.8

9.5 Help create MCHIP data management and reporting system.

1. Framework, indicator/data entry forms and reports for M&E data system developed. Quality MCHIP program data available in a centralized data system, updated on a routine basis, and captured in standardized format

1. Work with MCHIP Information Management team to develop a M&E data system for tracking and reporting MCHIP results to USAID that is available on the MCHIP Portal

All 1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6, 1.6.7, 1.6.8






CONTRIBUTING MCH

SUBELEMENT 9.6 Provide M&E technical

assistance, including capacity building, to MCHIP country programs.

1. Country M&E plans reflect MCHIP global M&E plan indicators and measurement priorities. M&E needs of core-funded country programs met.

2. M&E capacity of field-based M&E and program staff increased, with programs able to implement M&E plans and provide quality data to inform program implementation and for reporting to donors. M&E needs of MCHIP country programs met

1. Assist MCHIP country programs with design and implementation of their M&E plans

2. Help build the capacity of MCHIP staff, partners and consultants.

All 1.6.1, 1.6.2, 1.6.3, 1.6.4, 1.6.6, 1.6.7, 1.6.8


LAC 10.1 Technical assistance,

south-to-south learning, and sharing best practices

1. Based on TA provided under POPPHI, evaluation of AMTSL integration into Paraguay midwifery curriculum will occur

2. Best practices and competency-based methodology incorporated into Paraguayan midwifery curriculum

3. Paraguayan midwifery schools will have incorporated many of the best practices from the Peru model curriculum.

1. Work with Paraguay midwives on strengthening AMSTL practice; follow-up of the TOT done last year (for faculty)

2. Visit the 5 midwifery schools 3. Evaluate their pre-service and CE curricula re. AMSTL

and needs to be include AMSTL on it. 4. Two Paraguayan midwifery faculty visit model MN best

practices in Peru. TA provided to assist and facilitate uptake of best practices and competency-based curriculum.

5. Visits by two midwives and TA to two midwifery schools in Peru

6. South to South exchange between Peru and Paraguay (Peru midwifery faculty visiting Paraguay to support and monitor the changes to midwifery curriculum)

PPH, SBA

10.2 CAMBIO intervention (Changing AMTSL Behavior in Obstetrics)

1. CAMBIO intervention (Changing AMTSL Behavior in Obstetrics) replicated in 1 LAC country

1. CAMBIO intervention (Changing AMTSL Behavior in Obstetrics) replicated in 1 LAC country

2. Identify country 3. Identify 2–3 interested teaching hospitals 4. Orient hospital leadership and Identify coordinators

from each hospital 5. Conduct baseline of AMTSL practice 6. Identify opinion leaders 7. Initiate follow-up activities 8. Monitor and evaluate

PPH, SBA

10.3 Oxytocin in Uniject pilot in Honduras and Guatemala

1. Oxytocin in Uniject pilot in Honduras completed

2. Dissemination of oxytocin in Uniject pilot completed and scale-up activities initiated and monitored in Guatemala

1. The planned Honduras oxytocin in Uniject pilot is on hold and it is likely that this activity will move into MCHIP, year 2. POPPHI funding will be used for the Peru activities to ensure current LAC funding is expended.

2. TA to Honduras to initiate and monitor pilot activities and support monitoring and final evaluation

3. Guatemala Oxytocin in Uniject: • assist with dissemination of pilot finding and plan/

implement next steps for scale-up • provide TA and monitor • monitor and evaluate

PPH, SBA


10.4 Conduct review of postnatal care legal framework and policies in the Region

1. Review carried out in 6 countries and results and recommendations disseminated

2. Assistance to countries initiated for implementation and/or strengthening of postnatal care practices based on the results and recommendations of the survey

1. Carry out the review in 2 countries per sub-region (South America, Central America, and the Caribbean) (total of 6 countries)

2. Initiate advocacy activities and discussions with stakeholders in countries to promote recommended postnatal care practices

Newborn, SBA

10.5 Contribute to activities of The Latin America and Caribbean Newborn Health Alliance

1. Technical oversight and assistance provided for dissemination of best practices and information exchanges on newborn health in the LAC and the Caribbean

2. Technical support contributed for the implementation/ strengthening of national action plans for newborn health in 2 countries

1. Participate regularly in Alliance meetings and provide technical inputs for products such as website content, distance learning session, and newsletters

2. National workshops for the dissemination of the Regional Strategy and Action Plan carried out in 2 countries.

Newborn

10.6 Advocate for scale-up prevention and treatment of newborn sepsis- in 3 countries

1. In-country improvement of prevention and treatment of newborn sepsis initiated at facility and/or community levels in 3 countries

1. Identify 3 countries in the Region (based on MOH, Mission, and other partners interest) for implementation of the sepsis initiative

2. Carry out an evaluation of newborn policies and services related to prevention and treatment of sepsis in the continuum of home to hospital care in 3 countries

3. Identify participating facilities and communities (through work with NGOs) and form quality improvement teams.

4. Implement and measure initial changes to improve aspects of prevention and treatment of newborn sepsis identified at facility and community in the selected countries

5. Facilitate 4–6 regional distance learning sessions for technical updates and exchange of results.

Newborn


AFRICA/SD—The following activities appear elsewhere in this workplan. They are shown here again because we propose to fund or co-fund them with AFR/SD funds. Through Dec 2009 only See Activity 4.5.1

Democratic Republic of Congo: MCH/FP Core Support Ensure continued quality and expansion of CCM, ORT/Zinc, AMSTL, Newborn and Immunization interventions until a new USAID TA mechanism is in place Co-funded with Mission FS and MCH Core

1. Leveraged UNICEF, USAID/AXxes, and other partners to expand high-quality CCM activities in 100 health zones

2. Necessary policies, strategies and training capacity in place to continue CCM expansion

3. ORT revitalization campaign launched successfully with UNICEF and other partners

4. Findings and recommendations of the assessment of AMSTL/Newborn training and supervision used to develop a plan for further expanding and improving the results of these interventions

5. National EPI review completed and findings and recommendations disseminated and used in planning.

6. EPI Review recommendations implemented with MCHIP technical support.

7. Annual Memo of Understanding for the national immunization program defines government and donor commitments in 2010

8. USAID long-term MNCH strategy developed

Working with MOH, AXxes, UNICEF, other NGOs on: 1. iCCM (pneumonia, malaria, diarrhea, nutrition)

• Provide technical assistance and leverage support for the expansion of iCCM

• Conduct advocacy to ensure that iCCM policies and resources are in place

• Monitor progress and quality of iCCM training and expansion

• Document iCCM results • Develop a plan for institutionalizing iCCM training

capacity 2. ORT revitalization

• Support final preparations/materials for the launch • Provide partial support

3. AMSTL/Newborn • Continue support to AXxes for training and

supervision • Conduct an assessment of the introductory phase • With MOH and partners, develop and support the

implementation of a plan to improve quality and effectiveness of the intervention

• Advocate for policy change as required • Disseminate the results of the introductory phase

and facilitate planning for scale-up 4. Immunization

• Continue providing direct technical assistance to AXxes, GAVI CSO recipients and MOH to improve immunization coverage in targeted health zones

• Participate in the national EPI review • Facilitate use of the national EPI review findings in

planning • Participate in the annual EPI planning meeting and

development of macro EPI plan for 2010 • Assist in drafting the annual MOU defining partner

commitments • Continue GAVI HSS tracking study through Sept

2009 (GAVI funded cost-share) 5. Work closely with the USAID Mission and partners to

develop long-term MNCH strategy to expand and sustain iCCM, ORT, AMSTL/ Newborn and immunization investments

Pneumonia, ORT, Zinc, nutrition, MNH


See Activity 4.6.9

RED/MNH: Adaptation of RED to strengthen other MNCH interventions Test the use of an adapted RED approach to improve coverage and continuity of some aspect of MNCH/FP care in Nigeria

1. Adaptation of RED approach developed, being implemented and monitored in one country to improve the coverage and continuity of selected elements of MNCH care

In conjunction with MCHIP Field Support-funded MNH work

1. Identify one country with interest in adapting RED approach to improve coverage and continuity of selected elements of MNCH care (Nigeria, Liberia)

2. Revise RED guide, reference materials and monitoring tools for use in planning, organizing and monitoring MNH services for non-HIV positive women and newborns.


4. Monitor and documentation process and collection of results during implementation

ANC, Family Planning, HIV/PMTCT-MNCH Integration, nutrition, ORT, etc.

See Activity 4.2.1 and 4.2.2

iCCM and Malaria: Build evidence base and provide support to countries for implementation and scale-up of iCCM Document iCCM scale-up in three African countries and provide technical assistance in select MCH and PMI focus countries to intro/expand iCCM Co-funded with MCH and Malaria core

1. Review of existing analyses/ assessments of community based pneumonia treatment finalized and published in peer-review journal.

2. Lessons learned with scale-up of iCCM documents

3. iCCM introduced in 2 new countries including an urban setting.

4. Efforts advanced in 2 countries transitioning from BASICS support.

5. Recommendations for iCCM priority preventive interventions formulated (e.g., breast-feeding, complementary feeding, water/sanitation/hygiene, ITN)

1. Finalize review of existing literature/studies/ analyses to identify lessons learned and evidence gaps for iCCM scale-up

2. Work closely with PMI to support use of their framework when assessing countries for iCCM introduction.

3. Document and assess selected iCCM program components based on proposed CCM.ORG modules in at least two countries.

4. Through documentation/ assessment, identify innovative approaches to training, supervision, motivation, monitoring or drug supply to be tested in Year 3.

5. Continue providing technical assistance to iCCM country programs started by BASICS, including DRC (see above) and at least 1 of the following countries: Madagascar, Malawi, Rwanda, or Senegal

6. Based on the analyses, identify 1–2 new countries with USAID and initiate technical assistance activities

7. Collaborate with and leverage SPS and the BMGF CCM Logistics project in countries where they are working to strengthen drug logistics and availability in support of community treatment programs

8. Document prevention practices currently implemented, and develop priority prevention actions to complement CCM

ORT in diarrhea case management, Zinc in diarrhea case mgt, hygiene improvement for the prevention of diarrhea, nutrition


See Activity 4.6.1 and 4.6.3

Immunization: Regional technical leadership and country support Provide direct technical assistance and participate with WHO/AFRO, UNICEF and USAID to mobilize resources and coordinate support to countries In African countries with fragile or underperforming immunization systems, support the development and implementation of strategies to reach unimmunized and partially immunized children with life-saving vaccines Co-funded with MCH and FS

1. USAID immunization support to countries leveraged and well coordinated with WHO, UNICEF and others

2. 1–2 sub-regional RED adaptation/revitalization workshops conducted with WHO/AFRO and UNICEF

3. 2–3 countries in the region complete formal EPI assessments, reviews, country planning exercises, GAVI applications, vaccine introduction plans, etc. with MCHIP input and AFR/SD support

4. 2–3 countries implementing plans to increase coverage among unreached and partially immunized women and children with MCHIP technical support (RED revitalization plans, for example)

1. Contribute to global and regional technical advisory groups, task teams and working groups, including GAVI CSO Task Team, WHO SAGE, TLAC, and Optimise.

2. Participate with USAID in regional coordination and technical update meetings with WHO, CDC and others.

3. Participate in immunization partnership teleconferences and meetings (i.e., SAGE, GIM, TFI, WHO Regional WGs and Managers Meetings, GAVI technical WGs, NUVI, MCC, and VPPAG, AFRO/Africa Bureau collaboration).

4. Facilitate at least one subregional RED adaptation/revitalization workshops for Anglophone or Lusophone countries with WHO/AFRO and UNICEF.

5. Provide technical support to 2-3 countries to uncover the causes of low coverage and underperformance. This may include technical support for rapid assessments; coverage surveys; multi-agency EPI reviews (e.g., DRC, Kenya); rapid cold chain, vaccine management assessments; immunization program and data quality assessments; comprehensive Multi-Year Planning; and annual work planning.

6. Use AFR/SD, MCH and Field Support in 2-3 countries for innovation, advocacy, leveraging, and expansion of proven approaches to reaching unreached women and children with RI services, including RED and other RED-like approaches.

ANC, Family Planning

3.2.3 Newborn infection: Community-based infection management for newborn—Nigeria

1. Community-based management of neonatal sepsis introduced in Nigeria

1. Map status of neonatal sepsis management at community level in sub-Saharan Africa.

2. Provide technical support to the Nigerian Society of Neonatal Medicine (NISONM) to develop a strategic framework for community-based newborn care.

3. Provide technical and financial support to NISONM to introduce community-based management of neonatal sepsis in one selected sub-district.

Newborn

See Activity 2.4.2

PE/E FMN QoCA survey in one country in Africa

1. Conduct the PE/E QoCA survey in collaboration with Africa 2010 in one African Country

1. Dialogue with Africa/SD and Africa 2010, identifying. 2. Identify country research team to conduct the survey. 3. Analyze and present the results at country level.

PE/E, PPH

See Activity 7.3

Strengthen family planning knowledge of midwifery tutors

1. Technical assistance provided to ECSA-HC and Africa’s Health in 2010 to carry out second regional workshop on family planning for midwifery tutors.

1. In collaboration with regional partners provide assistance to define technical content of workshop with an emphasis on evidence-based postpartum and postabortion family planning.

2. Present specific workshop sessions. 3. Participate in follow-up of tutors from MCHIP countries.

SBA

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