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ACCESS Year Four Annual Report

October 1, 2007 – September 30, 2008 Submitted to: United States Agency for International Development under Cooperative Agreement #GHS-A-00-04-00002-00

Submitted by: Jhpiego in collaboration with Save the Children, Constella Futures, Academy for Educational Development, American College of Nurse-Midwives, IMA World Health

Submitted: October 2008 Revised: December 2008

Table of Contents ABBREVIATIONS AND ACRONYMS ............................................................................................IV

SUMMARY ..............................................................................................................................................VII

MAJOR ACHIEVEMENTS IN YEAR FOUR...................................................................................1 SKILLED BIRTH ATTENDANCE .................................................................................................................1

Core Funds ...............................................................................................................................................1 Field Funds ...............................................................................................................................................3 Regional: AFR/SD and Core Funds .........................................................................................................8 Regional: West Africa Funds ....................................................................................................................9

PREVENTION OF POSTPARTUM HEMORRHAGE .................................................................................10

Core Funds .............................................................................................................................................10 Field Funds .............................................................................................................................................10

NEWBORN CARE ......................................................................................................................................13

Core Funds .............................................................................................................................................13 Field Funds .............................................................................................................................................13

ANTENATAL CARE ...................................................................................................................................17

Core Funds .............................................................................................................................................17 Core Malaria Funds ................................................................................................................................17 Field Funds .............................................................................................................................................18

OTHER ACCESS RESULTS FOR WOMEN’S HEALTH...........................................................................20

ACCESS-FP Funds ................................................................................................................................20 Core FP/RH Funds .................................................................................................................................21 Field Funds .............................................................................................................................................21 Preliminary Work on Pre-eclampsia/Eclampsia......................................................................................23

CHALLENGES AND OPPORTUNITIES .......................................................................................24 Challenges..............................................................................................................................................24 Opportunities...........................................................................................................................................25

ANNEX A: CORE ACTIVITY MATRIX...........................................................................................26

ANNEX B: PROGRAM COVERAGE MATRIX............................................................................35

ANNEX C: SUCCESS STORIES .....................................................................................................40

ANNEX D: ACCESS BUREAU AND COUNTRY FUNDING TABLE (PY1–PY4) ...........43

ANNEX E: HIDN RESULTS PATHWAYS REPORT AND OP INDICATORS...................52

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Abbreviations and Acronyms ACCESS Access to Clinical, Community, Maternal, Neonatal & Women’s Health Services

AFSOG Afghan Society for Obstetricians and Gynecologists

AHTOP Accelerated Health Officer Training Program

AMTSL active management of the third stage of labor AMA Afghanistan Midwives Association ANC antenatal care

ANM auxiliary nurse-midwife

ART antiretroviral therapy APHIA AIDS, Population and Health Integrated Assistance Program BCC behavior change communication BEmONC basic emergency obstetric and newborn care BP/CR birth preparedness and complication readiness

BPHS basic package of health services

CAC community action cycle CAG community action group CEDPA Centre for Development and Population Activities CCG community core group CCMT community care management and treatment CMT community mobilization team CHEW community health extension worker CHW community health worker CKMC community-based Kangaroo Mother Care CRP community resource person CTO contract technical officer DFID Department for International Development (UK) DHS Demographic Health Survey DOT directly observed therapy DRH Division of Reproductive Health

EmONC emergency obstetric and newborn care ENC essential newborn care

FANC focused antenatal care

FBO faith-based organization

FMOH Federal Ministry of Health

FP family planning

FRONTIERS Frontiers in Reproductive Health Program

GMAP Global Malaria Action Plan

ACCESS Year Four Annual Report v

HC health center

HEW health extension worker

HIDN health, infectious diseases and nutrition HO health officer HP health post HAS health surveillance assistant HSSP Health Services Support Program IEC information, education and communication IMAI integrated management of adult illness IMCI integrated management of childhood illness IP infection prevention IPT intermittent preventive treatment

IR intermediate result

ITN insecticide-treated (bed) net

IUD intrauterine device JICA Japan International Cooperation Agency KMC Kangaroo Mother Care

LAM Lactational Amenorrhea Method

LBW low birth weight

LGA local government area

LRP learning resource package

MAISHA Mothers and Infants, Safe, Healthy and Alive Program

MCH maternal and child health

MCPC managing complications in pregnancy and childbirth

M&E monitoring and evaluation

MIP malaria in pregnancy

MMAM Primary Health Services Development Programme

MNH maternal and newborn health

MOH Ministry of Health

MOHSW Ministry of Health and Social Welfare

MOPH Ministry of Public Health

MSP making pregnancy safer MWRA married women of reproductive age NASCOP National AIDS and STD Control Programme NFHP National Family Health Program NGO nongovernmental organization NMCP National Malaria Control Programme NRHP National Reproductive Health Program

vi ACCESS Year Four Annual Report

PAC postabortion care

PE/E pre-eclampsia/eclampsia

PITC provider-initiated testing and counseling

PMI President’s Malaria Initiative

PMNCH Partnership for Maternal, Newborn and Child Health

PMTCT prevention of mother-to-child transmission of HIV

POPPHI Prevention of Postpartum Hemorrhage Initiative

PPFP postpartum family planning

PPH postpartum hemorrhage

PQI performance and quality improvement

QI quality improvement

QQT quality improvement team

RACHA Reproductive and Child Health Alliance

RBM Roll Back Malaria

RCH reproductive and child health

RHAC Reproductive Health Association of Cambodia

RH reproductive health

RN/M registered nurse-midwife

SBA skilled birth attendance/attendant

SBAI Safe Birth Africa Initiative

SBM/R Standards-Based Management and Recognition SIP syphilis in pregnancy

SNL saving newborn lives

SP sulfadoxine-pyrimethamine

SSC skin-to-skin care

TBA traditional birth attendant

TIMS© Training Information Monitoring System

TOT training of trainers

UNFPA United Nations Population Fund

UNICEF United Nations Children’s Fund

USAID United States Agency for International Development

VIA Visual Inspection of the cervix with Acetic Acid

WHO World Health Organization WRA White Ribbon Alliance

ACCESS Year Four Annual Report vii

Summary The Access to Clinical and Community Maternal, Neonatal and Women’s Health Services (ACCESS) Program seeks to increase use and coverage of maternal, neonatal and women’s health and nutrition interventions. ACCESS is a five-year, $75 million Leader with Associate Awards to Jhpiego in collaboration with Save the Children, Constella Futures, the Academy for Educational Development, American College of Nurse-Midwives and IMA World Health. Since its start in July 2004, ACCESS has received $65.2 million, leaving approximately $9.8 million for FY08 obligations before reaching the Program ceiling. ACCESS has worked in more than 25 countries with large country programs in Bangladesh, Tanzania, Kenya, Nigeria, Malawi, Ethiopia, South Africa and Rwanda. ACCESS has received four associate awards: ACCESS-FP, ACCESS/Afghanistan (Health Services Support Program [HSSP]), ACCESS/Cambodia, and Mothers and Infants, Safe, Healthy and Alive (MAISHA/Tanzania). This report presents ACCESS Program results and activities from 1 October 2007 to 30 September 2008 and is organized by the four results pathways of the United States Agency for International Development’s (USAID) Office of Health, Infectious Diseases and Nutrition (HIDN): skilled birth attendance (SBA), antenatal care (ANC), postpartum hemorrhage (PPH) and newborn care. Important results that do not fit under these pathways are presented under an “other results” category. The final section in this report discusses challenges and programmatic opportunities. Over the past year, through its global program implementation and technical assistance, ACCESS programs made skilled delivery care, including prevention of postpartum hemorrhage services and essential newborn care, available to over eleven million women of reproductive age in eight countries (Afghanistan, Ghana, India, Kenya, Malawi, Nigeria, Rwanda and Tanzania). In Bangladesh, ACCESS-trained counselors promoted essential newborn care at home births: of 38,306 women reached postpartum: 96% of newborns had clean cord care, 85% mothers initiated breastfeeding within one hour of birth, 87% of newborns were dried and wrapped immediately after birth. Beyond the results pathways, ACCESS activities have led to improved coverage for family planning in Nigeria and Kenya, improved post abortion care in Malawi and Haiti, and improved services in PMTCT and ARTs. In Malawi, Afghanistan, South Africa, Nigeria, Ghana, Kenya and Rwanda, ACCESS has improved the quality of care using performance standards at over 330 health facilities. ACCESS has continued collaboration with the World Health Organization (WHO), the Partnership for Maternal, Newborn and Child Health (PMNCH) and the White Ribbon Alliance (WRA). Through our small grant awards for innovative work, faith-based organization (FBO) grants are being implemented by a team representing both Islamic and Christian FBOs and the Ministry of Health (MOH), thereby strengthening working relationships and developing new strategies for sharing knowledge across networks. And with key stakeholders from USAID, UNICEF, Saving Newborn Lives (SNL), USAID cooperating agencies, researchers and field staff, ACCESS sponsored a one-day consultation meeting to discuss community-based skin-to-skin care (SSC) for low birth weight newborns.

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In the area of malaria, ACCESS contributed to the development of the Roll Back Malaria (RBM) Global Malaria Action Plan (GMAP)—which was finalized in September 2008—through its membership in the Malaria in Pregnancy (MIP) Working Group. When GMAP was officially launched in September at the Millennium Development Goals Summit in New York and in malaria-endemic regions, it was introduced as the global road map for malaria control and elimination around which all stakeholders can coordinate their actions. ACCESS also revised the Malaria Resource Package developed in 2003 to add updated information on MIP and to include an implementation guide. The guide, which outlines seven essential programming components that are needed to put MIP policy into practice at the health facility level, draws on existing country experiences, best practices and lessons learned for practical implementation. The ACCESS Program Web site, which is used to share news and disseminate key tools and resources, had nearly 10,000 new visitors in this year alone, and more than 4,000 people have now completed the seven ACCESS-developed USAID Global Health e-learning courses since their inception. ACCESS has also achieved key results using core funds at the country level. In Kenya and Rwanda, ACCESS contributed to efforts to update the knowledge and skills of service providers in the prevention of postpartum hemorrhage (PPH). From January to September 2008 at health facilities in two ACCESS focus districts in Rwanda where training has been completed, 91% of vaginal births received AMTSL. In India, ACCESS and CEDPA are working together to increase access to and demand for skilled community-based midwives. And in Nigeria, ACCESS continued work with the Mada community in Zamfara State to address financial barriers to health services, including developing ways for women to save and loan money to one another. Using field support funds in multiple countries, ACCESS worked to develop and provide input into national policies on maternal and newborn health (MNH) as well as to scale up capacity building, community outreach and demand generation for MNH interventions:

Over the past year, Kangaroo Mother Care (KMC) has continued to be supported in five country programs—Nigeria, Bangladesh, Malawi, Nepal and Rwanda (using core funds). In Rwanda, KMC was expanded to seven more hospitals.

In Ethiopia, ACCESS initiated the basic emergency obstetric and newborn care (BEmONC) skills strengthening of faculty for pre-service training of health officers and prepared materials for and initiated in-service training of health extension workers (HEWs). ACCESS/Ethiopia increased access to key MNH services by arranging to obtain free misoprostol for HEWs to use to prevent PPH in the third stage of labor, and trained 358 HEWs to improve service delivery at the health post and community levels.

In Cambodia, ACCESS contributed to the revision of national postabortion care (PAC) guidelines, assisted national MNH working groups and updated an integrated postnatal care (PNC) package for midwives for the MOH, which is being field-tested and developed through a partnership of nine international and local organizations.

In Nepal, ACCESS provided technical assistance to the USAID bilateral and Ministry of Health (MOH) to plan an intervention on community-level prevention of eclampsia using high doses of calcium.

ACCESS Year Four Annual Report ix

Afghanistan HSSP finalized national quality assurance standards, which were used to improve the quality of services as documented in baseline and follow-up assessments. HSSP also continued to build the capacity of local nongovernmental organizations (NGOs) implementing the basic package of health services (BPHS). The government of Afghanistan is moving forward to scale up, in a phased manner, the provision of misoprostol at the community level—a direct consequence of the pilot project for community-based prevention of PPH in Afghanistan, where results showed that the use of misoprostol is safe and programmatically effective.

ACCESS/Tanzania held a successful White Ribbon Day event with over 500 participants and assisted Zanzibar to form its own White Ribbon Alliance (WRA). ACCESS continued to scale up focused antenatal care (FANC) training in Tanzania nationally, and was cited for its good work during President Bush’s visit to the country.

President Bush visited Tanzania in February 2008 as part of an effort to observe the current PMI- and PEPFAR-funded initiatives in action. In preparation for this visit, ACCESS developed a press release; identified useful FANC information, education and communication (IEC) materials for display during official site visits; and provided updated program information to USAID for use in preparation of presidential remarks during his visit. The ACCESS FANC program was highlighted by President Bush during a speech he made at Meru District Hospital.

In Malawi, ACCESS continued to increase the quality of reproductive health (RH) services by supporting the Minitry of Health/Reproductive Health Unit to apply the Standards-Based Management and Recognition (SBM-R) quality improvement (QI) approach. At a national stakeholders meeting, RH focal persons from six participating district hospitals presented findings from their internal QI assessments, which measured 14 areas of RH, including prevention and management of PPH. Baseline results from March 2008 were similar across facilities, with a mean score of 34%. By August 2008, all facilities showed improvements, with a mean score of 71%.

A rapid needs assessment sponsored by ACCESS and NMCP in Malawi identified a severe shortage of staff trained on FANC and MIP and shortages of SP and other supplies for IPTp by directly observed therapy (DOT). In response, ACCESS trained 680 ANC service providers from all 28 districts in FANC/MIP and provided basic supplies for IPTp to all 730 health facilities across the country. Supportive supervision visits to 56 facilities revealed that over 80% had the requisite DOT supplies.

In Bangladesh, trained counselors conducted 84,014 pregnancy preparedness home visits, counseling pregnant women on healthy MNH behaviors and steps to take to prepare for birth. The counselors reached 18,999 (50%) recent mothers within 24 hours and 25,800 (67%) within 72 hours and conducted postpartum counseling visits. Among 38,306 women reached: 48% had a birth plan, 76% newborns were attended by a newborn care person, 96% of newborns had clean cord care, 85% mothers initiated breastfeeding within one hour of birth, 87% of newborns were dried and wrapped immediately after birth, and 80% of mothers delayed bathing their newborns for three days.

In Kenya, ACCESS worked to support the Division of Reproductive Health (DRH) to move forward with prevention of mother-to-child transmission of HIV (PMTCT) standards and services. Providers at ACCESS-supported pilot sites in Kenya successfully provided

x ACCESS Year Four Annual Report

integrated ANC/tuberculosis screening services. In addition, Kenya helped develop new policy guidelines on reproductive tract cancer and HIV counseling and testing. ACCESS moved toward integration of FP and STI services with HIV/AIDS services in Kenya with the development of two orientation packages—an FP orientation package and a STI orientation package—for service providers working in comprehensive HIV care centers. Both orientation packages were adopted by the NASCOP and other partners.

In South Africa, ACCESS-supported facilities demonstrated improved quality of antiretroviral therapy (ART) services and technical assistance led to the revision and dissemination of various HIV/AIDS service delivery guidelines.

During this reporting period in Nigeria, 22,092 women delivered with a skilled birth attendant at 18 ACCESS-supported facilities. Of these, 18,471 women received AMTSL (99% of vaginal births). At 16 ACCESS-supported facilities, 10,400 births (42%) were managed using the partograph. In addition, 1,284 women with eclampsia received treatment according to protocol at 17 hospitals reporting. And 18,037 mothers and newborns received postpartum/postnatal care within three days at 34 ACCESS-supported hospitals. With respect to family planning (FP), 26,836 individuals received FP counseling (23,485 females and 901 males at 37 facilities and 2,450 counseled by household counselors) and 1,974 clients at 25 facilities received FP counseling postpartum.

While new country programs, such as Malawi and Ethiopia, began activities during this reporting period, several other existing ACCESS country programs closed, including Haiti, West Africa and ACCESS/Afghanistan (separate from HSSP). ACCESS also received a new associate award in Tanzania—the Mothers and Infants, Safe, Healthy and Alive (MAISHA) Program—to improve clinical and community maternal, neonatal and women’s health services. Under the MAISHA Program, Jhpiego and its partners will collaborate with the Tanzanian MOHSW to deliver critical, evidence-based health interventions on a national scale to reduce maternal and newborn morbidity and mortality, contributing to the achievement of the national targets for Millennium Development Goals (MDGs) Four and Five. The ACCESS/Tanzania program has already successfully implemented this strategy to address malaria in pregnancy (MIP) and syphilis in pregnancy (SIP) using the platform of focused antenatal care (FANC), and will continue to do so under MAISHA. Similarly, ACCESS will assist the Tanzanian MOHSW to strengthen basic emergency obstetric and neonatal care (BEmONC), including the prevention and treatment of PPH, newborn resuscitation, treatment of sepsis, and immediate warming and drying. Finally, the MAISHA program will strengthen the platform of prevention of mother-to-child transmission of HIV/AIDS (PMTCT) established by USAID partners to address gaps in integrating MNH services for HIV-positive women and children. Overall, the MAISHA technical approach will adhere to the principles of integration, national coverage, quality, sustainability, accountability, innovation, gender equity and cost-effectiveness.

ACCESS Year Four Annual Report xi

ACCESS Year Four Annual Report 1

Major Achievements in Year Four SKILLED BIRTH ATTENDANCE Core Funds

In Nigeria, ACCESS continued work with local stakeholders and representatives from Zamfara State to implement a community initiative to address financial barriers to antenatal, obstetric and post-obstetric services. Members of the community were trained as facilitators for the Village Savings and Loan Associations, which now have 120 members. Eight Village Savings and Loan Associations were established—six more than originally planned due to high demand—to help women save money for themselves, for MNH-related and other emergencies, and for helping community members.

Collaborated with global stakeholders to support the international Women Deliver conference in London on 18–20 October 2007, including support to more than 20 participants and panelists. ACCESS and ACCESS-FP facilitated several panel discussions on PPH, SBA, postpartum family planning (PPFP), FBOs and malaria in pregnancy (MIP). WRA representatives presented panel discussions and provided country examples; two representatives from faith-based health networks in Africa presented papers that raised awareness of the role of FBOs in providing health care services.

Major issues to be addressed in the revision of the Managing Complications in Pregnancy and Childbirth Manual have been identified, and ACCESS staff are in the process of re-writing assigned technical sections. Communication with the Making Pregnancy Safer Department of WHO has been on-going to determine a revised timeline given the present delay.

USAID’s Global Health Maternal Survival: Programming Issues e-learning course was completed by more than 250 users since it was uploaded.

Continued to support the Partnership of Maternal, Newborn and Child Health (PMNCH) with a technical advisor who is assisting with implementation of their global activities.

Continued work on the “Guide to Save Mothers and Newborn Lives: A Toolkit for Religious Leaders” to help build the capacity of Christian and Islamic leaders to promote safe motherhood through their sermons and other presentations.

From January to September 2008 at three hospitals and 13 health centers in two ACCESS focus districts in Rwanda where EmONC training has been completed, 91% of vaginal births received AMTSL and 94% of all births were managed using the partograph.

In Rwanda, ACCESS expanded beyond the initial four districts. A new group of national-level trainers was trained. ACCESS and partners assisted the Ministry of Health (MOH) to design a plan for national-level scale up of the MNH strategy. A health facility survey and the qualitative assessment were completed and preliminary reports shared with the MOH and partners. Results informed the development of a draft national community behavior change strategy.

In Rwanda, nine hospitals and their corresponding health centers are benefiting from medical equipment and supplies donated by ACCESS to improve services and safe birth outcomes; increased use of partographs, AMTSL and infection prevention practices have been observed at six district maternity hospitals and 29 health centers; and trainers are ready

2 ACCESS Year Four Annual Report

Newly graduated midwives in Badakshan Province, Afghanistan, take the midwives’ pledge.

to begin on-the-job training of providers at five district hospitals, which is the next step in the strategy to scale up EmONC services in Rwanda.

In Ghana, ACCESS expanded activities—including all modules, BEmONC training, coaching, internal and external assessments, data collection and related training—to the southern part of the Birim North District to include eight new facilities, one of which is a district-level hospital, bringing the total number of facilities covered under the project to 11. Completed SBM-R Modules I, II and III for all 11 facilities. Trained five external assessors to increase sustainability of the quality improvement process and make the Birim North District a national model for the accreditation process.

In Ethiopia, 10 health centers that refer cases to Ambo Hospital Maternity Services were assessed, and EmONC service delivery improved at these health centers with the support of ACCESS and the Ethiopian Society of Obstetricians and Gynecologists (ESOG). Nine of 10 providers were trained in BEmONC (one provider was on leave), and referral linkages between 10 health centers and Ambo Hospital were strengthened.

In Jharkhand, India, where ACCESS and CEDPA trained an additional 19 auxiliary nurse-midwives (ANMs) to competency as SBAs in evidence-based care, and all 37 ACCESS-trained ANMs were provided continued support so that they could provide care in the community and at functional facilities. Among the reporting ANMs, AMTSL was provided at over 94% of deliveries and more than 98% of the newborns delivered by ACCESS-trained ANMs had clean cord care, immediate breastfeeding (within an hour), and immediate drying and wrapping. ACCESS also field-tested and finalized an ANM learning resource package, and continued to strengthen two hospitals and two ANM schools as training centers.

In India, worked with NGO Chetna Vikas to mobilize 223 villages and train more than 3,700 community members, resulting in 100% of these ACCESS-supported villages having a functional emergency transport system for birth preparedness and complications readiness (BP/CR) during pregnancy and childbirth, and 69% using the services provided by the ACCESS-trained ANMs in their area.

In Nepal, developed SBA in-service training site standards (tools), and supported eight training sites with use of the tools to make improvements and monitor the quality of SBA training. Disseminated six project reports on key interventions and results.


Field Funds At the request of the national Postabortion Care (PAC) Technical Working Group in

Cambodia, drafted an additional chapter to introduce medical management of incomplete abortion for the national postabortion care (PAC) guidelines, and an accompanying outline for a training module. The national protocol is being used to standardize PAC services in Cambodia.

Provided technical expertise and leadership at the national level in Cambodia as a member of coordination bodies at the MOH, including membership of the Secretariat of the High-Level Midwifery Task Force and the National Neonatal Health sub-working group. ACCESS technical assistance helped the MOH develop a vision statement, terms of reference and a five-year work plan for the Secretariat of the Midwifery Task Force.

In Afghanistan, 139 community midwives graduated from HSSP-supported community midwifery education programs. The midwives were trained in an 18-month competency-based program and have now been deployed to rural and remote areas of Afghanistan.

Afghanistan HSSP continued to build the capacity of NGOs implementing the Basic Package of Health Services (BPHS), training 607 health providers, NGO managers and representatives from the central and provincial MOPH to improve performance in: IP, partnership-defined quality, rational use of drug/management drug supply, gender, general management, behavior change communication (BCC) and human resource management.

Quality assurance standards for 14 areas of the Basic Package of Health Services (BPHS) have been finalized in collaboration with the Afghanistan Ministry of Public Health (MOPH) and the Central Quality Assurance Committee. Baseline assessment results from 38 health facilities in five provinces were presented to the leadership of the MOPH, and HSSP has been asked to expand implementation of the process to all 13 provinces supported by USAID. NGOs are implementing action plans to bridge the performance gaps identified.

Afghanistan HSSP continues its secretarial and technical support to the National Midwifery Education Accreditation Board (NMEAB) to monitor the quality of the midwifery education programs across the country. Over the last year, 13 midwifery education programs were re-accredited. All HSSP schools that were due for accreditation have also been re-accredited (see Figure 1 below).


The winning WRA quilt panel in Afghanistan depicting the story of Bibi Maroon, who died in childbirth.

Figure 1: Assessment Scores for Midwifery Schools

Afghanistan HSSP continued to provide technical support to the Afghanistan Midwives Association (AMA), and has now extended its support to the Afghan Society for Obstetricians and Gynecologists (AFSOG) to strengthen obstetric care. A partnership has been established between the two professional associations, with the AMA providing AFSOG with support in how to run a professional association. Both associations celebrated annual congresses, with the AMA celebrating its Fourth Annual Congress. AFSOG conducted their second congress, attended by 150 participants, with the theme, “Afghan obstetricians, gynecologists and midwives are working together to make women and newborn health better in Afghanistan.” AMA also ran a competition to design a quilt panel for the White Ribbon Alliance’s Mothers’ Memorial Quilt, started in 2007.

Three facilities in Malawi achieved target levels of performance and quality in IP with scores above 80% (88–91%) on IP standards. The facilities were nationally recognized by the MOH.

Developed a Community Mobilization Training Manual for the community MNH package in Malawi and trained 40 more HSAs. The manual targets trainers who train and supervise HSAs on community-level MNH knowledge and skills. Those receiving community mobilization training will be able to support collective analysis, planning and action within villages to combat issues that are more effectively addressed on a community level, such as

Non-binding and binding assessments of HSSP supported midwifery education schools against midwifery education

standards over all compliance by province

83% 83%82%88% 89%91%

95%97%95%92%

97% 98%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Badakhshan Bamyan Hirat Khost Paktiya Takhar

Non-Binding

Binding

Data source: HSSP accreditat ion dbDate: September 2008


President of the United Republic of Tanzania, Jakaya Kikwete, holds a baby at the WRA White Ribbon Day Ceremony.

lack of available transport or local financing schemes to enable the poorest families to take short-term loans for MNH-related emergencies.

In Malawi, assisted the MOH to strengthen BEmONC and PAC pre-service training following a national assessment in 2005, which showed that Malawi has only 2% of the WHO-recommended number of BEmONC facilities. ACCESS trained 12 tutors and 9 preceptors from all 13 nurse-midwifery training institutions in the delivery of BEmONC. Ten tutors and 8 preceptors were also trained in PAC.

The WRA of Tanzania, with support from ACCESS and other key partners, coordinated a successful White Ribbon Day event, with the President of the United Republic of Tanzania and his wife as the guests of honor. The WRA also provided technical assistance to Zanzibar to establish its own chapter of the Alliance, which was launched in March 2008.

ACCESS/Tanzania collaborated with the Ministry of Health and Social Welfare (MOHSW) to establish a Safe Motherhood Working Group, a sub-group of the Reproductive and Child Health Services National Coordination Group, to address MNH issues and the policy and social environments. ACCESS is the Secretariat for this national working group. The Safe Motherhood Working Group, in collaboration with the UN bodies and the MOHSW, organized a successful launch of the ambitious One Plan to cut the number of maternal, newborn and child deaths—alongside an advocacy campaign, Deliver Now for Women and Children in Tanzania—to mobilize communities around this issue. The launch was officiated by the President of United Republic of Tanzania and the Honorable Prime Minister of Norway on 22 April 2008 in Dar es Salaam.

Provided assistance to the Tanzania MOHSW, along with multiple UN agencies, to revise the One Plan, the implementation strategy for the National Road Map Strategic Plan to Accelerate Reduction of Maternal and Newborn Deaths in Tanzania (2006–2010). ACCESS also provided support to the Zanzibar MOHSW in developing their own national road map.

Strengthened the Accelerated Health Officer Training Program (AHOTP) in Ethiopia: upgraded eight of 20 hospitals in the country to serve as training sites; updated BEmONC knowledge and skills of faculty from AHOTP-affiliated universities and providers in the eight selected training hospitals to ensure standardization and quality of MNH training.


Bedessa Ethiopian mother and child.

In Ethiopia, strengthened the capacity of Ethiopian Institutions to train health extension workers (HEWs) in the Oromia region: upgraded 12 health centers to serve as training sites; developed HEW safe and clean delivery learning resource package in collaboration with the Federal Ministry of Health, UNICEF, Save the Children US, the Ethiopian Nurse Midwives Association and others; and trained trainers from the health centers.

ACCESS/Ethiopia arranged to obtain free misoprostol for HEWs to use to prevent PPH in the third stage of labor and contributed content on use of misoprostol for the national HEW training manual. Also trained 358 HEWs to improve service delivery at the health post and community levels and, to ensure transfer of skills on the job, provided supportive supervision visits to all health centers (HCs) and health posts (HPs) where the trained HEWs are posted.

In Ethiopia, improved MNH recordkeeping, set up a monitoring and evaluation system that captures MNH outcomes related to pregnancy, delivery and postpartum care (home visits at third trimester and postnatal period). Data collection instruments to link HPs to the community were revised and HEWs were oriented on the revisions.

During this reporting period in Nigeria, 22,092 women delivered with an SBA at 18 ACCESS-supported facilities. Of these, 18,471 women received AMTSL (99% of vaginal births). At 16 ACCESS-supported facilities, 10,400 births (42%) were managed using the partograph.

ACCESS/Nigeria conducted baseline SBM-R EmONC assessments in all its new facilities, provided feedback to facility staff, and provided technical assistance for action plan development with the quality improvement team members in the facilities. ACCESS facilitated follow-up assessments in continuing facilities and held a meeting for the development of FP performance standards to complement the EmONC performance standards. Scores for EmONC standards at six hospitals completing follow-up assessments are provided in Figure 2 below.


Trained household counselors in a role play in Nigeria.

Figure 2. EmONC Performance Scores in Nigerian Hospitals

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MMSH GezawaGH

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Zurmi GH KF-WCH

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In Nigeria, ACCESS renovated eight health facilities in Kano and Zamfara States and awarded contracts for additional five selected facilities.

ACCESS/Nigeria trained 85 female household counselors in Kano and Zamfara States who have started conducting household visits, three days per week and three to five visits per day to pregnant women in their communities. They counsel on the importance of ANC and BP/CR, inform about the danger signs during pregnancy, delivery and postpartum/newborn, and describe the importance of breastfeeding and birth spacing using the counseling flip chart developed by ACCESS.

ACCESS/Nigeria increased the capacity of community mobilizers to promote MNH using the community action cycle (CAC) concept. Twenty-one community mobilizers in Kano, Katsina and Zamfara States were trained as trainers, who in turn trained community mobilization teams (CMT) and community core groups (CCG) on how to mobilize communities for MNH in the 10 new local government areas (LGAs) in the three states. The trained CMTs and CCGs created 24 work plans, which are now being implemented.


Transporting a pregnant woman, Tanzania.

Regional: AFR/SD and Core Funds Completed revisions to the Best Practices in Essential and Basic Emergency Obstetric and

Newborn Care LRP based on pre-test recommendations. Package is currently being copyedited and formatted.

Planned and held second regional Clinical Training Skills and Curriculum Design courses in April for approximately 20 pre-service midwifery educators from three countries (Ethiopia, Ghana and Tanzania) to build more champions for integrating best practices in BEmONC with midwifery education and practice. Participants assisted in the facilitation of BEmONC Technical Update and Clinical Skills Standardizations in Ethiopia and Ghana, and will participate in upcoming advocacy meetings at the national level.

Integrated the MNH situation analysis with the MOH/Niger 2008 plan with Road Map partners in Niger, and prepared to implement it at the district level.

WHO-AFRO and ACCESS developed the capacity of six country teams to develop, implement and evaluate national road maps in Anglophone countries in eastern and southern Africa1 at a regional workshop in Entebbe, Uganda. Representatives from Malawi, the country most advanced in the operationalization of the Road Map, shared

their experience using a systematic approach to assess and analyze the situation as well as design and plan activities. Ugandan participants shared their successful experiences in community MNH and putting in place a functional MNH monitoring and evaluation system. Each team developed a plan for further operationalization of the Road Map in their own country and identified needs for technical assistance.

The regional Road Map workshop in Entebbe highlighted the need to provide countries with clear guidance on how to operationalize the Road Maps, especially at the district level. ACCESS translated the original WHO-AFRO Road Map guidelines from French to English and revised the draft guidelines with WHO-AFRO and partners at a meeting in Addis Ababa. ACCESS, WHO-AFRO and partners also reviewed the framework for the integration of FP, PMTCT, MIP and nutrition with MNH care during the same meeting.

Assisted the MNH team in Zambia to develop a strong and realistic advocacy plan to support the operationalization of the Road Map at the district level by using critical information—which was generated during a REDUCE-ALIVE workshop in Zambia—to promote MNH as one of the government’s priorities. A few donors also committed to support the implementation of the advocacy plan.

1 Country teams were from Malawi, Zambia, Uganda, Kenya, Namibia and Ethiopia.


Regional: West Africa Funds Participated in an assessment visit to Ngaoundere District, Cameroon, along with AWARE-

RH partners, with results showing: At the Protestant Hospital of Ngaoundere District, six staff members were formally

trained in EmONC and had used their new skills to educate other colleagues. The labor ward, antenatal clinic and postnatal clinic were all found to be clean and using appropriate IP practices (e.g., disposal of sharps). Moreover, essential care of the newborn was integrated with routine operations (e.g., protocols for newborn care were posted on the wall and underweight twins were in incubator care).

The Nurse Aide Training School integrated some FANC, partograph, AMTSL, IP and orientation to community mobilization techniques with its curriculum.

Cameroon held a dissemination of best practices workshop during which results from both clinical and social mobilization efforts under ACCESS, as well as other activities on developing referral systems and health mutual schemes, were shared, including:

Utilization of ANC services rose from 45% of pregnant women in 2004 to 63% in 2007 in urban areas, and from 29% to 80% in rural areas of Ngaoundere District.2

Facility-based deliveries in Ngaoundere rose from 16% in 2004 to 47% in 2007. The proportion of cesarean sections was nearly zero in 2004 and rose to 1.6% in 2007. A total of 94 providers were trained in EmONC and five were developed as trainers. For

social mobilization, 22 trainers were trained from 18 health zones, who in turn trained 575 community members. Thus, a core group of EmONC and social mobilization trainers was created as a resource for the country.

2 Data source: Presentation by District Health Team/Adamaoua.


PREVENTION OF POSTPARTUM HEMORRHAGE Core Funds

USAID’s Global Health Preventing PPH and Postpartum Care e-learning courses were completed by more than 500 users this reporting period, and more than 800 since inception.

Continued as chair of the Prevention of Postpartum Hemorrhage Initiative (POPPHI) technical working group on training, and participated in the technical working groups on uterotonic drugs and devices, and PPH. With ACCESS support, an AMTSL learning resource package is now available through the POPPHI Web site.

Supported nine technical and advocacy meetings on prevention of PPH in Cambodia attended by 62 stakeholders from USAID, UNICEF, UNFPA, WHO, JICA, GTZ, Save the Children, RACHA and RHAC, as well as the Director and Deputy of the National Reproductive Health Program (NRHP), Pursat, Provincial MCH staff, and national NRHP staff.

ACCESS/Cambodia prepared for PPH project implementation. Specifically, ACCESS/Cambodia drafted a BCC package; developed training materials; conducted an assessment of the referral hospital in Pursat to examine its ability to treat referred PPH cases; and completed a detailed implementation plan in collaboration with the NRHP and RACHA3. The PPH project proposal and accompanying materials were submitted for review to the Cambodian Ethical Review Committee.

Continued support and follow up of small grants to seven local organizations in six African countries (Madagascar, Kenya, Ethiopia, Burkina Faso, Mali and Democratic Republic of the Congo), who are continuing their country-level PPH activities to expand training for AMTSL. As of October 2008, ACCESS has trained 236 health care providers and 47 community leaders, and reached more than 100,000 community members with its PPH subgrants.

In Kenya, the MOH reference manual for the prevention and management of PPH was completed with ACCESS support. This guide for service providers will be used nationwide—primarily through the USAID major funding mechanism, APHIA—to update the knowledge and skills of service providers in the prevention of PPH. Twenty TOTs have been developed to assist in the scale-up of PPH prevention efforts nationwide.

Field Funds

Developed HEW safe and clean delivery learning resource package, oriented trainers to the package, and strengthened clinical sites (seven hospitals and 12 health centers) in Ethiopia to ensure adequate resources to support the learning and training activities of health officers and HEWs, who provide services at the health post and community levels, and will provide misoprostol to prevent PPH.

3 The Cambodian Ethical Review Committee did not approve the distribution of misoprostol; therefore, ACCESS will focus on strengthening AMTSL.

Participant practices bimanual compression of the uterus during PPH training in Kano State, Nigeria.


ACCESS-supported facility, Malawi.

HSSP presented final results from the community-based prevention of the PPH pilot project in Afghanistan to the MOPH and key stakeholders, providing convincing evidence of the effectiveness of the intervention to prevent PPH at homebirths (see Figure 3 below). The MOPH has approved the gradual expansion of the community-based prevention of PPH pilot project in the three provinces where the demonstration was conducted, as well as to two additional provinces.

Figure 3: Coverage of Community-Based PPH Interventions, Afghanistan

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In order to further strengthen the ACCESS/Nigeria objective of reducing maternal mortality as a result of PPH, ACCESS provided four community health extension workers (CHEWs) and 15 nurse-midwives from ACCESS-supported facilities with an additional two-day training on the prevention and management of PPH, the leading cause of maternal mortality in Nigeria.

ACCESS/Nigeria continued to increase the capacity of providers at its target facilities in EmONC (including prevention and management of postpartum hemorrhage), family planning, (including the Intrauterine Contraceptive Device, JADELLE® and PPFP), focused antenatal care, pregnancy-induced hypertension, and the SBM-R approach to quality improvement.

Technical updates in the prevention of postpartum hemorrhage, cervical cancer and pre-eclampsia were conducted for the Division of Reproductive Health (DRH) and partners in


Kenya to enable them to advocate, formulate, inform and disseminate national policies and guidelines. For example, the DRH managers—using the USAID-funded provincial APHIA programs—have since provided technical assistance to their provincial counterparts.

In Malawi, continued to increase the quality of RH services by supporting the MOH/RHU to apply the SBM-R quality improvement (QI) approach. ACCESS trained 108 members of district-level QI support teams in QI for RH. ACCESS held a national stakeholder’s meeting at which district health management teams and RH focal persons from six participating district hospitals presented findings for their internal QI assessments; baseline results from March 2008 were similar across facilities, with a mean score of 34%. By August 2008, all facilities showed improvements, with a mean score of 71%. Scores for standards related only to normal delivery, including AMTSL, are presented in Figure 4 below.

Figure 4. Results of Normal Labor and Delivery Assessments, Malawi, January–August 2008

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Community meeting, Bangladesh.

NEWBORN CARE Core Funds

Sponsored a one-day consultation meeting with 43 key stakeholders from USAID, UNICEF, SNL, USAID cooperating agencies, researchers and field staff to discuss community-based skin-to-skin care (SSC) for low birth weight newborns. Participants also made recommendations for delivery approaches, such as carrying out SSC in the community as part of a package of essential newborn care interventions (not as a stand-alone intervention), and recommending SSC for all newborns where feasible and acceptable.

Drafted articles on community-based management of neonatal sepsis and Kangaroo Mother Care (KMC) for the MotherNewBorNet newsletter. The first article on community-based management of neonatal sepsis is under final review and will be disseminated in October; the second will be finalized in November 2008.

USAID’s Global Health e-learning courses on Essential Newborn Care and Emergency Obstetric and Newborn Care were completed by more than 800 users this reporting period, and more than 1,100 since inception.

Field-testing in Rwanda, Nepal and Nigeria contributed to the final global facility-based KMC facilitators’ and participants’ manuals.

In Ethiopia, ACCESS adapted KMC training manuals for use, conducted KMC training of trainers for 16 health staff, and introduced KMC services in five hospitals.

In Nepal, ACCESS integrated KMC into postnatal care for low birth weight/premature babies at four hospitals and three primary health centers. Established facility-based KMC services at Mahakali Zonal Hospital and three primary health care centers, and trained 814 female community health volunteers on community KMC.

Based on lessons learned from ACCESS-funded activities in Kanchanpur District, Nepal, ACCESS developed national guidelines for management of LBW infants and KMC, which were endorsed by the MOHP and will be included as part of a community-based integrated neonatal care package to be implemented nationally.

In Rwanda, ACCESS initiated KMC services in seven hospitals, including the University Teaching Hospital in Kigali. Trained 24 service providers in KMC from the eight hospitals.

Field Fund

In Bangladesh, completed a community mobilization scale-up strategy and updated the maternal and newborn health (MNH) and community mobilization (CM) manuals and completed refresher trainings of over 1,160 individuals. The program also developed an MNH orientation manual for village doctors and initiated trainings.3In Bangladesh, CM activities have reached a population of over 500,000 in this reporting period. Of 458 community action groups (CAGs) formed, trained and supported by the project, 403 groups completed action plans to


address priority MNH problems. One in every four villages has already established a community-managed emergency transport system. Additionally, one in four has established an emergency finance scheme to assist women and newborns in obtaining timely, appropriate MNH care from difficult-to-reach public service points.

In Bangladesh, developed key training manuals in English and Bangla (for traditional birth attendants and community-based KMC) and held trainings of trainers (TOT): Trainers are training ACCESS counselors to coach mothers to provide KMC to all newborns.

Completed baseline survey data collection and preliminary analysis in Bangladesh and disseminated initial findings to district stakeholders.

Trained counselors in Bangladesh were notified of 38,306 deliveries during the reporting period. They reached 18,999 (50%) of those recent mothers within 24

hours and 25,800 (67%) within 72 hours, and conducted postpartum counseling visits. Among 38,306 women reached postpartum: 48% had a birth plan, 76% newborns were attended by a newborn care person, 96% of newborns had clean cord care, 85% mothers initiated breastfeeding within one hour of birth, 87% of newborns who were delivered at home were dried and wrapped immediately after birth, and 80% of mothers delayed bathing their newborns for three days. (See Figure 5 on the following page for comparisons with last year).

Male community members discussing women’s health, Bangladesh.


Figure 5: Practice of Key MNH Behaviors in Sylhet, Bangladesh by Year

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In collaboration with stakeholders, developed Malawi’s national Community Mobilization (CM) Training Manual. The manual targets trainers who train and supervise health surveillance assistants (HSAs), enabling them to train HSAs to empower communities to identify and solve their MNH issues. To date, ACCESS has trained 10 master CM trainers, and 30 district trainers.

Facilitated the integration of targeted community MNH activities into the District Implementation Plans in three ACCESS-focus districts in Malawi (Rumphi, Nkhotakota and Machinga) as part of the national pilot program to mobilize HSAs to provide counseling and referral services to antenatal and postnatal women in the community. Activities included: training of HSAs in the community MNH package; training in monitoring and supervision; organizing drama groups; and mobilizing community-based health care workers to increase access to MNH. Trained HSAs have the knowledge and skills to identify pregnant and postpartum women, provide counseling on MNH care, recognize danger signs, counsel on family planning and refer when appropriate.

Trained HSA, Rumphi, Malawi.


PNC role play during a training in Cambodia.

ACCESS/Malawi established KMC as a strategy to decrease neonatal mortality in three focal districts in Malawi. Following a KMC needs assessments in 13 health facilities in the three ACCESS districts, the program facilitated the establishment of KMC units, trained 47 service providers in KMC and ENC, conducted follow-up supervision visits and provided technical assistance to the DHMT to modify and restructure the neonatal ward to include a KMC unit.

In Nigeria, 18,037 mothers and newborns received postpartum/postnatal care within three days at 34 ACCESS-supported hospitals.

To add to the original two facilities offering KMC in Nigeria, ACCESS trained an additional 43 providers in KMC, including obstetricians, pediatricians and nurse-midwives in Kano and Zamfara States to expand the

coverage of facilities offering KMC services.

In Cambodia, ACCESS updated an integrated postnatal care (PNC) package for midwives for the MOH which is being field-tested and developed through a partnership of nine international and local organizations. This activity will result in: an updated national PNC policy, which incorporates key evidenced-based MNH interventions; a substantial group of trained trainers and midwives; extension to community-level workers, a revised supervision and M&E plan; 135 health centers orientated and implementing PNC services according to the new protocols; and a standardized approach to PNC applied by the MOH and all the major NGOs working in this area. In addition, by using this coalition, a jump start on scale-up will have been achieved, with continuing potential for further expansion.

ACCESS contributed to the updating of key RH policy documents in Cambodia, including the community-integrated management of childhood illness (IMCI) curriculum. ACCESS also collaborated with UNICEF and the NRHP on a neonatal situation analysis, helping to formulate recommendations that will serve as the basis for a newborn health action plan for Cambodia.

Afghanistan HSSP provided technical assistance to the MOPH and UNICEF to strengthen clinical training sites for training in obstetric care and care of the newborn. HSSP also launched the first competency-based clinical skills course in Basic Care of the Newborn in Afghanistan and trained 24 National Care of the Newborn trainers, contributing to building the capacity of NGOs implementing the BPHS and improving the quality of service delivery.

Men can practice KMC too (Nigeria).


ANTENATAL CARE Core Funds

USAID’s Global Health Antenatal Care and Prevention of Mother-to-Child Transmission of HIV e-learning courses completed by more than 1,500 users this reporting period, and more than 1,800 since inception.

Completed monograph on “Faith-Based Models for Improving Maternal and Newborn Health,” adding to the limited written resources about FBOs and health services.

In Rwanda, expanded the training of providers in FANC from 12 to 24 districts, and held two trainings to update district heads and providers in MIP using the ACCESS-revised LRP consistent with national MIP policies and guidelines. In 25 districts, 58 supervisors and trainers have been trained in FANC and MIP.

Through the FBO Small Grants Program, trained 70 providers in FANC, reached 49 facilities and provided them with supportive supervision to strengthen their ANC service delivery and improve linkages with the community.

Collaborated with the School of Biomedical Engineering at JHU to foster production of innovative products to measure physical effects of PE/E. Analysis of iron-distribution programs also carried out to determine feasibility of antenatal calcium distribution, and literature review resulted in compendium of information and resources for use in advocacy work at global and country levels.

Core Malaria Funds

Completed and published Malaria Action Coalition Final Report (October 2002–September 2007).

Developed two global resources for MIP prevention and control that will directly support countries in efforts to scale up malaria prevention and control: the MIP Implementation Guide and the revised Malaria in Pregnancy Resource Package, both of which are now available online in English and French.

Contributed to the development of a RBM global statement on community distribution of IPTp that will provide guidance to countries in their efforts to scale up MIP prevention and control.

Provided short-term technical assistance in Nigeria to address bottlenecks in implementation of GF activities, which has led to accelerated expansion of GF implementation.

Contributed to the development of the Roll Back Malaria (RBM) Global Malaria Action Plan (GMAP)—the global road map for malaria control and elimination around which all stakeholders can coordinate their actions and achieve the Millennium Development Goals.


IMAI training in Kenya includes sessions with expert patient trainers that give the participants realistic case histories and enhance learning.

Field Funds In Rwanda, funds from the President’s Malaria Initiative (PMI) were used to adapt

MIP/FANC manuals for use as training tools for national-level TOT for supervisors.

In Bangladesh, trained counselors conducted 84,014 pregnancy preparedness home visits, counseling pregnant women on healthy MNH behaviors and steps to take to prepare for birth.

ACCESS/Madagascar prepared for dissemination of the summary report of findings of the WHO evaluation, Enquête des Stratégies de Lutte contre le Paludisme Pendant la Grossesse à Madagascar, which identifies the principal barriers to sulfadoxine-pyrimethamine (SP) uptake in the country and makes recommendations to improve IPTp2 coverage nationwide. USAID/Madagascar is reviewing the report before it is disseminated during a half-day stakeholders’ meeting scheduled in November 2008.

A rapid needs assessment sponsored by ACCESS and NMCP in Malawi identified a severe shortage of staff trained on FANC and MIP and shortages of SP and other supplies for IPTp by DOT. In response, ACCESS trained 680 ANC service providers from all 28 districts in FANC/MIP and provided basic supplies for IPTp to all 730 health facilities across the country. Supportive supervision visits to 56 facilities revealed that over 80% had the requisite DOT supplies (i.e., buckets, trays, cups) on site; 11% reported a stock-out in the previous three months; 20% reported having an iron stock-out in the previous three months; and 68% reported having adequate insecticide-treated bead nets (ITNs) for pregnant women.

Supportive supervision visits to the four facilities implementing a pilot program of integrated ANC/tuberculosis screening services in Kenya revealed that screening for tuberculosis was being successfully integrated with ANC services: post-intervention, 91% of 1,069 new ANC clients and 55% of 1,143 ANC revisits were screened for TB.

In Kenya, The rollout of PMTCT-Plus has begun using the integrated management of adult illnesses (IMAI) approach, which was adapted for Kenya with support from ACCESS/Kenya in PY03. Adolescent and pediatric illnesses are included in the Kenya package. Over 200 MCH/ANC/maternity nurses and midwives from 82 high-volume PMTCT sites have been trained to date; of these, 42 sites did not offer ART services before.


President Bush at Meru District Hospital: “[PMI] supports treatment for those who are most vulnerable to malaria, especially pregnant women. Here in Tanzania, more than 2,400 health workers have been trained to provide specialized treatment that prevents malaria in expectant mothers.”

In collaboration with the Tanzanian Ministry of Health and Social Welfare (MOHSW), ACCESS continued to scale up clinical training capacity and high-quality service delivery for FANC/MIP/SIP in government and FBO-affiliated health facilities and pre-service education schools:

A total of 760 in-service clinical trainers have been trained since the start of the ACCESS Program in 2004: 679 of the trainers are providers from health facilities in all 21 regions and 81 of the trainers are zonal and regional RCH coordinators from all eight zones. Of these, 319 trainers were trained in this last program year.

This year, ACCESS supported the training of 540 additional providers in FANC/MIP/SIP clinical skills—for a cumulative total of 2,971, for an estimated 49.5% of providers who offer antenatal care in Tanzania. To date, an estimated 32% (1,575) of ANC facilities in the country have been covered.

This year, ACCESS assisted the MOHSW in Tanzania to revise the two-year certificate and three-year diploma nursing and midwifery curricula. To date, ACCESS has integrated FANC/MIP/SIP with the curricula and trained tutors and preceptors at all 51 pre-service nursing and midwifery schools in the country. This year, over 1,600 students graduated from these schools.

At ACCESS’s 30 sentinel facilities in Tanzania, over 33,400 ANC clients were provided services. Of these, 56% received IPT1 and 54% received IPT2, while 64% received TT2 and 77% received ITN vouchers. Positive trends in availability of SP commodities at the sentinel site facilities indicate that SP stock-outs are becoming less of an issue as compared to the beginning of the reporting period. However, 40% of facilities did report at least one SP stock-out.

President Bush visited Tanzania in February 2008 as part of a five-country trip to Africa. Observing the current PMI- and PEPFAR-funded initiatives in action was the focus of his trip. In preparation for this visit, ACCESS developed a press release; identified useful FANC IEC materials for display during official site visits; and provided updated program information to USAID for use in preparation of presidential remarks during his visit. The ACCESS FANC program was highlighted by President Bush during a speech he made at Meru District Hospital.

ACCESS/Tanzania collaborated with T-MARC Company Ltd. to integrate FANC messages with season four of the Mama Ushauri radio serial drama, providing national level exposure to appropriate and correct FANC information through the storylines. ACCESS participated in script development and review to ensure that correct FANC information was incorporated.

Developed and updated several training materials and tools with stakeholders in Tanzania, including the National FANC Advocacy Guides; FANC Learners Guide for Service Providers and Supervisors; Facilitators’ Guide for FANC Trainers; an orientation package for the infection prevention pocket guide; a tool for assessing performance of FANC services at the facility level; and a pre-service quality improvement tool.


OTHER ACCESS RESULTS FOR WOMEN’S HEALTH ACCESS supported the National Department of Health (NDOH) in South Africa to

introduce the new national PMTCT guidelines in three provinces. A total of 1,133 health workers (service providers, trainers and M&E coordinators) have been oriented to the new guidelines, which now include implementation of dual therapy (AZT and Nevirapine), replacing the single-dose Nevirapine regimen in the country.

ACCESS/Haiti supported the MOH to improve the quality of PMTCT and FP services at six facilities through facilitative supervision and coaching, which included feedback to service providers to improve their competencies in FP and PMTCT service provision.

ACCESS-FP Funds

Began new field-funded programs in Albania, India and Guinea.

Developed a second e-learning course for USAID's Global Health Learning Center to orient the learner to the rationale and importance of FP during the postpartum period, and to introduce the learner to service delivery, contraceptive method and programmatic considerations unique to FP during the postpartum period.

Revitalized the lactational amenorrhea method (LAM) through the LAM Working Group with the Institute of Reproductive Health at Georgetown University.

Hosted a meeting, “Postpartum Family Planning (PPFP): A review of programmatic approaches through the first year postpartum,” to systematically exchange experiences and lessons learned on PPFP programming; to share pre-tested tools to support PPFP programming and avoid duplication; and to prioritize programmatic topics for research and learning.

Increased PPFP community of practice to include more than 500 members from 66 countries, and served as a key information sharing mechanism for global discussions on topics related to PPFP such as healthy timing and spacing of pregnancy, key messages for PPFP, and PPFP contraceptive technology.

Published the Tanzania DHS secondary analysis of PP data, Uttar Pradesh, India secondary analysis of PP data, LAM technical brief, community-based PPFP and updated programmatic framework.

Promoted PPFP global forums such as the Scaling Up Best Practices Meeting in Bangkok, Thailand; Women Deliver conference in London; Union for African Population Studies Fifth African Population Conference in Arusha, Tanzania; Flexible Fund Meeting; and the Mini-University.

Carried out a postpartum care survey among USAID-supported cooperating agencies and partners to identify, document and share information on the status of postpartum care services they implement and support.

The FRONTIERS Program completed an evaluation of a successful PPFP pilot program implemented by ACCESS-FP in Kenya; final study report is available through the ACCESS Web site.


Core FP/RH Funds Translated the postabortion care learning resource package into French and field-tested the

package during a training of 11 providers in Haiti.

Collated feedback from field-tests in Bolivia and Haiti for incorporation into final draft of curriculum; expected date of completion is 30 October 2008.

Field Funds

With HSSP technical support and coordination, Afghanistan’s MOPH finalized and endorsed its first ever comprehensive National Health Communication Strategy for 2008–2010. This document creates a common framework for coordination among all agencies implementing and supporting communication activities in the country. An operational plan will now be developed.

In Kenya, assisted with the development of new policy guidelines on reproductive tract cancer, which include breast and prostate cancers, and HIV testing and counseling. ACCESS also supported the dissemination of the National Standards and Guidelines on Injection Safety and Medical Waste Management to 12 selected hospitals in two provinces. This process also built the capacity of the district trainers who participated in the dissemination.

ACCESS/Kenya initiated community-level training in infection prevention by supporting the orientation of CHEWs and CHWs in 12 communities thus promoting behaviors such as handwashing to minimize infections in the community and reduce visits to the hospitals.

Service delivery data collected in December 2007 from the eight provincial general hospitals where ACCESS/Kenya implemented provider-initiated testing and counseling (PITC) services last year showed that over 100,000 clients were provided with PITC services since completing the training in mid-2007. This year, ACCESS trained 594 service providers in 37 district hospitals across the country in PITC.

Preliminary results of an evaluation of ACCESS/Kenya’s HIV PITC services last year revealed: 1) ACCESS trained 73% of all 402 service providers providing services at provincial general hospitals; 2) number of clients offered HIV counseling increased from 2,861 to 4,662 after initiation of the program; 3) percentage of clients accepting HIV testing increased from 95% to 99%; and 4) 95% of clients offered HIV testing and counseling were satisfied with the service.

In Kenya, worked with the government agency NASCOP and led the ART Technical Working Group’s effort to standardize the multiple clinical mentorship models being used in the country into one unified, nationally accepted model. Through a slow, careful process of consensus building the model was created and the National Mentorship Guidelines and an orientation package were developed.

ACCESS moved toward integration of FP and STI services with HIV/AIDS services in Kenya with the development of two orientation packages—an FP orientation package and a STI orientation package—for service providers working in comprehensive HIV care centers. Both orientation packages were adopted by the NASCOP and other partners. Thirty national trainers were also developed to facilitate the integration of FP and STI services at comprehensive care centers throughout the country.


In Nigeria, 11,817 clients received FP counseling and 933 clients received PPFP counseling at 36 ACCESS-supported facilities. ACCESS staff helped to ensure that FP commodities were always available at the facilities.

Five facilities supported by ACCESS/South Africa and the Foundation of Professional Development demonstrated improved performance and quality of ART services using the SBM-R approach to quality improvement. Three facilities assessed during this period improved from a mean score of 37% to 52% out of 165 total standards.

Thirteen new Training Information Management Systems© (TIMS) sites have been established in South Africa during this period: 12 in the KwaZulu-Natal Department of Health and one at the Department of Public Service and Administration. These sites, added to the existing seven sites established in previous years, make a total 20 sites that are monitoring provider training, using the data for reporting, planning and decision making. Furthermore, the Free State Province Department of Health has created an overall strategy to improve monitoring and evaluation with ACCESS assistance, including review of indicators used.

A total of 129 health care providers and program coordinators were trained as trainers on the clinical guidelines for palliative care for adults in South Africa. Participants came from all nine provinces of South Africa and are now cascading the training in their own provinces.

ACCESS/South Africa continued to support two senior technical advisors at the National Department of Health, a service delivery/accreditation expert and a PLWHA coordinator. This support resulted in increased capacity and better collaboration and integration of different HIV/AIDS programs, as well as improvement in the implementation and adherence to the operational plans.

The technical advisor for HIV/AIDS service delivery helped increase capacity to accredit facilities nationally by providing support for accreditation to the provinces and the NDOH Comprehensive Care Management and Treatment (CCMT) Unit to revise policy guidelines, including Step-Down Care Guidelines, PMTCT Guidelines, Adult and Pediatric HAART Guidelines, and Home- and Community-Based Care Guidelines. He assisted the NDOH Human Resource Unit to develop training plans, and helped the TB/HIV cluster with the financial planning of HAART guidelines roll out. He further assisted provinces with conditional grants and CCMT plans.

The PLWHA coordinator helped finalize stigma mitigation indicators, PLHIV synergy strategy/audit, a national database for paralegals; and a support group database. She submitted the Workbook on HIV and AIDS Human Rights for approval and helped develop the Greater Involvement of People with AIDS Implementation Framework and an advocacy toolkit for people living with HIV/AIDS.

Cervical cancer prevention services were established at 12 facilities in the northwest province of South Africa, each of which has a nurse trained in Visual Inspection of the cervix with Acetic Acid (VIA) wash and cryotherapy. To date a total 547 clients have been screened using VIA: 505 women had normal results, 29 had pre-cancerous lesions and were treated with cryotherapy, and 13 women were referred for suspect cancer and other gynecological problems. As a result of this intervention, the National Department of Health is reviewing the National Cervical Cancer Screening Guidelines—which currently focus on Pap smears as the screening modality—to include VIA.


Increased access to long-term family planning methods (e.g., IUD, Norplant implants and vasectomy) at two facilities in southern Haiti through “mobile clinics” conducted by two visiting providers.

ACCESS/Haiti purchased and distributed $35,000 worth of equipment and supplies for LAPM/FP to be used in the bilateral project in public institutions.

Preliminary Work on Pre-eclampsia/Eclampsia

Continued worldwide advocacy for prevention and treatment of PE/E, including presentations to groups comprised of USAID and other partners, professional associations and technical working groups in Afghanistan, Bangladesh, Ethiopia, India, Kenya, Nepal, Tanzania and Zambia, and at several global conferences. Also participated in a WHO-sponsored consultation on the state-of-the-art treatments in PE/E in low-resource countries held in Oxford, England.

Provided technical assistance in Nepal to the USAID bilateral and MOH to introduce calcium into ANC and test its acceptability and effect on community-level prevention of eclampsia.

During this reporting period in Nigeria, 1,284 women with eclampsia received treatment according to protocol at 17 hospitals.

Technical updates in the prevention of postpartum hemorrhage, cervical cancer and pre-eclampsia were conducted for the Division of Reproductive Health (DRH) and partners in Kenya to enable them to advocate, formulate, inform and disseminate national policies and guidelines.

Met with USAID and partners in Tanzania to outline need for strategy at community and facility levels for prevention and treatment of PE/E; the USAID mission included this as part of proposed funding for BEmONC throughout the country.


Challenges and Opportunities Challenges

Planning for final year in the face of uncertainties: ACCESS currently ends on 26 July 2009. In its last year, ACCESS has received funding and requests to complete activities for ongoing programs in more than eight countries. Staff recognized early in the year that country programs would need a full year of implementation to match the objectives and expectations of the USAID missions and host country governments. Through extended dialogue with the ACCESS CTO, we submitted a letter requesting an extension of the Program through March 2010. This extension has not yet been approved; therefore, ACCESS work planning is currently in flux. In addition, planning for the possibility of losing key staff to the MCHIP Program has created some uncertainties in planning and travel schedules for Program Year Five. We anticipate knowing this information well in advance of Year Five start-up, and will readjust the work plan and level of effort of multiple key staff accordingly.

Delays in implementation of field programs: Several issues have delayed some elements of field implementation. In Afghanistan, a deteriorating security situation prevents travel to program sites; in Kenya, political violence; and in South Africa, the sudden passing of Lunah Ncube, Jhpiego’s Country Director, has created unexpected challenges for program implementation. In addition, Tanzania, Kenya, Ethiopia and South Africa reported delays due to staff attrition and turnover. In many instances, in-country staff who were trained through ACCESS have moved to other districts or other companies and are no longer available as a resource for the Program.

Collaboration with partners on tools and materials: ACCESS is working with other partners to develop or update documents that are of global significance by working in conjunction with several multilateral partners such as WHO and other collaborating agencies. Development of one of these documents—the Managing Complications in Pregnancy and Childbirth (MCPC) Manual—has been delayed because the Department at WHO has limited staff who must balance competing priorities, although they remain committed to this project.

Closing out programs while scaling up others: As ACCESS completes its fourth year, some country programs have closed out. These include Haiti, West Africa Regional Program and Nepal. In Nepal, ACCESS received field support funding for a new set of activities. However, to manage close-out efficiently in Nepal, ACCESS had already cut back staff and minimized program activities. Other countries, like Tanzania, are allocating funds that were discussed last year. As we enter into our final year, ACCESS will carefully plan close out for other countries to ensure a smooth transition.


Opportunities Opportunity for advocacy for maternal health in Rwanda: ACCESS has a new Country

Director in Rwanda, Jérémie Zoungrana, who is also a Board Member of the White Ribbon Alliance (WRA). This could be an opportunity to launch the WRA and could be an effective vehicle for advocacy to create political will for drastic changes that will give girls and women access to life-saving care.

Potential for scale up in India: The Government of Jharkhand in India has expressed strong interest in scaling up the ACCESS training approach for Jharkhand. In addition, the Indian Nurses Council is interested in using the learning resource package for the training course, approach and results, which has contributed to discussions about scaling up this project. Similarly, in Rwanda, strong interest in KMC by the government and stakeholders has paved the way to scale up the intervention beyond the original hospital.

Documenting “what works”: As the ACCESS Program ends, we have the opportunity to document what works in several strategic areas and to publish the results. In several ACCESS countries we conducted a baseline and an endline survey, which can generate evidence for these papers.

Integrating MNH and PMTCT: In Malawi, ACCESS has begun to work on an integrated program for MNH and PMTCT in two districts. Demonstrating an increasing trend in the coverage for PMTCT interventions, including infants on ARV, can be powerful evidence for the HIV community to recognize the potential of the MNH platform.

26

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

Ann

ex A

: Cor

e A

ctiv

ity M

atrix

Ta

ble

1: A

CC

ES

S C

ore-

Fund

ed A

ctiv

ities

and

Out

puts

for P

rogr

am Y

ear T

hree

(FY

08) f

rom

Oct

ober

1, 2

007–

Sep

tem

ber 3

0, 2

008

CO

RE

AC

TIVI

TY

MA

JOR

PR

OG

RA

MM

ATI

C O

UTP

UTS

/DEL

IVER

AB

LES

PRO

DU

CED

IR 1

: Glo

bal l

eade

rshi

p fo

r mat

erna

l, ne

onat

al a

nd w

omen

’s h

ealth

AN

D n

utrit

ion

prog

ram

s A

ND

pol

icie

s st

reng

then

ed

1.1

Thro

ugh

glob

al

partn

ersh

ips

prom

ote

way

s an

d m

eans

of

over

com

ing

polic

y an

d pr

ogra

m

barr

iers

to e

nsur

e m

ater

nal,

neon

atal

an

d w

omen

’s

heal

th g

oals

and

in

corp

orat

ion

of

evid

ence

-bas

ed

stra

tegi

es in

co

untry

C

ontin

ued

to s

uppo

rt th

e Pa

rtner

ship

for M

ater

nal,

New

born

, and

Chi

ld H

ealth

(PM

NC

H) t

hrou

gh J

anua

ry 2

008

with

a

tech

nica

l adv

isor

who

is a

ssis

ting

with

the

impl

emen

tatio

n of

thei

r glo

bal a

ctiv

ities

.

C

ontin

ued

as c

hair

of th

e P

reve

ntio

n of

Pos

tpar

tum

Hem

orrh

age

Initi

ativ

e (P

OP

PH

I) te

chni

cal w

orki

ng g

roup

on

train

ing,

an

d pa

rtici

pate

d in

the

tech

nica

l wor

king

gro

ups

on u

tero

toni

c dr

ugs

and

devi

ces,

and

PP

H. W

ith A

CC

ES

S s

uppo

rt, a

n A

MTS

L LR

P is

now

ava

ilabl

e th

roug

h th

e P

OP

PH

I Web

site

.

D

rafte

d ar

ticle

s on

com

mun

ity-b

ased

man

agem

ent o

f neo

nata

l sep

sis

(dis

sem

inat

ion:

Oct

ober

200

8) a

nd K

MC

(fin

aliz

ed:

Nov

embe

r 200

8) fo

r the

Mot

herN

ewB

orN

et n

ewsl

ette

r.

S

pons

ored

a o

ne-d

ay c

onsu

ltatio

n m

eetin

g in

May

200

8 w

ith S

avin

g N

ewbo

rn L

ives

and

US

AID

to d

iscu

ss s

tate

-of-t

he-a

rt co

mm

unity

-bas

ed s

kin-

to-s

kin

care

(SSC

) for

low

birt

h w

eigh

t new

born

s an

d id

entif

y re

com

men

datio

ns fo

r del

iver

y ap

proa

ches

, inc

ludi

ng th

at S

SC

in th

e co

mm

unity

sho

uld

be c

arrie

d ou

t as

part

of a

pac

kage

of e

ssen

tial n

ewbo

rn c

are

inte

rven

tions

(not

as

a st

and-

alon

e in

terv

entio

n), a

nd s

houl

d be

reco

mm

ende

d fo

r all

new

born

s w

here

feas

ible

and

ac

cept

able

.

Fi

eld-

test

ed a

nd fi

naliz

ed g

loba

l fac

ility-

base

d KM

C fa

cilit

ator

s’ a

nd p

artic

ipan

ts’ m

anua

ls (p

rintin

g: D

ecem

ber 2

008)

.

Te

chni

cal m

eetin

g of

Man

agin

g C

ompl

icat

ions

in P

regn

ancy

and

Chi

ldbi

rth (M

CP

C) M

anua

l Rev

isio

n Ta

sk F

orce

took

pl

ace

in G

enev

a on

22–

23 O

ctob

er 2

007,

atte

nded

by

AC

CE

SS

/Jhp

iego

and

WH

O M

akin

g P

regn

ancy

Saf

er (M

PS

) D

epar

tmen

t rep

rese

ntat

ives

. AC

CE

SS

/Jhp

iego

are

now

re-w

ritin

g as

sign

ed te

chni

cal s

ectio

ns a

nd c

omm

unic

atio

n w

ith th

e M

akin

g P

regn

ancy

Saf

er D

epar

tmen

t of W

HO

has

bee

n on

-goi

ng to

det

erm

ine

a re

vise

d tim

elin

e gi

ven

the

pres

ent d

elay

.

C

olla

bora

ted

with

glo

bal s

take

hold

ers

to s

uppo

rt th

e in

tern

atio

nal W

omen

Del

iver

con

fere

nce

in L

ondo

n, 1

8–20

Oct

ober

20

07, i

nclu

ding

sup

port

to m

ore

than

20

parti

cipa

nts

and

pane

lists

. AC

CE

SS

and

AC

CE

SS

-FP

faci

litat

ed s

ever

al p

anel

di

scus

sion

s on

PP

H, S

BA

, pos

tpar

tum

fam

ily p

lann

ing,

FB

Os

and

mal

aria

in p

regn

ancy

(MIP

). W

RA

repr

esen

tativ

es

pres

ente

d pa

nel d

iscu

ssio

ns a

nd p

rovi

ded

coun

try e

xam

ples

; tw

o re

pres

enta

tives

from

faith

-bas

ed h

ealth

net

wor

ks in

A

frica

pre

sent

ed p

aper

s, ra

isin

g aw

aren

ess

of th

e ro

le o

f FB

Os

in p

rovi

ding

hea

lth c

are

serv

ices

.

W

RA

: 1) S

uppo

rted

leve

rage

d by

two

Allia

nces

(Mal

awi a

nd Z

ambi

a) fo

r add

ition

al fu

ndin

g fro

m D

FID

to s

uppo

rt ro

ll-ou

t of

stra

tegi

es; 2

) dev

elop

ed o

r ref

ined

cou

ntry

-spe

cific

M&E

tool

s to

cap

ture

pro

gres

s to

war

d H

IDN

pat

hway

s; a

nd 3

) pro

vide

d te

chni

cal a

ssis

tanc

e (th

roug

h G

eorg

e W

ashi

ngto

n U

nive

rsity

Cap

ston

e P

rogr

am) t

o co

nduc

t a tr

aini

ng o

n da

ta c

olle

ctio

n an

d M

&E

and

car

ry o

ut fo

cus

grou

p di

scus

sion

s an

d ke

y in

form

ant i

nter

view

s in

five

targ

et fa

cilit

ies

in T

anza

nia.

27

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

CO

RE

AC

TIVI

TY

MA

JOR

PR

OG

RA

MM

ATI

C O

UTP

UTS

/DEL

IVER

AB

LES

PRO

DU

CED

1.2

Par

tner

with

faith

-ba

sed

heal

th c

are

netw

orks

to

expa

nd e

mer

genc

y m

ater

nal a

nd

new

born

car

e in

terv

entio

ns

O

rgan

ized

a p

anel

on

impr

ovin

g m

ater

nal a

nd n

ewbo

rn c

are

thro

ugh

faith

-bas

ed o

rgan

izat

ions

at W

omen

Del

iver

co

nfer

ence

and

ena

bled

two

repr

esen

tativ

es fr

om fa

ith-b

ased

hea

lth n

etw

orks

in A

frica

to p

artic

ipat

e an

d pr

esen

t pap

ers

at th

e W

omen

Del

iver

con

fere

nce,

rais

ing

awar

enes

s of

the

role

FBO

s pl

ay in

pro

vidi

ng h

ealth

car

e se

rvic

es to

wom

en a

nd

child

ren.

D

evel

oped

tool

kits

for r

elig

ious

lead

ers—

one

for C

hris

tian

lead

ers

and

one

for I

slam

ic le

ader

s—to

hel

p bu

ild th

eir c

apac

ity

for p

rom

otin

g sa

fe m

othe

rhoo

d in

thei

r com

mun

ities

and

with

in th

eir c

onst

ituen

cies

. Dra

fts a

re in

fina

l rev

iew

.

P

rese

nted

on

“Rol

e of

Fai

th-B

ased

Org

aniz

atio

ns in

Impr

ovin

g M

ater

nal a

nd N

ewbo

rn H

ealth

” at U

NFP

A O

ffice

s to

the

staf

f in

the

UN

sys

tem

, as

wel

l as

at th

e A

sia

Foru

m fo

r Chr

istia

n Le

ader

s.

C

ompl

eted

FBO

brie

f on

heal

th n

etw

orks

and

com

mun

ity h

ealth

pro

gram

s fo

cuse

d on

beh

avio

r cha

nge.

C

ompl

eted

mon

ogra

ph o

n “F

aith

-Bas

ed M

odel

s fo

r Im

prov

ing

Mat

erna

l and

New

born

Hea

lth,”

addi

ng to

the

limite

d w

ritte

n re

sour

ces

abou

t FB

Os

and

heal

th s

ervi

ces.

D

isse

min

ated

AC

CE

SS

reso

urce

s to

17

faith

-bas

ed h

ealth

net

wor

ks in

Afri

ca a

nd A

sia.

Th

roug

h th

e FB

O S

mal

l Gra

nts

Prog

ram

, tra

ined

70

prov

ider

s in

FA

NC

, rea

ched

49

faci

litie

s an

d pr

ovid

ed th

em w

ith

supp

ortiv

e su

perv

isio

n to

stre

ngth

en th

eir A

NC

ser

vice

del

iver

y an

d im

prov

e lin

kage

s w

ith th

e co

mm

unity

.

1.3

Dis

sem

inat

e A

CC

ES

S P

rogr

am

mat

eria

ls a

nd

reso

urce

s to

st

akeh

olde

rs

wor

ldw

ide

to

adva

nce

know

ledg

e of

pr

ogra

mm

ing

in

mat

erna

l and

ne

wbo

rn h

ealth

9,

000

AC

CES

S m

ater

ials

dis

sem

inat

ed: W

omen

Del

iver

con

fere

nce;

PR

IDE

Pro

ject

(Pak

ista

n); n

atio

nal R

H/C

H m

eetin

g (M

ozam

biqu

e; s

uppo

rted

by J

hpie

go’s

For

te S

aude

pro

ject

); A

PH

A; I

CM

Wor

ld c

onfe

renc

e.

M

ater

ials

com

plet

ed: T

hree

e-le

arni

ng c

ours

e te

chni

cal b

riefs

(on

PP

H, P

MTC

T an

d P

PC

); se

cond

FP

e-le

arni

ng c

ours

e;

FBO

hea

lth n

etw

orks

brie

f and

mon

ogra

ph o

n FB

O M

odel

s fo

r Im

prov

ing

MN

H; M

AC

fina

l rep

ort a

nd re

vise

d M

alar

ia

Res

ourc

e P

acka

ge; f

our A

CC

ES

S P

rogr

am re

sults

brie

fs; a

nd fo

ur A

CC

ES

S c

ount

ry b

riefs

(Nig

eria

, Ken

ya, B

angl

ades

h an

d A

fgha

nist

an).

Tr

aini

ng p

acka

ge a

nd im

plem

ente

r’s g

uide

on

com

mun

ity-b

ased

use

of m

isop

rost

ol a

re in

the

final

sta

ges

of e

ditin

g an

d pr

oduc

tion.

M

ore

than

3,1

00 p

eopl

e co

mpl

eted

the

seve

n e-

lear

ning

cou

rses

on

AN

C, P

ostp

artu

m C

are,

EN

C, P

MTC

T, M

ater

nal

Dis

abilit

y an

d P

reve

ntin

g P

PH

dev

elop

ed b

y A

CC

ES

S th

is y

ear.

A n

ew e

-lear

ning

cou

rse,

AC

CE

SS

-FP

: Pos

tpar

tum

Fa

mily

Pla

nnin

g e-

lear

ning

cou

rse

will

be a

vaila

ble

soon

.

A

CC

ES

S W

eb s

ite: 1

0,00

0 ne

w v

isito

rs a

nd n

early

250

dow

nloa

ds o

f maj

or p

ublic

atio

ns in

this

repo

rting

per

iod.

In A

pril,

th

e fir

st (o

f fou

r) “A

CC

ES

S U

pdat

e” w

as s

ent v

ia e

mai

l to

AC

CE

SS

sta

ff an

d m

ore

than

150

col

leag

ues

at U

SA

ID

Mis

sion

s, c

olla

bora

ting

orga

niza

tions

, and

HID

N a

nd A

CC

ES

S-F

P o

ffice

s.

28

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

CO

RE

AC

TIVI

TY

MA

JOR

PR

OG

RA

MM

ATI

C O

UTP

UTS

/DEL

IVER

AB

LES

PRO

DU

CED

IR 2

: Pre

para

tion

for c

hild

birt

h im

prov

ed

2.1

Indi

a: F

ield

-test

in

terv

entio

ns to

re

duce

mat

erna

l an

d ne

onat

al

mor

talit

y an

d m

orbi

dity

bas

ed o

n gu

idel

ines

for

skille

d at

tend

ance

at

birt

h de

velo

ped

for I

ndia

’s R

CH

II

prog

ram

N

inet

een

AN

Ms

train

ed to

com

pete

ncy

as S

BA

s in

evi

denc

e-ba

sed

care

and

pos

ted

to th

e co

mm

unity

, and

all

37

AC

CE

SS

-trai

ned

AN

Ms

wer

e pr

ovid

ed c

ontin

ued

supp

ort s

o th

at th

ey c

ould

pro

vide

car

e in

the

com

mun

ity a

nd a

t fu

nctio

nal f

acilit

ies.

A

mon

g th

e re

porti

ng A

NM

s, A

MTS

L w

as p

rovi

ded

at o

ver 9

4% o

f del

iver

ies—

with

100

% o

f AM

TSL

in 3

of 1

2 m

onth

s—an

d ov

er 9

8% o

f new

born

s de

liver

ed b

y A

CC

ES

S-tr

aine

d A

NM

s ha

d cl

ean

cord

car

e, im

med

iate

bre

astfe

edin

g (w

ithin

an

hour

), an

d im

med

iate

dry

ing

and

wra

ppin

g.

Fi

eld-

test

ed a

nd fi

naliz

ed a

n A

NM

lear

ning

reso

urce

pac

kage

.

C

ontin

ued

to s

treng

then

two

hosp

itals

and

two

AN

M s

choo

ls a

s tra

inin

g ce

nter

s.

W

orke

d w

ith N

GO

Che

tna

Vik

as to

mob

ilize

223

villa

ges

and

train

mor

e th

an 3

,700

com

mun

ity m

embe

rs, r

esul

ting

in

100%

of t

hese

AC

CE

SS

-sup

porte

d vi

llage

s w

ith a

func

tiona

l em

erge

ncy

trans

port

syst

em fo

r birt

h pr

epar

edne

ss a

nd

com

plic

atio

ns re

adin

ess

(BP

/CR

) dur

ing

preg

nanc

y an

d ch

ildbi

rth a

nd 6

9% u

sing

the

serv

ices

pro

vide

d by

the

AC

CE

SS

-tra

ined

AN

Ms

in th

eir a

rea.

28

3 m

ahila

man

dals

wer

e fo

rmed

and

are

con

duct

ing

regu

lar m

onth

ly m

eetin

gs; 8

2% h

ave

mon

thly

sav

ings

, whi

ch c

an b

e gi

ven

out a

s lo

ans

for o

bste

tric

emer

genc

y, a

nd 6

3% h

ave

open

ed b

ank

acco

unts

; ove

r 9,0

00 h

ome

visi

ts c

ondu

cted

fo

cuse

d on

cou

nsel

ing

on B

P/C

R m

essa

ges,

and

ove

r 7,0

00 re

sulti

ng in

a b

irth

plan

incl

udin

g al

l fou

r key

ste

ps; a

nd 2

,358

ne

w a

nd m

ore

than

8,0

00 re

peat

/con

tinui

ng p

regn

ant a

nd p

ostp

artu

m w

omen

vis

ited

at h

ome.

B

lock

leve

l wor

ksho

ps c

ompl

eted

in a

ll th

e 3

bloc

ks fo

r pro

gram

brie

fing

with

blo

ck le

vel o

ffici

als

of h

ealth

and

ICD

S

depa

rtmen

t alo

ng w

ith s

ervi

ce p

rovi

ders

.

R

esou

rces

and

exp

erie

nce

shar

ed w

ith o

ther

Jha

rkha

nd S

BA

pro

ject

s in

clud

ing

parti

cipa

tion

in V

ista

ar p

lann

ing

mee

tings

an

d tra

inin

gs.

B

asel

ine

repo

rt fin

aliz

ed, o

pera

tions

rese

arch

AN

M q

uarte

rly m

onito

ring

visi

t con

duct

ed, a

nd A

CC

ES

S m

onito

ring

visi

ts

cond

ucte

d.

2.2

Con

solid

ate

less

ons

lear

ned

thro

ugh

the

Mal

aria

Act

ion

Coa

litio

n in

se

lect

ed c

ount

ries

in A

frica

C

ompl

eted

(12/

07) a

nd p

ublis

hed

(2/0

8) th

e M

alar

ia A

ctio

n C

oalit

ion

Fina

l Rep

ort (

Oct

ober

200

2–S

epte

mbe

r 200

7).

D

evel

oped

two

glob

al re

sour

ces

for M

IP p

reve

ntio

n an

d co

ntro

l: th

e M

IP Im

plem

enta

tion

Gui

de a

nd th

e re

vise

d M

alar

ia

Res

ourc

e P

acka

ge; l

aunc

hed

on th

e P

rogr

am w

ebsi

te 5

/08.

C

ontri

bute

d to

the

deve

lopm

ent o

f a R

BM

glo

bal s

tate

men

t on

com

mun

ity d

istri

butio

n of

IPTp

at t

he N

ovem

ber 2

007

RB

M

Mal

aria

in P

regn

ancy

Wor

king

Gro

up m

eetin

g in

Zam

bia.

P

rovi

ded

shor

t ter

m te

chni

cal a

ssis

tanc

e (1

0/06

-9/0

8) in

Nig

eria

to a

ddre

ss b

ottle

neck

s to

impl

emen

tatio

n of

GF

activ

ities

.

C

ontri

bute

d to

the

deve

lopm

ent o

f the

Rol

l Bac

k M

alar

ia (R

BM

) Glo

bal M

alar

ia A

ctio

n P

lan

(GM

AP

): 9/

08.

29

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

CO

RE

AC

TIVI

TY

MA

JOR

PR

OG

RA

MM

ATI

C O

UTP

UTS

/DEL

IVER

AB

LES

PRO

DU

CED

IR 3

: Saf

e de

liver

y, p

ostp

artu

m c

are

and

new

born

hea

lth

3.1

Con

tribu

te to

the

know

ledg

e an

d ex

pans

ion

of

prev

entio

n of

PP

H

in A

CC

ES

S

coun

tries

Cam

bodi

a

Sup

porte

d 9

tech

nica

l and

adv

ocac

y m

eetin

gs o

n pr

even

tion

of P

PH

in C

ambo

dia

atte

nded

by

62 s

take

hold

ers

repr

esen

ting

US

AID

, UN

ICEF

, UN

FPA

, WH

O, J

ICA

, GTZ

, Sav

e th

e C

hild

ren,

RA

CH

A a

nd R

HA

C, a

s w

ell a

s th

e D

irect

or

and

Dep

uty

Dire

ctor

of t

he N

RH

P, P

ursa

t Pro

vinc

ial M

CH

sta

ff, a

nd n

atio

nal N

RH

P s

taff.

P

repa

red

for P

PH

pro

ject

impl

emen

tatio

n: d

rafte

d a

BC

C p

acka

ge; d

evel

oped

trai

ning

mat

eria

ls; c

ondu

cted

an

asse

ssm

ent o

f the

refe

rral

hos

pita

l in

Purs

at to

exa

min

e its

abi

lity

to tr

eat r

efer

red

PP

H c

ases

; and

com

plet

ed a

det

aile

d im

plem

enta

tion

plan

in c

olla

bora

tion

with

the

NR

HP

and

RAC

HA

. The

PP

H p

roje

ct p

ropo

sal a

nd a

ccom

pany

ing

mat

eria

ls

wer

e su

bmitt

ed fo

r rev

iew

to th

e C

ambo

dian

Eth

ical

Rev

iew

Com

mitt

ee.

Ken

ya

C

ompl

eted

MO

H re

fere

nce

man

ual f

or th

e pr

even

tion

and

man

agem

ent o

f PP

H.

Tw

enty

TO

Ts h

ave

been

dev

elop

ed a

nd p

rovi

ded

supp

ortiv

e su

perv

isio

n to

ass

ist i

n th

e sc

ale-

up o

f PP

H p

reve

ntio

n ef

forts

nat

ionw

ide.

PPH

Sm

all G

rant

s

As

of O

ctob

er 2

008,

AC

CES

S h

as tr

aine

d 23

6 he

alth

car

e pr

ovid

ers

and

47 c

omm

unity

lead

ers,

and

reac

hed

mor

e th

an

100,

000

com

mun

ity m

embe

rs w

ith it

s P

PH

sub

gran

ts.

3.2

Build

stra

tegi

c op

portu

nitie

s to

im

prov

e sa

fe

deliv

ery

in A

frica

Rw

anda

Expa

nded

bey

ond

the

initi

al 4

dis

trict

s an

d, w

ith o

ther

impl

emen

ting

partn

ers,

ass

iste

d th

e M

inis

try o

f Hea

lth (M

OH

) to

desi

gn

a pl

an fo

r nat

iona

l-lev

el s

cale

-up

of M

NH

. In

a co

llabo

rativ

e ef

fort,

a n

ew g

roup

of n

atio

nal-l

evel

trai

ners

was

trai

ned.

H

elpe

d to

est

ablis

h a

KM

C C

ente

r of E

xcel

lenc

e at

Muh

ima

Dis

trict

Hos

pita

l. In

itiat

ed K

MC

ser

vice

s in

8 h

ospi

tals

, in

clud

ing

the

univ

ersi

ty te

achi

ng h

ospi

tal i

n K

igal

i. Tr

aine

d 24

ser

vice

pro

vide

rs in

KM

C fr

om th

e 8

hosp

itals

.

E

xpan

ded

the

train

ing

of p

rovi

ders

in F

ANC

from

12

to 2

4 di

stric

ts, a

nd h

eld

two

train

ings

to u

pdat

e di

stric

t hea

ds a

nd

prov

ider

s in

MIP

usi

ng th

e A

CC

ES

S-re

vise

d LR

P c

onsi

sten

t with

nat

iona

l MIP

pol

icie

s an

d gu

idel

ines

. In

25 d

istri

cts,

58

supe

rvis

ors

and

train

ers

have

bee

n tra

ined

in F

AN

C/M

IP.

In

trodu

ced

SBM

-R in

5 d

istri

ct h

ospi

tals

.

N

ine

hosp

itals

and

thei

r cor

resp

ondi

ng h

ealth

cen

ters

are

ben

efiti

ng fr

om m

edic

al e

quip

men

t and

sup

plie

s do

nate

d by

A

CC

ES

S.

H

ealth

Fac

ility

Ass

essm

ent a

nd Q

ualit

ativ

e A

sses

smen

t wer

e co

mpl

eted

, and

pre

limin

ary

repo

rts w

ere

final

ized

and

su

bmitt

ed fo

r dis

sem

inat

ion

to M

OH

and

par

tner

s. T

he re

sults

of t

he a

sses

smen

t inf

orm

ed th

e de

velo

pmen

t of a

dra

ft na

tiona

l-lev

el c

omm

unity

beh

avio

r cha

nge

stra

tegy

.

30

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

CO

RE

AC

TIVI

TY

MA

JOR

PR

OG

RA

MM

ATI

C O

UTP

UTS

/DEL

IVER

AB

LES

PRO

DU

CED

3.2

CO

NT.

Thro

ugh

RC

LS (R

elig

ious

Lea

der N

etw

ork

to F

ight

Aga

inst

AID

S) a

nd in

col

labo

ratio

n w

ith IM

A, d

rafte

d M

NH

mes

sage

s fo

r rel

igio

us le

ader

s to

use

dur

ing

serm

ons

rela

ted

to b

oth

the

Kor

an a

nd B

ible

.

Tr

aine

d co

re g

roup

of 2

5 na

tiona

l-lev

el tr

aine

rs fr

om 9

hos

pita

ls.

Tr

aini

ng o

f Nya

mag

abe

Dis

trict

HC

s st

aff t

hrou

gh c

ost s

hare

with

Tw

ubak

ane.

In

crea

sed

EmO

NC

and

FAN

C c

apac

ity fo

r 28

HC

s pr

ovid

ers

in N

yam

agab

e D

istri

ct.

Tr

aini

ng o

f Em

ON

C p

rovi

ders

from

15

hosp

itals

to re

plac

e tu

rned

ove

r sta

ff.

In

3 o

f the

4 a

sses

sed

dist

ricts

, 15

of 2

1 ta

rget

faci

litie

s ar

e pr

ovid

ing

AM

TSL.

H

Cs

Em

ON

C ta

sks

defin

ed a

s a

basi

s fo

r tra

inin

g m

anua

l ada

ptat

ion.

Fu

nctio

nal K

MC

Uni

t ser

ving

as

a tra

inin

g ce

nter

for K

MC

sca

ling

up a

ctiv

ities

. Mor

e th

an 3

11 lo

w b

irth

wei

ght b

abie

s ad

mitt

ed th

is re

porti

ng p

erio

d.

Gha

na

C

ompl

eted

SBM

-R m

odul

es I,

II a

nd II

I of a

ll fa

cilit

ies,

whi

ch h

as re

sulte

d in

the

abilit

y of

key

per

sonn

el in

Biri

m h

ealth

di

stric

t to

train

and

tran

sfer

upd

ates

, qua

lity

assu

ranc

e an

d qu

ality

impr

ovem

ent.

O

f the

se fa

cilit

ies,

82%

reac

hed

the

targ

et 8

5% o

f the

sta

ndar

ds b

y th

e cl

ose

of th

e pr

ojec

t.

Tr

aine

d 39

peo

ple

on S

BM

-R M

odul

es.

Tr

aine

d 5

exte

rnal

ass

esso

rs to

incr

ease

sus

tain

abili

ty o

f the

pro

cess

and

mak

e B

irim

Nor

th a

nat

iona

l mod

el fo

r the

ac

cred

itatio

n pr

oces

s.

R

ecei

ved

natio

nal a

ttent

ion

and

visi

ts fr

om th

e D

irect

or G

ener

al a

nd U

SA

ID M

issi

on s

taff

for a

chie

vem

ents

in s

ervi

ces

stat

istic

s.

Tr

aine

d 14

mid

wiv

es in

sou

ther

n B

irim

Nor

th D

istri

ct in

BE

mO

NC

.

C

ompl

eted

Hea

lth M

anag

emen

t Inf

orm

atio

n S

yste

ms

wor

ksho

ps fo

r par

ticip

ants

from

all

11 fa

cilit

ies.

31

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

CO

RE

AC

TIVI

TY

MA

JOR

PR

OG

RA

MM

ATI

C O

UTP

UTS

/DEL

IVER

AB

LES

PRO

DU

CED

3.3

Impl

emen

t loc

al

finan

cing

m

echa

nism

s to

in

crea

se e

quity

of

heal

th s

ervi

ces

to

the

mos

t vu

lner

able

in

Nig

eria

A

CC

ES

S s

taff

supp

orte

d M

ada

com

mun

ity m

embe

rs a

nd s

take

hold

ers

in Z

amfa

ra s

tate

to d

evel

op p

lans

to o

verc

ome

finan

cial

bar

riers

to a

nten

atal

, obs

tetri

c an

d po

st-o

bste

tric

serv

ices

. Pla

ns in

clud

e tra

inin

g of

two

fem

ale

faci

litat

ors

to

orga

nize

and

sup

port

a pi

lot M

othe

rs’ C

lub,

whi

ch w

ill pr

ovid

e its

mem

bers

with

a m

eans

to s

ave

and

use

thos

e sa

ving

s to

m

ake

loan

s to

one

ano

ther

. Thi

s gr

oup

will

als

o di

scus

s an

d re

info

rce

posi

tive

RH

and

MN

H p

ract

ices

with

in th

e gr

oup

and

in th

e la

rger

com

mun

ity.

E

stab

lishe

d 8

Mot

hers

’ Clu

bs in

the

Mad

a co

mm

unity

.

Tr

aine

d 2

mem

bers

of t

he c

omm

unity

trai

ned

as fa

cilit

ator

s fo

r the

Mot

hers

’ Clu

bs.

12

0 w

omen

join

ed a

s m

embe

rs o

f the

Mot

hers

’ Clu

bs.

C

ompl

eted

initi

al M

&E

repo

rt on

the

esta

blis

hmen

t of t

he M

othe

rs’ C

lubs

in M

ada.

32

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

CO

RE

AC

TIVI

TY

MA

JOR

PR

OG

RA

MM

ATI

C O

UTP

UTS

/DEL

IVER

AB

LES

PRO

DU

CED

IR 4

: Man

agem

ent o

f obs

tetr

ic c

ompl

icat

ions

and

sic

k ne

wbo

rns

impr

oved

4.1

Incr

ease

acc

ess

to

skille

d at

tend

ance

at

birt

h th

roug

h st

reng

then

ing

of

pre-

serv

ice

mid

wife

ry

educ

atio

n of

fron

t-lin

e pr

ovid

ers

in

four

cou

ntrie

s (E

thio

pia,

Gha

na,

Mal

awi a

nd

Tanz

ania

)

In

tegr

ated

the

MN

H s

ituat

ion

anal

ysis

into

the

MO

H/N

iger

200

8 pl

an w

ith R

oad

Map

par

tner

s in

Nig

er.

C

olla

bora

ted

with

WH

O-A

FRO

to p

lan

and

faci

litat

e th

e E

nteb

be re

gion

al R

oad

Map

wor

ksho

p to

ass

ist c

ount

ry te

ams

in

oper

atio

naliz

ing

the

natio

nal R

oad

Map

doc

umen

t. S

ix c

ount

ry te

ams

from

eas

tern

and

sou

ther

n A

frica

par

ticip

ated

in th

e w

orks

hop,

dev

elop

ing

real

istic

pla

ns fo

r ope

ratio

naliz

atio

n an

d id

entif

ying

thei

r nee

d fo

r tec

hnic

al a

ssis

tanc

e.

R

egio

nal A

FR/S

D a

ctiv

ities

incl

uded

upg

radi

ng p

re-s

ervi

ce tr

aini

ng in

four

cou

ntrie

s (E

thio

pia,

Gha

na, M

alaw

i and

Ta

nzan

ia),

and

parti

cipa

nts

from

six

cou

ntrie

s (E

thio

pia,

Ken

ya, M

alaw

i, N

amib

ia, U

gand

a, a

nd Z

ambi

a) s

hare

d th

eir

expe

rienc

es d

evel

opin

g an

d op

erat

iona

lizin

g th

eir n

atio

nal R

oad

Map

doc

umen

t at a

regi

onal

wor

ksho

p pl

anne

d an

d co

nduc

ted

by A

CC

ES

S a

nd W

HO

-AFR

O in

Apr

il 20

08.

P

lann

ed a

nd h

eld

seco

nd re

gion

al C

linic

al T

rain

ing

Ski

lls a

nd C

urric

ulum

Des

ign

cour

se fo

r app

roxi

mat

ely

20 p

re-s

ervi

ce

mid

wife

ry e

duca

tors

from

3 c

ount

ries

(Eth

iopi

a, G

hana

, and

Tan

zani

a) in

ord

er to

bui

ld m

ore

cham

pion

s fo

r im

plem

entin

g be

st p

ract

ices

in b

asic

em

erge

ncy

obst

etric

and

new

born

car

e (B

Em

ON

C) i

nto

mid

wife

ry e

duca

tion

and

prac

tice.

P

artic

ipan

ts a

ssis

ted

in th

e fa

cilit

atio

n of

BE

mO

NC

Tec

hnic

al U

pdat

e an

d C

linic

al S

kills

Sta

ndar

diza

tions

in E

thio

pia

and

Gha

na, a

nd w

ill p

artic

ipat

e in

upc

omin

g ad

voca

cy m

eetin

gs a

t the

nat

iona

l lev

el.

C

ompl

eted

revi

sion

s to

BE

mO

NC

LR

P b

ased

on

pre-

test

reco

mm

enda

tions

; pac

kage

is in

fina

l pro

duct

ion.

Th

e M

OH

in M

adag

asca

r, w

ith a

dvoc

acy

and

supp

ort f

rom

AC

CE

SS, r

epea

ted

the

Roa

d M

ap F

orum

hel

d in

Sep

tem

ber

2007

in A

ntan

anar

ivo.

4.2

Assi

st th

e E

thio

pian

Soc

iety

of

Obs

tetri

cian

s an

d G

ynec

olog

ists

(E

SO

G) t

o bu

ild

capa

city

of s

kille

d pr

ovid

ers

in E

MN

C

10

hea

lth c

ente

rs re

ferr

ing

to A

mbo

Hos

pita

l Mat

erni

ty S

ervi

ces

wer

e as

sess

ed, a

nd E

mO

NC

ser

vice

del

iver

y im

prov

ed a

t th

ese

heal

th c

ente

rs w

ith A

CC

ES

S a

nd E

thio

pian

Soc

iety

of O

bste

trici

ans

and

Gyn

ecol

ogis

ts (E

SO

G) s

uppo

rt. N

ine

of 1

0 pr

ovid

ers

wer

e tra

ined

in B

EmO

NC

(one

pro

vide

r was

on

leav

e), a

nd re

ferr

al li

nkag

es b

etw

een

10 h

ealth

cen

ters

and

A

mbo

Hos

pita

l wer

e st

reng

then

ed.

4.3

Con

tinue

ex

pans

ion

of

Kan

garo

o M

othe

r C

are

serv

ices

for

impr

oved

m

anag

emen

t of

low

birt

h w

eigh

t ba

bies

Fi

eld-

test

ed a

nd fi

naliz

ed g

loba

l fac

ility

-bas

ed K

MC

faci

litat

ors’

and

par

ticip

ants

’ man

uals

(prin

ting:

Dec

embe

r 200

8).

H

eld

cons

ulta

tion

mee

ting

on c

omm

unity

KM

C w

ith 4

3 ke

y st

akeh

olde

rs fr

om U

SA

ID, U

NIC

EF, S

NL,

US

AID

coo

pera

ting

agen

cies

, res

earc

hers

and

fiel

d st

aff.

A re

port

of th

e m

eetin

g ha

s be

en d

isse

min

ated

to m

eetin

g pa

rtici

pant

s an

d st

aff o

f in

tere

sted

org

aniz

atio

ns th

at w

ere

not p

rese

nt a

t the

mee

ting.

E

thio

pia:

Ada

pted

KM

C tr

aini

ng m

anua

l for

use

, con

duct

ed K

MC

TO

T fo

r 16

heal

th s

taff,

and

intro

duce

d K

MC

ser

vice

s in

5

hosp

itals

.

N

epal

: Int

egra

ted

KM

C in

to p

ostn

atal

car

e fo

r LBW

/pre

mat

ure

babi

es a

t fou

r hos

pita

ls a

nd 3

prim

ary

heal

th c

ente

rs;

esta

blis

hed

faci

lity-

base

d K

MC

ser

vice

s at

Mah

akal

i Zon

al H

ospi

tal a

nd 3

prim

ary

heal

th c

are

cent

ers;

and

trai

ned

814

33

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

CO

RE

AC

TIVI

TY

MA

JOR

PR

OG

RA

MM

ATI

C O

UTP

UTS

/DEL

IVER

AB

LES

PRO

DU

CED

4.3

CO

NT.

fe

mal

e co

mm

unity

hea

lth v

olun

teer

s on

com

mun

ity K

MC

. Nat

iona

l gui

delin

es fo

r man

agem

ent o

f LB

W in

fant

s an

d K

MC

w

ere

deve

lope

d an

d en

dors

ed b

y th

e M

OP

H a

nd w

ill b

e in

clud

ed a

s pa

rt of

a c

omm

unity

-bas

ed in

tegr

ated

neo

nata

l car

e pa

ckag

e to

be

impl

emen

ted

natio

nally

. Com

plet

ed fi

nal r

epor

t on

the

com

mun

ity-b

ased

man

agem

ent o

f LB

W b

abie

s.

R

wan

da: I

nitia

ted

KM

C s

ervi

ces

in 7

hos

pita

ls, i

nclu

ding

the

univ

ersi

ty te

achi

ng h

ospi

tal i

n K

igal

i. Tr

aine

d 24

ser

vice

pr

ovid

ers

in K

MC

from

the

8 ho

spita

ls.

B

angl

ades

h: T

rain

ed a

ll 28

6 A

CC

ES

S c

ouns

elor

s on

how

to c

oach

mot

hers

to p

rovi

de K

MC

.

4.4

Pre

vent

ion

of

pre-

ecla

mps

ia/

ecla

mps

ia

P

rovi

ded

tech

nica

l ass

ista

nce

in N

epal

to th

e U

SA

ID b

ilate

ral a

nd M

OH

to in

trodu

ce c

alci

um in

to A

NC

and

test

its

acce

ptab

ility

and

effe

ct o

n co

mm

unity

-leve

l pre

vent

ion

of e

clam

psia

.

M

et w

ith U

SAI

D a

nd p

artn

ers

in T

anza

nia

to o

utlin

e ne

ed fo

r stra

tegy

at c

omm

unity

and

faci

lity

leve

ls fo

r pre

vent

ion

and

treat

men

t of p

re-e

clam

psia

/ecl

amps

ia; U

SA

ID m

issi

on in

clud

ed th

is a

s pa

rt of

pro

pose

d fu

ndin

g fo

r bas

ic e

mer

genc

y ob

stet

ric a

nd n

ewbo

rn c

are

thro

ugho

ut th

e co

untry

.

Te

leco

nfer

ence

with

par

tner

s fro

m U

SAI

D a

nd P

ATH

rega

rdin

g pr

even

tion

and

treat

men

t of p

re-e

clam

psia

/ ecl

amps

ia,

incl

udin

g di

scus

sion

of n

ext s

teps

to ra

ise

this

as

a so

lvab

le is

sue

in m

any

coun

tries

.

M

eetin

gs w

ith U

SA

ID, M

OH

and

oth

er p

artn

ers

in E

thio

pia,

Ken

ya a

nd S

outh

Afri

ca to

dis

cuss

impo

rtanc

e of

stra

tegy

to

decr

ease

mat

erna

l and

new

born

mor

talit

y du

e to

pre

-ecl

amps

ia/e

clam

psia

.

34

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

CO

RE

AC

TIVI

TY

MA

JOR

PR

OG

RA

MM

ATI

C O

UTP

UTS

/DEL

IVER

AB

LES

PRO

DU

CED

IR 5

: Pre

vent

ion

and

trea

tmen

t of p

riorit

y he

alth

pro

blem

s of

non

-pre

gnan

t wom

en o

f rep

rodu

ctiv

e he

alth

age

(Tar

gets

of O

ppor

tuni

ty)

5.1

Fiel

d-te

st a

nd

final

ize

the

revi

sed

post

-abo

rtion

car

e cu

rric

ulum

Tr

ansl

ated

PA

C L

RP

into

Fre

nch

and

field

-test

ed th

e pa

ckag

e du

ring

a tra

inin

g of

11

prov

ider

s in

Hai

ti.

C

olla

ted

feed

back

from

fiel

d-te

sts

in B

oliv

ia a

nd H

aiti

for i

ncor

pora

tion

into

fina

l dra

ft of

cur

ricul

um; e

xpec

ted

date

of

com

plet

ion

is 3

0 O

ctob

er 2

008.

A

nnex

B: P

rogr

am C

over

age

Mat

rix

35

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

Ann

ex B

: Pro

gram

Cov

erag

e M

atrix

A

CC

ESS

clin

ical

(e.g

., ca

paci

ty b

uild

ing

and

serv

ice

deliv

ery)

and

com

mun

ity-b

ased

(e.g

., de

man

d ge

nera

tion)

inte

rven

tions

ove

r the

pa

st y

ear h

ave

reac

hed

wom

en a

nd fa

mili

es in

Afg

hani

stan

, Ban

glad

esh,

Eth

iopi

a, G

hana

, Ind

ia, K

enya

, Mal

awi,

Nig

eria

, Sou

th

Afr

ica,

and

Tan

zani

a. T

able

1 b

elow

pre

sent

s inf

orm

atio

n on

the

type

s of i

nter

vent

ions

bei

ng im

plem

ente

d in

eac

h co

untry

and

the

asso

ciat

ed p

oten

tial p

opul

atio

n co

vera

ge (t

hose

livi

ng in

the

inte

rven

tion

targ

et c

omm

uniti

es a

nd/o

r fac

ility

cat

chm

ent a

reas

). It

is im

porta

nt to

not

e th

at th

is m

atrix

doe

s not

alw

ays c

aptu

re n

atio

nal-l

evel

pol

icy

wor

k. In

add

ition

, AC

CES

S co

untry

pro

gram

s are

at

diff

eren

t sta

ges o

f im

plem

enta

tion—

som

e be

gan

in 2

004

whi

le o

ther

s beg

an in

200

7—th

us, c

over

age

may

be

vast

ly d

iffer

ent.

Fina

lly, A

CC

ESS

is a

glo

bal,

core

-fun

ded

prog

ram

that

use

s its

cor

e fu

nds p

rimar

ily fo

r tec

hnic

al le

ader

ship

and

glo

bal l

earn

ing.

C

ore-

fund

ed c

ount

ry-le

vel i

nter

vent

ions

tend

to b

e re

lativ

ely

smal

l in

geog

raph

ic sc

ope

and

serv

e to

dem

onst

rate

tran

sfer

of r

esea

rch

to p

ract

ice

of e

vide

nce-

base

d ap

proa

ches

in M

NH

. The

se re

sults

are

then

use

d to

info

rm n

atio

nal a

nd g

loba

l pol

icy

and

prog

ram

min

g.

Fiel

d su

ppor

t-fun

ded

prog

ram

s, on

the

othe

r han

d, te

nd to

hav

e la

rger

geo

grap

hic

scop

e an

d fu

ndin

g fo

r sca

le-u

p.

Tabl

e 1:

AC

CES

S Pr

ogra

m C

over

age

CO

UN

TRY

INTE

RVE

NTI

ON

#

OF

CO

MM

UN

ITIE

S #

OF

FAC

ILIT

IES

# O

F D

ISTR

ICTS

/ D

EPA

RTM

ENTS

% O

F D

ISTR

ICTS

/ D

EPA

RTM

ENTS

# O

F R

EGIO

NS/

PR

OVI

NC

ES

TOTA

L PO

PULA

TIO

N

(IN T

AR

GET

A

REA

S)

# O

F W

OM

EN O

F R

EPR

OD

UC

TIVE

A

GE

(15–

49)

AFG

HA

NIS

TAN

P

PG

ski

lled

birth

at

tend

ant

inte

rven

tion

N/A

38

1 B

PH

S h

ealth

fa

cilit

ies1

119

out o

f 329

di

stric

ts

36%

13

out

of 3

2 pr

ovin

ces2

7,05

0,71

6 1,

410,

143

BA

NG

LAD

ESH

P

rena

tal/p

ostn

atal

co

mm

unity

ou

treac

h vi

sits

and

re

ferra

l

7 su

b-di

stric

ts

(upa

zilla

s)

N/A

1

out o

f 64

dist

ricts

1.

6%

N/A

1,

443,

841

287,

324

A

nnex

B: P

rogr

am C

over

age

Mat

rix

36

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

CO

UN

TRY

INTE

RVE

NTI

ON

#

OF

CO

MM

UN

ITIE

S #

OF

FAC

ILIT

IES

# O

F D

ISTR

ICTS

/ D

EPA

RTM

ENTS

% O

F D

ISTR

ICTS

/ D

EPA

RTM

ENTS

# O

F R

EGIO

NS/

PR

OVI

NC

ES

TOTA

L PO

PULA

TIO

N

(IN T

AR

GET

A

REA

S)

# O

F W

OM

EN O

F R

EPR

OD

UC

TIVE

A

GE

(15–

49)

ETH

IOPI

A

Hos

pita

ls

stre

ngth

enin

g in

B

Em

ON

C fo

r Ac

cele

rate

d H

ealth

O

ffice

r Tra

inin

g P

rogr

am

N/A

8

out o

f 20

AH

OTP

H

ospi

tals

(tot

al

115

hosp

itals

in

coun

try)

N/A

–Eac

h of

the

hosp

itals

are

di

stric

t hos

pita

ls

and

cove

r acr

oss

regi

onal

sta

tes

NA

To

tal o

f 11

regi

ons

(9

regi

ons

and

2 ci

ty

adm

inis

tratio

ns-

AA a

nd D

ire

Daw

a)

N/A

N

/A

HE

Ws

train

ed in

sa

fe a

nd c

lean

bi

rth to

incr

ease

ac

cess

to s

afe

deliv

ery

at th

e co

mm

unity

leve

l

~200

co

mm

uniti

es

12 h

ealth

cen

ters

se

rved

as

train

ing

faci

litie

s an

d 35

8 H

EW

s fro

m ~

200

heal

th p

osts

8 of

the

17 z

ones

in

the

Oro

mia

R

egio

n w

hich

co

ver 3

8 w

ored

as/d

istri

cts

Appr

oxim

atel

y 6,

360,

319

(the

popu

latio

n si

ze fo

r 3 o

f th

e 38

w

ored

as is

un

know

n, s

o th

is n

umbe

r re

flect

s th

e to

tal

popu

latio

n si

ze fo

r 35

wor

edas

).

GH

AN

A

Tech

nica

l Upd

ates

an

d C

linic

al S

kills

S

tand

ardi

zatio

n fo

r m

idw

ifery

ed

ucat

ors

11

1

(Acc

ra C

ity) o

ut

of 1

38 d

istri

cts

1%

1 ou

t of 1

0 re

gion

s 2,

029,

143

515,

402

(est

imat

e)

SB

M-R

pro

cess

an

d M

NH

Te

chni

cal U

pdat

es

and

Clin

ical

Ski

lls

Sta

ndar

diza

tion

for

mat

erni

ty p

rovi

ders

11

1

(Biri

m N

orth

) ou

t of 1

38

dist

ricts

1%

1 ou

t of 1

0 re

gion

s 15

1,40

1 73

,884

37

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

CO

UN

TRY

INTE

RVE

NTI

ON

#

OF

CO

MM

UN

ITIE

S #

OF

FAC

ILIT

IES

# O

F D

ISTR

ICTS

/ D

EPA

RTM

ENTS

% O

F D

ISTR

ICTS

/ D

EPA

RTM

ENTS

# O

F R

EGIO

NS/

PR

OVI

NC

ES

TOTA

L PO

PULA

TIO

N

(IN T

AR

GET

A

REA

S)

# O

F W

OM

EN O

F R

EPR

OD

UC

TIVE

A

GE

(15–

49)

IND

IA

Skille

d bi

rth

atte

ndan

ce

(com

mun

ity-b

ased

an

d fa

cilit

y-ba

sed

mid

wiv

es p

lus

com

mun

ity

mob

iliza

tion)

213

villa

ges

3 1

dist

rict

4.1%

(1 d

istri

ct

out o

f the

24

dist

ricts

in th

e S

tate

of

Jark

hand

)

N/A

11

8,87

8 20

,208

KEN

YA

AN

C/ T

B P

ilot

N/A

4

pilo

t hea

lth

faci

litie

s an

d 50

ot

her f

acili

ties

9 11

.8%

1

4,70

9,58

1,

201,

609

PM

TCT

N/A

4

4

5.

3%

4

3,50

6,34

7 85

6,73

3 PP

H

N/A

25

17

22

.4%

6

11,1

68,7

91

2,99

4,72

5 A

RT:

HIV

/FP/

STI

Inte

grat

ion

N/A

40

48

63

.2%

8

24,8

01,9

43

6,45

1,09

2

Inje

ctio

n sa

fety

12

12

12

15

.8%

2

5,50

2,00

0 2,

785,

000

HC

T/P

ICT

N/A

30

30

39

.5%

8

14,3

10,4

48

3,73

9,50

1 P

ostp

artu

m fa

mily

pl

anni

ng

(AC

CE

SS

FP

)

N/A

4

faci

litie

s in

one

di

stric

t (40

%)

1 di

stric

t: E

mbu

1.

3%

1 ou

t of 7

31

8,72

4 78

,087

MA

LAW

I P

QI i

n R

H

-- (R

H) 1

4 di

stric

t ho

spita

ls

repr

esen

ting

100%

of

dis

trict

hos

pita

ls

in th

e 14

dis

trict

s

14 d

istri

cts

50%

(14

out o

f 28

dis

trict

s)

3 ou

t of 3

re

gion

s 6,

550,

000

1,57

1,87

4

PQ

I in

IP

--

(IP) 2

4 ho

spita

ls,

repr

esen

ting

100%

of

targ

et h

ospi

tals

in

the

21 d

istri

cts

21 d

istri

cts

75%

(21

out o

f 28

dis

trict

s)

3 ou

t of 3

re

gion

s 9,

825,

000

2,35

7,81

1

A

nnex

B: P

rogr

am C

over

age

Mat

rix

38

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

CO

UN

TRY

INTE

RVE

NTI

ON

#

OF

CO

MM

UN

ITIE

S #

OF

FAC

ILIT

IES

# O

F D

ISTR

ICTS

/ D

EPA

RTM

ENTS

% O

F D

ISTR

ICTS

/ D

EPA

RTM

ENTS

# O

F R

EGIO

NS/

PR

OVI

NC

ES

TOTA

L PO

PULA

TIO

N

(IN T

AR

GET

A

REA

S)

# O

F W

OM

EN O

F R

EPR

OD

UC

TIVE

A

GE

(15–

49)

FAN

C/M

IP

-- 73

0 he

alth

fa

cilit

ies

repr

esen

ting

100%

of

hea

lth fa

cilit

ies

coun

tryw

ide

28 d

istri

cts

100%

3

out o

f 3

regi

ons

13,1

00,0

00

3,14

3,74

9

Pre-

serv

ice

and

in-

serv

ice

--

13 R

N/M

trai

ning

in

stitu

tions

re

pres

entin

g 10

0%

of R

N/M

trai

ning

in

stitu

tions

8 di

stric

ts

29%

(8 o

ut o

f 28

dist

ricts

) 3

out o

f 3

regi

ons

3,79

9,00

0 91

1,68

7

KM

C

--

11 h

ealth

faci

litie

s re

pres

entin

g 10

0%

of ta

rget

hea

lth

faci

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CES

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ZAN

IA

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C/M

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e: D

ata

sour

ces

for p

opul

atio

n fig

ures

incl

ude

natio

nal c

ensu

s da

ta; U

S C

ensu

s B

urea

u, In

tern

atio

nal D

atab

ase,

http

://w

ww

.cen

sus.

gov/

ipc/

ww

w/id

bpyr

.htm

l; W

orld

Gaz

ette

er a

t ww

w.w

orld

-gaz

ette

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om);

http

://po

pula

tion.

wn.

com

http

://w

ww

.odc

i.gov

/cia

/pub

licat

ions

/fact

book

/inde

x.ht

ml (

Mad

agas

car)

; Ken

ya 1

999

Pop

ulat

ion

and

Hou

sing

Cen

sus

Vol

ume

VII:

Ana

lytic

al R

epor

t on

Pop

ulat

ion

Pro

ject

ions

, 200

2 (K

enya

). N

iger

ia: P

opul

atio

n C

omm

issi

on re

port.

Mal

awi:

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rces

: P

opul

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ence

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eau,

200

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orld

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a S

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hani

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nzan

ia: W

omen

of r

epro

duct

ive

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at 2

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ulat

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Annex C: Success Stories Bangladesh: Respect for TBA Increased after Training Rasheda Begum, an experienced traditional birth attendant (TBA), has been delivering babies for more than 10 years. After the death of her mother-in-law, who taught her these traditional skills, the community began turning to Rasheda as the most trusted and dependable TBA in the area. Nevertheless, Rasheda confessed to knowing nothing about safe and clean delivery, handwashing, newborn stimulation, immediate breastfeeding, or community-based Kangaroo Mother Care (CKMC) practices at the time. Having now received TBA training from the ACCESS Program, she is feeling much more confident about her ability to help mothers and newborns. Since her training, Rasheda attended a delivery in which a baby stopped breathing. She was happy to see the impact of her training when she gave the newborn extra stimulation and the baby began breathing again. When, in a separate case, a placenta was taking longer than usual to expel, Rasheda gave the newborn to the mother and asked her to begin breastfeeding. Within minutes, the placenta came out smoothly. Rasheda also applied her new CKMC knowledge when confronted with a comparatively small newborn who was shivering after drying and wrapping. She put the newborn in CKMC position with the mother where it fell asleep quickly, and was warmed and well protected from risk. Ethiopia: Community Mobilization for Pregnancy-Related Complications Mobilizing communities to inform, address and solicit support for maternal and neonatal health emergencies is a major activity of the ACCESS HEW Training Program in Ethiopia. Tekaye Seifu, a HEW who completed training in the first round, was able to implement some of the CM skills she was exposed to during the training in Urgesa Kebele, a remote village near Bedelle in southern Ethiopia. Within a couple of months, Tekaye was able to organize a group of 80 women to meet once a week and to each contribute the equivalent of five US cents during each meeting. Recently, one member of the group suffered from pregnancy-related complications, and the collection was used to help fund her transportation to Bedelle Health Center for treatment. Women withdrawing funds for maternal or neonatal emergencies are not required to replenish what they use. Tekaye is proud of her success in mobilizing the women to have access to treatment for complications, and anticipates continuing the group meetings to assist more women in her village.

TBAs at a training.


Malama Hajara and her new born baby (first delivery at Dawanau PHC).

Nigeria: Success of a Community Action Cycle The objective of the community action cycle is to increase awareness of and strengthen access to EmONC services. After receiving proper training, the community mobilization team (CMT) members returned to their respective communities to begin the process of identifying groups and committees that will participate in the CM process. A broad spectrum of community members including women, men and adolescents were selected in Dawanau community and environs to form the community core group (CCG) and committees. During the exploration process, the communities and core group discussed the state of maternal

and newborn care and consensus was reached that the lack of skill birth attendants at Dawanau PHC is the root cause of high home delivery rates. To address this problem, the community requested the services of volunteer nurse-midwives from within and outside the community to establish delivery services at Dawanau PHC. In addition, the CCG and community partitioned a space at the PHC to serve as a labor room. It was laudable that three nurse-midwives volunteered to help provide delivery services at the health facility and resumed work there in November 2007. By the end of the quarter, nine deliveries had been recorded at Dawanau PHC. During the quarter, nurse-midwives were trained to provide long-acting methods of FP. Hajiya Ramatu Usman, a nurse-midwife working at Zurmi General Hospital and mother of five children, was a participants. She was so impressed by the long-term contraceptive potential of JADELLE® that she accepted the method herself and had it inserted during the training. She indicated that she would like to use it for four years. During the SBM-R training which followed, she expressed complete satisfaction with the method, “As the nurse-midwife-in-charge of the Maternity Unit in Zurmi General Hospital and after my training in IUD and JADELLE insertion/removal, I now see an average of six FP clients a day coming for different methods. I use the knowledge that I got during the ACCESS training to train my subordinates in the hospital. I am glad that I went through the training done by ACCESS, which has made me to be more confident to provide services to my clients. May the

Hajiya Ramotu Usman.


Almighty God continue to guide the ACCESS staff. I am ready to give my full support and will come to help whenever I am invited. My husband is also very happy with the JADELLE and wants my other two co-wives, who have 12 children between them, to also use the method.” Tanzania: Pre-service Education BEmONC for Nursing and Midwifery Schools in Tanzania Deodata Kihuwe is a midwifery tutor who attended a clinical standardization course on BEmONC, one of the activities in the Pre-service Education Initiative for Africa Region supported by WHO-AFRO/ACCESS/Jhpiego and the MOHSW. Conducted in September 2007, the course helped midwifery tutors and preceptors improve their clinical skills. In April 2008, Deodata participated in the Effective Teaching Skills course to improve her teaching skills, ability to communicate her BEmONC knowledge, and demonstrate the related skills. When Deodata went back to her school (Bagamoyo Nursing and Midwifery Certificate School) after the course, she gave feedback to the students, administrators and staff in the Department of Maternal Health at Bagamoyo District Hospital. Deodata explained the content of the course as well as the learning and teaching processes. Maro, the assistant medical officer-in-charge of the Maternal and Newborn Unit, was excited and said, “Providers in the labor ward will now be getting additional support. Deodata, you went through critical topics like removal of retained placenta and resuscitation of newborn. You will provide updates to other service providers.” Maro even phoned Jhpiego’s office on the following day to express his appreciation and said, “I am very happy to see that our hospital maternal and newborn care providers will be supported. Deodata will be of great help in the labor ward, especially on my absence! BEmNOC topics that Deodata went through are similar to what I was taught in LSS. Thanks to Jhpiego!” Ghana: SBM-R Success Leads to Improved Performance Holy Horniel Maternity Home is a private facility located in the Birim North District, Ghana. The midwife in charge is also the owner. The primary assessment tool for the project was a standardized basic emergency obstetric and neonatal care assessment tool (adapted using Ghana’s National Reproductive Health Standards and Protocols). The tool grouped standards under two areas: labor and delivery care and other infrastructure. During a baseline assessment in January 2008 (after the midwife, Contance Asante, had completed SBM-R Module I), the facility scored 57% on labor and delivery care and 60% on other infrastructure. After the midwife had completed SBM-R Module II, a second assessment of the facility revealed tremendous improvements in labor and delivery care (97%) and other infrastructure (100%). On a recent visit to donate an advanced childbirth simulator, further improvements beyond the required standards were observed and the midwife said, “We are most grateful to Jhpiego and its representatives. Our performance has improved so much and we promise to put this model to very good use and continue to improve on the standards attained.” During the SBM-R Module III workshop, Parent to the District, Mr. Kyeremeh (also the Deputy Director of Nursing Services at the regional level) was so impressed with the concept and the achievements that he stated, “I am going to apply SBM-R to all my activities at home!”


ANNEX D: ACCESS Bureau and Country Funding Table (PY1–PY4)

ACCESS COUNTRY PROGRAM YEAR FUNDING OBLIGATED (*ANTICIPATED) KEY ACTIVITIES

1 $0 2 $0 3 (new) $120,000 – Core Build capacity of skilled

providers in EMNC through Ethiopian Society of Obstetricians and Gynecologists

Training health officers Training community

health extension workers

Collaboration with AFR/SD pre-service initiative

4 (new) $1,792,476 – Field Training health officers in BEmONC

Training community health extension workers

ETHIOPIA

$105,000 – Core Build capacity of skilled providers in EMNC through Ethiopian Society of Obstetricians and Gynecologists

Collaboration with AFR/SD pre-service initiative ($174,991, core, for 3 countries)

1 $0 2 $0 3 (new) $180,000 – Core Expand EmONC

training Collaboration with AFR/

SD preservice initiative 4 $114,000– Core Expand EmONC training

GHANA

Core Collaboration with AFR/SD preservice initiative ($174,991, core, for 3 countries)



1 $0 2 (new) $100,000 – Field Expansion of PAC 3 $30,000 (Field carry

forward) Expansion of PAC and

FP

GUINEA

4 $100,000 - Field Revise pre-service module for school of medicine

Train medical faculty and update in clinical skills and instructional design

1 $0 Institutionalizing best practices for FP [activities began in PY 1 and will be reported in 1st annual report even though we never got an approved workplan]

2 (new) $1,120,000 – Field Institutionalizing best practices for FP

Training for voluntary counseling and testing (VCT) counselors and antiretroviral therapy (ART) within PMTCT programs

3 $1,700.000 – Field (est.) $125,000 – Core

Strengthen counseling and testing services for HIV in clinical setting

4 $3,132,740 – Field (anticipated)

Strengthen counseling and testing services for HIV in clinical setting

Scaling up ART services

KENYA

$64,000 – Core Expanding AMTSL service delivery

1 $0 2 $0 3 (new) $50,000 – Field Quality and

sustainability of focused antenatal care (FANC), intermittent preventive therapy (IPT) services

MADAGASCAR

4 $600,000-Field (FY08 PMI)

Scale up FANC and quality improvements



1 $0 2 $0 3 $ 215,000 – Core Expand EmONC

training Collaboration with

AFR/SD pre-service initiative

MALAWI

4 (new) $2,690,000 – Field Expansion of PAC, FP and Emergency Obstetric and Newborn Care (EmONC) in eight districts

FANC/IPT Community-based

maternal and newborn care

Kangaroo Mother Care (KMC)

1 $0 2 (new) $1,000,000 – Field

(multi-year) Emergency obstetric

care and obstetric fistula

3 $2,000,000 – Field Improvement of EmONC services

Community mobilization regarding access to skilled providers

Policy work on deployment of skilled providers

$125,000 – Core Conduct study on local financing mechanisms to increase equity of health services in Nigeria

4 $2,323,000 – Field Improvement of EmONC services

Community mobilization regarding access to skilled providers

Policy work on deployment of skilled providers

NIGERIA

$130,000 – Core Apply lessons learned on local financing mechanisms to increase equity of health services in Nigeria



1 $0 2 $0 3 (new) $650,000 – Core Implementation of Safe

Birth Africa Initiative 4 (new) $782,000 – Core Implementation of Safe

Birth Africa Initiative

RWANDA

$350,000 – Field/PMI Expand FANC/MIP 1 $0 2 $0 3 (new) $600,000 – Field Dissemination of clinical

guidelines around HIV/ AIDS prevention and treatment

SOUTH AFRICA

4 $1,245,000 – Field Dissemination of clinical guidelines and quality improvement around HIV/AIDS prevention and treatment

1 (new) $950,000 – Field Integrated ANC and PMTCT

Pre-service training in focused ANC

Dissemination of IP guidelines

Support to WRA 2 $1,625,000 – Field Integrated ANC and

PMTCT Preservice training in

focused ANC Dissemination of IP

guidelines Support to WRA Support to CEEMI

(Malaria Center) 3 $1,962,000 – Field Scale up FANC and MIP

Strengthen nutrition in in-service and pre-service training

$80,000 – Core Collaboration with AFR/SD pre-service initiative ($250,000, core, for 3 countries)

4 $3,973,000 – Field Scale up FANC and MIP

TANZANIA

Core Collaboration with AFR/SD pre-service initiative ($174,991, core, for 3 countries)



1 $0 2 $0 3 (new) $50,000 - Field (pay back) Enhance the Social

Mobilization effort to fight HIV/AIDS

ZAMBIA

4 $0 1 $920,000 – MAC Core

$770,000 – MAC Field Field support from

Kenya, Madagascar, REDSO ESA, Rwanda and WARP

Coordination with MAC core funding

2 $900,000 – MAC Core $685,000 – MAC Field

Field support from Kenya, Madagascar, REDSO and Mali

3 $440,000 – MAC Core ($200,000 new + $240,000 estimated carry forward)

Personnel support in field and HQ to consolidate lessons learned

MALARIA ACTION COALITION

4 $100,000 – MAC Core Personnel support in field and HQ to consolidate lessons learned

1 $0 2 (new) $3,000,000 - Field Support to the Afghan

Midwives Association (AMA)

Assist in the development of a new maternal and newborn health strategy

Establish demonstration project for the prevention of postpartum hemorrhage (PPH) for home births

Feasibility study for a maternity waiting home in Badakhshan Province

3 (new) Carry forward – Field $8,500,000 – Associate Award/HSSP (multi-year)

Support to AMA Continuation of PPH

study Activities to support

new program on improving quality of care in 13 provinces and training community midwives

AFGHANISTAN AFGHANISTAN (CONT.)

4 $4,391,056 – Associate Award/HSSP

Expansion and scale up of PPH prevention

Activities to support new program on improving quality of care in 13 provinces



and training community midwives

$112,624 – Field Support to AMA 1 $0 2 (new) $2,600,000 – Field

(multi-year) Support a community

based initiative in Sylhet to improve access to evidence-based maternal and newborn health interventions

3 $3,061,000 – Field Community mobilization and behavior change for maternal and newborn health

Policy work and advocacy for strengthening services

BANGLADESH

4 $0 1 $0 2 $95,000 – Core/ANE Policy support for

maternal and newborn health

Strengthen midwifery skills and increasing access to skilled providers

3 (new) $600,000 – Associate Award (1.8 million multi-year funding)

Policy support for maternal and newborn health


Expansion of evidence-based maternal and new born interventions

$200,000 – Core PPH prevention 4 $1,100,000 – AA (over

three years) Policy support for

maternal and newborn health


Expansion of evidence-based maternal and new born interventions

CAMBODIA

$120,317 – Core (includes carry forward)

PPH prevention



1 $0 2 (new) Core Improving auxiliary nurse

midwives (ANMs) skills to provide services and increasing demand in the community

3 $500,000 – Core $50,000 – Field

Improving ANM skills to provide services and increasing demand in the community

INDIA

4 $496,000 – Core Improving ANM skills to provide services and increasing demand in the community

1 (new) $200,000 – Field Development of human resource strategy for skilled birth attendants (SBAs) and community-based maternal and newborn care

2 $2,450,000 – Field (multi-year)

Develop SBA learning resource package

Develop and test a community strategy for the identification and management of low birth weight (LBW) infants

Assist with national guidelines for LBW in the National Neonatal Health strategy

Policy work on the enabling environment of SBAs in rural communities.

CEDPA (adolescent health)

3 $1,000,000 – Field (carry forward)

Curriculum development and training for skilled providers

Guidelines development for LBW infants

Community management of LBW infants

$160,000 – Core KMC

NEPAL

4 Carry forward TBD – Field TBD – Core

Continue expansion of KMC



1 (new) $1,500,000 – Field Increased accessibility and use of PMTCT

Strengthened reproductive health— postabortion care (PAC), infection prevention and family planning (FP)

Assess cervical cancer prevention

2 $695,000 – Field Increase accessibility and use of PMTCT services

Strengthen RH – PAC, FP, IP

Assess Cervical Cancer Prevention activities

3 $450,000 – Field Strengthen PMTCT training and services

Strengthen RH – PAC, FP, IP

HAITI

4 $130,000- Core FP/RH Field-test PAC module Revise curriculum

1 $0 2 $0 3 $127,000 Kenya

USAID/EAST AFRICA

4 $0 (carry forward) 1 (new) $200,000 Angola, Ethiopia,

Ghana, Mozambique, Nigeria, Mali, Senegal, Tanzania

2 $400,000 Zambia, Niger, Senegal, Burkina Faso, Mauritania, Ghana*, Ethiopia*, Malawi*, Tanzania*

3 $400,000 Ghana, Tanzania, Ethiopia, Malawi

AFR/SD BUREAU

4 $400,000 Ghana, Tanzania, Ethiopia



1 $430,000 Nepal, Bangladesh, Cambodia, Afghanistan, India, Indonesia, Philippines, Pakistan, West Timor

2 $0 ($373,150 carry forward)

Nepal, Bangladesh, Cambodia, Afghanistan, India, Indonesia, Philippines, Pakistan, West Timor


ANE BUREAU


1 (new) $50,000 Guatemala, Peru, Bolivia, DR, Paraguay

2 $75,000 (received as GH/HIDN core)

Bolivia, DR, Guatemala, Peru

3 *$0 ($17,271 carry forward)

LAC BUREAU

4 $0 1 (new) $300,000 Mauritania, Cameroon 2 $300,000 Cameroon, one new

country TBD 3 $300,000 Cameroon, Mauritania,

Togo, Niger

USAID/WEST AFRICA

4 $0 (carry forward) Cameroon, Mauritania, Togo, Niger

52

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

AN

NEX

E: H

IDN

RES

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S PA

THW

AYS

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OR

T A

ND

O

P IN

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ATO

RS

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TER

NA

L H

EALT

H P

ATH

WA

YS

Ski

lled

Car

e at

Del

iver

y M

ater

nal m

orta

lity

ratio

s ref

lect

the

wid

est d

ispa

rity

in h

uman

dev

elop

men

t ind

icat

ors b

etw

een

deve

lope

d an

d de

velo

ping

cou

ntrie

s and

bet

wee

n th

e ric

h an

d th

e po

or w

ithin

cou

ntrie

s. Ea

ch y

ear m

ore

than

500

,000

wom

en d

ie d

ue to

com

plic

atio

ns o

f pre

gnan

cy a

nd c

hild

birth

. Ano

ther

15

to 2

0 m

illio

n w

omen

suff

er d

irect

and

long

-term

dis

abili

ties t

hat a

re e

asily

pre

vent

ed if

safe

del

iver

y ca

re is

pro

vide

d to

the

maj

ority

of c

hild

bear

ing

and

refe

rral

to sp

ecia

lized

leve

l of c

are

to a

smal

l per

cent

age

who

dev

elop

com

plic

atio

ns. T

he m

ajor

dire

ct c

ause

s of m

ater

nal m

orta

lity

are:

hem

orrh

age,

hy

perte

nsiv

e di

sord

ers,

infe

ctio

n, a

borti

on, o

bstru

cted

labo

r and

ane

mia

. Man

y of

thes

e co

mpl

icat

ions

can

be

prev

ente

d or

app

ropr

iate

ly m

anag

ed if

a

skill

ed b

irth

atte

ndan

t (SB

A) i

s con

duct

ing

the

deliv

ery

at a

faci

lity

or a

t hom

e. S

kille

d bi

rth a

ttend

ant (

SBA

) is d

efin

ed a

s a h

ealth

pro

vide

r with

m

edic

al tr

aini

ng su

ch a

s a d

octo

r, m

idw

ife o

r nur

se. T

hese

skill

ed in

divi

dual

s req

uire

the

man

date

, com

mod

ities

, dru

gs a

nd e

quip

men

t to

prov

ide

skill

ed c

are.

USA

ID is

supp

ortin

g po

lices

, stra

tegi

es a

nd p

rogr

ams t

hat p

rom

ote

safe

del

iver

y by

skill

ed b

irth

atte

ndan

ts, a

s wel

l as i

mm

edia

te

post

partu

m c

are.

Bec

ause

of t

he st

agna

nt o

r inc

reas

ing

mat

erna

l mor

ality

ratio

s in

Afr

ica,

USA

ID w

ill fo

cus i

ts a

ctiv

ities

to a

ddre

ss th

is p

robl

em

parti

cula

rly in

Afr

ican

cou

ntrie

s. 1.

Re

sear

ch to

ana

lyze

glo

bal d

ata

to g

uide

pro

gram

min

g; to

ass

ess n

ew in

terv

entio

ns a

nd d

ocum

ent e

ffec

tiven

ess a

nd c

ost e

ffec

tiven

ess o

f sel

ecte

d st

rate

gies

; to

addr

ess r

emai

ning

cha

lleng

es, i

nclu

ding

hum

an re

sour

ces c

onst

rain

ts, f

inan

cial

bar

riers

and

equ

ity g

aps t

o se

rvic

e ut

iliza

tion

and

in

parti

cula

r SB

A u

se b

y th

e m

argi

naliz

ed a

nd u

nder

serv

ed w

omen

.

53

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

AC

TIVI

TY T

ITLE

EX

PEC

TED

RES

ULT

EN

D

DA

TE

IND

ICA

TOR

ST

ATU

S D

UR

ING

FIS

CA

L YE

AR

(F

Y08

REF

ERS

TO R

ESU

LTS

AC

CO

MPL

ISH

ED D

UR

ING

FY0

8 W

ITH

ALL

R

ESO

UR

CES

); FY

09 T

AR

GET

REF

ERS

TO

RES

ULT

S PL

AN

NED

TO

BE

AC

CO

MPL

ISH

ED D

UR

ING

10/

1/08

–9/3

0/09

W

ILL

ALL

RES

OU

RC

ES

NA

RR

ATI

VE

PAR

AG

RA

PH

FY08

Res

ults

FY

09 T

arge

t A

sses

smen

t of

mat

erni

ty c

are

and

birth

out

com

es

D

irect

cau

ses

of m

ater

nal

mor

talit

y (M

M)

Pe

rinat

al a

nd n

eona

tal

mor

talit

y

MM

glo

bal e

stim

ates

Impa

ct o

f ces

area

n se

ctio

n

Phys

ical

, psy

chol

ogic

al

and

econ

omic

co

nseq

uenc

e of

mor

talit

y an

d m

orbi

dity

Impa

ct o

f FP

on

MM

FY06

FY

06

FY07

FY

07

FY08

/09

FY 0

7

Com

plet

ed

Com

plet

ed

Ong

oing

O

ngoi

ng

Ong

oing

Mat

erna

l mor

talit

y m

easu

rem

ent t

ools

Sam

plin

g at

ser

vice

site

(S

SS

) to

mea

sure

MM

RA

PID

to m

easu

re M

M in

fa

cilit

ies

V

erba

l aut

opsy

FY08

FY

08

FY08

Ong

oing

O

ngoi

ng

Ong

oing

Impl

emen

tatio

n ap

proa

ches

Qua

lity

impr

ovem

ent

colla

bora

tives

Con

tinui

ty a

nd q

ualit

y of

ca

re

Fi

nanc

ing

FY08

FY

09

FY 0

9

Ong

oing

O

ngoi

ng

Ong

oing

54

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

2.

Intr

oduc

tion

and

expa

nsio

n of

pro

ven

inte

rven

tions

incl

udes

tech

nica

l lea

ders

hip,

adv

ocac

y an

d po

licy

dial

ogue

with

MO

H a

nd M

issi

ons t

o en

sure

safe

birt

h pr

omot

ing

use

of p

rove

n in

terv

entio

ns, s

uch

as c

lean

del

iver

y, u

se o

f the

par

togr

aph,

etc

., by

SB

As t

o ad

dres

s the

maj

or d

irect

ca

uses

of m

ater

nal d

eath

. Int

rodu

ctio

n in

cou

ntrie

s whi

ch h

ave

wea

k m

ater

nal h

ealth

serv

ices

will

focu

s on

one

dist

rict (

at le

ast 2

0% o

f po

pula

tion

or fa

cilit

ies)

. Exp

ansi

on is

def

ined

as m

ovin

g be

yond

one

dis

trict

and

cov

erin

g 20

% o

f the

pop

ulat

ion

in a

dis

trict

/sta

te/c

ount

ry. S

BA

is

an

indi

cato

r cap

ture

d by

DH

S. A

ttem

pt w

ill a

lso

be m

ade

to c

aptu

re d

ata

at th

e di

stin

ct/p

rovi

sion

al le

vel w

here

USA

ID p

artn

ers a

re a

ctiv

e.

Als

o se

e th

e pa

thw

ay o

n pr

even

tion

of p

ostp

artu

m h

emor

rhag

e.

A

CTI

VITY

TIT

LE

EXPE

CTE

D

RES

ULT

EN

D

DA

TE

IND

ICA

TOR

ST

ATU

S D

UR

ING

FIS

CA

L YE

AR

(F

Y08

REF

ERS

TO R

ESU

LTS

AC

CO

MPL

ISH

ED D

UR

ING

FY0

8 W

ITH

A

LL R

ESO

UR

CES

); FY

09

TAR

GET

R

EFER

S TO

RES

ULT

S PL

AN

NED

TO

B

E A

CC

OM

PLIS

HED

DU

RIN

G

10/1

/08–

9/30

/09

WIL

L AL

L R

ESO

UR

CES

NA

RR

ATI

VE P

AR

AG

RA

PH

FY08

RES

ULT

S FY

09 T

AR

GET

Te

chni

cal l

eade

rshi

p an

d pa

rtner

ship

to a

dvan

ce

SB

A a

ctiv

ities

at a

co

untry

leve

l

Tool

s di

ssem

inat

ed

& p

artn

ersh

ip w

ith

FBO

s, P

MN

CH

&

WR

A to

initi

ate

coun

try le

vel S

BA

ac

tiviti

es

FY08

co

mpl

eted

C

ompl

eted

P

roje

ct c

lose

-out

D

ocum

ents

sha

red

with

par

tner

s an

d its

us

e ex

pend

ed th

roug

h FB

Os,

WR

A an

d ot

her p

artn

ers.

W

ider

dis

sem

inat

ion

of d

ocum

ents

and

pr

ogra

mm

atic

less

ons

lear

nt w

ill b

e sh

ared

at t

he p

roje

ct c

lose

-out

mee

tings

. In

trodu

ctio

n of

in

terv

entio

ns fo

r ski

lled

birth

atte

ndan

ce th

roug

h E

ssen

tial M

ater

nal a

nd

New

born

Hea

lth (E

MN

H)

SB

A in

trodu

ced

in

7 co

untri

es (a

t le

ast 2

0% in

one

di

stric

t)

FY09

O

n-go

ing

9 (Cor

e: G

hana

, Ind

ia,

Tanz

ania

, Eth

iopi

a)

(Fie

ld: H

aiti,

C

amer

oon,

M

aurit

ania

, Nig

er,

Ethi

opia

, Tog

o)

3 (Gha

na, I

ndia

, E

thio

pia)

AC

CE

SS

had

fiel

d su

ppor

t fun

ds fo

r PA

C

from

the

PR

H O

ffice

thro

ugh

Dec

. 31,

20

07.

Expa

nsio

n of

ski

lled

birth

at

tend

ance

in c

ount

ries

SB

A e

xpan

ded

in 3

co

untri

es th

roug

h pr

e-se

rvic

e tra

inin

g

FY09

O

n-go

ing

4 (Fie

ld: M

alaw

i, Ta

nzan

ia, N

iger

ia,

Afg

hani

stan

)

7 (Fie

ld: M

alaw

i, Ta

nzan

ia,

Eth

iopi

a,

Nig

eria

,Gha

na,

Indi

a,

Afg

hani

stan

)

Mis

sion

fund

s ex

pand

ed a

ctiv

ities

in

Tanz

ania

, Mal

awi,

Nig

eria

, Afg

hani

stan

. A

ctiv

ities

will

expa

nd to

nat

iona

l lev

el in

G

hana

and

sta

te le

vel i

n In

dia

usin

g ot

her

non-

AC

CE

SS

reso

urce

s.

Pre

-ser

vice

trai

ning

pic

ked

up b

y M

issi

on

fund

ing

in M

alaw

i, Ta

nzan

ia, a

nd E

thio

pia.

Saf

e B

irth

Afri

ca In

itiat

ive

(SB

AI)

Focu

s in

1 A

frica

n co

untri

es to

in

crea

se S

BA a

nd

cove

rage

with

pr

oven

inte

rven

tions

FY09

O

n-go

ing

1 (Rw

anda

) 1 (R

wan

da)

Incl

ude

natio

nal-l

evel

sup

porti

ve a

ctiv

ities

fo

r SB

A a

nd fo

cuse

d ac

tiviti

es in

4 d

istri

cts

cont

inui

ng.

Ant

enat

al C

are

Pat

hway

55

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

Whi

le a

nten

atal

car

e (A

NC

) atte

ndan

ce h

as b

een

risin

g sl

owly

thro

ugho

ut th

e w

orld

, it r

emai

ns q

uite

low

in A

sia.

Mos

t pre

gnan

t wom

en in

Asi

a an

d A

fric

a do

not

mak

e th

e re

com

men

ded

min

imal

num

ber o

f ant

enat

al v

isits

(4 v

isits

). Q

ualit

y an

tena

tal c

are

(AN

C) i

mpr

oves

mat

erna

l hea

lth a

nd h

elps

to

pro

mot

e he

alth

y ou

tcom

es fo

r wom

en a

nd n

ewbo

rns.

Ant

enat

al c

are

(AN

C) c

an a

ssis

t in

early

det

ectio

n of

obs

tetri

c co

mpl

icat

ions

and

med

ical

pr

oble

ms e

xace

rbat

ed b

y pr

egna

ncy.

It is

a k

ey e

ntry

poi

nt fo

r pre

gnan

t wom

en to

rece

ive

a br

oad

rang

e of

pre

vent

ive

heal

th se

rvic

es in

clud

ing

nutri

tion

supp

lem

enta

tion;

pre

vent

ion

and

treat

men

t of m

alar

ia, H

IV/A

IDS,

syph

ilis;

and

teta

nus t

oxoi

d im

mun

izat

ion;

and

cou

nsel

ing

abou

t use

of a

sk

illed

birt

h at

tend

ant.

GH

will

exp

and

prog

ram

s to

stre

ngth

en fo

cuse

d an

tena

tal c

are

that

pro

vide

ass

essm

ent a

nd a

ctio

n to

pro

vide

car

e fo

r eac

h w

oman

’s in

divi

dual

situ

atio

n—ta

king

into

con

side

ratio

n th

e ex

istin

g co

untry

spec

ific

prev

alen

ce o

f inf

ectio

ns, s

uch

as m

alar

ia a

nd H

IV/A

IDS

for

mal

aria

in p

regn

ancy

(MIP

) and

pre

vent

ion

of m

ater

nal-t

o-ch

ild-tr

ansm

issi

on o

f HIV

(PM

TCT)

pro

gram

s. 3.

R

esea

rch

to a

sses

s the

eff

ectiv

enes

s of m

icro

nutri

ents

supp

lem

enta

tion

and

nutri

tiona

l app

roac

hes o

n ne

onat

al a

nd m

ater

nal s

urvi

val.

A

CTI

VITY

TIT

LE

EXPE

CTE

D

RES

ULT

EN

D

DA

TE

IND

ICA

TOR

ST

ATU

S D

UR

ING

FIS

CAL

YEA

R (F

Y08

REF

ERS

TO R

ESU

LTS

AC

CO

MPL

ISH

ED D

UR

ING

FY0

8 W

ITH

ALL

RES

OU

RC

ES);

FY 0

9 TA

RG

ET

REF

ERS

TO R

ESU

LTS

PLA

NN

ED T

O B

E A

CC

OM

PLIS

HED

DU

RIN

G 1

0/1/

08–9

/30/

09 W

ILL

ALL

RES

OU

RC

ES

NA

RR

ATI

VE P

AR

AG

RA

PH

FY08

Res

ults

FY

09 T

arge

t N

utrit

iona

l ap

proa

ches

for

neon

atal

/mat

erna

l he

alth

Effe

cts

of lo

w

dose

Vit

A o

n bi

rth

outc

omes

FY08

O

ngoi

ng

56

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

4.

Intro

duct

ion

and

expa

nsio

n w

ill in

clud

e ac

tiviti

es to

incr

ease

focu

sed

ante

nata

l car

e in

Afr

ican

cou

ntrie

s with

hig

h m

alar

ia a

nd H

IV/A

IDS

prev

alen

ce to

pre

vent

HIV

tran

smis

sion

from

mot

hers

to c

hild

. Stre

ngth

enin

g A

NC

will

be

part

of E

ssen

tial M

ater

nal a

nd N

ewbo

rn H

ealth

(E

MN

C) a

ctiv

ities

in m

ost t

arge

ted

coun

tries

.

AC

TIVI

TY T

ITLE

EX

PEC

TED

R

ESU

LT

END

D

ATE

IN

DIC

ATO

R

STA

TUS

DU

RIN

G F

ISC

AL

YEA

R

(FY0

8 R

EFER

S TO

RES

ULT

S A

CC

OM

PLIS

HED

DU

RIN

G F

Y08

WIT

H A

LL

RES

OU

RC

ES);

FY 0

9 TA

RG

ET R

EFER

S TO

R

ESU

LTS

PLA

NN

ED T

O B

E A

CC

OM

PLIS

HED

D

UR

ING

10/

1/08

–9/3

0/09

WIL

L A

LL

RES

OU

RC

ES

NA

RR

ATI

VE P

AR

AG

RA

PH

FY08

RES

ULT

S FY

09 T

AR

GET

P

rom

otio

n of

fo

cuse

d A

NC

with

W

HO

, IC

M, W

RA

an

d FB

Os

Dev

elop

men

t an

d di

ssem

inat

ion

of te

chni

cal

mat

eria

ls a

nd

prom

otio

n of

fo

cuse

d A

NC

at

coun

try le

vel

FY07

On-

goin

g C

ompl

eted

C

ore

fund

ing

supp

orte

d pa

rtner

s to

use

an

d di

ssem

inat

e te

chni

cal m

ater

ials

to

prom

ote

focu

sed

AN

C. M

ost

impl

emen

tatio

n is

cov

ered

by

field

sup

port

see

belo

w. M

alar

ia p

reve

ntio

n du

ring

preg

nanc

y is

a k

ey fo

cus

of A

NC

ac

tiviti

es.

Intro

duct

ion

of

focu

sed

AN

C

with

in E

MN

C

Focu

sed

AN

C

impl

emen

ted

in

3 co

untri

es

FY08

5 (Cor

e: In

dia)

(F

ield

: Rw

anda

, E

thio

pia,

RS

A, K

enya

)

4 (Cor

e: In

dia,

Mal

awi)

(Fie

ld: R

SA

, Ken

ya)

Cor

e O

HA

fund

s su

ppor

t int

egra

tion

of

PM

TCT

in F

AN

C in

Mal

awi.

PM

TCT

field

sup

port

fund

s us

ed in

Ken

ya

for F

Y08

.

Expa

nsio

n of

An

emia

pre

vent

ion

activ

ities

S

ee a

lso

the

nutri

tion

path

way

s

Scal

e up

an

emia

pr

even

tion

activ

ities

in o

ne

coun

try

FY08

4 (Fie

ld: M

alaw

i, N

iger

ia,

Tanz

ania

, Afg

hani

stan

)

5 (Fie

ld: M

alaw

i, N

iger

ia,

Tanz

ania

, Afg

hani

stan

, R

wan

da)

Mis

sion

fund

ing

FAN

C in

clud

ed in

Mal

awi R

H s

tand

ards

Expa

nsio

n of

fo

cuse

d A

NC

in

Tanz

ania

All A

NC

se

rvic

es

upgr

aded

with

M

IP a

nd

PMTC

T na

tion

wid

e

FY09

On-

goin

g O

ngoi

ng

Mis

sion

fund

ing

57

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

Pre

vent

ion

of P

ostp

artu

m H

emor

rhag

e P

athw

ay

Seve

re b

leed

ing

is th

e si

ngle

mos

t im

porta

nt c

ause

of m

ater

nal d

eath

wor

ldw

ide.

Ove

r 30%

of a

ll m

ater

nal d

eath

s are

due

to h

emor

rhag

e in

Asi

a an

d A

fric

a. A

n es

timat

ed 1

4 m

illio

n ca

ses o

f sev

ere

post

partu

m h

emor

rhag

e (P

PH) o

ccur

eve

ry y

ear w

ith a

cas

e fa

talit

y ra

te o

f app

roxi

mat

ely

1%

(140

,000

dea

ths)

. Ute

rine

aton

y ac

coun

ts fo

r 70–

90%

of a

ll PP

H c

ases

; act

ive

man

agem

ent o

f the

third

stag

e of

labo

r (A

MTS

L) is

an

evid

ence

-bas

ed,

feas

ible

, low

-cos

t int

erve

ntio

n th

at c

an p

reve

nt 6

0 pe

rcen

t of u

terin

e at

ony

that

lead

s to

hem

orrh

age

and

mat

erna

l dea

th.

1.

Res

earc

h to

dev

elop

a si

mpl

e sy

ringe

mec

hani

sm to

del

iver

a u

tero

toni

c dr

ug (o

xyto

cin)

in a

pre

-fill

ed d

evic

e (U

nije

ct),

a m

ulti-

coun

try su

rvey

to

dete

rmin

e th

e co

vera

ge o

f AM

TSL

prac

tice,

and

com

paris

on o

f the

rela

tive

impa

ct o

f oxy

toci

n ve

rsus

con

trolle

d co

rd tr

actio

n.

A

CTI

VITY

TIT

LE

EXPE

CTE

D R

ESU

LT

END

D

ATE

IN

DIC

ATO

R

STA

TUS

DU

RIN

G F

ISC

AL

YEA

R (F

Y08

REF

ERS

TO R

ESU

LTS

AC

CO

MPL

ISH

ED

DU

RIN

G F

Y08

WIT

H A

LL R

ESO

UR

CES

); FY

09

TAR

GET

REF

ERS

TO R

ESU

LTS

PLA

NN

ED T

O B

E A

CC

OM

PLIS

HED

D

UR

ING

10/

1/08

-9/3

0/09

WIL

L A

LL

RES

OU

RC

ES

NA

RR

ATI

VE

PAR

AG

RA

PH

FY08

RES

ULT

S FY

09 T

AR

GET

O

xyto

cin

in U

nije

ct d

evel

opm

ent

Oxy

toci

n in

Uni

ject

av

aila

ble

for f

ield

tria

l, pi

lots

, and

co

mm

erci

aliz

atio

n

FY09

O

n-go

ing

Glo

bal s

urve

y of

AM

TSL

prac

tices

C

over

age

of A

MTS

L pr

actic

es a

sses

sed

and

diss

emin

ated

in 1

0 co

untri

es

FY08

C

ompl

eted

8

coun

tries

Feas

ibilit

y of

usi

ng c

omm

unity

m

idw

ives

(mat

rone

s) to

adm

inis

ter

Oxy

toci

n in

Unj

iect

Feas

ibilit

y of

usi

ng

com

mun

ity m

idw

ives

to

adm

inis

ter O

xyto

cin

in

Uni

ject

dem

onst

rate

d in

Se

nega

l

FY09

C

ontin

uing

Com

paris

on o

f rel

ativ

e ef

fect

iven

ess

of th

ree

AM

TSL

com

pone

nts

Rel

ativ

e ef

fect

iven

ess

of

oxyt

ocin

vs.

con

trolle

d co

rd

tract

ion

clar

ified

for f

utur

e pr

ogra

m e

mph

asis

FY 0

9 Pl

anni

ng

58

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

2.

Intro

duct

ion

and

expa

nsio

n w

ill in

clud

e te

chni

cal l

eade

rshi

p in

mob

ilizi

ng M

issi

on su

ppor

t for

pre

vent

ion

of P

PH p

reve

ntio

n pr

ogra

ms;

ass

istin

g M

issi

ons w

ith th

e in

trodu

ctio

n an

d ex

pans

ion

of P

PH in

terv

entio

ns in

a to

tal o

f 29

coun

tries

(exp

ansi

on in

10

coun

tries

by

FY 2

008

(’07

fund

s).

A

CTI

VITY

TI

TLE

EXPE

CTE

D

RES

ULT

EN

D

DA

TE

IND

ICA

TOR

ST

ATU

S D

UR

ING

FIS

CA

L YE

AR

(FY0

8 R

EFER

S TO

RES

ULT

S A

CC

OM

PLIS

HED

D

UR

ING

FY0

8 W

ITH

ALL

RES

OU

RC

ES);

FY 0

9 TA

RG

ET R

EFER

S TO

RES

ULT

S PL

AN

NED

TO

BE

AC

CO

MPL

ISH

ED

DU

RIN

G 1

0/1/

08-9

/30/

09 W

ILL

ALL

R

ESO

UR

CES

NA

RR

ATI

VE P

AR

AG

RA

PH

FY08

Res

ults

FY

09 T

arge

t In

crea

sed

awar

enes

s of

AM

TSL

stan

dard

s in

25

coun

tries

FY06

New

glo

bal p

olic

y fo

r com

mun

ity-

base

d P

PH

FY06

Glo

bal a

nd

coun

try p

olic

ies

for P

PH

in m

id

and

low

-reso

urce

se

tting

s

FY09

Tech

nica

l le

ader

ship

Impr

oved

sys

tem

s fo

r ute

roto

nics

FY

09

On-

goin

g O

n-go

ing

Pro

ject

clo

se-o

ut

Con

tribu

tion

to re

gion

al a

nd n

atio

nal l

evel

m

eetin

gs a

nd P

OP

PH

I wor

king

gro

ups.

W

ider

dis

sem

inat

ion

of d

ocum

ents

and

pr

ogra

mm

atic

less

ons

lear

nt w

ill b

e sh

ared

at

clos

e-ou

t mee

tings

.

Intro

duct

ion

of

PP

H p

reve

ntio

n pr

ogra

ms

into

co

untri

es

PP

H p

rogr

ams

intro

duce

d in

at

leas

t 17

focu

s co

untri

es (a

t lea

st

25%

of f

acilit

ies

in

one

dist

rict)

FY09

O

n-go

ing

10

(Cor

e: G

hana

, Ind

ia,

DR

C, T

anza

nia,

E

thio

pia,

Ken

ya)

(Fie

ld: C

amer

oon,

M

aurit

ania

, N

iger

,Tog

o, E

thio

pia)

4 (Cor

e: G

hana

, In

dia,

Eth

iopi

a)

(Fie

ld, K

enya

)

Pilo

t act

iviti

es in

itiat

ed b

y co

re fu

nds.

M

issi

on fu

nds

thou

gh A

CC

ES

S o

r oth

er

bila

tera

l are

exp

andi

ng P

PH

act

iviti

es.

Gha

na a

nd E

thio

pia

will

con

tinue

to re

ceiv

e co

re p

rese

rvic

e fu

nds.

K

enya

will

intro

duce

PP

H a

t pro

vinc

ial l

evel

th

roug

h A

ssoc

iate

Aw

ard.

Ex

pans

ion

of

PP

H p

reve

ntio

n pr

ogra

ms

in

coun

tries

PP

H p

reve

ntio

n pr

ogra

ms

expa

nded

in 1

0 co

untri

es

(20%

of f

acili

ties

in c

ount

ry)

FY09

O

n-go

ing

4 (Cor

e: R

wan

da)

(Fie

ld: M

alaw

i, N

iger

ia, A

fgha

nist

an)

8 (Cor

e: R

wan

da),

(Fie

ld: A

fgha

nist

an,

Nig

eria

, Eth

iopi

a,

Mal

awi,

Tanz

ania

, In

dia,

Gha

na,)

Act

iviti

es w

ill e

xpan

d to

nat

iona

l lev

el in

Gha

na

and

stat

e le

vel i

n In

dia

usin

g ot

her n

on-

AC

CE

SS

reso

urce

s.

59

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

New

born

Hea

lth P

athw

ay

Each

yea

r, ap

prox

imat

ely

4 m

illio

n ne

wbo

rns d

ie w

ithin

the

first

mon

th o

f life

acc

ount

ing

for o

ver 6

0% o

f inf

ant m

orta

lity

and

alm

ost 4

0% o

f dea

ths

amon

g ch

ildre

n un

der f

ive

year

s of a

ge. M

ost n

eona

tal d

eath

s are

cau

sed

dire

ctly

by

infe

ctio

ns (3

6%) a

nd lo

w b

irth

wei

ght i

s the

mos

t im

porta

nt in

dire

ct

caus

e of

dea

th w

ith 6

0 to

80%

of n

eona

tal d

eath

s occ

urrin

g am

ong

new

born

s tha

t are

bor

n to

o sm

all.

Prio

rity

mus

t be

plac

ed o

n ho

me-

and

com

mun

ity-

base

d ap

proa

ches

bec

ause

a la

rge

maj

ority

of b

irths

occ

ur a

t hom

e an

d ca

n be

pre

vent

ed a

nd m

anag

ed a

t hom

e. A

n ad

ditio

nal c

onsid

erat

ion

in th

e A

frica

n co

ntex

t is t

hat o

ver h

alf a

mill

ion

new

born

s are

infe

cted

by

the

HIV

viru

s ann

ually

thro

ugh

mot

her-t

o-ch

ild- t

rans

miss

ion

(MTC

T). T

he u

ptak

e of

pre

vent

ion

of m

othe

r-to-

child

tran

smiss

ion

of H

IV (P

MTC

T) c

ontin

ues t

o be

lim

ited,

rang

ing

from

1%

to 1

0% in

sub-

Saha

ran

Afr

ica.

The

rela

tivel

y hi

gh a

nten

atal

car

e co

vera

ge in

Afri

ca (o

ver 7

5% fo

r one

visi

t) an

d sk

illed

birt

h at

tend

ance

(45%

) pro

vide

an

exce

llent

pla

tform

for s

calin

g up

PM

TCT

if th

e tw

o pr

ogra

ms a

re b

ette

r lin

ked.

1.

R

esea

rch

to a

sses

s pro

gram

feas

ibili

ty a

nd e

ffec

tiven

ess o

f com

mun

ity b

ased

Ess

entia

l New

born

Car

e (c

lean

del

iver

y an

d co

rd c

are,

war

mth

, ea

rly a

nd e

xclu

sive

bre

astfe

edin

g, a

nd e

arly

reco

gniti

on a

nd re

ferr

al fo

r com

plic

atio

ns);

com

mun

ity b

ased

infe

ctio

n m

anag

emen

t (ho

me-

base

d po

stna

tal c

are,

Chl

orhe

xidi

ne fo

r cor

d ca

re, s

impl

ified

ant

ibio

tic re

gim

en);

new

born

car

e an

d PM

TC

T in

tegr

atio

n; a

nd n

ewbo

rn te

chno

logy

de

velo

pmen

t (G

enta

mic

in in

Uni

ject

, Chl

orhe

xidi

ne, R

esus

cita

tion

devi

ce).

A

CTI

VITY

TIT

LE

EXPE

CTE

D

RES

ULT

EN

D D

ATE

IN

DIC

ATO

R

STA

TUS

DU

RIN

G F

ISC

AL Y

EAR

(FY0

8 R

EFER

S TO

RES

ULT

S A

CC

OM

PLIS

HED

DU

RIN

G F

Y08

WIT

H A

LL R

ESO

UR

CES

); FY

09

TAR

GET

R

EFER

S TO

RES

ULT

S PL

AN

NED

TO

BE

AC

CO

MPL

ISH

ED D

UR

ING

10/

1/08

-9/3

0/09

WIL

L A

LL R

ESO

UR

CES

NA

RR

ATI

VE

PAR

AG

RA

PH

FY08

RES

ULT

S FY

09 T

AR

GET

C

omm

unity

bas

ed E

NC

in

Ban

glad

esh

Pro

gram

fe

asib

ility

of

com

mun

ity b

ased

EN

C

dem

onst

rate

d

FY06

C

ompl

eted

in

2006

Com

mun

ity b

ased

in

fect

ion

prev

entio

n an

d m

anag

emen

t:

Chl

orhe

xidi

ne (J

HU

, B’

desh

)

Mul

ti-ce

nter

sep

sis

(WH

O &

BU

)

Stan

dby-

by

antib

iotic

&

resu

scita

tion

(BU

, Za

mbi

a)

G

enta

mic

in in

Uni

ject

Effe

ctiv

enes

s &

pr

ogra

m fe

asib

ility

dem

onst

rate

d

FY09

C

HX:

C

ontin

uing

S

epsi

s:

plan

ning

Za

mbi

a:

Con

tinui

ng

Gen

ta: p

lann

ing

New

born

tech

nolo

gy

G

enta

mic

in in

U

nije

ct

FY09

G

enta

: sta

rted

60

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

AC

TIVI

TY T

ITLE

EX

PEC

TED

R

ESU

LT

END

DA

TE

IND

ICA

TOR

ST

ATU

S D

UR

ING

FIS

CAL

YEA

R (F

Y08

REF

ERS

TO R

ESU

LTS

AC

CO

MPL

ISH

ED D

UR

ING

FY0

8 W

ITH

ALL

RES

OU

RC

ES);

FY 0

9 TA

RG

ET

REF

ERS

TO R

ESU

LTS

PLA

NN

ED T

O B

E A

CC

OM

PLIS

HED

DU

RIN

G 1

0/1/

08-9

/30/

09 W

ILL

ALL

RES

OU

RC

ES

NA

RR

ATI

VE

PAR

AG

RA

PH

avai

labl

e fo

r fie

ld tr

ial

D

eliv

ery

mec

hani

sm

for C

HX

deve

lope

d

Use

of

resu

scita

tion

devi

ces

eval

uate

d in

In

dia

and

mor

e w

idel

y av

aila

ble

in

Afri

ca

S

epsi

s sc

reen

ing

land

scap

e an

alys

is

FY08

CH

X: s

tarte

d

Res

us:

cont

inui

ng

Sep

sis

scr.

tool

an

alys

is:

com

plet

ed

Met

a-an

alys

is o

f glo

bal

new

born

dat

a (3

0 co

untri

es)

Glo

bal s

tatu

s of

ne

wbo

rn c

are

asse

ssed

FY06

C

ompl

eted

61

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

2.

Intr

oduc

tion

and

expa

nsio

n w

ill in

clud

e te

chni

cal l

eade

rshi

p in

mob

ilizi

ng M

issi

on su

ppor

t for

new

born

hea

lth p

rogr

ams;

ass

istin

g M

issi

ons

with

the

intro

duct

ion

and

expa

nsio

n of

new

born

inte

rven

tions

in a

tota

l of 2

7 co

untri

es (1

8 in

trodu

ctio

n an

d 9

expa

nsio

n) b

y 20

08

A

CTI

VITY

TIT

LE

EXPE

CTE

D R

ESU

LT

END

DA

TE

IND

ICA

TOR

ST

ATU

S D

UR

ING

FIS

CA

L YE

AR

(F

Y08

REF

ERS

TO R

ESU

LTS

AC

CO

MPL

ISH

ED D

UR

ING

FY0

8 W

ITH

ALL

RES

OU

RC

ES);

FY 0

9 TA

RG

ET R

EFER

S TO

RES

ULT

S PL

AN

NED

TO

BE

AC

CO

MPL

ISH

ED

DU

RIN

G 1

0/1/

08–9

/30/

09 W

ILL

ALL

R

ESO

UR

CES

NA

RR

ATI

VE P

AR

AG

RA

PH

FY08

RES

ULT

S FY

09 T

AR

GET

Te

chni

cal

lead

ersh

ip

Tech

nica

l gui

delin

es

and

mat

eria

ls

deve

lope

d

FY09

O

n-go

ing

9 co

untri

es

(Rw

anda

, Nig

eria

, M

alaw

i, C

ambo

dia,

Indi

a,

Afgh

anis

tan,

N

epal

, Eth

iopi

a Ba

ngla

desh

)

Pro

ject

clo

se-o

ut

Wid

er d

isse

min

atio

n of

doc

umen

ts a

nd

prog

ram

mat

ic le

sson

s le

arnt

will

be

shar

ed a

t the

pro

ject

clo

se-o

ut m

eetin

gs

Intro

duct

ion

of

new

born

car

e in

to

coun

tries

EN

C in

trodu

ced

in a

t le

ast 1

2 ne

w c

ount

ries

(at l

east

3 d

istri

cts)

FY09

O

n-go

ing

9 (Cor

e: In

dia,

G

hana

, Ta

nzan

ia,

Eth

iopi

a, K

enya

) (F

ield

:, M

aurit

ania

, To

go, N

iger

, C

amer

oon,

E

thio

pia)

4 (Cor

e: In

dia,

G

hana

, Eth

iopi

a)

(Fie

ld: K

enya

)

Ken

ya: A

t pro

vinc

ial l

evel

thro

ugh

Ass

ocia

te A

war

d in

FY

09.

Expa

nsio

n of

ne

wbo

rn c

are

in

coun

tries

ENC

exp

ande

d in

9

new

cou

ntrie

s (>

3 di

stric

t)

FY09

O

n-go

ing

7 (Cor

e: R

wan

da,

Nep

al)

(Fie

ld: N

iger

ia,

Ban

glad

esh,

A

fgha

nist

an,

Cam

bodi

a,

Mal

awi)

10

(Cor

e: R

wan

da)

(Fie

ld: E

thio

pia,

N

iger

ia,

Ban

glad

esh,

A

fgha

nist

an,

Mal

awi,

Cam

bodi

a,

Tanz

ania

, Ind

ia,

Gha

na)

Cor

e fu

nds

in R

wan

da. A

ctiv

ities

will

ex

pand

to n

atio

nal l

evel

in G

hana

and

st

ate

leve

l in

Indi

a us

ing

othe

r non

-A

CC

ES

S re

sour

ces.

Th

roug

h M

issi

on fu

ndin

g in

Nig

eria

, B

angl

ades

h, A

fgha

nist

an, C

ambo

dia,

an

d M

alaw

i, Ta

nzan

ia a

nd E

thio

pia.

62

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

OP

IND

ICA

TOR

S

MA

TER

NA

L A

ND

CH

ILD

HEA

LTH

08

targ

et, t

o be

ach

ieve

d w

ith a

ll fu

nds,

as

of 9

/30/

08

(as

set i

n N

ovem

ber,

2007

PR

)

08 a

ctua

l, ac

hiev

ed w

ith

all f

unds

, as

of

9/30

/08

(as

repo

rted

in

Dec

embe

r, 20

08 P

R)

Expl

anat

ion:

1,0

00 c

hara

cter

text

bo

x (p

er in

dica

tor)

requ

ired

to

expl

ain

devi

atio

n (1

0%) w

hen

targ

ets

are

not m

et, t

arge

ts a

re

sign

ifica

ntly

exc

eede

d, o

r whe

n dr

oppi

ng a

n in

dica

tor.

Dro

p-do

wn

incl

udes

: a) s

hift

in p

rogr

amm

ing

emph

asis

; b) u

nexp

ecte

d pr

ogra

m

impl

emen

tatio

n de

lays

; c) h

ost

gove

rnm

ent e

nviro

nmen

t; d)

late

ar

rival

of p

rogr

amm

ing

fund

s; e

) dr

oppi

ng in

dica

tor;

or f

) oth

er.

09 ta

rget

, to

be

achi

eved

w

ith a

ll fu

nds,

as

of 9

/30/

09

(as

set i

n D

ecem

ber,

2008

PR

)

2010

ta

rget

, to

be

achi

eved

w

ith a

ll fu

nds,

as

of 9

/30/

10

(as

set i

n D

ecem

ber,

2008

PR

)

DQ

A:

Dat

e D

QA

was

co

mpl

ete

d fo

r thi

s in

dica

tor

Num

ber o

f peo

ple

train

ed in

re

sear

ch w

ith U

SG

assi

stan

ce

3,90

0

Num

ber o

f po

stpa

rtum

/new

born

vis

its

with

in 3

day

s of

birt

h in

U

SG

-ass

iste

d pr

ogra

ms

80,0

00

818

Gha

na, I

ndia

Num

ber o

f ant

enat

al c

are

(AN

C) v

isits

by

skill

ed

prov

ider

s fro

m U

SG

-as

sist

ed fa

cilit

ies

210,

000

5,85

0 In

dia

Num

ber o

f peo

ple

train

ed

in m

ater

nal/

new

born

he

alth

thro

ugh

US

G-

supp

orte

d pr

ogra

ms*

65,0

00

7,27

6 A

ctua

l exc

eeds

targ

et s

ince

AC

CE

SS

-su

ppor

ted

e-le

arni

ng c

ours

es g

rant

ed

mor

e ce

rtific

ates

than

ant

icip

ated

whe

n th

e ta

rget

s w

ere

set a

nd m

ore

mah

ila m

anda

l le

ader

s pa

rtici

pate

d in

trai

ning

s as

par

t of

the

Indi

a ac

tiviti

es th

an a

ntic

ipat

ed

Num

ber o

f del

iver

ies

with

a

skille

d bi

rth a

ttend

ant (

SB

A)

in U

SG

-ass

iste

d pr

ogra

ms

110,

000

12,8

79 G

hana

, R

wan

da, I

ndia

63

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

MA

TER

NA

L A

ND

CH

ILD

HEA

LTH

08

targ

et, t

o be

ach

ieve

d w

ith a

ll fu

nds,

as

of 9

/30/

08

(as

set i

n N

ovem

ber,

2007

PR

)

08 a

ctua

l, ac

hiev

ed w

ith

all f

unds

, as

of

9/30

/08

(as

repo

rted

in

Dec

embe

r, 20

08 P

R)

Expl

anat

ion:

1,0

00 c

hara

cter

text

bo

x (p

er in

dica

tor)

requ

ired

to

expl

ain

devi

atio

n (1

0%) w

hen

targ

ets

are

not m

et, t

arge

ts a

re

sign

ifica

ntly

exc

eede

d, o

r whe

n dr

oppi

ng a

n in

dica

tor.

Dro

p-do

wn

incl

udes

: a) s

hift

in p

rogr

amm

ing

emph

asis

; b) u

nexp

ecte

d pr

ogra

m

impl

emen

tatio

n de

lays

; c) h

ost

gove

rnm

ent e

nviro

nmen

t; d)

late

ar

rival

of p

rogr

amm

ing

fund

s; e

) dr

oppi

ng in

dica

tor;

or f

) oth

er.

09 ta

rget

, to

be

achi

eved

w

ith a

ll fu

nds,

as

of 9

/30/

09

(as

set i

n D

ecem

ber,

2008

PR

)

2010

ta

rget

, to

be

achi

eved

w

ith a

ll fu

nds,

as

of 9

/30/

10

(as

set i

n D

ecem

ber,

2008

PR

)

DQ

A:

Dat

e D

QA

was

co

mpl

ete

d fo

r thi

s in

dica

tor

Num

ber o

f peo

ple

train

ed in

ch

ild h

ealth

and

nut

ritio

n th

roug

h U

SG

-sup

porte

d he

alth

are

a pr

ogra

ms

*

350,

000

Num

ber o

f wom

en re

ceiv

ing

activ

e m

anag

emen

t of t

he

third

sta

ge o

f lab

or (A

MS

TL)

thro

ugh

US

G-s

uppo

rted

prog

ram

s

22,0

00

9,24

7 G

hana

, R

wan

da, I

ndia

Num

ber o

f new

born

s re

ceiv

ing

antib

iotic

trea

tmen

t fo

r inf

ectio

n fro

m a

ppro

pria

te

heal

th w

orke

rs th

roug

h U

SG

-sup

porte

d pr

ogra

ms

12,0

00

Num

ber o

f new

born

s re

ceiv

ing

esse

ntia

l new

born

ca

re th

roug

h U

SG

-su

ppor

ted

prog

ram

s

75,0

00

674

Indi

a

Num

ber o

f chi

ldre

n re

ache

d by

US

G-s

uppo

rted

nutri

tion

prog

ram

s

750,

000

64

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

MA

TER

NA

L A

ND

CH

ILD

HEA

LTH

08

targ

et, t

o be

ach

ieve

d w

ith a

ll fu

nds,

as

of 9

/30/

08

(as

set i

n N

ovem

ber,

2007

PR

)

08 a

ctua

l, ac

hiev

ed w

ith

all f

unds

, as

of

9/30

/08

(as

repo

rted

in

Dec

embe

r, 20

08 P

R)

Expl

anat

ion:

1,0

00 c

hara

cter

text

bo

x (p

er in

dica

tor)

requ

ired

to

expl

ain

devi

atio

n (1

0%) w

hen

targ

ets

are

not m

et, t

arge

ts a

re

sign

ifica

ntly

exc

eede

d, o

r whe

n dr

oppi

ng a

n in

dica

tor.

Dro

p-do

wn

incl

udes

: a) s

hift

in p

rogr

amm

ing

emph

asis

; b) u

nexp

ecte

d pr

ogra

m

impl

emen

tatio

n de

lays

; c) h

ost

gove

rnm

ent e

nviro

nmen

t; d)

late

ar

rival

of p

rogr

amm

ing

fund

s; e

) dr

oppi

ng in

dica

tor;

or f

) oth

er.

09 ta

rget

, to

be

achi

eved

w

ith a

ll fu

nds,

as

of 9

/30/

09

(as

set i

n D

ecem

ber,

2008

PR

)

2010

ta

rget

, to

be

achi

eved

w

ith a

ll fu

nds,

as

of 9

/30/

10

(as

set i

n D

ecem

ber,

2008

PR

)

DQ

A:

Dat

e D

QA

was

co

mpl

ete

d fo

r thi

s in

dica

tor

Num

ber o

f cas

es o

f chi

ld

pneu

mon

ia tr

eate

d w

ith

antib

iotic

s by

trai

ned

faci

lity

or c

omm

unity

hea

lth w

orke

rs

in U

SG

-sup

porte

d pr

ogra

ms

13,0

00

Num

ber o

f chi

ldre

n le

ss th

an

12 m

onth

s of

age

who

re

ceiv

ed D

PT3

from

US

G-

supp

orte

d pr

ogra

ms

(can

no

t dro

p th

is in

dica

tor)*

180,

000

Num

ber o

f chi

ldre

n un

der 5

ye

ars

of a

ge w

ho re

ceiv

ed

vita

min

A fr

om U

SG

-su

ppor

ted

prog

ram

s (c

an

not d

rop

this

indi

cato

r)

620,

000

Lite

rs o

f drin

king

wat

er

disi

nfec

ted

with

US

G-

supp

orte

d po

int-o

f-use

tre

atm

ent p

rodu

cts

360,

000,

000

Num

ber o

f cas

es o

f chi

ld

diar

rhea

trea

ted

in U

SA

ID-

assi

sted

pro

gram

s*

1,00

0,00

0

Num

ber o

f bas

elin

e or

fe

asib

ility

stud

ies

* 1

2 Ba

selin

e st

udie

s w

ere

cond

ucte

d in

R

wan

da a

nd In

dia

durin

g th

is p

erio

d.

0

Num

ber o

f spe

cial

stu

dies

80

65

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

MA

TER

NA

L A

ND

CH

ILD

HEA

LTH

08

targ

et, t

o be

ach

ieve

d w

ith a

ll fu

nds,

as

of 9

/30/

08

(as

set i

n N

ovem

ber,

2007

PR

)

08 a

ctua

l, ac

hiev

ed w

ith

all f

unds

, as

of

9/30

/08

(as

repo

rted

in

Dec

embe

r, 20

08 P

R)

Expl

anat

ion:

1,0

00 c

hara

cter

text

bo

x (p

er in

dica

tor)

requ

ired

to

expl

ain

devi

atio

n (1

0%) w

hen

targ

ets

are

not m

et, t

arge

ts a

re

sign

ifica

ntly

exc

eede

d, o

r whe

n dr

oppi

ng a

n in

dica

tor.

Dro

p-do

wn

incl

udes

: a) s

hift

in p

rogr

amm

ing

emph

asis

; b) u

nexp

ecte

d pr

ogra

m

impl

emen

tatio

n de

lays

; c) h

ost

gove

rnm

ent e

nviro

nmen

t; d)

late

ar

rival

of p

rogr

amm

ing

fund

s; e

) dr

oppi

ng in

dica

tor;

or f

) oth

er.

09 ta

rget

, to

be

achi

eved

w

ith a

ll fu

nds,

as

of 9

/30/

09

(as

set i

n D

ecem

ber,

2008

PR

)

2010

ta

rget

, to

be

achi

eved

w

ith a

ll fu

nds,

as

of 9

/30/

10

(as

set i

n D

ecem

ber,

2008

PR

)

DQ

A:

Dat

e D

QA

was

co

mpl

ete

d fo

r thi

s in

dica

tor

Num

ber o

f inf

orm

atio

n ga

ther

ing

or re

sear

ch a

ctiv

ities

130

Num

ber o

f cou

ntrie

s w

ith

expa

nsio

n of

pos

tpar

tum

he

mor

rhag

e pr

even

tion

inte

rven

tions

(AM

TSL)

*

22

4 In

dia,

Gha

na,

Eth

iopi

a, R

wan

da

Indi

a, G

hana

and

Eth

iopi

a in

trodu

ced

AMTS

L an

d ex

pand

ed in

Gha

na

4 In

dia,

G

hana

, Et

hiop

ia a

nd

Rw

anda

N/A

Num

ber o

f cou

ntrie

s w

ith

intro

duct

ion

and

expa

nsio

n of

cut

ting

edge

nut

ritio

n in

terv

entio

ns (e

.g.,

CTC

and

M

N fo

rtific

atio

n)

49

Num

ber o

f cou

ntrie

s w

ith

intro

duct

ion

and

expa

nsio

n of

new

dia

rrhe

al d

isea

se

prev

entio

n an

d m

anag

emen

t pr

ogra

ms

(PO

U, z

inc

and

OR

T)*

23

Pers

on-d

ays

of te

chni

cal

supp

ort p

rovi

ded

to m

issi

ons

thro

ugh

TDYs

500

66

AC

CES

S Ye

ar F

our A

nnua

l Rep

ort

MA

TER

NA

L A

ND

CH

ILD

HEA

LTH

08

targ

et, t

o be

ach

ieve

d w

ith a

ll fu

nds,

as

of 9

/30/

08

(as

set i

n N

ovem

ber,

2007

PR

)

08 a

ctua

l, ac

hiev

ed w

ith

all f

unds

, as

of

9/30

/08

(as

repo

rted

in

Dec

embe

r, 20

08 P

R)

Expl

anat

ion:

1,0

00 c

hara

cter

text

bo

x (p

er in

dica

tor)

requ

ired

to

expl

ain

devi

atio

n (1

0%) w

hen

targ

ets

are

not m

et, t

arge

ts a

re

sign

ifica

ntly

exc

eede

d, o

r whe

n dr

oppi

ng a

n in

dica

tor.

Dro

p-do

wn

incl

udes

: a) s

hift

in p

rogr

amm

ing

emph

asis

; b) u

nexp

ecte

d pr

ogra

m

impl

emen

tatio

n de

lays

; c) h

ost

gove

rnm

ent e

nviro

nmen

t; d)

late

ar

rival

of p

rogr

amm

ing

fund

s; e

) dr

oppi

ng in

dica

tor;

or f

) oth

er.

09 ta

rget

, to

be

achi

eved

w

ith a

ll fu

nds,

as

of 9

/30/

09

(as

set i

n D

ecem

ber,

2008

PR

)

2010

ta

rget

, to

be

achi

eved

w

ith a

ll fu

nds,

as

of 9

/30/

10

(as

set i

n D

ecem

ber,

2008

PR

)

DQ

A:

Dat

e D

QA

was

co

mpl

ete

d fo

r thi

s in

dica

tor

Num

ber o

f mis

sion

s ac

cess

ing

cent

rally

-des

igne

d or

man

aged

mec

hani

sms

usin

g th

eir o

wn

fund

ing*

38

Rat

io o

f mis

sion

fund

ing

to

core

fund

ing

in c

entra

lly-

man

aged

mec

hani

sms

desi

gned

to s

uppo

rt th

e fie

ld*

42,0

00,0

00/

38,0

00,0

00

Num

ber o

f tec

hnol

ogie

s un

der d

evel

opm

ent

8

Num

ber o

f ins

tanc

es o

f in

terv

entio

ns b

eing

in

trodu

ced

or e

xpan

ded

in

coun

tries

214

ACCESS Year Four Annual Reportafter birth. Beyond the results pathways, ACCESS activities have led...

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Transcript of ACCESS Year Four Annual Reportafter birth. Beyond the results pathways, ACCESS activities have led...