coag no. 72068718ca00001

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COAG No. 72068718CA00001

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TABLE OF CONTENT

I- EXECUTIVE SUMMARY ............................................................................................................................................................... 5

II- INTRODUCTION ......................................................................................................................................................................... 12

III- MAIN ACHIEVEMENTS DURING QUARTER 3 ........................................................................................................................ 12

III.1. IR 1: ENHANCED COORDINATION AMONG THE PUBLIC, NONPROFIT, AND COMMERCIAL SECTORS FOR RELIABLE SUPPLY AND

DISTRIBUTION OF QUALITY HEALTH PRODUCTS ........................................................................................................................................................ 12 III.2. IR2: STRENGTHENED CAPACITY OF THE GOM TO SUSTAINABLY PROVIDE QUALITY HEALTH PRODUCTS TO THE MALAGASY PEOPLE . 18 III.3. IR 3: EXPANDED ENGAGEMENT OF THE COMMERCIAL HEALTH SECTOR TO SERVE NEW HEALTH PRODUCT MARKETS ACCORDING TO

HEALTH NEEDS AND CONSUMER DEMAND ............................................................................................................................................................... 36 III.4 IR 4: IMPROVED SUSTAINABILITY OF SOCIAL MARKETING TO DELIVER AFFORDABLE, ACCESSIBLE HEALTH PRODUCTS TO THE

MALAGASY PEOPLE ................................................................................................................................................................................................... 46 III.5. IR5: INCREASED DEMAND FOR AND USE OF HEALTH PRODUCTS AMONG THE MALAGASY PEOPLE ........................................................ 51 III.6. CROSS-CUTTING ACTIVITIES ....................................................................................................................................................................... 58

III.7 SUCCESS STORIES ........................................................................................................................................................................................ 69

IV- KEY CHALLENGES AND SOLUTIONS ....................................................................................................................................... 70

V- MAJOR ACTIVITIES PLANNED FOR NEXT QUARTER (YEAR 2, JULY – SEPTEMBER 2020) ............................................. 71

VI- ADAPTIVE APPROACH/METHODOLOGY DURING COVID-19 CONTEXT .......................................................................... 74

VII- FINANCIAL SUMMARY ............................................................................................................................................................. 75

ANNEXES ............................................................................................................................................................................................... 76

ANNEX A - PERFORMANCE MONITORING PLAN (PMP) ...................................................................................................................................... 77 ANNEX B – YEAR 2 WORKPLAN UPDATE .............................................................................................................................................................. 86 ANNEX C - ENVIRONMENTAL MITIGATION AND MONITORING REPORT ............................................................................................................ 122

ANNEX D - SUCCESS STORIES ......................................................................................................................................................................... 137 ANNEX E – STOCK INVENTORY AS OF JUNE 2020 .................................................................................................................................... 148

ANNEX F – STOCK STATUS BY END OF JUNE 2020 ................................................................................................................................... 150 ANNEX G - DESCRIPTIONS OF THE SEVEN QUALITY DIMENSIONS FOR THE RDQA ............................................................................................. 153

ANNEX H - COACHING TEMPLATE FOR DRUG SHOPS ............................................................................................................................ 155 ANNEXE I- REDEPLOYMENT OF MALARIA COMMODITIES .................................................................................................................................... 157 ANNEX J - DONATION CONDUCTED UNDER COVID-19 ......................................................................................................................... 162

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ACRONYMS

A2F Access to Finance

ABM AccèsBanque Madagascar

ADDO Accredited Drug-Dispensing Outlet

AMM Agence de Médicaments de Madagascar

CACSU Cellule d’Appui à la Couverture Santé

Universelle

cCD Community-based Continuous

Distribution

CCO Centre de Commandement

Opérationnel/Operational Command

Centre

CCOR Centre de Commandement Opérationnel

Régional/Regional Operational

Command Centre

CGL Comité de Gestion Logistique

CHV Community Health Volunteers

CHRD Centre Hospitalier de Réference de

District/District Reference Hospital

Centre

CCRCE Commission for Communication on Risk

and Community Engagement

CNFM Conseil National des Femmes de

Madagascar

CSR Corporate Social Responsibility

CoAg Cooperative Agreement

COGS Cost of Good Sold

CPT Certified Peer Trainer

CSB Centre de Santé de Base/Basic Health

Center

CUA Commune Urbaine d’Antananarivo

DCA Development Credit Authority

DEPSI Direction des Etudes de la Planification

et du Système d’Information

DFC United States International

Development Finance Corporation

DGFS Direction Générale de Fourniture des

Soins

DGMP Direction Générale de la Médecine

Préventive

DHIS-2 District Health Information System - 2

DPS Direction de la Promotion de la Santé/

Directorate of Health Promotion

DLMT Direction de Lutte contre les Maladies

Transmissibles

LLIN Long Lasting Insecticide-treated Net

LMIS Logistic Management Information

System

LTA Long Term Agreement

MEL Monitoring, Evaluation and Learning

MNCH Maternal Newborn and Child Health

MDA Market Development Authority

MEL Monitoring, Evaluation and Learning

MENETP Ministère de l’Education Nationale et de

l’Enseignement Technique et

Professionnel

MERL Monitoring Evaluation Research and

Learning

MoPH Ministry of Public Health

MSH Management Sciences for Health

MYS Ministry of Youth and Sport

NCC National Coordination Committee

NGO Non-Governmental Organization

NMCP National Malaria Control Program

NSP National Supply Plan

PA Point d’Approvisionnement/Supply

Point

PAIS Plan d’Action d’Intégration des Intrants

de santé

PARC Point d’Approvisionnement Relais

Communautaire/Community Supply

Point

PBO Pyrethroid and Piperonyl Butoxide

PCR Polymerase Chain Reaction

PDPN Plan Directeur Pharmaceutique National

PMI President’s Malaria Initiative

PMP Performance Monitoring Plan

PPE Personal Protection Equipment

PPR Performance Plan and Report

PPN Politique Pharmaceutique Nationale

PSHP Private Sector Humanitarian Platform

PSM Procurement and Supply Management

PSI/M Population Services

International/Madagascar

Pha-G-Dis Pharmacie de Gros de District

Pha-Ge-Com Pharmacie à Gestion Communautaire

RBM Roll Back Malaria

RH Reproductive Health

RDT Rapid Diagnostic Test

RLA Regional Logistic Advisor

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DRENETP Direction Régionale de l’Education

Nationale et de l’Enseignement

Technique et Professionnelle

DPLMT Direction de la Pharmacie, des

Laboratoires et de la Médecine

Traditionnelle

DRSP Direction Régionale de la Santé

Publique/ Regional Directorate of Public

Health

DSFa Direction de la Santé Familiale

DSSB Direction des Services de Santé de Base

EFOI Entreprendre au Féminin Océan Indien

EMMP Environmental Mitigation Monitoring

Plan

FANOME Financement pour l’Approvisionnement

Non-stop en Médicaments

FP Family Planning

GAS Gestion des Approvisionnements et des

Stocks

GESI Gender Equality and Social Inclusion

GF Global Fund

GOM Government of Madagascar

HPN Health Population and Nutrition

RHD Regional Health Director

IMPACT Improving Market Partnerships and

Access to Commodities Together

IR Intermediate Result

IPM Institut Pasteur de Madagascar

IPTp Intermittent Preventive Treatment

during pregnancy

ISM Integrated Social Marketing

SBCC Social and Behavior Change

Communication

SGL Logistics Sector Group

SHOPS Plus Sustaining Health Outcomes in the

Private Sector Plus

SILC Savings and Internal Lending

Communities

SLRC Service de la Législation, de la

Réglementation et du Contentieux

SP Sulfadoxine Pyriméthamine

SPD Superviseurs de Point de Distribution

STTA Short-term Technical Assistance

TA Technicien Accompagnateur

TFP Technical and Financial Partners

TMA Total Market Approach

TMI Total Market Initiative

ToT Training of Trainers

TWG Technical Working Group

UCP Unité de coordination des Projets

UHC Universal Health Coverage

UNFPA United Nations Population Fund

UTGL Unité Technique de Gestion Logistique

USAID United States Agency for International

Development

WHO World Health Organization

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I- EXECUTIVE SUMMARY

Intermediate Results 1:

Enhanced coordination among public, non-profit, and commercial sectors for supply and distribution of

health products

Despite the COVID-19 pandemic and the challenges concerning the availability of the Ministry of Public Health

(MoPH) staff in pursuing Total Market Approach (TMA) activities, the IMPACT team was able to implement

activities in the TMA roadmap operational plan during Quarter 3.

• The malaria market assessment report was finalized with the contribution of the National Malaria Control

Program (NMCP) by providing key malaria information.

• The Direction de la Pharmacie, des Laboratoires, et de la Médecine Traditionnelle (DPLMT) and the

IMPACT team continued updating the Politique Pharmaceutique Nationale (PPN) and the Plan Directeur

Pharmaceutique Nationale (PDPN) on May 3 and May 16 through face-to-face meetings. The updated

documents were sent to all members of the committee by e-mail for review.

• The IMPACT team and the Direction des Etudes, de la Planification, et du Système d'Information (DEPSI)

represented by the National e-Health Observatory Manager, Dr. Rado Randriamboavonjy, met on May 5

to update the progress of the Logistics Management Information System (LMIS) TMA operational plan as

part of the overarching TMA roadmap. As a result, the participants decided that the LMIS subcommittee

will focus on the development of the LMIS strategic plan for the next 3-5 years based upon the findings

of the LMIS evaluation, including any actions engaging the private sector. It had been also decided this

LMIS strategic plan would include the engagement of the pharmaceutical wholesalers in sharing their

LMIS data, such as sales data, that will be used for quantification exercises and market share analysis.

Through this LMIS strategic plan, the LMIS subcommittee is envisioning to develop a user-friendly and

confidential software that will allow key stakeholders, including the pharmaceutical wholesalers, to

analyze national drug distribution and sales based on their sales data.

• On June 10, IMPACT had a meeting with the Direction de la Santé Familiale (DSFa) team, represented by

the director and the three heads of departments from the Family Planning (FP)/Reproductive Health (RH)

and the Maternal, Newborn, and Child Health (MNCH)/Safe Motherhood to present the purpose and the

methodology of the two upcoming FP and MNCH market assessments and to understand the expected

type of data from the assessment such as: the quantity and the type (presentation and brand name) of

MNCH and FP products available and distributed by the private sector, the market size of both MNCH and

FP products, the profile of the users of these products, the market failures, and the recommendations to

engage the private sector to adequately invest in the procurement of these products to avoid stockouts

or over stocks in the country.

• On June 17, a refresher leadership training was held with seven TMA Champions and the director of the

DPLMT based on the leadership principles acquired and challenges encountered. This training is of great

interest to participants and seeks to ensure that they can have their voice heard and defend their views

on issues that are important to them.


Strengthened capacity of the GOM to sustainably provide quality health products to the Malagasy people

During Quarter 3, IMPACT technically and financially supported the NMCP, DSFa, and technical partners to

conduct quantification exercises for malaria and FP commodities in June and July 2020. The quantification

exercise for MNCH commodities is scheduled for the end of July 2020 and will include the participation of the

private sector and other donors and NGOs (UNICEF, UNFPA, Marie Stopes Madagascar, FISA, ACCESS, Mahefa

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Miaraka, UCP, etc.). The quantification plans will be finalized and submitted to the Comité de Gestion

Logistique (CGL) for validation in August 2020 and to donors for resource mobilization.

IMPACT continued to support the malaria Gestion des Approvisionnements et des Stocks (GAS) committee, the

MNCH Technical Working Group (TWG) at the central level, and 12 regional (except Melaky region) Unité

Technique de Gestion Logistique (UTGL) and 76 districts GAS committees to analyze stock status and

consumption reports to plan malaria and MNCH commodities distribution for the period of April to June 2020.

As the stock of ACTs and RDTs is insufficient at SALAMA with months of stock varying between 1.2 to 6.1 for

the different formulations of ACTs and 3.3 months of stock of RDTs as shown in the dashboard of stocks status

(Annex F) , IMPACT has advised the GAS committee at the central level to only deliver to districts a reduced

quantity to cover a maximum of two to three months of stock and taking into account stock available at

districts instead of 6 months to 9 months while closely monitoring the shipments of orders in the pipeline.

In Quarter 3, all PMI orders for ACTs were delivered to SALAMA (details in table 6), which increased stock to

an average of 2.8 to 11.3 months maximum stock for the different formulations at the central level that will

enable to distribute for the rest of 2020. The rationing system will continue with ACTs and RDTs until the

orders from PMI and the Global Fund are totally delivered. At the district level, the Regional Logistic Advisors

(RLA) supported the district GAS committees to analyze stock at District level (Pha-G-Dis) and health facilities

(Centre de Santé de Base – CSB) and organized redeployment from 16 Pha-G-Dis to supply 20 districts (See

details on page 23/ Table 8) in order to face the malaria peak season.

IMPACT supported two meetings of the MNCH TWG led by DSFa to analyze consumption data and plan for

distribution of MNCH commodities to the 78 supported districts. As the country is experiencing an overstock

of Oxytocin, the MNCH TWG led by DSFa proposed to distribute 560,000 vials through the SALAMA FANOME

circuit and distribute the Oxytocin to public, subsidized, and private sector health facilities. In addition, IMPACT

is also working with Procurement and Supply Management (PSM) project to explore a transfer of 650,000 vials

of Oxytocin to another country as the expiration dates are May and June 2021.

Long Lasting Insecticide-treated Nets (LLIN) community-based Continuous Distribution (cCD)

In Quarter 3, 45% (445,100 LLINs) of cCD LLINs were transported to 12 Points d’Approvisionnement Relais

Communautaire/ Community Supply (PARCs) and 51.2% (227,700 LLINs) of those were received by 180 Points

d’Approvisionnement (PAs).

A total of 188,102 LLINs have been received by 1,363 Kom’Lay and 138,071 LLINs (73.4%) have been

distributed to the targeted population in 6 districts of Group 1 (Tamatave 2, Brickaville, Mananjary, Manakara,

Vohipeno, Tuléar 2).

Despite the COVID-19 context, training activities were completed in June for the two remaining districts of

Group 1 (Manakara and Vohipeno) and for the six districts of Group 2. Some adaptations have been done to

complete these trainings, such as relocating trainings to districts with no COVID-19 cases, dividing participants

into 13 small groups of 24 participants to respect social distancing, multiplying sessions, and providing masks

and handwashing stations. Thus, 98% of targeted participants have been trained. The 2% difference is due to

the non-availability of some teachers at the training because schools were closed due to COVID-19.

IMPACT supported the NMCP to transport 85,000 LLINs through emergency system from Antananarivo to 30

targeted districts due to the increase of malaria cases. (See details in page 32/table 13).

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In the meantime, 2,640 radio spots were broadcasted to cover the 280 communes, through local radio stations

in the 12 targeted districts, as an alternative to home visits. New Social and Behavior Change Communication

(SBCC) posters integrating malaria and COVID-19 messages were developed and printed by IMPACT and used

by Community Health Volunteers (CHV) in cCD areas. Three thousand hand washing devices were also installed

at LLIN distribution points (located close to the CHV selected by the community, who ensure the distribution)

in the fokontany to strengthen preventive and hygiene measures against COVID-19.

For the 2021 LLIN mass distribution campaign, the procurement of 3,677,000 LLINs is in progress and the

expected time of arrival (ETA) for first deliveries is October 14th, 2020.

During Quarter 3, the National Coordination Committee (NCC) met to discuss the detailed action plan and the

budget of the 2021 LLINs mass distribution campaign.

COVID-19 response linked to intermediate results 2

During Quarter 3, IMPACT supported the MoPH on the following activities in the 13 USAID-supported regions:

• IMPACT ensured the reception of 2,497 hand washing devices and the transportation of 4,000 masks

donated by DOD / USAID, PPE (protective face and surgical masks, infection prevention products

donated by Chinese Government from CCO Ivato warehouse to 5 USAID-supported regions and 1,872

hand washing devices to 11 PSI regional warehouses.

• As an active member of COVID-19 Regional Operational Command Centre (CCOR), IMPACT

participated in 52 meetings (1 meeting per week through the 13 USAID-supported regions).

• IMPACT has also organized the donation of health commodities (infection prevention products) and

equipment to DRSP / CCOR in 10 USAID-supported regions (details in annex J),

• Supported financially the transportation of 9 PCR (Polymerase Chain Reaction) specimen from Haute

Matsiatra (8) and Menabe (1) to IPM Antananarivo, and 4 PCR from Analanjirofo to Toamasina.

• Conducted training of 25 hygienists, 264 health workers and 162 cleaning workers on the use of PPE

and on effective and appropriate waste management in the regions of Atsinanana (170), Diana (143),

and Haute Matsiatra (138).


Expanded engagement of the commercial health sector to serve new health product markets, according to

health needs and consumer demand

• During Quarter 3, IMPACT has integrated a new member into the Private Sector Humanitarian Platform

(PSHP). Vitafoam, specializing in foam manufacturing, has joined the PSHP and is interested in focusing

their Corporate Social Responsibility (CSR) on health. In total, 17 members have been integrated into the

PSHP since IMPACT started.

• Memorandum of Understandings (MOUs) for the transportation of health commodities with EDM,

SOMAPHAR, INTER AIDE, and AQUALMA were drafted in Quarter 3 and are expected to be implemented

in Quarter 4. Meanwhile, KRED and SOPHARMAD are in the process of integrating access to finance and

the related MOUs are being finalized. The signature of the MOU is between IMPACT and the entity.

• With to the involvement of the private sector in the COVID-19 response, IMPACT had the opportunity to

present the PSHP and IMPACT at the Operational Coordination Center on April 24th, and during the UN

Global Compact Summit on June 16th.

• In Quarter 3, a technical committee comprised of DEPSI, DPLMT, and IMPACT continued the test of two

tools called “Pharmaplus and Maishamed.” Pharmaplus was selected to be tested because it is used by

many pharmacies in Madagascar for financial and stock management. Maishamed was also tested as it

seems promising through its experience in Tanzania and Kenya under the ADDO program. These tests

aimed to identify if parameters and functionality of these tools were useful for drug shops. A TOR for a

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competitive tender was developed and finalized and will be launched at the beginning of Quarter 4.

Interoperability with DHIS2 was also tested which was confirmed by technicians from IMPACT.

• Helped AccèsBanque Madagascar (ABM) develop ACCES SALAMA (COVID-19 loan product), Pharmaloan,

and PA motorbike loan.

• Supported expanded lending to health commodities supply enterprises: one loan totaling $6,665 was

disbursed by ABM in Quarter 3, and 10 loans totaling $20,408 were disbursed by Baobab.

• Provided one-on-one business and financial management coaching by phone to 16 drug shop owners

(nine men, seven women).

• Assisted drug shop owners in the Atsinanana region in creating a regional drug shop association,

ADEMERA, which was formalized in April.

• Conducted a phone survey with 71 drug shops to identify the main issues they are facing during the

COVID-19 pandemic regarding their commodity supplies and financing needs. The 71 interviewed drug

shops reported that drug supply was not affected by the COVID-19 crisis since goods transportation are

always authorized. However, there are stock-out of health products in high demand such as anti-malaria

medicines, vitamin C, and PPE (masks, hand sanitizer).

GOM facilitates the work of the commercial sector

IMPACT disseminated (through email) the technical report developed by the international expert in

pharmaceutical regulation to USAID, DAMM, and DPLMT. An action plan was developed with immediate and

mid-term activities that was shared with USAID to mobilize resources and technical expertise to support

DAMM in its effort to improve the functioning of the internal organization (administrative, financial, and

technical management). In the next quarter, IMPACT will work with DAMM to approach other donors to

mobilize additional resources to implement activities defined.

Intermediate Results 4

Improved sustainability of social marketing to deliver affordable, accessible health products to the

Malagasy people

In Quarter 3, IMPACT distributed: 647,659 cycles of Oral Contraceptives, 450,623 doses of Intra-muscular

injectable contraceptives, and 68,358 Sub-cutaneous Injectable Sayana Press received from UNFPA in May

2020.

In addition,

• 22,365 units (74%) compared to the annual target (30,378 units) of Arofoitra were distributed from

Quarter 1 to Quarter 3.

• For ORS, 21,230 units were distributed during Quarter 3 but the total sales from Quarter 1 to Quarter 3

represent 120% of the annual target (58,906 units).

• Currently, Sûr’Eau Pilina is in stock out at the PSI warehouses but is still available at PARC and PA level

with only 1% stock out at the end of June 2020. The total sales of Sur’Eau Pilina from Quarter 1 to Quarter

3 represent 32.75% of the annual target (3,620,780). The Sûr’Eau 150ml liquid has just been delivered

and will be distributed in the community circuit pending the arrival of the Sur'Eau Pilina expected on July

27th to avoid stock out of WASH products.

• The total sales from Quarter 1 to Quarter 3 of Pneumox is 43.4% compared to the annual target (219,635).

Pneumox was received only in June due to delay of the SALAMA delivery.

• Thirty-five out of 69 PARC and 463 out of 859 PA received promotional items from IMPACT as a result of

the high quality of their work during Quarter 2 following the results of the personal performance review.

Two PARC and 38 PA were also trained on cCD LLIN distribution procedures.

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• For the drone pilot phase, flight tests were halted during Quarter 3 while awaiting the importation of new

batteries which was delayed due to COVID-19. Batteries arrived in Maroantsetra at the end of June and

flight deliveries will resume in July 2020.

Intermediate Results 5

Increased demand for and use of health products among the Malagasy people

During Quarter 3, IMPACT continued to provide technical and financial support to the MOPH by sending

2,614,443 SMS messages about malaria for World Malaria Day in collaboration with the NMCP in the 13

USAID-supported regions. The message was focused on sensitizing people to avoid self-medication and to

encourage them to go to the health center for seeking treatment. IMPACT also participated in reviewing the

communication activities for the Malaria National Strategic Policy 2018-2022.

In collaboration with Health Promotion Department (Direction de la Promotion de la Santé – DPS) and DSFa,

a new TV spot on FP was produced and will be broadcasted to national and regional TV and radio to sensitize

the population on all available FP methods (oral contraceptives, condoms, injectables, and cycle beads), and

to inform them on where to get FP commodities (health center, CHVs, and drug shops).

To promote health products, 6,929 radio spots were broadcast, including 1,682 radio spots on IPTp and 1,682

radio spots on case management of malaria from May 29th to June 30th in 27 districts, 1,230 radio spots on

Sur'Eau Pilina from April 1st to 13th in 30 districts, and 2,335 radio spots to support cCD in 12 districts from

May 29th to June 30th.

During Quarter 3, the youth training curriculum has been revised to integrate gender and social inclusion

aspects. The training session will happen when travel between regions and the meeting are authorized.

A total of 3,219,776 people received a broadcasting messages through SMS on MNCH in the 10 USAID-

supported regions to pay attention to the health of mothers and children and to refer them to the health

center in order to receive appropriate health care.

Eleven SMS campaigns for health providers (PA, PARC, CHV, Pha-G-Dis) were organized and carried out to

encourage them to continue their efforts to promote health care and products and to sensitize them on stock

management.

COVID-19 response linked to communication activities

• IMPACT is an active member of the communication committee on risk and community engagement

(CCRCE) and participated in the regular coordination weekly meeting led by the DPS with the other

technical and financial partners.

• 24,000 COVID-19 prevention posters were produced for schools in Quarter 3. Ten IMPACT

communication teams used mobile sound systems to raise awareness about COVID-19 in communities

in 34 districts. They realized 354 sensitization activities

• IMPACT produced printed media in the response to COVID-19, including: 830 posters and 1,200 flyers

on the prevention of COVID-19 for DRSP of Antsinanana and Analanjirofo; 10,000 posters on

handwashing for drug shops, hospitals, medical centers, PA/PARC, IMPACT offices and warehouses,

and hygienists; 200 posters describing the definition of suspected cases of COVID-19 for 190 CSB and

10 CHRD of Atsimo Andrefana; 1,200 flyers on prevention of COVID-19 for households during social

mobilizations in Tamatave. The printed media helped to support the MOPH in the fight against COVID-

19 in accordance with the approved supplemental funding workplan.

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• The 910 call center was also strengthened with the increase of the number of hotliners from 18 to 30.

Cross-Cutting

Monitoring Evaluation, Research and Leaning

Monitoring and Evaluation

• A monthly average reporting rate of 75% at Pha-G-Dis level from October 2019 to May 2020 resulted

from the LMIS provisional roadmap developed by a committee composed of DPLMT, DEPSI, Measure

Evaluation, DSFa, and NMCP and the close follow-up from the helpdesk.

• Ninety percent (90%) of Pha-G-Dis had computers available for LMIS during Quarter 3. 36 out of 37

laptops initially purchased by IMPACT were sent to and received by the Pha-G-Dis. The remaining eight

(10%) Pha-G-Dis that do not have computers are: 3 Pha-G-Dis in Ambatofinandrahana, Antanifotsy,

and Ambatolampy that are waiting for the UCP donation; Pha-G-Dis in Sambava; part of the new 37

laptops from IMPACT that need repairs upon receipt by the Pha-G-Dis (to be repaired in July).

Marolambo will receive a laptop from IMPACT in July as part of the 37 donations from IMPACT and

three additional donations from IMPACT for Ankazoabo, Antalaha, and Morafenobe are expected to

be delivered in July. In sum, 40 new computers are from IMPACT.

• Ninety nine percent (99%) have access to an Internet connection as a result of the MOU signed by the

three USAID funded projects: ACCESS, Mahefa-Miaraka, and IMPACT.

• Ninety two percent (92%) of Pha-G-Dis providers received training on CHANNEL. The new staff in

charge of CHANNEL received on-the-job training during formative supervision by the

RLA/EMAR/EMAD.

Research

• Conducted further data analysis to finalize the malaria market assessment report.

• Started literature review on youth key informant interviews focused on FP among youth experts from

the MOPH, United Nation Institutions (UNFPA, WHO, etc.), donors, key partners implementing youth

activities, and different youth associations. The results from the literature review and interviews will

be used to identify youth profiles and segmentation, and then to suggest strategies for

communications on youth behavior change for FP.

• Addressed USAID concerns on motivation and barriers on the IPTp uptake study and the protocol was

shared with USAID.

Knowledge Management

• Supported IMPACT staff in collecting project success stories remotely based on performance

indicators and improvement per activity (level of commodities stockout, data reporting rates,

commodity distributions, etc.). Eight (08) success stories are presented in Annex D of this report.

• Continued to work with the USAID Madagascar communication team to disseminate success stories

through USAID platforms, such as websites and Facebook pages for world events.

Gender Integration and Social Inclusion (GESI)

During Quarter 3, IMPACT focused on integrating gender equality and social inclusion across several targeted

interventions, namely:

• Strengthened strategic partnerships with Conseil National des Femmes de Madagascar (CNFM) and

Entreprendre au Féminin Océan Indien (EFOI) to build capacity to serve as GESI Champions. The

integration of external partners was a recommendation of the GESI analysis in Year 1, to ensure that

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the differential needs of women, men, youth, and marginalized individuals are taken into account in

health commodities supply chains, and that these needs will continue to be sustainably addressed

after IMPACT has closed.

• Facilitated dialogues with CNFM and EFOI to outline role in TMI TWG.

• Integrated GESI best practices, such as the roles of men, women, and all parental figures to promote

wholistic family health and how providers can offer services without bias or discrimination, into

malaria and MNCH SBCC campaigns.

• Updated MOU with the ACCESS project and coordinated approach to upcoming GESI-informed family

planning communication campaign.

• Updated training curriculum for PAs and PARCs to include GESI considerations and facilitated capacity

building for GESI-influenced social marketing for health commodities distribution.

• Integrated GESI considerations into existing slide presentations for trainings at partner bank (Accès

Banque Madagascar and Baobab Banque Madagascar) branches to sensitize bank staff to the market

potential of drug shops, pharmacies, and other health commodity/supply chain businesses, and to help

banks to reach and retain clients in more inclusive ways.

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III- INTRODUCTION

Improving Market Partnerships and Access to Commodities Together (IMPACT) is funded by the United States

Agency for International Development (USAID) and led by PSI/Madagascar as the prime recipient and its

consortium partners for five years from September 4, 2018 until September 3, 2023.

IMPACT supports the Government of Madagascar to improve the capacity of the Malagasy health system to

ensure that quality pharmaceuticals and health commodities are available and accessible to all Malagasy

people on a sustainable basis. IMPACT’s expected outcome is to increase total market performance for and

use of health products and sustained health system performance. IMPACT has five intermediate results such

as (i) enhanced coordination among the public, nonprofit, and commercial sectors for reliable supply and

distribution of quality health products ; (ii) strengthened capacity of the Government of Madagascar (GOM)

to sustainably provide quality health products to the Malagasy people; (iii) expanded engagement of the

commercial health sector to serve new health markets according to health needs and consumer demand; (iv)

Improved sustainability of social marketing to deliver affordable, accessible health products to the Malagasy

population; (v) Increased demand for and use of health products among the Malagasy people.

This report will summarize the activities carried out during Quarter 3 of the fiscal year 2020 by the consortium

partners. The narrative provides updates on accomplishments, challenges, and solutions for Quarter 3.

IMPACT implemented activities on the fight against COVID-19 under a redirection of funding from cancelled

and/or postponed activities ($610,300) and supplemental funding ($700,000). The purpose of the two funding

streams are to (i) help the GOM to purchase and transport health and expendable commodities (infection

prevention products) from the central level to districts and communes (ii) sensitize Malagasy people in the 13

USAID-supported regions on COVID-19, and (iii) train hygienists and health workers at the regional health

facilities on waste management and infection prevention and control (IPC). Monthly reports were submitted

to USAID for May and June 2020 that are compiled and reported in this Quarter 3 report.

IV- MAIN ACHIEVEMENTS DURING QUARTER 3

III.1. IR 1: Enhanced coordination among the public, nonprofit, and commercial sectors for reliable supply

and distribution of quality health products

Sub-IR 1.1 The total market for health products in Madagascar is understood and documented

IR1.1.1: Support the implementation, monitor and evaluate the overarching TMA roadmap for all health

products based on the discussions and decisions taken during the TMA

The overarching TMA roadmap was finalized and submitted to the Secretary General of the MOPH for final

approval and validation in Year 2 Quarter 2 before the public dissemination despite the General Secretary’s

busy schedule during Quarter 3, he assured the IMPACT project that he would sign off on the roadmap in

order to disseminate it in July as the TMA activities have already started since July 2019.

Given the meeting restrictions due to the COVID-19 pandemic, working sessions to implement activities in the

operational plan of the TMA roadmap were completed with a limited number of participants.

The table below summarizes participants and meeting details during the reporting period.

13

Table 1: Summary of participant and meeting details

Dates Venue Purpose of the

meeting

Results and comments Total Female Male Participants

organization

May 3 DPLMT

office

Meeting with DPLMT

for the updates of the

PPN and PDPN

documents.

DPLMT incorporated changes to

the PPN and PDPN documents,

based on feedback gathered

from the PPN/PDPN

subcommittee’s members

3 2 1

- 2 from DPLMT - 1 from IMPACT project

May 5 DPLMT

office

Meeting with DEPSI

and DPLMT to update

the progress of the

activities carried out by

the IMPACT project,

which are part of the

operational plan of the

LMIS committee

It was decided that the next LMIS

subcommittee meeting will be

on July 2 to:

• Present the LMIS assessment

findings

• Develop a multiyear LMIS

strategic plan,

• Engage the pharmaceutical

wholesalers in sharing their

data through an engagement

letter

• finalize the ministerial note

formalizing the TMI TWG large

group (under the AOB item as

the DEPSI took the lead in

developing and submitting the

ministerial note to the General

Secretary)

6 0 6

- 1 from DPLMT - 1 from DEPSI - 4 from IMPACT project

May 16 DPLMT

office

Meeting with DPLMT

for the

compilation of

document updates and

feedback request to all

committee members

Continue incorporating changes

to the PPN and PDPN documents

3 2 1

- 2 from DPLMT

- 2 from IMPACT project

June 3

Havana

Resort

Hotel

Meeting with DEPSI

and DPLMT to prepare

the agenda of the next

meeting of the LMIS

sub-committee , and

to identify the

indicators needed for

LMIS analysis

The methodology to facilitate

the LMIS subcommittee meeting

was decided.

Although the private sector

representatives could not attend

this meeting, they have shared

in advance the

indicators/information they

would need. Therefore, the

participants at the meeting were

able to identify the type of

indicators needed for both

private and public sectors .

4 1 3

- 1 from DPLMT

-1 from DEPSI

- 2 from IMPACT project

June 10

Sakama

nga

Hotel

Meeting with DSFa to

present the purpose

and the methodology

of the two upcoming

FP and MNCH market

assessments; and to

The DSFa provided a list of FP

and MNCH documents and tools

that the private sector should

know and utilize 7 5 2

- 4 from public sector - 3 from IMPACT project

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Dates Venue Purpose of the

meeting

Results and comments Total Female Male Participants

organization

understand the type of

data they are

expecting from the

assessment

June 17

Havana

Resort

Hotel

Introduction on

advocacy training and

follow up of TMA

roadmap activities

with the TMA

Champions

The participants shared their

experiences on the application of

the leadership principles they

have learned.

The participants are very

interested in pursuing the

training

13 9 4

- 6 participants from public sector: the General Director of Preventive Medecine (DGMP), the 3 directors from DAMM, DPLMT, and DSFa, and the NMCP national coordinator - 2 from private sector - 3 from IMPACT project - 1 from PATH Senegal - 1 from PATH Kenya

• Under the leadership of the DPLMT, sections of the Politique Pharmaceutique Nationale and the Plan

Directeur Pharmaceutique National (PPN PDPN) documents were updated by the DPLMT and IMPACT

representatives through two working sessions held respectively on May 3 and May 16. Before each

working session, a reminder was sent to all members of the PPN PDPN subcommittee to get their

feedback on the updated sections in PPN PDPN documents. Some participants who were not present

during the last meeting have sent their feedback. To be more efficient and to save time, the DPLMT

decided to move on with a small committee to finalize all the sections of the PPN PDPN documents. The

final updated versions of these documents will be shared in Quarter 4 with the MOPH and all the PPN

PDPN subcommittee members for final approval before publication and dissemination scheduled in

Quarter 1 of Year 3.

• Under the leadership of DEPSI, two working sessions were held with the LMIS subcommittee of the TMA

TWG to monitor the progress made by IMPACT in terms of LMIS activities that are part of the operational

plan of the LMIS subcommittee. Set up in October 2019, the LMIS subcommittee initial members are

composed by representatives from the directorates at the public sector (such as DEPSI who leads the

initiative, DPLMT, DAMM, DSFa, and PNLP), from the professional bodies (Pediatric Academic Society and

Surgery Academic Society), from international NGOs (ACCESS, IMPACT and JHPIEGO), and from the

private sector (three pharmaceutical wholesalers that are Medico, Pharmatek and SK-Pharma; and from

Mirana Santé – an health insurance company). Additional members are also encouraged to join the

subcommittee to gather their opinion and point of view.

- The discussion on May 5 focused on the following:

1. The progress on LMIS evaluation and the plan for the dissemination of the results during a

workshop to develop a strategic LMIS plan for the next 3-5 years.

15

2. The possibility of engaging pharmaceutical wholesalers to share LMIS data, such as sales data,

that will be used for quantification exercises and market share analysis. A ToR was drafted and

shared with the LMIS TMA TWG subcommittee for feedback and comments. This ToR will be

used as an advocacy tool to convince pharmaceutical wholesalers to share data.

3. Progress on the open bid to recruit an agency to propose software for stock management and

LMIS tools for drug shops that are currently using a manual register book. The LMIS evaluation

recommendation proposed a list of software. However, the recruitment process of the agency

that will provide the appropriate software is not specified in the LMIS evaluation report.

Therefore, for the LMIS subcommittee, IMPACT launched an open bid to select the best provider

and to ensure transparency in the selection.

4. Progress of the MOPH note to formalize the TMI TWG committee as it is at the General

Secretary’s for approval.

- The second working session of DEPSI, DPLMT, and IMPACT was held on June 3rd to identify the

indicators and data that would be of interest to the private sector, and to prepare the next face-to-

face meeting with the LMIS subcommittee members scheduled in early Quarter 4. The outcome of the

meeting is that the private sector is very keen to get some updated information and data from the

public sector to expand their business, such as the updated location and number of drug shops across

the country, and the quantity of selected imported drugs to avoid overstock. It was also agreed that

the next meeting with the LMIS subcommittee will be on July 2nd (Quarter 3) to present the LMIS

evaluation findings among the private sector, and to discuss about the indicators (and data) needed

by the private sector.

• The activities of the “texts and regulations” subcommittee were pending because of the limited

number of staff available at the Direction de l’Agence de Médicaments de Madagascar (DAMM), and

their role in the fight against COVID-19 which is the GoM priority. Nevertheless, the director of the

DAMM assured that TMA activities would continue in July through virtual meetings. This

subcommittee will be analyzing, disseminating, and ensuring the implementation of the regulatory

texts governing health commodities to create an improved enabling environment for private

investment in the health sector and health commodities in Madagascar.

IR1.1.2: Support the development and implementation of the malaria TMA roadmap and monitor and

evaluate its progress to ensure the availability of quality malaria products at all

IMPACT has submitted the narrative report of the malaria market assessment to USAID. This assessment

produced a wealth of findings on the markets for malaria commodities, with primary takeaways as follows:

• Most stakeholders confirmed that there was good collaboration between the public sector and NGOs but

noted limited engagement between the public sector and the commercial/private sectors. Indeed, there

is a limited collaboration between these market actors to share information and the common initiatives

to expand the malaria market.

• Availability and accessibility of malaria commodities to all Malagasy people on a sustainable basis remains

challenging.

• Limited understanding and knowledge of many malaria products among end users. The findings of the

malaria market assessment will be shared on a virtual meeting with the RBM group in Quarter 4, followed

by the development of the TMA malaria roadmap in Year 3.

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In line with USAID’s recommendations, the findings will be presented to the NMCP in early September for

their comments; then will be disseminated by TMA champions to the RBM committee including the private

sector by the end of September.

IR1.1.4 : With the MOPH , build the capacity of TMA Champions to successfully steward and lead the TMA TWG and subcommittees (including the study tour to a country that has successfully implemented the TMA)

Seven TMA Champions and the director of the DPLMT attended the refresher leadership training on June 17

at the Havana hotel. The participants shared their experiences on the application of the leadership principles

by emphasizing their successes, the challenges encountered, and determining if they need any ongoing

support. For instance, one of the participants shared his experience on emotional intelligence, and his

difficulty in managing it. He was given a self-assessment by remaining calm and managing his emotions during

tense discussions and under pressure.

Most said that time management section helped them a lot.

This session was combined with a virtual introduction to advocacy training conducted by two trainers from

PATH Kenya and Senegal.

During the session, the participants were

introduced to the ten steps to develop an

advocacy strategy and they were presented with

a successful advocacy strategy from Kenya for

the introduction of Amoxicillin DT as a first-line

treatment in children with pneumonia.

All the participants found the session very useful

and relevant, and showed enthusiasm to pursue

and complete the training. The date of the next

advocacy training session is planned at the end

of Quarter 4, assuming international travel

restrictions are lifted. A virtual structure for this

training is also being considered.

IR1.1.5 : Disseminate the official TMI roadmap documents (overarching, Malaria, FP and MNCH) signed by representatives of the public, private and non-profit sectors

No achievement for Quarter 3.

The overarching TMA roadmap will be officially presented once validated and signed off by the Secretary

General of the MOPH. This will be done in Quarter 4.

The dissemination of the malaria market assessment findings is also planned in Quarter 4.

Sub-IR 1.2: GOM leads TMI stakeholders to coordinate health product quantification and forecasting,

procurement, and distribution according to market assessments and segmentation

IR1.2.1 : Organize meetings to revise and validate the Terms of Reference (ToR) of the UTGL to ensure its updated tasks and responsibilities.

Figure 1: The TMA Champion and Director of DPLMT attending the virtual training session on introduction to advocacy – June 17, 2020

17

During Quarter 3, IMPACT continued to support the UTGL in reviewing the ToR of actors involved in supply

chain of commodities at all levels. Four levels of actors have been defined, including: (i) actors at the central

level; (ii) actors at the regional level, including the regional UTGL; (iii) actors at the district level, including the

GAS district committees; and (iv) actors at the community level (including CSB and CHVs). This is a continued

activity that started in November 2019 with DPLMT, all vertical programs, and all Technical and Financial

partners (TFP).

IMPACT supported the UTGL to organize seven meetings in May and June with the Secretary General of MoPH,

SALAMA, DGFS, UCP, DPLMT Director, and UTGL members to ensure harmonization and alignment of all

stakeholders in the integrated management of health commodities. Currently, the supply chain system in the

public sector is still fragmented: essential medicines, malaria, and FP commodities are stored and distributed

to districts through SALAMA, while other commodities from vertical programs such as nutrition and HIV/STI

are stored and distributed through a parallel circuit defined by each program. The vision of the MOH is to

integrate all commodities through a unique circuit based at SALAMA to Pha-G-Dis and to CSB. In the new ToR,

the roles and responsibilities have been well articulated and adapted to the organizational changes within the

MoPH that were released earlier in 2020. The ToR document will add the role of pharmacists within hospitals,

the existence of district GAS committees and regional UTGL, and the role of DAMM at the central level. The

next steps of the process will include: 1) share the revised document with the regional management teams to

collect feedback; 2) hold a workshop to validate the document at the end of July; 3) creation of a ministerial

note to disseminate and guide implementation of the new ToR at all levels.

IR1.2.2: Organize quarterly meetings (UTGL, CGL, and GAS committee) to analyze routine data on key indicators in public hospitals, such as stock-out, LMIS issues, etc. for learning and adapting the use of DHIS2 in collaboration with the MERL team. During Quarter 3, IMPACT participated in five meetings organized by the PNLP to discuss the achievements

made towards the mid-term review of the National Strategic Plan (NSP) during the period of 2018-2019. The

review serves as an opportunity for all Roll Back Malaria (RBM) partners to analyze data, indicators, and to

update targets and key interventions for 2020-2022. A revised strategic plan and the M&E plan is required for

the NMCP to submit a request to Global Fund for a new grant under the new funding mechanism (NFM) to

secure resources for the next three years. IMPACT supported the GAS committee to collect and analyze

historical data on the consumption of malaria commodities (ACTs, RDTs, and Sulfadoxine-Pyrimethamine)

from 2018 to 2020 and to forecast the needs for the next three years. Furthermore, IMPACT participated in

the identification of key activities and interventions to improving the supply chain (capacity building, last mile

distribution, LMIS, etc.) to be funded through the NFM3 in order to strengthen the supply chain in Madagascar.

18

III.3. IR2: Strengthened capacity of the GOM to sustainably provide quality health products to the

Malagasy people

Sub-IR 2.1: Health commodities and pharmaceuticals are continuously accessible and available in the public

sector

IR2.1.1: Provide capacity building through trainings and consistent coaching to GOM and partner members

of UTGL on forecasting and supply planning, including the use of Quantimed

Quantification of Malaria commodities

IMPACT technically and financially supported the NMCP to prepare the quantification workshop that was held

from June 2nd to 5th, 2020. Prior to the quantification workshop, a technical committee formed in April by five

representatives from NMCP and technical partners, with the remote support from Andualem Oumar’s Short-

Term Technical Assistance (STTA), collected necessary data available on services and consumption of malaria

commodities. The technical committee collected and analyzed data and developed gap analysis tables

according to the PMI template. The gap analysis table was used during the 2021 Malaria Operational Plan to

secure funding to procure malaria commodities in 2022.

Data were analyzed and compiled to facilitate discussions and validation with the larger group of 26

participants invited to the workshop. The table below shows the disaggregation of participants at the

workshop.

Table 2 : Quantification Workshop of Malaria Commodities Participants

Organization Male Female Total % of participants

Ministry of Health 7 11 18 69%

Partners (IMPACT, ACCESS, Mahefa

Miaraka) 5 3 8 31%

Total 12 14 26 100%

% 46% 54% 100%

At the end of the quantification workshop, the data on the number of projected malaria cases and the

forecasted quantities needed to test and treat malaria cases for the period of 2020 to 2022 were approved by

the participants. The quantification results will be presented to the RBM and the Comité de Gestion Logistique

(CGL) for validation in Quarter 4 in order to proceed with resource mobilization and the procurement. From

the gap analysis completed, all needs of malaria commodities for 2020 are covered.

Quantification of Family Planning Commodities

IMPACT contributed to the quantification workshop organized by UNFPA from June 29th to July 2nd, 2020 to

forecast the needs for FP commodities distributed through the public and subsidized distribution channels.

Participants used historical consumption data reported by CSBs, NGOs (SALFA, FISA, etc.), and through the

social marketing sector to project the quantities needed from 2020 to 2022. A meeting will be organized in

July with the private sector to sensitize them on the need to be part of future quantification exercises. Due to

unavailability of consumption data and services rates, the quantification for the private sector will be added

in the future quantification years. IMPACT is working on the LMIS for both sectors as a long-term strategy to

capture data necessary for future quantifications exercises.

19

Forecasting and supply plans were generated and validated by the participants, and they will be presented to

the CGL for validation to mobilize resources to cover 2021 and 2022 needs and to proceed with the

procurement process.

Table 3 : Quantification Workshop of Family Planning Commodities Participants

Organization Male Female TOTAL %

Ministry of Health 8 7 15 63%

Technical Partners (USAID, UNFPA, UNICEF, IMPACT, ACCESS, ACCESS COLLABORATIVE, Mahefa Miaraka,)

4 1 5 21%

NGOs (FISA, SALFA, SAF/FJKM, MSM) 1 3 4 17%

TOTAL 13 11 24 100%

% 54% 46% 100%

Quantification of MNCH commodities

During Quarter 3, IMPACT supported the DSFa/Service de Santé Maternité Sans Risque (SMSR) to plan for the

annual quantification exercise for MNCH commodities. Data to be collected and all technical documents to be

used as a reference were defined and available. A schedule and the process for quantification and list of

participants was also defined. The quantification workshop will be held in Quarter 4 (in September).

IR2.1.3: Coordinate orders, deliveries generation and pipeline monitoring according to agree upon supply

plan with SALAMA, PSM, GOM institutions and USAID

IMPACT continued to collaborate with GHSC-PSM to coordinate and track deliveries of all pending

procurements. PSM shared weekly update reports highlighting a list of PSM orders impacted by the COVID-19

pandemic, the current status of the order, and an estimated delivery date (EDD). The PSM report showed the

necessary information per each order in the pipeline that could be impacted due to a delay with the order at

the supplier (e.g. because supplier factories closed or suppliers were experiencing delays in receiving Active

Pharmaceutical Ingredients), or a logistics delay (e.g. limited freight vessels), or both. The information received

from PSM allowed IMPACT to share weekly updates on upcoming deliveries with in-country partners such as

USAID, DSFa, PNLP, ACCESS, Mahefa Miaraka, UCP, and SALAMA.

Furthermore, IMPACT collaborated with freight forwarders to organize quick clearing of orders and avoid

delays in customs. Despite the lockdown imposed due to COVID-19, the products were cleared on time and

received at SALAMA and PSI warehouses while respecting disinfection measures and all security measures to

protect storekeepers.

The tables below show the status of orders in the pipeline highlighting shipments of malaria and FP

commodities received in Quarter 3 and estimated delivery dates for outstanding orders.

Table 4: Status of 2019 orders - Family Planning commodities

Product Specifications Unit Quantity Ordered

Quantity Delivered

Estimated Delivery Date (EDD)

Note

Levonorgestrel/Ethinyl Estradiol 150/30 mcg + Fe 75 mg, 28 Tablets/Cycle (SM), 1 Cycle [Zinnia-F]

Cycle 1,052,352 1,052,352 3/24/2020 Delivered at PSI warehouse on April 24, 2020

20

Pregnancy Tests, Test 200,000 - 5/31/2020

Pre-alert shipment notice. ETA estimated in July. The delay was due to the quality control process

Table 5: Status of 2020 orders - Family Planning

Product Specifications Unit Quantity Ordered

Quantity Delivered

Quantity Remaining

Notes

Depot (IM) Medroxyprogesterone Acetate 150 mg/mL (1 mL) Vial, w/ AD Syringe, 1 Each

vial 900,000 900,000 0 Delivered to PSI on May 05, 2020.

vial 1,600,000 0 1,600,000

Partial shipment of 900,000 units will be delivered to PSI warehouse in July 2020. The second shipment of 700,000 vials is expected to be delivered in August.

vial 2,500,000 900,000 1,600,000 Total

Etonogestrel 68 mg/Rod, 1 Rod Implant, 1 Each piece 35,064 0 35,064

Pre-alert shipment notice received, expected to arrive in July.

Standard Days Method Color-Coded Plastic Beads, 1 Each

piece 17,000 16,998 2

Delivered to PSI on June 18, 2020. The difference of two pieces has been reported to PSM.

Levonorgestrel/Ethinyl Estradiol 150/30 mcg + Fe 75 mg, 28 Tablets/Cycle (PS), 1 Cycle

cycle 3,200,400 0

3,200,3400

Partial delivery of 1,400,112 cycles will be completed in July 2020 at PSI warehouse. The second delivery of 1,800,288 cycles is expected to arrive in September 2020.

Pregnancy Test test 400,000 0 400,000 Delivery expected to arrive in September

Table 6: Status of 2020 orders – PMI-funded malaria commodities

Product specifications Unit Quantity Ordered

Quantity Delivered

Quantity Remaining

Notes

Artesunate/Amodiaquine 25/67.5 mg Tablet, 25 x 3 Blister Pack Tablets

treatment 5,250 5,250 0 Delivered to SALAMA on July 08, 2020


treatment 52,350 52,350 0 Delivered to SALAMA on May 11, 2020

Artesunate/Amodiaquine 50/135 mg Tablet, 25 x 3 Blister Pack Tablets

treatment 547,400 547,400 0 Delivered at SALAMA on May 11 and July 07, 2020.

21

Product specifications Unit Quantity Ordered

Quantity Delivered

Quantity Remaining

Notes


treatment 386,000 0 386,000 Will be delivered to SALAMA in July 2020.


treatment 91,600 91,600 0 Delivered to SALAMA on July 08, 2020


treatment 213,725 213,500 0 Delivered to SALAMA on May 11 and July 07, 2020.


treatment 301,625

0 301,625

Will be Delivered to SALAMA in July 2020


treatment 186,525 80,400 106,125

80,400 delivered to SALAMA on May 11th, 2020 and 106,125 delivered to SALAMA on July, 07th, 2020.

Artemether/Lumefantrine 20/120 mg Tablet, 30 x 6x3 Blister Pack Tablets

treatment 64,800 64,800 0 Delivered to SALAMA on June 11, 2020.

Malaria Rapid Diagnostic Test (RDT) HRP2/pLDH (Pf/PAN) Cassette, 25 Tests

test 1,000,000 1,000,000 0 Delivered to SALAMA on June 24, 2020.


test 1,290,325 0 1,290,325

Shipment expected to arrive in August 2020. Needs close monitoring as PSM reported risk of potential logistics delays

Artesunate (w/ 1 Amp NaHCO3 5% + 1 Amp NaCl 0.9%) 60 mg Vial, 1 Set

vial 25,000 25,000 0 Delivered to SALAMA on April 16, 2020

Sulfadoxine/Pyrimethamine 500/25 mg Tablet, 150 Tablets

tablets 1,500,000 0 1,500,000 Shipment expected to arrive in December 2020

IR2.1.4: Provide technical assistance to support the central level GAS Committees to develop quarterly

distribution plans for malaria, MNCH, and FP/RH products based on quarterly stock status obtained from

district/GAS committees

Distribution plan for Malaria products

Due to COVID-19 and the delay in deliveries, as well as an increase of malaria cases reported in Madagascar

since January 2020, the GAS Committee imposed a rationing distribution of quantities due to insufficient stock

at SALAMA and the inability to fulfill all requisitions submitted by the Pha-G-Dis. The quantities in the pipeline

initially purchased by PMI and Global Fund were not delivered on time at SALAMA due to international logistics

issues and manufacturing processes impacted by the COVID-19 pandemic. To face the situation, IMPACT and

PMI were able to quickly purchase and coordinate deliveries with PSM of available Arthemeter- Lumefantrine

(AL) combination therapies while waiting the deliveries of AS/AQ, and get the AL delivered in early April.

22

In Quarter 3, all the 114 districts received stock through emergency transportation by SALAMA to keep the

minimum level of three months stock at districts. At the end of Quarter 3, SALAMA received stock of

Arthemeter-Lumefantrine (AL), ACTs, and RDTs that will enable the GAS Committee to replenish stocks of

districts. The stock of RDT is still under the minimum stock level of six months and the rationing system will

continue for RDTs in Quarter 4 until new orders in the pipeline from PMI and Global Fund are delivered.

Table 7: Summary of quantities of malaria commodities shipped in Quarter 3 to the 114 districts

Product Specification Unit PMI/ IMPACT Global Fund/ UCP Total quantity

shipped to districts

Artemether- Lumefantrine, 20mg/120mg, 6 tablets

treatment 31,560 5,010 36,570


treatment 104,310 7,620 111,930


treatment 0 62,880 62,880


treatment 0 43,830 43,830

Artesunate/Amodiaquine 25/67.5 mg Tablet, 25 x 3 Blister

treatment 1,175 11,800 12,975


treatment 17,825 N/A 17,825


treatment 21,925 50,975 72,900


treatment 64,550 34,400 98,950

Malaria Rapid Diagnostic Test (RDT), 25 Tests

test 782,400 2, 729,975

3,512,375


tablet 2,793,750 4,987,950 7,781,700


vial 200 71,596 71,796

Artesunate 100 mg of 2 Supp suppository 0 12,384 12,384

Quinine 300mg Tablet tablet 0 148,700 148,700

In Quarter 3, both quantities of AL and ACTs were distributed to districts. IMPACT supported the GAS

Committee to draft a ministerial note on the use of both combinations in treating simple malaria cases. The

job aid on case management practices in Madagascar was shared with districts together with the note signed

by the Secretary General. The note explained that AL is only used at CSBs while Community Health Volunteers

(CHVs) are only allowed to dispense ACT. In the next quarter, IMPACT will collaborate with ACCESS, Mahefa

Miaraka, UCP-Global Fund, the NMCP, and regions to track the appropriate use of AL. It has been reported

that CSBs are not using AL as predicted despite 255,210 treatments that were shipped to districts in Quarter

3. The RLA will work closely with district GAS committees to sensitize the CSB on the proper dispensing of AL

to avoid expiration.

IMPACT provided technical and logistical support to the NMCP and SDSP of Farafangana for conducting a

supervision field visit to coordinate quantification and management of malaria commodities for 2020 and

23

2021. The commodities include needs for routine malaria case management and those used for the malaria

community case management study (PECADOM) being implemented with support from the Institut Pasteur

de Madagascar (IPM) and sponsored by USAID-PMI. The quantities estimated for the study will be shipped to

the district of Farafangana before October 2020, as the study will resume depending on the evolution of

COVID-19 situation. During the field supervision visit, the NMCP staff had various meetings with the district

and regional teams and partners supporting the malaria community case management in this district, namely

IPM and INTERAIDE. As an outcome of this field visit, the quantification exercise was completed as well as a

plan to reinforce district, CSB, and CHV capacities on stock management.

Distribution Plan for MNCH Products

IMPACT supported the DSFa to collect consumption data reports and requisitions to plan distribution of MNCH

commodities (Oxytocin, Gentamycine (newborn and mothers), and Magnesium Sulfate MgSO4) to the 114

districts. Two meetings were organized to analyze reports and orders submitted by 73 out of 114 districts

(DFSa was still continuing to collect additional orders from the remaining districts in Quarter 4). The

distribution plan was validated by the TWG formed by DSFA, IMPACT, UNFPA, UNICEF, SALAMA, and ACCESS.

The table below summarizes the quantities of MNCH commodities to be shipped by SALAMA to districts in

August 2020. UNFPA agreed to distribute the required stock of Misoprostol tablets to all 114 districts to treat

post-partum hemorrhage in CSBs without a cold chain. The letter of UNFPA accepting the distribution will be

signed in August.

DSFa will continue to collect additional requisitions and reports from the remaining 43 districts (as DSFa has

received 71 requisitions and reports) and plan the distribution in the next quarter. Note that 18 districts in the

three regions supported by World Bank PARN have enough stock of MNCH commodities (Oxytocin,

Gentamycin (newborn and mothers), and Magnesium Sulfate MgSO4) purchased by UCP-Global Fund through

the PARN project.

Management of overstocked Oxytocin

During Quarter 3, IMPACT explored various opportunities to distribute the Oxytocin procured by USAID and

delivered in country in 2018. IMPACT submitted memos on the possible ways to manage the overstock which

was validated by USAID in June:

• A quantity of 560,000 vials of Oxytocin will be officially donated to SALAMA to be distributed through its

channel of distributions (districts, hospitals, NGOs, private sector) in all 22 regions. DSFa will facilitate this

process once the donation letter is signed officially by USAID. This quantity will be added to the existing

stock at SALAMA of almost 700,000 vials of Oxytocin.

• A quantity of 650,000 vials of Oxytocin will potentially be transferred out of the country. IMPACT is closely

working with PSM to explore a country that can accept this donation as the expiration dates are May and

June 2021. Malawi and Zambia have expressed interest to take this stock of Oxytocin and are raising funds

for transportation and the freight forwarding process.

• The DSFa will share a note recalling the correct needs of Oxytocin to prevent and treat Postpartum

Hemorrhage (PPH) to boost the consumption of this product.

• The RLA will work with district GAS committees to monitor the distribution and consumption of Oxytocin.

24

Distribution of Malaria, MNCH, and FP commodities at peripheral level At the end of each month, Pha-G-Dis are conducting a physical inventory report of essential commodities

available in their warehouses, which are entered into CHANNEL software regularly. The RLA of IMPACT

supported all the 78 districts in the 13 USAID-supported regions to analyze inventory reports and evaluate

stock status levels to make decisions to place orders with SALAMA (in case of shortage), organize a

redeployment (in case of overstock), and to plan distribution to CSBs.

As the stock of malaria commodities was insufficient at the central level, the RLA supported the district GAS

committees to plan redeployments to enable all CSBs to test and treat malaria cases while the stock status

situation was improved. Through the analysis, quantities of malaria commodities reported in the table below

were redeployed from 16 Pha-G-Dis to other 20 Pha-G-Dis that were understocked and 11 CSB were able to

redeploy malaria commodities to 8 CSB. This interim measure was implemented while waiting for shipments

from SALAMA and allowed the districts and CSB to address the malaria peak season. The regions, districts, and

technical partners (IMPACT, ACCESS, Mahefa Miaraka, and UCP-Global Fund) contributed to the transport of

the redeployed commodities.

While analyzing stock status of MNCH commodities, the district GAS committees detected an excess stock of

1,320 units of chlorhexidine in the district of Vavatenina that were redeployed to the districts of Brickaville,

Vatomandry, and Antanambao Manampotsy. These units of chlorhexidine will expire in December 2020 so

this redeployment was mainly done in order to use the commodities before the expiration date. In addition,

480 doses of misoprostol were redistributed from the district of Antsiranana I where they were overstocked

to address shortage in the district of Ambanja.

The table below summarizes the quantities of malaria commodities redeployed in Quarter 3. Table 8: Malaria Commodities Redeployed in Quarter 3 (See annex I for more details of the redeployment)

Product specification Unit Quantity

Artesunate/Amodiaquine 25/67.5 mg Tablet, 25 x 3 Blister Pack Tablets treatment 313

Artesunate/Amodiaquine 50/135 mg Tablet, 25 x 3 Blister Pack Tablets treatment 306

Artesunate/Amodiaquine 100/270 mg Tablet, 25 x 3 Blister Pack Tablets treatment 4,001

Artesunate/Amodiaquine 100/270 mg Tablet, 25 x 6 Blister Pack Tablets treatment 4,771

Artesunate (w/ 1 Amp NaHCO3 5% + 1 Amp NaCl 0.9%) 60 mg Vial, 1 Set vial 1,304

Malaria Rapid Diagnostic Test (RDT) HRP2/pLDH (Pf/PAN) Cassette, 25 Tests test 8,633

Sulfadoxine/Pyrimethamine 500/25 mg Tablet, 150 Tablets tablets 9,668

These redeployment activities were conducted through supervision visits with no additional transportation costs. Mass drug administration of Sulfadoxine- Pyrimethamine (SP) On April 27, 2020, the GOM announced a mass distribution campaign and requisitioned Sulfadoxine-

Pyrimethamine (SP) to reduce the increase of malaria cases in nine selected districts. 5,713,800 tablets were

estimated to be distributed to the population residing in 95 communes of nine districts (Bekily, Betroka,

Befotaka, Marolambo, Vondrozo, Iakora, Ivohibe, Ikalamavony, and Manja). Through the first distribution in

May, a quantity of 2,619,575 tablets (46%) was distributed and the remaining quantity of 3,094,225 tablets is

currently stocked in various location (NMCP, districts, and regions). The second mass distribution campaign

scheduled in June was cancelled by the MOH and will no longer happen. The GAS Committee is collecting

distribution reports and proof of delivery from the nine districts and will adopt strategies to better manage

the leftover quantities to avoid expiration. The expiration date for the SP is August and November 2021. It is

25

likely that the remaining quantity of SP will be redistributed from districts where they are stocked to

neighboring districts during Quarter 4 to be used through IPTp during pregnancy. The consumption of SP has

increased during the last 6 months of 2020 and there is no risk of expiration of the SP in the country. The GAS

Committee will work with IMPACT and UCP to mobilize resources for transportation to support the Direction

Régionale de Santé Publique (DRSP).

IR2.1.5: Conduct TOT and cascade trainings for supply chain management at all levels of the supply chain,

in collaboration with the UCP/Global Fund, ACCESS, Mahefa Miaraka and other partners

IMPACT collaborated with UCP to support the UTGL at the central level in the development of an orientation

guide for members of the regional UTGL and district GAS committees for better overall performance. The

agenda and the content for the three-day orientation are being finalized and will be validated by the Service

de Formation du Personnel (SFP) of the MOPH. During the orientation, members of the regional UTGL and

district GAS committees will be enabled to:

• Identify challenges in the supply chain within their region or district and identify solutions to address the

challenges.

• Establish an effective coordination structure for logistics management within their region or district.

• Set performance goals/indicators to track for better management of stocks.

• Plan field visit supervision of Pha-G-Dis and Pha-Ge-Com/CSB.

• Apply the principles of accountability and transparency at Pha-G-Dis and Pha-Ge-Com levels.

• Develop and implement an action plan to improve supply chain management within their region or

district.

The guide was pretested in the region of Vatovavy Fito Vinany and will be finalized in the next quarter.

Orientation of the committee members will follow starting in Quarter 4.

Formative Supervision using the continuous quality improvement approach - SPARS

The RLAs pre-tested the SPARS tool that is being developed with remote support from the MSH home office.

The SPARS tool is harmonized with the existing supervision and EMMR guides and at the end of the supervision

visit to the Pha-G-Dis or Pha-Ge-Com, the data collected will allow the supervisor and supervisee to visualize

scoring through a graph and agree upon a plan to reinforce capacity building and define corrective measures

for future performance in terms of supply chain management. The SPARS tool was pre-tested with 44 Pha-G-

Dis (out of 78) and 103 Pha-Ge-Com (out of 1,734) supervised by the RLA in Quarter 3 in collaboration with

regional (EMAR) and district (EMAD) teams. The SPARS tool will be finalized in Quarter 4 and used for future

supervisions visits.

Through the formative supervisions during the pre-test of SPARS in Quarter 3, Pha-G-Dis and Pha-Ge-Com

staff were capacitated to:

• Calculate and update the Average Monthly Consumption (AMC).

• Evaluate stock available and define the months of stock to detect the need to resupply (shortage) or

redistribute (overstock).

• Correctly complete stock management tools, such as stock cards and physical inventory reports

• Use the Rapport- Bon de Commande while submitting a requisition to SALAMA (Pha-G-Dis) and to Pha-G-

Dis (CSB).

26

• Comply with existing Standard Operating Procedures (SOP) for commodity management and waste

management.

• To update and enter data into CHANNEL at the Pha-G-Dis level: a video guide and user-manual were given

to Pha-G-Dis as job aids.

• Prepare documentation and invoices for the reimbursement claims for transportation and storage costs

in relation with the last mile distribution strategy to UCP.

• Reinforce communication on the use of AL and ACTs to treat simple malaria cases. CSB were reminded

that AL is only used at the CSB level and not the community level.

As an outcome of these field supervisions visits and follow up calls conducted by the RLA, 55 Pha-G-Dis (out

of 78) and 633 CSB (out of 1,734) submitted invoices and necessary documentation to the UCP and are

awaiting payment. The RLA will continue to follow-up with the remaining districts and CSB to submit invoices

to UCP.

Support UTGL regional and district GAS committees to strengthen coordination in supply chain at peripheral

level

At the end of June, 12 regional UTGL (out of 13) and 76 (out of 78) district GAS committees were established. For the Melaky Region, the UTGL and GAS committee will be set up in July.

IMPACT continued to support the functioning of these committees. All 12 regional UTGL and 36 (out of 76)

district GAS committees have organized their quarterly periodic coordination meetings. The 36 districts are

among those not yet affected by COVID-19, and members of the GAS committees complied with security

measures imposed. The 40 districts GAS committee are in regions affected by the COVID-19 and have been

not be able to organize meetings due to restrictions of meetings.

The coordination meetings generally focused on:

• Stock status analysis for Pha-G-Dis and CSB.

• Analysis and validation of requisitions for resupply of commodities from SALAMA to Pha-G-Dis, and from

Pha-G-Dis to CSB.

• Discussion on improving commodity management at Pha-G-Dis, Pha-Ge-Com (CSB), and CHV levels.

• Planning of formative supervision of Pha-G-Dis and CSBs.

• Collecting and reviewing invoices of Pha-G-Dis and CSB to submit reimbursement in relation to the last

mile distribution.

In this quarter, success stories are included in Annex D of this report to showcase the benefit of the

coordination forums. There are still challenges to address in order to make the UTGL regional and districts

GAS committees work, including:

• ToR for the committees are not yet well understood by all members.

• Lack of ownership to organize the meetings. IMPACT is still pushing the authorities of regions and districts

to call meetings.

• Less competence and skills to analyze consumption and inventory data and take necessary corrective

actions.

To address this, IMPACT is advocating with the Secretary General to disseminate an official note on the new

ToR that clearly mentions the establishment of the different committees and set up indicators of performance

to track progress in terms of stock management at district and CSB levels. Furthermore, IMPACT is

27

collaborating with other partners (UCP, ACCESS) to reinforce the capacity of stock managers at regional,

district, and CSB levels on the analysis of LMIS data to take corrective actions.

Collaboration with other key partners: ACCESS, Mahefa Miaraka, and ATR/UCP

During Quarter 3, the RLA organized 10 meetings with representatives of Mahefa Miaraka, ACCESS, and

ATR/UCP in 6 supported regions (Atsimo Andrefana, Sava, Diana, Vatovavy Fitovinany, Boeny and Menabe)

to share stock status levels and analyze issues around availability of malaria, FP, and MNCH commodities to

better coordinate the transportation of commodities in case of redeployment. Dashboards of the Pha-G-Dis

stock status were discussed as well as the status of shipments from SALAMA in order to understand the

commodity status and detect CSB with high risk of stocks outs in order to identify corrective measures early

on.

IR2.1.6: Assist the MOPH in creating a five-year LMIS strengthening roadmap and developing and testing a new LMIS software using results from the LMIS in-depth evaluation

LMIS Strategic Plan

The LMIS evaluation report was finalized and submitted to USAID and IMPACT started the preparation for the

LMIS strategic plan workshop. The workshop will be an opportunity to disseminate the LMIS evaluation report

to a larger group of members of the LMIS TMA subcommittee from all sectors (public, subsidized, and private).

During the workshop, participants will be asked to use the findings and recommendations to plan for a long-

term (5 year) LMIS improvement for Madagascar. IMPACT coordinated with the LMIS committee on the

agenda, selection of participants, and methodology to guide the strategic workshop scheduled in Quarter 4.

IR2.1.7: Generate evidence through a national supply chain assessment and End User Verification surveys to develop adequate strategies, policies, and SOPs for securing commodities and strengthening the public supply chain IMPACT started planning the second EUV survey scheduled in Quarter 4. Due to COVID-19, the NSCA has been rescheduled to Year 3. IR2.1.8: Conduct continuous distribution of LLINs in 12 targeted districts. Procure 1,000,000 LLINs (924,700 standard Nets, 75,300 PBO nets) in coordination with the National Malaria

Control Program, PSM, Roll Back Malaria, and PMI and organize the logistics to store 1,000,000 LLINs in

PSI's warehouse and transport the LLINs to 12 targeted districts (approximately 500,000 households)

The main activity during Quarter 3 was the introduction of cCD in the Group 2 districts. This activity includes

the transportation of LLINs to PARCs according to the supply plan. Despite the COVID-19 pandemic, all the

PARCs in the 12 districts have received LLINs and are already functional.

The table below summarizes the transportation of LLINs and distribution activities carried out since the start

of the cCD in February to June 2020.

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Table 9: Number of LLINs transported from PARC and PAs to Kom’Lay

PARC level PA level Kom’Lay level

Households level (% achievement compared to # of ITN received by

Kom’Lay)

Districts Number of PARC

Targeted LLINs to

be transport

ed to PARC

LLINs transported to PARC

%

Targeted LLINs to

be received

by PA

LLINs received by PA

%

Targeted LLINs to

be received

by Kom’Lay

LLINs received

by Kom’Lay

% LLINs

distributed by Kom’Lay

%

Group 1

TOAMASINA II 1 69 500 41 700 60 41 700 27 800 67 27 800 23 050 83 15 790 69

BRICKAVILLE 1 59 500 35 700 60 35 700 23 200 65 23 200 16 330 70 8 435 52

TOLIARA II 1 99 000 59 400 60 59 400 59 400 100 59 400 59 150 100 43 357 73

MANAKARA 1 134 500 80 700 60 80 700 44 200 55 44 200 31 658 72 19 853 63

VOHIPENO 1 43 500 26 100 60 26 100 17 400 67 17 400 14 814 85 11 460 77

MANANJARY 1 112 500 67 500 60 67 500 43 300 64 43 300 43 100 100 39 176 91

Group 2

ANTANAMBAO MANAMPONTSY 1

17 850 5 100 29 5 100 0 0 0 N/A N/A

MAHANORO 1 85 750 24 500 29 24 500 0 0 0 N/A N/A

FARAFANGANA 1 116 550 33 300 29 33 300 0 0 0 N/A N/A

VANGAINDRANO 1 112 350 32 100 29 32 100 0 0 0 N/A N/A

BEKILY 1 61 950 17 700 29 17 700 12 400 70 12 400 N/A N/A

PORT BERGÉ 1 72 450 21 300 29 21 300 0 0 0 N/A N/A

TOTAL 12 985 400 445 100 45 445 100 227 700 51 227 700 188 102 83 138 071 73

• Regarding the LLINs transportation to PARCs in the 12 target districts, the achievement is 60% compared

to the annual target for the Group 1 districts and 29% for Group 2.

• Among the 445,100 LLINs delivered to the 12 PARCs, 227,700 LLINs were recovered by the PAs (51.2 %).

• The PAs of the six districts of Group 2 have not yet recovered their quota during this period except Bekily.

• Among the 188,102 LLINs recovered by the Kom’Lay, 138,071 LLINs were distributed to the target

households, which is 73.4% of the target.

Develop training materials and organize cascade trainings of key actors involved in the continuous

distribution of LLINs, including PAs, CHVs, teachers, school directors, etc.

Planned training activities have been the most affected by the COVID-19 pandemic.

To overcome the delay while respecting the COVID-19 prevention measures, the following strategies have

been adopted:

• Increase the number of training sessions by reducing the participants up to 25 persons per session to

respect the social distancing guidelines.

29

• Relocation of the ToT to the district level: instead of organizing the ToT in Antananarivo, they were

organized in the districts.

• Combination of central ToT with district ToT: regional, district, and commune: trainers have been trained

together to save time.

• Set up barrier measures during training sessions: mandatory mask wearing for trainers and participants, installation of hand washing devices in all training rooms, etc.

From the NCC support, IMPACT can mobilize 22 central and regional trainers to carry out:

• The completion of the remaining Kom’Lay training sessions in Manakara and Vohipeno;

• The ToT at the district level of Bekily, Antanambao Manampotsy, Mahanoro, Vangaindrano, Farafangana, and Port Bergé.

Table 10: Kom’Lay training in Manakara and Vohipeno, achievements during Quarter 3

Districts Target Kom’Lay Members

Trained % Comments

Manakara

1,986 1,972 99%

634 Mobilizer Agents, 319 Distributor Agents, 319 Chiefs of Fokontany, 312 School Directors, and 379 teachers Gender aggregate for all participants: 1,388 Men and 584 Women

Vohipeno

866 811 94%

261 Mobilizer Agents, 133 Distributor Agents, 133 Chiefs of Fokontany, 107 School Directors, and 177 teachers 55 participants were absent but have benefited from on-the-job training by the TA during supervision visits. Gender aggregate for all participants: 521 Men and 204 Women

2,852 2,783 98%

Table 11: ToT achievements at district level for the 06 districts of Group 2

Regional

participants District

participants Communal participants

IMPACT staff

TOTAL TRAINED TARGET %

BEKILY 4 4 43 4 55 55 100%

MAHANORO 0 4 45 5 54 58 93%

FARAFANGANA 4 4 75 7 90 90 100%

PORT BERGE 2 4 43 6 55 57 96%

MANAMPOTSY 0 4 24 3 31 31 100%

VANGAINDRANO 4 4 80 6 94 94 100%

TOTAL 14 24 310 31 379 385 98%

The variance between the targeted vs the trained people comes from the four missing participants in

Mahanoro and one person in SOFIA who were not available.

Train and supervise new PARCs and PAs for Continuous LLIN Distribution.

Table 12: Training of PARC and PA for Bekily and Port Bergé districts in Group 2

District Date of the

training PARC PA

Attendance rate

Men Women

Bekily June 05 and 06 1 20 100% 7 14

Port Bergé June 15 and 16 1 18 100% 14 5

Total 2 38 100% 21 19

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In June 2020, two PARC and 38 PA in Bekily and Port-Bergé districts were trained on the LLIN cCD. The

attendance rate was 100% with 21 men and 19 women. The two-day training took place in the district where

the PARC are located and focused on the following themes:

• Malaria disease and prevention

• Distribution of LLINs through cCD

• Use of management tools, transportation, and storage payment system

With these two districts, IMPACT has completed the training of the 12 districts selected for the cCD activities.

The trained PARC and PA will now begin the distribution of LLIN for the cCD.

A follow-up session and on-the-job training will be scheduled by SPDs for the trained PA and PARC during the

monthly supervision visits.

Coordination of continuous distribution of LLINs in 12 targeted districts

IMPACT continues to support the monthly NCC coordination meetings (including the MENETP team) to

monitor field activities and address challenges encountered during the LLIN distribution. Due to COVID-19,

these meetings are conducted through conference calls. The cCD operational team at the district level (TA

Supervisor and TA) participate in regular coordination meetings with EMAD and the USAID implementing

partners ACCESS and TIPTOP. Teams from the ACCESS program attended the cCD ToT.

Set up an M&E system to collect, analyze, and disseminate accurate and timely data on LLIN distributed

through continuous distribution in approximately 3,095 Kom'Lay.

The cCD data collection from Kom’Lay to CSB, and then to SDSP was started during Quarter 3. The TAs work

with CSB Chiefs, in collaboration with the other USAID’s IP (ACCESS and Mahefa Miaraka) on data control and

validation. Data from the LLIN distribution at Group 1 were collected and available during the month of April

2020.

Since February 2020, 150,142 LLINs have been distributed through Group 1 which represent 16% of the annual

target.

The LLIN quantities distributed and the reporting rates from February to June 2020 reflect the effects of the

COVID-19 pandemic (see the graphs below).

Also, the Kom’Lay of the 27 communes of Manakara and 06 of Vohipeno have not been trained on cCD

activities until June 2020 due to COVID-19 travel restrictions.

Graph 1: Reporting Rate from February to June 2020

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39% of Kom’Lay sent their activity reports compared to all 1,363 fokontany in February 2020, 87% in March,

63% in April, 57% in May, and 29% in June. The reporting rate during the last three months from Kom’Lay has

been influenced by the COVID-19 pandemic due to the travel restrictions and the health workers needing to

respond to the outbreak.

The low reporting rates will be addressed and integrated into the follow-up from the helpdesk team by closely

monitoring and improving the responsiveness at all levels (Kom’Lay, CSB, and TA Supervisor).

Graph 2: Analysis of vouchers and LLINs distribution

Due to COVID-19, the Kom’Lay are limited in their ability to conduct home visits to check the distribution of

vouchers at the household level because community members refuse to receive CHV Mobilizers at home in

order to avoid COVID-19 contamination. However, almost all households that received vouchers went to

collect their LLINs.

Approaches adjusted following COVID-19 context:

Activity: Support to Kom’Lays in reporting cCD activities

Initial strategy: Adjusted strategy:

The TA ensures the verification and

compilation of cCD reports before

validation by the Chief of CSB ➔

o Remote assistance by phone to

Kom’Lay through focal points

o Data collection by phone from

Kom’Lay to district level

In addition to the social distancing during the implementation of the cCD activities, a catch-up plan has been

developed and will be implemented. This plan includes:

• Strengthening the monitoring and local assistance by TAs;

• Ensure the LLINs transportation to the Kom’Lay;

• Revision of distribution forecasts by Kom’Lay based on the number of home visits conducted.

0

10,000

20,000

30,000

40,000

50,000

February-20 March-20 April-20 May-20 June-20

Trend of vouchers and LLINs distribution

Voucher distributed LLINs distributed

32

Develop and disseminate Behavior Change Communication through mass media campaigns, household

visits, radio spots, posters, etc. to mobilize households and school children in the 12 targeted districts to

correctly use and maintain LLINs

During Quarter 3,

• 2,640 radio spots were broadcasted in the six districts of Group 1.

• In collaboration with the IMPACT communication team, 24,00 posters were developed and produced on

malaria and COVID-19 prevention. These tools will be distributed at the fokontany level and used by CHVs

and teachers at schools in Quarter 4.

• 3,000 hand washing devices installed in LLIN distribution points (located close to the CHV selected by the

community who ensure the distribution).

IR2.1.9: Provide technical and financial support to the NMCP to develop and implement activities for the

preparation of 2021 LLIN campaign including the procurement of LLIN

As planned in the NSP 2018 - 2022, the NMCP intended to organize a mass LLIN distribution campaign in the

control districts in order to "Protect at least 90% of the population in the targeted areas by LLINs distribution,

including key populations, by the end of 2022" and achieve the LLINs universal coverage target.

On May 8, 2020, the NCC met on the following agenda:

• Update on the preparatory activities of the 2021 LLIN mass distribution campaign: LLINs acquisition,

discussion on LLIN campaign scheme, activities budgeting, review of basic data, and preparation of the

review of strategies;

• Assessment of the cCD activities: LLINs distribution and social mobilization activities;

• Follow-up of the distribution of LLINs in emergency situations: transportation to targeted districts.

2021 Mass distribution Campaign Preparation activities

During Quarter 3, the following activities were followed up by the NCC, including NMCP, PMI, IMPACT, and

other Global Fund implementing partners:

- Assess the progress of the preparatory activities against the planned activities: logistical preparation

for LLINs reception, database analysis (RGPH3 and MoHP data triangulation), macro planning, and

strategy review for activities.

- Analyze the budget available and the gap for the 2021 LLIN mass campaign.

- State the confirmation/positioning of donors of their funding contribution for the 2021 LLINs

campaign.

Distribution of emergency LLINs to address malaria outbreak in 41 districts

In Quarter 3, the NCC contributed by setting-up the response action plan due to the resurgence of malaria

cases in the selected 41 districts distributed as follow:

- 10 districts covered by cCD strategy - 30 specifically targeted for emergency LLIN distribution - 01 is Antananarivo Renivohitra not targeted by LLIN distribution strategy (elimination zone)

The emergency distribution led by the NMCP focused on:

33

• Emergency distribution of 85,000 LLINs within 30 priority districts.

• Broadcast of TV spots and SMS to enhance the prevention of malaria through the use of LLINs.

IMPACT and UNICEF ensured the transportation of 85,000 LLINs to the 30 targeted districts.

NB: The remaining 10 districts, targeted by the action plan, are in the cCD intervention area, so prevention

strategies are implemented in parallel with the fight against COVID-19. The last district is Antananarivo

Renivohitra, an elimination district, which is not targeted by the LLINs distribution strategy.

Table 13: List of 30 districts target of emergency LLINs distribution

Regions Districts Number of

LLINs

Regions Districts Number of

LLINs

HAUTE MATSIATRA Ikalamavony 10 900 ANDROY Ambovombe 1 000

ATSIMO ATSINANANA Vondrozo 15 600 ANOSY Amboasary 1 000

ATSIMO ATSINANANA Befotaka 5 750 ANOSY Taolagnaro 2 000

IHOROMBE Iakora 9 350 ATSIMO ANDREFANA Ampanihy 1 000

ATSINANANA Marolambo 2 100 ATSIMO ANDREFANA Betioky 1 000

ANOSY Betroka 11 000 ATSIMO ANDREFANA Morombe 1 000

MENABE Manja 3 300 ATSIMO ATSINANANA Midongy 1 000

IHOROMBE Ivohibe 4 400 ATSINANANA Vatomandry 1 000

ALAOTRA MANGORO Amparafaravola 1 000 DIANA Nosy Be 1 000

ALAOTRA MANGORO Andilamena 1 000 MELAKY Maintirano 1 000

ALAOTRA MANGORO Anosibe An'ala 1 000 MELAKY Morafenobe 1 000

AMORON I MANIA Ambatofinandrahana 1 000 SOFIA Bealanana 1 000

ANALAMANGA Andramasina 1 000 SOFIA Mandritsara 1 000

ANALANJIROFO Sainte Marie 600 VATOVAVY FITOVINANY Ifanadiana 1 000

ANALANJIROFO Vavatenina 1 000 VATOVAVY FITOVINANY Nosy Varika 1 000

IR2.1.10 Procurement of expandable equipments (PPE) / health commodities to COVID-19

During the month of May and June, IMPACT:

• Supported the MOPH by providing commodities for COVID-19 to prevent and control infection in hospitals

receiving COVID-19 patients and using 4X4 vehicles working to identify suspected cases

• Assisted the MOPH in conducting quantification and forecasting exercises to determine the commodities

required for the MOPH

• Ensured the reception of 2,497 hand washing devices, 625 of which are already distributed: 400

distributed to hospitals in the regions of Haute Matsiatra, Diana, Atsinanana, Analanjirofo, Boeny, and

Atsimo Andrefana, and 225 delivered to Shops Plus for private hospitals and clinics.

IR2.1.11 Ensure storage and transportation of health products of the three priorities health areas and

COVID-19 related health commodities from central level to districts and communes, eventually in

collaboration with the private sector

IMPACT ensured the transportation of 4,000 masks donated by DOD / USAID:

- 2,500 masks were transported to Toliary and donated to DRSP Atsimo Andrefana.

- 1,500 masks were transported by IMPACT from Antananarivo to the Rano WASH and Diorano office

in Moramanga. Rano WASH was in charge of the transportation of the masks to Ambatondrazaka

and the donation to DRSP of Alaotra Mangoro

• IMPACT supported the transportation of PPE (protective face and surgical masks, disposable protective

clothing, infrared thermometer, medical protective goggles, disposable sterilized rubber surgical gloves

and medical isolation shoe covers, donated by Chinese Government from CCO Ivato warehouse to 5

USAID-supported regions namely Vakinankaratra, Haute Matsiatra, Atsinanana, SAVA, Atsimo Andrefana

34

• IMPACT has also transported 1,872 hand washing devices to 11 PSI regional warehouses (Diego, Sambava,

Mahajanga, Antsohihy, Toamasina, Antsirabe, Maintirano, Fianarantsoa, Manakara, Morondava, and

Toliary). These devices will be distributed to CCOR/DRSP (780) and PA/PARC (1,092).

IR2.1.12 Provide technical and financial support on Covid-19 to the MOPH based on MOPH central and DRS requests. During the month of May and June, IMPACT conducted the following activities:

• As an Active member of COVID-19 Regional Operational Command Centre (CCOR), IMPACT participated

in regular meetings with CCOR with Technical and Financial Partners (TFPs). In May, IMPACT attended at

least 52 meetings (1 meeting per week through the 13 USAID-supported regions).

• Donation of health commodities (infection prevention products) and equipment to DRSP / CCOR in 10

USAID-supported regions:

- In May, CCOR/DRSP in nine regions (Atsimo Andrefana, Haute Matsiatra, Amoron'i Mania, Vatovavy

Fito Vinany, Boeny, Sofia, Diana, Atsinanana, Analanjirofo) each received 865 (865 * 9 = 7,785 pieces)

units of washable protective masks.

- In June, CCOR/DRSP in nine regions (Atsimo Andrefana, Haute Matsiatra, Amoron'i Mania, Vatovavy

Fito Vinany, Boeny, Sofia, Diana, Atsinanana, Analanjirofo) received a total of 3,045 bottles of

hydroalcoholic gels 500 ml, 215 cans of bleach (5L), 125 and 230 rolls of trash bags (30L and 100L

respectively), 305 hand towel rolls, 225 pack of chamois, 1,270 bottles of handwashing liquid soap,

and 210 virucide of 150ml, etc. Details per region are provided in the Annex J.

• Supported the DRSP of DIANA region for the transportation of COVID-19 medicines from Antsiranana to

Ambilobe and Nosy Be from May 11 to 15

• Supported financially and logistically the DRSP of DIANA to store (using PSI warehouse) and to send

(paying the shipment cost) on 30/05/20, to Antananarivo the donation received from India Government

(29 boxes of Azithromycin 500 mg and 03 boxes of hydroxychloroquine Tab 200 mg)

• Ensured the distribution to 880 PA and 60 PARC (a total of 940 of PA+PARC) in the 11 USAID-supported

regions (Diana, Sofia, Sava, Atsinanana, Boeny, Vatovavy Fitovinany, Atsimo Andrefana, Haute Matsiatra,

Amoron'i Mania, Analanjirofo, Menabe) of three units each of washable protective masks (940*3 = 2,820

pieces).

• Supported financially the transportation of 13 PCR (Polymerase Chain Reaction) specimen through using

nasal swabs to screen for COVID-19, from Haute Matsiatra (8), Menabe (1), Analanjirofo (4) that (9) to

IPM Antananarivo (9) and (4) to Toamasina.

• Supported the CCO/DRS of Atsinanana to transport COVID-19 expendable equipment and supplies,

second donation funded by IMPACT/USAID, from Toamasina to Fenerive-Est, Soanierana Ivongo,

Mananara Nord, Sainte-Marie, Vavatenina and Maroantsetra.

• IMPACT conducted disinfections of warehouses, offices and vehicles. In May, 6 spraying were conducted

at the 11 PSI/IMPACT offices including 11 warehouses and 20 vehicles by contracting with local service

providers such as BHL. In June, IMPACT conducted disinfection of warehouses, offices, and vehicles on

average four times by external providers:

- Diana: one warehouse, one office by “BHL”, and four vehicles by “Kala Auto”

- Boeny: one warehouse, one office, and two vehicles by “Alitia”

- Atsinanana: one warehouse, one office, and three vehicles by “BHL”

- Analanjirofo: one vehicle by “BHL”

- Vatovavy Fito Vinany: one warehouse, one office, and two vehicles by “Aleo Misoroka”

- Haute Matsiatra: one warehouse, one office, and two vehicles by “Aleo Misoroka”

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- Disinfection of vehicle by service station: two in Atsimo Andrefana, two in Melaky, one in

Vakinankaratra

- Disinfection of vehicle by driver himself: one in Menabe, one in Sava, and two in Sofia

• Provided logistic support (8 vehicles, 1 video projector, 1 megaphone, etc.) during tam tam (using vehicle)

to sensitize the population on awareness and prevention of COVID-19

• Provided 80 Sim Cards including airtime and Internet data (8 per region: 4 for CCOR and 4 for DRSP) to 10

USAID-supported regions.: Diana, Sava, Atsinanana, Sofia, Boeny, Atsimo Andrefana, Analanjirofo, Haute

Matsiatra, Vatovavy Fitovinany, and Amoron’i Mania. The 80 Sim Cards are provided to the health

workers at district level to submit information and data at a real time to CCO national.

• Participated in the training of trainers (TOT) workshop on prevention and response activities at

community level for the fight against COVID-19, organized by the DVSSER, Epidemiological Surveillance

and Response, in collaboration with ACCESS, on May 7th and 8th, 2020 at the National Center for Water,

Sanitation and Rural Engineering (CNEAGR) Nanisana. During the TOT, participants updated the training

documents (trainer's guide and participant manual including management tools etc.) for CHV at

community level on epidemiological surveillance

IR2.1.13 Train hygienists and health workers at the regional health facilities on waste management In May, IMPACT provided technical and financial support to the 6 concerned hospitals with DRS ( located in 5

districts: Toamasina I & II, Fianarantsoa I, Toliary I, Fénerive-Est, and Antsiranana I) in collaboration with the

MOPH (DRSP and Districts) and other partners to identify hygienists and health workers at the districts health

facilities who will be trained on waste management and infection prevention and control in response to

COVID-19.

In June, IMPACT conducted training of 451 (274 female and 177 male) that 25 hygienists, 264 health workers

and 162 cleaning workers on the use of PPE and on effective and appropriate waste management in the

regions of Atsinanana (170), Diana (143), and Haute Matsiatra (138).

Sub-IR 2.2: The public-sector supply chain achieves financial sustainability

IR2.2.1: Conduct a total cost analysis of the public supply chain and propose an alternative and more

efficient supply chain model by establishing at least two scenarios with the MOH to improve SALAMA's

financial sustainability

During Quarter 3, IMPACT continued to prepare data collection for the Total Cost Analysis (TCA). A database

tool was created in the DHIS2 platform to entry and compile data collected by smartphones.

TCA questionnaires validated by the steering committee were shared through emails with technical partners

(UNICEF, USAID, WHO, implementing partners of USAID, and others under HP Plus). The TCA was also

introduced to the new Director General of SALAMA in May, and IMPACT is currently awaiting approval to

collect data from SALAMA. Due to the lockdown and security measures related to COVID-19, field data

collection has been postponed to the next quarter depending on the lifting of the travel restrictions.

The TCA will provide a set of important data to guide the development of the new integrated supply chain

strategic plan (PAIS) for the period of 2021-2025. The PAIS process has benefited a strong leadership from the

Secretary General who led a technical committee to implement PAIS and TCA activities composed by

representatives from the Secretary General’s office, the General Directorate of the Provision of Care (DGFS),

the General Directorate of Preventive Medicine (DGMP), DPLMT, UCP, and IMPACT. The final report is

expected in November 2020.

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III.4. IR 3: Expanded engagement of the commercial health sector to serve new health product markets

according to health needs and consumer demand

Sub-IR 3.1: Commercial actors are incentivized to expand into new health product markets

IR3.1.1: Create partnerships with PSHP and non-PSHP members to collaborate in generating innovative solutions on transportation, data collection, and health-focused CSR and CSV.

In Quarter 3, IMPACT continued to recruit new members to join the PSHP and Vitafoam, a company

specializing in foam manufacturing, integrated into the PSHP.

MOUs for the transportation of health commodities with EDM, SOMAPHAR, INTER AIDE, AQUALMA were

drafted in Quarter 3 and are expected to be implemented in Quarter 4. KRED and SOPHARMAD are in the

process of integrating access to finance and MOUs are being finalized.

Table 14 : Summary of the collaboration with PSHP and non PSHP members in Quarter 3

Company Proposed Partnership Status Next Steps / Observations

Vitafoam: company specializing in foam manufacturing

Promoting CSR by participating in the transportation of health commodities

First meeting done in June to present PSHP.

Second meeting will be held in Quarter 4 to define the collaboration on the health products transportation

INTER AIDE: community health program located in the southeast of Madagascar

Coordination of providing the health commodities stock status by CHVs regularly. The stock status is shared with IMPACT through CHV in communes where INTERAID is operating (Vohipeno and Manakara districts, Vatovavy Fito Vinany region).

Meeting was done in Quarter 3 and MOU was drafted

Finalizing, signing, and implementing MOU in Quarter 4.

KRED–BNI: new offer for SMEs

Facilitating access to finance for drug shops and pharmacies

MOU drafted Finalizing and implementing MOU in Quarter 4

Access Bank – SOPHARMAD (pharmaceutical wholesalers)

Facilitating access to finance and capacity building for drug shops and pharmacies

MOU drafted Finalizing and implementing MOU in Quarter 4

SOMAPHAR: pharmaceutical wholesalers

Transportation of health commodities (social marketing):

Draft contract created

Finalizing and implementing contract in Quarter 4

Akbaraly Foundation: Lead of PSHP health commission and working on health to contribute on the IMPACT goal to align with GOM and USAID priorities, particularly on commodities

Health commodities transport in Haute Matsiatra and Boeny for free

MOU drafted and sent to MOPH for feedback

Finalizing and implementing MOU in Quarter 4

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Company Proposed Partnership Status Next Steps / Observations

Electricité de Madagascar: an electricity provider and member of the AXIAN Group located in 1,300 communes of Madagascar

Health commodities transportation for free. The first step of collaboration will start in Vatomandry district, Atsinanana region.

MOU drafted and waiting for signature from EDM.

Finalizing and implementing MOU in Quarter 4

As the private sector is looking for innovative transportation solutions, a meeting between IMPACT, and

SALAMA (represented by the new CEO) was organized in June. The discussion focused on the collaboration

between EDM and IMPACT to transport heath products in the Atsinanana region and the potential upcoming

partnership between PSHP and SALAMA.

SALAMA expressed concern about the emergency transport of health commodities due to the restriction

of its truck pooling, then strongly urged private sectors to assist SALAMA in this operation. SALAMA will

manage the contract with the transporter companies.

During Quarter 3, IMPACT formalized and signed a MOU with the company AQUALMA SA (Aquaculture de la

Mahajamba). AQUALMA is one of the leading companies in breeding, processing, and exporting of shrimp in

Madagascar. Located in Besalampy (Melaky Region) and Mahajamba (Boeny region), AQUALMA has

collaborated with IMPACT in transporting health commodities specifically for public sector and social

marketing to Besalampy and Mahajamba every two months.

IR3.1.2: Organize quarterly meetings to monitor and assess the progress of health commission action plan. Table 15: Activities planned, achievements, and perspectives

Activity Planned Achievements/Outcomes Planned Activities Progress

Mobilize members

in UHC

IMPACT met the Director of CACSU

(Cellule d’Appui à la Couverture Santé

Universelle) in June 2020 for an update

about the Universal Health Coverage

(UHC) process and current situation,

and to figure out how the private

sector can contribute to UHC. The

Director will share the UHC report of

pilot zone in Vatomandry health

district with the PSHP.

• IMPACT/PSHP: Exploring partnerships with

private sector in UHC

• CACSU: Sharing of activities report for

Vatomandry district, which is the pilot

zone for UHC in Madagascar.

Ongoing

Create new

partnerships with

the private sector

New company recruited: VITAFOAM • Formalize recruitment by signing PSHP

membership form.

• Organize meetings to identify

collaboration on health commodities

transport

Completed

Transport Solutions Virtual meeting with EDM to finalize

agreement about health products

transportation in Vatomandry District,

Atsinanana region from Pha-G-Dis to

Pha-Ge-Com.

• The MOU will be signed in Quarter 4. The

transportation of health commodities will

start in district of Vatomandry as soon as

the COVID-19 restrictions are lifted.

Ongoing

Support IMPACT in collecting LMIS data and organizing

- Outlet identification completed in SAVA.

- Training completed in Boeny

• Train drug shops in Diana in coordination

with the MOPH.

Ongoing

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Activity Planned Achievements/Outcomes Planned Activities Progress

capacity building of drug shops owners

IR3.1.3: Conduct mapping exercise to identify/select outlets to collaborate with IMPACT on LMIS among

representative sample of pharmacies and drug shops:

During Quarter 3, a technical committee composed by DEPSI, DPLMT, and IMPACT conducted a test of two

tools called “Pharmaplus” and “Maishamed.” The objective of the test was to identify or develop a tool for

drug shops in order to facilitate their stock and financial management and also to allow IMPACT and the MOPH

to collect and use data for decision-making from the private sector. These tests aimed to identify if parameters

and functionality of these tools would be useful for drug shops, and the interoperability with DHIS2.

During the identification of pharmacies and drug shops exercise, it has been noted that many pharmacies use

Pharmaplus software, so it was tested by IMPACT, DPLMT, and a representative from the LMIS TMA TWG (Dr.

Rado Randriamboavonjy) to determine whether it could be adapted for drug shops or not. In addition,

Maishamed was also tested, which is the tool used in Tanzania and Kenya under the ADDO program. The series

of testing demonstrated that both software “Pharmaplus” and “Maishamed” can be used as stock

management tools, financial tools, and LMIS tools for drug shops. An open bid was organized to recruit a

provider that is able to propose the best solution/tool. A ToR with further details on technical specifications

of the needs (stock, finance, and LMIS management) was developed for the bid. This is a competitive tender

open for all companies operating in this domain wishing to participate. This is a process adopted to ensure full

transparency on the selection.

IR3.1.4: Ensure that the Health Commission members of the PSHP participate in the TWG and follow up on the roadmap as a way to engage the commercial sector to identify barriers in the health sector and provide solutions Despite COVID-19, the health commission remains alert in discussing the action plan implementation process

for health commodities transport, UHC, and LMIS support.

A meeting between the IMPACT team was organized to discuss how to motivate private sector to participate

in all upcoming TWG/TMA meetings.

IR3.1.5a : Revitalize regional drug shop associations in preparation of the ADDO pilot phase to be conducted

in Year 3

Throughout this fiscal year, IMPACT has collaborated with DPLMT to sensitize drug shops in Analanjirofo, Atsinanana, and Boeny to form regional associations. During Quarter 3, IMPACT developed guidelines explaining the steps to follow for creating and managing a regional association. This guide is being reviewed internally before sharing with DPLMT, DAMM, and the associations of drug shops for feedback and validation. At the end of Quarter 3, one association (in Atsinanana) had been formally established with about 23 members, and two more (in Analanjirofo and Boeny) representing 33% of the registered drug shops by DPLMT in the region, are in the process of being created. IR3.1.5b : Develop curriculum for training of peer trainers with simplified materials and tools, to be used in piloting a sustainable mechanism for business strengthening program of drug shops This activity has been delayed due to COVID-19, the ToT curriculum will be developed in Quarter 4. Increase access to finance for private health commodities supply chain stakeholders

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IR3.1.6 : Strengthening partner banks and other financial institutions' capacity to better serve private health

commodities supply chain.

In its efforts to minimize the impact of the COVID-19 pandemic, the GoM declared a public emergency on

March 20, 2020. Among the various measures implemented, the government asked banks to give forbearance

of up to six months on clients’ loan repayments. This new policy has affected IMPACT’s work with partner

banks AccèsBanque Madagascar (ABM) and Baobab Banque Madagascar. Loans that were disbursed by the

bank and were guaranteed by the United States International Development Finance Corporation (DFC) require

DFC approval prior to being restructured. IMPACT is working closely with partner banks to identify loans that

will be restructured and acquire approval from DFC.

During Quarter 3, access to finance activities were focused on the following:

Properly restructuring health sector loans, including those backed by the guarantees1;

IMPACT has been providing support to ABM and Baobab as they evaluate loan restructuring requests from

borrowers working in the health commodities supply chain. As previously noted, loans that are backed by the

DFC guarantee require the DFC approve any restructuring. The team worked closely with the two partner

banks in indicating them the process to be followed in case of restructuration in accordance to the Guarantee

agreement: preparing formal request to DFC with copy to the local mission, changing maturity date in Credit

Monitoring System following approval from DFC, etc.). In Quarter 3, no guaranteed loans under the IMPACT

project were restructured.

Support partner banks in continuing to lend to health sector

To help ensure that the private health sector is being supported during the COVID-19 pandemic and can

continue to fulfill its role as an essential part of the Madagascar health care system, IMPACT is working with

banks to help them to continue to lend to the health sector during the pandemic. This support has been

effective: although partner banks have suspended new lending to other sectors, they have continued making

loans to health sector. During Quarter 3, 11 loans were disbursed to health supply chain enterprises, up from

eight loans in Quarter 2. The USAID mission’s quick approval of loans to purchase pharmaceuticals has been

very helpful in allowing the bank to increase loans to pharmacies and drug shops during this difficult period.

Out of these 11 loans:

• 1 is from Vohemar (SAVA)

• 1 from Antsohihy (SOFIA)

• 1 from Toliara I (Atsimo Andrefana)

• 1 from Marovoay (Boeny)

• 1 from Ambato-Boeni (Boeny)

• 1 from Morondava (Menabe)

• 2 from Antsirabe (Vakinankaratra)

• 1 from Antananarivo (Analamanga)

• 1 from Maevatanana (Betsiboka)

• 1 from Tolagnaro (Anosy)

1 Guarantees were originally established by USAID’s Development Credit Authority (DCA) for ABM and Baobab. In October 2019, DCA merged with OPIC to become the U.S. International Development Finance Corporation (DFC). The loan guarantees which were referred to as DCA guarantees in previous IMPACT reports will now be referred as “the guarantee(s)”.

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Revise capacity building plans and training curricula for DCA partner banks to incorporate GESI issues and

as needed, to consider newly identified needs

The IMPACT A2F and GESI teams worked together during Quarter 3 to develop new content for the training

workshops for partner banks. The training materials are now being revised to include information about

gender and social inclusion issues in this sector, and to help the banks’ branch agents understand how they

can develop new business to better serve the financial needs of the sector by integrating a GESI lens into their

products and service delivery.

Train and support DCA partner banks in credit analysis and loan structuring for health commodities

businesses

Due to COVID-19 travel restrictions, IMPACT A2F did not conduct any bank training workshops for regional

branches in Quarter 3. IMPACT was able to provide direct assistance to bank staff on how to request USAID

approval for pharmaceutical loans under the guarantees. In Quarter 3, the banks have become progressively

more comfortable with the approval procedures, needing less support from IMPACT. The banks’ ownership of

this process is a very encouraging sign of the sustainability of their work with pharmacies and drug shops.

Develop and adapt loan products and financial tools for small and micro health enterprises in health

commodities sector (e.g., scoring, nano loans, pharma loans, motorbike loans)

IMPACT has helped partner banks design the following new financial products in Year 2:

ACCES SALAMA Loan (formerly COVID-19 Loan). IMPACT assisted ABM in designing a special loan to help

private health enterprises purchase the commodities they need during the COVID-19 pandemic such as facial

masks, hand sanitizer, and respiratory assistance devices. The loan product is structured to allow bulk

purchases, to ensure that supply chain stakeholders have sufficient inventory to respond to pandemic needs.

According to health enterprises, this loan product is interesting, but they have been reluctant to import large

quantities of supplies until the government’s distribution strategy is clear. As a result, at this point, there is no

demand for this product.

The sector has reported that during previous health emergencies, the government has sometimes distributed

protective equipment for free or at very low prices, and health supply enterprises have taken on a loss on

inventory purchased.

Pharmaloan. This loan product would facilitate access to credit for pharmacies and drug shops to purchase

health commodities from partner wholesalers willing to collaborate with ABM. Only pharmacies or drug shops

recommended by a partner wholesaler would be eligible for a Pharmaloan, subject to further review and

approval by the bank. To be eligible for the pharmaloan, pharmacies or drug shops should (a) be a client of

the wholesaler for at least 6 months, (b) have a minimum level of monthly transaction of not less than 1 million

Ar with the wholesaler, (c) have not more than 7 days of payment delay vis a vis the wholesaler. IMPACT team

developed these criteria in collaboration with the bank and wholesaler teams based on various discussions

and meetings. SOPHARMAD is the first wholesaler to express interest in this type of loan, and in Quarter 3,

the company provided the contacts of three pharmacies and one drug shop to the bank for a pilot test. An

MOU between SOPHARMAD ABM, and IMPACT was developed during Quarter 3 to formalize the partnership

before the effective implementation of the product.

PA Motorbike Loan. This loan product is designed to allow PAs to purchase motorbikes which could be used

for the transportation of social marketing commodities from PARCs. IMPACT has organized a pilot test with

ABM for PAs located less than 50 km from ABM branches in the 13 regions covered by IMPACT. Pharmaloan

procedures were approved by bank management in Quarter 3, and a list of 198 geographically eligible PAs

was produced by ABM’s regional branches. The IMPACT distribution and A2F teams are working closely with

41

ABM in implementing this pilot phase of the product, and the first loan disbursements are expected in Quarter

4, depending on the number of PAs meeting the eligibility criteria which are mainly related to PA’s

geographical location (within 75 km around bank’s branch, PA’s morality (based on PSI’s appreciation) and

PA’s repayment ability under 36 months.

Collaboration with additional financial institutions

During Quarter 3, KRED, the microfinance department of BNI Madagascar, contacted IMPACT to express

interest in financing drug shops in IMPACT’s priority regions. Promoting competition among financial

institutions should be beneficial to health commodity enterprises, so IMPACT has drafted an MOU with KRED

to collaborate on improving access to finance for drug shops.

Design and develop new financial mechanism (e.g. risk sharing facility), following principles of USAID's

Blended Finance Roadmap for Global Health, possibly including additional financial institution partners, to

facilitate A2F within the pharmaceutical supply chains and other stakeholders

Due to the pandemic, the next steps of gathering information, defining, and beginning to structure a financing

instrument have been postponed to Year 3.

Results IR3.1.6: In Quarter 3, ABM and Baobab2 disbursed 11 loans totaling $27,074 to pharmacies and drug shops, of which

three (one in Antsohihy and two in Ambato-Boeni) were placed under the guarantee. There were three loans

to men totaling $7,778, and eight loans to women for $19,296. Most loans were used for inventory and

working capital.

Table 16: Loans Disbursed to Health Commodity Enterprises in Year 2, Quarter 3

Year 2 Quarter 33 Year 2 Cumulative to Date Year 2 Targets

Guaranteed

loans

Non-Guaranteed

loans

TOTAL LOANS

Guaranteed loans

* Non-Guaranteed

loans

TOTAL LOANS

Targets Achievement

in %

Number of loans

3 8 11 7 26 33 50 66%

Volume of loans

$10,286 $16,788 $27,074 $35,684 $69,061 $104,745 $90,000 118%

* Non-guaranteed loans are those to supply chain actors but the purposes of which is not directly linked to its

health activity or purpose is for mix use (health and non-health sector use).

IR3.1.7 : Provide business strengthening capacity building to enterprises in health commodities supply chain

and develop partnership with private companies to sustain the training.

Although regional training could not be conducted in Quarter 3 due to the lockdown and travel restrictions,

IMPACT was able to carry out coaching by phone. In addition, the team established regular communication

with networks of drug shops in the regions which already received IMPACT’s business training: Analanjirofo,

Antsinanana, and Boeny.

Develop and adapt business-strengthening training curricula for drug shops Updates were made in Quarter 3 in training curricula based on the results of the last training in Boeny in

February 2020 and include:

2 Due to a reporting lag, loans reported for Baobab in Quarter 3 were disbursed March 1-May 31, 2020.

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• Improving the Malagasy translation

• Adapting the practical exercises to make them as realistic as possible

• Improving the management tools (inventory sheet, transaction journal, debtor book)

Provide initial business-strengthening training to drug shops

Due to COVID-19 travel restrictions, no regional drug shop trainings were conducted in Quarter 3.

Provide one-on-one coaching on business strengthening to enterprises/individuals identified as potential peer trainers in health commodities supply chain During this quarter, 16 post-training coachings were provided: five to potential peer trainers (three men, two

women), four to drug shop owners from the Boeny region (four men), seven in the Atsinanana region (two

men, five women). All the coachings were conducted over the phone. To more effectively monitor the

situation of drug shops and analyze the information collected during coaching, the team has developed a new

coaching template. A sample of the template is provided in Annex I.

Key findings from coaching:

• All coached drug shops reported using the new management tools provided during training.

• Although they find the management tools practical and helpful, drug shops reported that it is difficult for

one person to dispense drugs to clients while also recording all transactions in the management tools.

Ideally, there would be one person in charge of the shop management and another one person

responsible for drug dispensing. This reinforces the need for regulatory reform to change the current rule

that only the licensed owner is allowed to run a drug shop. The ADDO model, using certified managers

and dispensers, would permit more flexibility.

• Drug shop owners stated that they are also using the IMPACT management tools in their other (non-

health sector) businesses.

• By using the debtor book, owners have seen a decrease in the number of debtors, because clients are

reluctant to sign the book for each debt they take. Using debtor book has led to drug shop improving

management of debts, increasing collection and dissuading clients from borrowing if they are unable to

make payments. The improved cash-flow allows for improved levels of inventory

In addition to the coachings conducted by phone, the team established regular communication with networks

of drug shops in the regions which already received IMPACT’s business training: Analanjirofo, Antsinanana,

and Boeny.

Survey on COVID-19 impact on drug shops

In Quarter 3 to help ensure the availability and accessibility of health commodities during the pandemic,

IMPACT conducted a short phone survey to identify how COVID-19 was affecting drug shops. The survey was

conducted during April 2020 with 71 drug shops in three regions (35 from Atsinanana, 27 from Boeny, and 9

from Analanjirofo). These participants had previously benefited from IMPACT support as they had attended

business training sessions.

The main results are presented below:

• In general, drug shops have not been negatively affected by travel restrictions because the transportation

of goods and medicines is exempt from the restrictions.

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• Drug shops are experiencing stock outs of malaria products, flu medicines, and Vitamin C, as well as

limitations on order quantities due to insufficient wholesaler inventory.

• Most drug shops confirmed a need for financing, primarily for inventory purchases.

• In addition to financing needs, some drug shops asked for protective equipment from IMPACT to help

them better serve the population.

As a result of this survey, IMPACT gave the two partner banks a list of 61 drug shops needing inventory. The

banks asked their respective branches to directly contact the drug shops, and in Quarter 3 five drug shops

(two in Atsinanana, three in Boeny) received loans. The banks are continuing to contact drug shops. As part of

IMPACT’s COVID-19 response for the private sector, the project decided to donate the following items to

pharmacies and drug shops in five regions (Boeny, Atsinanana, Analanjirofo, Sava and Diana):

Table 17: Details of items donated to pharmacies and drug shops

Private Enterprises

Number Hand-Washing

Station (1/entity) Mask

(3/entity) Hand Sanitizer (2 bottles/entity)

Sur'eau or Bleach (2 bottles/entity)

Poster on measures to protect against

COVID-19 (2/drug shop,

1/pharmacy)

Drug shops 143 143 572 286 286 286

Pharmacies 53 53 0 0 106 53

TOTAL 196 196 572 286 392 339

The items are being ordered and purchased, and distributions will be coordinated with regional IMPACT team

in Quarter 4.

Identify potential partnerships with private training companies to expand and sustain options for business training to enterprises in the health commodities supply chain In order to establish a sustainable training mechanism for pharmacies, IMPACT began identifying organizations

that would be able to take over and deliver training after the end of the IMPACT project. In Quarter 3,

FORMASANTE, a private training firm which already offers technical and management training modules to

pharmacies, agreed to sign an MOU with IMPACT. The firm is also interested in developing customized

modules for drug shops with IMPACT. In addition, SOMAPHAR, the pharmaceutical wholesaler which co-

sponsored the drug shop training in Boeny last quarter, also expressed its interest in creating a training

partnership with IMPACT.

Explore digital inventory management applications for use by private health commodities enterprises and

which would be incorporated into future business training

Following the exploration of digital inventory management tools developers (PHARMA Plus and Maisha Meds),

the selection process for the application was launched in Quarter 3 will be completed in Quarter 4.

Sub-IR 3.2: GOM facilitates the work of the commercial sector

IR3.2.1 : Facilitate high-level advocacy meetings involving the MOPH, Ministry of Commerce, customs

services, Ministry of Economy and Finance, the National Board of Physicians and the National Board of

Pharmacists to develop policies and regulations that will favor importation and commercialization of a

packet of vital Essential medicines, including contraceptives, anti-malarial, and key MNCH products.

As a result of COVID-19 restrictions, IMPACT was not able to organize face-to-face meetings to set up the pilot

steering committee of ADDOs as planned. The ADDO committee will include representatives from DAMM, the

DPLMT, the National Orders of Pharmacists and Doctors, and the Associations of drug depots. Instead, IMPACT

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developed a draft of the roadmap for the pilot phase with the ToR for the ADDO steering committee that was

circulated internally for feedback. The proposed roadmap is based on the following strategies:

• review/update of legal framework

• awareness and motivation of all involved stakeholders;

• planning and implementation of the pilot phase;

• training and coaching of drug shop owners, dispensers, and supervisors; and

• supervision and evaluation during the pilot phase.

The establishment of the ADDO steering committee is planned for the next quarter.

IR3.2.2 : Support DAMM and MOH to put in place strong regulatory processes related to the registration, importation, and distribution of medicines based on reviews of the Common Technical Document, New Law on Regulatory Body in Africa, and experience from other countries through study tours.

In Quarter 3, the technical report developed by the international expert in Pharmaceutical regulation Dr. Marie

Paule Fargier was finalized and shared with USAID, DAMM, and DPLMT. An action plan with immediate and

mid-term activities to implement was developed and shared with USAID and UCP-Global Fund for resource

mobilization. It is anticipated that DAMM will share the report and action plan with other key partners to

mobilize funds and necessary technical assistance to improve the functioning of the DAMM.

As a next step, the TMA Regulation subcommittee will use recommendations set by the STTA to review and

update the existing legislative and institutional laws and decrees governing the pharmaceutical sector in

Madagascar to comply with the latest international recommendations and guidelines. Comparative analysis

of existing texts with the New African Union Model Law on the Regulation of Medical Products shows that

Malagasy legislation must still include provisions relating to the classification and prescription of medicines,

the fight against the illicit market, counterfeit and sub-standard medicines; the obligation of declaration of

conflict of interest for the members of the National Registration Commission; and the appeal procedures

applicable in the event of litigation. The report also notes that basic technical skills already exist at the DAMM

level, but the technical team needs to better structure its procedures and archiving system to be more efficient

and transparent. To this end, it is recommended to develop clearly defined guidelines for best practices and

to establish a computerized archiving system.

Based on the Global Benchmarking Tool (GBT) self-evaluation, the DAMM is recommended to completely

review the service of the pharmaceutical inspection, which currently lacks human resources and an adequate

budget; and needs to set up a procedure manual.

IR3.2.3 : Support DAMM in streamlining the registration and importation procedures for medicines based on the latest WHO recommendations.

In order to streamline and harmonize the procedures relating to the registration and quality assurance of

medicines, a draft of a new registration guide for medicines in accordance with the Common Technical

Document (CTD) format is being drafted with remote support from the international expert Dr. Marie Paule

Fargier, and will be shared with DAMM for discussion and validation.

The final version of the MOU set between the MOPH and its technical and financial partners for the

harmonization of quality assurance procedures is available and ready to be signed. This latest version is the

result of discussions, comments, and various amendments proposed by each of the parties involved, and

45

includes, in particular, a provision relating to effective collaboration between DAMM and SALAMA in terms of

quality assurance procedures for medicines.

IR3.2.4 : Support the MOPH and the professional associations to revitalize the inter-ministerial committee to fight counterfeit and illegal medicines. A strategy will be defined through a mid-term evaluation of the Stratégie de Lutte Contre le Marché Illicite and the Contrefaçon des Medicaments et Intrants de Santé and an action plan will be developed.

No activity was implemented because DAMM, DPMLT, and the Secretariat of the Inter-ministerial committee

are currently not available to organize a meeting with all involved parties.

46

III.4 IR 4: Improved sustainability of social marketing to deliver affordable, accessible health products

to the Malagasy people

Sub-IR 4.1.1: Socially marketed products are continuously available at convenient and accessible locations

IR4.1.1: Distribution of socially marketed products across 10 regions for MNCH and FP/RH products and distribution of only FP/RH products in three PARN Regions through PARCs and PAs. In Quarter 3, IMPACT continued to distribute a range of socially marketed FP/RH and MNCH products to

support the national program despite the COVID-19 pandemic. The supervisions of PA and PARC were

conducted and 100% of the data from PA and PARC were collected and sent to the central office. This allows

IMPACT to have accurate situation of the stockout status at the end of each month.

Table 18 and 19 show the distribution of FP/RH and MNCH health products through Quarter 3 against annual

targets.

Table 18: Distribution of FP/RH commodities in Quarter 3

YEAR 2

FP PRODUCT Year 2 Target Quarter 1

Achievement Quarter 2


Achievement % of Year 2

Target Achieved

OC (Community Channel)

1,724,880 484,152 748,871 647,659 109%

Injectable (Depo-Provera/TRICLOFEM) (Community Channel)

1,473,355 513,453 567,313 450,623 103%

FP condom Protector Plus (Community and Commercial Channels)

1,633,794 557,904 445,488 332,928 82%

FP Youth Condom Yes (Commercial Channel)

671,689 N/A N/A N/A N/A

Sayana Press (Community Channel)

474,355 6,601 N/A 63,008 15%

Pregnancy Test (Community Channel)

100,000 4,245 20,604 2,525 27.4%

• Oral Contraceptive (Microgynon and Combination 3): The distribution of Oral Contraceptives in Quarter

3 is stable compared to Quarter 2. The annual target has already been exceeded by 9 points due to an

increase of regular users from Mahefa Miaraka since Quarter 2. Feedback from CHVs to PAs in different

regions indicates that users prefer Combination 3 to Zinnia F as Zinnia F has a bitter taste.

• Intra-muscular Injectable Contraceptive (Depo-Provera/Triclofem): The distribution of Intra-muscular

Injectable Triclofem had a slight decrease of 20.57% compared to Quarter 2 due to the resumption of

Sayana Press distribution since June 2020. However, the Intra-muscular Injectable cumulative quantity

distributed has achieved 103% vs the annual target. Some Sayana Press users used Triclofem during its

stockout, which is why the target for Triclofem was exceeded.

• Sub-cutaneous Injectable Contraceptive (Sayana Press): 390,200 units of Sayana Press were received

from UNFPA in mid-May 2020. At the end of Quarter 3, distribution of Sayana Press resumed, and the

quantity distributed represents 15% of the annual target.

• Yes With You Male Condom: The procurement of this product is not initiated. The portfolio analysis

recommends maintaining Yes condoms by introducing new flavors (banana or vanilla) depending on the

47

consumer choice. Final approval of the product portfolio by USAID and dialogue with the private sector

will condition and determine the procurement of Yes With You.

• Protector Plus Male Condom: The cumulative of the Protector Plus distribution reached 82% of the

annual target with 67% coming from commercial sector distribution.

• Pregnancy Test Kit: Despite the scale-up of the pregnancy test kits in Menabe by Mahefa Miaraka, the

cumulative of pregnancy test distribution in SOFIA and Menabe regions is only 27.4% of the annual target

as all trainings planned by Mahefa Miaraka in these regions are postponed due to the COVID-19

pandemic. Pregnancy tests are available at all PA and PARC in SOFIA and Menabe. At the end of June, it

was reported that 19,133 tests are still available at PSI’s warehouse which will be enough for almost 8

months of stock for the 2 regions (SOFIA and Menabe). The scale-up scheduled in SAVA for Mahefa

Miaraka and the trainings planned by ACCESS in its zones were delayed due to the travel restrictions from

COVID-19.

Table 19: Distribution of MNCH Commodities in Quarter 3

YEAR 2

MNCH PRODUCTS Target Quarter 1



Achievement % of Year 2

Target Achieved

ORS/Zinc DTK (Community)

58,906 21,008 28,838 21,230 120%

Sur Eau 150 ml (Commercial)

904,910 N/A N/A N/A N/A

Sur Eau Pilina (67mg Tablet) (Community)

3,620,780 703,300 289,200 206,820 33%

Arofoitra (CHX 7,1%) (Community)

30,378 12,946 1,871 7,548 74%

Pneumox (amoxicilline) (Community)

219,635 48,182 18,352 28,878 43.4%

• ORS/Zinc: After the end of the rainy season, the distribution of ORS and ORS/Zinc in Quarter 3 has

decreased by 26.38% compared to Quarter 2 but the cumulative distribution from Quarter 1 to Quarter

3 remains high and has reached 120% of the annual target.

• Sûr’Eau 150 ml (commercial): The delivery of Sûr’Eau 150 ml began in mid-June 2020. Sûr’Eau liquid

150ml will temporarily replace Sûr’Eau Pilina in some PARC and PA which have experienced stock out

since the arrival of the Sûr’Eau Pilina in July.

• Sûr’Eau Pilina (community): IMPACT continued to distribute the remaining stock of Sûr’Eau Pilina but

most of PSI’s warehouses ran out of stock from Quarter 2. This situation explains the low achievement of

33% of the annual target. Though PSI’s warehouses have stock out, it has not yet impacted PARC and PA as their

stock out rate remained 0% in April and May and 1% in June. When the product arrives in Quarter 4,

IMPACT will continue to promote the product by increasing e demand and using Sûr’Eau Pilina to purify

water especially during the COVID-19 pandemic.

• Arofoitra (Chlorhexidine 7.1%): The distribution of Arofoitra achieved 74% of the annual target. 3,519

tubes were allocated as start-up for ACCESS’ CHVs in Atsimo Andrefana and Atsinanana. Apart from these

start-up quantities, distribution increased in Quarter 3 after a training of CHVs led by Mahefa Miaraka in

Antalaha and Sambava health districts.

• Pneumox: 237,000 blisters of Pneumox arrived in mid-May 2020 after the stock out due to delay of

delivery by SALAMA and distribution resumed in June. Thus, the cumulative distribution achieved 43.4%

of the annual target.

48

Training of the distribution staff: In June 2020, six SRD (Superviseurs Régional de Distribution) were trained

virtually in a ToT about gender themes, equity, and social inclusion in supply chain management. This training

was scheduled in three virtual sessions from the end June until mid-July. The six SRD will organize cascade

trainings of PAs and PARCs from the end of July 2020 until the end of September.

Training and refresher training of PA and PARC: The number of PA and PARC increased from 925 at the

beginning of IMPACT project to 961 at the end of Quarter 3, including 70 PARC and 891 PA. This increase is

due to the extension of ACCESS zones in Nosy Varika, Beroroha, and Morombe.

In Quarter 3, nine PARC and 142 PA (49 men and 102 women) were receiving refresher training on the

improvement of the supply chain management during a two-day training.

Table 20 below shows the districts and attendance rate of each district during the trainings.

Table 20: PA and PARC trained in Quarter 3

Districts Date Initial number of Participants

PARC PA TOTAL PA and PARC Trained

Attendance Rate

Men Women

Nosy Varika May 19th and 20th 20 1 19 20 100% 9 11

Manakara June 18th and 19th 24 0 21 21 88% 4 17

Diego I&II May 28th and 29th 24 1 23 24 100% 9 15

Ambanja June 15th and 16th 32 2 29 31 97% 8 23

Ambilobe June 8th and 9th 20 2 18 20 100% 9 11

Manandriana May 25th and 26th 8 1 7 8 100% 3 5

Ambositra May 28th and 29th 16 1 14 15 94% 2 13

Fandriana June 5th and 6th 12 1 11 12 100% 5 7

Total 156 9 142 151 97% 49 102

Figure 3: Training in Manakara

IR4.1.2: Establish a motivation system for PAs and PARCs and follow up on their quarterly performance to address supply chain inefficiencies in social marketing in order to prevent stockout. In Quarter 3, IMPACT organized a personal performance review (PPR) of PARC and PA based on the quality of

their work during Quarter 2. The number of PARC and PA was 954 (including additional PARC and PA recruited

in the Mahefa Miaraka and ACCESS zones) in Quarter 2. The evaluation was based on the following criteria: (i)

availability of products, (ii) respect of storage conditions, (iii) quality on the completion of all management

tools, and (iv) GPS coordinates indicating their location as a proof that they were evaluated by the SPD. 35

Figure 2: The DRS of DIANA giving an opening speech for the training of PA and PARC in Ambilobe.

49

PARC and 463 PA met set criteria during this performance review, and they have received IMPACT promotional

items, including pens, badge holders, and key holders in May. The number of PA and PARC who met all the

criteria of the evaluation has increased from 25% to 53% for PARC and from 27.47% to 52.14% for PAs between

Quarter 1 and Quarter 2. PAs and PARCs are evaluated at the end of each quarter.

IR4.1.3: Expand last-mile distribution and emergency distribution through a pilot to deliver health products using drones. From April to June 2020, drone flight tests delivering health commodities to PA were on stand-by as the

available batteries had reached their life cycle and were no longer able to carry out flights Batteries were

ordered by Aerial Metric, but due to the lock-down in China due to COVID-19, the shipment and arrival of the

batteries was delayed. Domestic and international flights in China have been suspended and the only battery

supplier in China has stopped working since January 2020.

Following Aerial Metric’s request, flight tests to transport health commodities were suspended from April 1st

to June 30th, 2020. Flight tests will resume in July 2020.

The new batteries arrived in Madagascar from China on June 6th and 7th, 2020 and took two weeks to be

transported to Maroantsetra.

IR4.1.5: Select and introduce socially marketed products across 10 IMPACT regions and 3 PARN regions

through the private sector (pharmaceutical and commercial channels) pending the results of the COGS

analysis.

DMPA-SC (Injectable Sub-Cutaneous) and Yes With You condoms have been identified and recommended to

be introduced into the private sector (products adapted to the for-profit sector are categorized for the

population who can afford them) following the portfolio and COGS analysis to satisfy all segments of the

market needs. Conversations with IMPACT and the pharmaceutical private sector will start in Quarter 4. The

dialogue will focus on the quantification of private sector products, their willingness to serve all the segments

of the market (not only Quintile 4 and 5 of the socio-economic category), and the collaboration with IMPACT.

IR4.1.6: Define the needs for a product monitoring system and conduct a study of a product tracking system.

Find technological solutions which allow IMPACT to earn and grow brand loyalty while protecting the brand

from supply chain fraud, including counterfeiting and theft.

IMPACT explored technological solutions, such as barcodes to track each stage of the distribution and to

mitigate the leakage of FP products (selected to start with this project) and the ability to identify FP social

marketing products at the public sector.

During control visits, this tracking system will make it easy to read the tracking code and check the stock status

of the products stored in warehouses by using laser readers/scanners or to identify the origin of the product

by using a cellphone.

National and international suppliers were prospected in order to gather proposals and quotes to study the

feasibility of setting up the system. Local suppliers did not complete the requirements of the tender, so the

tender had to be launched internationally during Quarter 3. An international supplier has been identified and

contacted.

50

Sub-IR 4.1.2: Socially marketed products achieve cost recovery at an affordable price for consumers

IR4.2.1 : Leverage TMA findings from IR1 to analyze COGS and continue to propose options for the

optimization of financial sustainability for the current socially marketed products portfolio and explore

brand extension of Yes With You condoms and introduce a new brand of pharmaceutical products depending

the results of the COGS analysis.

Analysis of the Cost of Goods Sold (COGS) showed huge trade margins for FP products. A step forward for

optimizing financial sustainability is to slightly increase the prices of the majority of FP products except Rojo

(cycle beads). Many prices have not increased since 2015 and should be adjusted while taking into account

the ability of end-users to pay by observing market dynamics or conducting a willingness to pay survey. New

prices are proposed in the COGS analysis.

DMPA-SC and Yes With You condoms stand out as priority products to be reintroduced into the private sector

according to the products portfolio analysis.

DMPA-SC was identified because according to the products portfolio analysis, injectables no longer exist in

the pharmaceutical sector since the end of the USAID ISM project in September 2017. Injectables are the most

chosen FP method in Madagascar and the socio-economic quintiles 4 and 5 comprise 69.7% of women using

injectables in urban areas, which were supplied to them at pharmacies (source: TraC 2017). The private sector,

especially pharmacies, is therefore encouraged to offer DMPA-SC self-injection, which can be used by the

clients themselves. DMPA-SC self-injection is now authorized in Madagascar and since January 2020, the

MOPH has been progressively introducing the DMPA-SC self-injection in 17 districts according to the national

strategy. Introduction into the pharmaceutical channel should follow the strategic plan elaborated by the FP

committee led by DSFa. The possibility of introduction of a brand of self-injection other than Sayana Press

should be explored in order to avoid leaks of products from the public and community sector to the

pharmaceutical sector. The introduction of DMPA-SC self-injection in the pharmaceutical channel would be

accompanied with appropriate messages for information and training of pharmacies, drug shops, and users.

The development of the modern contraceptive methods prevalence rate relies on the development of the

DMPA-SC self-injection as its self-injectable aspect will have great potential for the private sector.

Yes With You male condoms were identified to be reintroduced into the private sector because some brands

of condoms are present in pharmacies but with high prices varying from more than 4,000 Ar to 45,000 Ariary,

serving high socio-economic segments. After visiting retailers, a gap of condoms was noticed in the

commercial channel despite the existence of a few brands which do not cover the retail market but cover

mainly gas station shops. The gap is left by Yes With You, an elaborated perfumed condom, which has little

competition in its range in the commercial sector and pharmaceutical sector for middle and low middle

segments.

51

III.6. IR5: Increased demand for and use of health products among the Malagasy people

IR5.1.1 : In collaboration with the demand creation subcommittee of the TMA TWG, develop and implement

activities to increase demand and use of health productsIR5.1.2 : Provide technical and financial support to

contribute to the activities of the MoH

During Quarter 2, the demand creation subcommittee of the TMA TWG has developed a communication plan

based on the correct use of health products and self-medication planned to be finalized in Quarter 3. Due to

COVID-19, staff from the MOH (DPS, DPLMT, and AMM) were not available in April and May. Finally, a virtual

meeting was confirmed, and IMPACT provided the data connection to the staff from the MOH. As the donation

of the data connection was completed at the end of Quarter 3, the next meeting will be held in Quarter 4.

IR5.1.2 : Provide technical and financial support to contribute to the activities of the MOPH

Support the celebration of World Malaria Day

During World Malaria Day on April 25th, 2,614,443 SMS messages were sent to women and men over 15 years

old in the 13 USAID-supported regions. The SMS were sent in collaboration with the NMCP. The content of

the message focused on sensitizing people to avoid self-medication and to encourage them to go to the health

center to seek for treatment.

To highlight the month of childhood in June, SMS messages on MNCH were sent to 3,219,776 people (women

and men over 15 years old) who are enrolled in the Telma, Airtel, or ORANGE networks in the 10 USAID-

supported regions. People were sensitized to pay attention to the health of mothers and children and refer

them to the health center to receive appropriate health care and commodities when they are sick.

Support the implementation activities on demand creation of products related to the Malaria Control

Communication Plan 2019-2022 in collaboration with the National Malaria Control Program (PNLP),

From June 16th to 23rd, the NMCP organized a review of the Malaria National Strategic Policy 2018-2022

through a virtual meeting that the MOPH, financial and technical partners, and NGOs attended. IMPACT

provided technical support to the NMCP communication team to review the communication activities related

to the national strategic policy. Based on the review findings, the NMCP was recommended by the technical

and financial partners to improve the monitoring of the activities in order to adjust communication campaign

(messages and channel). The NMCP will work closely with the monitoring and evaluation NMCP team to setup

a system to monitor and evaluate the communication activities. The Malaria Control Communication Plan will

be updated in Quarter 4 according to this revised Malaria National Strategic Policy.

COVID-19 response

IMPACT Participated in 11 virtual conference of the weekly coordination meetings organized by the CCRCE led

by the DPS with other TFPs such as WHO, UNICEF, ACCESS, UNFPA, etc. In May, activities with the budgets on

communication against COVID-19 were completed by each partner based on request from DPS and regions.

For IMPACT, support is focused on the printing of printed media (poster, job aid, flyers), the production of TV

and radio spots, broadcasting of TV and radio spots in the 13 USAID-supported regions, and payment of salary

of the 30 hotliners for the call center 910. In June, outcomes of the meetings included: (i) Updates on activities

and contributions from each partner as per their mandate (ii) Allocation of regions by intervention area for

each Technical and Financial Partner (TFP) (iii) Needs of DPS and the regions in terms of communication

activities were identified and collected (iv) Validation of the messages on COVID-19 prevention: SMS and

“Clash-info,” in the form of sketches and songs to convey key COVID-19 messages.

52

IMPACT participated in two meetings of the COVID-19 Logistic Committee on June 3rd and 9th, 2020. Meetings

focused on (i) logistic stock status, quantification of the gap of PPE, commodities and tests for COVID-19, and

a procurement update (ii) Improvement of the stock management and shipment tracking application which

helps the CCO to manage commodities by using all data and (iii) Sharing difficulties to collect data from regions

and finding resolutions.

IR5.1.3 : Conduct communication campaigns for promoting health products of the three prioritized health areas (Malaria, FP and MNCH) through radio, TV spots, job aids, and digital communication incorporating gender messaging to promote and use health commodities for population and providers

Production spot TV on FP

During Quarter 3, IMPACT produced a TV spot on FP that is focused on the several methods of FP (oral

contraceptives, condoms, injectables), and where to get them (health centers, CHVs, and drugstores). Gender

messaging and social inclusion were integrated into this TV spot. The script of the TV spot was already

validated by DSFA and DPS of the MOPH, then IMPACT will broadcast the spots in Quarter 4.

Broadcast Radio and TV spots

IMPACT aired 1,230 radio spots in 30 districts of the 10 USAID-supported regions from April 01st to 13th, 2020

in order to promote and increase the knowledge of Sur’Eau Pilina.

1,682 radio spots on IPTp and 1,682 radio spots on malaria case management were broadcast from May 29th

to June 30th, 2020 in 27 districts of the 13 USAID-supported regions where the malaria prevalence is very high

following the information provided by the NMCP. The messages encourage the population to go to health

facilities or CHWs and use health commodities, especially for vulnerable populations including pregnant

women and children under 5. The radio spot on IPTp uptake encourages pregnant women to complete their

antenatal consultation (ANC) and receive SP to protect her and her unborn child from malaria. Family and

friends are also sensitized to support pregnant women. For malaria case management, in case of fever, they

are encouraged to go to the health center where they will be tested with an RDT to confirm if it is malaria and

receive the appropriate treatment.

Table 21 : Summary of the Radio Spots Aired in Quarter 3

Communication campaign

Period Region Number of

Districts Number of Spots Aired

Comments

Broadcast of IPTp uptake Radio

Spots

May 29th to June 30th,

2020

Sofia 2 116

Diana 3 232 2 radio stations in Diego

Boeny 2 116

V7V 2 116

Menabe 1 58

Sava 4 232 2 radio stations in

Sambava

Atsinanana 5 348 2 radio stations in

Toamasina

Analanjirofo 5 290

Atsimo Andrefana 3 174

Total 27 1,682

Broadcast of malaria case

May 29th to June 30th,

2020

Sofia 2 116

Diana 3 232 2 radio stations in

Antsiranana

53

Communication campaign

Period Region Number of

Districts Number of Spots Aired

Comments

management radio Spots

Boeny 2 116

V7V 2 116

Menabe 1 58

Sava 4 232 2 radio stations in

Sambava

Atsinanana 5 348 2 radio stations in

Tamatave

Analanjirofo 5 290


Total 27 1,682

Broadcast of Sur’Eau Pilina Radio Spots

April 1st to April 13th,

2020

Sofia 2 82

41 spots aired per station

Diana 4 164

Boeny 2 82

V7V 2 82

Menabe 1 41

Sava 4 164

Atsinanana 6 246

Analanjirofo 5 205


Total 30 1,230

Broadcast of LLIN cCD Radio Spots

April 1st to 30th, 2020

Vatovavy Fitovinany 3 650 (Group 1) LLIN cCD

campaign Atsinanana 3 600


Atsimo Atsinanana 2 495 2 radio stations in Vangaindrano/2nd wave

of LLIN cCd campaign Analanjirofo 2 330

Total 12 2,335

Promote health products in the field with communication teams using mobile sound systems

Ten communications teams composed of an animator and a driver used mobile sound systems to promote

CHX, Sur’Eau Pilina, and Protector Plus condoms in the 10 USAID-supported regions (Atsinanana, Analanjirofo,

Diana, Sava, Sofia, Boeny, Menabe, Melaky, Atsimo Andrefana, Vatovavy Fitovinany). Approximately 38

districts and 133 communes were reached, with an average of 4 districts and 13 communes per region. These

teams sensitized the community on the use of the health products, and they worked with the CHVs to create

demand by helping them to promote and sell their products. However, the sales of the products were affected

by the COVID-19 situation. The communications teams respected barrier measures including social distancing.

514 sensitizations were held which reached 68,518 people.

Table 22: Percentage of sales from Communication Teams and CHVs Total Quarter 3

Sales of Sur'Eau Pilina 206,820

Sales made during sensitization by Communication Teams with CHVs 6 374

% of sales from Communications Teams and CHVs 3.1%

Sales of CHX 7,548

Sales made during sensitization by Communication Teams with CHVs 314

% of sales from Communications Teams and CHVs 4.2%

Sales of Protector Plus (rural) 332,928

54

Total Quarter 3

Sales made during sensitization by Communication Teams with CHVs 11 564

% of sales from Communications Teams and CHVs 3.5%Re

IR5.1.3a Increase demand creation of health products, and raise awareness of the population on COVID-19

on the field with communication teams using mobile sound systems

IMPACT conducted sensitization activities using mobile sound systems to raise awareness of the population

on COVID-19 under the coordination of the CCOR/DRS.

In Quarter 3, IMPACT conducted 354 sensitizations in 41 districts as follows:

• In May, 140 sensitizations in 20 districts (Maintirano, Morafenobe, Ambatomainty, Ambatoboeny,

Befandriana, Mandritsara, Antsohihy, Manakara, Vohipeno, Antalaha, Sambava, Betioky Sud, Ampanihy,

Benenitra, Ambilobe, Mahanoro, Mananara Nord, Morondava, Malaimbandy, Mahabo)

• In June, 214 sensitizations in 21 districts (Ambanja-Nosy Be- Sambava- Antsohihy- Befandriana-

Antsalova- Vavatenina- Vatomandry- Sakaraha- Morombe- Ambatoboeny- Beloha Tsiribihina-

Miandrivazo- Ifanadiana- Bealalana- Andapa- Betioky Sud- Toliara II- Maintirano- Morafeno- Antsiranana

I)

IR5.1.3b Produce and broadcast Radio and TV spot on COVID-19

• Advertising coverage (photos, interviews of officials and health providers) for the donation of 2,500 and

1,500 face masks from DOD in Tulear and Ambatondrazaka respectively.

• IMPACT ensured the coverage of donation ceremonies:

- In May, media coverage of donation ceremonies conducted in regions (3 publications on

Facebook, 15 TV broadcasts in 9 regions and 5 radio broadcasts in 9 regions

- In June, media coverage of Official donation events of expendable equipment and supplies in 10

regions (Antsinanana, Analanjirofo, Atsimo Andrefana, Diana, Sava, Boeny, Vatovavy Fitovinany,

Amoron’i Mania, Menabe, and Sofia) were broadcasted through national TV stations (TVM,

TvPlus, and Viva TV) during the weeks of June 22nd and June 29th.

• Three scripts for TV spots were developed by DPS and shared with all partners for comments. IMPACT

will financially support the TV spots in July

IR5.1.3c Produce and distribute/disseminate Job aids on COVID-19

• IMPACT ensured the production of 24,000 posters on COVID-19 prevention message for schools. IMPACT

also coordinated the advertising coverage (photos, interviews of officials and health providers) for the

donation of 2,500 and 1,500 face masks from DOD in Tulear and Ambatondrazaka respectively.

• IMPACT ensured the production and distribution of:

- 830 posters and 1,200 flyers on COVID-19, which were delivered and distributed by the DRS

(Atsinanana and Analanjirofo)

- 10,000 posters on handwashing to be distributed to drug shops, hospitals, medical centers,

PA/PARC, IMPACT offices and warehouses, and hygienists.

- 200 posters describing the definition of suspected cases disseminated to 190 CSB and 10 CHRD in

Atsimo Andrefana.

- 1,200 COVID-19 prevention flyers to households in Tamatave during the sensitization activities on

COVID-19 using mobile sound systems in districts.

55

IR5.1.4: Provide technical and financial support to the Ministry of Youth and Sport (MYS) to develop and

implement Youth activities in collaboration with Telma Foundation based on the Human Centered Design

(HCD) study and support training for youth on health, leadership, communication, etc.

Due to the COVID-19 situation, the training session for Blue Ventures youth members could not be held in

Quarter 3 because the trainers from Ministry of Youth and Sport (MYS) and PSI are from Antananarivo.

Meanwhile, IMPACT has integrated a module on gender and social inclusion into the training curriculum.

During the COVID-19 lockdown, social media has become increasingly popular and IMPACT is preparing a show

for youth on contraceptive methods to be broadcasted on Facebook and played on radio stations for rural

areas supported by IMPACT. The broadcasts are scheduled in Quarter 4.

IR5.1.5: Support the 910-call center in partnership with ACCESS During Quarter 3, IMPACT continued to support the 910 call center in collaboration with ACCESS. The numbers

of calls received on the three priority health areas (malaria, FP and MNCH) decreased drastically and calls

related to COVID-19 tripled in Quarter 3 compared to Quarter 2.

Table 23 : Summary of the number of hotline calls received during Quarter 3 vs Quarter 2

Quarter 2 Year 2 (January-March 2020)

Quarter 3 Year 2 (April- June 2020)

Number % Number %

Hotline calls received on malaria (% of total) 17,642 14% 1,615 0.4%

Hotline calls received on Family Planning (% of total)

843 1% 27

0.3%

Hotline calls received on MNCH (% of total) 9,238 8% 523 0.3%

Hotline calls received on other (% of total)*

*Calls for diseases: measles, COVID-19,

plague, etc.

95,331 77%

420,187 99%

Total hotline calls received 123,054 100% 422,352 100%

IMPACT conducted awareness campaigns through SMS messaging to the public in the 13 USAID-supported

regions. Targeted SMS were also sent to PA, PARC, CHV, and Pha-G-Dis:

Table 24: Summary of SMS sent during Quarter 3

HEALTH AREA

MESSAGES ENGLISH TRANSLATION TARGET GROUP

NUMBER OF PEOPLE

REACHED

PERIOD

MALARIA Tohizo hatrany ny ady @ Tazomoka efa fanaontsika hatrizay. Malagasy tsy ho fatin'ny tazomoka ! Mankasitraka

Sustain our usual contributions to fight against malaria. Malagasy won’t die from malaria! Thanks

PHA G Dis + PARC + PA +

CHV

3,697

10/04/2020

MALARIA

Salama, in 3 misafo sy mihinana SP eny @ CSB dia voaaro tanteraka @ tazomoka ny vehivavy bevohoka sy ny zaza ao ambohoka. Malagasy tsy ho fatin’ny Tazomoka

Hi, to protect pregnant women and their unborn child against malaria, 3 prenatal consultations are required during pregnancy to receive 3 SP doses.

CHV

3,340

11/04/2020

FP SAYANA PRESS

Salama e, efa tonga ao @ PARC ny Sayana Press. Ilazao koa ny AC maka fanafody ao aminao. Mankasitraka!

Hi, Sayana Press is now available at your PARC. Please inform your CHVs when it will be available from you. Thanks

PA

163

25/05/2020

56

HEALTH AREA


NUMBER OF PEOPLE

REACHED

PERIOD

FP

Salama, tohizo hatrany ny ezaka efa nataontsika ahazoan'ny mpiaramonina fomba fandrindrana fiainampianakaviana sahaza azy, toy ny pilina, tsindrona, kapaoty

Hi, continue all efforts to offer to your community various contraceptive methods like pill, injectables, condoms

CHV

4,794

25/05/2020

EMMP

Salama, arovy @ taratry ny masoandro sy hamandoana ny fanafody mandritra ny fitaterana sy ny fitahirizana azy satria manimba azy izany. Mankasitraka hatrany

Hi, to ensure the quality of medicines, avoid sunlight, wet areas, and moisture during the transportation and in storage. Thanks again

PARC + PA + CHV + PHA-

G-Dis

4,960

01/06/2020

MNCH

Entano ny manodidina anao hanadio rano @ Sûr'Eau pilina, izay sady mora vidy, mora ampiasaina, mora tehirizina ary misoroka ny aretim-pivalanana

Educate those around you to treat their water with Sûr’Eau because it is cheap, simple to use, easy to store, and prevents diarrheal diseases.

CHV

4,547

03/06/2020

MALARIA

Ny fatoriana anaty lay misy odimoka isak'alina,mandavantaona no antoka mahomby @ fisorohana ny vokadratsin'ny tazomoka indrindra ho an'ny vehivavy bevohoka

Sleeping under an ITN every night and throughout the year prevents the harmful effects of malaria on pregnant women.

CHV

4,113

06/06/2020

MNCH

Entano ny ray amandreny fa ny fanomezany ORS no manolo haingana ny rano very @ zaza raha vao voan'ny aretimpivalanana.

Educate parents that giving ORS to children to replace the loss of water during diarrhea.

CHV

4,802

16/06/2020

MALARIA

Entano ny raimpianakaviana hitondra ny vadiny hisafo eny @ CSB, hiarovana ny vadiny sy ny zaza ao ankibony tsy ho fatin’ny Tazomoka

Encourage fathers to take their wives to prenatal consultations at the health center to prevent his wife and unborn child from dying from malaria

CHV

4,531

20/06/2020

EMMP

Diovy matetika ny trano sy ny vata fitehirizana fanafody ary tsy afangaro amin’ny sakafo mba tsy ahatongavan’ny biby mpandrava

Clean frequently stock rooms and storage boxes to prevent pest attacks. Store food separately from health commodities.

PARC + PA + CHV + PHA-

G-Dis

4,169

23/06/2020

MALARIA

Hafaro ny vahoaka fa fatoriana isak'alina ary mandavantaona anaty lay misy odimoka maharitra dia miaro antsika Malagasy tsy ho fatin’ny Tazomoka.

Remind your community that sleeping under an ITN every night and throughout the year prevents malaria. Malagasy won’t die from malaria!

CHV

4,836

30/06/2020

MALARIA

Fadio ny manao dokotera tena, manatona tobimpahasalamana ! Malagasy tsy ho fatin’ny tazomoka !

Avoid self-medication, go to the health center! Malagasy will not die from malaria!

General Public (through Telma and Airtel subscribers)

2,614,443

25/04/2020

MALARIA

Ny fatoriana anaty lay misy odimoka isak'alina,mandavantaona no antoka mahomby @ fisorohana ny vokadratsin'ny tazomoka indrindra ho an'ny vehivavy bevohoka

Sleeping under an ITN every night and throughout the year prevents the harmful effects of malaria on pregnant women.

General Public (through Orange subscribers)

545,002

27/05/2020

MNCH

Araho maso akaiky ny fahasalaman’ny reny sy ny zaza ! Manatona tobimpahasalamana ahazoana ny fanafody sahaza ! Zonao ny ho salama!

Pay attention to the health of mothers and children. Go to the health center to receive appropriate treatment and

General Public (through Orange, Telma and

3,219,776

24/06/2020

57

HEALTH AREA


NUMBER OF PEOPLE

REACHED

PERIOD

medicines! It’s your right to be healthy!

Airtel subscribers)

IR5.1.5a Support the 910 call center in partnership with ACCESS (including recruitment, training , and supervision of the new hotliners) Supplemental Fund To strengthen the 910 Call center, IMPACT increased the number of hotliners from 18 to 30. Two teams of 15 hotliners work from 6:30 a.m. to 10:30 p.m. They were trained on May 22nd and are operational from May 22nd to August 20th. In May, 150,018 calls were received, 98% of which were on COVID-19. In June, 104,432 calls received from the 910-call center with 102,771 calls (98.04 %) on COVID-19. IR5.1.5b Send SMS broadcast to the targeted population (on the 3 health areas including Covid-19) Supplemental Fund Ten SMS messages on COVID-19 prevention were developed and validated by the CCRCE and the Health Promotion Department of the MOPH. These will be broadcasted from July.

58

III.8. Cross-Cutting Activities

Cross-cutting activities focus on five aspects: Monitoring, Evaluation, Research, Learning, and Gender/Social

Inclusion.

III.6.1. Monitoring, Evaluation, Research, Learning

6.1.1. Monitoring and Evaluation

CC2.1: Strengthen LMIS/HMIS (all sectors: public, private, non-profit, and commercial) including formative

supervision, capacity building of data senders, and supporting implementation of the LMIS roadmap with

consideration of DHIS2 as the main LMIS electronic tool.

Progress on the implementation of the provisional roadmap.

Status of computer used for LMIS at Pha-G-Dis

Table 25: Status of computer used for LMIS at Pha-G-Dis

Donation Status

Donation from IMPACT

• Thirty six out of 37 laptops initially purchased by IMPACT were received by the

Pha-G-Dis.

• The laptop for Marolambo (the one remaining laptop not yet delivered to Pha-G-

Dis) was already sent and is expected to be received by the Pha-G-Dis provider in

July.

• In Quarter 3, Pha-G-Dis in Sambava received the new laptop, reported that it was

damaged, and replaced with a new one which was sent via Colis-Express transport

company at the end of June and is expected to arrive in Sambava in July. The

damaged Laptop from Sambava will be repaired in Antananarivo and will be sent

to Sakaraha.

• In addition, IMPACT will provide three more laptops to Pha-G-Dis in Ankazoabo,

Antalaha, and Morafenobe after they reported having irreparable laptops which

was confirmed by the RLA. The shipment is scheduled in Quarter 4.

UCP donation • Three (Ambatofinandrahana, Antanifotsy, Ambatolampy) who are included in the

list which is monitored closely by IMPACT with the UCP National Director.

In sum, the remaining eight (10%) of Pha-G-Dis that do not have a computer include: two IMPACT donations

for Marolambo and Sambava that are in progress.

Ninety nine percent (99%) had access to Internet connection: When Pha-G-Dis providers did not have enough

Internet data to enable the submission of LMIS data, they collaborated with the locally based ACCESS staff

(based at SDSP) who shared Internet data as part of the agreement in the MOU signed by the three USAID

funded projects: ACCESS, Mahefa-Miaraka, and IMPACT.

Ninety two percent (92%) of Pha-G-Dis providers received training on CHANNEL: The four new staff

responsible for the manipulation of CHANNEL (Benenitra, Soalala, Fianarantsoa I, and Isandra,) were trained

by the RLA/EMAR/EMAD. In Quarter 3, there were additional newly recruited staff that will need training on

CHANNEL and additional trainings will be organized in Quarter 4 for Antsalova, Besalampy, Manakara, Betioky,

Mananara Nord, and Miandrivazo.

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Graph 3: Progress on the implementation of the provisional roadmap

The following are updates on the progress on the unlimited Internet connection donation project for Boeny,

Atsimo Andrefana, and Melaky DRSP and their 20 SDSP to be supported by IMPACT:

- DEPSI received an update on the appropriate mobile company for each region and district based on the

information from the field Internet users. This information delayed the procurement process.

- Analysis of financial proposals from each mobile company (Airtel, Orange, and Telma) with DEPSI,

including costs for materials and installation. The fiber-optic Internet from Telma is the recommended

system but it is relatively expensive. Thus, negotiations will be initiated through Axian Foundation to get

preferential prices under the public and private partnerships (led by DEPSI).

- IMPACT will proceed with a one-year contract in Quarter 4.

Helpdesk

Table 26 provides a summary of the additional barriers noted by the helpdesk from Pha-G-Dis providers on

LMIS data submission.

Table 26: LMIS submission issues and solutions

Barriers Districts Explanations Solutions Timeline

- No computer available for LMIS data

Ambatofinandrahana, Antanifotsy, Ambatolampy, Marolambo, Sambava, Sakaraha, and Ankazoabo

- Awaiting donation from UCP: Ambatofinandrahana, Antanifotsy, Ambatolampy

- and IMPACT: Marolambo, Sambava, Sakaraha, and Ankazoabo

- Accelerate shipment for IMPACT donation.

- Close follow-up with UCP to monitor the progress of the shipment.

July- August 2020

- Software bugs

Andapa, Mananara Nord, and Miandrivazo

- Computers attacked by viruses

- Supervision field visits by RLA to install antivirus software and scan the computers.

July- August 2020

- Human resources issue

Antsalova - No Pha-G-Dis

providers

- In Antsalova, the EMAR decided to stay at Pha-G-Dis 20 days per month from July to September 2020 to ensure data sending.

July-September 2020

47% 44%

94%

73%76%

97% 96% 95%90%

99% 100%92%

0%

20%

40%

60%

80%

100%

Availability of acomputer for Channel

Internet access Electrical issues/power cut

Training in CHANNEL

Quarter 1 Quarter 2 Quarter 3

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Barriers Districts Explanations Solutions Timeline

- Recruitment and training of a new provider will be completed in the next 3 months.

Betioky and Manakara - New providers not trained on CHANNEL.

- Trained the new Pha-G-Dis providers by RLA.

- Pha-G-Dis provider, EMAD, and EMAR are recommended to ensure the transfer of skills on CHANNEL to the new staff.

July- August 2020

Vavatenina

- Workload/not enough time (Pha-G-Dis is only present for four half days per week).

- Reorganization and coordination within the association working with the provider.

August 2020

- Bad quality of Internet connection

Benenitra and Betafo - Quality of the Internet network at Pha-G-Dis is very bad

Pha-G-Dis providers are obliged to submit LMIS data to the nearest city with a good Internet network: - Toliary for Benenitra - Antsirabe for Betafo

July 2020

Reporting rate progress

• As a result of the LMIS provisional roadmap, including the contribution of the helpdesk, the monthly

average reporting rate was 85% from October 2019 to May 2020 (see Graph 4).

• The reporting rates from DHIS2 were stable at around 90% as the data entries are ensured by the

Commodity Health Manager based at SDSP who is mainly dedicated to DHIS2. For Pha-G-Dis, the LMIS

reports come progressively and the system still receives reports from previous months, sometimes as

much as three or four months before because they did not respect the set deadlines.

Graph 4: Monthly progress on reporting rates from Quarter 1 to Quarter 3 Year 2

CC2.2: Support technically and financially the DPLMT to conduct Routine Data Quality Assessment (RDQA)

at all levels and sectors.

The objective of the RDQA was to check the performance system through the seven quality dimensions:

availability, completeness, timeliness, integrity, confidentiality, precision, and accuracy (See Annex G for a

detailed description of the seven quality dimensions). The tool used for the RDQA exercise was adapted from

the Measure Evaluation RDQA tool to fit the LMIS context in Madagascar.

93% 92% 91% 91% 92% 93% 93% 93%

86% 85%81%

86% 86% 86% 85% 82%

20%

40%

60%

80%

100%

Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20

DHIS2 CHANNEL

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Following the COVID-19 restrictions, the central team was unable to carry out the RDQA exercises in Quarter

3 for PARCs and PAs. However, the RLAs were asked to conduct the RDQA among Pha-G-Dis and Pha-Ge-Com

in the regions where they conducted supportive visits. They revisited 10 Pha-Ge-Com already supervised for

the RDQA exercise that presented low scores in the previous quarters and seven Pha-G-Dis in five regions:

Vatovavy, Diana, Sofia, Menabe, and Haute Matsiatra as presented in the table 27 and table 28.

Pha-G-Dis (table 27)

- For the five regions visited in Quarter 1 and Quarter 2, the overall data quality score improved above

80%. The scores for the seven Pha-G-Dis improved but were still under the benchmark of 80%. Accuracy

means that the data from stock monitoring sheets should match with data submitted on a monthly basis

in the CHANNEL system.

- In Mananjary, availability (means that supporting documentation are not available) and completeness

(means that the document contained all the required entries of the indicator as appropriate) improved

significantly from 50% in Quarter 2 to 100% in Quarter 3. Following are the main lessons learned that

can be duplicated to other Pha-G-Dis:

• Working with the Pha-G-Dis providers to create the missing management tools.

• Frequent supervision visits to monitor progress on the implementation of the

recommendation.

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Table 27: Summary of the RDQA findings for the Pha-G-Dis

Region VATOVAVY DIANA SOFIA MENABE HAUTE MATSIATRA

District\Pha-G-Dis Mananjary Ambanja Antsiranana II Antsohihy Boriziny Miandrivazo Ambalavao

Period Q2 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q2 Q3 Q2 Q3 Q1 Q3

Overall Data Verification Score¹ 74% 97% 91% 94% 90% 93% 94% 98% 88% 98% 90% 87% 85% 94%

System Assessment Score² 91% 94% 81% 81% 84% 100% 88% 100% 97% 100% 94% 94% 90% 93%

Overall Data Quality Score³ 82% 95% 86% 87% 87% 96% 91% 99% 92% 99% 92% 90% 87% 94%

Availability 50% 100% 100% 100% 100% 100% 100% 100% 78% 100% 100% 100% 62% 100%

Completeness 50% 100% 100% 100% 78% 78% 100% 100% 78% 100% 100% 100% 100% 100%

Timeliness 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 67% 67% 67%

Integrity 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Confidentiality 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 50% 100% 100%

Precision 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Accuracy 70% 79% 34% 56% 51% 73% 59% 87% 58% 84% 77% 91% 65% 94%

For Pha-G-Dis the results of the RDQA were provided to the Pha-G-Dis providers by RLA with EMAR and EMAD support who will also ensure the implementation of

the recommendations. The RLA will conduct follow up on the implementation of the recommendation during their formative supervision.

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Pha-Ge-Com (Table 28)

At the Pha-Ge-Com level the overall data quality score improved from Quarter 1/Quarter 2 to Quarter 3. For

example, for the Pha-Ge-Com of Tsaravary in the district of Mananjary, the score increased from 44% in

Quarter 2 to 64% in Quarter 3 (but still under the benchmack of 80%), and the same trend was noted in the

Antsatsaka district of Ambanja. For those Pha-G-Dis (Tsaravary and Antsatsaka), confidentiality, precision, and

accuracy are still the main issues. For some Pha-Ge-Com, the scores reached the benchmark: from 75% in

Quarter 1 to 83% in Quarter 3 (Pha-Ge-Com in Antanamitarana district of Antsiranana II) and from 79% in

Quarter 1 to 86% in Quarter 3 (Pha-Ge-Com in Ambalavao district of Ambalavao).

Overall data quality score was improvement in Ampandriankilandy, Antsatsaka, Tsaravary, and

Ampanaovantsavony but remained below the benchmark of 80%.

Based on the results from the Quarter 2 and Quarter 3 RDQA exercises, there is a need to address the

following:

- Conduct on-the-job training of Pha-Ge-Com led by the EMAD to reinforce the correct use of

management tools considering the seven quality dimensions.

- Raise awareness of the Pha-Ge-Com on the use of cleaned data with good quality to calculate AMC,

stock status, preparing orders, etc. to facilitate self-monitoring of the stock management at their level.

This would raise the Pha-Ge-Com interest to take care of the quality of the data used for their work.

The SDSP is encouraged and recommended to monitor the progress of those points on a regular basis (for

example monthly according to their availability). To reinforce this system, the RLA with work closely with

EMAD for this activity.

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Table 28: Summary of the RDQA findings for the Pha-Ge-Com

Region SOFIA HAUITE MATSIATRA

District\Pha-G-Dis Antsohihy Mampikony Port Bege Ambalavao

CSB Ampandriakilandy Mampikony Boriziny Ambalavao Ampanaovantsavony

Period Q1 Q3 Q1 Q3 Q2 Q3 Q1 Q3 Q1 Q3

Overall Data Verification Score¹ 42% 72% 89% 97% 86% 84% 85% 93% 75% 85%

System Assessment Score² 38% 83% 85% 96% 88% 92% 73% 79% 62% 73%

Overall Data Quality Score³ 40% 78% 87% 97% 87% 88% 79% 86% 68% 79%

Availability 0% 67% 86% 100% 72% 90% 100% 100% 100% 100%

Completeness 0% 59% 71% 100% 72% 68% 100% 100% 100% 100%

Timeliness 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Integrity 100% 100% 100% 100% 100% 100% 50% 100% 50% 100%

Confidentiality 50% 50% 100% 100% 100% 100% 50% 50% 0% 0%

Precision 0% 67% 71% 100% 83% 70% 100% 100% 100% 100%

Accuracy 41% 63% 94% 80% 71% 60% 96% 100% 76% 97%

Region DIANA VATOVAVY FITOVINANY

District\Pha-G-Dis AMBANJA Antsiranana II Mananjary

Pha-Ge-Com Antsatsaka Ambodisakoana Antanamitarana Mahavanona Tsaravary

Period Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q2 Q3

Overall Data Verification Score¹ 66% 84% 98% 99% 84% 87% 84% 98% 68% 79%

System Assessment Score² 67% 71% 79% 79% 67% 79% 83% 83% 19% 50%

Overall Data Quality Score³ 66% 77% 88% 89% 75% 83% 83% 91% 44% 64%

Availability 56% 89% 100% 100% 72% 72% 78% 100% 50% 93%

Completeness 56% 89% 100% 100% 100% 100% 78% 100% 50% 93%

Timeliness 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Integrity 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Confidentiality 39% 56% 100% 100% 100% 100% 78% 100% 50% 50%

Precision 39% 61% 100% 100% 56% 56% 78% 100% 50% 50%

Accuracy 70% 94% 83% 95% 57% 81% 74% 86% 78% 67%

- 1: Average score on the seven quality dimensions (availability, completeness, timeliness, integrity, confidentiality, precision, accuracy)

- 2: Qualitative assessment of the strengths and weaknesses of the functional areas of the data management and reporting system. A series of questions are used to calculate the average score based on the responses

- 3: Average score on “Overall Data Verification Score” and “System Assessment Score”

Legend Score

90% and above

80% - 89%

Below 80%

65

The RDQA issues reported by IMPACT among Pha-Ge-Com are regularly communicated to ACCESS for further

action. Additionally, the RLA will monitor the implementation of the recommendation during formative

supervision.

CC2.3: Implementing monitoring and evaluation system ITN community continuous distribution, including

creating M&E tools, training, data collection and supervision, RDQA (budget included in the continuous

distribution activities)

The M&E team is coordinating the collection of the monthly cCD activities reports from the TA Supervisors

(see details of the achievements in the cCD section).

6.1.2. Research

CC2.5 Conduct market assessment studies for FP and MNCH, including key informant interviews, outlet

surveys, and routine data in collaboration with IR1.

Market assessment on FP: Participation in several meetings to improve the FP market assessment framework

with both PATH and PSI headquarter teams. Discussions focused on a household survey among customers to

be included as part of the data collection tools to better understand their FP use behavior, particularly since

2017 when problems started to occur within the FP market, such as the discontinuation of the social marketing

products after the end of the Integrated Social Marketing (ISM) project and recurrent stockouts which

occurred in the public sector due to challenges in quantifying needs for FP products. The study protocol will

be designed in July and data collection will be conducted depending on the evolution of COVID-19.

CC2.6 Implement additional studies, including: archetype study/segmentation, journey mapping,

assessment of pharmacies and drug shops on products supply, KAP study on IPTp use, and an evaluation on

the introduction of the last mile distribution strategy (drones) at the community level.

CC2.6.1 Elaborate study design of the archetypes/Segmentation study, recruit agency to implement the

study from creation/finalization of the survey tools to the dissemination of the results

The communication team decided to implement an archetype and segmentation study among youth with a

focus on FP (other areas can be examined later). The first step was to conduct a literature review to understand

youth profiles. The results of this first step will be used to guide the key informant interviews that will be

conducted among the youth experts from MOPH, United Nation Institutions (UNFPA, WHO, etc.), donors, key

partners implementing youth activities, and different youth associations. After the completion of these steps,

including the literature review and key informant interview, a final archetype and segmentation will be

formulated to suggest strategies for communication on youth behavior change for FP. The literature review

will be completed in July and the key informant interviews will be conducted remotely in September.

CC2.6.4 Formulate research needs and share with USAID that will recruit an external agency to evaluate the

pilot phase of the introduction of drone as last mile distribution

The study protocol was finalized and validated by USAID. Aerial Metric could not find a drone-adapted battery

in Madagascar after deliveries from China were temporarily suspended due to COVID-19 and had to stop the

delivery by drone in Quarter 3 in Maroantsetra. The pilot activity is expected to resume early in July once new

batteries are delivered from the supplier in China. The evaluation of the pilot activity will be led by USAID. This

is suspended due to the COVID-19 situation.

66

CC2.6.5 Elaborate study design of the qualitative study to understand knowledge, attitude and practice on

IPTp use. Recruit the agency that will implement the study from creation/finalization of the survey tools to

the dissemination of the results.

- The study protocol was finalized and approved by the PSI Research Ethic Board based in Washington,

D.C.

- USAID provided comments on the study protocol which were shared with the PSI Regional Researcher.

The compilation of all responses to USAID’s comments was completed in June and the revised protocol

will be sent to USAID for a second review.

- Fieldwork will be organized when interviewers can travel outside of the Analamanga region.

6.1.3. Knowledge Management

CC2.7: Knowledge Management: Support partners in developing and collecting success stories and

documenting IMPACT's innovations in the field.

CC2.7.1 : Organize field visits to collect success stories and project's innovations (Ex: last mile distribution

using drones , achievements of the TWG, youth program, ect.) every quarter

Based on performance indicators improvement per activity (level of commodities out of stock, data reporting

rates, commodities distributions, etc.), IMPACT identified potential success stories and developed guidelines

and writing tips for success stories, which were shared with regional staff to collect success stories, and which

was also a method for enabling regional staff to document the success of their activities. Eight success stories

were collected (See list in Section III.7 of this report and the details are presented in Annex D).

CC2.7.2: Post success stories through the project’s online platforms (Website and Social media), to USAID

Madagascar and to Consortium partners platform

During Quarter 3, IMPACT continued to work with USAID Madagascar to disseminate success stories through

USAID platforms, such as websites and Facebook pages.

- For World Health Volunteer Week (April 5-11), IMPACT’s story of a CHV in Ambohimanarivo village,

Brickaville district was submitted to USAID and accepted for publication to USAID Madagascar’s

website and Facebook page. This story features the important role played by CHVs in remote and so

far villages from health facilities and how IMPACT supports them in supplying essential life-saving

products like Sur’Eau Pilina.

- During the World Health Day on April 7th, under the theme “Celebrating Nurses and Midwives,”

IMPACT’s proposal for a Facebook post was also accepted and posted on USAID Madagascar’s

Facebook page. The post was about IMPACT’s contribution to procure commodities and provide

technical support to the MOPH to ensure that health products for malaria, FP, and MNCH were

available.

For internal communication, IMPACT continues to use the Intranet to enhance learning and share important

information and files among IMPACT staff, such as the latest news about the project activities, achievements,

and key documents (national laws and policies, researches findings, project templates, PMP updates, stock

out status, sales reports, etc.).

- During Quarter 3, a dashboard tracking the evolution of project key indicators was made available to

staff. This automated dashboard has an objective to help IMPACT monitoring the evolution of the

indicators per IR. Based on monthly results from the previous quarters, a linear projection was

67

calculated to estimate the level of the indicators at the end of Year 2. As soon as an underperformance

appears, corrective measures will be undertaken.

- To monitor the implementation of the workplan, an online tracking tool using Excel has been

developed and available on the Intranet. This Excel monitoring tool is updated every Friday by the

IMPACT team leads and the summary is shared with all staff on a weekly basis.

- IMPACT also created a page dedicated to COVID-19 to keep staff updated daily on the latest COVID-

19 statistics in Madagascar and around the world.

CC2.7.3: Identify with the consortium partners the appropriate tools to disseminate IMPACT results (market

assessment and studies, TMA Roadmap, LMIS Assessment and roadmap, supply chain assessment, End User

Verification).

Due to the delay of the validation process taking longer than expected, the dissemination of the malaria

market assessment study, LMIS assessment, and End User Verification to partners and all stakeholders (MOPH,

private sector, technical and financial partners) is rescheduled for Quarter 4.

III.6.2. Gender and Social Inclusion

CC1.1: Target women and human rights associations to serve as strategic partners of IMPACT and to play

an active role in the Total Market Approach

Strengthened Strategic Partnerships with CNFM and EFOI to Build Capacity to Serve as GESI Champions

IMPACT continues to maintain strategic partnerships with women’s rights organizations and associations

including Conseil National des Femmes de Madagascar (CNFM) and Entreprendre au Féminin Océan Indien

(EFOI). In Quarter 3, IMPACT worked to onboard the newly elected CNFM President and continue

conversations with the existing EFOI leadership team (President and General Secretary) through a series of

orientations to strengthen collaboration. Orientations centered on participatory dialogues around IMPACT

program objectives, defining the TMA, the role of gender and social inclusion in achieving UHC, and the

importance of women’s and socially marginalized groups’ voices within TMI TWG. As women’s empowerment

and human rights leaders, CNFM and EFOI will continue their partnership with IMPACT and play active roles

within working groups and committees. In Quarter 4, CNFM and EFOI will also take active roles in IMPACT-

sponsored health campaigns and platforms such as the upcoming FP campaign in September.

CC1.2: Ensure the participation of key GESI partners in TMI TWG

Facilitated Dialogues with CNFM and EFOI to Outline Role in TMI TWG

To complement support to strategic partners CNFM and EFOI, IMPACT works to integrate the GESI partners

into the TMI TWG to advocate for inclusion and equity across the working group activities, promote women’s

representation and leadership, and achieve greater impact in the health sector. While working group meetings

were postponed in Quarter 3 due to COVID-19, IMPACT coordinated with CNFM and EFOI leadership to plan

for future engagement including entry in and contribution to relevant sub-work groups and committees. In

Quarter 4, IMPACT will continue regular planning with CNFM and EFOI to maximize impact on TMI TWG

activities.

CC1.3: Produce and distribute SBCC tools on GESI for different target groups

No activities scheduled or carried out in Quarter 3.

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CC1.4: Integrate GESI-informed messaging into family planning & MNCH communication campaigns

Integrated Gender and Social Inclusion Best Practices into Malaria and MNCH SBCC Campaign

In Quarter 3, IMPACT’s GESI and communications teams worked closely to integrate gender and social

inclusion-based themes in all key health messages for the malaria and MNCH SBCC campaigns. The GESI-

influenced messages pulled from evidence gathered during IMPACT’s gender analysis, such as the lack of

engagement among men in family and child health issues (because they associate health issues with women’s

roles), and limited practice of equitable health services among health providers. Newly crafted messages

supported the roles of men, women, and all parental figures to promote wholistic family health. Key messages

were also developed to sensitize providers about equal rights for all patients without biases or discrimination.

Due to COVID-19, public celebrations around World Malaria Day (April), Mother’s Day (May), and Children’s

Month (June) aligned with implementation of the campaigns, were suspended. However, the IMPACT team

actively pivoted to target messaging to SMS, radio, and TV broadcasting. In Quarter 4, IMPACT will continue

collaborating with partners on upcoming health campaigns, including developing relevant SBCC materials.

Updated Memorandum of Understanding with ACCESS Project and Coordinated Approach to Upcoming

GESI-Informed Family Planning Communication Campaign

Recognizing the ongoing challenges to increasing contraceptive prevalence rate in Madagascar, including

misconceptions around FP among different target groups, IMPACT sought partnerships with other relevant

health projects and leveraged support for increasing FP. In Quarter 3, IMPACT initiated a partnership with the

ACCESS project for an upcoming September 2020 FP campaign. The campaign, centered around the

International Day for Family Planning, will promote the common goal of sustainably improving the health of

Malagasy people through a strengthened health system and efficient health market. IMPACT facilitated a

series of design conversations to establish roles and responsibilities, including that IMPACT will focus on access

to health products and demand creation, and ACCESS will target social behavior change. Additional support

will be provided through a partnership with the MAHEFA MIARAKA project, which will cover regional

interventions for a more sustainable impact. The campaign planning team (composed of FP, communications,

and GESI focal persons from each project) also developed suggested communication activities to guide the

campaign roll-out. This collaboration is ongoing and will continue through Quarter 4 and the end of the FP

campaign.

CC1.5: Raise awareness of IMPACT stakeholders on GESI integration into a TMA through meetings and an

annual workshop

No activities scheduled or carried out in Quarter 3.

CC1.6: Build the capacity of IMPACT staff to serve as GESI champions

Developed and Facilitated Capacity Building for GESI-Influenced Social Marketing Health Commodities

Distribution

Following the March 2020 IMPACT staff training, IMPACT’s distribution team requested the integration of

gender and social inclusion concepts into the existing training curriculum for PAs and PARCs carrying out

health commodity distribution at the community level Specific identified challenges (from supportive

supervision and related discussions) included that women PAs and PARCs faced challenges around decision-

making and utilization of household financial resources to purchase health commodities.

In Quarter 3, IMPACT worked with SRDs and SPDs to update the training curriculum and prepare them to roll

out the training to PAs and PARCs. The training content includes concepts of gender, gender equality, gender

equity, and social inclusion; identifying how gender and social inclusion themes may impact PAs and PARCs in

their distribution activities; and strengthening distributor capacity for decision-making in the purchase and

69

management of health inputs at the household and community levels. As part of curriculum development,

IMPACT applied an innovative training of trainers (TOT) iterative co-design capacity building approach with

regional supervisors (SRDs and SPDs) that included a series of remote training and teach back methods and

facilitated the incorporation of feedback from participants into final training content. The curriculum is

available in French and Malagasy to facilitate learning across different language levels. In Quarter 4, the six

regional supervisors (SRDs and SPDs) will complete the final TOT components and will carry out field-based

training for PAs and PARCs.

Integrated GESI Considerations into Training Presentations for Partner Bank Branches

In Quarter 3, IMPACT’s GESI and A2F teams collaborated to integrate GESI considerations into training

workshops for regional branches of banks partner which serve to sensitize bank staff to the market potential

of drug shops, pharmacies, and other health commodity/supply chain businesses. The new GESI segment

incorporates information for financial institutions to better understand current banking trends for male and

female clients and to raise awareness of the banks potential business to meet the financial needs of women

pharmacists and drug shop owners. These additional supports help banks to reach and retain clients in more

inclusive ways. The updated presentation will be used during workshops with the banks starting in Quarter 4.

III.7 Success Stories

• Commune of Sakoana: Supply Point (PA), Health Facility Head and Community Health Volunteers work

together to protect newborns from umbilical cord infections

• Menabe region: Redistributing medicines from private to public health facilities the children

treatment with malaria

• Menabe region: Targeted, coordinated, and efficient supervision: Health stakeholders join efforts to

fight malaria.

• The use of Helpdesk improves data reporting rate from Pha-G-Dis to the central Ministry of Public

Health (MOPH)

• Atsimo Andrefana region: Engagement of a primary school teacher helps to continue Community

Continuous Distribution activities during the COVID-19 Pandemic

• Toliara II: Using handwashing devices locally made prevent COVID-19 spread during the continuous

LLIN distribution campaign

• Maintaining the private sector’s commitment by providing health commodities during the COVID-19

Pandemic

• Innovation during COVID-19: How remote capacity building will help advance equitable health

commodity supply chain distribution in the social marketing sector

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V- KEY CHALLENGES AND SOLUTIONS

Key challenges Solutions

Challenges related to Covid-19

• Restrictions on in-person meetings due to COVID-19 • Organizing virtual meetings until COVID-19

restrictions are lifted

• Delay on training of drug shops in DIANA due to

travel restrictions of the COVID-19

• Training of drug shops in DIANA have been

rescheduled in Quarter 4

(A2F) Reluctance of partner banks to continue lending

during the COVID-19 pandemic

• Support partner banks in restructuring loans

and in developing adapted products to address

client needs and respond to the situation

• Lack of adequate financial products for banks to

help health commodities enterprises face COVID-

19’s economic impact

• Support rapid development of financial

products adapted to current needs (COVID-19

loan, pharmaloan)

• Reduction/ Cessation of individual coaching to drug

shops due to COVID-19

• Develop a coaching tool for standardized

approach and implement remote coaching by

phone

• Unavailability of MOPH staff (DPS, DPLMT) to attend

meetings for the demand creation subcommittee of

the TMA TWG.

• Virtual meetings will be held at the end of the

day when staff from the MOPH are more

available. IMPACT will also provide data

connection to them.

• Activities not carried out or postponed during the

quarter vs planned activities due to COVID-19

(meetings, integration of GESI partners into TMI

TWG, and annual staff capacity building related to

gender and social inclusion).

• To address these challenges, the GESI team

applied several adaptive management

techniques including, remote work, planning

more frequent but smaller and separate

meetings with key GESI partners, and

rescheduling select activities for Quarter 4.

• Unavailability of DPLMT, DSFa, and DRSP to meet to

identify and determine the criteria for transferring

PA to Pha-Ge-Com and PARC to Pha-G-Dis.

• Reschedule the meeting depending oN the

evolution of the COVID-19

• Delay of arrival of the products (Pneumox, Sûr’Eau

Pilina, and Sûr’Eau 150 ml) due to COVID-19

restrictions can entail a stock out of some products

• IMPACT continues to follow the pipeline and

current orders

• Due to travel restrictions, research activities were

put on stand-by

• Awaiting COVID-19 restrictions to be lifted

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VI- MAJOR ACTIVITIES PLANNED FOR NEXT Quarter (YEAR 2, JULY – SEPTEMBER 2020)

IR 1: Enhanced coordination among the public, nonprofit, and commercial sectors for reliable supply and

distribution of quality health products

• Signature of the TMA roadmap by the General Secretary of MOPH and dissemination to all TWG members.

• Finalization of the update of the PPN PDPN document by the committee.

• Organization of a SIGL strategic plan development workshop for the next 3 to 5 years.

• Prioritization and analysis of texts and regulations related to the pharmaceutical sector and health

commodities by the texts and regulations committee.

• Sharing the findings of the malaria market assessment on a virtual meeting with the RBM.

• Advocacy training of TMA champions.

IR 2: Strengthened capacity of the GOM to sustainably provide quality health products to the Malagasy

people

• Finalize quantification reports for malaria and FP and present them to the CGL for validation and resource

mobilization.

• Support DSFa to conduct the annual quantification exercise for MNCH commodities.

• Generate new orders in ARTMIS as per the supply plan in accordance with the Fiscal Year 2020 Malaria

Operational Plan.

• Support central and district GAS committees to plan the distribution of malaria commodities for Year 3,

Quarter 1.

• Support the creation of UTGL (Melaky) and two GAS committees (Antsalova, Maintirano).

• Coordinate with SALAMA, DSFA, and UNFPA to transport MNCH commodities to districts.

• Conduct formative supervision of Pha-G-Dis and Pha-Ge-Com on stock management.

• Conduct data collection in relation of the TCA.

• Plan for a second EUV survey.

• Contribute to COVID-19 activities through CCO meetings in the 13 supported regions.

Community-based Continuous Distribution

• Delivery of LLINs is planned for Quarter 4 in the districts of Manakara, Vohipeno, Mananjary, and Tulear

II belonging to Group 1 in August 2020.

• Transportation of required LLINs for the next two months for Group 2 districts is planned for September

2020.

• Conduct training at commune level for the members of 1,571 Kom’Lay in the six districts of Group 2.

• Development of the macro plan in collaboration with the AMP (Alliance Malaria Prevention) Technical

Assistants.

• Review and validation of strategies for mass campaign.

• Finalization of budgeting for activities for mass campaign.

• Preparation for reception and storage for 3,677,000 PMI LLINs at the central level.

IR 3: Expanded engagement of the commercial health sector to serve new health product markets according

to health needs and consumer demand

• Recruit new private sector members to participate in IMPACT activities (transport, LMIS, TMA TWG).

• Monitor the implementation of health commission action plan.

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• Finalize and implement MOUs with EDM, INTER AIDE, and SOMAPHAR for transportation of health

commodities.

• Launch the tender process to develop tools for drug shops to collect data.

• Ensure that the health commission participates in the TMA TWG.

• Develop curriculum for training of peer trainers with simplified materials and tools, to be used in piloting

a sustainable mechanism for business strengthening program of drug shops

• Develop TOT curriculum for drug shop peer trainers.

Strengthening partner banks and other financial institutions' capacity to better serve private health

commodities supply chain:

• Revise training curricula for partner banks to incorporate GESI issues and, as needed, to consider newly

identified needs.

• Train and support partner banks in credit analysis and loan structuring for health commodities businesses

(continuous activity – Training planning to be revised depending on availability of DPLMT team and on

COVID-19 travel restrictions).

• Develop and adapt loan products and financial tools for small and micro health enterprises in health

commodities sector (e.g., pharma loans, motorbike loans, COVID-19 response product).

Provide business strengthening capacity building to enterprises in health commodities supply chain and

develop partnership with private companies to sustain the training:

• Provide initial business-strengthening training to drug shops in Diana and Sava, if COVID-19 situation

permits.

• Provide one-on-one coaching on business strengthening to enterprises/individuals identified as potential

peer trainers or having specific management needs during the pandemic.

• Identify potential partnerships with private training companies to expand and sustain options for business

training to enterprises in the health commodities supply chain.

• Explore digital inventory management applications for use by private health commodities enterprises and

which would be incorporated into future business training (in collaboration with other IMPACT partners).

GOM facilitates the work of the commercial sector

• Organize a first meeting of the ADDO pilot steering committee

IR4: Improved sustainability of social marketing to deliver affordable, accessible health products to the

Malagasy people

• Continue the distribution of social marketing products to the 10 regions of IMPACT and 3 regions of PARN.

• Continue the logistic activities for transporting cCD LLINs from PARC to PA.

• Continue supervising and monitoring PA and PARC.

• Conduct training for PA and PARC about improvement of the supply chain.

• Implement the portfolio analysis and the COGS analysis recommendations when the final version is

approved.

• Exploration of the extension of Yes With You male condoms by introducing a new scent validated by a

consumer panel in the commercial market.

• Extension of the distance for flight tests (> 25 km) for drones.

• Dialoguing with the private sector about FP products portfolio analysis results when the document is

finalized and approved.

73

IR5: Increased demand for and use of health products among the Malagasy people

• By the end of Quarter 4, the leading members of the demand creation subcommittee of the TMA TWG

will finalize the communication plan on safe behavior of health commodities through virtual meetings.

• Broadcast the new TV spots on FP to the 13 USAID-supported regions.

• Implement activities in collaboration with ACCESS and Mahefa Miaraka for the celebration of the World

Contraception Day in September.

• Produce and broadcast a show for youth through Facebook and broadcast on radio for rural areas of

IMPACT intervention.

• Continue to send SMS broadcasts to the providers (PA, PARC, CHVs, Pha-G-Dis, and Pha-Ge-Com) to

encourage them to continue their efforts on the promotion of health products and on stock management.

Cross-cutting

Monitoring and Evaluation

• Strengthen the monitoring of the LMIS provisional action plan for Pha-G-Dis using helpdesk and formative

supervision.

• Finalize contracts with the selected mobile companies for the donation of Internet connection for RDSP

and SDSP in the three regions to be supported by IMPACT (Melaky, Boeny, and Atsimo Andrefana).

• Conduct RDQAs in regions to be determined in Quarter 4.

• Integrate cCD data into the national MOPH DHIS2.

• Implement recommendations on the LMIS strategic plan based on the results from the LMIS evaluation

report.

Research

• Create and finalize study protocols for data collection tools: household survey to be created, and outlet

survey and key informant interviews to be adjusted as per the revised framework.

• Finalize tools related to the key informant interview for the archetype/segmentation study among youth

on FP use. The data collection is scheduled in September.

• Prepare data collection for the IPTp study once the study protocol is approved by USAID and when the

COVID-19 restrictions are lifted.


• Support IMPACT staff in collecting success stories remotely or organize field visits if travel to the regions

is authorized.

• Continue to provide content to be posted on PSI and USAID Madagascar Facebook pages for the upcoming

world events (World Sexual Health Day on September 4th, World Contraception Day on September 26th)

and COVID-19 activities in line with USAID guidance for more visibility on the interventions.

• Support the dissemination of IMPACT results (malaria market assessment study, LMIS assessment, and

End User Verification) to partners and all stakeholders involved (MOPH, private sector, technical and

financial partners).

Gender and Social Inclusion

In Quarter 4, IMPACT will focus on the following activities to promote gender and social inclusion across

project activities:

• Ensure participation of key GESI partners in TMI-TWG.

• Integrate GESI-informed messaging into upcoming FP campaign.

• Strengthen collaboration among IMPACT stakeholders to integrate GESI into TMA.

74

• Produce and distribute GESI-informed factsheets, flyers, and other knowledge management and

communication products.

• Provide IMPACT staff with capacity building tailored to project needs.

VII- Adaptive approach/methodology during COVID-19 context

Activity Approaches during COVID-19 context/restriction

cCD Since the SPD (Superviseur de Distribution) were not able to travel to collect logistic data they use phone calls to collect the information.

LMIS data collection among PARC and PA/supervision visits specifically for Atsinanana region

The SPD alternate the supervision visits for every two months: - One month the SPD use phone call to collect LMIS data with PARC and

PA - The second month, the SPD conduct supervision visits to collect LMIS

data within PARC and PA. SPD conduct check on the accuracy of the LMIS data collected through phone call: DHIS2 data versus manual stock management tools. If the data do not match then the SPD proceed to the modification, notify the database manager and document the modification that will be communicated to the Distribution Manager.

RDQA The RDQA among Pha-G-Dis and Pha-Ge-Com were conducted by the RLA (if it was conducted by the central team before COVID-19 context). The central team prepared a video to show and train the field teams on how to conduct RDQA.

Reporting rate among Pha-G-Dis With less supervision visits, IMPACT with the MOPH reinforced the use of helpdesk to monitor data submission using phone call

Meeting Virtual meetings instead of face-to-face meetings

Training Remote trainings

75

VIII- FINANCIAL SUMMARY

Table 29: Financial summary

Description Total Estimated

Amount Obligated Amount

Actual Expenditures

as of Mar 2020

Estimated Expenditures Apr-Jun 2020

Estimated remaining

Funds as of June 2020

Malaria

31 985 102

5 421 500 3 184 058 836 132 1 401 310

MCH 4 695 795 3 147 890 661 122 886 783

FP/RH 5 079 520 3 108 672 660 247 1 310 601

COVID-19 700 000 - 11 830 688 170

TOTAL $ 31 985 102 $ 15 896 815 $ 9 440 620 $ 2 169 331 $ 4 286 864

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ANNEXES

77

ANNEX A - Performance Monitoring

Plan (PMP)

Note:

- PMI Quarterly report is attached in an Excel File sent with this Annual Performance Report

- HPN Quarterly report is available on DHIS2 website https://data.mis-psimada.org/

https://data.mis-psimada.org/

78

USAID IRs and Sub-IRs

Reporting to

Indicator Measure of Unit

Year 2 % of achievement.

Observations/Deviation explanations Achievement Quarter 1



Target

Intermediate Outcomes/Outputs

Short-term Outcomes

SO2 (IR 2.9)

PPR USAID

Couple Year Protection (CYP) in USG supported programs

Number

Public sector 60 872 14 266 737 109 697

69%. The emergency distribution for public sector is completed. The remaining products will be distributed to the marketing social channel.

Private for nonprofit sector 163 430 195 465 174 359 679 148 79%

Commercial sector N/A N/A N/A 67 915 Data from pharmaceutical wholesalers is not yet available.

IR1: Enhanced coordination among public, non-profit, and commercial sectors for supply and distribution of health products

IR1.1. The total market for health products in Madagascar is understood and documented

IR1.1.9 PMP

IMPACT

GOM-led TMI TWG (Technical Working Group) meets at least four times a year as a forum for consultations and roundtables between public, non-profit, and commercial stakeholders

Number 0 1 0 4,0

25%. Low achievement because indoor meeting with more than 50 participants is not recommended due to the COVID-19 pandemic then meetings are cancelled.

IR2: Strengthened capacity of the GOM to sustainably provide quality health products to the Malagasy people

IR2.1. Health commodities and pharmaceuticals are continuously accessible and available in the public sector

IR2.1.1 (IR2.4.1 IR3.1.3)

PMP USAID

Average stockout rate at service delivery points (SDP) of tracer essential drugs (MCH, malaria)

Public sector Pha-G-Dis

Malaria

ACT New born

Percent

19 19 29 10,0 - In quarter 3, the stock of malaria commodities was insufficient at SALAMA central level. - The Comité GAS applied a rationing and shipped to districts with only stock to cover the maximum of 3 months, without any safety stock. Then the quantity to be distributed to CSB was not enough, that is why many Pha-G-Dis were stocked out after May. - Beginning of July, a stock of 1,784,475 treatments ACT (AS/AQ and AL) purchased by

ACT Infant 9 23 43 10,0

ACT Adolescents 11 14 17 10,0

ACT Adult 12 13 10 10,0

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Rapid Diagnostic Test (RDT)

7 11 5 10,0 PMI arrived and was delivered at SALAMA to allow resupply to Pha-G-Dis and correct this situation. A million of rapid tests was also delivered in the same period. Sulfadoxine-

pyrimethamine (SP) 11 7 4 10,0

Injectable Artesunate 11 15 21 10,0

MCH

Oxytocin (10 IU Injection)

20 15 33 21.2 - Stock out is calculated based on the tracer products for program, although districts have the same products under FANOME system. - Pha-G-Dis do not send procurement orders to SALAMA and DSFa for resupply. Due to availability of the products through FANOME and Vertical programs, there is still confusion at district level on the distribution circuit. - In Quarter 4, all the 78 districts will be supported to submit purchase order as requisitions to DSFa.

Magnesium Sulfate (500mg Inj)

64 70 73 45,0

Gentamicin (20mg inj) 70 86 91 45,0

Gentamicin (80mg inj) 68 82 83 39.6

Pha-Ge-Com

Malaria

ACT New born 24 11 8 10,0 - Stock out of ACTs is slightly higher than the target of 10% which is due to the insufficient stock at SALAMA and Pha-G-Dis levels. - Stock out rate at CSB level is less than the stock out rate at Pha-G-Dis level that was explained by the efforts of redeployment organized by the RLA, EMAR, EMAD and the GAS committees at district level to redistribute stock at peripheral levels. - In the next Quarter and with all deliveries of ACT and RDTs, the situation will evolve.

ACT Infant 14 14 12 10,0

ACT Adolescents 14 14 13 10,0

ACT Adult 14 13 14 10,0

Rapid Diagnostic Test (RDT)

8 10 8 10,0

Sulfadoxine-pyrimethamine (SP)

28 9 9 10,0

Injectable Artesunate N/A N/A N/A 10,0

MCH

Oxytocin (10 IU Injection)

30 23 26 26.05 - The CSB have FANOME products which is the

reason why they do not systematically submit procurement request to Pha-G-Dis

- This indicator is only calculated based on the stock of commodities distributed by DSFa and its partners (free of charge).

Magnesium Sulfate (500mg Inj)

43 44 47 33.3

Gentamincin (20mg inj)

50 65 73 38.8

80

Gentamicin (80mg inj) 57 69 76 40.5 - In Quarter 4, CSBs will be able to place their

Purchase Order with the Pha-G-Dis for tracer products.

Private for nonprofit sector

PARC MCH


Percent

22 0 1 5,0

Sur Eau Pilina (67mg tablet) (Community)

0 0 3 5,0


1 0 0 5,0

Pneumox (amoxycilline) (Community)

0 10 29 5,0

- Pneumox was out of stock at PSI central warehouses. - Product arrival was at end of May 2020 and distribution started in June which explained increase stock out rate in Quarter 3.

Pregnancy Test (Community)

0 0 2 5,0

PA MCH


21 0 0 5,0


0 0 0 5,0


0,3 0 0 5,0


0 2 13 5,0

- Pneumox was out of stock at PSI central warehouses. - Product arrival was at end of May 2020 and distribution started in June which explained increase stock out rate in Quarter 3.

Pregnancy Test (Community)

0 0 1 5,0

IR2.1.2 (HL7.1.3)

PPR USAID

Average stockout rate of contraceptive commodities at Service Delivery Points by family planning methods

Public sector Pha-G-

Dis

Implantable Hormonal Contraceptives

Percent

26 33 34 10.5 - During the Q3, SALAMA stock was sufficient to ship enough quantities to districts. - There is a problem of quantification at district level which explained stock out rate for Implant and IUD. Order did not respond to the exact

Injectable Hormonal Contraceptives (Depo provera)

16 20 18 36.0

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Injectable Hormonal Contraceptives (Sayana Press)

27 27 27 32.3 need at Pha-G-Dis level. - The RLA will continue to monitor closely the quantification exercise at district level. - IMPACT plan training on stock management in the next Quarter.

Intrauterine Devices 31 34 33 28.5

Oral Hormonal Contraceptive. Microgynon

11 19 19 14.3

Oral Hormonal Contraceptive. Microlut

21 28 23 28.5

Pha-Ge-Com

Implantable Hormonal Contraceptives

8 7 7 21.8

Stock status at CSB level is very good. The RLA will continue to work with EMAR, EMAD, and GAS Committees at districts to ensure that commodities are delivered from Pha-G-Dis to CSB.

Injectable Hormonal Contraceptives (Depo provera)

9 8 7 11.3

Injectable Hormonal Contraceptives (Sayana Press)

N/A N/A N/A 37.5

Intrauterine Devices 3 3 3 39.0

Oral Hormonal Contraceptive. Microgynon

11 9 10 13.5

Oral Hormonal Contraceptive. Microlut

6 5 5 24.8

Private for nonprofit sector PARC

Oral Contraceptive (Community)

Percent

0 0 0 5,0

Injectable (Community)

0 0 0 5,0

FP Condom Protector Plus (Community)

0 1 0 5,0

Sayana Press 3 22 18 5.0

- Product was out of stock at PSI warehouses at the end of Quarter 2 and the beginning of Quarter 3. - Products was received in May and distribution started in June

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PA

Oral Contraceptive (Community)

0 0 0 5.0

Injectable (Community)

0 0 0 5.0


0 0 0 5.0

Sayana Press 1 11 14 5,0

- Product was out of stock at PSI warehouses at the end of Quarter 2 and the beginning of Quarter 3. - Products was received in May and distribution started in June

IR2.1.16 PMP

IMPACT

Number/Percentage of required supply plans submitted to GHSC-PSM during the quarter.

Number

2 1 0 12,0 During Quarter 3, the UTGL planned quantification annual exercises which will be finalized in July 2020. The supply plans will be available and submitted with delays in August while waiting final validation by the CGL.

Malaria 1 1 0 4,0

FP/RH 1 N/A 0 4,0

MCH 0 N/A 0 4,0

IR2.2. The public-sector supply chain achieves financial sustainability

IR2.2.1 PMP

IMPACT Percent of product that is unusable due to expiry or damage

SALAMA Expiry

Percent 0 0 0 1,0 There is no expiry drugs at SALAMA Damaged

Pha-G-Dis Expiry

Percent 0,01 0,6 0,02 5,0 This indicator improved and met the target as the RLA made a lot of efforts to support the GAS committee districts to organize redistribution of overstocks identified through stock status analysis.

Damaged

Pha-Ge-Com Expiry

Percent 8 6 4 5,0 Damaged

IR3: Expanded engagement of the commercial health sector to serve new health product markets, according to health needs and consumer demand

IR3.1. Commercial actors are incentivized to expand into new health product markets

IR3.1.2 PMP

IMPACT

Number of loans (in general) disbursed to businesses (excluding service providers)

Number 14 8 11 50,0 66%. In Quarter 3, 3 loans under guarantee and 8 not covered.

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IR3.1.3 PMP

IMPACT Value of loans (in general) disbursed to businesses (excluding service providers)

USD 57 281 19 728 27 074 90 000

116%. Thanks to the banks' involvement in the A2F team's training sessions, the regional drugs shop has had closer contacts with the banks and willing to request substantial loans for the purchase of stocks and investments as well.

IR3.1.4 PMP

IMPACT Number of people trained in business and financial management

Number 27 27 0 80,0

68%. In Quarter 3, zero training, due to the COVID-19 context, that prevents travel between regions. Also, pending the decision of DPLMT on the availability of their team for the awareness sessions in conjunction with the training sessions.

IR4: Improved sustainability of social marketing to deliver affordable, accessible health products to the Malagasy people

IR4.1. Socially marketed products are continuously available at convenient and accessible locations

IR4.1.2 PMP

IMPACT Number of socially marketed products distributed

Number

FP

OC Community 484 152 748 871 647 659 1 724

880

109%. The annual target has already been exceeded by 9% due to an increase of regular users from Mahefa Miaraka since Quarter 2.

Injectable (Depo-Provera/TRICLOFEM) Community

513 453 567 313 450 623 1 473

355

103%. The annual target was exceeded. Some Sayana Press users used Triclofem during when there was stockout of Sayana Press.


557 904 445 488 332 928 1 633

794 82%.

FP Youth Condom Yes (Commercial)

N/A N/A N/A 671 689 Product not yet available

Sayana Press 6 601 0 63 008 474 355

15%. - Product was out of stock at PSI warehouses at the end of Quarter 2 and the beginning of Quarter 3. - Products was received in May and distribution started in June 2020

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MCH

ORS/Zinc DTK (Community) 21 008 28 838 21 230 58 906

120%. In Quarter 3 distribution of ORS decreased by 26% compared to Quarter 2 after the rainy season but the cumulative distribution remains high.

Sur Eau 150 ml Commercial N/A N/A N/A 90 491


703 300 289 200 206 820 3 620

780

33%. The distribution in Quarter 3 represented the remaining stock of Sûr’Eau Pilina. However, most of PSI’s warehouses ran out of stock from Quarter 2.


12 946 1 871 7 548 30 378

74%. Distribution increased in Quarter 3 after CHVs training led by Mahefa Miaraka respectively in Antalaha and Sambava health districts. The quantity distributed included starter lot for CHV.


48 182 18 352 28 878 219 635

43%. - Pneumox was out of stock at PSI central warehouses. - Product arrival was at end of May 2020, and distribution started from June.

Pregnancy Test (Community) 4 325 20 604 2 525 100 000

27%. The poor performance in Quarter 3 was clarified by the scale cancelled due to COVID-19 travel restrictions. Mostly distribution in Sofia and pre-positioning in Menabe region for the scale up of this product by Mahefa Miaraka. It is noted that the target defined in Year 2 includes some quantity for scaling up in other regions

IR5: Increased demand for and use of health products among the Malagasy people/Output/Activity

IR.5.4 PMP

IMPACT Number of mass media spots aired

Number

Health area MALARIA 0 2 640 5 699 10 000

83%. Broadcast of 1,682 radio spots on IPTp and 1,682 radio spots on case management from May 29th to June 30th in the 13 Intervention area of IMPACT. Support the cCD with 2,335 radio spots aired in the 12 districts from May 29th to June 30th, 2020.

85

FP 0 0 0 10 000

0%. No spots radio and spots TV produced and disseminated in Quarter 3. New TV and radio spots on FP were developed in Quarter 3 and will be broadcasted in Quarter 4. Protector Plus and Yes condoms are out of stock, so IMPACT did not boost the purchase of the products by the end users.

MCH 1 700 8 299 1 230 15 000 75%. Broadcast of 1,230 radio spots on Sur'Eau Pilina from April 1st to 13th

PMP COVID-19

Indicators on COVID-19 was submitted to USAID for approval and will be presented in the annual Year 2 report with achievement figures.

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ANNEX B – Year 2 Workplan Update

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Description of the Activity

Timeline YEAR 2 Status Comments

Quarter 1 Quarter 2 Quarter 3 Quarter 4

Oct

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Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

Intermediate Result 1 Enhanced coordination among public, non-profit, and commercial sectors for supply and distribution of health products

1.1 The total market for health products in Madagascar is understood and documented

IR1.1.1

Support the

implementation, monitor

and evaluate the

overarching TMA roadmap

for all health products

based on the discussions

and decisions taken during

the TMA Technical

Working Group (TWG)

meetings in Year 1

X X X X X X X X X X X X Ongoing

TMA roadmap submitted

to General Secretary and

DGMP of MOPH for

approval

IR1.1.2

Support the development

and implementation of the

malaria TMA roadmap and

monitor and evaluate its

progress to ensure the

availability of quality

malaria products at all

levels

X X X X X X X X X X X X Ongoing This activity will occur in Q4

after final validation of

Malaria market assessment

findings and report

IR1.1.3

Support the development

and the implementation of

the FP and MNCH TMA

roadmap to ensure the

availability of quality FP

and MNCH products at all

X X X X X X X X X X X X Postponed

in Year 3

Given the COVID-19,

research activities will be

delayed (data collection

mainly).

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Oct

19

Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

levels and monitor and

evaluate its execution

IR1.1.4

With the MOPH, build the

capacity of TMA

Champions to successfully

steward and lead the TMA

TWG and subcommittees

(including the study tour to

a country that has

successfully implemented

the TMA)

X X X X X

Partially

Postponed

in Year 3

Partially postponed in Year

3

Traveling outside the

country is currently

forbidden.

IR1.1.5

Through the IMPACT


platform and

dissemination meetings,

ensure that TMA results

from roadmap analyses,

studies and market

assessments are known to

all key stakeholders

X X X X Ongoing

Malaria market

assessment to be

presented and

disseminated in Q4

1.2 GOM leads TMI stakeholders to coordinate health product quantification and forecasting, procurement, and distribution according to market assessments and segmentation

IR1.2.1

Organize meetings to

revise and validate the

Terms of Reference (ToR)

of the UTGL to ensure its

X X X X Ongoing

Awaiting for new members

to be officially appointed

by the SG. After, IMPACT

will support the UTGL to

orient new members on

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Oct

19

Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

updated tasks and

responsibilities.

their Terms of reference

and assist in developing

work plan.

IR1.2.2

Organize quarterly

meetings (UTGL, CGL, and

GAS committee) to analyze

routine data on key

indicators in public

hospitals, such as stock-

out, LMIS issues, etc. for

learning and adapting the

use of DHIS2 in

collaboration with the

MERL team. X X X X

Continuous

activity

In May, IMPACT supported

UTGL to restart activities.

A meeting with UTGL

members was organized to

identify key activities to

implement in May - June

and July despite the

COVID-19 situation.

Among those activities,

IMPACT will support

quantification exercise of

malaria, and

review/update of ToR of

all actors (from central,

region, district, and CHV)

in supply chain

management. The new

ToR includes officialization

of Comités GAS and UTGL

at peripheral levels.

IR 2.1 Health commodities and pharmaceuticals are continuously accessible and available in the public sector

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Oct

19

Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

IR2.1.1

Provide capacity building

through trainings and

consistent coaching to

GOM and partner

members of UTGL on

forecasting and supply

planning, including the use

of Quantimed and Pipeline

(NMCP, DSFa, DPLMT,

SALAMA)

X X X X X X X Ongoing

The training has been

completed, but coaching is

a continuous activity

IR2.1.2

Assist the GOM and UTGL

members in leading the

annual system wide

forecasting exercises for

the public and private

sector for FP/RH, MNCH,

and malaria commodities

and support UTGL and

SALAMA to help mobilize

resources to procure

commodities in the supply

plans

X X X X X X Ongoing

IMPACT supported the

PNLP to prepare a

workshop on

quantification of malaria

commodities (scheduled

from June 2 to 5)

IR2.1.3

Coordinate orders ,

deliveries generation and

pipeline monitoring

according to agreed upon

supply plan with SALAMA,

X X X X X X X X X X X X Continuous

activity

100% of orders for malaria

commodities have been

generated. This year,

IMPACT is tracking orders

in pipeline and plan

reception at SALAMA. In

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Oct

19

Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

PSM, GOM institutions and

USAID

May, 822,000 treatments

of ACTs were received and

delivered to SALAMA (May

15).

IMPACT received also a

shipment alert notice and

prepared all documents

necessary for clearing for:

1 million of RDTs tests

(planned to arrive on June

17th ) and 788,475

treatments of ACTs (July

1). Furthermore, the order

of 1,500,000 tablets of SP

was re-activate to deliver

in December 2020 (put on

hold to avoid expiry).

IR2.1.4

Provide technical

assistance to support the

central level GAS

Committees to develop

quarterly distribution plans

for malaria, MNCH, and

FP/RH products based on

quarterly stock status

obtained from district/GAS

committees


activity

IMPACT supported the

Comité GAS malaria to

plan distribution in all the

114 districts for the

quarter of April to June. In

May, the malaria GAS

Comité started collecting

Rapport/Bons de

commande to plan

distribution for next

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Oct

19

Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

quarter (July to

September).

IR2.1.5

Conduct TOT and cascade

trainings for supply chain

management at all levels of

the supply chain, in

collaboration with the

UCP/Global Fund, ACCESS,

Mahefa Miaraka and other

partners

X X X X X X X Continuous

activity

In collaboration with

ACCESS, Mahefa Miraka,

DPLMT, DSSB, NMCP, SFP

and other directions of the

MoPH, completed

trainings of 117 staff of

CSB in Maroantsetra and

Mahanoro. In May, the

CRL identified 136 new

staff onboarded in regions

and districts to plan

training/refresher

trainings on stock

management and Channel

in the months of July and

August (in respect of

COVID-19 protective

measures).

IR2.1.6

Assist the MOPH in

creating a five-year LMIS

strengthening roadmap

and developing and testing

a new LMIS software using

results from the LMIS in-

depth evaluation


activity

LMIS assessment report

finalized. A workshop will

be organized in July to

disseminate findings of the

evaluation to lead

participants to develop a

LMIS five-years roadmap.

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Oct

19

Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

IR2.1.7

Generate evidence through

a national supply chain

assessment and End User

Verification surveys to

develop adequate

strategies, policies, and

SOPs for securing

commodities and

strengthening the public

supply chain

X X X X X X X X X

Ongoing

* EUV reports finalized and

will be disseminated in Q4

* The NSCA will be

postponed in Year 3: There

are a lot of in-country

advocacy meetings to

organize with in country

stakeholders and the

Ministry of Health to get

buy-in, mobilize STTA from

PSM (as Travels are

suspended) that are

postponed in Q4. Data

collection will likely

happen earlier Year 3

IR2.1.8

Conduct continuous

distribution of LLINs in 12

targeted districts.


Group 1 :

- LLIN Distribution and

trainings started in 06

districts

Group 2 :

Activities started in May.

Distribution to start in Q4

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Oct

19

Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

IR2.1.9

Provide technical and

financial support to the

NMCP to develop and

implement activities for

the preparation of 2021

LLIN campaign including

the procurement of LLIN

X X X X X X X X X Ongoing

Preparatory activities

started, including

budgeting. LLIN Mass

Campaign strategy review

scheduled in Q4

IR2.1.10

Procurement of

commodities and

expandable

equipment/commodities

x x x Ongoing

- Supported the MOPH by providing commodities for COVID-19 - Under the lead of MOPH, conducted quantification and forecasting exercises - Reception of 2,497 hand

washing devices where

625 already distributed:

400 distributed to

hospitals in the regions

IR2.1.11

Transportation of COVID-

19 expendable equipment

and supplies (following

cyclic shipment of malaria,

FP/RH, and MNCH

commodities)

x x x x x Ongoing Ongoing

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19

Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

IR2.1.11.1



and supplies from PSI

central warehouses to

District

x x x x x Ongoing

Transportation of 4,000

masks donated by DOD /

USAID:

-2,500 masks were transported to Toliary and donated to DRSP Atsimo Andrefana. -1,500 masks were

transported by IMPACT

from Antananarivo to the

Rano WASH and Diorano

office in Moramanga.

Rano WASH was in charge

of the transportation of

the masks to

Ambatondrazaka and the

donation to DRSP of

Alaotra Mangoro.

-Supported the transportation of expendable equipment and supplies from CCO Ivato warehouse to 5 USAID-supported regions namely Vakinakaratra, Haute Matsiatra, Atsinanana, SAVA, Atsimo Andrefana.

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Oct

19

Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

-Transported 1,872 hand

washing devices to 11 PSI

regional warehouses

IR2.1.11.2



and supplies from District

to Commune x x x x x Ongoing

Depending on the DRS and

district requests and the

needs

IR2.1.12

Providing technical and

financial support on

COVID-19 to the MOPH

depending on MOPH

central and DRS request

x x x x x Ongoing

- Active participation of IMPACT at various regular meetings with CCOR and TFPs -Donation sessions held in regions -Supported transportations depending on MOPH central and DRS request

- Disinfection of

warehouses, offices, and

vehicles was conducted

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Oct

19

Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

IR2.1.12.1

Ensure preventive measure

against COVID-19 among

DRS and IMPACT staffs x x x x x Ongoing Ongoing

IR2.1.12.2

Provide PPE (personal

preventive equipment) to

DRS and IMPACT staffs

against COVID-19 by

distributing expendables

and equipment

x x x x x Ongoing Ongoing

IR2.1.13

Train hygienists and health

workers at the regional

health facilities on waste

management x x x x x Ongoing

Training of 451 (274

female and 177 male) on

the use of PPE and on

effective and appropriate

waste management

IR 2.2 The public-sector supply chain achieves financial sustainability

IR2.2.1

Conduct a total cost

analysis of the public

supply chain and propose

an alternative and more

efficient supply chain

model by establishing at

least two scenarios with

the MOPH to improve

X X X X X X

Ongoing The TCA report with

scenarios might be delayed

depending on data

collection and analysis

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Oct

19

Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

SALAMA's financial

sustainability

IR2.2.2

Strengthen management

of FANOME at Pha-G-Dis

and Pha-Ge-Com levels to

increase transparency and

good governance.

X X X X X X Postponed

to Year 3

Activity postponed to year

3 (funds redirected to

COVID-19)

Intermediate Result 3 Expanded engagement of the commercial health sector to serve new health product markets, according to health needs and consumer demand

IR 3.1 Commercial actors are incentivized to expand into new health product markets

Review the scope of the

private sector

humanitarian platform to

engage businesses in

health product markets

IR3.1.1

Create partnerships with

PSHP and non-PSHP

members to collaborate in

generating innovative

solutions on

transportation, data

X X X X X X X X X X X Continuous

activity

In quarter 3 we recruited

new member to join the

PSHP, (Vitafoam)

Quarter 4 : MOU with EDM,

KRED,SOPHARMAD will be

signed

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Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

collection, and health-

focused CSR and CSV.

IR3.1.2

Organize quarterly

meetings to monitor and

assess the progress of

health commission action

plan.

X X X Ongoing

Virtual meeting was done

to monitor health

commission action plan

related to Universal Health

Coverage (UHC), finalizing

agreement about health

commodities

transportation with EDM

and a meeting with LMIS

subcommittee to develop a

tool for drug shop.

Q4: organize meeting to

continue the monitoring of

health commission action

plan

IR3.1.3

Conduct mapping exercise

to present IMPACT and

LMIS data submission

among representative

sample of pharmacies and

drug shops

X X X X X X X X X X X Ongoing

During this quarter 3, a

meeting with the LMIS

subcommittee was

organized to launch the

competitive tender for the

development of inventory

management software.

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Oct

19

Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

Q4: validating offer

(tender)

IR3.1.4

Ensure that the Health

Commission members of

the PSHP participate in the

TWG and follow up on the

roadmap as a way to

engage the commercial

sector to identify barriers

in the health sector and

provide solutions


activity

No TWG in Quarter 3 but

discussion with IMPACT

team how to motivate

private sector in the

upcoming TWG.

Q4: Ensuring that health

commission participate in

the TWG even virtual

meeting.

IR3.1.5a

Revitalize regional drug

shop associations in

preparation of the ADDO

pilot phase to be

conducted in Year 3

X X X X Ongoing Ongoing

IR3.1.5b

Develop curriculum for

training of peer trainers

with simplified materials

and tools, to be used in

piloting a sustainable

mechanism for business

strengthening program of

drug shops

X X X Postponed

in Year 3

Due to COVID-19, drug

shop trainings, where

potential peer trainers are

identified, will not be

completed until end of

Year 2, so ToT will be

delayed to Year 3 but the

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Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

curriculum will be ready by

Q4. Workplan revised.

Increase access to finance

for private health

commodities supply chain

stakeholders

IR3.1.6

Strengthening partner

banks and other financial

institutions' capacity to

better serve private health


X X X X X X X X X X X X Ongoing Ongoing

IR3.1.6 IR3.1.6.1

Revise capacity building

plans and training curricula

for DCA partner banks to

incorporate GESI issues

and, as needed, to take

into account newly

identified needs.

x Ongoing

Incorporating GESI issues

into training curriculum in

progress. Meeting with

banks depends on the

evolution of the current

situation. Delayed for Q4.

Work in progress with GESI

specialists

IR3.1.6 IR3.1.6.2 Train and support DCA

partner banks in credit

analysis and loan

structuring for health

commodities businesses.


57% Year target, DIANA

session in March re-

planned to next Quarter.

- 68 staff from the two

partner banks trained from

Atsinanana and Mahajanga

(February 2020) branches.

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Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

No realization during Q3

due to the COVID-19 travel

ban.

- List of drug shops trained

shared with partner banks

for prospection.

Target number might not

be reached due to travel

ban in regions

IR3.1.6 IR3.1.6.3

Develop and adapt loan

products and financial

tools for small and micro

health enterprises in

health commodities sector

(e.g., scoring, nano loans,

pharma loans, motorbike

loans). *** X X X X X X X X X X X X Ongoing

- Two products

“Pharmaloan”, COVID-19

product ready to be

launched. An MOU to be

signed between

ABM/SOPHARMAD/IMPAC

T.

- One loan product

“PA/PARC- Motorbike

Loan” also ready after a

final fine-tuning by ABM.

Catalogs from suppliers

sent to pre-selected PAs.

- Restructuration of loans

under DFC following the

recommendation of GOM

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Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

presented by the partner

banks.

IR3.1.6 IR3.1.6.4

Design and develop new

financial mechanism (e.g.

risk sharing facility),

following principles of

USAID's Blended Finance

Roadmap for Global

Health, possibly including

additional financial

institution partners, to

facilitate A2F within the

pharmaceutical supply

chains and other

stakeholders.


This activity will need

more time to explore the

different options, and the

current travel ban will

create delays.

Strengthen the business

management of

enterprises in health

products supply chain

IR3.1.7

Provide business

strengthening capacity

building to enterprises in

health commodities supply

chain and develop

partnership with private

X X X X X X X Ongoing

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Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

companies to sustain the

training.

IR3.1.7 IR3.1.7.1

Develop and adapt

business-strengthening

training curricula for drug

shops.

X Completed

100% Year Target

A living document to be

adapted to the drug shops

level of education. Training

materials translated in

Malagasy used for the

session in Mahajanga on

27-28 Feb. 2020. Update

based on comments from

the last session submitted

to HQ.

IR3.1.7 IR3.1.7.2 Provide initial business-

strengthening training to

drug shops.

X X X

X

(resch

edule

d on

Q4)

X

(resch

eduled

on Q4

Ongoing

72% Year target in number

and 40% in nb of region.

50% Quarter 2 target due

to the cancellation of the

DIANA session planned for

March

- 54 drug shops owners and

dispensers from the region

of Atsinanana and Boeny

(27 on Feb. 2020) trained.

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19

Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

Training combined with a

half day sensitization

session conducted by

DPLMT. Target number

might not be reached,

depending on the lift of

travel ban in region

-Meeting with DPLMT on

Feb. 20 hold to discuss the

planning of next

sensitization and training

sessions.

Due to the travel ban in

region target number

might not be reached

Last 5th session may be

postponed in Year 3

IR3.1.7 IR3.1.7.3

Provide one-to-one

coaching on business

strengthening to

enterprises/individuals

identified as potential peer

trainers in health


X X X X X Completed

100% of year target.

10 DM coached: 3 in

Atsinanana and 7 in Boeny.

Some of them are

identified as potential peer

trainers.

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Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

Starting using the new

coaching tool (form).

IR3.1.7 IR3.1.7.4

Identify potential

partnerships with private

training companies to

expand and sustain options

for business training to

enterprises in the health

commodities supply chain. X X X Ongoing

The formalization of the

partnership will be

rescheduled in Quarter 4

due to COVID-19.

Internal discussion to be

launched to elaborate a

proposition of

collaboration.

IR3.1.7 IR3.1.7.5

Explore digital inventory

management applications

for use by private health

commodities enterprises

and which would be

incorporated into future

business training.

X X X X Ongoing

90% Year target;

In collaboration with PSI

and Axian Foundation. 2

products identified:

Maisha Meds and Pharma

Plus. ToR finalized and

bidding process launched

with Axian.

IR 3.2 GOM facilitates the work of the commercial sector

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Nov

19

Dec

19 Jan 20

Feb

20

Mar

20 Apr 20

May

20 Jun 20 Jul 20

Aug

20

Sep

20

IR3.2.1

Facilitate high-level

advocacy meetings

involving the MOPH,

Ministry of Commerce,

customs services, Ministry

of Economy and Finance,

the National Board of

Physicians and the National

Board of Pharmacists to

develop policies and

regulations that will favor

importation and

commercialization of a

packet of vital Essential

medicines, including

contraceptives, anti-

malarial, and key MNCH

products.


activity

Rescheduled in Q4:

There are still advocacy

meetings to organize with

the Ministry of Health and

Ministry of Budget on tax

exemption on medical

devices as part of Essential

medicines.

IR3.2.2

Support DAMM and MOPH

to put in place strong

regulatory processes

related to the registration,

importation, and

distribution of medicines

based on reviews of the

Common Technical

Document, New Law on

Regulatory Body in Africa,


activity

90%- STTA has come in

Madagascar from Jan 26-

February 7 to support

DAMM on Common

Technical Document in

relation of Registration,

and on the domestication

of African Union Law on

Medicines. The Literature

review on pharmaceutical

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and experience from other

countries through study

tours.

regulations has been

validated during a

workshop held with the

Comité AMT/legal texts.

During this week, The STTA

report was shared with

USAID, DAMM and DPLMT

for feedback. As a next

steps: the report will

integrate comments from

USAID, DAMM and DPLMT

(if any) and be shared to SG

and other key partners 2) a

list of legal texts to

review/update will be

shared by the STTA in

relation of the Health Code

to the GTT/AMT for further

steps

IR3.2.3

Support DAMM in

streamlining the

registration and

importation procedures for

medicines based on the

latest WHO

recommendations.


activity

90%- the MOU between

Ministry of Health and

Partners around the H6+

group (Procurement

Quality Assurance) has

been amended by DAMM

and DPLMT and is ready to

be finalized and signed.

The memo was once again

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shared with all H6-Plus

partners for last review

before to proceed to

signature.

IR3.2.4

Support the MOPH and the

professional associations

to revitalize the inter-

ministerial committee to

fight counterfeit and illegal

medicines. A strategy will

be defined through a mid-

term evaluation of the

Stratégie de Lutte Contre le

Marché Illicite and the

Contrefaçon des

Medicaments et Intrants

de Santé and an action plan

will be developed.

X X X X X X Ongoing

Reinitiated contact with

DPLMT to explore activities

that can be implemented

for the rest of this Year.

Meetings may be delayed

due to COVID-19

Intermediate Result 4 Improved sustainability of social marketing to deliver affordable, accessible health products to the Malagasy people

IR 4.1 Socially marketed products are continuously available at convenient and accessible locations

IR4.1.1

Distribution of socially

marketed products across

10 regions for MNCH and

FP/RH products and

distribution of only FP/RH

products in three PARN


activity Continuous activity

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Regions through PARCs

and PAs.

IR4.1.2

Establish a motivation

system for PAs and PARCs

and follow up on their

quarterly performance to

address supply chain

inefficiencies in social

marketing in order to

prevent stockout.



IR4.1.3

Expand last-mile

distribution and

emergency distribution

through a pilot to deliver

health products using

drones.


To be completed by end of

Year 2

Pilot < 50 km

IR4.1.4

Transition the community

distribution model from

select PAs and PARCs to

the Pha-Ge-Com and Pha-

G-Dis in coordination with

DDS/DPLMT/DSFa/ACCESS

/Mahefa Miaraka.

X X X X X X Postponed

in Year 3

Prior the transfer of PA to

Pha-Ge-Com and PARC to

Pha-G-Dis, the Pha-G-Dis

and Pha-Ge-Com

performance needs to be

improved, which is an

activity rescheduled in

Quarter 4. Thus, the PA and

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PARC transfer to Pha-Ge-

Com and Pha-G-Dis will be

postponed to Year 3.

IR4.1.5

Select and introduce

socially marketed products

across 10 IMPACT regions

and 3 PARN regions

through the private sector

(pharmaceutical and

commercial channels)

pending the results of the

COGS analysis.

X X X X X X X X X Ongoing Ongoing

IR4.1.6

Define the needs for a

product monitoring system

and conduct a study of a

product tracking system.

Find technological

solutions which allow

IMPACT to earn and grow

brand loyalty while

protecting the brand from

supply chain fraud,

including counterfeiting

and theft.



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IR 4.2 Socially marketed products achieve cost recovery at an affordable price for consumers

IR4.2.1

Leverage TMA findings

from IR1 to analyze COGS

and continue to propose

options for the

optimization of financial

sustainability for the

current socially marketed

products portfolio and

explore brand extension of

Yes With You condoms and

introduce a new brand of

pharmaceutical products

depending the results of

the COGS analysis.



IR4.2.1 IR4.2.1.1

Continue to explore

optimization of financial

sustainability for the

current socially marketed

products portfolio and

explore brand extension of

Yes With You condoms


activity

65% completed

Yes With You positioning

known

AMM ongoing in

collaboration with PSM et

the provider

Next step: Choice of Yes to

be adopted

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IR4.2.1 IR4.2.1.2

Explore introduction of

new brand of

Pharmaceutical

products pending the

results of the COGS

analysis

X X X X X X X X X Continuous


Intermediate Result 5 Increased demand for and use of health products among the Malagasy people/Output/Activity

IR5.1.1

In collaboration with the

demand creation

subcommittee of the TMA

TWG, develop and

implement activities to

increase demand and use

of health products X X X X X X X X X X X

Continuous

activity

Due to COVID-19, staff

from the MOH (DPS,

DPLMT and AMM) were

not available in April and

May. The timeline of the

activities and the budget of

the communication plan

on the safe use of health

commodities and self-

medication will be finalized

through virtual meeting in

Quarter 4.

IR5.1.2


financial support to

contribute to the activities

of the MoPH X X X X X X X X X X X X

Continuous

activity

Support the NMCP through

SMS sending during World

Malaria Days.

Participation on the review

of communication

activities related to the

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malaria national strategic

policy, organized by NMCP

IR5.1.2.4


financial support to

contribute to the activities

of the MoH against COVID-

19 led by DPS on demand

creation

X X X X X

Ongoing every week

IR5.1.3

Conduct communication

campaigns for promoting

health products of the

three prioritized health

areas (Malaria, FP and

MNCH) through radio, TV

spots, job aids, and digital

communication

incorporating gender

messaging to promote and

use health commodities for

population and providers


activity

-Production of a new TV

spot on FP

-Broadcast radio spot on

Sur’Eau Pilina, IPTp, case

management and to

support cCD

IR5.1.3a

Increase demand creation

of health products, and

raise awareness of the

population on COVID-19 on

the field with

communication teams

X X X X X

IMPACT communication

teams using mobile sound

systems raise awareness of

the population on COVID-

19 on the field. In their

activities of promoting

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using mobile sound

systems

health products in the field

(CHX, Sur’Eau Pilina and

Protector plus), messages

to prevent Covid-19 are

incorporated.

IR5.1.3b

Produce and broadcast

Radio and TV spot on

COVID-19

X X X X X

The scripts for the

production of three (3) TV

spots were developed by

DPS.

IR5.1.3c

Produce and

distribute/disseminate Job

aids on COVID-19

X X X X X

Production and

dissemination of Flyers and

posters

IR5.1.4


financial support to the

Ministry of Youth and Sport

(MYS) to develop and

implement Youth activities

in collaboration with Telma

Foundation based on the

Human Centered Design

(HCD) study and support

training for youth on

health, leadership,

communication, etc.


activity

Integration of a module on

gender and social inclusion

in the training curriculum

for Youths leader

Preparation of a show for

youth on contraceptive

methods to be

broadcasted on Facebook

and played on radio

stations for rural areas

supported by IMPACT.

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IR5.1.5

Leverage new technology

to drive demand for

malaria, FP/RH and MNCH

health commodities. X X X X X X X X X X X X Continuous

activity

- Continue to support the

910- Call Center until the

transfer to ACCESS

- Broadcast SMS to

General Population and

to providers (PA, PARC,

Pha-G-Dis, CHVs)

IR5.1.5a

Support the 910-call center

in partnership with ACCESS

(including recruitment,

training and supervision of

the new hotliners)

X X X X X Ongoing

Strengthening of the 910-

call center with the

recruitment and training of

12 hotliners.

IR5.1.5b

Send SMS broadcast to the

targeted population (on

the 3 health areas including

COVID-19)

Ongoing

The ten messages on

COVID-19 for SMS

broadcast were created

with DPS.

IR5.1.6

Develop a strategy for

youth on the use of

vouchers for youth health

coverage and

implementation of a

voucher pilot.

X X X X X X

The development of the

strategy is ongoing and

adjusted with the findings

of segmentation and

journey mapping

researches.

Cross Cutting Gender

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CC1.1

Target women and human

rights associations to serve

as strategic partners of

IMPACT and to play an

active role in the Total

Market Approach.

X Ongoing

Continuing in Quarter 4:

IMPACT held several virtual

meetings with EFOI’s

General Secretary and

CNFM’s President this

quarter to strengthen

collaboration and facilitate

future planning.

CC1.2

Ensure the participation of

key GESI partners in TMI

TWG.

X Ongoing

Continuing in Q4:

GESI partners, CNFM and

EFOI, confirmed interest

and availability to actively

participate in TMI TWG and

relevant sub-committees.

In Quarter 4 and Year 3 this

engagement is planned to

extend to also include

engagement with PHSP

and its relevant sub-

committees. Partner

integration will champion

GESI efforts across key

health platforms and

contribute to

representation and

leadership opportunities

among women and youth.

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CC1.3

Produce and distribute

SBCC tools on GESI for

different target groups.

X Ongoing

IMPACT identified a

number of opportunities to

develop GESI-influenced

and project tailored SBCC

and other KM related

products and will

coordinate in Quarter 4

and into Year 3 to carry

them out.

CC1.4

Integrate GESI-informed

messaging into family

planning & MNCH

communication

campaigns.

X Ongoing

IMPACT produced GESI-

responsive health

messaging for malaria and

MNCH communication

campaigns. IMPACT also

established partnerships

with ACCESS and MAHEFA

MIARAKA projects and

began preparations for an

upcoming family planning

campaign in September.

CC1.5

Raise awareness of IMPACT

stakeholders on GESI

integration into a TMA

through meetings and an

annual workshop.

X Ongoing This activity is rescheduled

for Quarter 4 due to

COVID-19.

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CC1.6

Build the capacity of

IMPACT staff to serve as

GESI champions. ***

X X Ongoing

GESI-influenced training of

trainers (TOT) conducted

and validated with regional

health commodity

distribution supervisors.

Roll-out to community-

based distributors planned

for Quarter 4.

IMPACT orientation for

bank partners updated to

incorporate GESI

considerations.

Orientations with bank

partners to be carried out

in Quarter 4 and beyond.

Cross Cutting MERL

CC2.1

Strengthen LMIS/HMIS ( all

sectors: public, private,

non-profit, and

commercial) including:

formative supervision,

capacity building of data

senders, and supporting

implementation of the

LMIS roadmap with

consideration of DHIS2 as

X X X X X X X X X X Continuous


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the main LMIS electronic

tool.

CC2.2

Support the mapping

exercise to identify and

train pharmacies and drug

shops for LMIS data.

X X X X X Continuous


CC2.3

Support technically and

financially the DPLMT to

conduct Routine Data

Quality Assessment

(RDQA) at all levels and

sectors.

X X X X X X X X Continuous


CC2.4

Implementing monitoring

and evaluation system on

continuous distribution,

including: creating M&E

tools, training, data

collection and supervision,

RDQA (budget included in

the continuous distribution

activities)

X X X X X X X X X X Continuous


CC2.5

Conduct market

assessment studies for FP

and MNCH, including key

informant interviews,

X X X X Ongoing Ongoing

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outlet surveys, and routine

data in collaboration with

IR1.

CC2.6

Implement additional

studies, including:

archetype

study/segmentation,

journey mapping,

assessment of pharmacies

and drug shops on

products supply, KAP study

on IPTp use, and an

evaluation on the

introduction of the last

mile distribution strategy

(drones) at the community

level.

X X X X X X X X Ongoing Ongoing

CC2.7

Knowledge Management:

Support partners in

developing and collecting

success stories and

documenting IMPACT's

innovations in the field.



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ANNEX C - Environmental Mitigation

and Monitoring Report

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Table 1 : Summary Number of the Outlets Visited

Type of Outlet Number Visited Total Outlet Number of Field

Team Supervisors

Public Sector

SALAMA/central warehousing 0 6

13 RLA Pha-G-Dis 44 78

CSB/Pha-Ge-Com 103 1,734

Non-profit sector (social marketing)

Warehouse 5 14

27 DPS PARC 70 70

Supply Point 891 891

Public Sector:

General findings:

• 90% (40/44) of Pha-G-Dis and only 58% (60/103) of Pha-Ge-Com visited received a face-to-face training on

management of expired, obsolete and surplus commodities. But the RLA and Management teams of regions

(EMAR) and districts (EMAD) conducted the on-the-job training during the supervision visits

• During the supervision visit, RLA detected malaria commodities (ACT and RDT) expired and not yet destroyed at

Pha-G-Dis (5,022) and Pha-Ge-Com (6,024) visited.

• Only 14 out of 44 Pha-G-Dis (32%) and 13 out of 103 Pha-Ge-Com (12%) had guidelines and appropriate

communication tools on storage condition. Note that SALAMA has not been visited during Year 2 Quarter 3

Challenges identified included:

• 21% (22/103) of CSBs visited in Quarter 3 without non-medical equipment to prevent infection and

contamination.

• The providers of Pha-G-Dis and Pha-Ge-Com are not recognizing the importance of on-the-job trainings

• Lack of guidelines and job aids on good storage practices in Pha-G-Dis and PhaGeCom.

Recommendations:

• Organize indoor trainings in close collaboration with other partners once the situation of COVID619 will evolves

and allow indoor trainings.

• While printing laminated copies, the RLA will print hard-copies and disseminate guidelines on best

storages practices to Pha-G-Dis and PhaGeCom during the supervision visits.

• IMPACT, Unité de Coordination des Projets (UCP), ACCESS and Mahefa Miaraka will continue to capacitate Pha-

G-Dis and Pha-Ge-Com to analyze stocks status and monitor stocks to detected surplus and organize

redistribution as soon as possible to avoid expiries

• The expired products to be destroyed by the Pha-G-Dis as soon as possible

Social Marketing:

General findings:

- no expiration, surplus, or obsolete products were detected during the visits to warehouses, PA, and PARC.

- All PARC and PA visited had guidelines and communication tools in their storage rooms. - One warehouse was not trained on management of expired products and coordination and distribution of

quality health products.

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- All warehouses visited were equipped with guidelines and communication tools on stock management except for one.

Challenges identified included:

- Due to COVID-19 travel restrictions, the supervision of regional warehouses was performed by local teams

from the communications department using the supervision questionnaire.

- For central warehouses, the technical workshop including a training on the coordination and distribution of

quality health products and expiration management was cancelled due to COVID-19.

Recommendations:

• Perform remote training during Quarter 4 to ensure appropriate training of warehouse teams on management

of expired products and coordination and management of quality health products.

• On-the-job training to reinforce the PA and PARC training done during the SPD supervision visits

• Continue to include the management of surplus products at PARC and PA in the scope of the SPD during the

supervision visits to avoid waste.

• IMPACT will continue to print updated tools that will highlight instructions and guidelines on storage conditions.

The updated version of the tools will be available for SPD for distribution during monthly supervisions for PARC

and PA.

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ACTIVITY MITIGATION MEASURES SUMMARY FIELD MONITORING/ISSUES/RESOLUTION OUTSTANDING ISSUES, PROPOSED

RESOLUTION

1. Capacity building through technical workshops and training to enhance coordination and distribution of quality health products.

1. Technical assistance, trainings, workshops, and tools developed must include appropriate management practices for facilities of health commodities and integrate sound procedures to manage and properly dispose of health care waste (including expired health products).

1.1.2. Provide supervision of CSB providers by using a Rapid Monitoring Tool to assess infrastructure and equipment for handwashing, infection prevention (decontamination and containers for infectious waste), waste cans, safety boxes, etc.

Infrastructure and non-medical equipment for infection prevention: - handwashing device with a bucket to catch - soap for washing hand - tissue for cleaning - chlorinated water

Issues: 21% (22/103) of CSBs visited in Quarter 3 without non-medical equipment to prevent infection and contamination. Resolution: During the COVID-19, the consumption of the non-medical equipment has increased which led to stock out. The CSB is organizing purchase of those non-medical equipment.

Outstanding Issues:

• Lack of rigorous monitoring of stock levels to resupply on time

Recommendations:

• the CSB should kept a safety stock of the non-medical equipment to avoid stock out

• the CSB agreed to monitor closely consumption and detect possible shortage and proceed to procurement as soon as possible

1.1.3. Provide CSB providers with: garbage cans & gloves for ordinary waste; sharps containers and gloves; handwashing device with a bucket to catch handwashing water

Medical equipment for infection prevention: - Safety box - Sharps containers - Gloves - Garbage disposal

Issues: 4/103 CSB (3%) are not equipped with medical equipment for infection prevention. Resolution: The CSB will send a requisition for the medical equipment to Pha-G-Dis.

Outstanding Issues: The CSB does not always give proper attention to the purchase of medical equipment for infection prevention to ensure resupply on time. Recommendations:

• IMPACT will assist the Pha-G-Dis to maintain stocks levels sufficient to distribute to CSB

• IMPACT will capacitate Pha-G-Dis to analyze reports of CSB and detect issues on time. As CSB have budget to purchase the equipment, there should be no stock outs

• IMPACT will alert ACCESS to support CSB in estimating correctly quantities to procure and avoid shortage/stock outs

1a (Activity type 1: 1) Use of host country developed 2b) None

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Support to healthcare facilities and systems [1.2] ) Support or provide technical assistance to develop processes, SOPs, and standards for aspects of healthcare such as waste management, disinfection, and service delivery

processes, SOPs and standards will be promoted; however, these processes must be assessed to evaluate whether they adequately address potential health and safety and environmental impacts of the operation of healthcare services and generated wastes. 2) If no SOPs exist or gaps are identified, develop and implement SOPs in accordance with best management practices. 3) When adequate waste management procedures (WMP) are not available, develop and implement a WMP that addresses management of waste streams associated with healthcare services. See USAID’s Integrated Waste Management Plan for additional guidance.

The training used the training curriculum of the Ministry, including waste management from the NATIONAL CONTINGENCY PLAN FOR THE PREPARATION AND RESPONSE TO ACUTE RESPIRATORY DISEASE EPIDEMIC CAUSED BY THE NEW CORONAVIRUS 2019-nCov. Practices are carried out during the trainings with visual inspection by the trainers, formative follow-up supervision were carried out by the EMAD / EMAR to verify that waste management are implemented

1b (Activity type 1: Support to healthcare facilities and systems [1.3]). Support to healthcare facilities and systems: training, technical assistance, and capacity building of health care workers, waste workers, staff, community health care workers, and volunteers in areas of PPE use, waste management, procurement, storage, and disposal of commodities, and disinfection

1) Training/curricula/ supervision that creates waste as part of the training will address appropriate best management practices concerning the proper management of healthcare waste, sample handling and disposal, and PPE use. PPE must be provided to trainers, if dictated by the type of training. 2) Trainers will be equipped with PPE, as dictated by the type of training. 3) Training on waste management, storage of commodities, disinfection, and PPE use must be in

No results to report for the below indicators. However, all upcoming technical assistance, trainings, and capacity building will consider the mitigation measures. 1) Review training, curricula, and/or supervision activities to ensure they address appropriate best management practices (Quarterly review). 2) PPE provided and used by trainers (Quarterly review). 3a) Review training procedures and logs to verify training was conducted (Quarterly review). 3b) Conduct visual inspections to document that workers are trained and following the proper waste and PPE procedures. Include dates of visits, findings, and any non-compliance issues (At least once during six months of implementation).

None

https://docs.google.com/document/d/1E0uUAiKjHX2TpDx3VzileMf0vvKyqwX9/edit#bookmark=id.111kx3o

https://www.usaid.gov/documents/1865/integrated-waste-management-plan-iwmp

https://www.usaid.gov/documents/1865/integrated-waste-management-plan-iwmp

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accordance with the USAID guidance and best standard of practice promoted by local authorities at the time of the training. PPE for healthcare and waste workers depends on the setting, personnel, and type of activity. See WHO’s Rational Use of PPE for COVID-19.

2. Social Marketing, Education, & Social Behavior Change Communication (SBCC).

2. “Programs involving nutrition, health care, or population and family planning services” These activities promote the use of commodities such as condoms, drugs, and insecticide-treated nets. Improper disposal of these items by end-users (the targets of the marketing messages)

2.1.1 Include messages on proper storage, use and disposal of commodities in the communication campaigns using various channels such as mass-media. Messages will be tested with a diverse audience (differences in sex, age, literacy level, and socio-economic status). Details of the activities will be included in the communication plan.

SMS were sent to PA, PARC, CHVs, and Pha-G-Dis to sensitize them on stock management and the precautions to be taken on the storage of the health products and cleaning of storage cupboards. Two messages were sent as follows: -“To ensure the quality of medicines, avoid sunlight, wet areas, and moisture during the transportation and their in storage”. - “Clean frequently stock rooms and storage boxes to prevent pest attacks. Store food separately from health commodities”.

Outstanding Issues: Proper disposal during storage and transportation are still challenges. Recommendations: IMPACT continues working with HPD to produce various promotional materials (job aids, posters, etc.) to sensitize on proper disposal during storage and transportation. IMPACT does not have a waste management process cycle available yet. It’s on going. It will be available during Quarter 4.

2a (Activity type 1: Communication, outreach, planning - [1.1]). Social behavior change: communications, outreach, planning

1) Stay informed about ways to prevent COVID-19 transmission over the course of the activities, including where appropriate, training staff and beneficiaries on social distancing, PPE use, and disinfection. Guidance can be found from local authorities or at the following websites: ● CDC’s Coronavirus Disease Site ● WHO Getting your Workplace

Ready for COVID-19 ● UNICEF, WHO, IRCF Key Messages

and Actions for COVID-19 Prevention and Control in Schools

1) Updates made to activities and training procedures to include COVID-19 best practices as appropriate (On a monthly basis). Teams on the field are regularly sensitized on the methods to prevent COVID-19 and on the systematic use of PPE, SHA gel during the activities and respect of social distancing

➔ Commodities (mask and SHA gel) have been made available

➔ Development of Job aid on COVID-19 is also ongoing Issue: no non-compliance noted 2) Increase in use of remote training and meetings (On a monthly basis).

2) Outstanding issue: MOPH Internet access Resolution: The partners support the MOPH to provide credit for Internet access

https://apps.who.int/iris/bitstream/handle/10665/331498/WHO-2019-nCoV-IPCPPE_use-2020.2-eng.pdf

https://apps.who.int/iris/bitstream/handle/10665/331498/WHO-2019-nCoV-IPCPPE_use-2020.2-eng.pdf

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html

https://www.who.int/docs/default-source/coronaviruse/getting-workplace-ready-for-covid-19.pdf?sfvrsn=359a81e7_6

https://www.who.int/docs/default-source/coronaviruse/getting-workplace-ready-for-covid-19.pdf?sfvrsn=359a81e7_6

https://www.who.int/docs/default-source/coronaviruse/key-messages-and-actions-for-covid-19-prevention-and-control-in-schools-march-2020.pdf?sfvrsn=baf81d52_4



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2) Where appropriate and available, remote training and other non-face to face communications will be utilized when possible until the risk of infection passes. 3) Local COVID-19 regulations on the size of gatherings and travel advisories will be followed.

IMPACT applied teleworking then all meeting is through virtual conference. The communication commission held its weekly coordination meeting through virtual conference. Issues: bad quality of Internet connection and unavailability of Internet access for MOPH team. 3) Local regulations on the size of gatherings and travel advisories incorporated into activities (On a monthly basis). For sensitization activities, communication team avoided gathering people. They deliver messages through mobile sound system across the city (using vehicle to respect regulation on distancing). Issue: none

3. Storage, management, distribution, transportation & disposal of public health commodities & equipment.

3. Storage, Management, Distribution & Disposal of Public Health Commodities & Equipment

3.1.1. Include in training curriculum how to properly manage expired (properly logged), obsolete or surplus commodities for PSI central warehouse, PARC, PA and public sector (SALAMA/central warehousing, Pha-G-Dis, Pha-Ge-Com and CSB). A disposal plan will be created and will be available for the trainees following the national guidelines. Curriculum will be adapted to different literacy or education levels to ensure effective understanding

Nonprofit sector

Number of PSI central warehouse, PARC, PA trained on expired, obsolete, and surplus commodities:

Type Male Female Total

Warehouse 5 2 7

PA 390 501 891

PARC 27 43 70

- 4 warehouses had more than two people trained

- - All employees at PSI central warehouse, PARC, and PA visited were trained on management of expired, obsolete, or surplus commodities except for one warehouse

- Issues: One warehouse not trained as the last training was cancelled. Resolution: Organize remote workshop and training to ensure training is effective for warehouse workers.

Outstanding Issues: One warehouse among the five visited did not receive appropriate training on management of expired, obsolete, and surplus commodities. A technical workshop planned in February was cancelled due to COVID-19. Recommendations: During Quarter 4, organize a remote workshop and training on stock management to ensure the training is effective for warehouse workers.

Public sector

Number of public sector staff trained:


Outstanding Issues: The providers of Pha-G-Dis and Pha-Ge-Com are not recognizing the importance of on-the-job trainings.

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SALAMA 0 0 0

Pha-G-Dis 15 25 40

CSB/Pha-Ge-Com

14 46 60

- - - 90% (40/44) of Pha-G-Dis and 58% (60/103) of Pha-Ge-Com

visited received a face-to-face training on the management of expired, obsolete, and surplus commodities. The RLA and management teams from the regions (EMAR) and districts (EMAD) conducted on-the-job trainings during the supervision visits. Issues: Trainings are key to reinforce the capacity of providers in stock management. Resolution: RLA, EMAR, and EMAD will continue to do on-the-job trainings and organize indoor trainings in coming months once the COVID-19 situation evolves. The training curriculum was validated in March 2020

Recommendations:

• Use the quarterly district/regional coordination meetings as an opportunity to train/refresh staff on stock management.

• Organize indoor trainings in close collaboration with other partners once the situation of COVID-19 improves to allow indoor trainings.

3.1.2. Regularly check expiry date of commodities during monthly visit of PSI central warehouse, PARC, PA and public sector (SALAMA/central warehousing, Pha-G-Dis, Pha-Ge-Com and CSB). “If there are expired products in the warehouse, the supervisor will take appropriate action to rectify the practice"

Nonprofit sector

Number of expired, obsolete, and surplus products at PSI central warehouse, PARC, and PA:

Product Expiry Surplus Obsolete

Warehouse 0 0 0

PA 0 0 0

PARC 0 0 0

- - No expired, surplus, or obsolete product were detected during the visits to the warehouse, PA, and PARC Issues: none Resolution: none

Outstanding Issues: None Recommendations: Continue to sensitize warehouses, PA, and PARCs on the proper management of expiration dates during remote meetings.

Public sector

Number of expired, obsolete, and surplus products at the public sector:

Outstanding Issues: Analysis and close monitoring of stock levels is key to detect risks of expired

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Product Expired Surplus Obsolete

SALAMA 0 0 0

Pha-G-Dis 5,022 0 0

Pha-Ge-Com 6,024 125 0

- During the supervision visit, the RLA detected malaria

commodities (ACT and RDT) expired and were not yet destroyed at the Pha-G-Dis and Pha-Ge-Com visited and that were quarantined.

Issues: Keeping expired medicines in stock can be a risk for distribution. Resolution: Sensitize the Pha-Ge-Com to send the expired medicines to the Pha-G-Dis. The Pha-G-Dis will destroy all expired products as soon as possible.

products in order to redistribute quantities to avoid waste. Recommendations:

• IMPACT, UCP), ACCESS, and Mahefa Miaraka will continue to capacitate Pha-G-Dis and Pha-Ge-Com to analyze stocks status and monitor stocks to detect surplus and organize redistributions as soon as possible to avoid expiration.

• The distribution of malaria commodities is being monitored at the central, regional, and district levels through the GAS committees established.

• The expired products will be destroyed by the Pha-G-Dis as soon as possible.

3.1.3. Provide guidelines and appropriate communication tools on storage conditions for each product by following standard guidelines for Proper Storage and distribution of Health Commodities for PSI central warehouse, PARC, PA and public sector (SALAMA/central warehousing, Pha-G-Dis , Pha-Ge-Com and CSB)

Nonprofit Sector

Number of PSI central warehouse, PARC, and PA that have guidelines and communication tools:

Warehouse 4

PARC 70

PA 891

- All warehouses visited were equipped with guidelines and

communication tools except for one. - All PARC and PA visited had guidelines and communication

tools in their storage rooms. Issues: Storage rooms were equipped for PA, PARC, and warehouses except for one warehouse. Resolution: Identify warehouses that do not have appropriate guideline and provide updated tools.

Outstanding Issues: One warehouse did not have appropriate communication tools Recommendations: Continue checking the existence of communication tools in Quarter 4

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Public Sector

Number of public sectors that have guidelines and communication tools:

SALAMA -

Pha-G-Dis 14

CSB/Pha-Ge-Com 13

- - - Only 14 out of 44 Pha-G-Dis (32%) and 13 out of 103 Pha-Ge-

Com (12%) had guidelines and appropriate communication tools on storage conditions. Note that SALAMA has not been visited during Quarter 3. Issues: Lack of guidelines and job aids on good storage practices at Pha-G-Dis and PhaGeCom. Resolution: Print and disseminate laminated copies of good storage practices in all Pha-G-Dis and Pha-Ge-Com

Outstanding Issues: Absence of hard copies of posters on guidelines for proper storage and stock management is still an issue at Pha-G-Dis and Pha-Ge-Com. Recommendations:

• While printing laminated copies, the RLA will print hard-copies and disseminate guidelines to Pha-G-Dis and Pha-Ge-Com during the supervision visits.

3a (Activity type 3: Procurement and training [3.1]). Procurement or logistics support (distribution and transport) for healthcare commodities, diagnostic kits, PPE, and equipment for response to emerging threats

1) Procure health commodities that comply with host country and international regulatory, shipping, and packaging requirements to ensure that only appropriate products enter the supply system. This includes products that are manufactured at facilities that meet good manufacturing practice (GMP) certification requirements, as recommended by the WHO or are pre-qualified by WHO. 2) Develop and implement an inspection and quality assurance process for assessing and monitoring product quality. Considerations include, but are not limited to:

1a) Review product specifications (verification prior procurement) to ensure they meet host country and international regulatory, shipping, and packaging requirements. Results: For commodities, a list from the Malagasy Drug Agency is used to identify all certified wholesalers. For medical equipment, Certifications and norm compliance of products are requested from supplier Issues: none 1b) Maintain copies of procurement records (e.g., manufacturing records, Certificate of Analysis, test data, regulatory certificates, etc.) (Quarterly verification). Results: Procurement process are ongoing and information on this section will be provided when the delivery is done Issues: none 2) Verify that the quality assurance process was developed and implemented (At least once during six months of implementation). Results: For commodities, a list established by the Malagasy

None

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● Selecting reliable and vetted suppliers:

● Using existing quality assurance mechanisms established by WHO

● Establishing a system to report poor quality, expired, or defective products; and

● Performing regular pre- and post-shipment testing.

3) Develop and implement SOPs for the safe distribution of health commodities being transported in bulk in motorized vehicles. 4) Develop and implement SOPs for the safe transport of samples and supplies being transported in bulk in motorized vehicles.

Drug Agency is used to identify all certified wholesalers, for medical equipment. Certifications and norm compliance of products are required from supplier. International procurement of commodities that follow the quality assurance process for Madagascar under COVID-19 procurement. Expired products are monitored and removed from stock. Disposal of special waste including pharmaceuticals is planned twice a year (at least one to be happened between June and October 2020). Incineration process is in accordance with the National Medical Waste Management Policy issued in 2014. Disposal plan was already put in place during quantification process in May: IMPACT worked closely with MOPH and IMPACT consortium partners to quantify the needs of health commodities (infection prevention products) in order to prevent having or managing expired products. IMPACT will work closely with MOPH to develop a health commodities disposal plan based on real needs per region and districts (good quantification and monitor expiration date of the products). 3) and 4) Verify that SOPs were reviewed to ensure they are appropriate (Quarterly review). Development of SOP for the safe distribution of health commodities being transported in bulk in motorized vehicles is in process. The following standards were applied during the transportations of PPE (donation from Chinese Government), transportation of health commodities (infection prevention products) from central to regions, and to districts:

- Ensure good storage before transportation - Ship the bulk in a well-sealed cardboard box or in a

well closed container and to be careful with fragile products

- Protect boxes of products from direct sunlight and rain.

- Avoid mixing transport of health commodities with animals as well as food with strong odors such as dried fish.

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- In the car: open the windows to ensure good air circulation.

During rainy season or transport by boat, dhow or canoe, wrap the boxes with plastic to protect the boxes of products.

3b (Activity type 3: Procurement and training [3.2]). Training, capacity building, technical assistance of health workers responding to COVID-19

Activities will be conducted following guidelines and must comply with local, national, USAID, or its own organizational environmental policies.

No results to report for the below indicators. However, all upcoming technical assistance, trainings, and capacity building will consider the mitigation measures. Trainings and capacity building (site visits) will be done every month (starting from July), then IMPACT will report on this indicator on a monthly basis.

5. Climate Risk Management

5.1. Proper storage and transportation of commodities and LLIN

5.1.1.2. Organizing capacity building through technical workshops and training to enhance coordination and distribution of quality health products: among PSI central warehouse, PARC, PA and public sector (SALAMA/central warehousing, Pha-G-Dis , Pha-Ge-Com and CSB), and those responsible for sending commodities and LLINs.

Nonprofit

Number staff from PSI central warehouse, PARC, and PA:


Warehouse 4 1 5

PA 27 43 70

PARC 390 501 891

* Some of warehouses had more than two people trained - All employees at PSI’s central warehouse, PARC, and PA visited were trained on coordination and distribution of quality health products except for two warehouses. Issues: Two Warehouses did not receive training on coordination and distribution of quality health products. Resolution: Remote training will be organized in Quarter 4 to ensure warehouses receive appropriate information on the coordination and distribution of quality products.

Outstanding Issues: Technical workshop including training on coordination and distribution of quality products and expiration management was cancelled due to COVID-19. Recommendations: During Quarter 4, organize a remote workshop and training to ensure the training is effective for warehouse workers.

Public Sector

Number of staff from the public sector trained:


SALAMA 0 0 0

Pha-G-Dis 12 23 35

CSB/Pha-Ge-Com 11 41 52

-

Outstanding Issues: None. Recommendations:

• Pha-G-Dis and Pha-Ge-Com/CSB staff meet on a quarterly basis to discuss stock management.

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- - 79 % of Pha-G-Dis and 50 % Pha-Ge-Com providers participated in the workshop to enhance coordination and distribution of health products of good quality.

- Issues: Coordination committees are set up to enhance coordination of stock management. Resolution: Ensure Pha-G-Dis and Pha-Ge-Com are informed on time to participate in the district coordination meetings.

• Established 76 GAS committees (out of 78) that are meeting every quarter to analyze stock levels at Pha-G-Dis and plan distribution of commodities to all Pha-Ge-Com.

Climate Risk Management (COVID-19 activities)

Type of activity Climate risk Risk

rating How Risks are Addressed at Project

Level

Opportunities to Strengthen Climate Resilience

5.2. Activity Type 1 — Communication, outreach, planning.

Cyclones, floods and droughts are the main climate risks. Travel for training, capacity building, or other activities is interrupted due to extreme weather events (cyclones, floods, spread of disease). Resources or government attention and response are shifted away from COVID-19 related-activities due to direct impacts of extreme weather events (cyclones, floods, droughts). Infrastructure used for training, IT, research, etc. damaged by extreme weather events (evapotranspiration, floods, landslides, cyclones, dust/sands infiltration, lack of water and spread of disease).

Low - In Madagascar, dry season runs from May to October that fit to the period of implementation of the COVID-19 activities. Activities will be done during dry season with low risk affected by climate.

- During dry season, road infrastructure is adequate for travel enabling implementation of activities.

- The resurgence of COVID-19 affects communication between regions where COVID-19 is intense vs in regions still free COVID-19 (fear of contamination). We suspend some activities such as research (face-to-face interview used for household survey etc.),

- Training follows SOP on COVID-19 prevention.

N/A

5.3. Activity Type 1 — Support to healthcare facilities and systems

In some cases, gradual changes in climate, or extreme weather events, will impact where diseases occur, impacting where surveillance should occur.

Moderate - Training conducted during dry season. - Trainings organized under COVID-19

(waste management training) follows SOP on COVID-19 prevention instruction

- IMPACT will follow with the CCO whether the spread of COVID-19 in Atsinanana region is affected by weather and climate change (humid and cold). This will help to well prepare

135

Type of activity Climate risk Risk

rating How Risks are Addressed at Project

Level

Opportunities to Strengthen Climate Resilience

Climate risks: cyclones, floods, evapotranspiration, droughts and spread of disease

for other regions.

Supply chain distribution interrupted due to extreme climate or weather events (floods, cyclones, landslides, evapotranspiration, increased temperature, sand/dust infiltration, spread of disease). Extreme climate and weather events leading to more demand for services. If construction is planned, then potential damage to construction due to climate shocks or disruption in program implementation due to pauses in work related to spread of disease.

Moderate - Since Atsinanana is the most affected region of COVID-19 support from central level was focused more in this region (with increase quantity distributed on infection prevention products).

- Consider trend of COVID-19 new positive cases in the most affected regions in order to properly quantify needs and the procurement.

5.4. Activity Type 3 — Procurement, training

Both long term climate change and climate shocks lead to direct or indirect impacts that increase populations vulnerability. For example, heat waves may decrease the immune systems in some locations and populations. Or, rainfall patterns and increased temperatures could increase occurrence of the spread of diseases. Supply chain distribution interrupted due to extreme climate or weather events. Extreme climate and weather events leading to more demand for services.

Low - Since Atsinanana is the most affected region of COVID-19 support from central level was focused more in this region (with increase quantity distributed on infection prevention products).

- IMPACT approved and authorized local procurement of health commodities (infection prevention products) for Atsinanana region to speed-up response to the MOPH request.

- Consider trend of COVID-19 new positive cases in the most affected regions, in order to properly quantify needs and the procurement.

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Photos illustrating COVID-19 preventive measures during trainings

Use of protective masks during training, Ambilobe Handwashing device at the entrance of training venue, Ambanja

Participants distancing during Community-based Continuous Distribution (cCd) Training of Trainers in Mahanoro

137

ANNEX D - SUCCESS STORIES

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Commune of Sakoana: Supply Point (PA), Health Facility Head and Community

Health Volunteers work together to protect newborns from umbilical cord

infections

The rural commune of Sakoana is located 10 kilometers from Manakara, in the Vatovavy Fitovinany region.

On average, the number of births in the

health facility (CSB) of Sakoana is 20 per

month, according to data provided by the

head of the Sakoana CSB, Fidèle

RANDRIAMAMONJY. In rural communes of

Madagascar like Sakoana, hygiene and

infection control can be an issue. If

untreated, these infections, especially

those related to the umbilical cord, can

cause newborn death.

To encourage the use of Arofoitra

chlorhexidine (CHX), the supply point (PA),

CHVs, and the head of the CSB are working

together to protect newborns from

umbilical cord infections. To do this,

Sakoana's PA ensures that the product is

always available. CHVs identify pregnant

women in the commune and sensitize them

on the importance of using this effective antiseptic to prevent infections in newborns and the need to have

a tube of Arofoitra available before delivery. The CSB head, during the four prenatal consultations stresses

the importance of the use of Arofoitra and requires the availability of this product at the time of delivery.

Among the CHVs, Marline BAO’s work in the Fokontany (village) of Ranomena is remarkable and the CSB

head has particularly recognized her contribution to increasing the number of pregnant women coming to

the maternity ward of the CSB in Sakoana. “Arofoitra is a very effective antiseptic against neonatal

umbilical cord infection. It significantly reduces the risk of infections. The use of CHX Arofoitra has become

systematic after childbirth and we appreciate the PA's work to ensure the permanent availability of this

product," said the head of the CSB.

In March 2020, the consumption of Arofoitra from the PA of the Sakoana commune was at six tubes, but

as a result of the close collaboration between the CSB and the CHVs, there has been an increase in

consumption since April. The average monthly consumption during the last three months (April - June

2020) has increased by 20 tubes.

The IMPACT project, through its distribution team, ensures the continuous availability of life-saving health

products for maternal, newborn, and child health in the Vatovavy Fitovinany region.

From left to right : The Chief of CSB of Sakoana (RANDRIAMAMONJY Fidèle), CHV (BAO Marline) and the PA

(RANAIVO Paul)

139

Menabe region: Redistributing medicines from private to public health facilities to

treat children with malaria

Using a Total Market Approach, the IMPACT project works to improve access to health commodities for the

Malagasy population. For example, the IMPACT Regional Logistics Advisors are working to strengthen the

capacities of health actors in both the public and

private sector to effectively manage health

commodities within their regions and districts by

assisting them in identifying problems and finding

solutions that fit their local context.

The supply chain in the public sector starts at the

Pha-G-Dis District Pharmacy and health facilities

(CSB) order medicines based on what stock is

running low. Once they place their order, the

commodities are moved from the pharmacy to the

health centers. In the Befasy district, Menabe

region, the malaria commodities currently in stock

at the public health facilities are not meeting the

population’s needs.

In June, during a supervision visit conducted by

the IMPACT Logistics Regional Advisor and the Ministry of Public Health regional staff at the Wanda

Blenska Catholic Private Dispensary in Befasy, the team identified a surplus of antimalarial medicines that

are set to expire in October 2020. The IMPACT Regional Logistics Advisor asked the Pharmacy Manager to

redistribute the antimalarial medicines to the public sector where there was high demand that was not

being met. Despite the private pharmacy buying these commodities with their own funds in 2018, they

agreed to donate them for free to the public sector.

As a result of this re-distribution, 54 doses of infant antimalarial products were redeployed between private and public health centers in Befasy. With these medicines available at the community level, 54 children infected with malaria will be able to receive antimalarial medicine free of charge.

A young girl with her little brother going to consult a community health volunteer to test for Malaria in the

commune of Lohena Befasy

140

Menabe region: Targeted, coordinated, and efficient supervision: Health

stakeholders join efforts to fight malaria.

In the Menabe region, the malaria peak season occurs from June to August with a spike in malaria cases

during this period. During the coordination meeting led by the regional Ministry of Health and technical

partners, including the IMPACT project, a joint

malaria response visit to the health facility of

Lohena, whose malaria cases increased a lot three

weeks prior, was planned. This mission was

organized with the regional management team and

it was decided that the IMPACT project would

support the transportation of Antimalarial supplies

from the district pharmacy (Pha-G-Dis) to the

health facility (CSB) which is at 120 km away and to

make a targeted advanced strategy in the

fokontany (Village) of Lohena whose malaria cases

were experiencing an upsurge.

In order to ensure the effectiveness of this mission,

the USAID-funded project Mahefa Miaraka who

implements community health activities was also solicited. During the response mission, the tasks were

well coordinated. Two MOPH district management teams and the health facility head tested patients with

rapid diagnostic tests (RDT), MOPH district management teams filled in the consultation register, the

Technical Assistant for Mahefa Miaraka and the Medical Inspector sensitized people on the importance of

using mosquito nets, and the IMPACT Regional Logistics Advisor (RLA) supported the dispensing of

medicine to people who had a positive RDT.

As a result of this joint initiative, 540 RDTs were performed, 432 of which were positive (80% positivity

rate). All positive cases received the necessary treatment. This initiative reduced malaria cases during the

following weeks. Therefore, the commodities that the IMPACT project transported have been used directly

and have saved lives. This mission was also an opportunity to further strengthen the coordination of

actions between the USAID-funded health projects and the MOPH that they support.

Malaria testing in a Fokontany of Lohena

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The use of HelpDesk improves data reporting rate from district pharmacies to the

DPLMT

To strengthen the Logistic Management Information System (LMIS) reporting rates from district

pharmacies (Pha-G-Dis) to DPLMT (central office based in Antananarivo), the DPLMT, supported by the

IMPACT project through the national LMIS committee (DEPSI, DSFa, EMAR, EMAD), has set up a HelpDesk

in January 2020, which will play the role of a call center to remind the Pha-G-Dis providers to submit LMIS

data.

The HelpDesk is composed of two people who work at PSI’s office where they have unlimited and high-

speed Internet connection available. To identify Pha-G-Dis that did not submit LMIS data, the HelpDesk

team checks the reporting rates using a dashboard presented in the IMPACT Intranet. Then, all Pha-G-Dis

which did not send LMIS

data are called and

reminded to submit data for

the relevant period. When

Pha-G-Dis providers

encounter any challenges

preventing data submission,

they can call the HelpDesk

hotline free of charge and

the HelpDesk will try to

solve the problem. If the

problem is not addressed, a

request management

system is set up and the

issue is transmitted to the

CHANNEL focal point at the

DPLMT, the IMPACT

Monitoring and Evaluation team, and to the Regional Logistics Advisers (RLA) involved. These staff will also

try to resolve the issue remotely and will organize field visits if necessary.

The use of the HelpDesk has proven to be successful. Before the implementation of HelpDesk, the average

data reporting rate was at 32%, in Year 1. After the implementation of this system and as a result of joint

efforts of the MOPH and IMPACT (donation of laptops, internet connection, and field supportive

supervisions), the average reporting rate increased to 78% during the same time period in Year 2 (October

2019- May 2020). The average data completion rate of 46% in Year 1 also increased to 76% in Year 2.

the

Call-Center Functioning

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Atsimo Andrefana region: Engagement of a primary school teacher

helps to continue Community Continuous Distribution activities during

the COVID-19 Pandemic

Jean Nomé LAHINIRIKO is a 31-year-old

teacher at the primary school of

Ambohimahavelona, Toliara II district, in

the region of Atsimo Andrefana. Jean

Nomé is a member of the Kom’Lay, which

is the Long-Lasting Insecticide-treated

Nets (LLIN) distribution coordination

committee of the Fokontany. Jean Nomé

is considered a model citizen in his

community and is very engaged and

dedicated in his role of Kom’Lay.

In March 2020, a national health

emergency was declared throughout

Madagascar due to the COVID-19 pandemic. Subsequently, schools were closed and all malaria prevention

activities at schools were also suspended.

Despite this difficult period, Jean Nomé still took the initiative to check in with households to ensure that

his students were protected against malaria. During his visits, he was happy to see that five of his students

and their families who did not previously sleep under a LLIN (identified using fuchsia bracelets) are now

sleeping under a LLIN. As a reward, Jean Nomé gave them each green bracelets.

Despite the closure of schools, Jean Nomé was able to ensure the continuity of his activities. Thanks to his

dedication and dynamism the LLIN community continuous distribution (cCD) activities with students

continued. “Even in this time of pandemic, I would like to ensure that targets are reached by the end of

the cCD campaign and ensure that malaria will not claim any lives in the Fokontany,’’ he said.

The Fokontany of Ambohimahavelona is among the 296 Fokontany of the district of Toliara II where the

USAID/PMI-funded IMPACT project conducted the cCD campaign.

LAHINIRIKO Jean Nomé at the right with his student wearing the green bracelet and her family

143

Toliara II: Using locally made handwashing devices to prevent COVID-

19 spread during the continuous LLIN distribution campaign

Like all regions of Madagascar, the Atsimo Andrefana region is working to prevent the spread of

COVID-19 and the local population is working to follow

the prevention guidance. The Fokontany of Ambalaboy

is among the 296 Fokontany of the district of Toliara II

which benefited from the Long-Lasting Insecticide-

treated Nets (LLINs) continuous community distribution

(cCD) and COVID-19 did not stop the community from

completing the planned distribution activities.

Jean Baptiste RANDRIAMANANTENA is a 58-year-old

father of six living in the Fokontany of Ambalaboy. He is

the president of an association named VOAMAMY.

During the LLIN cCD in the Fokontany, Jean Baptiste

offered handwashing devices to cCD beneficiaries and

coordination teams to reinforce the prevention of

COVID-19 through his association.

During the distribution, the beneficiaries passed one-

by-one to wash their hands with soap using the

handwashing device in a yellow container before taking

their nets. “We offered these devices to ensure that the

LLIN distribution can continue safely, as combatting

malaria is also one of our priorities even during this

difficult pandemic period,” Jean Baptiste said. The

devices were passed on to the president of the Fokontany

and used by the cCD coordination team (Kom’Lay).

The cCD activities in the Fokontany were able to continue

thanks to the support from Jean Baptiste and the

VOAMAMY association.

RANDRIAMANANTENA Jean Baptiste and Kom’Lay members with handwashing device

Handwashing device handed over to Kom’Lay

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Maintaining the private sector’s commitment to providing health

commodities during the COVID-19 Pandemic

Following the outbreak of COVID-19 infections in Madagascar in early 2020, the government

imposed a nationwide lockdown restricting travel and limiting business activities within the

country. Despite these constraints, the IMPACT team was committed to finding ways to support

its private sector partners in continuing to provide vital health commodities to their

communities during the crisis.

Phone survey and coaching

In order to determine how the COVID-19 pandemic is affecting the suppliers of private health

commodities in rural areas, IMPACT conducted phone interviews to survey 71 drug shops in the

Atsinanana, Boeny, and Analanjirofo regions. The major issues identified were:

• Stock outs of malaria products, flu medicines, and Vitamin C, and restrictions on order quantities due

to insufficient wholesaler inventory;

• Need for financing to purchase inventory;

• Requests for protective equipment from IMPACT.

Following the survey, IMPACT gave the partner banks a list of 61 drug shops needing financing. In

Quarter 3, five drug shops received loans thanks to IMPACT’s intervention, and the banks are continuing

to contact drug shops on the list. In addition, as a contribution to the COVID-19 response for the private

sector, IMPACT decided to provide masks, hand sanitizer, and bleach to 143 drug shops and 53

pharmacies in five regions.

To continue helping drug shops improve their management challenges even when it was not possible to

meet with them face to face, the A2F team adapted its coaching method from in-person to over-the-

phone sessions, successfully coaching 16 drug shops in

Quarter 3.

Creation of drug shop association

IMPACT’s continued mentorship of drug shops during

the lockdown allowed the project to support the

creation of a regional drug shop association,

l’Association de Depôts de Médicaments (ADEMERA),

in the Atsianana region in April. Another association is

in the process of being created in Boeny. These

professional associations will help coordinate drug

shop activities and improve operational practices as

part of IMPACT’s business training and regulatory

awareness-raising activities and should facilitate the

development of an ADDO system in the future.

Supporting partner banks during COVID-19. The pandemic and the subsequent lockdowns have created significant economic hardship around the world, with banks in many countries cutting off credit to companies which have lost revenue. For pharmacies and drug shops, access to financing is especially important to ensure that they can continue to supply their communities with essential pharmaceuticals and medical supplies during the pandemic. The USAID guarantees, accompanied by technical assistance through the IMPACT program, have been crucial in allowing partner banks AccèsBanque Madagascar

During IMPACT business training in Mahajanga in February 2020, drug shop owners in Boeny discussed

the possibility of creating their regional association

145

(ABM) and Baobab Banque to continue to lend to health commodity enterprises during the pandemic. In a time when the financial sector has been cutting credit to many sectors, the partner banks have been able to continue disbursing loans to the private health sector Despite complications related to COVID-19, IMPACT supported partner banks in increasing the amount of loans disbursed between April and June, with 11 loans disbursed in Quarter 3, an increase of 37% increase from the previous period, and in strengthening the banks’ relationships with drug shops (eight out of the 11 loans disbursed). Additionally, thanks to the coverage of the DFC guarantee, ABM was able to provide offer three health commodity enterprises restructured loan terms that were even longer than the six months recommended by the Government of Madagascar. Finally, IMPACT helped banks develop a new loan product (ACCES SALAMA) to support the health sector in purchasing equipment and supplies to respond to COVID-19.

146

Innovation in the time of COVID: How remote capacity building will help

advance equitable health commodity supply chain distribution in the

social marketing sector

Social marketing seeks to address major gaps in access to health commodities. As part of IMPACT’s Total

Market Approach (TMA), social marketing, along with public and commercial sector collaboration,

contributes to efforts to attain Universal Health Coverage (UHC) for all Malagasy people. Specifically, social

marketing promotes a community distribution model for health commodities including malaria, family

planning, and maternal, newborn, and child health products, reaching communities who otherwise may

not receive them. Through the model, Regional Distribution Supervisors (SRDs) distribute products to

volunteer district level agents who in turn distribute to community members and consumers, particularly

low and middle-income families. Across the 13 regions where IMPACT operates, six SRDs, 31 Distribution

Point Supervisors (SPDs), 67 district-level volunteers (PARCs), and 887 community-level volunteers (PAs)

work together to deliver affordable, accessible health products to the Malagasy population. Their efforts

supplement similar distribution schemes in the public sector.

Health commodities distribution, particularly on a volunteer basis, is not without its challenges. A rapid

analysis (with SRDs, SPDs, PARCs, and PAs) of influential factors impacting distribution success in May 2020

revealed that at the district and community levels, PARCs and PAs, and especially women PARCs and PAs,

face challenges in decision-making around using household financial resources to purchase health

commodities. Recognizing an opportunity to address barriers and improve the experience and

performance of distributors, IMPACT’s gender and social inclusion (GESI) and social marketing distribution

teams collaborated to integrate GESI concepts into the existing capacity building curriculum for health

commodities distribution agents. The training of trainers (TOT) is offered to supervisors (SRDs and SPDs)

who will in turn share the learning with PARCs and PAs to carry out in their respective areas.

Due to the ongoing COVID-19 pandemic

threat, the teams recognized that travel

and in-person gatherings were limited,

which prompted the development and

implementation of an innovative remote-

based training series. After the initial

curriculum development in French,

IMPACT’s gender lead facilitated the first

round of training with a small group of six

SRDs and three SPDs who validated the

content, provided feedback, and offered

suggestions for revisions, including

incorporating real distribution case

scenarios from the different regions. In

addition, as the trainers for the upcoming sessions with PARCs and PAs, the SRD and SPD group played an

active role in translating the materials to Malagasy, to ensure that the content would be well understood

by all participants. Additional virtual sessions were conducted to allow each new trainer the opportunity

to teach back the content and check their understanding in both languages. The training methodology

included sensitization activities on themes related to gender and social inclusion, content and information

sharing, small group online discussions, and practical activities. The series focused on addressing

Regional distribution supervisors practice delivering training to PAs and PARCs through virtual simulation.

147

challenges related to gender and social inclusion, improving inequities in the community, work, and home

spaces, and promoting women’s empowerment.

As of June 30, 2020, two sessions have been conducted with SRDs and select SPDs as part of this innovative

co-designed iterative approach and an additional three sessions are planned in the first month of Quarter

4. The sessions have not only strengthened the understanding of gender and social inclusion-related

concepts among social marketing distribution team leaders, but through their participatory involvement

has also influenced their willingness and ability to apply learning across job functions. SRDs and SPDs now

better grasp the importance of understanding who their customers are and what products they buy,

ordering health products to meet client needs, selling health commodities to all members of the

community without stigma or discrimination, and recognizing the impact of gender roles, responsibilities,

attitudes, and practices at the household and community level that influence consumer access to and

utilization of products and distribution efforts. In the coming months, the SRD and SPD training team will

share their learning with other SPDs before cascading the training out to all 954 PARCs and PAs. The

integration of a GESI lens to health commodities distribution promotes a more inclusive and equitable

process within the health supply chain, ensuring all segments of the Malagasy population benefit from

health products and services that meet their needs.

148

ANNEX E – STOCK INVENTORY AS OF

JUNE 2020

149

Table 2: SALAMA Physical inventory report of Malaria commodities, End of June 2020

Product specifications unit Batches Expiry date Quantity per batch-

pacx Total quantity


tablet 9E55 1-avr.-22 1,248,750 1,248,750


treatment 19E003 1-août-22 29,800 29,800


treatment 19E005 1-oct.-22 362,575 362,575


treatment 19E018 1-oct.-22 91,450 91,450


treatment 19E012 1-oct.-22 32,800 32,800


treatment KR398 1-août-21 3,180 3,180


treatment ID93293 1-déc.-22 42,690 42,690


treatment ID93294 1-déc.-22 22,080 22,080


test MR19E66 1-oct.-21 100


test 101344 to

101354 31-janv.-22 1,000,000 1,000,100


vial ZA1190725 1-juil.-22 7,770 7,770

Table 3: SALAMA Physical inventory report of MNCH commodities, End of June 2020

Product specifications unit Batches Expiry date Quantity per batch

Total quantity per product

GENTAMICINE 10MG/ML INJ - AMP 2ML - (20MG) - BTE/100 -

ampoule 8EB01206 1-mai-21 52,200

ampoule 8EB02272 1-juin-21 32,000 84,200

GENTAMICINE 40MG/ML INJ - AMP 2ML - (80MG) BTE/100 -

ampoule QD2180201 1-févr.-21 14,900

ampoule QD6171111 1-nov.-20 21,000 35,900

MAGNESIUM SULFATE 50% INJ.AMP.10ML - BTE/10

ampoule 0094649 1-févr.-21 15,720

ampoule 2218MG-A/4 1-mai-21 10,980 26,700

OXYTOCINE 10UI/ML INJ. AMP. 1ML - B/10

ampoule 80274 1-mai-21 123,860

ampoule 80462 1-juin-21 751,800

ampoule 80463 1-juin-21 334,400 1,210,060

150

ANNEX F – STOCK STATUS BY END OF

JUNE 2020

151

Table 4: Dashboard- stock status of malaria commodities: End of June 2020

Commodity Unit

Stock on Hand at SALAMA

as per June 30th

2020

AMC (July-August - September 2020) as per quantificati

on

Moths of

Stock

Shipment expected

Estimated Date of Delivery

Donor

Artesunate/Amodiaquine 25/67.5 mg Tablet, 25 x 3 Blister

Treatment

34 230 10 279 3,3

5 250 1/07/2020 PMI

98 650 30/07/2020 GF

187 500 01/12/2020 GF

Artesunate/Amodiaquine 50/135 mg Tablet, 25 x 3 Blister

Treatment

362 845 59 630 6,1

50 650 25/06/2020 PMI

386 000 1/07/2020 PMI

150 000 30/08/2020 GF

717 450 01/12/2020 GF


Treatment

156 240 33 406 4,7

21 225 Date 25/06/20202 PMI

91 600 1/07/2020 PMI

527 525 01/12/2020 GF


Treatment

41 645 34 805 1,2

106 125 Date 25/06/2020 PMI

301 625 Date

1/07/2020 PMI

495 475 01/12/2020 GF


Vial 7 770 24 814 0,3

142 000 31/07/2020 GF

333 300 30/09/2020 GF

Malaria Rapid Diagnostic Test (RDT), 25 Tests

Kit 1 172 925 334 721 3,5

1 426 312 31/08/2020 GF

1 426 313 31/10/2020 GF

1 290 325 12/10/2020 PMI

3 459 325 31/12/2020 GF

Sulfadoxine/Pyrimethamine 500/25 mg Tablet

Tablet 1 700 400 335 498 5,1 1 500

000 29/12/2020 PMI

Quinine 300mg tablet

Tablet 203 500 9 085 22,4 189 000 07/07/2020 GF

126 000 01/12/2020 GF

Artesunate suppository

Suppository

2 848 2 860 1,0 12 720 31/07/2020 GF

84 500 30/09/2020 GF

Primaquine tablet

Tablet 0 2 282 0 125

000 07/07/2020 GF

152

Table 5: Dashboard- stock status of MNCH commodities: End of June 2020

Product stock at

SALAMA- June 2020

Second PULL

distribution in July 2020

Stock remaining

at SALAMA

SALAMA stock and orders in pipeline

Comments

GENTAMICINE 10MG/ML INJ - AMP 2ML - (20MG) - Box/100 -

84,200 76,100 8,100 -

The stock to be shipped to districts in August. There is no stock neither order in pipeline to be delivered at SALAMA in 2020

GENTAMICINE 40MG/ML INJ - AMP 2ML - (80MG) Box/100 -

35,900 35,900 0 3,239,900

The stock to be shipped to districts in August. There is huge stock and order in pipeline to be delivered at SALAMA in June 2020

MAGNESIUM SULFATE 50% INJ.AMP.10ML - Box/10

26,700 10,040 16,660 -

The stock to be shipped to the 114 districts and hospitals. There is no stock neither order in pipeline to be delivered at SALAMA in 2020

OXYTOCINE 10UI/ML INJ. AMP. 1ML - Box/10

1,210,060 90,000 1,120,060 831,400

The overstock is to donate to SALAMA and explore transfer to Malawi or Zambia (PSM) . There is huge stock and order in pipeline to be delivered at SALAMA in 2020

153

ANNEX G - Descriptions of the seven

quality dimensions for the RDQA

154

Data Quality Parameter Descriptions

1- Availability

The extent to which data and its supporting documentation are available. Review availability of the indicator source documents for the selected reporting period. Source documents depends on the indicator but will often refer to client intake forms, registers, cards redeemed vouchers, etc. Specify the name of the documents reviewed.

2-Completeness

Complete means that the document contained all the required entries of the indicator as appropriate. Review completeness of the indicator source documents for the selected reporting period.

3-Accuracy The degree to which the data correctly reflects what they were intended to measure. It is also known as validity. Accurate data correctly measure actual events, cases, units, etc.

4-Timeliness

The extent to which data is up to date (current) and is made available on time. Review the timeliness of documents received from the site for the selected reporting period. Reports can either be summary reports or reports of aggregated data that is submitted to the next reporting level e.g. regional or district level.

5-Integrity The extent to which data is protected from unauthorized changes or manipulation. Review the source document for any indication of unauthorized (accidental or deliberate) insertion, modification or destruction of data.

6-Confidentiality The extent to which information or data is protected and kept secure.

7-Precision The extent to which data is collected with the level of detail required to measure the indicator e.g. disaggregation by commodity type, etc.

155

ANNEX H - COACHING TEMPLATE FOR

DRUG SHOPS

156

IMPACT Madagascar : Fiche de Coaching pour les dépôts de médicaments

Nom de l’établissement Dépôt de médicaments ………………………………….

Adresse (Ville/Commune/Région)

Nom de la personne coachée

Titre/poste de la personne coachée Genre

Numéro de portable

Adresse électronique

Temps passé en coaching …heures Date ../../2020

Nom du Coach IMPACT

VOLETS D'ASSISTANCE TECHNIQUE

1. Législation et pharmacologie

Situation lors de la formation Changement

constaté

Contraintes évoquées

face à la réalisation

de l'amélioration

Conseils

suggérés

Régularisation de l'autorisation

Conformité de la gestion par rapport à la législation

(gérance par un tier ou non)

Respect des distances minima par rapport aux autres

établissements de santé

Rangement et classification des médicaments

Gestion des médicaments périmés

Approvisionnement

Visa des commandes au niveau Médecin Inspecteur

2. Gestion de stock


constaté

Contraintes face à la

réalisation de

l'amélioration

Conseils

suggérés

Utilisation effective de fiches ou livre de stock

Inventaire périodique

Gestion des commandes et des ruptures de stock

3. Tenue des livres


constaté

Contraintes face à la

réalisation de

l'amélioration

Conseils suggérés

Utilisation du journal des opérations

Utilisation d'un carnet des débiteurs

Analyse de la rentabilité

4. Autres volets abordés

5. Date prévue pour l'effectivité des améliorations à mettre en œuvre lors du coaching

6. Suivi d'un besoin en financement éventuel

7. Date du prochain coaching

157

ANNEXE I- Redeployment of malaria

commodities

158

Redeployment of malaria commodities - Pha-G-Dis level

Region Pha-G-Dis supplier

Product specifications

Quantity (treatment/kit/tablet/ampoule)

Pha-G-Dis beneficiary

Unit price $

Total value $

BOENY MITSINJO Artesunate/Amodiaquine 50/135 mg Tablet, 25 x 3 Blister Pack Tablets

150 SOALALA 0.37 55.5


1,600 SOALALA 0.55 880


150 SOALALA 0.96 144


50 MAHAJANGA I 0.55 27.5


250 MAHAJANGA II 0.55 137.5


850 AMBATOBOENY 0.55 467.5


350 MAROVOAY 0.55 192.5

BOENY MAHAJANGA I Artesunate/Amodiaquine 100/270 mg Tablet, 25 x 3 Blister Pack Tablets

95 MAHAJANGA II 0.55 52.25

DIANA ANTSIRANANA II Artesunate/Amodiaquine 100/270 mg Tablet, 25 x 6 Blister Pack Tablets

25 NOSY-BE 0.96 24

DIANA ANTSIRANANA II Malaria Rapid Diagnostic Test (RDT) HRP2/pLDH (Pf/PAN) Cassette, 25 Tests

25 NOSY-BE 0.24 6

DIANA AMBILOBE Malaria Rapid Diagnostic Test (RDT) HRP2/pLDH (Pf/PAN) Cassette, 25 Tests

100 NOSY-BE 0.24 24

MELAKY MAINTIRANO Artesunate/Amodiaquine 100/270 mg Tablet, 25 x 3 Blister Pack Tablets

300 BESALAMPY 0.55 165

MELAKY MAINTIRANO Artesunate/Amodiaquine 100/270 mg Tablet, 25 x 6 Blister Pack Tablets

300 BESALAMPY 0.96 288

VAKINANKARATRA

ANTANIFOTSY Artesunate/Amodiaquine 100/270 mg Tablet, 25 x 6 Blister Pack Tablets

50 ANTSIRABE 2 0.96 48

VAKINANKARATRA

MANDOTO Artesunate/Amodiaquine 100/270 mg Tablet, 25 x 6 Blister Pack Tablets

250 BETAFO 0.96 240

VAKINANKARATRA

MANDOTO Artesunate/Amodiaquine 100/270 mg Tablet, 25 x 3 Blister Pack Tablets

250 BETAFO 0.55 137.5

VAKINANKARATRA

MANDOTO Malaria Rapid Diagnostic Test (RDT) HRP2/pLDH (Pf/PAN) Cassette, 25 Tests

2,000 BETAFO 0.25 500

ATSIMO ANDREFANA

MOROMBE Malaria Rapid Diagnostic Test (RDT) HRP2/pLDH (Pf/PAN) Cassette, 25 Tests

3,500 TOLIARA I 0.24 840

ATSIMO ANDREFANA

MOROMBE Malaria Rapid Diagnostic Test (RDT) HRP2/pLDH (Pf/PAN) Cassette, 25 Tests

2,500 SAKARAHA 0.24 600

V7V IFANADIANA Artesunate (w/ 1 Amp NaHCO3 5% + 1 Amp NaCl 0.9%) 60 mg Vial, 1 Set

200 Nosy Varika 1.6 320

V7V MANAKARA Artesunate (w/ 1 Amp NaHCO3 5% + 1 Amp NaCl 0.9%) 60 mg Vial, 1 Set

100 MANAJARY 1.6 160

Sofia Mampikony Artesunate/Amodiaquine 100/270 mg Tablet, 25 x 3 Blister Pack Tablets

200 Port bergé 0.55 110

159


1,200 Port bergé 0.96

1,152


1,842 Mandritsara 0.96

1,768.32


921 Analalava 0.96 884.16

DIANA ANTSIRANANA II Sulfadoxine/Pyrimethamine 500/25 mg Tablet, 150 Tablets

150 Pha-G-Dis Diego I 0.13 19.5

DIANA ANTSIRANANA II Sulfadoxine/Pyrimethamine 500/25 mg Tablet, 150 Tablets

1,900 Pha-G-Dis Nosy-Be 0,13 247

DIANA AMBILOBE Sulfadoxine/Pyrimethamine 500/25 mg Tablet, 150 Tablets

6,000 Pha-G-Dis Ambanja 0,13 780

DIANA AMBILOBE Sulfadoxine/Pyrimethamine 500/25 mg Tablet, 150 Tablets

1,000 Pha-G-Dis Nosy-Be 0,13 130

MENABE Morondava Artesunate/Amodiaquine 25/67.5 mg Tablet, 25 x 3 Blister Pack Tablets

34 Miandrivazo 0,28 9,52

MENABE Manja Artesunate (w/ 1 Amp NaHCO3 5% + 1 Amp NaCl 0.9%) 60 mg Vial, 1 Set

1 000 Miandrivazo 1,6

1,600

BOENY Mitsinjo Artesunate/Amodiaquine 50/135 mg Tablet, 25 x 3 Blister Pack Tablets

150 Mahajanga II 0,37 55,5

BOENY Soalala Malaria Rapid Diagnostic Test (RDT) HRP2/pLDH (Pf/PAN) Cassette, 25 Tests

100 CSBU Soalala 0,24 24


100 CSBU Soalala 0,24 24


100 CHRD2 Soalala 0,24 24


100 CSB1 Antanandava 0,24 24

BOENY Soalala Artesunate/Amodiaquine 100/270 mg Tablet, 25 x 3 Blister Pack Tablets

25 Mitsinjo 0,55 13,75

Total value 12,175

160

Redeployment of malaria commodities - CSB level

District CSB supplier Product specifications

Quantity (treatment/kit/

tablet/ ampoule)

Pha-G-Dis/CSB

beneficiary

Unit price $

Total value $

DIANA/ ANTSIRANANA II

Ramena Artesunate (w/ 1 Amp NaHCO3 5% + 1 Amp NaCl 0.9%) 60 mg Vial, 1 Set

4 Pha-G-Dis Diego II

1.6 6.4

DIANA/ ANTSIRANANA II

Ramena Malaria Rapid Diagnostic Test (RDT) HRP2/pLDH (Pf/PAN) Cassette, 25 Tests

58 Pha-G-Dis Diego II

0.24 13.92

DIANA/ AMBANJA

Ambalahonko Artesunate/Amodiaquine 25/67.5 mg Tablet, 25 x 3 Blister Pack Tablets

31 Pha-G-Dis Ambanja

0.28 8.68

DIANA/ AMBANJA

Antsakoamanondro Artesunate/Amodiaquine 100/270 mg Tablet, 25 x 3 Blister Pack Tablets


0.55 11

DIANA/ AMBANJA

Antsakoamanondro Artesunate/Amodiaquine 100/270 mg Tablet, 25 x 6 Blister Pack Tablets


0.96 31.68

DIANA/ AMBANJA

Antsakoamanondro Sulfadoxine/Pyrimethamine 500/25 mg Tablet, 150 Tablets


0.13 60.84

DIANA/ AMBANJA

Ampasindava Artesunate/Amodiaquine 100/270 mg Tablet, 25 x 3 Blister Pack Tablets

8 Pha-G-Dis Ambanja

0.55 4.4

DIANA/ AMBANJA

Ampasindava Malaria Rapid Diagnostic Test (RDT) HRP2/pLDH (Pf/PAN) Cassette, 25 Tests


0.24 24

DIANA/ AMBANJA

Ampasindava Sulfadoxine/Pyrimethamine 500/25 mg Tablet, 150 Tablets


0.13 19.5

DIANA/ AMBANJA

Ankingameloka Malaria Rapid Diagnostic Test (RDT) HRP2/pLDH (Pf/PAN) Cassette, 25 Tests


0.24 36

DIANA/ AMBANJA

Antsatsaka Artesunate/Amodiaquine 25/67.5 mg Tablet, 25 x 3 Blister Pack Tablets

5 Pha-G-Dis Ambanja

0.28 1.4

DIANA/ AMBANJA

Antsatsaka Artesunate/Amodiaquine 50/135 mg Tablet, 25 x 3 Blister Pack Tablets

6 Pha-G-Dis Ambanja

0.37 2.22

DIANA/ AMBANJA

Antsatsaka Artesunate/Amodiaquine 100/270 mg Tablet, 25 x 3 Blister Pack Tablets

3 Pha-G-Dis Ambanja

0.55 1.65

Morondava Dispensaire Wenda Blenska


10 CSB Lohena 0.28 2.8



10 CSB Bevantaza

0.28 2.8

Manja Befamoty Artesunate/Amodiaquine 25/67.5 mg Tablet, 25 x 3 Blister Pack Tablets

25 CSB Andranopasy

0.28 7


25 CSB Ankoba 0.28 7



0.28 21



34 Pha-G-Dis Miandrivazo

0.28 9.52

Soalala CSB2 Antsakoamileka


5 CSBU Soalala 0.28 1.4

Soalala CSB2 Antsakoamileka


35 CSB2 Andranomavo

0.28 9.8

161

Soalala CSB1 Antanandava Artesunate/Amodiaquine 25/67.5 mg Tablet, 25 x 3 Blister Pack Tablets

6 CSB2 Andranomavo

0.28 1.68

Mitsinjo CSB2 Antongomena Bevary


18 AC Antongomena

0.28 5.04

Total value $ 289.73

162

ANNEX J - DONATION CONDUCTED

UNDER COVID-19

163

COVID-19 REPORT Annexes

Table 1: Donation sessions conducted in May to CCOR / DRSP

Date Place Recipient Articles & Quantity Media

05-19-2020 Toamasina DRSP & CCO Atsinanana

- 115 bottles of hydroalcoholic gels 500 ml - 10 cans of bleach (5L) - 4 rolls of trash bag 100L - 64 hand towel rolls - 5 pack of Chamois - 45 bottles of handwashing liquid soap - 8 Airtel Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS)

TV Plus / TVM / RDB And other medias called by the governor

05-20-2020 Fianarantsoa DRS & CCO Haute Matsiatra

- 50 bottles of hydroalcoholic gels 500 ml - 10 cans of bleach (5L) - 05 rolls of trash bag 100L - 10 rolls of trash bag 30 L - 36 hand towel rolls - 60 chamois - 50 bottles of handwashing liquid soap 300 ml - 8 Airtel Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS)

TV: VIVA - TVM - TV PLUS Radio: RNM

05-20-2020 Fénerive-Est DRSP & CCO Analanjirofo

- 115 bottles of hydroalcoholic gels 500 ml - 10 cans of bleach (5L) - 4 rolls of trash bag 100L - 64 hand towel rolls - 5 packs of chamois - 45 bottles of handwashing liquid soap - 8 Airtel Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS) - 150 posters A3

TVM

05-22-2020 Sambava DRSP & CCO SAVA

- 40 bottles of hydroalcoholic gels 500 ml - 9 cans of bleach (5L) - 4 rolls of trash bag 100L - 4 rolls of trash bag 30 L - 60 hand towel rolls - 16 chamois - 12 bottles of handwashing liquid soap - 8 Airtel Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS)

TV: TV Varatraza - TVM- MBS Radio: Radio varatraza, Jupiter, MBS Newspaper: L'Express de Madagascar

05-22-2020 Antsiranana DRSP & CCO DIANA


TV: TV Varatraza - TVM- MBS Radio: Radio Varatraza, Jupiter, MBS Presse: L'Express de Madagascar

05-22-2020 Tulear DRSP & CCO Atsimo Andrefana

- 30 bottles of hydroalcoholic gels 500 ml - 20 cans of bleach (5L) - 25 rolls of trash bag 100L - 25 rolls of trash bag 30 L - 60 hand towel rolls - 40 chamois - 40 bottles of handwashing liquid soap - 8 Orange Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS)

TV: TV Plus - TVM

164


05-27-2020 Ambositra DRS & CCO Amoron'i Mania

- 50 bottles of hydroalcoholic gels 500 ml - 6 cans of bleach (5L) - 05 rolls of trash bag 100L - 10 rolls of trash bag 30 L - 36 hand towel rolls - 60 chamois - 50 bottles of handwashing liquid soap 300 ml - 8 Airtel Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS)

TV: VIVA - TVM Radi : RNM

05-27-2020 Manakara DRS & CCO Vatovavy Fitovinany

- 50 bottles of hydroalcoholic gels 500 ml - 5 cans of bleach (5L) - 05 rolls trash bag 100L - 10 rolls trash bag 30 L - 36 hand towel rolls - 60 chamois - 50 bottles of handwashing liquid soap 300 ml - 8 Airtel Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS)

TV: TVM Radio: TVM

05-27-2020 Mahajanga DRSP & CCO Boeny


TV: TVM-VIVA Radio: RNM-VIVA

05-28-2020 Antsohihy DRSP & CCO Sofia


- TV: TVM-VIVA - Radio: RNM-VIVA

06-02-2020 Morondava DRS & CCO Menabe

- 30 bottles of hydroalcoholic gels 500 ml - 20 cans of Javel (5L) - 25 rolls of trash bag 100L - 25 rolls of trash bag 30 L - 60 hand towel rolls - 40 chamois - 40 bottles of handwashing liquid soap - 8 Airtel Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS)

TVM

165

Table 2: Donation sessions conducted in June to CCOR / DRSP


06-22-2020 Fianarantsoa DRS & CCO Haute Matsiatra

- 340 bottles of hydroalcoholic gels 500 ml - 20 cans of bleach (5L) - 05 rolls of trash bag 100L - 10 rolls of trash bag 30 L - 30 hand towel rolls - 5 chamois - 80 bottles of handwashing liquid soap 300 ml - 865 washable protective masks

Photos recorded

06-24-2020 Toamasina DRSP & CCO Atsinanana

- 600 bottles of hydroalcoholic gels 500 ml - 600 bottles of hydroalcoholic gels 200 ml - 60 cans of bleach (5L) - 60 rolls of trash bag 30L - 30 rolls of trash bag 100L - 60 hand towel rolls - 60 pack of 12 Chamois - 45 bottles of handwashing liquid soap - 150 bottles of liquid soap 1L - 90 bar soap - 150 mops - 90 brush brooms - 60 garbage bin - 60 plastic buckets 10L - 60 cups 1L - 60 insecticide spray - 100 virucid 150ml - 865 washable protective masks

TVM: TV Plus

06-24-2020 Antsohihy DRSP & CCO Sofia

- 150 bottles of hydroalcoholic gels 500 ml - 10 cans of bleach (5L) - 5 rolls of trash bag 100L - 20 rolls of trash bag 30 L - 10 hand towel rolls - 10 pack of chamois - 100 bottles of handwashing liquid soap - 10 mops - 865 washable protective masks

TV: TVM

06-24-2020 Mahajanga DRSP & CCO Boeny

- 225 bottles of hydroalcoholic gels 500 ml - 20 cans of bleach (5L) - 5 rolls of trash bag 100L - 20 rolls of trash bag 30 L - 10 hand towel rolls - 10 pack of chamois - 150 bottles of handwashing liquid soap - 20 mops - 865 washable protective masks

TV: VIVA & TVM

06-25-2020 (06-27-2020) (06-29-2020)

Fénerive-Est Soanierana- Ivongo Sainte-Marie Vavatenina Maroantsetra

SDSP Analanjirofo

- 800 bottles of hydroalcoholic gels 500 ml - 30 cans of bleach (5L) - 60 rolls of trash bag 30L - 30 rolls of trash bag 100L - 45 hand towel rolls - 60 pack of 12 Chamois - 45 bottles of handwashing liquid soap - 500 bottles of liquid soap 1L - 60 bar soap

TV: TVM

166


- 30 mops - 30 brush brooms - 30 garbage bin - 30 plastic buckets 10L - 30 cups 1L - 30 insecticide spray - 60 virucid 150ml - 865 washable protective masks

06-25-2020 Antsiranana DRSP & CCO DIANA

- 180 bottles of hydroalcoholic gels 500 ml - 15 cans of bleach (5L) - 10 rolls of trash bag 100L - 10 rolls of trash bag 30 L - 60 hand towel rolls - 20 chamois - 80 bottles of handwashing liquid soap - 40 virucid 100ml - 865 washable protective masks

TV: TV Plus

06-25-2020 Ambositra DRS & CCO Amoron'i Mania

- 330 bottles of hydroalcoholic gels 500 ml - 20 cans of bleach (5L) - 05 rolls of trash bag 100L - 10 rolls of trash bag 30 L - 30 hand towel rolls - 5 pack of chamois - 80 bottles of handwashing liquid soap 300 ml - 865 washable protective masks

TV & radio VIVA

06-25-2020 Manakara DRS & CCO Vatovavy Fitovinany

- 330 bottles of hydroalcoholic gels 500 ml - 20 cans of bleach (5L) - 05 rolls trash bag 100L - 10 rolls trash bag 30 L - 36 hand towel rolls - 60 chamois - 50 bottles of handwashing liquid soap 300 ml - 865 washable protective masks

TV: TVM Radio : RNM

06-29-2020 Tulear DRSP & CCO Atsimo Andrefana

- 90 bottles of hydroalcoholic gels 500 ml - 20 cans of bleach (5L) - 30 rolls of trash bag 100L - 30 rolls of trash bag 30 L - 30 hand towel rolls - 50 chamois - 50 bottles of handwashing liquid soap - 692 washable protective masks

TV : TVM

coag no. 72068718ca00001

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