name of the cooperation agreement: management …pdf.usaid.gov/pdf_docs/pa00n193.pdf · ldp+fs...

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Name of the Cooperation Agreement: Management Sciences for Health, Leadership, Management and Governance Project (LMG) Cooperation Agreement Number: AID-OAA-A-11-00015 Programmatic areas covered by the Cooperation Agreement: • Human Resources for Health • Strategic Information FISCAL YEAR: 2016 ACTIVITY REPORT Beginning of the period: October 1, 2016 End of the period: December 31, 2016

Written by: Serge KOUADIO Signature: ………………………………………….

Date: 01/13/2017

Approved by: Antoine N’DIAYE Signature: …………………………………………. Date: 01/13/2017

Date of transmission: 01/13/2017

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Table of Contents I – SUMMARY ........................................................................................................................................................ 3

II – NARRATIVE OF RESULTS ACHIEVED ................................................................................................................. 4

III - DIFFICULTIES AND / OR CONSTRAINTS DURING THE PERIOD ....................................................................... 14

IV - OUTLOOK / Key Activities for the Next Period.............................................................................................. 14

ANNEX 1: DISTRIBUTION AND INSTALLATION OF MATERIALS AND EQUIPMENT BY REGION ............................ 17

Acronyms COGES Hospital management committees

CSE Epidemiological Monitoring Officer DD Departmental Health Directorates DCPEV Central Directorate of Immunization Program DMR Desired Measurable Results DR Regional Health Directorates

DRSHP Regional Health Directorate and Public Hygiene ECD District Health Team ERS Regional Health Team GHSA Global Health Security Agenda HG General Hospital INHP National Institute of Public Hygiene KBF Kabadougou-Bafing-Folon LDP+FS Leadership Development Program + on health facilities LMG/CIEB Leadership, Management and Governance Project to Strengthen

Coordination and Governance Capacity at Sub-national Levels for Ebola Preparedness in Côte d’Ivoire

M&E Monitoring and Evaluation MIS Management Information Systems MSHP Ministry of Health and Public Hygiene PNLS National Aids Control Program PNLP National Malaria Control Program SAS Health action Department

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I – SUMMARY The following is a summary of the activities carried out from July 1 through September 30, 2016, by the Leadership, Management and Governance Project to Strengthen Coordination and Governance Capacity at Sub-national Levels for Ebola Preparedness in Côte d’Ivoire (LMG/CIEB), funded by USAID/Côte d’Ivoire through FY 2015 Omnibus Ebola Emergency Appropriations. The goal of this initiative is to build sustainable, well governed, and effective coordination structures for preparedness and response to Ebola and other infectious threats at the decentralized level. Specific objectives that will contribute to this goal include the following:

• Objective 1: Increase the capacity and performance of the sub-national health directorates through improved leadership, management, and governance practices of leaders and managers of health in the Departmental Health Directorates (DDs), Regional Health Directorates (DRs), and in the private sector

• Objective 2: Improve governance, ownership, and coordination practices on sub-national levels for advocacy, mapping, strategic planning, activity monitoring, application of regulations, and information to DRs and DDs

• Objective 3: Establish routine cross-sectorial collaboration mechanisms among actors from human, animal, and environmental health to pilot implementation of the One Health Initiative and whole government approach to addressing existing and emerging infectious threats

• Objective 4: Integrate health emergency preparedness and response in broader, national strategies that aim to strengthen systems and thus ensure sustainability and coherence of these initiatives over time.

On October 27, 2015, USAID approved the full LMG/CIEB workplan package for project year 2 (October 2016 – June 2017). The project provides support to the three health regions and corresponding health districts that border Liberia and Guinea in Western Côte d’Ivoire:

• Health Region of Tonkpi: Biankouma District, Danané District, Man District, and Zouan-Hounien District

• Health Region of Kabadougou-Bafing-Folon: Odienné District, Touba District, and Minignan District

• Health Region of Cavally-Guémon: Kouibly District, Bangolo District, Duékoué District, Toulépleu District, Bloléquin District, and Guiglo District

During this reporting period (October-December 2016), the LMG/CIEB achieved the following:

Objective 1: • Completed the Training of Trainers (TOT) for the district level LDP+ process with 25

participants. • Held a Stakeholder Alignment Meeting (SAM) in each of the 13 districts with a total of

331 participants. • Held the first LDP+ workshop with 13 referral hospitals, 13 improvement teams, and 17

participants. For each of the above activities, the LMG/CIEB employed a multi-sectoral approach, as evidenced by the involvement of participants from non-health sectors (agriculture, water and forests, social affairs, aquaculture, education, and construction).

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6 9 8

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K B F C G T O N K P I

FIGURE 1: TOT LDP+ PARTICIPANTS Health Sector Other Sector

• 100% of the three regions finalized their performance and reward system process. • All 3 regions and 13 districts received furniture and equipment to improve their

performance.

Objective 2: • 41 out of 48 (85%) of planned monthly district health team (ECD) and regional health

team (ERS) meetings held. • 6 out of 13 (46%) of planned regional and district quarterly coordination meetings

held. • 14 out of 18 (78%) of planned district and regional integrated supervision missions carried

out. • 19 out of 26 (73%) of planned data validation site visits completed in the three regions.

Objective 3: • 1 out of 3 (33%) of planned monthly regional Ebola committee meetings held. • 7 out of 39 (13%) of planned monthly meetings of the departmental committees for the

fight against Ebola held.

Objective 4: • All three regions began implementing their integrated Ebola and infectious disease

preparedness activities. II – NARRATIVE OF RESULTS ACHIEVED

LMG/CIEB project achievements following official workplan approval: In line with the LMG/CIEB project workplan, which was officially approved by USAID/Côte d’Ivoire on October 27, 2015, the following activities were carried out during the reporting period of October – December 2016. Objective 1: Increase the capacity and performance of the sub-national health directorates through improved leadership, management, and governance practices of leaders and managers of health in the Departmental Health Directorates (DDs), Regional Health Directorates (DRs) and in the private sector LMG/CIEB launched the LDP+ process in the district-level referral hospitals in each of the three regions. In addition, each of the three regions finalized its performance and reward system process and LMG/CIEB provided equipment, furniture, and technical assistance to the Regional Health Directorates (DR) and Departmental Health Directorates (DD).

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27 33 33

50

129

67


FIGURE 2: STAKEHOLDER ALIGNMENT MEETING

PARTICIPANTS Health Sector Other Sector

Launch of LDP+ with health facilities (referral hospitals): LMG/CIEB also launched the LDP+ process with district referral hospitals. From November 2-4, 2016, LMG/CIEB held a TOT for trainers from the health districts in Kabadougou-Bafing-Folon (KBF), Tonkpi, and Cavally-Guémon (CG) with 25 participants. These trainers were selected from participants in the LDP+ conducted at the regional level. For each region, participants came from the following sectors:

• Kabadougou-Bafing-Folon: six participants from the health sectors and one participant from the Department of Animal and Fish Resources

• Cavally-Guémon: nine participants came from the health sector (representing the DDs, Medecin Chef du Service d’Action Sanitaire (SAS), and Institute National pour le Hygiène Publique (INHP) and one participant from the Ministry of Water and Forests

• Tonkpi: eight participants from the health sector. On November 8, 2016, LMG/CIEB held a Stakeholder Alignment Meeting (SAM) in each of the 13 districts within the three target regions. The SAM provided an opportunity for stakeholders to come together and align and mobilize around the LDP+ process in order to meet health challenges and achieve results for improved health systems in their districts. A total of 339 participants attended these meetings. For each region, participants came from the following sectors:

• Kabadougou-Bafing-Folon: Of the 77 participants at the district-level SAMs, 27 were from the health sector (35%) and 50 were from other sectors (65%)--including prefectures and sub-prefectures, associations of women and young people, religious leaders, animal and fish resources, the mayors’ offices and regional councils, agriculture, defense and security, and traditional chiefs.

• Cavally-Guémon: Of the 162 participants at the SAM, 33 participants came from the health sector (20%) and 129 from non-health sectors (80%). The non-health sectors included prefectures and sub-prefectures, traditional chiefs, local authorities, waters and forests, education, agriculture, environment, traditional healers, animal and fish resources, religious leaders, and social services.

• Tonkpi: Of 100 participants that attended the SAM, 67 (67%) represented the health sector, and 33 individuals (33%) came from non-health sectors. The non-health sector representatives included prefectures and sub-prefectures, NGOs, traditional leaders, animal and fish resources, local authorities, waters and forests, education, agriculture, environment, traditional healers, animal and fish resources, religious leaders, social services, media, and associations of women and youth.

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47 50

29

22 12

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FIGURE 3: LDP+ WORKSHOP 1 PARTICIPANTS

Health Sector Other Sector

From November 9-11, 2016, all 13 districts of the 3 regions also held their first LDP+ workshop learning meeting in their different referral hospitals. These workshops were attended by 171 participants. For each region, participants came from the following sectors:

• Kabadougou-Bafing-Folon: There were three improvement teams (69 participants) with 47 participants (32%) coming from the health sector and 22 participants (68%) coming from non-health sectors, including prefectures and sub-prefectures, associations of women and youth, religious leaders, local communities, agriculture, defense and security, and traditional leaders.

• Cavally-Guémon: The workshops were held with six improvement teams (62 participants), with 12 participants (20%) of participants attending from non-health sectors.

• Tonkpi: The first workshop was held with four improvement teams (40 participants), with 11 (27%) of participants coming from the non-health sector. These non-health sectors included water and forests, animal and fish resources, and agriculture.

During each of the first workshops, LMG/CIEB carried out the following sessions:

1. Introduction to the LDP + program, the Leadership Development Triangle (see figure 4), and decision-making bodies (the Directeur Générale de la Santé (DGS), DR, and DD)

2. Overview of leadership and management development 3. Presentation of LDP+ videos presenting LDP+ results at health facilities in Egypt and

Kenya 4. Work climate 5. Personal vision and objectives 6. Creating a vision of the priority

health area 7. The Challenge Model 8. Desired Measurable Results

(DMR) 9. Monitoring and evaluation (M&E) 10. Leadership practice: scanning

By the end of the first workshop, participants had begun to develop their challenge models, finished defining the “current situation,” and begun formulating their desired measurable results.

Development of a performance and reward system: All districts and regions have identified the selection criteria for the merit recognition awards. In Cavally-Guémon, nominees were selected

Figure 4: Leadership Development Triangle

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and shared with the DRS. In Tonkpi, the performance criteria were validated by the ERS, and the award ceremony will be held during the January 2017 annual review meetings in each region. LMG/CIEB assisted the ECDs and ERS with the development of selection criteria and the selection process. Delivery of materials and equipment to the DRS and DDS: From October 11-23, 2016, LMG/CIEB delivered materials and equipment to the DRs and DDs in each of the three regions (see Annex 1 for the list of equipment delivered). These materials (i.e., computers, printers, projectors, flipcharts, desks, etc.) will fully equip the DRs and DDs and allow them to perform the management and coordination functions that the LMG/CIEB project is strengthening through its technical assistance. To ensure that this equipment is well maintained, service providers have been identified in every region to maintain information technology. Objective 2: Improve governance, ownership, and coordination practices on sub-national levels for advocacy, mapping, strategic planning, activity monitoring, application of regulations and information to DRs and DDs Quarterly regional data validation workshops, including data on HIV, malaria, vaccination, reproductive health, and family planning: With financial support from the National AIDS Control Program (PNLS), the National Malaria Control Program (PNLP), and other programs such as the National Program for Nutrition (PNN), each region held its regional malaria and HIV data validation workshop during this reporting period. LMG/CIEB monitoring and evaluation staff provided technical support by participating in the workshops and facilitating group work and by providing support to the chargés de surveillance épidémiologique (CSE) to verify data in registration documents, activity reports, and other forms of reporting. This support aims to improve regional capacity to review and validate disease data, which in turn better equips regional health staff to have a clear picture of disease prevalence and treatment in their regions Table 1 presents the dates of each quarterly data validation workshop held during the reporting period.

Table 1: Dates of quarterly validation workshops Quarterly HIV data validation workshops Region Workshop date Workshop location DR Cavally-Guémon October 20-22, 2016 Duékoué DR Kabadougou-Bafing-Folon October 24-26, 2016 Touba DR Tonkpi October 17-19, 2016 Man Quarterly malaria data validation workshops DR Cavally-Guémon October 23-24, 2016 Duékoué DR Kabadougou-Bafing-Folon October 20-22, 2016 Touba DR Tonkpi October 20-22, 2016 Man Quarterly reproductive health/family planning (RH/FP) data validation workshops DR Cavally-Guémon October 3, 2016 Duékoué DR Kabadougou-Bafing-Folon November 5-7, 2016 Touba

PERFORMANCE AND REWARD SYSTEM: A system that recognizes high performing health staff, with both non-monetary recognition and prizes, based on pre-determined criteria.

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In the three health regions, LMG/CIEB technical advisors continued to work with their respective DRs to advocate for the importance of conducting integrated regional data validation for future workshops. Integrated workshops are more efficient and allow for a better use of resources as the staff travel and workshop logistics only need to occur once, instead of three times, for malaria, HIV and AIDS, and maternal health data to be validated. To support this effort, LMG/CIEB Technical Advisors coached the DRs to write the terms of reference for integrated data validation workshops. Regional and district semi-annual review meetings: With the support of LMG/CIEB, the KBF ERS organized its regional semi-annual review meeting on October 1, 2016. The meeting achieved its objective to reinforce coordination and monitoring of health interventions in order for the ERS to better track the evolution of planned health activities. During the regional semi-annual review meeting, participants discussed the challenge of malaria, which is the principal cause of both medical consultations and death in the region. In addition, ERS staff presented the committee results, including the number of meetings and monitoring visits to the border areas. Quarterly review meeting organized by the DRS and the DDS: During the reporting period, continued LMG/CIEB technical support helped the ECDs in each region hold quarterly coordination review meetings. These different meetings essentially allow the ERS to monitor activity implementation in order to make decisions regarding activities that have not yet been completed. The dates for each meeting are presented in Table 2. In Kabadougou-Bafing-Folon (KBF), the ERS and ECDs presented third quarter activity results during the coordination meeting. These included results from HIV, malaria, Ebola, Expanded Vaccination Program (PEV), RH/FP Program, and PNN activities. At each level, participants analyzed results for quarter 3 indicators. In addition, participants reviewed and discussed the contribution of non-health sectors to health activities, challenges to activity implementation, and strategies for overcoming these obstacles. In Cavally-Guémon, participants in the ECD quarterly review meetings reviewed the status of health indicators, challenges towards achieving targeted results, and recommendations to overcome identified challenges. During the ERS meeting, which included participation from twelve non-health sectors, participants reviewed third quarter results from HIV, malaria, Ebola, EPI, RH/FP, and PNN district activities. Participants also analyzed the performance of interventions and their achievement of target indicator levels. Lastly, participants updated the health district contingency plans and presented strategies for resolving difficulties in implementation. In Tonkpi, the Biankouma ECDs held its quarterly coordination review meeting on November 25, 2016. Participants discussed the launch of the LDP+ process at the General Hospital in Biankouma and decided when to schedule a review session for the LDP+ teams. Table 2: ECD quarterly coordination review meetings

Regions Districts Date Tonkpi Man Planned for next quarter

Biankouma November 25, 2016 Danané Planned for next quarter Zouan-Hounien Planned for next quarter

DR Tonkpi Planned for next quarter

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Cavally-Guémon Guiglo Planned for next quarter Duékoué October 13-14, 2016 Kouibly October 13-14, 2016 Bangolo Planned for next quarter Toulépleu Planned for next quarter Bloléquin October 18-19, 2016

DR Cavally-Guémon December 14-15, 2016 Kabadougou-Bafing-Folon (KBF)

Odienné Planned for next quarter Minignan December 05, 2016 Touba Planned for next quarter

DR KBF November 28, 2016 Monthly ECD and ERS meetings: In preparation for the end of LMG/CIEB activity implementation in June 2017, the LMG/CIEB is transferring financial and organizational responsibility for the ECD meetings to the districts in order to facilitate the sustainability of LMG/CIEB-supported routine tasks as outlined in the minimum package of activities identified by the DGS. LMG/CIEB provided technical support for the organization of regular ECD and ERS meetings. LMG/CIEB also continued to provide some financial support to the meetings as the project has not yet transferred full financial responsibility to the districts. The ECDs and ERS held 85% of planned meetings. LMG/CIEB notes that participants, in particular those from non-health sectors, are increasingly engaged and motivated. During these meetings, participants discussed activities carried out during the month in order to better coordinate efforts, identify common challenges, address gaps, determine strategies for overcoming problems, and stay updated on progress. Participants identified individuals to follow up on action items and provided updates on epidemiological surveillance. Table 3 summarizes the ECD/ERS meetings held during the current reporting period. Table 3: ECD/ERS meetings held during the reporting period

Regions Districts Actual Target % Tonkpi Man 3 3 100%

Biankouma 3 3 100% Danané 3 3 100% Zouan-Hounien 2 3 67%

DR Tonkpi 1 3 33% Cavally-Guémon Guiglo 3 3 100%

Duékoué 3 3 100% Kouibly 3 3 100% Bangolo 3 3 100% Toulépleu 3 3 100% Bloléquin 3 3 100%

DR Cavally-Guémon 3 3 100% Kabadougou-Bafing-Folon (KBF)

Odienné 2 3 67% Minignan 3 3 100% Touba 2 3 67%

DR KBF 1 3 33% Total 41 48 85%

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LMG/CIEB technical advisors and M&E staff continue to coach the DRs and DDs to organize meetings by respecting regular monthly calendars, regularly discussing plans for upcoming meetings with DR and DD staff, and working with the DR and DD staff on the agenda for each meeting. When there are agenda conflicts, the LMG/CIEB Technical Advisor troubleshoots with the DRs and DDs to identify alternatives in order to carry out planned meetings. For example, LMG/CIEB technical advisors helped the DRs and DDs identify other staff members who can represent the Regional and District Health Directors at meetings. The Regional and District Health Directors often are unable to attend planned meetings due to scheduling conflicts; by delegating responsibility for the meetings to other staff members, more meetings can be held despite Regional and District Health Director unavailability.

Organization of integrated supportive supervision visits: During this reporting period, LMG/CIEB provided technical and financial support to regional and district integrated supportive supervision visits, and the DRs and DDs carried out 78 % of planned visits. During the supervision visits, LMG/CIEB helps DR and DD staff review the availability of documents and national tools (norms, procedures, policies, etc.) at the sites. In addition, staff analyze the site data management system, management practices for each health area (PEV, HIV, maternal and child health [MNCH], Ebola, and malaria). Lastly, during the site visit, staff members verify the availability of key medications and laboratory inputs. The dates for the supportive supervision visits are listed below in Table 4. Table 4: Integrated supportive supervision visits Location Dates DR Tonkpi November 28 -December 3, 2016. DD Man October 3-27, 2016 DD Biankouma October 24-27, 2016 DD Danané November 25-27, 2016 DD Zouan-Hounien November 25-27, 2016 DR Cavally-Guémon DD Guiglo October 12-26, 2016 DD Duékoué October 27-31, 2016. DD Bangolo October 12-14, 2016 DD Toulépleu October 17-21, 2016 DD Bloléquin October 17-19, 2016 DD Kouibly October 24-31, 2016 DR Kabadougou-Bafing-Folon DD Minignan October 7-8, 2016 DD Touba November 23 – December 1, 2016

November 28, to December 1, 2016 LMG/CIEB provided technical support to the DRS and DDS by drafting terms of reference for the supervision missions and by participating in each mission. As during preceding quarters, LMG/CIEB provided vehicles and fuel to the DR teams to conduct the supportive supervision visits. Supervision missions included supervision of work conducted for epidemiological surveillance, reproductive health, malaria control/treatment, and family planning. This allowed the districts to review gaps that were identified at the bi-annual meetings. These gaps include

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mismanaged filing practices, poor archiving of reports, and unavailability of texts that meet MSHP standards. These supervisory missions enable the DRS and DDS to provide guidelines on good governance and better management at the health center level. Work with the DR to develop and distribute four quarterly information bulletins: During the reporting period, LMG/CIEB provided technical support to the regional CSEs for the development of information bulletins. The CSEs developed and presented the information bulletins during the regular coordination review meetings. These bulletins provided an overview of the level of DRS and DDS activity implementation, which helps to promote transparency, accountability and data-based decision-making. Below are summaries of the status of the information bulletins for each region.

• Cavally-Guémon: For the third quarter, all six districts will be featured in the newsletter after the data validation workshops. The newsletter for the third quarter will focus on the activities that took place from July-September 2016. It will present the results achieved in the six districts.

• Kabadougou-Bafing-Folon: The DR will develop the bulletin after the HIV and malaria data have been validated during the quarterly data validation workshop.

• Tonkpi: The district CSEs drafted the information bulletins. The drafts were submitted to each respective DD for signature, and the ECDs are currently reviewing and revising the documents. The Biankouma district and the DR validated their respective newsletters in October and November 2016. The LMG/CIEB team in Man will also contribute to the third quarter newsletter by adding information about the HIV and malaria data validation workshops.

In each of the three regions, the LMG/CIEB technical advisor and M&E associate provide regular support to each DDS to develop the bulletins through coaching visits and phone calls. During this reporting period, the LMG/CIEB M&E associates helped draft a template for the bulletins and collected data for the bulletins during data validation missions. These information bulletins are distributed to health centers and highlight health center performance, which serves as a source of recognition and motivation for health center staff.

Record archiving support: In all three regions, the LMG/CIEB Project continued to provide regular M&E coaching to the regional and district-level CSEs and other DR and DD staff members--including the Head of the Health Action Service, the CSE Deputy Director, and the secretary--to implement a physical and electronic archiving system. These archiving systems are based on the documentation classification and archiving plan submitted by each DR and DD. The LMG/CIEB M&E staff took advantage of all LMG/CIEB supported activities (meetings, workshops, site visits) to work with the above-mentioned staff on this activity and to reinforce their capacities. The archiving systems will enable the DR and DD to more effectively build on achievements while documenting the sources of verification for all activities. This is a routine activity. Many changes are now visible in the archiving of DDs and DRSHP. For example, in Cavally-Guémon, there is now a dedicated staff person who follows up on meeting and activity reports and ensures that the reports are archived. Prior to LMG/CIEB, there was no staff member accountable for this process. The project will continue to provide assistance so the archiving process becomes institutionalized at the regional and district level.

Quarterly integrated data validation site visits: During the reporting period, LMG/CIEB

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provided technical and financial support for district integrated data validation site visits. The CSEs chose indicators that were underperforming after a review of previous performance and results. The site visits provided the opportunity for the LMG/CIEB M&E staff to coach the CSEs and other stakeholders involved in data collection and record archiving. These activities enable the DR and DD to take a more active role in building on past achievements while documenting the sources of verification for all activities. During the quarter, the districts organized 73% of planned site visits. These dates and location of these visits are listed below in Table 5. Table 5: Quarterly data validation site visits

Regions Districts Date Tonkpi Man October 13-15, 2016

Biankouma October 25-27, 2016 December 13-15, 2016 Zouan-Hounien October 27-29, 2016

Cavally-Guémon Guiglo September 29-October 2, 2016 October 25-26, 2016 November 8-14, 2016 December 12-14, 2016 Duékoué November 8-14, 2016 Kouibly November 8-14, 2016 Bangolo November 8-14, 2016 Toulépleu December 5-8, 2016 November 8-14, 2016 November 17, 2016 December 7, 2016 Bloléquin November 8-14, 2016

Kabadougou-Bafing-Folon (KBF)

Odienné November 21-24, 2016 Minignan October 25- 27, 2016 Touba October 18-20, 2016

During these visits, the DDs noted that there was an improvement in the quality of the data transmitted by the sites to the district. For example, reporting on data related to the rate of assisted births has improved compared to previous visits. LMG M&E staff will continue to provide coaching support to the regional CSEs to conduct monthly site monitoring so that the DDs will be able to do this moving forward without LMG support. Objective 3: Establish routine cross-sectorial collaboration mechanisms among actors from human, animal, and environmental health to pilot implementation of the One Health Initiative and whole government approach to addressing existing and emerging infectious threats Monthly regional Ebola coordination committee meetings: With LMG/CIEB technical support, Cavally-Guémon held one monthly meeting during the reporting period on November 30, 2016, and they plan to hold another meeting on December 27, 2016. During the November meeting, participants discussed the epidemiological situation in the region, updates on activity implementation, and recommendations from the epidemiological monitoring.

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The Regional Health Directors of Tonkpi and KBF were still not replaced during the quarter; as a result, no meetings were held. Other prefectures and sub-prefectures are carrying out administrative work, but the absence of a Regional Health Director makes it very challenging to convene regional meetings, such as the Ebola coordination committee meetings, that are under the authority of the Regional Health Director. In January 2017, the new DRs were appointed, so this should not be an issue in the next quarter. Monthly departmental Ebola coordination committee meetings: At the departmental level, LMG/CIEB provided technical support to the Ebola coordination committees in a number of ways. For example, the LMG/CIEB Technical Advisors assisted the DDs in writing SOWs and invitation letters for the meetings and provided financial and logistical support to the meetings. Table 6 provides the dates and locations of meetings held. Table 6: Monthly departmental Ebola coordination committee

meetings Regions Districts Date Cavally-Guémon Guiglo October 28, 2016

Duékoué November 30, 2016 Kouibly December 7, 2016 Bangolo October 28, 2016 and December

20, 2016 Toulépleu October 18, 2016 Bloléquin

Kabadougou-Bafing-Folon (KBF)

Minignan December 5, 2016

Many of the departmental coordination committees--in particular in Tonkpi and KBF--are not currently fully functional. This is due in part to the fact that the regional prefect has not yet issued a regional decree to make them functional. LMG/CIEB will encourage addressing the challenges with the committees with the improvement teams during the LDP+ process. launch of the LDP+ process at the district level will help increase the number of meetings held through reinforcement of L+M+G practices and consistent district-level LMG/CIEB coaching. Objective 4: Integrate health emergency preparedness and response in broader, national strategies that aim to strengthen systems and thus ensure sustainability and coherence of these initiatives over time Presentation of regional Ebola coordination committee results: During the reporting period, the regional Ebola coordination committees presented their results during the semi-annual review meetings of KBF and the quarterly coordination review meetings of Cavally-Guémon. The agenda for each meeting included a presentation by the regional coordination committee to fight Ebola on activities, including epidemiological monitoring. Integration of regional fight against Ebola coordination activities into regular coordination meetings: The DRs and DDs now regularly integrate updates from regional and departmental Ebola activities and disseminate these during regular district and regional

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coordination meetings. In addition, non-health sectors are invited to these meetings to promote the One Health model. III - DIFFICULTIES AND / OR CONSTRAINTS DURING THE PERIOD III.1: Difficulties and / or Constraints Since the reporting period is the last quarter of the calendar year, there was an increase in the amount of competing activities as the majority of the departmental health activities take place at the end of the year. This increase in activities added to the workload of and strain on the already inadequate number of health staff. As a result, it was particularly challenging to plan LMG/CIEB district activities this quarter. Implementation was hindered further by the continued absence of the Tonkpi and KBF DRs. These vacant leadership positions made it challenging to carry out planned activities, as the DR is the regional MSHP representative and is responsible for coordinating regional health activities. The DR also serves as the secretary of the regional committee for the fight against Ebola. The LMG/CIEB project is hopeful that the DR will be replaced in early 2017, which will accelerate the pace of routine activity implementation in those regions. III.2: Solutions to Difficulties and / or Constraints To assist with the implementation of program activities, the LMG/CIEB Technical Advisors provided technical support to the DR and DD to draft terms of reference for activities. In addition, the LMG/CIEB team held working sessions with the interim DRs to provide an overview of the LMG/CIEB project and ensure that they were able to assume the DR responsibilities and assist with activity implementation as quickly as possible. Although the interim DRs were present, they prioritized meetings at the MSHP, making it difficult to accomplish activities in the regions. IV - OUTLOOK / Key Activities for the Next Period Key activities for the LMG/CIEB for the next quarter: The LMG/CIEB team will continue to work closely with USAID, stakeholders, and partners to implement the following scheduled activities in the next reporting period (January-March 2017):

Objective 1: Increase the capacity and performance of the sub-national health directorates through improved leadership, management and governance practices of leaders and managers of health in the Departmental Health Directorates (DDs), Regional Health Directorates (DRs) and in the private sector

1 Conduct and provide financial support for four one-day first coaching missions with each LDP+ improvement team between workshops

2 Provide technical and financial assistance to conduct the second LDP+ session with six participants from the district's reference hospital

3 Assist the DRs in preparing for and conducting a four-day Governance Academy workshop with 4 representatives (including one female) from each of the 13 hospital management committees (COGES)

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4 Provide technical support to the DD to conduct and document regular touchbases to facilitate communication and follow up on activity implementation using a template developed by the project and now regularly utilized by the DDs

Objective 2: Improve governance, ownership, and coordination practices on sub-national levels for advocacy, mapping, strategic planning, activity monitoring, application of regulations, and information to DRs and DDs 5 In each of the three regions and the 13 districts, provide financial and technical

support (including preparation of agendas, discussion points, and writing/distribution of meeting notes), in collaboration with other implementing partners, to the regional health team to hold a two-day quarterly coordination meeting with participants from the district health teams (ECD) and local authorities in each region to evaluate the status of activity implementation by the DR, DD, and Ebola coordination committees (financial support is partial and leverages the funding provided by other partners such as IRC, Red Cross, and Aconda VS)

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In each of the three regions and the 13 districts, provide financial and technical support (including preparation of agendas, discussion points, and writing/distribution of meeting notes), in collaboration with other implementing partners, to the regional team to hold one three-day annual meeting in each region to share results, best practices, and lessons learned, and evaluate the status of activity implementation by the DR, DD, and Ebola coordination committees with all service providers and regional stakeholders, including the district health teams, implementing partners, NGOs, and local authorities

7 In each of the three regions and the 13 districts, coach and provide financial support to the senior regional health team and the senior district health team to conduct integrated supportive supervision, in collaboration with other implementing partners, to all six districts and referral hospitals

8 In each of the three regions, provide mentoring to the DR to conduct regional integrated data validation workshops, including data on HIV, malaria, immunization, reproductive health, and family planning

9 In each of the 13 districts, provide mentoring and financial assistance to the DD, in collaboration with JSI/Measure, to hold one quarterly integrated data validation site visits, including data on HIV, malaria, immunization, reproductive health, and family planning

10 In each of the three regions and the 13 districts, coach the DR and DD to develop and distribute one quarterly information bulletin

11 In each of the three regions and the 13 districts, provide ongoing coaching to DR and DD administrative and M&E personnel to establish a physical and digital archiving system for those districts requiring additional assistance

12 In each of the three regions, provide financial and technical support (including preparation of agendas, discussion points, and writing/distribution of meeting notes) to the departmental health directorate to hold 9 monthly senior departmental health team (ECD) meetings to review management priorities in collaboration with other implementing partners

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13 In each of the three regions, mentor and provide financial support to the district health team, in collaboration with other implementing partners, to hold a three-day workplanning workshop to develop a detailed, budgeted annual workplan for 2017

Objective 3: Establish routine cross-sectorial collaboration mechanisms among actors from human, animal, and environmental health to pilot implementation of the One Health Initiative and whole government approach to addressing existing and emerging infectious threats 14 In each of the three regions, under the leadership of the regional coordination

committee to fight against Ebola, facilitate an alignment meeting on One Health with participants, including representatives from all sectors, NGOs, businesses, local authorities, community leaders, and religious groups

15 Develop/update, in collaboration with Abt. Associates, the DR's Ebola contingency plan, integrating activities from other sectors in accordance with the One Health initiative

16 Under the leadership of the DR, document, monitor, and report on the implementation of the One Health initiative in each sector during quarterly coaching missions

17 In each of the three regions, provide financial and technical support (including preparation of agendas, discussion points, and writing/distribution of meeting notes) to conduct monthly meetings with the regional coordination committee to fight against Ebola

18 In each of the three regions and the 13 districts, organize quarterly five-day technical support missions to help DR and DD teams document, validate, and disseminate success stories and best practices

19 In each of the three regions, coach and provide financial support to the regional coordination committee to fight against Ebola to conduct three quarterly monitoring missions of the departmental coordination committee to fight against Ebola

20 In each of the three regions, coach and provide financial support to the departmental coordination committee to fight against Ebola to follow up on activity implementation by each departmental coordination committee to fight against Ebola

21 In each of the 13 districts, mentor the DD to reinforce its capacity to mobilize emergency funds available in its catchment area to address existing and emerging infectious threats

Objective 4: Integrate health emergency preparedness and response in broader, national strategies that aim to strengthen systems and thus ensure sustainability and coherence of these initiatives over time 22 Under the leadership of the DD, ensure that all activities of the regional

coordination committee to fight against Ebola and other existing and emerging infectious disease threats are integrated into the regular quarterly coordination meetings

23 Mentor the DD to integrate L+M+G practices and tools such as the challenge model in its regular activities and document the process for scale up

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ANNEX 1: DISTRIBUTION AND INSTALLATION OF MATERIALS AND EQUIPMENT BY REGION

CITY ACTIVITIES RESULTS Guiglo (DR – District)

Installation and commissioning of : • 1 Canon copier • Coaching in basic maintenance practices

Installation and remittance

• 1 multi-function printer • 4 laptops • 2 desktops • 2 inverters • 4 external hard discs • 4 air conditioners • 1 binding machine

All the equipment is received in good condition and fully functional, ready to use

Bloléquin Remittance and installation of : • 1 multi-function printer • 2 laptops • 1 desktop • 1 inverter • 1 table for flipchart • 1 external hard drive • 2 air conditioners


Toulépleu Remittance and installation of: • 1 multi-function printer • 2 laptops • 1 desktop • 1 inverter • 1 table for flipchart • 2 external hard drive • 2 air conditioners


Duékoué Remittance and installation of: • 1 multi-function printer • 2 laptops • 1 desktop • 1 inverter • 1 projector • 1 table for flipchart • 2 external hard drive • 2 air conditioners


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Bangolo Remittance and installation of: • 1 multi-function printer • 2 laptops • 1 desktop • 1 inverter • 1 table for flipchart • 2 external hard drive • 2 air conditioners


Kouibly Remittance and installation of: • 1 multi-function printer • 2 laptops • 1 desktop • 1 inverter • 1 projector • 1 table for flipchart • 2 external hard drive • 2 air conditioner


Man (DR – District)

Installation and commissioning of: • 1 Canon copier • Coaching in basic maintenance practices

Installation and remittance of:

• 1 multi-function printer • 4 laptops • 2 desktops • 4 external hard drive • 2 air conditioners • 1 projector • 1 binding machine


Biankouma Installation and remittance of: • 1 multi-function printer • 2 laptops • 1 desktop • 1 inverter • 2 external hard drive • 2 air conditioners


Danané Installation and remittance of: • 1 multi-function printer • 2 laptops • 1 desktop • 1 inverter • 1 projector • 1 table for flipchart • 2 external hard drive • 2 air conditioners


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Zouan-Hounien

Installation and remittance of: • 1 multi-function printer • 2 laptops • 1 desktop • 1 inverter • 1 projector • 1 table for flipchart • 2 external hard drive • 2 air conditioners


Odienné (DR – District)

Installation and commissioning of : • 1 Canon copier • Coaching in basic maintenance practices

Installation and remittance of: • 1 multi-function printer • 4 laptops • 2 desktops • 2 inverters • 4 external hard drives • 4 air conditioners • 1 binding machine


Minignan Installation and remittance: • 1 multi-function printer • 2 laptops • 1 desktop • 1 inverter • 2 air conditioners • 2 external hard drives


Touba Installation and remittance : • 1 multi-function printer • 2 laptops • 1 desktop • 2 inverters • 1 table for flipchart • 1 projector • 2 external hard drives • 2 air conditioners


name of the cooperation agreement: management …pdf.usaid.gov/pdf_docs/pa00n193.pdf · ldp+fs...

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