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Epi Info Trainers of Trainers in Babil

Begin District Trainings

PHCPI Completes Assessment to

Evaluate the Impact of Outreach

Activities Report

KMOH Prepares for Nafei’ Akrawy

Certification

USAID/PHCPI MDG-supported

Studies Highlighted During ACCESS’

7th International Health Conference

Tareeq Al Sha’ab local Newspaper

Highlights PHCPI’s Achievements in

WEEKLY PROGRESS REPORT March 1 – 5, 2015

PHCPI week in review: Epi Info training course, ACCESS 7th International Health Conference and ANC-PNC training for

paramedics in Muthanna.

WEEKLY REPORT MARCH 1-5, 2015

2 | USAID/Primary Health Care Project in Iraq (PHCPI) - Weekly Report (March 1 - 5, 2015)

Support MOH efforts to Strengthen Public Health Surveillance for the Prevention and Control of Priority Diseases

Epi Info Trainers of Trainers in Babil Begin District Trainings

The Ministry of Health had only ten trainers of trainers (TOTs) for Epi Info 3.5.3 able to conduct workshops throughout the country. In order for the Ministry to further training and initiate Epi Info at the primary health care center (PHCC) level, a core of TOTs was needed at the Directorate of Health (DOH) level. To support this, PHCPI conducted 3 TOT trainings for at least two members from each DOH in order to ensure sustainability and future cascade trainings to the PHCCs. Fifty eight TOTs were established during PHCPI’s trainings.

Mr. Rafid Abdul Sahib and Ms. Hawraa Yas, two TOT Epi Info graduates from Babil, developed a training plan and have begun implementation. On March 2, 2015, Mr. Rafid and Ms. Hawraa conducted the first in a series of trainings for Babil DOH and district staff. Over the course of three days, the TOT team trained 11 participants from the DOH, 8 from the Districts and 3 from Babil CDC. According to Mr. Rafid, because of the high frequency of turnover among staff, the district staff that were trained by the project are no longer working in the surveillance units. As such, the trainings are of utmost importance to ensure the

continuation of Epi Info at the district level. Also, by training the CDC units in Babil, who previously did not use the program, the DOH is expanding the use of Epi Info to other units that can benefit from the program. The next step will be to train PHCCs and hospitals that have capabilities to implement Epi Info (i.e. computers and internet).

Expand Community Outreach Activities among IDP Populations

PHCPI Completes Assessment to Evaluate the Impact of Outreach Activities Report

PHCPI completed the “Impact of Outreach Activities on IDPs” assessment report. The aim of the rapid assessment was to evaluate the efficacy and effectiveness of the outreach activities in addressing health needs and requirements of IDPs in targeted areas in Iraq. This document discusses, in detail, the methodology that was used for the assessment including sampling, data collection, timelines, and data entry and analysis. The assessment complements the MOH’s disease-focused tools.

The rapid assessment collected information from 55 PHCCs from six targeted provinces, 250 IDPs that participated in the outreach activities and 50 health volunteers that conducted the activities. Results showed IDPs were very

Mr. Rafid Abdul Sahib conducted the first in a series of Epi Info trainings for Babil DOH and district staff .



pleased with the information received and the technique used to conduct the activities. Over 89% said they would highly recommend these types of activities to other IDPs. Although it was found that some of the clinics in Baghdad, Dohuk and Erbil were deficient in data on health indicators for IDPs (many of these clinics do not register IDPs that come to the clinic for services), the available data revealed that heath topics and issues encountered during these activities represent health priorities for IDPs. The same was true of people involved in the activities who confirmed they will recommend such activities to their colleagues in the future.

PHCPI has worked to increase IDPs’ knowledge and access to quality reproductive and child health care services with the goal of reducing short- and long-term maternal and child morbidity and mortality (MDGs 4 & 5). The assessment gave the first indications of the impact PHCPI outreach activities had on increasing IDPs’ awareness of maternal and child health issues, the adoption of basic hygiene practices and the strengthened link between IDP communities and PHC services.

PHCPI Meets with Karkh Health Promotion Unit

On March 1, 2015, PHCPI’s Health Promotion Advisor met with the Health Promotion Section Manager for Al Karkh DOH to discuss the progress and coordination of PHCPI’s and the DOH’s joint activities. The manager expressed the

importance of the project’s work in enhancing the quality of health promotion in the DOH through community mobilization, IEC materials and awareness activities. She also acknowledged the project’s contribution through capacity development for the health and medical staff and how it has increased their knowledge and skill through the PHCPI-developed guidelines and training courses.

The manager stated that the DOH, in general and her section specifically, were keen to continue with programs and continue PHCPI initiatives like local health committees (LHCs) and contact teams to improve behavior. These groups are always eager to help and have already proven to be very supportive during various field work and campaigns conducted by the DOH. Also discussed was the project’s support to the national polio vaccination campaign. The Director recognized the effort conducted by PHCPI and expressed her gratitude and admiration for the flyers and plastic bags produced by the project to support the Spring Polio Campaign.

Health Promotion Advisor Discusses Polio Campaign with MOH

On March 4, 2015, the Health Promotion Advisor met with the Director of the Health Promotion Department and the Health Education Unit Manager to discuss PHCPI support to the national polio campaign round II which scheduled to be conducted during the last week March, 2015. The Director of Health Promotion, Dr. Alia’a AlAzawi, appreciated all the assistance provided by the project in supporting the polio campaigns, especially the IEC materials developed by the project (flyers and plastic bags) which greatly assisted in the success of the campaign by increasing people’s awareness of the importance of vaccinating their children. Additionally, the Director was very impressed with PHCPI’s plan to use social media like Facebook to increase the awareness and visibility of the campaign and other health related topics. The Facebook campaign proved to reach a wider population with the ability to gain feedback through comments, shares and likes. The Manager of the Health Education Unit also clarified the importance of health messages developed for IDPs as they address essential and diverse topics which represent health needs and priorities for these vulnerable groups.



USAID/PHCPI Legacy and Transition Activities

KMOH Prepares for Nafei’ Akrawy Certification

PHCPI staff conducted a field visit to Nafei’ Akrawy (NA) PHCC to see the progress the clinic made towards certification and ensure all recommendation made by USAID and the project were implemented. PHCPI also met with KMOH PHCC Department Manager and focal point, Dr. Dluvan Sherko, DG of Erbil DOH, Dr. Saman Barazanchi, PHCC Directorate Manager, Dr. Shekhwan Asaad Abdullah and NA PHCC Manager, Dr. Hajar Mohammad about the upcoming certification ceremony next week. In the meeting, both Dr. Sherko and Dr. Mohammed confirmed that PHCPI has completed all of their obligations for NA PHCC by providing medical equipment, training staff on guidelines and orienting staff on Model Clinic concepts.

Due to federal budgeting issues throughout the country, and especially within the Kurdistan region, there have been delays in the clinic’s physical rehabilitation. NA PHCC is currently working on adding a section to the clinic to increase the medical units, however, all construction throughout the KMOH has stopped due to a lack of funds. No clear date is yet known for when the construction will be complete. As such, the Model Clinic Technical Working Group (MC TWG) has agreed to consider 70% as the passing score for these clinics.

Following this, the clinic was re-evaluated to ensure it has applied the suggestions of USAID/PHCPI and has met all other required certification criteria. The PHCPI team,

including the Regional Supervisor and the Activity Coordinator, performed a preliminary evaluation of the clinic. PHCPI found that the clinic has already taken actions towards the certification by reorienting themselves with the guidelines and training curriculums, and even using PHCPI’s Online Learning Management System (OLMS). Additional refresher courses were given to clinic staff in Infection Prevention Control (IPC) by the PHCC manager and IPC officer to ensure the staff compliance with the IPC guidelines. Also, properly covered waste containers for both medical and non-medical waste were provided and distributed throughout the clinic, with different color bags. The clinic has displayed posters for health education in the waiting areas and inside health service rooms. A training room that was available to the PHCC was stocked by PHCPI with a computer, data show and white screen to ensure trainings continue, especially for new staff. PHCPI also provided a UPS for the lab equipment and computers.

On seeing these dramatic changes in the attitude and dedication of the staff, a committee, authorized by KMOH and PHCPI, performed a formal evaluation of the PHCC to assess compliance with the MC criteria. The clinic scored 84%. The score was lowered due to the physical rehabilitation and the lack of use of the new Integrated Medical Records.

Polio vaccination at the Nafei’ Akrawy PHCC.

PHCPI staff discuss implementation of recommendations.

MARCH 1-5, 2015


WEEKLY REPORT Medical Equipment for Phase I Model Clinics

The MOH contributed to Phase I model clinics by supplying 32 clinics with modern medical equipment (diagnostic aids, X-ray, CR, ultrasound and printers) for a total cost of USD $2,618,657. Upon entering Iraq, since these equipment were imported from Japan, the Ministry of Environment conducted radiological inspection and cleared the equipment to be used. Afterwards, KIMADIA, the national company responsible for all medical equipment and medical supplies in Iraq, also had to do inspections to evaluate its performance and accuracy. KIMADIA has declared the equipment accurate and meet their requirements and are now being distributed and installed by the DOHs in the Model Clinics.

MOH Conducts Second Assessment of PHCCs for Phase II Model Clinics

After the MOH Assessment Committee completed the initial assessments of MOH-identified clinics for Phase II Model Clinic Replication, scores were given to each of the PHCCs based on the PHCPI-developed criteria. The scores were given to each of the PHCCs with the comments and suggestions for interventions to increase their scores.

The committee has now re-evaluated eight clinics from four different provinces. After the initial assessment, these clinics have implemented the suggestions and comments as well as the model clinic criteria. All of the clinics that were re-evaluated showed significant improvement in scores post-intervention (see table below).

MNCH Advisor Conducts Field Visits in Muthanna

PHCPI’s MNCH Advisor held a meeting with the Public Health Department (PHD) Manager from the Muthanna DOH as well as other section managers. The PHD Manager, expressed his appreciation for all the support Muthanna DOH has received from project. The doctors and paramedics from the PHD Units have participated in many PHCPI training courses including MNCH TOT. The skills and knowledge gained from the trainings (such as ANC/PNC, MDSR, premarital counselling, maternal and child nutrition, IMNCH, newborn care, EMONC, supportive supervision, TBA training tools and EPI) have spread to the rest of the PHCCs through the TOT graduates, which include 5 districts, 26 clinics and 37 sub-clinics.

Due to the culture of the community in Muthanna, most women do not visit clinics attended by male staff. For this reason, during 4th ANC visits, the DOH is giving pregnant women a bag containing hygienic materials for her and her baby as an incentive.

There are 11 traditional birth attendants (TBAs) trained by PHCPI linked to the PHCCs in the province. The TBAs and the LHCs set up by the project are proving to be very effective in spreading health education and awareness within the community and among the IDPs. TBAs and LHCs have proven a vital part of health awareness in Muthanna as there are more rural areas than urban.

With the influx of IDPs into Muthanna (1,400 families are being hosted by the province), the Surveillance Section Manager greatly appreciated PHCPI’s role in training the districts in Epi Info and providing a TOT course for the DOH.

PROVINCE PHCC INITIAL SCORE

(%)

FINAL SCORE

(%)

BASRAH Al-Raabet 65.3 81.2

Ez Aldin Saleem 68.7 87.5

DHI QAR

Al-Emam Al Qadem 61.7 84.5

Al-Naser Al-Namoothajy

74 90

MAYSAN Ali Al-Ridha 66.6 77.8

Dijjlah 65.3 92.6

WASIT Al-Mustafa 70.2 86

Al-Shifa’a 68.5 88.4

PHCPI’s MNCH Advisor and Health Promotion Unit Manager

at the Karkh DOH



The Manager is hoping to implement Epi Info at the district-level but has so far been unable to due to lack of computers and internet. He is especially anxious to begin Epi Info reporting at the district-level to help control the outbreak of communicable diseases as there have already been 450 cases of cutaneous Leishmaniasis, Pediculosis and scabies among students in primary schools.

Visit to Al Hurreah PHCC in Muthanna

The MNCH Advisor conducted a field visit to Al Hurreah PHCC in Muthanna, a PHCPI-targeted clinic. The advisor found the clinic to be well organized and implementing MNCH programs. The delivery room is well equipped and the staff are following the criteria for safe delivery and for referral of risky groups. Instructions, charts, information and IEC materials developed by the project are found throughout the clinic. MNCH indicators such as the ANC 4th visit and PNC are 55% and 91% respectively, an increase from last year, and measles vaccination coverage is 87%. The clinic was also seen using the integrated medical records developed by PHCPI. The clinic expressed their gratitude for the PHCPI flyers and bags that were distributed during the Spring Polio Campaign, stating it helped to increase awareness not just for polio, but for the overall vaccination schedule which was printed on the flyers.

DOHs Continue PHCPI-developed Trainings

Al Karkh DOH

Al Karkh DOH has conducted several workshops for the PHCCs related to MNCH including a 5-day workshop for physicians and paramedics working in PHCCs in Al Mahmoodia and Abu Ghrab Districts. The workshop used PHCPI guidelines and wall charts as job aids to conduct the trainings. Other trainings in EMONC were also conducted for physicians and midwives working in delivery rooms of PHCCs in Al Mahmoodia, Abu Ghraib, Al Tajee and Subia Al Bour Districts. These trainings all used the guidelines (training curriculums for facilitators and participants) and job aids (partograph of labor, protocol, labor notes and management of prolonged labor).

In a meeting with Dr. Abdul Ghani Sadoon, Al Karkh PHC Department Manager initiated a campaign last week for IDPs. The campaign utilized the health volunteers trained by the project to conduct the activities during the campaign as well as PHCPI developed health messages and guidelines. During the campaign, IDPs received lectures on basic health services covering topics related to maternal and child health, personal hygiene, protection from communicable diseases such as measles and poliomyelitis, nutrition, and non-communicable diseases such as

PHCPI’s MNCH Advisor with the staff of Al Hurreah PHCC.



hypertension. PHCPI-developed IEC materials related to these topics were also distributed among IDPs and health volunteers provided the IDPs with psychological aid and support in accordance with the guidelines developed by PHCPI.

Karbala DOH

Last week, the Karbala DOH conducted a 5-day training course for paramedics working in peripheral PHCCs in Al Hussainia District. The facilitator used the guidelines and wall chart, updated and developed by PHCPI, as a job aids.

Dr. Baida, EMONC focal point in Karabala DOH, conducted a training course in EMONC for physicians and midwives working in the delivery rooms of PHC centers in Al Hundia District. The trainer, who was trained by PHCPI, used the guidelines (training guide for facilitator and participants) and the Job Aids (partograph of labor, protocol, labor notes and management of prolonged labor) developed by the project.

Recent PHCPI Documents Translated into Arabic and Kurdish

Since October 2014, PHCPI focused on helping to support MOH coordination efforts for strengthened surveillance and immunization systems, improved PHC staff capacity in prevention and control of priority communicable diseases, and increased access for internally displaced persons (IDPs) to PHC services. Ultimately, achieving these objectives will assist the MOH in meeting MDGs 4 & 5. As such, PHCPI has developed and revised several documents in each of these areas in coordination with international experts, the MOH and, occasionally, with other donors such as WHO and UNICEF.

PHCPI documents represent part of the project legacy for the MOH and KMOH and, as such, PHCPI translated these documents into the two most commonly used languages in Iraq, Arabic and Kurdish. As many staff in the Ministry, as well as other stakeholders that might benefit from the documents (i.e. LNGOs), are not proficient in English, this will ensure the documents are used to their fullest potential.

USAID/PHCPI MDG-supported Studies Highlighted During ACCESS’ 7th International Health Conference

USAID/PHCPI participated in ACCESS’ 7th International Health Conference in Oman from March 1-7, 2015 which was held under the patronage of H.H. AlSayyid Shihab binTariq Al-Said, Advisor to his Majesty the Sultan. The conference was jointly organized by ACCESS’ Community Health and Research Center and the Sultanate of Oman Ministry of Health and focused on six themes: regional public health issues, primary health care, capacity building; social determinants of health; infectious diseases; occupational health, trauma and environmental hazards; mental health and chronic disease and ethics and palliative care.

PHCPI’s scope and impact in Iraq was greatly highlighted at the conference with wide visibility and ability to share lessons learned. In addition, Chief of Party, Dr. Hala Jassim Al-Mossawi, facilitated an oral presentation on the project’s study of Assessing Maternal and Child Health Quality and Barriers to Improvement in Iraq. She highlighted USAID’s legacies in Iraq and changes made as a results of PHCPI’s interventions. In addition, PHCPI shared with the Oman Ministry of Health, and conference

IMNCH trainings using PHCPI-developed IEC materials and wall charts.



participants, copies of the products developed by the project (electronic and hard versions) including health messages and guidelines. Oman’s MOH Health Promotion Manager, Dr. Halima AlHania’a, appreciated USAID’s participation and efforts to support the Iraqi health sector and thanked USAID for the valuable products. Oman local media and news highlighted USAID/PHCPI’s presentation and achievements in Iraq in an article issued on March 5, 2015.

The conference brought top health and governmental officials, a broad mix of more than 500 attendees representing 22 MENA countries, including physicians, public health professionals, epidemiologists, scholars and environmental experts, among others. Over 140 health professionals and officials from the US also attended the conference. This conference represents an incomparable opportunity to demonstrate health achievements in Iraq as well as learn of successes from other Arab countries with similar health landscapes. Speakers included medical and academic professionals from across the U.S., Oman, Egypt, Saudi Arabia, Palestine, Lebanon, Iraq, Jordan, the UAE, Qatar, Algeria, Morocco, Yemen, Kuwait, the UK, Sudan and India with a goal to create collaborative initiatives aimed at improving the management of mental health and chronic

disease conditions in Arab patient populations around the world.

MDGs 4 & 5: Supporting the Reduction of Maternal and Under-Five Mortality

Beginning in Fiscal Year 2014, PHCPI focused its technical assistance on helping the MOH meet its Millennium Development Goals (MDGs) 4 & 5 of reducing child mortality and improving maternal health in target project areas. The project developed a package of low-cost, high-impact interventions for improving maternal, neonatal, and child health (MNCH). Using the project’s capacity building strategy, PHCPI, in partnership with the MOH, has updated a number of clinical guidelines related to MNCH. These guidelines are being introduced to primary health care service providers through the cadre of TOTs developed by PHCPI in each province. The project’s MNCH initiative is further strengthened by the LHCs working within the catchment areas of each of the project’s target clinics. These LHCs are working in partnership with clinics to increase demand for and use of PHC services, particularly among vulnerable populations, including IDPs.

PHCPI has conducted four studies for MCH including a study of ANC services at PHCCs across Iraq to determine gaps in quality and access to care, a study on pediatric

Dr. Hala Jassim, PHCPI COP, facilitates oral presentation on PHCPI’s MDG 4&% targeted study.



deaths in hospitals, judiciary offices and Forensic Pathology Units to determine causes of under-five mortality and key health care gaps and a study on TBAs to determine knowledge gaps and their impact on MNCH. Additionally, PHCPI conducted an assessment of Maternal Deaths Recording and Reporting to determine the value of mortality reporting as a monitoring tool.

PHCPI worked closely with the MOH to develop, update, and disseminate guidelines, job aids and conduct training workshops to improve immunization throughout Iraq. PHCPI activities led to over 2,198 vaccinators and 535 supervisors being trained on Iraq’s Expanded Program of Immunization (EPI), AFP, vaccination side effects, vaccination guidelines, cold-chain management for vaccines, vaccination ages and the schedule of vaccination.

As a result of PHCPI’s MDG-focused interventions, clinics supported by the project have seen significant increases in MDG 4 and 5 indicators. Additionally, under-5 mortality in provinces where the project was active significantly decreased from 2012 to 2014.

Tareeq Al Sha’ab local Newspaper Highlights PHCPI’s Achievements in Iraq

Tareeq Al Sha’ab (Arabic for: The People’s Way) interviewed USAID/PHCPI COP, Dr. Hala Al Mossawi. In the article, the author concluded that this project should be far from over. According to the article, one of the project’s key programs is “increasing community partnerships in primary health care” as it facilitates access to PHC services especially for the vulnerable groups, ultimately reducing

morbidity and mortality. The article goes on to list PHCPI’s achievements over the past four years leading towards improving primary health care in Iraq.

Tareeq Alsha’ab Newspaper emphasized that the exchange of experience, capacity building and information are the elements of the modern policy adopted by most health systems around the world. Informational and technological revolutions are racing against time and civilization, and transparency is always needed. Health status in Iraq suffers due primarily to poor health awareness, inadequate statistics/data, lack of professional knowledge, weak performance and absence of monitoring and follow-up.

For these reasons and more, the author states that the “vital goals achieved by the project need further support as the health status in Iraq requires more training and effort to raise the level of performance as well as scientific, clinical and technological knowledge.”

PHCPI Activities—Progress towards achieving deliverables

Project Staffing

Dr. Atheer is the Regional supervisor and coordinator for KRG activities, Dr. Saif Amthal for the Central Region and Dr.

Haider Saadoon is the contact for the South Region.



Personnel Count March 1– 5, 2015

Expatriate Personnel Male Female Sub Total

Baghdad 0 1 1

Sub Total 0 1 1

CCN Personnel Male Female Sub Total

Baghdad 17 5 22

Erbil 1 0 1

Basrah 1 0 1

Sub Total 19 5 24

Total 25

DELIVERABLE TOTAL GOAL % COMPLETE

EPI Training 2,057 2000 103%

Epi Info Training 339 260 130%

Orientation Workshop for Health

Volunteers 206 200 103%

Outreach Activities 250 250 100%

IDP Families reached through Activities 8,151 6,000 136%

Immunization Master Trainers 80 80 100%