MATERNAL AND CHILD SURVIVAL PROGRAM (MCSP)

STRENGTHENING LIBERIA'S FRONTLINE HEALTH WORKFORCE POST-EBOLA

Part 1 of 3: Environmental Screening Form

Project Name:

Maternal and Child Survival Program/Human Resources for Original IEE File #/DCN:

Health - Strengthening Liberia's Frontline Health Workforce: Pre- _gh13-16 Service Education for Registered Midwives and Medical Laborato1y Technicians

Name of Prime Implementing Organization: Date of Screening: Jhpiego

Name of Sub-awardee Organization (if this EMMT is for a Funding Period for this award: sub):

FY 2016 - FY 2018

Geographic location of USAID-funded activities (Province, District):

• Lofa County Current FY Resource Levels: • Grand Gedeh County

• Montserrado County FY$10m

• Bong County

This report prepared by: Date of Previous EMMT for this

Name: Marion Subah organization (if any):

Date: May 10, 2017 Novemeber 15, 2016

Indicate which activities your organization is implementing.

Key Elements of Program/ Activities Implemented Yes No

1 Education, Technical Assistance, or Training x

Includes: strategic planning, data analysis, technical consultation, surveys, knowledge and information transfer, meetings, technical material development, outreach programs, and training services.

2 Research and Development x

Includes: health-related research and development activities aimed at advancing knowledge and technology, including research and evaluation, monitoring and surveillance, programs, pilot studies, case studies, and assessments.

3 Public Health Commodities x

Includes: procurement, storage, h·anspo1tation, distribution, and disposal of public health commodities, including pharmaceuticals, nutritional supplements, chemicals (e.g., disinfectants, solvents, laboratory reagents, etc.), medical supplies, and family . planning commodities (e.g., conh·aceptives, condoms, etc.).

4 Small-Scale Construction or Rehabilitation x

Includes: hospitals, clinics, laboratories, voluntary and counseling testing centers, or training centers. Total surface area of the disturbed environment is under 10,000 square feet and less than $200,000 total cost.

5 Small-Scale Water and Sanitation x

Includes: pond and spring improvements and installation of hand-dug wells, individual or community latrines, hand-washing stations, and small-scale septic and leach field systems.

6 Nuh·ition x

Includes: small-scale food production, procurement and distribution of supplements, preventing undernutrition, providing nutritional care and support, and improving nutritional outcomes in programs.

7 Vector Control x

Includes: procurement, distribution, or use of pesticide products such as insecticide-treated bed nets, larvicide agents, and fumigants.

NOTE: USAID uses USEPA's definition of pesticides, which includes "any substance intended for: preventing, destroying, repelling, or mitigating any pest. This includes herbicides, fungicides, plant regulators, and desiccants."

Emergency Response x

8 Includes: coordinat ion with outside organizations and technical expe1ts, deployment of resources and response teams, and development of technical materials.

DESCRIPTION OF ACTIVITIES: The Maternal and Child Survival Program (MCSP) is a global U.S. Agency for Internat ional Development (USAID) cooperative agreement to introduce and support high-impact hea lth interventions in 24 priority count ries with the ultimat e goa l of ending preventable child and maternal deaths (EPCMD) w ithin a generation.

In light of the second order impacts of the 2014 Ebola Virus Disease (EVD) Outbreak, USAID/liberia requested MCSP to support its commitment to strengthening Liberia's frontline health workforce through the new MCSP/ Human Resources for Health (HRH) project. This project, funded with Ebola Emergency Funding, is particularly focused on M idwifery and Medical Laboratory technician pre-service education in targeted institutions throughout the country. Due to Jhpiego's and our partners' history in Liberia, MCSP/ HRH is uniquely positioned to contribute to USAID/ Liberia's strategy toward strengthening and expanding Liberia's skilled health workforce and ending preventable child and maternal death.

GOALS AND OBJECTIVES MCSP/HRH's overarching goal is to rapidly mitigate the second order impacts of Ebola through a t argeted techn ica l approach focused on clinica l competency of front line midwives and lab technicians, and an aggressive

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implementation strategy designed for rapid improvements and results. MCSP/HRH will reach the project goal- to strengthen the capability and resilience of Liberia's frontline health workforce to address second order impacts from the Ebola crisis- by strengthening pre-service training of midwives and laboratory personnel-two critical cadres whose shortage and lack of adequate training contribute to Liberia's vulnerability to public health crisis. This will be accomplished through the following specific objectives:

1. Increase the quality of instruction at targeted pre-service training institutions by upgrading the techn ical competencies and teaching skills of faculty, including clinical preceptors, and strengthening curricula, course materials, and delivery of both didactic and clinica l training.

2. Strengthen the learning environment at targeted pre-service training institutions and clinical teaching sites in a comprehensive way through improved access to high-quality instructional resources, equipment, and technology.

To this end, MCSP/HRH will target the 5 functional midwifery schools and 3 laboratory schools.

TECHNICAL APPROACH The technical approach and implementation strategy MSCP will employ is driven by three main considerations:

1. Not business as usual : the situation in Liberia, the nature of Ebola funding, and the short time period of this project, require rapid results, including hiring and support of add itional local faculty-consistent with goa ls outlined in the Health Workforce Program Strategy.

2. Need to show rapid and measurable results: MCSP/HRH needs to support quick restorat ion of quality maternal and lab services to mitigate the second order impacts of EVD. Our implementation strategy has taken this Government of Liberia expressed need very seriously.

3. Clinical competence is core: Jhpiego's 2012 integrative review of the direct and indirect influences on pre­service education provides clear evidence: early, varied and robust clinical practice is the heart of developing competent graduates. We have reflected this strategic priority in our technical approach.

The conceptual model based on this literature review frames MCSP/HRH's technical approach. Priority actions for each direct influencing factor will be addressed, all towards the primary goal of clinical competence. Ongoing work with CSH, World Bank, HRSA, Global Fund and other partners to st rengthen regulation and performance outcomes will be leveraged.

Figure 1: Pre-Service Educational Conceptual Model

PRE-SERVICE EDUCATION

DEPLOYMENT

L TIO.I

3I Page

OUTCOMES

I ifLutllCltal FAOTOll

• • · , . .

Health and Health Systems Impact

HlllULATION

May 10, 2017

STRATEGIC PRIORITIES MSCP/HRH will focus on three strategic priorities, including: prioritizing clinical practice to quickly improve service delivery, ensuring sufficient IPC, and critical MNH and essential laboratory skills; a geographic focus for clinical practice site expansion that is consistent with GOL recent census data as well as with GOL priorities and other USAID investments; and, applying evidence from two literature reviews conducted by MCSP, as well as program learning from MCHIP and MCSP programs are app lied in our technical approach and recommendations for key interventions.

IMPLEMENTATION STRATEGY MCSP/HRH's implementation strategy is summarized in the graphic below, including the priority actions for each primary influencing factor to ensure competence and strengthen the pre-service education system. MCSP/HRH will apply recent pre-service education best practices from previous MCHIP and current MCSP programs, such as expanding the network of clinical practice sites by preparing rural primary health care clinics and staff to accept students for rotations, and providing simulation-heavy, workplace-based technical updates and coaching for clinical practice site staff .and faculty.

Figure 2: Implementation Strategy

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Short-Term Saturation: Rapid <;el up tor twinning

Heavv initial short-term technical assistance and start up support ----=--- Long-Term Capacity Building :

Rapid Start-Up:

Strengthened clinical processes

School leadershlp and manauement support

Desk review and Assessment of Program Management Support

Clinical Practice

Expanded PHC sites

Preceptor corners

Preceptor preparation

Clinical mentors/ quality assurance

Simulation labs

Gender sensitization

Coordination

Prioritize Cllnlcal Practice

Students

Leveraging of senior students

Student remediation

Marketing of the professions

Pre-deployment preparation

Facultv/ Preceptors

Blended teaching skill updates

Site-based refresher training

Structured twinning

Build Local Capacity

Geographic Focus

lnlraslructure/ Curriculum Management

Skills lab updates Rapid task and guidance analysis

Computer lab, Strengthened learning clinical practice

resources rotations

Leadership and Curriculum management update development/

twinning Leveraging of open-source

digital content

Rapid Results

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Key MCSP HRH Liberia Interventions

Rapid Assessment and Start Up

OBJECTIVE I: Increased quality of instruction at targeted pre-service training institutions achieved by upgrading the technical competencies and teaching skills of faculty, including clinical preceptors, and strengthening curricula, course materials and delivery of both didactic and clinical training.

Task I. I: Support hir ing of additional faculty in midwifery and lab schools

Task 1.2: Provide faculty with up-to-date teaching skills and facu lty development opportunities

Task 1.3: Strengthen the preparation of clinical preceptors

Task 1.4: Upgrade the technical competencies of faculty, preceptors and matriculating class of midwifery and lab graduates

Task 1.5: Strengthen clinical instruct ion

Task 1.6: Upgrade teaching and learning curricula

OBJECTIVE 2: Strengthened learning environment at targeted pre-service training institutions and teaching sites through a comprehensive approach to improving access to high-quality instructional resources equipment and technology

Task 2.1 Improved skills labs at midwifery schools, improved and sufficient equipment for lab schools

Task 2.2 Provide equipment, supplies and light infrastructure improvements to strengthen clinical sites.

Task 2.3 Establish improved clinical practice management processes

Task 2.4 Support schools to strengthen management and administrative systems, leveraging structured twinning partnerships

Task 2.5 Coordinate the upgrade of existing computer labs, or establishment of new ones

RESEARCH, MONITORING AND EVALUATION

MCSP/HRH's research, monitoring and evaluation activities and systems have been designed to regularly collect and synthesize data in order to inform program planning and decision-making. Data collection activities will rely as much as possible on the routine data that is already collected by institutions and cl inical practice sites .

Several formative assessments have been undertaken.

• A Ra pid Needs Assessment as part of collect ing specific and detail information t o inform the in-depth work planning and implementation of the proj ect. The objective of t he Rapid Needs Assessment was to determine needs and actions that can be used t o direct timely action aimed at identifying potentia l "quick fixes" and bottlenecks that may require long-te rm and sustained interventions. Scores were used to guide program planning decisions needed to prioritize act ions, develop budgets, and allocate resources and logica lly sequence steps aimed at improvement.

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• A Task Analysis was conducted for MLT and midwives in May 2016 to focus efforts on st rengthening the education of these two cadres of health care workers most effectively. The focus of this particular Task Analysis study was t o inform curricula revisions for the two target cadres of midwives and ML Ts. Results have been documented in a short report and are currently being used to inform curricula updates.

• A Gender Analysis has also been undertaken; similar to the Task Analysis. The objective of the Gender Analysis was to assess the gender determinants of successes and challenges of midwifery and lab technician students and the gender responsiveness of pedagogy, t eaching skills, and management systems at the targeted 5 functional midwifery schools and 3 la boratory schools, with the ultimate goa l of identifying key gender issues to be addressed to improve student enrollment, retention (reduce drop­out), and performance.

These assessments have and will continue to be used to inform program act ivities and decision making. No other research activities are planned at this t ime.

EXPECTED RESULTS Interventions implemented under this program will ensure that clinical/practice sites are expanded and st rengthened for both midwives and lab technicians, and training is coordinated to have comprehensive classroom, clinical practice and laboratory components for both cadres. MCSP/HRH will ensure that preceptors are equipped with teaching and practical clinical skills and resources and that the learning environments and resources at target institutions are enhanced to maximize learning. Furthermore, when updating curricula, MCSP/HRH will take into consideration the impacts of the Ebola outbreak and address GOL priorit ies such as IPC.

MCSP/ HRH will work closely with the MOH, NMCP and other USAID-supported programs working to st rengt hen health systems and health workforce planning. MCSP/ HRH will prioritize work on student selection and recruitment, as well as academic program management to plan and forecast for student intake. It will also

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Environmental Monitoring and Mitigation Template (EMMT)

MCSP HRH Program

Part 2 of 3: Environmental Mitigation and Monitoring Plan (EMMP)

Category of Describe specific Activity from environmental threats of your Description of Mitigation Who is responsible Monitoring Indicator Monitoring Method Frequency Section 3 of organization's activities Measures for these activities as for monitoring? of theMNCH (based on analysis in Section required in Sections 4 and 5 of Monitoring

Project PIEE 3 of the MNCH Project PIEE) the MNCH Project PIEE 1. Education, • No environmental • Proper waste • Program • Practices are • Supportive During Technical impact segregation and Officer compliant Supervision training and Assistance, anticipated disposal through with MOH • During training supervision Training • While facilitating provision of color • Pre-service IPC Policies,

and other visits trainings, there will be coded bins Education activities at the small amounts of waste Guidelines site generated during • Rearrangement of Advisors

and practice demonstration clinical training settings

Minimum and client flow to meet • Products, such as MOH IPC standard Standards

reagents for lab tests, • Pre Service

medications, syringes, • Monitoring the Education • Numberof

gloves, condoms, availability of Post Institution severe adverse

needles, cotton swabs, Exposure Prophylaxis Mentors events

gauze, forceps, etc. may and Guidelines managedand contribute to • Monitoring, managing reported environmental pollution and reporting adverse following

events Jhpiego

• Use of water dispensers guidelines

during trainings and meetings

• Ensure that Ministry of Health's Infection Prevention and Control Protocols and Minimum Standards are in place and being . operationalized

• Staff training on MOH Minimum Standards on Medical Waste Management and the

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Environmental Monitoring and Mitigation Template (EMMT)

Category of Describe specific Activity from environmental threats of your Description of Mitigation Who is responsible Monitoring Indicator Monitoring Method Frequency Section 3 of organization's activities Measures for these activities as for monitoring? of theMNCH (based on analysis in Section required in Sections 4 and 5 of Monitoring

Proiect PIEE 3 of the MNCH Project PIEE) the MNCH Proiect PIEE

Use of Personal Protective Equipment (PPE) scheduled and completed

2. Research • No environmental • N/A • N/A • N/A N/A N/A and impact Development anticipated as

research only includes social and behavior qualitative studies and assessment and no clinical trials demonstrations or practical or introduction and evaluation of any substance

3. Public • Expired • Capacity building of • MCSP • Proportion of • Site/Pre Every Health commodities can health care Program facilities with Service Third Commodities cause harm if used providers, in Officer staff trained in Training Month

by humans particular Preceptors logistics and Institutions • Expired and Pre Service • County pharmaceutical Supervision

commodities can Education Institution Health team products, contaminate the Faculty on Proper (CHT) LMIS and soil, harm Commodity Supply Supply Chain vegetation and Management Chain Management pollute water Systems to minimize Officer System (SCMS) systems expiration or waste • Proportion of

• Expired laboratory of Public Health • County facilities with reagents may lead Commodities Health system in place to erroneous results • Ensure MOH system Officers to identify ifused to identify expired expired

• Unsafe disposal of commodities, • District reagents and

consumables such reagents and other Health drugs, remove

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Environmental Monitoring and Mitigation Template (EMMT)

Category of Describe specific Activity from environmental threats of your Description of Mitigation Who is responsible Monitoring Indicator Monitoring Method Frequency Section 3 of organization's activities Measures for these activities as for monitoring? of theMNCH (based on analysis in Section required in Sections 4 and 5 of Monitoring

Project PIEE 3 of the MNCH Project PIEE) the MNCH Project PIEE

as condoms and medical utilities, Officers them from gloves can remove them from shelves, place contaminate soil, shelves, place them • Officer in label on boxes harm vegetation, in well labeled boxes Charge at and forward to and pollute water. and/ or color coded Health disposal/incine They may also disposal bins, and Facility ration points spread infection to forward them to • Proportion of humans incineration/ disposal facilities with

points is adhered to • Pre-service expired drugs

education in store at time advisors of verification

visit

• Pre-service education mentors

• Preceptors/ Master mentors

4. Small- N/A N/A N/A N/ A N/A N/A Scale Construction

5. Small- N/A N/A N/A N/A N/A N/A Scale Water and Sanitation

6. Nutrition N/A N/A N/A N/A N/A N/A

7. Vector N/A N/A N/A N/A N/A N/A Control

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Environmental Monitoring and Mitigation Template (EMMT)

Category of Describe specific Activity from environmental threats of your Description of Mitigation Who is responsible Monitoring Indicator Monitoring Method Frequency Section 3 of organization's activities Measures for these activities as for monitoring? of theMNCH (based on analysis in Section required in Sections 4 and 5 of Monitoring

Proiect PIEE 3 of the MNCH Project PIEE) the MNCH Project PIEE 8. N/A N/ A N/A N/A N/A N/A Emergency Response

Prepared by: Kolt' fo.. (£.~

Date: __ 5/19/2017 _____ _

Koki Agarwal, Director, MCSP

Mission Environmental Officer:

Signature Date: ______ _ _

Reviewed and Approved by:

Signature M~ Date: 5/31/2017

Agreement Officer's Representative/Contracting Officer's Representative

Concur:

Signature ~ ~ Date: {;1/ J] /;;;_ I

GH Bureau Environnemental Officer

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