Program to Build Leadership and Accountability in …pdf.usaid.gov/pdf_docs/PA00MFQV.pdfIn photo (from left to right): Dr. Francis Udoikpong, former Akwa Ibom Commissioner for Health;

Program to Build Leadership and Accountability in Nigeria’s Health

System – PLAN-Health, Nigeria

Quarterly Progress Report, October - December, 2015

Author: Management Sciences for Health

Date: December 1, 2015

To provide support and technical assistance to government agencies actively involved

in the development and implementation of health policies and to develop local

expertise to build capacity for leadership and management in Nigeria.

5 Key Words: Leadership, Capacity, Nigeria, PLAN Health, Prevention

The following document is a quarterly report written by Management Sciences for

Health for submission to USAID under the agreement.

Management Sciences for Health 200 Rivers Edge Drive Medford, MA 02155 Telephone: (617) 250-9500 http://www.msh.org

This report was made possible through support provided by the US Agency for International Development and

under the terms of Cooperative Agreement Number 620-A-00-10-00009-00. The opinions expressed herein are

those of the author(s) and do not necessarily reflect the views of the US Agency for International Development.

http://www.msh.org/

Page 1

Leadership, Management and Sustainability (LMS) Project, Program to Build Leadership and Accountability in Nigeria’s Health System (PLAN-Health)

Quarterly Report 1st Quarter FY16 – October 1to November 30, 2015

Page 2

Submission Date: December 1, 2015 Cooperative Agreement Number: 620-A-00-10-00009-00 Activity Start Date and End Date: June 11, 2010 to December 6, 2015 AOR Name: Dr. Abimbola Kola-Jebutu

Submitted by: J o y K o l i n , P r o j e c t D i r e c t o r

Management Sciences for Health (MSH) Plot 564/565 Independence Avenue, Central Business District Abuja, Nigeria Tel: +234 805005345 Email: c/o Country Representative Dr. Zipporah Kpamor ([email protected])

Joy Kolin, Project Director ([email protected])

Photo on cover: Group photo from the PLAN-Health Akwa Ibom project review and dissemination meeting, October 28, 2015. Photo by MSH.

In photo (from left to right): Dr. Francis Udoikpong, former Akwa Ibom Commissioner for Health; Ms. Kathleen Alvarez, Portfolio Director, Management Sciences for Health (MSH); Ms. Joy Kolin, Project Director PLAN-Health, Management Sciences for Health (MSH); Sir Etekamba Umoren, Akwa Ibom Secretary to the State Government; Dr. Glory Emmanuel Edet, Commissioner of Women Affairs and Social Welfare, Akwa Ibom State; Dr. Philip Dayal, Deputy Director, Office of HIV/AIDS-TB, USAID/Nigeria; Dr. Dominic Ukpong, Akwa Ibom State Commissioner for Health; Mrs. Stella Usah, Permanent Secretary, Akwa Ibom State Ministry of Health

mailto:[email protected]

mailto:[email protected]

Page 3

Table of Contents

ACRONYMS ..................................................................................................................................................... 4

1. PROGRAM OVERVIEW/SUMMARY .......................................................................................................... 6

2. ACTIVITY IMPLEMENTATION PROGRESS ............................................................................................... 13

3. INTEGRATION OF CROSSCUTTING ISSUES AND USAID FORWARD PRIORITIES .................................... 22

4. STAKEHOLDER PARTICIPATION AND INVOLVEMENT ............................................................................ 23

5. MANAGEMENT AND ADMINISTRATIVE ISSUES .................................................................................... 23

6. LESSONS LEARNED ................................................................................................................................ 23

7. PLANNED ACTIVITIES FOR NEXT QUARTER ........................................................................................... 24

8. WHAT DOES USAID NOT KNOW THAT IT NEEDS TO? ........................................................................... 24

9. HOW IMPLEMENTING PARTNER HAS ADDRESSED A/COR COMMENTS FROM THE LAST QUARTERLY OR SEMI-ANNUAL REPORT............................................................................................................................ 24

ANNEX A: PROGRESS SUMMARY .................................................................................................................. 25

ANNEX B: TraiNET REPORT ........................................................................................................................... 53

ANNEX C. SUCCESS STORY ............................................................................................................................ 54

ANNEX D. TBA DOCUMENTS (cover pages) .................................................................................................. 57

Page 4

ACRONYMS

AIDS Acquired Immune Deficiency Syndrome AKSACA Akwa Ibom State Agency for the Control of AIDS AKSASCP ANC

Akwa Ibom State AIDS/STD Control Programme Antenatal Care

AOR Agreement Officer's Representative ARRDEC Antof Rural Resource Development Center ART Antiretroviral Therapy BoT Board of Trustees CBHI Community-Based Health Insurance CBSHIP Community Based Social Health Insurance Program CCM Country Coordinating Mechanism CHS College of Health Sciences CPD Community Partners for Development CSO Civil Society Organization DPRS Department of Planning, Research and Statistics EOP End of Project EULG FCT

Essiem Udim Local Government Federal Capital Territory

FMOH Federal Ministry of Health FMWA Federal Ministry of Women Affairs HCT HIV Care and Treatment HIV Human Immunodeficiency Virus HMIS Health Management Information System HR Human Resources IPC Interpersonal Communication IR Intermediate Result LDP Leadership Development Program LGA Local Government Area M&E Monitoring and Evaluation MNCH MoH

Maternal, new-born and child health Ministry of Health

MOU Memorandum of Understanding MSH Management Sciences for Health NACA National Agency for the Control of AIDS NASCP National AIDS Control and Prevention Program NHIS National Health Insurance Scheme NHOCAT National Harmonized Organizational Capacity Assessment Tool NPHCDA National Primary Healthcare Development Agency NSHDP National Strategic Health Development Plan OAU Obafemi Awolowo University OOP Out-of-pocket Payment OPG Overarching Project Goal OVC Orphans and Vulnerable Children PEPFAR President’s Emergency Plan for AIDS Relief

Page 5

PHC Primary Healthcare Center PLAN-Health Program to Build Leadership and Accountability in Nigeria’s Health System PMP Performance Monitoring Plan PMTCT Prevention of Mother-to-Child Transmission PSI Public Service/Sector Institutions SMoH State Ministry of Health STG STI

Standard treatment guidelines Sexually Transmitted Infection

TA Technical Assistance TB Tuberculosis TBA Traditional Birth Attendant TOR Terms of Reference TOT Training-of-trainers TWG Technical Working Group USAID United States Agency for International Development UUTH University of Uyo Teaching Hospital

Page 6

1. PROGRAM OVERVIEW/SUMMARY

Program Name:

Program to Build Leadership and Accountability in Nigeria’s Health System (PLAN-Health)

Activity Start Date And End Date:

06/11/2010 to 12/06/2015

Name of Prime Implementing Partner:

Management Sciences for Health

[Contract/Agreement]Number:

620-A-00-10-00009-00

Name of Subcontractors/Subawardees:

None

Major Counterpart Organizations

None

Geographic Coverage (cities and or countries)

Akwa Ibom State, Gombe State and the Federal Capitol Territory (FCT)

Reporting Period:

October 1, 2015 – November 30, 2015 (First Quarter)

Total Estimated Contract/Agreement Amount:

$24,995,963

Obligations to Date: $21,754,265

Current Pipeline Amount: $1,030,256

Accrued Expenditures This Quarter (October actuals and November and December accruals):

$820,011

Activity Cumulative Accrued Expenditures to Date (November 30):

$20,724,009

Estimated Expenditures Next Quarter:

$210,245.38

Report Submitted Date: Joy Kolin, Project Director

Submission Date December 1, 2015

Page 7

1.1 Program Description/Introduction The Program to Build Leadership and Accountability in Nigeria's Health System (PLAN-Health) is a five-year follow-on to the Capacity Building Project which ended in May 2010. PLAN-Health strengthens the leadership and management capacity of the Government of Nigeria and civil society institutions at the national and state levels to provide improved HIV and AIDS and associated health services. To achieve this objective, PLAN-Health has two broad, but related, strategic goals: (1) Provide support and technical assistance to government agencies actively involved in the development and implementation of health policies and their respective frameworks; and (2) Develop local expertise to build capacity for leadership and management within the Nigerian context. These goals are reached through six intermediate results:

• IR1. Leadership and management practices of civil society organizations (CSOs) and public sector institutions (PSIs) strengthened.

• IR2. Organizational systems of CSOs and PSIs developed/strengthened. • IR3. Governance practices, e.g., accountability, board development, business development, of

CSOs and PSIs strengthened. • IR4. Partnerships and coordination among CSOs and PSIs at all levels strengthened. • IR5. A new cadre of individuals and institutions providing technical assistance in management

and leadership that meets international standards developed. • IR6. Institutional capacity of the National Health Insurance Scheme (NHIS), state counterparts,

local communities and select CSOs strengthened to provide access to quality health services through sustainable community based health insurance programs.

Page 8

1.2 Summary of Results to Date

The PLAN-Health project’s Performance Monitoring Plan (PMP) documents five Overarching Project Goals (OPGs) with 15 outcome level indicators and 31 output level indicators, for a total of 51 indicators. As of November 30, 2015 the project achieved End of Project (EOP) targets for four out of the five OPG indicators. For OPG #1.4, the only OPG indicator that was not met, PLAN-Health was able to achieve 90% of the indicator target by working with all PSI clients that had the ability to contribute towards achieving this target. Targets for OPG #1.1 and OPG #1.2 were met while the targets for OPG #1.2 and OPG #2.1 were surpassed. EOP targets for 13 out of the 15 outcome level indicators have been met. The two outcome level indicators that are below the EOP targets achieved 87.50% (Outcome #2.2) and 91.67% (Outcome #4.1) of their indicator targets. Please see Annex A for an explanation of why these indicators did not meet their targets by EOP. During this quarter, the project continued and finalized the implementation of the no-cost extension activities during this reporting period and achieved 100% of its targets. A summary of specific achievements is in Annex A of this report.

Page 9

Table 1: Summary of PLAN-Health achievement against indicator targets

Standard indicators

Baseline FY11 (June 2010)

Annual Target (EOP Target)

Cumula-tive Achieved (Jul 2010 – Dec 2015)

Q1 FY15 Achieve- ment (Oct - Dec 2014)

Q2 FY15 Achieve-ment (Jan-Mar 2015)

Q3 FY15 Achieve-ment (Apr - Jun 2015)

Q4 FY15 Achieve- ment (Jul – Sept 2015)

Q1 FY 16 Achieve-ment ( Oct – Nov 2015)

Annual Performance Achieved to the End of Reporting Period (% of target)

On Target Y/N

OPG#1.1: HIV patient satisfaction index

0 4 4 1 1 0 0 0 100% Y

OPG#1.2: #/% of CSOs receiving PLAN-Health support demonstrate improved HIV/AIDS service delivery, disaggregated by level (S, L)

0% 66% 84% 67% 88% 0% 0 0 88% Y

OPG#1.3: Health facilities in selected LGAs show improved HIV/AIDS service delivery

0 45 45 0 1 3 5 0 100% Y

Page 10

Standard indicators










On Target Y/N

OPG#1.4: Improved coordination of Federal PSIs with State PSIs and State PSIs with their local counterparts in selected States

0 10 9 0 0 0 0 0 90% Y

OPG#2.1: A structure is identified or created that will coordinate the cadre of health professionals that demonstrate expertise in health systems strengthening

0 1 2 0 0 0 0 0 200% Y

1.1 # of organizations with managers using acquired leadership skills

0 32 32 0 0 0 0 0 100% Y

Page 11

Standard indicators










On Target Y/N

1.2 # organizations achieving desired performance according to action plan indicators

0 37 38 0 0 0 0 0 105.41% Y

2.1 # of Nigerian CSOs with capacity to manage USAID grant funds as defined in a pre-award survey checklist

0 15 16 3 2 2 0 0 106.67% Y

3.4 # of CSOs that successfully source funds using project tools and approaches

0 16 19 5 3 0 0 0 118.75% Y

5.1.2 # of individuals completing fellowship program

0 125 190 35 0 0 0 0 148.00% Y

Page 12

Standard indicators










On Target Y/N

6.1 # of health finance managers with improved understanding of health insurance management for CBSHIP

0 60 64 0 0 0 0 0 106.67% Y

13

2. ACTIVITY IMPLEMENTATION PROGRESS 2.1 Progress Narrative

This report summarizes the last quarter of the PLAN-Health project. The report encompasses activities implemented during the months of October and November, as the project end date is December 6, 2015. During this quarter the project continued to focus on the four main activity areas of the no-cost extension:

1. Strengthening the Ukana West Ward II community-based health insurance (CBHI) scheme 2. Supporting the Obafemi Awolowo University (OAU) Fellowship program 3. Development and institutionalization of a policy framework to coordinate, regulate and

supervise traditional birth attendants (TBAs) and other unskilled birth attendants for increased uptake of PMTCT and improved maternal and child health indices

4. Strengthening Akwa Ibom CSOs’ resource mobilization and fundraising skills to enhance sustainability

Since this is the last project quarter, teams focused on transitioning activities to stakeholders, documenting results, and drafting the final technical report.

One of the highlights from this period was the project review and dissemination meeting in Akwa Ibom State that took place on October 28, 2015. A total of 108 stakeholders from the Akwa Ibom state government, USAID, CSOs, implementing partners and donor organizations joined MSH and the PLAN-Health team in Uyo, Akwa Ibom to celebrate project achievements. The guests of honor included the Commissioner of Women Affairs and Social Welfare, Akwa Ibom State (who represented the wife of the Governor); the Akwa Ibom Secretary of State Government; current and past Akwa Ibom health commissioners; the Deputy Director of the Office of HIV/AIDS-TB at USAID/Nigeria; and the Akwa Ibom Ministry of Health’s Permanent Secretary.

During the event the Commissioner of Women Affairs and Social Welfare unveiled eight TBA policy guidelines developed by PLAN-Health for deployment in three pilot LGAs in Akwa Ibom State. The Akwa Ibom State Health Commissioner, Dr. Dominic Ukpong, appreciated the US Government for helping Akwa Ibom to have quality health and is hoping to enroll 1000 people in the CBHI scheme in 2016. The Secretary to the State Government, Sir Etekamba Umoren, noted how proud he was that USAID picked Ukana West Ward II for the CBHI scheme. He was also hopeful that the success of the program in Ukana will encourage USAID to scale up in other LGAs in Akwa Ibom State.

14

Photo 1: (from left to right): Akwa Ibom Health Commissioner, Dr. Dominic Ukpong; Akwa Ibom Secretary to the State Government, Sir Etekamba Umoren; Former Akwa Ibom Health Commissioner, Dr. Emem-Abasi Bassey; and Deputy Director, Office of HIV/AIDS-TB, USAID/Nigeria, Dr. Philip Dayal. Photo by MSH

PLAN-Health beneficiaries presented testimonials, illustrating the positive health impact the project made in the state. For example, the Director of the Akwa Ibom State Ministry of Health Department of Planning, Research and Statistics (DPRS) stated that PLAN-Health helped revive key state policy structures like the State Council on Health. The project also helped the SMoH improve its data reporting from 46% in 2013 to about 86% in 2015 on the district health information system (DHIS) national platform. Support to the Akwa Ibom State AIDS/STD Control Programme (AKSASCP) resulted in the development of institutional policy frameworks for the engagement of TBAs within five identified thematic areas (regulation, coordination, monitoring and supervision and PMTCT services). This policy is the very first in Akwa Ibom and will provide a coordinated and regulated approach to engaging TBAs for improved maternal, newborn and child health (MNCH) services and increased PMTCT uptake going forward. The CBHI scheme in Ukana West Ward II is the first of its kind in Nigeria, solely funded and owned by the community. With PLAN-Health technical assistance, over 500 people are enrolled; utilization rates at the health facility have increased by over 1100%; there is a medical doctor available for consultation on designated clinic days; and an institutionalized drugs management system is in place, ensuring drugs are available.

Thirty-eight health professionals from Akwa Ibom took part in the Fellowship program and created demand for the HIV/PMTCT program in the LGAs where they work. And nine CSOs in Akwa Ibom were able to raise $1.2m as a result of the capacity building they received from PLAN-Health. In addition, the

15

small grants managed by the CSOs for PMTCT demand creation led to:

• 1272 pregnant women completing a minimum of 4 ANC visits • 1518 pregnant women completing ANC referrals by TBAs • 560 male partners attending at least one ANC visit with their partners • 526 pregnant women were HIV counselled, tested, and received their results

Additional information about the dissemination meeting is also featured in Annex C (success story). 2.2 Implementation Status

During this quarter, activities focused on IRs 3, 5 and 6. Below is a summary of this quarter’s interventions under these specific IRs. IR 3: Governance Practices (e.g., accountability, board development, business development) of CSOs and PSIs Strengthened Planning meetings with stakeholders across various levels of the state governments’ health sector for TBA engagement in three Local Government Areas (LGAs) in Akwa Ibom State. In October 2015, two planning meetings were held with stakeholders related to the TBA engagement initiative in Akwa Ibom State. The purpose of the first meeting was to discuss and agree on various roles and responsibilities assigned to designated offices in the SMoH and to identify concrete action steps and resources required to implement the TBA engagement initiative. A consensus on the modalities for sensitization and mobilization of TBAs was reached. These include existing platforms such as the ward focal person /Director Primary Health Care /Reproductive Health Coordinator platform that holds its meeting every month, as well as the ward focal person/TBA platform. These platforms exist in the three pilot LGAs and will be used to sensitize and mobilize TBAs.

The second meeting included focal persons for the TBA engagement initiative (also known as the “Lagos study tour team”) at the SMoH to crystallize plans, actions and resources needed to train the tutors that will handle the first batch of TBAs for training at basic and internship level and to execute the basic training and internship. Six (6) persons were identified to serve as TBA tutors drawn from the SMoH, National Primary Health Care Development Agency (NPHCDA) and the Lagos State Traditional Medicine Board. Furthermore, eighteen (18) persons from the health facilities across the three LGAs were identified to serve as tutors for the TBA basic and internship training. The tutors include focal persons for reproductive health, PMTCT, family planning, social mobilization and matrons with the medical superintendents serving as supervisors.

The basic training was proposed to either be held centrally or separately in the LGAs. Based on a comparison of detailed budgets for both options, the SMoH decided to have simultaneous trainings at the LGA. The venue for internships will be in the Eket and Ikot Ekpene health facilities. The Etinan facility was assessed as not suitable. TBAs from this LGA will do the internship at Ikot Ekpene. The SMoH will

16

assess the proposed venue for the training and the registration of TBAs for the TBA training will commence then after. A training committee was set up with the following organizations as members: 1. School of Health Technology 2. Hospital Management Board 3. Public Health Department 4. National Association of Midwives and Nurses (NAMN) 5. National Primary Health Care Development Agency (NPHCDA) 6. Community Medicine Department, University of Uyo Teaching Hospital 7. Association of General and Private Medical Practitioners of Nigeria (AGPMPN) 8. Implementing partners will serve as observers (UNICEF, UNFPA, WHO, MSH, FHI 360) Printing and dissemination of policy and training documents for TBA engagement initiative. During this period, PLAN-Health supported the Akwa Ibom State Government and its Ministry of Health to print guidelines for TBA engagement in training, regulation, coordination, monitoring & supervision and PMTCT. The project also printed manuals for trainers and participants in the TBA engagement initiative as well as internship log books, tally cards, referral cards, certificates.

Photo 2: Dr. Glory Edet, Honorable Commissioner for Women’s Affairs and Social Welfare, unveiling the TBA guidelines. Photo by MSH

The documents were unveiled by the representative of the wife of the Governor of Akwa Ibom State, the Honorable Commissioner for Women’s Affairs and Social Welfare, Dr. Glory Edet, at the PLAN-Health

17

dissemination meeting in Uyo (see photo above). The documents have been delivered to the Department of Public Health, Akwa Ibom State Ministry of Health for use and dissemination to TBAs and stakeholders. Resource mobilization and fundraising technical assistance for Akwa Ibom CSOs. In November 2015, the team organized a training workshop for six Akwa Ibom CSOs in Uyo to strengthen their skills in online fundraising. The training was facilitated by one of PLAN-Health’s supported CSOs, Antof Rural Resources Development Centre (ARRDEC) based in Oron, Akwa Ibom. ARRDEC had previously received funding from GlobalGiving, the first and largest global crowdfunding community for nonprofits with support from PLAN-Health and other partners and individuals. ARRDEC used its experience to provide technical support to the other PLAN-Health CSOs. Each CSO present registered on the GlobalGiving site and sent out requests for support to partners for donation to a cause identified by CSOs in their community. The CSOs have plans to continue to meet and support each other on a regular basis, after project end. They have created a support network that serves as a forum to exchange information, learn best practices and apply some of the practices that were shared by PLAN-Health.

IR 5: A new cadre of individuals and institutions providing technical assistance in management and leadership that meets international standards developed Technical assistance provided to implement resource mobilization and marketing strategy development for the College of Health Sciences, Obafemi Awolowo University (CHS, OAU). The team provided technical support and follow up to ensure that the resource mobilization plans developed in August 2015 by OAU are followed through and implemented to mobilize resources. The OAU team has visited 21 organizations and individuals to market the fellowship program and six organizations have committed to sending two participants each for the next program which is planned for February 2016. Benue State University (BSU) has also made significant progress after the project disengaged with them in June 2015. BSU had meetings with the Benue State Commissioner of Health to come up with a long-term arrangement to develop specialized packages (based on the fellowship program) to train public sector health workers. A fellowship program is planned for March 2016. BSU is also working towards developing a Master’s in Public Health with a focus on health systems strengthening. The project is happy to see that the fellowship program will successfully continue and grow, after the project ends.

IR 6: Institutional Capacity of National Health Insurance Scheme (NHIS), State Counterparts, Local Communities and Select CSOs Strengthened to Provide Access to Quality Health Services through Sustainable Community-Based Health Insurance Program (CBHI) Demand generation and community sensitization to increase the CBHI enrollee base. In an effort to increase the number of people enrolled into the CBHI scheme, there has been routine sensitization on clinic days at the facility for patients who pay out-of-pocket which has led to an increase in the enrollee

18

base. As of November 30, 2015, a total of 546 people have been enrolled into the scheme and ten people re-enrolled. Processing NHIS subsidy for under-five children and pregnant women. The CBHI scheme was supported through the Essien Udim Local Government to provide birth certificates for children who are below the age of five years and did not previously have birth certificates. Birth certificates are a pre-requisite for the subsidy for under-five children from NHIS. The names of all under-five children and pregnant women registered into the scheme since inception, with all required documents (birth certificates, ultra-sound scans etc.) have been submitted to the NHIS for subsidy payment, and processing is presently on-going.

Interpersonal communication (IPC) training for CBHI health facility staff. In October 2015, PLAN-Health conducted a two-day training for CBHI health facility staff to address the gaps identified during the clients’ satisfaction survey conducted in July 2015. The focus of the IPC training was improving work climate, attitudinal change, emotional intelligence and interpersonal communication in health service delivery. A total of 15 participants were involved in the training. Participants included nurses from the facility, a doctor from the University of Uyo Teaching Hospital (UUTH), BoT members and a representative of Essien Udim Local Government (EULG). By the end of the training sessions, an action plan and a code of conduct to improve communication were developed by the participants. The CBHI scheme will continue to follow up with facility staff to ensure that the action plan and the code of conduct are adhered to for improved delivery of service at the facility.

Photo 3: BoT Member, EULG rep and PHC facility staff in group work during IPC training. Photo by MSH

19

Training on standard treatment guidelines (STGs) for the CBHI facility staff. In October 2015, PLAN-Health organized and conducted a five-day training on standard treatment guidelines. A quality of care assessment, client satisfaction survey and structured communication sensitizations of the scheme had revealed poor attitude of the facility staff towards patients and weak compliance with STG. The training aimed to build the capacity of the PHC facility staff on proper management of patients (including enrollees) on diseases covered in the CBHI benefit package using the national standard treatment guidelines and the current guidelines of some vertical disease programs in Nigeria (malaria, diarrhea and pneumonia, family planning, and prevention of malaria in pregnancy). Eight participants attended the training, including three nurses, three community health extension workers (CHEWs), one pharmacy technician and one NYSC doctor. Topics covered in the training included:

• Management of uncomplicated malaria in children under-5 years of age and in the general population

• Management of malaria including its prevention in the pregnancy • Pre-referral treatment of malaria at the PHC • Management of diarrhea, pneumonia, laboratory investigations of diseases at PHC level • Management of common skin conditions at the PHCs.

Other topics discussed include management of sexually transmitted infections (like HIV/AIDS) and urinary tract infections. Management of labor and injuries, key components of the benefit package and treatment of minor surgical conditions were also discussed.

The training included hands-on sessions and clinical demonstrations, including:

• Measurement of fundal height to estimate the gestational age of pregnant women using a measuring tape

• Correct measurement of blood pressure of clients • Drug adherence instructions to clients/enrollees at the pharmacy to ensure clarity of

instructions to clients • Calculation of correct doses of drugs to clients/enrollees based on the weight of clients

especially in children • Correct techniques in administration of vaccines

Follow-up actions recommended include:

• Scheduling of topics to staff for health awareness and education in the facility and supervision of the sessions by the officer in-charge and/or doctors. There should also be guidance of staff on topics selected for health education

• Pasting of standard treatment guidelines/protocols on the management of some endemic diseases at the service provision areas to guide staff adherence to treatment procedures. Provision of copies of the STGs in the facility is also strongly recommended

• Posting of more staff to the facility

20

• Regular clinical meetings (at least fortnightly) to update staff knowledge on the correct management of diseases.

The BoT and CBHI secretariat (with PLAN-Health support) are following up to ensure that these recommendations are implemented.

Photo 4: The consultant from UUTH (Dr. Ekanem), Ikot Ideh PHC facility staff, pharmacy technician and NYSC doctor during the standard treatment guidelines training. Photo by MSH

Orientation and technical assistance on financial management for new staff deployed from Essien Udim Local Government (EULG) to the CBHI Secretariat. As part of the government support to the CBHI scheme, EULG deployed five staff to the CBHI health facility/secretariat in November 2015. The employees deployed are a finance officer, administrative officer, a cleaner and two security guards. In order to familiarize the new technical staff (finance officer and the administrative officer) with the CBHI scheme and to enable the new team members to understand key CBHI principles and the work of the secretariat, the BoT (supported by PLAN-Health) organized a two week orientation program from November 9-17, 2015. The resource persons were drawn from the CBHI secretariat, BoT Chair and PLAN-Health staff.

21

A key component of the orientation program was the financial management technical support, which involved a detailed introduction and explanation of the financial management system at the CBHI secretariat. The new staff were trained on inflow and outflow of financial expenditures of the scheme. They were taken through the CBHI financial policy and procedure manual, and introduced to the tools, templates and documents used for recording financial transactions. The new staff members are gradually integrated into the scheme and secretariat roles. There will be further continuous hands –on support from the secretariat staff over the next few months.

Photo 5: CBHI Secretariat Staff, BoT Chair and the new staff during the financial management technical assistance. Photo by MSH Documentation of CBHI implementation in Akwa-Ibom. As part of the preparations towards transition of the CBHI scheme to the government and the BoT, PLAN-Health drafted a CBHI implementation in Akwa-Ibom document that details the design and ongoing implementation of the Ukana West Ward II CBHI scheme. The document highlights initial results, assessments conducted, challenges and lessons learned (it is neither an evaluation nor a review of the CBHIS pilot). The document (both in electronic and hard copy) has been shared with selected stakeholders in Akwa-Ibom. Stakeholders include: CBHI scheme (BoT and Secretariat), State Ministry of Health (Commissioner/DPRS and HIS Desk Officer), State NHIS Office, UUTH and the CBHI referral facility (Cottage Hospital, Ukana). We hope the document will

22

be a useful resource for the scale-up and implementation of other CBHI schemes in Akwa-Ibom State. 2.3 Implementation challenges

During this quarter, the project encountered a number of challenges that impacted the implementation of planned activities. Fellowship While OAU continues to utilize resource mobilization skills and knowledge gained from PLAN-Health, there are still challenges with ensuring full subscription to the upcoming fellowship program. OAU has made progress gaining the commitment of six organizations to send participants, however they need to increase the engagement, be more proactive, and reach out to a wider audience to ensure larger participation in the program. TBA initiative The close-out of the PLAN Health project caused the shift of activities as the time left was not adequate for the completion of TBA training activities. In addition, due to the busy schedule of ministry staff, the training of trainers could not take place as planned and had to be postponed. CBHI Low enrolment into the CBHI scheme: The entitlement mentality of the members of the Ukana West Ward II community (‘’After all, the immediate past Governor is ‘their son’ and should allow free access.’’) is still limiting enrollment into the scheme. The project is embarking on continuous sensitization activities and social mobilization strategies to improve enrollment. One of these activities is the engagement of pastors to reach church members for CBHI enrollment. However, sensitization to churches could not take place this quarter as some of the pastors did not consent to the sensitization meetings to hold in their churches. The CBHI secretariat is embarking on more advocacy visits to the pastors to overcome this challenge. Inadequate knowledge of facility staff on standard treatment guidelines: Limited knowledge of the clinical features and treatment of various diseases covered by the CBHI scheme for enrollees, poor prescription and dispensing practices, and weak adherence to standard treatment guidelines (STGs) and protocols have affected the quality of care received at the facility. However with the training conducted on the STGs, there should be an improvement in the quality of care. 2.4 M&E Plan Update See PMP update in Annex A.

3. INTEGRATION OF CROSSCUTTING ISSUES AND USAID FORWARD PRIORITIES 3.1 Gender Equality and Female Empowerment

There are on-going plans by USAID to conduct a gender analysis for its projects. One of the PLAN-Health clients, Community Partners Development in Akwa-Ibom, has been selected to participate in this study.

23

The project is supporting all efforts for smooth implementation of the gender analysis. 3.2 Sustainability Mechanisms Nothing new to report this quarter. 3.3 Environmental Compliance

N/A 3.4 Youth Development

Nothing new to report this quarter. 3.5 Policy and Governance Support Activities were reported under IR3. 3.6 Local Capacity Development

Nothing new to report this quarter. 3.7 Public Private Partnership and Global Development Alliance

Impacts Nothing new to report this quarter.

3.8 Conflict Mitigation N/A

3.9 Science, Technology, and Innovation Impacts

N/A

4. STAKEHOLDER PARTICIPATION AND INVOLVEMENT Nothing new to report this quarter.

5. MANAGEMENT AND ADMINISTRATIVE ISSUES No management or administrative issues to report this quarter.

6. LESSONS LEARNED

• CBHI: The development of a treatment price list by the cottage hospital will help guide against over-billing for referral services. There is also a need for continuous training of the facility staff on the standard treatment guidelines to enhance continuous quality of care at the PHC facility.

• TBAs: Identifying key drivers of change is critical for the success of initiatives that may seem controversial. The TBA engagement program has received support and the buy-in of key

24

stakeholders in the state because the project identified persons that can support sensitizing others and leading the initiative. The TBA initiative has formed a group called the “Lagos six” - these people were part of the team that visited the Lagos Traditional Medicine Board on a study visit in March 2015. Since the visit they have continued to preach to other stakeholders of the importance of regulating the activities of TBAs in the state and have become the champions of the initiative.

7. PLANNED ACTIVITIES FOR NEXT QUARTER This is the last quarter of the project (the project end date is December 6, 2015).

8. WHAT DOES USAID NOT KNOW THAT IT NEEDS TO? Nothing to report this quarter.

9. HOW IMPLEMENTING PARTNER HAS ADDRESSED A/COR COMMENTS FROM THE LAST QUARTERLY OR SEMI-ANNUAL REPORT We did not receive any comments from the last quarter.

25

ANNEX A: PROGRESS SUMMARY The PLAN-Health project’s performance measurement and tracking system is guided by its PMP, which is made up of 51 indicators:

• 5 Overarching Project Goal (OPG) level indicators • 15 outcome level indicators and • 31 output level indicators

As of November 30, 2015, the project achieved End of Project (EOP) targets for four of the five OPG indicators. The OPG indicator that was not met achieved 90% of its target. EOP targets for approximately 84% (26 out of 31) of all output level indicators were met. A number of indicators exceeded their EOP targets. For those indicators that were not met we have included the following explanations. S/N

Indicator Number

Target Actual Percentage achievement

Comment

1 OPG#1.4 10 9 90% The project actively worked with all potential PSI clients that have the ability to contribute towards meeting this target. There are no other PSI clients to work for, and therefore, we did not meet this target.

2 Outcome #2.2

16 14 87.50% In terms of the numbers for PSIs, the project was originally supposed to work with NASCP, NACA, FMoH-DPRS, FMWA-OVC, and NPHCDA at the federal level and their corresponding state departments across Gombe, FCT, and Akwa Ibom. However, in 2012, USAID directed the project to discontinue to work with FMWA (and its corresponding agencies at the state level) given that the CUBS project was working with them. The project also did not work with NPHCDA. As a result of these changes that occurred through the course of implementation, the project is working with only 14 PSI clients, and is not able to meet the target of working with 16 PSIs.

3 Output #2.3.2

17 12 70.59% The target for this indicator was set anticipating that the Country Coordinating Mechanism (CCM) would hold dashboard review meetings every quarter. However, this has not been the case, and we are not able to achieve the EOP target.

4 Output #2.3.3

20 12 60% Same as #2.3.2 above.

5 Output #2.3.4

20 12 60% Same as #2.3.2 above.

26

6 Outcome #4.1

12 8 91.67% Same as Outcome #2.2 above. The scope of work planned for approximately 75% of PSIs the project worked with to develop strategic plans. However, with the reduced number of PSIs, the project could only support 66.67% of the PSIs to develop strategic plans.

7 Output #4.1.2

14 9 64.29% Same as Outcome #2.2. In addition we will not meet this indicator target because it is outside our scope of work and sphere of influence to enforce implementation of operational plans for these PSIs.

8 Output #4.1.4

17 14 82.35% Same as Outcome #2.2.

PLAN-Health no-cost extension: During the reporting period under review, the PLAN-Health project completed implementation of the no-cost extension. 100% (25 out of 25) of the activities planned for the no-cost extension have been completed.

• Eight activities were designed to contribute to IR 3 (Governance practices of CSOs and PSIs strengthened). Four of the activities planned under IR3 were completed during the reporting period, the other four in the previous reporting period;

• One activity under IR 4 (Coordination among PSIs at all levels and partnerships with CSOs strengthened) started in the previous quarter and was finalized during this reporting period;

• Four activities under IR 5 (A new cadre of individuals and institutions providing technical assistance in management and leadership that meets international standards developed) were carried out this period (while the other four were completed last quarter);

• Nine activities under IR 6 (Institutional capacity of NHIS, state counterparts, local communities and select CSOs strengthened to provide access to quality health services through sustainable community based health insurance program) were implemented last quarter. The outstanding activity from last quarter under this IR has been carried out.

• Two activities were designed for project management, dissemination and reporting at the end of the project. End of project dissemination events were conducted as planned. All technical briefs were drafted and the final project report will be circulated internally to MSH and externally to USAID no later than December 6, 2015.

The table below summarizes implementation progress during the no-cost extension: IR Area Total number

of activities planned for under the IR

Number of activities

completed from July 1 – September

30 2015

Number of activities completed from

October 1 – November 30 2015

Percentage of activities completed

IR 3 8 4 4 100% IR 4 1 0 1 100% IR 5 4 4 0 100% IR 6 10 9 1 100% End of project activities

2 2 100%

27

Table1(a): PMP Indicator progress - USAID Standard Indicators and Project Custom Indicators

Indicator Data

Source Baseline data EOP Quarterly Status – Last 5 Quarters Performance

Achieved to Date (in %) (Actual/EOP Target)

Comment(s) Actual Indicator performance against EOP targets

FY 11 (June 2010)

value EOP Cumulative Planned target

Actual Cumulative Achievement (Jul 2010 –Dec 2015)

Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan– Mar 2015)

Q3 FY15 (Apr – Jun 2015)

Q4 FY 15 (Jul – Sept 2015)

Q1 FY 16 (Oct – Nov 2015)

Overarching Project Goal 1: Institutional capacity of select public and civil society organizations at Federal, State and Local levels strengthened for improved HIV and other health services for Nigeria's vulnerable populations OPG #1.1: HIV Patient satisfaction index Project

records June 2010

0 4 4 1 1 0 0 0 100% The project has met the end of project target for this indicator

OPG #1.2: #/% CSOs receiving PLAN-Health support demonstrate improved HIV/AIDS service delivery, disaggregated by level (S, L)

Project records

June 2010

0 66% 84% 60% 88% 88% 88% 88% 88% The project has exceeded the end of project target for this indicator

28

Indicator Data Source Baseline data EOP Quarterly Status – Last 5 Quarters Performance Achieved to Date (in %) (Actual/EOP Target)


FY 11 (June 2010)


Actual Cumulative Achievement (Jul 2010 – Dec 2015)

Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)

Q4 FY15 (Jul – Sept 2015)

Q1 FY 16 (Oct – Nov 2015)

OPG #1.3: Health facilities in selected LGAs show improved HIV/AIDS service delivery. Project

records/health facility records

June 2010

0 45 45 0 1 3 5 0 100% The project has met the end of project target for this indicator

OPG #1.4: Outcome: Improved coordination of Federal PSIs with State PSIs and State PSIs with their local counterparts in selected States. Project

records June 2010

0 10 9 0 0 0 0 0 90% We did not meet this target by EOP (see table on page 25-26 for details)

29

Indicator Data Source

Baseline data EOP Quarterly Status – Last 5 Quarters Performance Achieved to Date (in %) (Actual/EOP Target)


FY 11 (June 2010)


Actual Cumulative Achievement (Jul 2010 –Dec 2015)

Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan– Mar 2015)

Q3 FY15 (Apr– Jun 2015)

Q4 FY15 (Jul-Sept 2015)

Q1 FY 16 (Oct – Nov 2015)

Overarching Project Goal 2: Capacity for building management and leadership skills and practices in the Nigerian's health sector developed and institutionalized OPG# 2.1: A structure is identified or created that will coordinate the cadre of health professionals that demonstrate expertise in health systems strengthening. Project

records June 2010

0 1 2 0 0 0 0 0 200% The project has exceeded the end of project target for this indicator.

30




FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)

Q4 FY 15 (Jul-Sept 2015)

Q1 FY 16 (Oct – Nov 2015)

Intermediate Result (IR) 1: Leadership and management practices of Civil Society Organizations and Public Sector Institutions strengthened Outcome 1.1:# of organizations with managers using acquired leadership skills to improve their organizational performance, disaggregated by type (CSO, PSI) and level (F, S, L) MOST or

other evaluation Report

2010 0 32 32 0 0 0 0 0 100% The project has met the end of project target for this indicator.

Output: 1.1.1:# of management and leadership workshops conducted for organizations supported by PLAN-Health, disaggregated by type (CSO, PSI) and level (F, S, L) Project

record 2010 0 12 20 1 0 0 1 0 175.00% The project

has exceeded the end of project target for this indicator.

31




FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)

Q4 FY 15 (Jul-Sept 2015)

Q1 FY 16 (Oct – Nov 2015)

Output: 1.1.2: # of organizations with leadership workshops completed, disaggregated by type (PSI, CSO) and level (F, S, L)

Project record

2010 0 37 59 1 0 0 1 0 159.46% The project has exceeded the end of project target for this indicator.

Output: 1.1.3# of managers of organizations supported by PLAN-Health who have completed management and leadership training events, disaggregated by type (PSI, CSO) and level (F, S, L) Project


has exceeded end of project target for the indicator.

32



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)

Q4 FY 15 (Jul – Sept 2015)

Q1 FY 16 (Oct – Nov 2015)

Outcome: 1.2: # of organizations that have achieved their desired performance according to indicators in action plans within 12 months of completing an LDP Interviews,

Program Reports, Updates

2010 0 37 38 0 0 0 0 0 105.41% The project has exceeded end of project target for the indicator.

Outcome: 1.3: # of organizations whose staff show an increase in the work climate score as a result of using leadership and management practices, disaggregated by type (CSO, PSI) and level (F, S, L) Work

climate assessment tool


33



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)


Q1 FY 16 (Oct – Nov 2015)

Intermediate Result (IR) 2: Organizational systems (e.g., HR, Finance, HMIS, Supply Chain, Service Delivery, and Planning) of Civil Society Organizations and Public Sector Institutions developed /strengthened Outcome: 2.1 # of Nigerian CSO with capacity to manage USAID grant funds as defined in a pre-award survey checklist.

USAID pre-award survey checklist


Output: 2.1.1# of organizations that received technical assistance in the areas of HR, Finance, HMIS, Supply chain management or planning, disaggregated by type (CSO, PSI) and level (F, S, L) Project

records 2010 0 37 102 1 1 0 0 0 245.95% The project has

exceeded end of project target for the indicator.

34



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)


Q1 FY 16 (Oct – Nov 2015)

Outcome: 2.2 # of GON institutions that improve their systematic monitoring of implementation of HIV/AIDS/other health strategic and operational plans, disaggregated by level (F, S, L) Documents

review 2010 0 16 14 0 0 0 0 0 87.50% We did not

meet this target by EOP (see table on page 25-26 for details).

Output: 2.2.1 # of individuals from GON institutions with increased knowledge and skills in the areas of HR, Finance, HMIS, Supply Chain, Quality Management, Management or Operational Planning, disaggregated by level (F, S, L) Project



35



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)


Q1 FY 16 (Oct – Nov 2015)

Output: 2.2.2: # of individuals from CSOs with increased knowledge and skills in the areas of HR, Finance, HMIS, Supply Chain, Quality Management, Management or Operational Planning, disaggregated by level (F, S, L) Project



Outcome 2.3: # of organizations that show improvement in timeliness and/or accuracy of organizational data in systems supported by PLAN-Health, disaggregated by type (CSO, PSI) and level (F, S, L) Project



36



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)

Q4 FY 15 (Jul – Sept 2015)

Q1 FY 16 (Oct - Nov 2015)

Output: 2.3.1 # of organizations that with PLAN-Health support develop and/or apply organizational policies, strategies, plans, processes at federal, state and local government levels, disaggregated by type (CSO, PSI) Project

reports, policy documents

2010 0 36 62 1 0 2 0 0 194.44% The project has exceeded end of project targets for this indicator.

Output: 2.3.2 # times per year that quarterly dashboards reviewed by Oversight Committee, and submitted to CCM according to standards.

Document review

2010 0 17 12 1 0 0 0 0 70.59% We do not expect to meet this target by EOP (see table on pages 25-26 for details).

37



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)


Q1 FY 16 (Oct – Nov 2015)

Output:2.3.3 CCM demonstrates the use of dashboard for analysis and decision making

Document review

2010 0 20 12 1 0 0 0 0 60% We do not expect to meet this target by EOP (see table on pages 25-26 for details).

Output:2.3.4 Availability of documentation that includes findings from review of dashboard

Document review

2010 0 20 12 1 0 0 0 0 60% We did not meet this target by EOP (see table on pages 25-26 for details).

38



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)


Q1 FY 16 (Oct – Nov 2015)

Output: 2.3.5 CCM has instruments/tools for oversight

Oversight tools

2010 0 3 3 0 0 0 0 0 100% The project has achieved end of project targets for this indicator.

Intermediate Result (IR) 3: Governance practices (e.g., accountability, board development, business development) of Civil Society Organizations and Public Sector Institutions strengthened Outcome: 3.1:# of organizations that have systems in place to disseminate policy and policy guidelines, disaggregated by type (CSO, PSI) and level (F, S, L) Copy of the

written mechanism

2010 0 15 15 0 6 1 0 0 100% The project has achieved end of project targets for this indicator.

39



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)


Q1 FY 16 (Oct – Nov 2015)

Outcome: 3.2 # of organizations with mechanisms in place to obtain stakeholders feedback that affect the delivery of quality health services, disaggregated by type (CSO, PSI) and level (F, S, L) Project


exceeded the end of project targets for this indicator.

Outcome: 3.3 # of organizations with functional boards, disaggregated by type (CSO and PSI: SACA)

Board documents (Board development plan) Interviews with Board members


40



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)


Q1 FY16 (Oct – Nov 2015)

Output: 3.3.1 # of organizations whose board members have clear understanding of their roles and responsibilities as determined by their by-laws, constitution or other reference document. Project report 2010 0 7 27 1 0 0 0 0 385.71% The project has

exceeded end of project targets for this indicator.

Output: 3.3.2 # of organizations with board development plans developed with PLAN-Health support

Project record 2010 0 8 27 1 0 0 0 0 337.50% The project has exceeded end of project targets for this indicator.

41



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)


Q1 FY 16 (Oct – Nov 2015)

Output: 3.3.3 # of organizations the Boards of which receive PLAN-Health technical assistance.


Outcome: 3.4 # of CSOs that successfully source funds and manage programs that help them achieve their mission. (S, L)

Project report 2010 0 16 19 12 1 0 0 0 118.75% The project has exceeded end of project target for this indicator.

42



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)


Q1 FY 16 (Oct – Nov 2015)

Output: 3.4.1# of CSOs that wrote proposal that successfully received funding from donors to deliver quality health services, disaggregated by level (S, L) Project


has exceeded end of project targets for this indicator.

Output: 3.4.2 # of proposals funded as a result of skills acquired with PLAN-Health assistance.

Project record


43



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)


Q1 FY 16 (Oct – Nov 2015)

Output: 3.4.3# of CSOs whose personnel have been trained in proposal writing, disaggregated by level (S, L)


Output: 3.4.4# of CSOs trained in business development plan/fundraising, aligned with their organizational mission disaggregated by level (S, L)


44



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)


Q1 FY 16 (Oct – Nov 2015)

Output: 3.4.5# of CCM members participating in capacity strengthening workshops or activities delivered by PLAN-Health

Project record 2010 0 45 89 0 0 0 0 0 155.56% The project exceeded its end of project target for this indicator.

Intermediate Result (IR) 4: Coordination among Public Sector Institutions at all levels and partnerships with Civil Society Organizations strengthened

Outcome: 4.1 # of PSIs that have a strategic plan that aligns with NHSDP or NSP, and have evidence of systematically attempting to implement this plan disaggregated by level) Review of

implementation plan

2010 0 12 11 0 0 0 0 0 91.67% We did not meet this target by EOP (see table on page 25-26 for details).

45



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)


Q1 FY 16 (Oct – Nov 2015)

Output:4.1.1 # of PSIs that have operational plans aligned with their strategic plans, disaggregated by level (S/L)

Review of implementation plan


Output: 4.1.2 # of PSIs that show and sustain an increase in percent implementation of their operational plans.

Review of implementation plan

2010 0 14 9 0 0 0 0 0 64.29% We do not expect to meet this target by EOP (see table on page 25-26 for details).

46



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)


Q1 FY 16 (Oct – Nov 2015)

Output: 4.1.3 % of coordination meetings that is effective.

Agenda Minutes Attendance Register

2010 0% 60% 100% 100% 100% 100% 100% 100% 100% The project has achieved end of project targets for this indicator.

Output: 4.1.4 # of PSIs that have updated information on their partners and their area of focus/ responsibilities

Updated PSI partners register

2010 0 17 14 0 0 0 0 0 82.35% We did not meet this target by EOP (see table on page 25-26 for details).

47



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)


Q1 FY 16 (Oct – Nov 2015)

Outcome: 4.2 PSI partners have improved understanding of their roles and responsibilities as identified in their operational plans

2010 0 17 51 0 0 0 0 0 300% The project has exceeded end of project targets for this indicator.

Output: 4.2.1 PSIs have operational plans with defined roles and responsibilities for their partners

Review of operational plans

2010 0 17 53 0 0 0 0 0 311.76% The project has exceeded end of project target for this indicator.

48



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)


Q1 FY 16 (Oct – Nov 2015)

Intermediate Result (IR) 5: A new cadre of individuals and institutions providing technical assistance in management and leadership that meets international standards developed Outcome: 5.1 # of individuals satisfactorily providing TA to Nigerian's health institutions

Project records

2010 0 150 226 0 0 0 0 0 150.67% The project has exceeded end of project target for this indicator.

Output: 5.1.1% of individuals identified by PLAN-Health that demonstrate expertise in health systems strengthening disaggregated by the NSHDP priority areas Project

records 2010 0% 50% 80% 0% 0% 0% 0% 0% 80.00% The project has

exceeded end of project target for this indicator.

49



FY 11 (June 2010)


Actual Cumulative Achievement (Jul 2010 - Dec 2015)

Q1 FY15 (Oct - Dec 2014)

Q2 FY15 (Jan - Mar 2015)

Q3 FY15 (Apr - Jun 2015)


Q1 FY 16 (Oct – Nov 2015)

Output: 5.1.2# of individuals who successfully complete a PEPFAR Fellowship program.

Project record 2010 0 125 190 35 0 55 0 0 148.00% The project has exceeded the end of project target for this indicator.

Output 5.1.3: An MOU is developed and operationalized between MSH and an institution in alignment with MSH's organizational objectives

Project record 2010 0 1 2 0 1 0 0 0 200.00% The project has exceeded end of project target for this indicator.

50



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)


Q1 FY16 (Oct – Nov 2015)

Intermediate Result (IR) 6: Institutional capacity of NHIS, State counterparts, Local communities and select CSOs strengthened to provide access to quality health services through sustainable community based health insurance program. Outcome: 6.1 # of health finance managers with improved understanding of health insurance management for CBSHIP

Project records

2010 0 60 64 0 0 0 0 0 106.67% The project has exceeded the end of project target for this indicator.

Output: 6.1.1 # of senior level managers trained in CBSHIP

Project record 2010 0 60 64 0 0 0 0 0 106.67% The project has exceeded the end of project target for this indicator.

51



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)


Q1 FY 16 (Oct – Nov 2015)

Output: 6.1.2# of organizations trained in implementation of CBHIS


Output: 6.1.3 # of study tours facilitated by PLAN-Health


52



FY 11 (June 2010)



Q1 FY15 (Oct – Dec 2014)

Q2 FY15 (Jan – Mar 2015)

Q3 FY15 (Apr – Jun 2015)


Q1 FY 16 (Oct – Nov 2015)

Output: 6.1.4 # of enrollees in CBHI across all clients


Outcome: 6.2 # of PLAN-Health supported organizations implementing CBSHIP according to NHIS guidelines

Review of Implementation Organizations Plans

2010 0 3 3 0 0 0 0 0 100.00% The project has achieved 100% cumulative target for this indicator.

ANNEX B: TraiNET REPORT

TraiNET Report for October to November 2015

.

Title of Activity Male Female Standard Treatment Guidelines 2 7 Interpersonal Communication Training

5 6

ANNEX C. SUCCESS STORY USAID/PLAN-Health Project Showcases Key Intervention Results in Akwa Ibom State, Nigeria

By Amarachi Obinna-Nnadi, Communications Specialist, MSH

The United Stated Agency for International Development (USAID)-funded Program to Build Leadership and Accountability in Nigeria’s Health System (PLAN-Health) celebrated the successful completion of its five-year project at an end-of-project dissemination meeting on October 28, 2015. Implementing partner Management Sciences for Health (MSH) showcased key results, lessons learned, and challenges of the project aimed at decreasing the high HIV prevalence rate in Akwa Ibom State.

The PLAN-Health project, funded by PEPFAR-USAID through an Associate Award as part of the (now concluded) Leadership, Management and Sustainability (LMS) project, focused on strengthening the leadership and management capacity of the Government of Nigeria and civil society institutions at the national and state levels to provide improved HIV and AIDS and associated health services. PLAN-Health worked in three states: Federal Capital Territory, Gombe, and Akwa Ibom.

The end-of-project meeting was one of several activities planned to celebrate the end of the five-year USAID project (2010 – 2015). During the life of the project, PLAN-Health worked with 52 organizations (both PSIs and CSOs) and built the capacity of 1,570 individuals at the federal and state levels. Key achievements include:

• 310 managers were trained in the PEPFAR Fellowship Program, and subsequently 4.4 million people were reached by these Fellows through community outreach activities. The Fellowship is also institutionalized in two public universities.

• 299 managers from 38 organizations completed the Leadership Development Program. During the 6 month experiential learning program, teams applied leading and managing skills to develop and implement health service delivery improvement plans.

• The project recorded significant improvements in health statistics reporting by state agencies, and incorporating health information into the district health information system. Reporting of health statistics increased from 0% to 60% by the FCT, from 39% to 77% in Gombe State, and from 22% to 86% in Akwa Ibom State.

• Resource mobilization training for CSOs in the FCT, Gombe, and Akwa Ibom led to $49.8 million in additional resources from the Government of Nigeria and international donors to implement health and HIV projects.

• The number of sites providing prevention of mother-to-child transmission (PMTCT) services increased from 34 in 2011, to 393 in 2014 in Akwa Ibom State. The number of people accessing PMTCT services rose from 18,000 in 2011, to 117,000 in 2014 in Akwa Ibom State.

• PLAN-Health drafted and developed a policy framework for the regulation of 2,795 traditional birth attendants in Akwa Ibom to improve maternal, newborn, and child health services and prevention of mother-to-child transmission services uptake. This is the first policy framework ever developed in the state for engaging traditional birth attendants.

• The project designed and developed the first community-based, -funded, -owned, and -governed insurance scheme in Nigeria, in Akwa Ibom state. As of October 2015, over 500 people enrolled and have health insurance for the first time in their lives.

A total of 108 PLAN-Health stakeholders and partners, including high level national and local government officials, USAID, public sector institutions, civil society organizations, other implementing partners, and beneficiaries from communities were present at the October 28 end-of-project meeting.

The Akwa Ibom State Governor’s wife, Mrs. Martha Emmanuel Udom, was represented by the Commissioner of Women Affairs and Social Welfare, Dr. Glory Emmanuel Edet. Dr. Edet acknowledged the important role TBAs have played in their local communities, especially in the areas of education and health. She stated, “I was thrilled that the Akwa Ibom State Ministry of Health, with assistance from the USAID-funded PLAN-Health project, is developing policies, guidelines and standards of practice to regulate, coordinate, train, monitor, and supervise the activities of unskilled birth attendants in the state for improved maternal, new-born, and child health; and also increased prevention of mother-to- child transmission treatment among women in the state. This is commendable and I am happy to be associated with this initiative.” She also unveiled eight traditional birth attendant policy guidelines developed by PLAN-Health for deployment in three pilot LGAs in Akwa Ibom State.

The Akwa Ibom Secretary to the State Government, Sir Etekamba Umoren, assured USAID that as long as the community-based health insurance (CBHI) program remains in Essien Udim Local Government Area (LGA), he will ensure that it succeeds and that community members benefit from it.

USAID/Nigeria Deputy Director, Office of HIV/AIDS-TB, Dr. Philip Dayal, commended the state government for its involvement and encouraged it to increase its health budget to sustain the program.

The former Akwa Ibom State Commissioner of Health, Dr. Emem Bassey, in his goodwill message said, “The choice of Essien Udim LGA to pilot the CBHI scheme in the state was because community members were ready to work and willing to own the program.” He encouraged the State Ministry of Health to continue working closely with community members to ensure a successful transition of the program from the US government.

Although the PLAN-Health project comes to an end on December 6, 2015, MSH looks forward to continuing to engage with USAID/Nigeria, the national and local government, and civil society partners through a buy-in to the Leadership, Management and Governance (LMG) Project through April 2016.

Photo: Unveiling of the policy framework for engaging traditional birth attendants. Photo by MSH.

(Third from left to right) Akwa Ibom State Commissioner of Health, Dr. Dominic Ukpong; PLAN-Health Project Director, Joy Kolin; Commissioner of Women Affairs, Dr. Glory Emmanuel Edet; Secretary to the State Government, Sir Etekamba Umoren; Deputy Director, Office of HIV/AIDS &TB, USAID/Nigeria, Dr. Philip Dayal; Permanent Secretary, Akwa Ibom State Ministry of Health, Mrs. Stella Usah.

ANNEX D. TBA DOCUMENTS (cover pages)