HANAN QUARTERLY NARRATIVE REPORT - JSIhanan.jsi.com/Docs/Project/2007_q3_report.pdf · HANAN...

HANAN QUARTERLY NARRATIVE REPORT

Reporting Period: July 1, 2007 to September 30, 2007

Submitted to: USAID West Bank/Gaza

Date: September 20, 2007

Table of Contents

I. Overview of Progress and Accomplishments .............................................3

II. Major Activities and Outputs .......................................................................8

A. Program Activities ......................................................................................9 B. Support Functions ....................................................................................19 C. Finance ....................................................................................................21 D. Administration ..........................................................................................22

III. Constraints.................................................................................................27

IV. Cumulative List of Tools, Methods, and Publications............................27

V. Expected Activities of the Next Reporting Period ...................................29

Annex I: Third Quarter Financial Report (July-September 2007)..................31

3

I. Overview of Progress and Accomplishments Project results Over the remaining project quarterly reports, an increasing emphasis will be placed on reporting documented project outcomes, in addition to project activities. Project outcomes are measured primarily through annual household surveys, clinic scorecard tools and checklists and, studies of the effectiveness of the Communications and Marketing (C&M) interventions. During this reporting period, a concerted effort was made to simplify and fine-tune the existing Hanan Monitoring and Evaluation (M&E) systems to help ensure that M&E tools accurately and adequately measure Hanan results, and ultimately, to help assess whether the Project has achieved its desired objectives. Following from this effort, and starting with this quarter’s report, Project results will be included and presented in three ways: total beneficiaries reached; outputs/activities undertaken; and results/outcomes achieved to date. Cumulative beneficiaries1 reached and activities completed: Table 1. Summary of beneficiaries reached as of August 31, 2007

Indicator End of Project Target

Cumulative as of August 31,

2007

USAID Fiscal Year: October 1, 2006 -August 31, 2007

1

Total Beneficiaries (WRA + U5) 311,000 314,440 305,667

WRA 171,000 166,056 157,842

C U5 140,000 148,384 147,825 1 Data for this report is only available through August 31, 2007

As of August 31, 2007, there have been 133,693 participants in Hanan Community Mobilization activities including: 69,691 women of reproductive age (WRA); 14,998 children under 5 (U5) years of age; and, 49,004 family members. The total number of WRA and U5 beneficiaries is thus 84,689. Under Hanan’s Communications and Marketing component, 35 theatre performances on maternal and child health topics have been held in the West Bank and Gaza since the beginning of the Project. There were 11,091 participants. Of them, 1,528 were women of reproductive age and 2,088 were children under 5 years of age. By the end of August 2007, Hanan's series of 10 radio plays on maternal and child health topics were broadcast on 12 radio stations throughout the West Bank and Gaza. Results from the ongoing post-intervention study are expected to provide us with more precise estimates of the numbers of beneficiaries who heard the plays and the outcomes. This data will be available for inclusion in the next quarterly report. Currently, the Hanan Project is working with 118 clinic and hospital partners, exceeding

1 “Beneficiaries” refers to the total number of participants in Hanan activities. It is possible that the same

individuals are counted more than once if they attend multiple activities.

4

the project target of 80. This includes 59 clinics (6 of which are new joint MOH clinics), 15 hospitals, and 44 new MOH clinics (16 Level 1 clinics and 28 Level 2 and Level 3 clinics to be upgraded). In 11 of these facilities we are providing procurement only. As of August 31, 2007, 1,772 participants from these clinics and hospitals (doctors, nurses and midwives) have received training on maternal and child health and clinic management. According to the health service statistics that we have collected from 33 of these clinic partners during the period December 2006 to May 2007, the providers that work in these 33 clinics and that received training through the Hanan Project saw 94,836 women of reproductive age and 131,298 children under 5 years of age, for a total of 226,134 beneficiaries reached with improved quality services. The revised scorecard tool, administered late this quarter by the Hanan Public Health team, now collects basic health service statistics from each of the Hanan participating clinics on a retrospective, quarterly basis. For example, the current administration is collecting service statistics from the three months covering June-August 2007. This will allow us, as of the next quarterly report, to continue to provide estimated updates as to the number of direct beneficiaries in Hanan participating clinics, though there will be a difference between the months for which the service statistics are collected and the months included in the quarterly reports. In other words, the next quarterly report, covering October-December 2007 will contain service statistic data from June-August 2007; and the 1st quarter 2008 report (covering January-March 2008), will include clinic beneficiary data from September-November 2007. The end of project report, to be completed in June 2008, will contain the cumulative estimated number of clinic clients benefiting from improved quality of services as a result of Hanan activities, from December 2006 through the end of project technical activities in March 2008. Table 2 below summarizes Hanan activities to date, including both clinic- and community-based training, the development of media products, and clinic knowledge promotion activities. Details on clinic and emergency response procurement can be found in this report under ‘Section D. Administration, Procurement.’ Table 2. Summary of project outputs/activities as of August 31, 2007

Indicator End of Project

Target

Cumulative as of August

31, 2007

USAID Fiscal Year: October 1, 2006 -August 31, 2007

Training on MCHN Protocols and Guidelines

3080 1386* 1044

Training on Key Management Practices 218 374 374

Knowledge Promotion Activities (KPA) 4000 24,011** 22,535

Media Products 10 19*** 19

CBO Staff who have received training on influencing positive behavior change at community level

300 403 345

* The total of MCHN trainees includes those receiving formal and on-the-job training (OJT) ** 24,011 total KPA includes: 3875 health education sessions, 14570 home visits and 5566 individual counseling sessions *** Media product include: H2H theatre performances, broadcasting of 10 radio plays, radio plays CD, songs CD, 4 different education booklets, magazine health information tips, Q&A flyer

5

Project results/outcomes achieved: During the quarter a comparative analysis of Hanan’s 2005 and 2006 household survey data was completed, culminating in a concise analytical document titled “Hanan Community Mobilization Results, 2006.” The main findings are presented in this document. Data contained in the analysis only includes communities in which Hanan conducted activities between the two surveys. Furthermore, the comparative analysis only considered indicators that could feasibly reflect outcomes generated by the community mobilization (CM) activities implemented over the survey period. The baseline survey was carried out in September of 2005, Hanan CM activities commenced in July 2006, and the midpoint survey completed in November-December of 2006. Thus there were five months of Hanan CM activities that took place between the two surveys, and only in West Bank. As a result, only a subset of Hanan’s Performance Monitoring Plan (PMP) indicators are contained in the report, as well as a number of supporting indicators that reflect intermediate results sought by Hanan; including all five indicators of knowledge and two indicators of behavior change. The five knowledge improvement indicators include:

• Knowledge of the danger signs of pregnancy; • Knowledge of dietary anemia prevention practices; • Mothers’ recall of six key child/infant nutritional messages; • Knowledge and exposure to information regarding breastfeeding; and • Knowledge of the signs of childhood illness.

The only two indicators of behavior change that had the potential to reflect the results of community mobilization activities before the second survey included:

- Percentage of mothers reporting exclusive breastfeeding over the preceding 24 hours; and

- Percentage of children reported to have suffered from diarrhea within the two weeks preceding the survey.

These indicators are unique in that they reflect outcomes immediately following the intervention period, whereas other indicators of targeted behaviors would reflect behavior undertaken before Hanan activities began. The end of project survey, to be carried out during the next quarter, will be summarized into a report including data toward all of Hanan’s PMP indicators, reflective of Hanan’s full package of community and clinic services, throughout West Bank and Gaza. The analytical report presents compelling evidence that Hanan activities are enjoying early success in increasing knowledge and healthy behaviors that can be measured after the short implementation time. The analysis provides evidence that Hanan community mobilization activities had a positive effect on mother’s knowledge of targeted maternal and child health messages. Furthermore, the results suggest that these activities may be contributing to significant improvements in healthy behaviors promoted through Hanan activities.

6

Mothers demonstrated significant improvements in their ability to recall all three Hanan maternal-child health messages that contribute to the Project’s performance monitoring indicators. In intervention areas, respondents’ ability to identify five danger signs of pregnancy increased from 2.2 to 26.7%; knowledge of anemia prevention methods increased from 8.3% to 25.8%; and, mothers’ knowledge regarding the symptoms of both diarrhea and acute respiratory infections increased from 6.6% to 15.2%. The higher recall levels were not paralleled in the general survey population. Evidence regarding additional targeted health messages suggests that counseling contributed to improvements in knowledge. In the case of breastfeeding, large jumps in the number of respondents receiving counseling on the subject are paralleled by substantial improvements in the number of respondents correctly identifying the age at which to introduce fluids and foods to infants.

Counseling and knowledge of appropriate period for exclusive breastfeeding (mothers of children under 1 year)

Sample size

Mother counseled by health worker on breastfeeding

Mother knows 6-9 months as age to introduce fluids/foods

2005 2006 2005 2006 2005 2006

Intervention Areas

228 187 38.6% 72.2% 52.2% 61.5%

Jenin 133 108 45.1% 74.1% 54.1% 63.9%

Hebron 95 79 29.5% 69.6% 49.5% 58.2%

All Areas 494 665 42.3% 57.1% 49.0% 53.7%

Bold blue = significant difference between annual results (p ≤.05) Additionally, mothers that received advice or counseling regarding child nutrition demonstrated significantly better recall of three out of six Hanan messages after the intervention, lending credence to the hypothesis that Hanan counseling had a focused effect on its recipients’ recall of health messages. Significant improvements in the practice of two targeted health behaviors supports the underlying program theory that its activities to improve knowledge will result in beneficiaries practicing healthy behaviors, resulting in improved health outcomes for beneficiaries. Almost 50% more mothers testified to exclusively breastfeeding their infants under six months of age, and the proportion of mothers exclusively breastfeeding their 5 month-old infants jumped to 43% from just 5%, implying that after the intervention mothers were much more likely to breastfeed exclusively through the sixth month. A similar change is evident in the 44% drop in diarrhea cases among children in the two weeks preceding the survey.

7

Child has had diarrhea in the last two weeks

Sample size Child had diarrhea within two weeks

2005 2006 2005 2006

Intervention Areas 229 194 26.6% 14.9%

Jenin 133 119 27.1% 16.8% Hebron 96 75 26.0% 12.0%

All Areas 517 697 22.2% 18.2%

Bold blue = significant difference between annual results (p ≤.05) With proper nutrition and diarrhea prevention an explicit theme of Hanan activities, this figure is especially powerful considering that, among all survey respondents, children of mothers that had not received counseling or information regarding diarrhea suffered from the disease 50% more than children of mothers that had received information. Partnership activities with the Ministry of Health (MOH) During the quarter, the Hanan Project reinitiated collaboration with the Palestinian National Authority Ministry of Health. Hanan and the MOH held a number of joint planning meetings during the reporting period, including a day-long meeting on September 3, 2007 to define selection criteria and identify specific clinic sites where Hanan will work with the Ministry to establish level 1 clinics, upgrade level 1 clinics to level 2 clinics, and where Hanan will assist with upgrading level 2 clinics to level 3 clinics. As a result of this meeting, it was agreed that Hanan will assist the Ministry to establish 16 Level 1 clinics and to move 28 clinics to Level 2 or Level 3. Level 1 clinics will be established in Tulkarem, Salfeet, Jericho, Jenin and Hebron districts. Work to upgrade Level 1 and Level 2 clinics will take place in all of the above districts plus additionally in Jerusalem, Qalqilya, Nablus, BeitLahem, and Ramallah. Hanan will provide the needed equipment, training and capacity building to establish and/or upgrade these clinics.

Table 3. MOH clinics to be supported by Hanan

District Clinic Level to be established

Tulkarem Al Ras 1

Ezbet Shoufeh 1

Thenabeh 2

Shwikeh 2+

Jericho Al Diuk El Fouka 1

Fasayel Al Fouka 1

Marj El Ghazal 1

El Nouemeh El Sharqiyeh 1

El Nouemeh El Gharbeyeh 2

El Jeftlik 2+

Hebron El Hijri 1

8

Khalet Saleh - Yatta 1

El Dier 1

Hriez 1

Khalet El Ghazel 1

Halhoul Old City 1

Khalet El Dar 2

Kurza/Yatta 2

Hmideh (Al A'Rrab) 2+

Tafouh 2+

Ain Sarah 2+

Haram 2+

Salfeet Qireh 1

Khirbet Qies 1

Skaka 2

Jenin Bir El Basha 1

Um El Tout 1

Faqua'a 2+

Jalqamous 2+

Burqin 2+

Jerusalem Ze'im 2

Al Ram 2+

Anata 2+

Qalqilya East clinic 2+

El Daba'a 2+

Nablus Sabastiah 2+

Qabalan 2+

Deir El Hatab 2+

BeitLahem Harmalah 2+

El Shawawreh 2+

Ramallah Saffa 2

El Tireh 2+

Deir Ammar 2+

Budrus 2+

Hanan will reprint five MOH health education documents and facilitate the production of an MOH message to be broadcast just prior to each broadcast of Hanan’s radio plays. In addition, Hanan will join representatives from WHO, UNICEF, UNRWA, and JAICA at MOH Nutrition Technical Committee meetings. Hanan staff will also be represented on the Ministry’s Nutrition Steering Committee.

9

II. Major Activities and Outputs

A. Programmatic & Technical Activities

1. Clinical Services Strengthening

Supportive supervision Hanan teams in both Gaza and West Bank continued their clinic strengthening work in 62 partner clinics and one partner hospital. During the quarter, work was initiated in an additional 6 joint private-public clinics. Each of these new clinics were visited by Hanan staff, Quality Improvement Plans (QIPs) developed to document and prioritize needs, and relevant interventions begun including the distribution of Maram protocols and Hanan job aides. In addition to conducting 224 supportive supervision visits, Hanan staff completed 309 checklists covering acute respiratory infection, diarrheal disease, antenatal care, postnatal care, growth monitoring, infection prevention and control, new born care, and delivery and neonatal resuscitation. On-the-job-training was conducted a total of 107 times throughout the quarter covering a variety of MCHN topics, and the scorecard tool for collecting data on clinic quality and adherence to protocols was completed for all Hanan partner clinics. Clinic graduation During the reporting period, a framework for graduating clinics was developed and approved by the Hanan Public Health team. Clinics with observed and documented improvements in quality of services were considered for graduation, typically following the implementation of a series of recommended, focused interventions (specific training, procurement, etc). Clinic graduation eligibility will continue to be assessed over the next quarter, and updates will be provided in future quarterly reports. Institutionalization and meeting with partners The Public Health team attended several meetings with partners during the reporting period to discuss how Hanan can participate and assist in building their organizational capacity. Meetings took place with Palestinian Medical Relief Society (PMRS), United Nations Relief and Works Agency (UNRWA), Near East Council of Churches (NECC) and Lutheran World Federation at which Hanan staff reviewed the activities and tools being used by the Project, and discussed the possibility of adapting and institutionalizing tools and interventions for use directly by the partners beyond the life of the Hanan project. Decision makers from some partner organizations expressed interest in adopting the checklists and scorecard tool for their own use. Subsequently during the quarter, training on the scorecard took place with PMRS district managers, and clinics were identified where PMRS district managers will accompany Hanan Satellite Office teams to jointly complete the scorecard reading. Joint scorecard administration will be completed by the end of the quarter. Once the data collection is

10

completed in these facilities, the Hanan Monitoring & Evaluation team will summarize and present the results back to PMRS staff during the next quarter in order to facilitate a further discussion on the potential usefulness to PMRS in adopting this quality improvement tool—as is or with adaptations—for use beyond the Hanan project. Formal training During the reporting period, Hanan conducted formal training courses for health professionals throughout West Bank and Gaza. Training topics covered during the quarter include: Child Nutrition and Growth Monitoring; Infection Prevention and Control; and Acute Respiratory Infection Management. In order to strengthen UNRWA’s capacity to use data for decision making, its program managers were trained in the use and application of Excel spreadsheet and SPSS statistical software packages.

Excerpt from “Cries of Life: The Story of Beit-Hanoon Clinic”—a Hanan Project Success Story, August 27, 2007

In a Beit-Hanoon UNRWA clinic in the northern Gaza Strip, clinic midwives learn about antenatal care, nutrition, and mother and child care through Hanan training courses. In addition to learning about the importance of providing care for women and children in one physical location, Ahlam, a clinic midwife admits that when she started working at the clinic three years ago, she did not have up-to-date health and nutritional information to help young mothers and their babies. "When I arrived, I didn't know mothers should feed babies with their natural milk until 6 months after the child’s birth.” She turns to advise Fedaa, a postnatal mother who holds her week-old newborn, Amal. "I think I have become a better, more informed midwife. Now when women come to me for counseling, I am glad I can pass along information I gathered during training.” In conservative communities such as Beit-Hanoon, where newly married couples usually live in their parents’ homes, mothers are encouraged to learn more about MCHN, especially those who are unfamiliar with ante-natal and postnatal care. Almost two thirds of women in the West Bank and Gaza receive no postnatal care at all. “We discovered that the mothers-in-law of young women also benefit from effective postnatal counseling sessions,” says Ahlam. “Once they understand the benefits, they encourage their daughters to visit the clinic. This way, we reach more women.” "We’re thankful for the training that Hanan provided," says Ahlam. "We enjoy listening to the cries of newborn babies, especially because now they are healthy cries. They are cries of life."

Assessment of Caritas Baby Hospital primary health care service provision The Caritas Baby Hospital approached the Hanan Project to conduct an assessment of the provision of services by its Rural Health Preventive Medical Center. Since 1990, the Center has been providing a comprehensive package of health and social services to the people of Nahalin. The Board Members of Caritas have taken a decision to close

11

the Center by the end of 2008. Therefore, the Management of Caritas asked for Hanan’s assistance in assessing and documenting relevant success, achievements and lessons learned before the Center closes. In doing so, Hanan focused primarily on the rural health services provided to Nahhalin village during this quarter. Secondarily, relevant implications and recommendations regarding rural health service provision in general will be summarized and provided to Caritas by the end of the quarter. The assessment encompassed the complete service package of the Medical Center, including: pediatric services; well baby clinic- and home-based services; antenatal and postnatal care services (including home visits); health and social education provision; social work services; and vocational services (sewing classes). The Hanan team conducted interviews at the Caritas Baby Hospital and Nahalin outreach clinic, and focus group discussions with village women. The assessment includes findings and recommendations for both the Medical Center in Nahhalin and the Caritas Baby Hospital, including recommendations for the future of their outreach, primary health care and preventive medicine services. The report will be delivered to Caritas by the end of the quarter.

2. Emergency and Humanitarian Assistance

Pre-hospital Emergency Medical Services (PHEMS)

During this quarter, Hanan launched the Pre-hospital Emergency Medical Services (PHEMS) training program in collaboration with the Centre for the Development of Primary Health Care (CDPHC). The overall objective of this activity is to contribute to improving access to quality pre-hospital emergency medical care and life saving measures and to mitigate the problem of movement restrictions of providers and beneficiaries. This training is offered to doctors, nurses and paramedical staff who are likely to encounter conditions in which timely transfer of patients or victims of injury to emergency services is prevented, and also to non health providers’ in communities. The training is offered to those who currently work in health facilities operated by governmental, non-governmental organizations, UNRWA health facilities, and in health facilities of the private sector.

The PHEMS curriculum is made up of three modules as follows:

Module 1: Basic PHEMS principles and general emergencies Module 2: Trauma and surgical emergencies Module 3: Medical, pediatric and obstetric emergencies

During the months of July and August, a training needs assessment was completed in the West Bank for health and non-health providers to focus the training on their specific needs, and to identify communities and participants. Based upon this assessment, 90 health providers and 90 non-health providers were identified to receive the training.

The selection of communities and target institutions was based on the following criteria:

12

• Having high prevalence of emergency cases • Lack of EMS services • Lack of medical services such as clinics, hospitals and emergency care

facilities • Shortage of medical staff trained on PHEMS • Communities that are facing physical accessibility problems to medical

services • Vulnerable and marginalized communities • Close to confrontation areas that are at high risk of being exposed to

causalities • Communities that can provide local facility to serve as an EMS room or

integrate this into an existing structure Training on module 1 was completed for 68 health providers and 90 non-health providers in the West Bank as of the end of September 2007, and the process of identifying participants and conducting the needs assessment has begun in Gaza. Advanced Life Support in Obstetrics (ALSO) and Neonatal Resuscitation Continuing the collaboration with the Foundation for Health and Social Development (Juzoor), Hanan conducted the second course in Advanced Life Support in Obstetrics (ALSO) and Neonatal Resuscitation (NRP) for 30 health professionals in the West Bank. Participants included midwives, physicians, nurses, and ob/gyns. The objective of the course is to contribute to the improvement of reproductive health services in Palestine through building the capacity of health providers to effectively manage and provide emergency obstetric care and neonatal resuscitation, using internationally accepted evidence-based best practices. The course will be offered again in the next quarter for health professionals from the Gaza Strip.

3. Communications and Marketing Assessing the impact of Hanan’s communications activities

A purchase order was signed with Alpha International to conduct a post-test study with women who are pregnant, postpartum, and/or have children under-5 years. Specifically, the study will measure media habits, exposure to Hanan’s communications activities, comprehension of messages being promoted through these activities, and impact in terms of usefulness and practice. In addition, the study will measure “unprompted” and “prompted” recall of Hanan’s key health messages. The total sample size for this study is 2,500 women - 2,000 from the Hanan Community Mobilization program’s intervention areas and 500 from control districts across the West Bank and Gaza.

13

In response to listener demand, the station manager of Kol al

Nas in Tulkarem has broadcast – at the station’s expense –

all ten plays during the weeks between paid rounds.

The Alpha and Hanan C&M teams met for a kick-off meeting to discuss and finalize study objectives, methodology, sample size, and timeline for completion. Subsequently, a 30-minute questionnaire was drafted in English and translated into Arabic, a pilot study was conducted, the questionnaire was finalized, and 27 field interviewers trained. Data collection is currently underway and expected to be completed by the end of this quarter. The final report will be submitted early in the next quarter. Impact of Hanan’s radio plays Broadcasting of Hanan’s ten radio plays, scripted and produced by Studio One of Ramallah, continued this quarter during peak listening times (11 am and 4:30 pm on Tuesdays and Saturdays). Based on feedback from local community-based organizations (CBOs) and women’s organizations in Jenin district, Radio Farah was substituted for Al Balad; Al Houriah and Al Shabab stations, both popular in the Gaza Strip, were also dropped from the original list as they ceased to function following the June clashes. The radio plays have proven to be quite popular among listeners. Early feedback received from the post-test study mentioned above suggests that women find the use of radio to broadcast plays a “new and different way” of communicating messages that “stays” with them; the plays themselves are “very real” and “suitable for all ages”; the topics are “close to the hearts and minds” of women; and, that they have “personally benefited” from listening to the plays. In response to listener demand, the station manager of Kol al Nas in Tulkarem has broadcast – at the station’s expense - all ten plays during the weeks between paid rounds. In addition to broadcasting the plays via radio, the CDs of these plays have been used quite successfully, albeit sporadically due to limited availability of CD players, by community health workers, CBOs, and clinics during health education sessions. Hanan’s MCHN messages appear in print The August 2007 issue of “You & Your Baby”, a high quality magazine targeting pregnant women and parents of babies/young children, carried a selection of Hanan’s key messages that included: the importance and timing of antenatal and post natal care; danger signs during pregnancy and the postnatal period; anemia prevention during pregnancy and in children under 5; signs and symptoms of diarrhea and ARI in children under 5; and, how to provide home care for children under 5 who have diarrhea or ARI. Twenty-seven messages on these topics were presented in a Q&A format and appeared as “footer bars” (3 cm strips that run along the bottom of each non-advertising page). The magazine also carried a 2-page story titled “Greatest of Them All” about the most nutritious liquids for young children. This children’s story first appeared in Hanan’s coloring book.

14

Hanan’s Educational Booklets: 1) Antenatal care through postnatal care 2) Neonatal care & breastfeeding 3) Complementary feeding & growth monitoring 4) Prevention, home management & referral for ARI & diarrhea in children under-5 years

The magazine’s publisher provided Hanan with 125 free copies of the August issue for distribution among community health workers. The C&M team conducted an in-service training for the community health workers (CHWs) in the West Bank and Gaza on how the materials could be used as an educational tool during home visits and health education sessions, and so far, feedback has been very positive. The 27 questions and answers (Q&As) will be categorized and compiled into two flyers for distribution by the CHWs to women and their families. Utilization of songs CDs While Hanan’s songs CDs continue to be distributed across the West Bank and Gaza to CBOs, kindergartens and partner clinics, the general lack of availability of CD players has posed a constraint to utilization. The CM field teams will therefore arrange to directly distribute the CDs during home visits to women who have CD players or computers in their homes. Other alternatives, such as private sector channels (private GPs, Ob/Gyns, pediatricians, pharmacies), will also be explored. Booklets and booklet holders During this quarter, the El Nasher advertising company was awarded the contract to finalize the design and re-printing of Hanan’s four health education booklets as well as to design and produce holders to aid booklet display. Based on findings from a pre-test of the booklets conducted by Global Management, El Nasher revised the booklet covers, selected the font style, finalized the “taglines” for each booklet, and designed the inside layout. In addition, in collaboration with the Hanan team, the El Nasher team developed the text and illustrations. The booklets cover the following four topic areas: 1) Antenatal care through postnatal care, 2) Neonatal care and breastfeeding, 3) Complementary feeding and growth monitoring, and 4) Prevention, home management and referral for ARI and diarrhea in children under-5 years. The booklets adopt a lifecycle approach and range in length from 12-18 pages. The four booklets have been tested and feedback has been very positive on all aspects including the unusual size (14.5 cm square), the use of black-and-white line drawings, and the “reference” style format. Women found the information to be new and useful, and a valuable refresher. Many women intended to keep the booklets as a reference for themselves, and some stated their willingness to share the booklets with family and friends who could benefit from it. The booklets will be printed by the end of the quarter and delivered early in the next quarter.

15

“…I am really impressed with Hanan’s work. I…attended an awareness session for around 20 women done by PCHRD CM team in north Gaza in a very marginalized area…. the team has built a strong relationship with the women there who have become very keen to participate in their sessions and other activities. It was also impressing to see how competent the health workers were in terms of knowledge and skills to pass and discuss the knowledge. The participating women were also very active participants in the discussion through the previous knowledge they gained from the health workers through home visits and the other sessions they had before. I can see how successful the community mobilization work [is] by Hanan and its partners, where I know very well how much effort Hanan has done to build the capacity of PCHRD’s CM team.”

---Firyal Snounu, USAID

4. Community Mobilization

Second round community mobilization program Similarly, a new contract was signed with the Center for Development in Primary Health Center (CDPHC) to implement community mobilization and knowledge promotion activities among 18 communities in Nablus, Salfeet, Ramallah, and Jerusalem districts. A cadre of 28 female community health workers, mobilizers and supervisors has been assigned to be the core of the community mobilization program in the field. The community capacity assessment (CCA) tool was used to help identify community needs and priorities, and to set the stage for building a partnership with the local community. The CCA included three components: documenting community profiles, CBO assessments, and focus group discussions among pregnant and postpartum women, and mothers of children under 5. As a result, 18 community profiles, 38 CBO assessments and 36 focus group discussions were conducted. In addition, the CDPHC team visited 19 MCH clinics, 27 kindergartens and 11 influential people to introduce the community mobilization program, assess available resources and to form local health committees. The findings and the results of the CCA were incorporated into community action plans, developed jointly with the communities themselves. The CDPHC community team also received one training on community mobilization, and one on maternal health using the life cycle approach addressing mothers’ health care through antenatal, delivery, postnatal and breastfeeding. During the quarter, a second round community mobilization contract was signed with PMRS to implement the community mobilization and knowledge promotion activities among 12 new communities in vulnerable areas in Jenin and Hebron districts. Twelve CHWs and mobilizers started the implementation of the community capacity assessments (CCAs) among the designated communities. Anemia screening campaign During the quarter, PMRS and Hanan launched an anemia screening initiative targeting pregnant and postpartum women, and children under 5 residing in Hanan’s designated first round communities in Jenin and Hebron districts in the West Bank. The purpose of

16

“My participation as a volunteer in the program empowered me, strengthened my confidence and increased others’ trust in my abilities”

--A volunteer in Ti’nik, Jenin

Recipe guideline training -role play, Jenin

this effort was to provide a better understanding about the magnitude of the anemia problem in the communities in which community program served. The campaign was publicized in mosques, local clinics and CBOs. Screened mothers received health education material and counseling by the CHWs on the importance of iron and folic acid supplementation and the importance of a healthy and balanced diet. All screened target groups received appropriate preventive and curative iron supplementations according to the screening outcome. In three months time, those found to be anemic will be followed-up by the PMRS medical team to assess level of improvement. Overall, in Hebron, 1049 beneficiaries were tested including 273 pregnant and 60 postpartum women, and 716 children under five. In Jenin, 1220 beneficiaries were screened including122 pregnant and 22 postpartum women, and 884 children under five. The percentage of anemic pregnant mothers was 19.7% and 18.8% in the districts of Hebron and Jenin, respectively, while anemia prevalence among the screened children under five was 38% in Hebron and 23.2% in Jenin. Promoting healthy kitchens in the West Bank and Gaza During this quarter, a Hanan nutrition consultant compiled a recipe book containing 30 traditional Palestinian recipes that are both nutritious and easy-to-prepare. Recipes were collected by PMRS and PCHRD CHWs from women living in different

communities in the West Bank and Gaza. Prior to inclusion in the book, recipes were reviewed by the consultant to ensure that they met the specific nutritional and caloric requirements of pregnant, postpartum and lactating women. The recipe book lists ingredients, quantities, cooking methods, caloric contents per serving and ways of combining foods to increase nutritional values, specifically targeting pregnant and lactating mothers, as well as to meet the nutritional needs of children under five years of age. Four training sessions were conducted during the quarter for PMRS and PCHRD CHWs in Jenin, Hebron, North Gaza and Gaza city on how to incorporate the recipe book into health education sessions on nutrition, anemia prevention and healthy eating, as well as how to provide individual counseling according to the needs of mothers.

End of round one community mobilization program in the West Bank The end of round one community mobilization activities in Hanan’s 28 initial communities in Jenin and Hebron was on August 30, 2007. Prior to this,

community sustainability plans were prepared, an evaluation and an end of project ceremony took place, facilitated by PMRS and Hanan teams. The 28 community sustainability plans include identified needs and priorities in each community, resources available, and specifics such as how activities will be carried out and who will be taking the lead.

17

“The program encouraged the spirit of volunteering and providing support to our community. In addition it strengthened the social networking and motivated the local institutions to develop unique relationships to work Together to solve their community needs”

--CBO representative, Idna

Health Education Session, North Gaza

The PMRS and Hanan team also worked together to develop a qualitative, open-ended questionnaire that addressed different aspects of the community program. A total of about 300 questionnaires from participating CBO staff and from beneficiary mothers were collected. Data will be analyzed and reported in the next quarterly report. Two ceremonies to commemorate the end of round one activities were held in Jenin and Hebron districts and were attended by representatives of all 28 designated communities. The ceremonies included presentations on the accomplishments of the CM program and the communities’ sustainability plans, in addition to entertainment. The participants expressed their gratitude to PMRS and Hanan for their dedication and efforts, and their commitment to continue working to improve the health of mothers and children in their communities. Mobilizing the community – North Gaza and Gaza A major barrier that pregnant women in Gaza and North Gaza face when they seek early ANC services is being turned away by clinic staff when they attempt to seek services within their first trimester. Some clinic protocols call for the first ANC visit to take place after the first trimester. This was the case in the Gaza community of Salateen where community members were able to organize themselves to convince their local clinic to register pregnant women earlier. Seeing the same thing happen in the communities of Beit Lahia and North Beit Lahia, CHWs shared the experiences of Salateen with key community leaders in these two communities. With the help of the

PCHRD community team, these community leaders organized two meetings involving influential women and men in Beit Lahia and North Beit Lahia. As a result, the group organized themselves and approached the Al Shaima clinic (north Beit Lahia) and Beit Lahia clinic (central Beit Lahia) to communicate their concerns and request a change in clinic policy. Both clinics responded favorably to the requests from their communities and subsequently changed their service protocols to receive and register women early in their

first trimester of pregnancy.

18

Anemia campaign in Tayaseer, Jenin

5. Joint Clinic-Community Activities

Community clinic linkages initiative As a part of the community-clinic linkage effort and with the support of the Hanan teams, three sites—two in Hebron (Idna and Al Daheriya) and one in Jenin (Selit Al Harthia)—were identified during this quarter to establish linkages and facilitate networking between the clinics and the communities they serve. The communities were selected from those in which both Hanan clinic strengthening and community activities are taking place. The aim of the linkage was for the clinic and the community to work together to plan and implement prioritized interventions that target identified health needs, mobilize local resources, and then to assess the extent to which desired outcomes were achieved. An intended outcome of the process is the establishment of sustainable collaborations—through coalitions or formal committees—that will continue to meet and identify needs, plan joint interventions, assess outcomes and use the data for planning future joint activities.

Among the three identified sites, with the facilitation of the Hanan team, several coordination meetings with municipalities’ staff, key community representatives, and PMRS community mobilization members took place to agree upon steps for strengthening linkages between the clinic and the community. The participants identified joint MCHN health priorities such as anemia among pregnant and postpartum women in Al Daheriya, and postnatal care in Idna and Selit Al Harthia. The

resulting campaigns included a variety of activities such as home visits, health education sessions in the PMRS clinic and CBOs, and

individual counseling sessions. Celebration festivals were held to commemorate the completion of the campaigns, which included different activities such as theater, songs, Q&A sessions, and poetry.

During the postnatal campaign in Selit Al Harthia, 116 home visits, 12 health education sessions, and 40 individual counseling sessions were implemented. In Al Daheriya, the anemia campaign for pregnant and post partum women provided blood screening for 41 women; 17 of whom were diagnosed with anemia. Health education materials and counseling on the importance of a healthy diet were provided for the participating mothers. In Idna, the postnatal care campaign reached a total of 500 women and involved: a clinic open day; health education sessions; home visits; distribution of information flyers & health education materials; listening to Hanan’s songs and plays on CD; a theater play; and placement of educational flyers in electricity bills. A large number of private and public sector partners were involved, and following the campaign the committee

19

Anemia campaign in Raqua, Hebron

members agreed to meet on a monthly basis to focus efforts on child health. Currently, the committee is networking with local schools to assess children’s hemoglobin status which will be supported by PMRS and the community-clinic committee.

In fact, following each of the campaigns, an evaluation session was conducted to review the process and outcomes of the joint initiative, identify lessons learned, and begin planning for future activities. During the quarter, Hanan’s Gaza staff also began working with clinics and community members in Tufah, Shejaea, and Beit Hanoun to assess the possibility of establishing linkage activities in these

areas.

B. Support Functions

1. Monitoring and Evaluation

The Complementary Feeding Practices Study During the quarter, the Center for Development in Primary Health Care (CDPHC) completed and submitted the final report on the Complementary Feeding Practices study. The goal of this qualitative study was to provide Hanan with recommendations for key project interventions at the clinic and community level that will support mothers in implementing positive complementary feeding practices. The study consisted of 32 focus groups with mothers of children aged 4-24 months, and 60 key informant interviews with individuals viewed as having an influence on complementary feeding practices.

On August 7, 2007, Dr. Mohammed Shaheen of CDPHC presented the findings from the study to Hanan and partner CBO staff. Findings from the report were immediately incorporated into the Community Mobilization and Communications and Marketing team activities and health education messages, and also helped inform Hanan Public Health staff as they conduct supervision visits and on-the-job training on counseling related to complementary feeding and breastfeeding practices. Plans were set underway during the quarter to transform the lengthy research report into a concise summary for wider distribution to stakeholders over the next quarter. End of Project Household Baseline Survey Through an open tender process, Alpha International was provisionally selected to conduct the end of project (EOP) household survey. Financial negotiations are taking

20

place, and it is expected that a contract will be drafted and signed by the end of the quarter. The focus of the household survey is to collect data on outcome indicators pertaining to maternal and child health and nutrition. Data collection for the EOP survey will involve the use of two questionnaire modules, one focusing on mothers of children aged 0-11 months and another on mothers of children aged 0-59 months. Indicators address the health status of women and children in relation to antenatal care, exclusive breastfeeding, postnatal care, the intake of iron and folic acid supplementation, management of childhood illnesses, as well as the childhood prevalence of acute respiratory infection, diarrheal disease, anemia, stunting and wasting, and vitamin A intake. Being the end of project survey, and with the renewed collaboration with the MOH, Hanan staff will work to ensure the questionnaires and methodology are consistent with previous administrations so that project outcomes can be effectively measured, and at the same time will work with MOH staff to discuss the possibility of adapting the questionnaires so that they capture additional data on indicators of specific interest to the MOH. Strengthening data collection and reporting systems During this reporting period, a concerted effort was made to simplify and fine tune the existing Hanan M&E systems to help ensure that M&E tools accurately and adequately measure Hanan activities, and ultimately, to help assess whether the Project has achieved its desired objectives. In doing so, the following activities took place during the quarter:

� The clinic scorecard tools and guidelines—consisting of medical record review, client and provider interviews, and the collection of basic health service statistics—were streamlined. Furthermore, a separate set of scorecard tools were developed for use in UNRWA clinics to accommodate difference between UNRWA clinical protocols and those that Hanan promotes.

� Measurement tools were designed to document the outcomes of the management intervention activities that will be taking place over the remaining life of the project.

� A database was designed to capture data from the new Home Visit Form newly in use by the Community Mobilization teams in West Bank and Gaza. The database contains a number of reports to be generated on a monthly basis that will help inform ongoing CM activities, and hopefully form the basis of a sustainable intervention to be carried on by Hanan’s current implementing partners (CDPHC, PMRS and PCHRD).

� The C&M post-test questionnaire was reviewed and revised to ensure capture of Hanan CM activities in addition to C&M activities.

2. Policy and Advocacy

There are no policy and advocacy activities to report for this quarter.

21

3. External relations and strategic partnerships Hanan communications During this reporting period, the Hanan Project began to work more intensively to increase efforts to qualitatively document success stories resulting from Project activities. The Project Communications Plan was reviewed and revised, and two success stories were drafted and submitted to USAID during the quarter: “Cries of Life: The Story of the Beit-Hanoun Clinic”, and “The Story of Umm Mohammed and the Zababdeh Well-Baby Clinic in Jenin.” A third story describes the positive outcomes resulting from collaboration between Hanan and another USAID-funded project, the Emergency Water and Sanitation project, implemented by Hanan’s partner, ANERA.

In many rural areas of the West Bank and Gaza, health care is scarce and underdeveloped. To improve the situation, two USAID-funded programs cooperate,

supporting municipal clinics with training, medicines and water and sanitation facilities. Through the USAID-funded Hanan project, clinic staff receives on site training in a number of fields to make them better prepared to serve the women and children of their communities. The program also provides them with essential medical equipment used to provide maternal and child health services. One of the important subjects of the training is how to prevent and control the spread of infection within the clinic. Here Hanan has cooperated with another USAID funded project implemented by ANERA, the Emergency Water And Sanitation (EWAS) project. Thanks to EWAS support, the clinic staff can wash their hands at several places including the emergency room, where they did not even have access to water earlier, let alone a hand basin. Instead, staff members had to go to the communal bathroom to wash their hands. And talking about toilets, there are now several of them, including one reserved for the staff – an important measure to avoid spreading of infectious diseases. The emergency room as been tiled, making it much easier to keep clean. A 150 m3 water cistern had been installed, as well as several smaller containers, a water pump, a solar/electrical water heater and a water filter. All this provides not only clean drinking water to both patients and staff, but also allows staff to keep medical instruments much cleaner. So far, two Hanan partner clinics in the West Bank have been renovated by EWAS, and another five are coming up. In addition, a number of Hanan partner clinics have been evaluated by ANERA staff for future projects, depending on approval of the donor, USAID.

C. Finance

Budget vs. Expenditures: Summary and Analysis On April 26, 2007 USAID West Bank/Gaza Mission approved Hanan’s third budget modification covering the extended period of March 2007 until June 2008. In this

22

budget, the total USAID contribution of Federal funds, now fully obligated, is $19,186,044. We estimate the total project expenditures through September 30, 2007 to be approximately $11,520,382. For further detail, please see Annex I: Third Quarter Financial Report (July – September, 2007). This figure, which represents, 60% of the total budget and obligated funds for 79% time passed on the Project, includes actual expenditures through August 31, 2007 of $11,071,166 and estimated expenditures for September 2007 of $449,216. It is worth noting that because our accounting and reporting systems are on the cash basis, the project’s considerable financial obligations and commitments against program funds are not reflected in our financial reports until funds are disbursed. Cost Sharing As noted in the last quarterly report, the Project has significantly increased its efforts to meet its cost sharing obligations. The total cost share contribution from all trainings / workshops conducted so far by Hanan is approximately $40,000. ANERA has made in-kind contributions of medical supplies to organizations and communities in the West Bank and Gaza throughout the Palestinian Territories in medical supplies worth approximately $8,154,564 through March 2006. We are currently determining ANERA’s in-kind cost share contribution for the period April 1st to December 31st, 2006 and we estimate the Project’s cost share contribution through ANERA to be an additional $7,388,455, for a grand total for the two years through December 31, 2006 of approximately $15,543,019.

D. Administration

Procurement The procurement, approved last quarter for medical and audio visual equipment needed by Hanan partner clinics, was finalized in the amount of $1,334,273.75. Contracts were prepared and signed with vendors for commitments totaling $1,035,092.75. A number of these items have already been delivered to the clinics, and others are awaiting delivery. The remaining $299,181 is pending USAID waiver approval. A blanket waiver was granted for the Hanan project on July 24th, 2007. This waiver has allowed Hanan to procure locally for essential items such as medical records and educational materials, and has thus sped up the procurement process for these items significantly. Printing of the medical records amounted to $50,380. Clinic signage procurement totaled $9000. A small procurement in the amount $5,081.79, consisting mainly of disposables, was also delivered to Hanan clinics.

23

Also during the quarter, the procurement for CBOs has been finalized and delivered in the amount of $20,000, and the tender for the procurement for the MOH was posted. A large item, an oxygen extractor for Sheik Zayed hospital, arrived to port during the quarter and is currently going through customs clearance. Visitors and Consultants The Project hosted three visitors from JSI Research and Training Institute to the Ramallah and Gaza offices during the quarter: Table 4: International visitors during the reporting period Name Period Title

1. Laurie Cappa July 07 – July 24 JSI Documentations Consultant 2. Herman Willems July16 – July 28 JSI Public Health Consultant 3. Mounia Msefer August 18- September 01 JSI Finance Manager

Table 5 below summarizes the local consultants hired by the Project during the reporting period. Table 5: Local consultants during the reporting period Name Period SOW Area

1. Fuad Hodali July 1st – July 20th Database Consultant Ramallah

2. Murad Abu El-Haija August 23rd–September 11th SPSS Trainer Ramallah

3. Ian Maxwell June 21st–September 10th Procurement Writer HBLS Analytical Report

Ramallah

4. Ibrahim Afana August 27th – August 28th Nutrition Consultant Gaza

5. Amina Hamad July 1st – September 30th Biomedical Engineer Ramallah

6. Sulaiman Turkman July 29th – August 2nd IPC Training Qalqilya

7. Fatima Na’seih July 31st – August 2nd IPC Training Qalqilya

Program subcontracts Table 6 below provides a cumulative summary of all active program subcontracts, currently valued at: $2,574,588. Table 6: Status of Program subcontracts

Organization Project Component Type of contract

Current Status

Amount

Juzoor Foundation

Public Health (Maternal Health Training)

Purchase Order Implementation 251,707.50

School of Community Health - PMRS

Public Health (Child Health Training)

Purchase Order Implementation 98,031

24

Juzoor Foundation

Public Health (ALSO) Subcontract Implementation 162,965

CDPHC Public Health (PHEMS)


PMRS Community Mobilization Subcontract Completed 297,436

PCHRD Community Mobilization Subcontract Implementation 229,438

New Vision Community Mobilization Purchase Order Completed 44,000

Sama Productions

Communications and Marketing

Subcontract Terminated 220,000

Al Kasaba Communications and Marketing

Purchase Order Completed 18,500

Studio 1 Communications and Marketing


Studio 1 Communications and Marketing


Heart-to-Heart International

Communications and Marketing


Global Communications and Marketing


CCAST Monitoring and Evaluation (household survey)


CDPHC Monitoring and Evaluation (Comp. feeding practices)


Studio One Communications & Marketing

Purchase order Implementation 89,400

Nasher Communications & Marketing


Alpha Communications & Marketing

Purchase Order Implementation 36,824.50

Alnay Mother and child Health messages


CDPHC Community Mobilization round 2


Palestinian Medical Relief Society (PMRS)

Community Mobilization round 2

Sub contract Implementation 87,064

Community Mobilization round 2

Sub contract In process 142,030

TOTAL $2,716,618

Level of Effort Table 7 below details the current level of effort on the Project. Table 7: Project Level of Effort

25

Name Position Status Employer Office Start Date on Project

Effort Level

Nadira Sansour

Training Specialist Full-time

JSI Ramallah January 13, 2005

100%

George Shoufani

Director of Finance Full-time


100%

Rand Salman Deputy Director of Public Health & MHN Specialist

Full-time

ANERA Ramallah January 18, 2005

100%

Hassna Dajani

Director of Admin. Full-time

ANERA Ramallah January 25, 2005

100%

Mahmoud Abu Radaha

Capacity Building Specialist

Full-time

EMG Ramallah January 28, 2005

100%

Emad Khoury Driver Full-time

JSI Ramallah February 1, 2005

100%

Hisham Al Haj Driver Full-time

JSI Gaza February 6, 2005

100%

Sana Abu Mazyad

Administrative Assistant Full-time

JSI Gaza March 23, 2005

100%

Maher Saqqa Finance & Admin. Manager

Full-time

JSI Gaza March 26, 2005

100%

Rola Tahboub Senior Finance Advisor Full-time

JSI Ramallah April 11, 2005

100%

Nuha Judeh Cleaner Full-time

JSI Ramallah April 11, 2005

100%

Haya Mousleh Human Resources Coordinator

Full-time

JSI Ramallah May 22, 2007

100%

Randa Bani Odeh

Associate Director for Community Mobilization

Full-time

JSI Ramallah June 13, 2005

100%

Saeda Abu Ramadan

Finance & Admin. Assistant

Full-time

JSI Gaza June 13, 2005

100%

Kumkum Amin

Director of Community Mobilization & Marketing

Full-time

JSI Ramallah July 15, 2005

100%

Daoud Abdeen

Associate Director for Capacity Building

Full-time

EMG Ramallah July 18, 2005

100%

Sahar Mukhaimer

CM/ C&M Coordinator Full-time

ANERA Gaza August 1, 2005

100%

Samar Sharif Admin Assistant Full-time

ANERA Hebron August 1, 2005

100%

Majed Al Bakri IT Manager Full-time

JSI Ramallah August 1, 2005

100%

Diane Abraham

Team Leader Full-time

ANERA Hebron August 18, 2005

100%

Sahar Abu Samra

Team Leader Full-time

ANERA Gaza September 1, 2005

100%

Tharaa Nasser

Accountant Full-time

JSI Ramallah September 6, 2005

100%

Nadira Shibly Procurement / Contracting Manager

Full-time

ANERA Ramallah September 12, 2005

100%

26

Rula Abu Nimreh

Procurement Coordinator

Full-time

JSI Ramallah May 1, 2007

100%

Hanan Awartani

Receptionist/ Admin. Assistant

Full-time

JSI Jenin November 1, 2005

100%

Najah Hamarshi

Public Health Officer Full-time

JSI Jenin November 1, 2005

100%

Firas Khalaf Communication & Marketing Specialist

Full-time

JSI Ramallah November 6, 2005

100%

Anne Scott Project Director Full-time


100%

Salwa Wishah Hostess Full-time


100%

Dina Husary M&E Specialist Full-time


100%

Abdel Naser Soboh

Satellite Office Team Leader

Full-time

JSI Gaza August 1, 2006

100%

Jasem Humied

Deputy Project Director Full-time

JSI Gaza July 1, 2007

100%

Lubna AlShareef

Monitoring & Evaluation Specialist

Full-time

JSI Gaza August 15, 2006

100%

Khader Abu Hasan

Program Officer Part-time

JSI Gaza October 1, 2006

80%

Omar Majdalawi

Community Program Supervisor

Full-time

JSI Gaza October 8,2006

100%

Tasneem Atatrah

Health Education Specialist

Full-time

JSI Jenin May 14, 2007

100%

Wafa Shikaki Community Program Supervisor

Full-time

JSI Ramallah November 19, 2006

100%

Wissal Karaja Program Officer Full-time

JSI Hebron November 21, 2006

100%

Suzzane Shamali

Program Officer Full-time


100%

Deirdre Rogers

Director of Monitoring and Evaluation

Full-time

JSI Ramallah June 14, 2007

100%

Itimad Abu Ward


JSI Gaza May 1, 2007

100%

Aula Al-Salmy Program Officer Part-time

JSI Gaza April29, 2007

85%

Amal Turban Community Health Officer

Full-time


100%

Samira Khatib Program Officer Full-time

ANERA ANERA-Nablus

July 22, 2007

100%

Dr. Iyad Samara


JSI Jenin July 22, 2007

100%

Suhail Samander

Driver Full-time

JSI Ramallah August 8, 2007

100%

Ibrahim Bin Bashi

Driver Full-time


100%

27

Personnel Changes

• Saeda Abu Ramadan’s title was been changed from Administrative Assistant/Receptionist to Finance and Administrative Assistant.

• Issa Khoury resigned as a driver on September 01, 2007. • Amal Turban was appointed as Community Health Officer in Gaza office on 24 June,

2007. • Samira Khatib was appointed as Program officer in Northern District/Nablus ANERA

office on 22 July, 2007. • Dr. Iyad Samara was appointed Program Officer in the Jenin Satellite office on 22

July, 2007. • Ibrahim Bin Bashi was hired as a Driver based in the Ramallah office on 25 July,

2007. • Suhail Samander was hired as a Driver based in the Ramallah office on 08 August,

2007. • Abdullah Abu Dayya resigned as Capacity Building/Management Specialist in Gaza

on 01 August, 2007. • Dr. Nisreen Abu Middain resigned as Public Health Program Supervisor for Gaza on

01 August, 2007.

III. Constraints Internal clashes and delays in vetting continued to be the primary constraints for the Project this quarter. June in Gaza saw internal clashes, resulting in the subsequent closure of two radio stations that had been broadcasting Hanan’s plays, thus reducing regional dissemination of Hanan’s MCHN messages throughout the quarter. Furthermore, delays in renewal vetting for a number of clinics in both West Bank and Gaza have interrupted Hanan activities in these clinics. The delay in vetting Al Nasher significantly impacted the timeline for finalizing the design and layout of the four Hanan educational booklets. This was followed by a delay while waiting for USAID approval of the materials, and the concurrent MOH request for feedback on the content of all four booklets, which further postponed the printing of the booklets. Vacancies in the Gaza office, including the Training Specialist and the Management Specialist in charge of clinic management intervention activities, posed a challenge to completing planned activities. This has also impacted the ability to potentially graduate some clinics where management interventions are planned for but have not yet been implemented due to the staffing shortage. However, during the quarter the Project has successfully hired two new staff in Gaza responsible for implementing Hanan training and management intervention activities.

28

IV. Cumulative List of Tools, Methods, and Publications Tools & Methodologies Publications/Reports -Vulnerability Assessment Methodology -Health Facility Assessment Methodology -Training Manual for Community Mobilizers and Community Health Workers -Guidelines for forming Community Coalitions -Job Aides: -Neonatal resuscitation desk calendar -Neonatal resuscitation wall chart -Infection prevention and control -ARI and DD (reprints from UNICEF, PMRS and WHO) -Newborn care desk calendar -Checklists: -ARI; DD; Management; Infection Prevention and Control;

Growth Monitoring; Antenatal Care; Postnatal Care; Emergency Preparedness; Preparation for Normal Delivery; Normal Delivery; Equipment Needed for Delivery

-Clinic Management Menu -Clinic Rapid Assessment Methodology & Quality Improvement Plan -On-the-job Training Guidelines -Household Survey Questionnaires and LQAS Tabulations -Project Reporting and M&E Query Forms, and tracking databases -MCHN technical guidelines for CHWs -C&M post-test campaign questionnaire -CM Home visit form and database

Technical Papers and Reports: -Hanan Household Baseline Survey: Maternal and Child Health and Nutrition Indicators at the Household Level in the West Bank and Gaza -Hanan Baseline Health Facility Assessment for Maternal and Child Health and Nutrition Services: First Cohort Clinics in the West Bank and Gaza -Women’s Perspectives on Maternal and Child Health and Nutrition: Findings from Hanan Focus Groups -Community Capacity Assessments: West Bank & Gaza -Hanan Project Community Mobilization Results, 2006

Training Report: -Community Mobilization for Community Health Workers Technical Tools: -Supervisory Checklists: Standardizing High Quality Maternal and Child Health and Nutrition Services in Primary Care Settings -The Hanan Model Clinic: Criteria for the Organization and Delivery of Essential Maternal and Child, Health and Nutrition Services -Hanan’s Approaches to Providing Training and Follow-on Support: Child Health, Nutrition and Growth Monitoring and Management of Diarrheal Disease and Acute Respiratory Infection - Home Visit Form Technical Briefs: -Empowering Communities, Sustaining Social Change: Community Mobilization in the West Bank and Gaza Presentations: -Epidemiologic Data Underlying Hanan’s Choice of Interventions -Hanan’s Quality Improvement Strategy -Overview of Hanan Nutritional Activities Other: -Hanan Brochure -Hanan Communications Plan -Website Content

29

V. Expected Activities of the Next Reporting Period As the project moves into the last six months of technical program activities, additional emphasis is being placed on activities to measure and document project outcomes. Some highlights of the work plan through the end of the calendar year are as follows: For the Public Health team: • Working with Ministry of Health to upgrade clinics from level 1 to level 2, and from

level 2 to level 3 facilities, and procure necessary equipment • Reprinting of PMRS health education booklets and medical records • Reprinting of UNRWA newborn care materials • Finalization and production of ANC and IPC job aides • Training of clinic partners For the Communications and Marketing team: • Writing up results and findings from the Communications and Marketing campaign

post-test study of radio plays and other communication activities • Distribution of Hanan educational booklets • Promotion and airing of additional radio plays • Distribution of recipe book for HCWs For the Community Mobilization team: • Working with Ministry of Health to create new level 1 clinics and procure necessary

equipment • Continue to work with new Round 2 partners, CDPHC and PMRS, to expand

activities in new communities in West Bank, and procure necessary equipment • Continue to support PCHRD to expand Round 2 activities to new communities

throughout Gaza and procure necessary equipment • Distribution of new Home Visit Form to partners and implementation of new Home

Visit Form database by partners For the Monitoring and Evaluation team: • Complete the design, procure necessary equipment, conduct fieldwork and the initial

analysis of the end of project household survey • Analyze data collected from all clinics in the third round of Balanced Scorecard

administration • Begin review and analysis of pre/post findings from Management Interventions

checklists from clinics that are graduated • Develop and conduct presentation on project outcomes at stakeholders meeting

scheduled for October 29, 2007.

30

------------------------------------------ Anne Scott Hanan Project Director September 20, 2007

31

Annex I: Third Quarter Financial Report (July-September 2007) JSI RESEARCH & TRAINING INSTITUTE, INC.

THE HANAN PROJECT

USAID 3rd Actual Actual Estimated Total Remaining Percentage

Contribution Quarter EXPENSES EXPENSES EXPENSES Expenditures Funds Funds

LINE ITEM Federal Funds 7/07 - 9/07 Jul. 07 Aug. 07 Sep. 07 & Projections Expended

SALARIES 3,931,990 310,330 111,877 93,218 105,235 2,879,216 1,052,774 73%

ALLOWANCES 1,258,545 59,076 18,674 28,850 11,552 943,326 315,219 75%

CONSULTANTS 19,768 0 0 0 0 28,500 -8,732 144%

OTHER DIRECT COSTS / TRAVEL / EQUIPMENT 1,921,939 97,469 48,246 23,275 25,948 1,487,092 434,847 77%

INDIRECT COSTS / OVERHEAD 1,474,502 129,875 49,748 43,031 37,095 1,344,743 129,759 91%

PROGRAM COSTS 7,382,413 575,118 247,315 96,614 231,188 2,498,197 4,884,216 34%

SUB-RECIPIENTS 3,196,887 141,844 60,424 43,223 38,197 2,339,308 857,579 73%

TOTAL 19,186,044 1,313,711 536,285 328,211 449,216 11,520,382 7,665,662 60%

Current Amount of Obligated Federal Funds 19,186,044 Estimated Remaining Obligated Federal Funds 7,665,662

Notes: 1. The Report is on a Cash Basis 2. There is a lag in reporting of 1 month for actual field/local expenditures. Thus, Actual Expenditures for each month are made up of the Actual Field

Expenses for the month before/prior and the Actual Home Office Expenses for the current month. 3. Estimated Expenditures for the 3rd/last month of a quarter is made up of Actual Field/Local Expenditures of the prior month and Estimated Home

Office Expenditures for the 3rd/last month.

HANAN QUARTERLY NARRATIVE REPORT - JSIhanan.jsi.com/Docs/Project/2007_q3_report.pdf · HANAN...

Documents

Transcript of HANAN QUARTERLY NARRATIVE REPORT - JSIhanan.jsi.com/Docs/Project/2007_q3_report.pdf · HANAN...