MCHIP Zimbabwe FY12 Q4 Report - 30Oct12 finalpdf.usaid.gov/pdf_docs/PA00JSW4.pdf · MCHIP/Zimbabwe...

MCHIP/Zimbabwe Quarterly Report (Jul-Sept 2012)

Maternal and Child Health Integrated Program

Zimbabwe

FY12 Fourth Quarterly Report

July 1 – September 30, 2012

United States Agency for International Development

under Cooperative Agreement # GHS-A-00-08-00002-000

Submitted to the USAID/Zimbabwe Mission by:

Jhpiego in collaboration with

John Snow Inc.

Save the Children

Macro International Inc

PATH

Institute of International Programs/Johns Hopkins University

Broad Branch Associates

Population Services International


Table of Contents

Acronyms and Abbreviations ................................................................................................................................. 2

1. Introduction ............................................................................................................................................... 4

2. Highlights of This Quarter’s Achievements ............................................................................................... 4

3. Analysis of Select Indicator Data from the Quarter .................................................................................. 8

4. Management, Finance, and Administration ............................................................................................ 20

5. Challenges and Opportunities ................................................................................................................. 21

6. Success Story: Motivating VHWs to better performance – a little support goes a long way ................ 22

7. Visitors/International Travel ................................................................................................................... 23

Annex 1. MCHIP/Zimbabwe Indicator Table: Achievements in FY12 Q4 against Annual Targets ....................... 25

Acronyms and Abbreviations

ACT Artemisinin-Based Combination Therapy

ARK Absolute Return for Kids

BFHI Baby Friendly Hospital Initiative

CHC Child Health Card

cIYCF Community-based Infant and Young Child Feeding

DHE District Health Executive

DHIO District Health Information Officer

EHT Environmental Health Technician

EmONC Emergency Obstetric and Newborn Care

ENMR Early Neonatal Mortality Rate

EPI Expanded Program on Immunization

EQOC Equity and Quality of Care (study)

FP Family Planning

FY Fiscal Year

HBB Helping Babies Breathe

HF Health Facility

HMIS Health Management Information System

HW Health Worker

IMNCI Integrated Management of Newborn and Childhood Illness

IRS Indoor Residual Spraying

IYCF Infant and Young Child Feeding

KAB Knowledge, Attitude, and Beliefs

KC/KMC Kangaroo Care/Kangaroo Mother Care


MCAZ Medicines Control Authority of Zimbabwe

MCCM Malaria Community Case Management

MCHIP Maternal and Child Health Integrated Program

MMR Maternal Mortality Ratio

MNCH Maternal, Newborn and Child Health

MNH Maternal and Newborn Health

MOHCW Zimbabwe’s Ministry of Health and Child Welfare

MPH Mutare Provincial Hospital

MPMA Maternal and Perinatal Mortality Audit

NIHFA National Integrated Health Facility Assessment

OJT On the Job Training

PCN Primary Care Nurse

PCV Pneumococcal Vaccine

PHE/T Provincial Health Executive/Team

PPFP Postpartum Family Planning

PPH Postpartum Hemorrhage

PQI Performance Quality Improvement

QA/QI Quality Assurance/Quality Improvement

RDT Rapid Diagnostic Test Kits (for malaria)

RED Reaching Every District

SBA Skilled Birth Attendant

SBM-R Standards Based Management and Recognition

TOR Terms of Reference

TOT Training of Trainers

TWG Technical Working Group

USAID United States Agency for International Development

UZ University of Zimbabwe

VHW Village Health Worker

WHO World Health Organization

WHT Ward Health Team

ZDHS Zimbabwe Demographic and Health Survey

ZNFPC Zimbabwe National Family Planning Council

Children wear t-shirts with the message “Exclusive

Breastfeeding Worked for Me” on the back during

the World Breastfeeding Week commemoration.

1. Introduction

Completion of FY12 Quarter 4, covering the period July to September 2012, signaled the end of MCHIP’s

second full year of implementation in Zimbabwe. As with previous quarters, Q4 saw continued progress in

MCHIP/Zimbabwe’s programmatic implementation at national, provincial, district, and community levels.

The MCHIP team maintained course across each of its four major objective areas as well as in cross-cutting

areas like monitoring and evaluation. This Q4 report describes in detail technical and operational

achievements made in the quarter (as well as during the year) and presents data and analysis on select key

indicators from the MCHIP/Zimbabwe Performance Monitoring Plan (PMP). This report begins with a

summary of the project’s highlights for the quarter, then presents in graphical form data on select project

indicators. These sections are followed by a description of challenges and opportunities experienced in the

quarter, a project success story, and a detailed breakdown of the project’s Q4/annual achievements against

our FY12 indicators and annual targets (Annex 1).

2. Highlights of This Quarter’s Achievements

MCHIP/Zimbabwe continues to make significant achievements, both programmatically and operationally. A

summary of highlights from FY12 Q4 is listed below:

Highlights of Q4 Technical Achievements

At regional level:

• In August, MCHIP/Zimbabwe’s Child Health and Immunization Advisor provided substantial technical

assistance to MCHIP/Malawi and the Malawian Ministry of Health’s National Immunization Program.

The Child Health and Immunization Advisor supported MCHIP/Malawi in its efforts to assist the

Malawian MOH to conduct a data quality self-assessment (DQS).

At national level:

• In Q4, MCHIP together with the Ministry of

Health and Child Welfare (MOHCW) and

other partners participated in multiple

international commemorations including

World Population Day in July, World

Breastfeeding Week in August, World

Humanitarian Day in August, and World

Malaria Day in September. In addition to

providing technical and financial support to

these events, MCHIP exhibited materials at

these commemorations, providing an

opportunity for MCHIP staff to disseminate

information about our work to a broad

audience as well as enhance networks with

other partners.

• During Q4, MCHIP continued to support the

Zimbabwe National Family Planning Council

(ZNFPC) in promoting family planning

Part of the IEC/BCC material pretest group at

Chakohwa Clinic. Community members were shown

various health materials and asked to give

feedback. Child health-related IEC/BCC materials

focused on topics including diarrhea, measles,

pneumonia, and key household practices.

Community feedback has since been used to

improve the messages and materials.

issues. In early July, MCHIP and other partners supported ZNFPC to hold a national stakeholder’s

meeting focused on “repositioning family planning in Zimbabwe”. This meeting provided a forum for

in-depth discussions on family planning issues and provided MCHIP with an opportunity to advocate

for strengthened efforts around post-partum family planning (PPFP). Results from this meeting will

help guide ZNFPC’s strategy in coming years. Meanwhile, MCHIP will continue to support ZNFPC in

the development of a PPFP training package, which is anticipated to be completed in FY13.

• In Q4, MCHIP continued to provide substantial technical and financial support to the MOHCW

through various training of trainers (TOTs) activities. MCHIP staff helped facilitate (and supplied

training equipment for) two Helping Babies Breathe (HBB) TOTs held in mid-August. In addition,

MCHIP’s Child Health Technical Officer participated in a Child Health Card/WHO growth chart TOT in

mid-July 2012, as well as a Baby Friendly Hospital Initiative (BFHI) TOT in September. MCHIP’s Child

Health Technical Officer has subsequently helped to cascade CHC/growth chart training in Mutare

and Chimanimani and is now a recognized BFHI “assessor” who can participate in BFHI health facility

assessments.

• In July, MCHIP’s Newborn Health Coordinator supported the MOHCW and Absolute Return for Kids

(ARK) in conducting a national newborn corners assessment aimed at identifying existing services,

gaps, and opportunities surrounding essential newborn care service provision in 20 district hospitals.

MCHIP’s Newborn Health Coordinator also assisted in drafting the assessment report, which has

since been circulated. In addition to these activities, the MCHIP Newborn Health Coordinator also

attended a regional newborn corners training in August.

• MCHIP is supporting the National Malaria Control Program (NMCP) in developing a Malaria

Community Case Management (MCCM) training package. The purpose of this training package is to

standardize MCCM training nationally. MCHIP supported a 2-day stakeholder’s meeting at the end

of September focused on developing a facilitator’s and participant’s manual, based on existing

MCCM protocols and guidelines. A draft package is expected during FY13 Q1.

• MCHIP continued to support the MOHCW’s Quality Assurance (QA) Unit throughout Q4, in its efforts

to raise the profile of quality assurance and quality improvement (QI) concepts nationally and to

develop a national QA/QI policy and strategy. MCHIP supported a stakeholders’ sensitization

meeting in September on QA/QI, which was attended by 52 Hospital Managers, Quality Assurance

Focal Persons from 20 District Hospitals, and the consultant team tasked with drafting the QA/QI

policy and strategy. Recommendations from

this meeting will feed into the development of

the national QA/QI policy and strategy, which

MCHIP will continue to support in FY13.

• Throughout the quarter, MCHIP continued to

support the MOHCW in developing MNCH-

related IEC/BCC messages/materials. MCHIP

supported the MOHCW Health Promotion Unit

in formulating, pretesting and finalizing BCC

materials on child health conditions as well as

MNH topics. A pretest for MNH materials was

conducted in September by staff from the

MOHCW RH Unit, the Manicaland provincial RH

focal person, the MOHCW Health Promotions

Unit at provincial and district levels, and

MCHIP. Pretested materials included:

translated versions of the You and Your

Pregnancy booklet, a Kangaroo Care pamphlet,

and a Newborn Care pamphlet. The pretest

yielded interesting insights on community

behaviors, such as the taking of African herbs


before labor and reluctance towards institutional deliveries and seeking of neonatal health services.

One recommendation resulting from the pretest exercise was to conduct a community-level baseline

assessment in order to formulate an advocacy and communications strategy.

• During Q4, MCHIP continued to provide technical support to the National Integrated Health Facility

Assessment/Equity and Quality of Care {NIHFA/EQOC} Task Force and consultant team. In mid-July,

MCHIP participated in a 5-day review workshop on the draft NIHFA/EQOC reports, providing detailed

feedback and suggestions for improvement to report writers. It is anticipated that the final reports

will be ready by end-October 2012.

• In July, as part of ongoing support to the national Nutrition Unit, MCHIP’s Nutrition Consultant led

an external verification meeting on the Breastfeeding KAB report and the IYCF Program Review

preliminary report. A brief on the IYCF Program Review findings was distributed at the meeting and

the final report is anticipated in October.

• Finally, throughout the quarter MCHIP staff participated in discussions around the oxytocin potency

study, which MCHIP will conduct in conjunction with MOHCW and the Medicines Control Authority

of Zimbabwe (MCAZ). Data collection is being planned for November 2012.

At provincial, district, and health facility levels:

• MCHIP continues to support provincial-level planning and review, buy participating in: 1) a Provincial

Health Team (PHT) meeting and 2) a provincial maternal and perinatal mortality audit meeting

(MPMA), both held in August. The PHT meeting – the first held in Manicaland since 2009 – provided

an opportunity for MOHCW and health partners in Manicaland to gather, review progress in the

districts for the previous six months, and make plans for the second half of the year. Presentations

were made by district offices, provincial offices, and health partners. One result from the meeting

was a request made by partners for strengthened provincial-level coordination, to reduce confusion,

competition, and waste among partners. Regarding the MPMA meeting, MCHIP staff gave

presentations on the national MPMA guidelines and how to document information using audit tools.

Challenges identified during the MPMA meeting include: blood supply remains a problem in most

districts, with some districts struggling to buy blood; the lack of availability of urine dipsticks and

oxyctocin in the province remains a problem; there is low knowledge among nurses on use of the

partograph; a reminder was given to health workers (HWs) to respect clients’ rights when offering

family planning methods and not to impose particular methods on clients.

• In early September, MCHIP supported a “mop-up” emergency obstetric and newborn care (EmONC)

training for high-volume hospitals and polyclinics in Mutare district. Twenty-nine HWs (14

participants from Mutare Provincial Hospital, 8 from Mutare City Health and 5 from Sakubva District

Hospital) were trained by EmONC trainers who were themselves trained recently at an MCHIP-

supported EmONC TOT. This training thus provided an important opportunity for new trainers to get

training practice, as well as for MCHIP to observe and follow the new trainers up. Post-training

follow up (PTFU) of eight trainees from this course was then conducted with MCHIP support. PTFU

and supportive supervision for EmONC-trained HWs will be the priority focus for MCHIP in FY13.

• From mid to late-September, MCHIP supported training of 78 HWs from Mutare and Chimanimani

on the revised Child Health Card/WHO Growth Standards. The objective of this training was to train

HWs on how to monitor child growth using the new WHO Growth Standards. New child health cards

are reportedly available now in Mutare and Chimanimani.

• In Q4, refurbishments for the Biriiri Kangaroo Mother Care (KMC) unit were completed. The unit has

four beds and is now operational (to date, one baby has been admitted). Discussions on the

establishment of a KMC unit at Mutare Provincial Hospital (MPH) are in their final stage, and we

hope to have it functional in FY13 Q2. Procurement of KMC goods for Marange Rural Hospital, Biriiri

Hospital, St. Andrews, and Nyanyadzi Hospital was completed in Q4, and a formal handover of these

goods will be done in FY13 Q1.

Health workers participating in a supportive

supervision visit and clinical peer review.

Here, one nurse acts as clinical supervisor

and provides practical skills training and

feedback to her colleague on assisting a

vaginal delivery.

• Finally, throughout Q4, the MCHIP team continued to

support quality improvement activities in the districts.

In August, the Chimanimani district team, with support

from the District Nursing Officer and the involvement

of district health facility managers, conducted

supportive supervision (SS) and MNH-focused clinical

peer reviews at two sites (Chakohwa and Nyanyadzi).

Most of the MOHCW officers involved had been

trained previously in clinical SS supported by MCHIP.

Participants used SBM-R MNH standards to guide the

peer reviews, with providers assessed generally

performing well across all areas (64% of standards

achieved during the Chakohwa visit). Other findings

from Chakohwa included:

- The facility has diligently worked on its QI

action plans since SBM-R Module 1. Most of

the gaps remaining are minor and can be

overcome with continued support.

- There is a need to further capacitate

supervisors whose skills are almost at the same level as those they are supervising.

- There is a need to involve community members of HF quality committees in assessing client

satisfaction and inputs.

At community level:

• In Q4, MCHIP reached a breakthrough with its community MNCH activities and was able to launch

the implementation of its community MNCH Performance Quality Improvement (PQI) activities with

Village Health Workers (VHWs). In early July, a meeting was held in Nyanga to sensitize both the

Provincial and District-level Health Executives (PHE and DHEs) on MCHIP’s cPQI approach and at the

same time to develop implementation plans. This meeting was followed by the sensitization of

health workers from implementation sites in Mutare and Chimanimani. The two meetings helped

map the way forward for a long-awaited VHW baseline assessment, which was conducted in early

August. VHWs from PQI “intervention” and “control” sites were assessed. The baseline assessment

report, which will be ready by the end of FY13 Q1, will inform MCHIP and the MOHCW about quality

improvement needs among VHWs and will provide guidance for subsequent cMNCH PQI activities.

Highlights of Q4 Program Management Achievements

• During Q4, the MCHIP team developed its FY13 workplan and budget and refined the project’s Year

3 performance targets. The FY13 workplan and budget have since been reviewed and approved by

USAID/Zimbabwe and USAID/Washington.

• As part of the FY13 workplanning process, the MCHIP senior management team developed ideas for

a new staffing configuration in MCHIP’s learning districts. Full details of the staff restructuring and

envisioned benefits of the new configuration are included in the FY13 workplan document. In

addition to staff restructuring, senior management reviewed current office spaces/locations at

Harare and district levels, and has decided to relocate its Harare office based on cost-cutting and

other considerations. An office move is planned for the first quarter of FY13.

• The MCHIP Finance and Administration (F&A) team conducted an internal F&A review in early

September. The F&A team briefed senior management about the findings of the review and action

items identified are already being carried forward.


3. Analysis of Select Indicator Data from the Quarter

In this section we present quarterly results in graphical form for select project indicators. Complete

quarterly data for all project indicators can be found in the table in Annex 1.

Objective 1: Support the MOHCW to formulate national health policies, strategies and

programs that increase the population’s access to affordable, evidence-based, high

impact MNCH/FP interventions

Detailed results for indicators 1.1 and 1.2 can be found in Annex 1. Under indicator 1.1 (# of national

policies/guidelines/protocols/strategies developed with MCHIP support), in July, MCHIP provided substantial

technical support to the Zimbabwe National Family Planning Council (ZNFPC) and other stakeholders in the

conductance of a national stakeholder’s meeting focused on “repositioning family planning in Zimbabwe”.

During this meeting, stakeholders built consensus on high priority, achievable long and short term FP

interventions, discussed models to improve access to FP and expand method mix in Zimbabwe, and drafted

an action plan to strengthen FP services in Zimbabwe. During this meeting, MCHIP highlighted the need for

strengthened PPFP services and further committed its support to assist revision of national PPFP training

materials. Other activities supported in the quarter included: finalization of the RED Field Guide, continued

work on finalizing national EmONC training materials (including supportive supervision tools), continued

work on finalized national KMC training materials, technical support for drafting of a national MCCM training

package for VHWs, review of the IYCF Policy, and support for the drafting of a national QA/QI Policy and

Strategy, among others. Support for each of these activities will continue during FY13 as needed.

Under indicator 1.2 (# of MNCH/FP evaluations/reviews conducted with findings shared with stakeholders),

this quarter MCHIP provided support for finalization of the IYCF Program Review, the results of which will

feed into development of the National Nutrition Strategy. In July, MCHIP’s Newborn Coordinator provided

technical support to the MOHCW and ARK in a national baseline assessment of newborn corners, draft

results of which were disseminated in September. Throughout the quarter MCHIP also provided continued

technical support towards finalization of the NIFHA/EQOC reports, which will be completed in FY13 Q1.

Finally, during Q4 MCHIP conducted baseline assessments of VHWs in Mutare and Chimanimani, the results

of which will be used to guide MCHIP’s community performance quality improvement (cPQI) activities in the

coming year.

Objective 2: Improve the quality of maternal, newborn and child health services provided at

health facilities in learning sites and support national level scale up plans

MCHIP has two “goal-level” indicators: “G1. Facility-based maternal mortality ratio (MMR)” and “G2. Facility-

based early neonatal mortality rate (ENMR)”. Data for each of these indicators are shown in the graphs

below.


The graph above shows the facility-based maternal mortality ratio (MMR) for FY11 and FY12 for Mutare and

Chimanimani districts. The table below shows the actual numbers of facility-based maternal deaths

occurring in Mutare and Chimanimani during this same period, as well as comments about where deaths

occurred and, for the period Jan-Sep 2012, a breakdown of the causes of maternal death.

Facility-based maternal

deaths in MCHIP

districts for:

Total # Comments

FY11 18 All occurred at Mutare Provincial Hospital (MPH). Mortality cause

data was not available.

FY12 32 31 of the 32 total deaths occurred at MPH and 1 occurred at

Mutambara Hospital. For the period January-September 2012, 39%

of deaths were from postpartum hemorrhage (PPH), 30% from

eclampsia, 16% from sepsis, and 15% from other causes like

complications from abortions (source: MOHCW maternal line listing

data). For FY12 Q4, there were 10 total maternal deaths in the two

districts (9 of 10 total deaths occurred at MPH and 1 occurred at

Mutambara Hospital).

Maternal mortality data is challenging to interpret given the many difficulties in obtaining accurate mortality

data over time, variance in reporting behaviours of health workers over time, issues affecting service

delivery over time (such as logistics issues/drug stock outs), the absence of reliable community-based

mortality data, and other factors. In terms of the project’s achievements for the year in this area, MCHIP’s

FY12 annual target for this indicator was to reduce the MMR in the districts to 239 maternal deaths/100,000

live births. As of the end of Q4, the facility-based MMR for FY12 was 232 maternal deaths/100,000 live

births, indicating that MCHIP met this annual target.

This achievement notwithstanding, it is useful to look more specifically at the data to try to understand what

has occurred in the districts over time in this area. Based on the figures presented above, it appears that

facility-based maternal deaths increased sharply from FY11 to FY12, but this increase is likely due to

improved reporting of maternal death data from one year to another (MCHIP has provided significant

support throughout Manicaland province since 2011 for HMIS strengthening among health workers and

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IND. G1. Number of facility-based maternal deaths per 100, 000 live births

(data from 79 HFs in Mutare and Chimanimani)


health information personnel). In terms of the location where facility-based maternal deaths are occurring,

the vast majority of deaths (all but one) reported in Mutare and Chimanimani occurred at MPH, which

makes sense given that MPH is the provincial (referral) hospital and all facilities in the seven districts of

Manicaland refer to MPH. This is important to understand as mortality statistics reported at MPH are not

actually all “Mutare district” cases, but rather represent cases originating from other districts of Manicaland

province (where MCHIP is not supporting intensive MH-improvement activities). MPH itself is an SBM-R-

supported facility, and as such has received significant amounts of MCHIP support during FY12 in terms of

training, supervision, and material support, but mortalities occurring at MPH due to the “first and second

delays” of patients originating from non-MCHIP districts will continue to contribute to high mortality at MPH.

Finally, logistics issues such as oxytocin stock-outs could have also contributed to maternal deaths in the

province throughout the year, especially given that from Jan-Sep 2012, PPH was the most common cause of

maternal death in these districts. Although no official statistics are available, MCHIP has monitored the

oxytocin supply situation throughout the year and has noted that health facilities in Mutare and

Chimanimani have faced both shortages and stock-outs in FY12.

Based on the information above, in FY13, MCHIP’s approach to reducing maternal mortality in the districts

will include supporting activities like the SBM-R quality improvement interventions; supporting routine

provincial-level maternal and perinatal mortality audit meetings; strengthening district-wide referral

systems; and strengthening of community skills in birth preparedness and recognition of pregnancy-related

danger signs. In addition, MCHIP will work on strengthening delivery of comprehensive EmONC services at

select high-volume HFs (such as MPH), and will explore ways to provide technical assistance to other districts

in Manicaland which refer cases to the provincial hospital.

The number of facility-based early neonatal and intrapartum deaths per 1000 live births is plotted by month

for the period October 2010 to September 2012. Though monthly data tends to be “noisy”, over time the

data indicate a generally downward trend in facility-based neonatal and intrapartum mortality in the 17

SBM-R supported facilities. This trend might be attributed to a number of factors, such as improvements

made in the quality of care provided in these facilities. For example, most of these facilities have shown an

improvement in the use of the partograph and in achieving standards for managing newborn complications.

During SBM-R baseline assessments, none of the 17 facilities met the standards for use of partograph or

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IND. G2. Number of early neonatal and intrapatum deaths per 1000 live births

(data from 17 SBM-R suported sites)


managing newborn complications. However, at the second SBM-R assessment, 63% of the facilities achieved

standards in use of the partograph and 70% met the standards for managing newborn complications

correctly.

MCHIP’s annual target for this indicator across both districts (not just within the 17 SBM-R-supported sites)

was to reduce the facility-based ENMR by 10% relative to FY11 levels (FY12 target=51/1,000 total births). As

of the end of FY12 Q4, the facility-based ENMR for Mutare and Chimanimani districts was 33/1,000 total

births, indicating that MCHIP exceeded its annual ENMR target.

In FY13, MCHIP’s approach to reducing early neonatal mortality in the districts will include supporting

activities like the SBM-R quality improvement interventions; supporting routine provincial-level maternal

and perinatal mortality audit meetings; and strengthening health worker skills in essential newborn care

(including neonatal resuscitation).

The graph above presents MCHIP’s annual target for training of trainers (TOT) as outlined in the PMP

(target=50 trainers). In terms of sub-targets by training area as outlined in the FY12 annual workplan, MCHIP

planned on conducting one TOT in EmONC, one in IMNCI, one in KMC, and one in post-partum family

planning (PPFP). In Q3, MCHIP supported two additional TOTs in EmONC at national level to

validate/standardize the national EmONC training package that neared finalization in Q2. In Q3, MCHIP also

supported three TOTs (two at national level and one at provincial level) on the introduction of the

Pneumococcal Conjugate Vaccine 13 (PCV 13). In Q4, MCHIP supported two national-level TOTs in HBB (in

collaboration with the MOHCW, UNICEF, and the Church of Latter Day Saints), as well as one national-level

TOT on the recently revised WHO child growth standards which is now included in the national child health

card.

As of year-end, MCHIP had far surpassed its annual TOT target, though we were not able to meet our TOT

goal for IMNCI or PPFP trainings. MCHIP continues to provide support to ZNFPC regarding revision of the

national FP/PPFP training package, and plans to provide technical assistance to ZNFPC for PPFP training for

health workers in FY13 as needed. Regarding IMNCI roll out, discussions with the MOHCW Child Health Unit

progressed in Q4 and training support for health workers in Manicaland is planned for FY13 Q1.

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IND. 2.2 Number of trainers trained, by type of training

(Oct 2011- Sep 2012)


The graph above presents MCHIP’s annual training target for health workers as outlined in the PMP

(target=500 HWs), as well sub-targets by training area, as described in the FY12 annual workplan. In Q4,

MCHIP focused training efforts in the areas of EmONC/HBB, HMIS, and WHO growth standards/child health

card trainings. Cumulatively speaking for the year, MCHIP met or surpassed its training targets in some

areas (EmONC/HBB, RED, HMIS, supportive supervision), did not meet its training targets in other areas

(IMNCI, PPFP, FANC), and provided training support in unanticipated areas (PCV introduction, new child

growth standards) as the need arose. In general, MCHIP strove to be strategic, targeted, and responsive to

the situation on the ground and to adapt to changing training needs and realities within the external

environment throughout the year. MCHIP’s experience in FY12 has helped to shape its training approach

and targets in the coming year.

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FA

NC

IPC

RE

D

PC

V

WH

O G

row

th S

tds/

CH

C

IMN

CI

WA

SH

IYC

F

HM

IS/M

&E

Su

pp

ort

ive

Su

pe

rvis

ion

Oth

er

To

tal I

nd

ivid

ua

ls r

ece

ivin

g a

ny

tra

inin

g

Nu

mb

er

of

HW

s tr

ain

ed

IND. 2.3 Number of HWs trained, by type of training

(Oct 2011- Sep 2012)

Actual (Oct 2011-Sept 2012)

FY12 Annual target (Oct 2011-Sep 2012)

Indicator 2.4 reads “percent of MCHIP SBM-R supported facilities achieving set target for MNH clinical

standards for the year”, with the FY12 annual target being “100% of 17 HFs reaching at least 80% of MNH

standards”. During Q4, MCHIP supported MOHCW staff in conducting a third SBM-R assessment, focused on

maternal and newborn health areas. The graph above presents assessment results for the MNH area

specifically (CH results are discussed below). According to this assessment, as of the end of FY12, only four

of the 17 facilities assessed (24%) met at least 80% of MNH standards. A 24% achievement falls short of the

100% target MCHIP had set at the beginning of the year, though there are still signs of significant

achievement among those facilities not meeting the 80% standard after 12 months. In all cases shown

above, health facility performance has improved relative to performance measured at baseline, with noted

performance improvements in the areas of management of normal labour and delivery and management of

neonatal complications. Noted challenges for why some facilities may be struggling to improve their

performance include pressure from competing programs (with too many workshops being held resulting in

staff being away from facilities too often) as well as infrastructural issues that some HFs will struggle to

overcome (such as those needing to physically expand in order to meet standards for privacy, improved

patient flow, improved access to sinks in exam rooms, etc.). In addition, the Primary Care Nurse up-skilling

program has also contributed to staff shortages, with some health facilities like Odzi, Mt Zuma, Bazeley

Bridge, and Gutaurare being manned by Nurse Aides (who have not been trained as part of SBM-R support).

The MCHIP team has observed major problems with inconsistency of care provision given the constant

movement of health workers in and out of their stations.

In FY13, MCHIP will continue to support SBM-R activities, with a shift in emphasis from training of health

workers to support for post-training follow up, supportive supervision, on the job mentoring, and health

information recording and use. These activities will help consolidate gains seen in FY12 and aid in

institutionalization of quality improvement concepts and activities.

37

33

22 23 2

8

24

20

45

26

26

35

23

37

36

25 2

8

47

75

55

55 56

91

62

49

57

77

53

60

55

22

51

69

65

54

70

61

33

82

69

48

87

60

75

71

67

.8

39

32

78 8

3 84

0

10

20

30

40

50

60

70

80

90

100

Ba

zele

y B

rid

ge

clin

ic

Bir

iwir

i H

osp

ita

l

Ch

ak

oh

wa

clin

ic

Ch

ima

nim

an

i H

osp

ita

l

Da

ng

am

vu

ra c

lin

ic

Gu

tau

rare

cli

nic

Ma

ran

ge

Ru

ral

Ho

spit

al

Mu

tam

ba

ra H

osp

ita

l

Mu

tare

Pro

vin

cia

l H

osp

ita

l

Mu

tsva

ng

wa

cli

nic

Nya

ny

ad

zi H

osp

ita

l

Od

zi c

lin

ic

Ru

situ

Ho

spit

al

*S

aku

bva

Dis

tric

t H

osp

ita

l

(SD

H o

pe

ne

d i

n J

uly

20

11

)

Sa

ku

bva

Po

lycl

inic

St

An

dre

ws

Ho

spit

al

Zim

un

ya

cli

nic

% o

f M

NH

Sta

nd

ard

s fu

lly m

et

pe

r fa

cility

(o

f 1

06

sta

nd

ard

s)

Baseline (Nov/Dec 2010)

2nd Assessment(self -assessment) (Oct 2011)

3rd Assessment (external assessment) (Sep/Oct 2012)

IND. 2.4 MCHIP SBM-R supported facilities achieving set target for MNH clinical

standards for the year (17 SBM-R supported sites)

Indicator 2.5 reads “percent of MCHIP SBM-R supported facilities achieving set target for CH clinical

standards for the year”, with the FY12 annual target being “100% of 22 HFs reaching at least 60% of CH

standards”. During Q4, MCHIP supported MOHCW staff in conducting a second SBM-R assessment focused

on child health, despite the fact that MCHIP’s child health-related quality improvement activities were

known to have lagged behind relative to MNH areas. Throughout FY12, MCHIP met great challenges in

terms of initiating CH-related quality improvement activities, for example, in training health workers in

IMNCI. These challenges were largely related to coordination issues at the MOHCW national level, as well as

delays in the availability of a national IMNCI training package. As IMNCI training was to be the foundation

for subsequent quality improvement activities (procurement support, post-training follow up/on the job

training, supportive supervision, resource mobilization, etc.), delays in training resulted in significant

implementation challenges down the line.

Given this, the results shown in the graph above should be interpreted with caution. According to this

assessment, as of the end of FY12, six of the 21 facilities assessed (29%) met at least 60% of CH standards,

but it is unlikely that these achievements can be attributed to the SBM-R process (rather it might reflect

other general support that MCHIP and others have provided to these facilities). However, at second

assessment, most HFs did show improvement over their baseline performance.

In FY13, MCHIP again plans to provide training support for IMNCI and is hopeful that activities will move

forward. As with MNH areas, MCHIP will also continue to support SBM-R activities, and will strengthen SBM-

R CH implementation with MOHCW support.

62

%

4%

47

% 54

%

4%

21

% 29

%

23

%

44

%

39

%

19

%

11

%

8%

7%

4%

50

%

24

%

45

%

25

%

47

%

20

%

57

%

8.7

%

47

%

33

%

4%

78

.6%

8%

58

.3%

10

%

57

%

18

%

18

.2%

38

%

22

%

85

%

83

.3%

86

%

71

%

17

%

93

.8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Ba

zele

y B

rid

ge

cli

nic

Bir

iwir

i H

osp

ita

l

Bu

rma

Va

lle

y

Ch

ak

oh

wa

cli

nic

Ch

ay

am

iti

clin

ic

Ch

ima

nim

an

i H

osp

ita

l

Ch

iwe

re c

lin

ic

Da

ng

am

vura

cli

nic

Gu

tau

rare

cli

nic

Ma

ran

ge

Ru

ral

Ho

spit

al

Mt

Zu

ma

Mu

tam

ba

ra H

osp

ita

l

Mu

tare

Pro

vin

cia

l H

osp

ita

l

Mu

tsv

an

gw

a c

lin

ic

Ny

ah

od

e c

lin

ic

Ny

an

ya

dzi

Ho

spit

al

Od

zi c

lin

ic

Ru

situ

Ho

spit

al

Sa

ku

bv

a P

oly

clin

ic

St

An

dre

ws

Ho

spit

al

Zim

un

ya

cli

nic

% o

f C

H s

tan

da

rds

ach

ieve

d

Baseline Assessment(self -assessment) (Oct 2011)

2nd Assessment (external assessment) (Sep/Oct 2012)

IND. 2.5 MCHIP SBM-R supported facilities achieving set target for CH clinical standards for

the year (21 SBM-R supported sites)


MCHIP’s achievements under these two indicators (women receiving first ANC visit and at least 4 ANC visits)

came very close to meeting the annual targets. For FY12 (Oct 2011 –Sep 2012), the total number of

expected pregnancies district-wide for the two districts was 25,547. These figures were obtained from

ZIMSTAT 2011 and 2012 census projected figures. Based on this denominator, the percent of expected

pregnant women receiving first ANC in MCHIP learning districts for FY12 was 20,240/25,547=79%.

In terms of the percent of pregnant women in MCHIP learning districts receiving at least 4 ANC visits in FY12

relative to the expected number of pregnancies in the districts, 75% of expected pregnant women (Mutare

and Chimanimani district-wide) received at least 4 ANC visits. These figures are consistent with the general

understanding that ANC coverage in Zimbabwe tends to be high.

20240

19264

21500

19700

18000

18500

19000

19500

20000

20500

21000

21500

22000

Number of pregnant women receiving first ANC

visit

Number of pregnant women receiving at least 4

ANC visits

No

. o

f p

reg

na

nt

wo

me

n

IND. 2.6 & 2.7 Number of pregnant women recieving first ANC visit and at least 4 ANC

visits (n=72 health facilities in the two districts)

Cummulative to date

(Oct 2011-Sep 2012)

Annual target

(Oct 2011-Sept 2012)

36%

55%

47% 48% 47%50%

0%

10%

20%

30%

40%

50%

60%

Q1

(Oct-Dec 2011)

Q2

(Jan-Mar 2012)

Q3

(Apr -Jun 2012)

Q4

(Jul-Sep 2012)

12 month

average

(Oct 2011-Sep

2012)

Annual target

(Oct 2011-Sept

2012)

% o

f p

reg

na

nt

wo

me

n

IND. 2.8 % of pregnant women receiving malaria IPT2 during ANC

(n=72 health facilities in the two districts)


MCHIP came close to meeting its annual target for percent of pregnant women receiving malaria IPT2 during

ANC. Relative decreases from Q2 to Q4 could be due to the decline of the malaria season, which occurred

during Q3. According to recent WHO Zimbabwe Weekly Epidemiological Bulletins, malaria cases have been

on a steady decline since mid-April and Q4 tends to consist of low-burden months.

Based on cumulative results to date, MCHIP surpassed its annual target of 11,000 in this area. In terms of

the percent of women district-wide delivering with a SBA relative to all deliveries occurring in Q4 (facility

births plus recorded home births), for Q4, 91% of all deliveries in the districts had a SBA present (NB: the

number of home deliveries reported through the HMIS for Q4 was 375, thus the % of SBA deliveries for the

two districts in total was 3,858/(3,858+375)=91%). Note however that this percentage is likely an

overestimate, as the number of home births only reflects those captured by the HMIS system. Thus, while

the real percentage of women delivering with an SBA is likely lower than 91%, the figure is useful for

observing general trends over time.

The percentage of low birth weight newborns admitted in KMC increased in Q4 relative to previous quarters

as all four MCHIP-supported KMC units (Mutambara Mission Hospital, Rusitu Mission Hospital, Sakubva

District Hospital, and Chimanimani Hospital) continued to admit patients. For FY12, cumulative KMC

3133 3666 3902 3858

14559

11,000

02000400060008000

10000120001400016000

Q1

(Oct-Dec 2011)

Q2

(Jan-Mar 2012)

Q3

(Apr -Jun 2012)

Q4

(Jul-Sep 2012)

Cummulative to

date

(Oct 2011-Sep

2012)

Annual target

(Oct 2011-Sept

2012)

No

. o

f d

eliv

eri

es

IND. 2.9 Number of deliveries with a skilled birth attendant

(n=72 health facilities in the two districts )

4%8%

24%26%

15%

50%

0%

10%

20%

30%

40%

50%

60%

Q1

(Oct-Dec 2011)

Q2

(Jan-Mar 2012)

Q3

(Apr -Jun 2012)

Q4

(Jul-Sep 2012)

Cummulative to

date

(Oct 2011-Sep

2012)

Annual target

(Oct 2011-Sept

2012)

% o

f LB

Ws

ad

mit

ted

in

KM

C

IND. 2.12 Percentage of LBW newborns admitted in KMC



coverage within the two districts was 15%, which was below MCHIP’s annual coverage target and reflects a

continued high rate of unmet need for KMC services in the districts. In order to meet some of this need, in

Q4 MCHIP continued work with five additional facilities in Mutare and Chimanimani (Marange Rural

Hospital, Biriwiri Hospital, St. Andrews Hospital, Nyanyadzi Hospital, and Mutare Provincial Hospital) to

establish or revitalize KMC units there. Opening of these additional KMC units in FY13 will increase

availability of KMC services and ease pressure on existing KMC units.

The malaria “cumulative to date” figure suggests lower malaria disease burden in FY12 relative to the same

period last year (the basis for the FY12 target). Accurate data on current morbidity and mortality due to

malaria would be useful in interpreting this data, but unfortunately is not currently available. However,

according to 2011 Mutare and Chimanimani MOHCW district reports, there was 92% coverage of indoor

residual spraying (IRS) in Mutare district and 80% IRS coverage in Chimanimani. These high IRS coverage

rates could explain low rates of malaria transmission seen in FY12. In addition, starting in Q3 of this year, 60

VHWs in Chimanimani and 47 VHWs in Mutare began malaria community case management (MCCM)

activities, and were reporting testing and management of confirmed malaria cases at village level. Though

accurate data is not yet available regarding numbers of cases being treated in the community, it is possible

that MCCM activities are resulting in reduced numbers of cases being seen at health facilities. Even so, it is

likely that routine malaria case data being reported through the HMIS system is not as reliable as it could be,

as health workers continue to struggle with case definition and recording malaria cases (“suspected”,

“confirmed”, “treated”) consistently.

Regarding diarrhoea and pneumonia disease burden at the end of FY12, the number of cases of each

continued to increase sharply between Q3/Q4 and previous quarters. It is unclear what the explanation is

for this sharp increase, but it could be due to seasonal variations in disease incidence (Q3 was the start of

the winter season), improved community care-seeking behaviours when children are sick with diarrhoea and

pneumonia symptoms, and/or issues with HMIS reporting (i.e., health worker confusion regarding the case

definition of pneumonia, leading to over reporting of cases).

5651

22086

44306

17500 17300

30000

05000

100001500020000250003000035000400004500050000

Number of confirmed cases of

malaria in children <5

Number of cases of diarrhoea

seen in children <5

Number of cases of pneumonia

treated in children <5

Nu

mb

er

of

case

s in

ch

ild

ren

<5

IND. 2.13, 2.14, 2.16 Case morbidity in children under 5, by disease type


Cummulative to date… Annual target…


Objective 3: Improve the coverage and quality of high-impact MNCH/FP interventions provided

by health care workers in the community, including VHWs and other agents

The graph above presents MCHIP’s annual training target for VHWs as outlined in the PMP (target=450

VHWs having received any type of training), as well as achievements as of the end of FY12. The graph

reflects the same information reported in Q2 and Q3, as no VHW training took place in Q4. Instead, focus in

Q4 was on sensitizing provincial and district-level stakeholders on MCHIP’s community-based MNCH

Performance Quality Improvement (PQI) approach, working with VHW supervisors on providing supportive

supervision to VHWs in their catchment areas, and conducting a cPQI baseline assessment in both districts.

Results of the baseline assessment will be shared with stakeholders during the first quarter of FY13.

Objective 4: Increase routine immunization coverage in Manicaland province and support the

nationwide introduction of PCV by 2012 and rotavirus vaccine by 2013

As of the time of writing, EPI data for the province was complete for July and August 2012 but one district’s

data (Mutasa) was missing for September 2012*. Once complete data is received, it is possible that Q4

coverage could increase, but even so, the decrease in Q4 relative to other quarters is odd. One possible

explanation for the decrease in Penta 3 coverage for the quarter is that there may have been a vaccine

shortage, though we have confirmed with the national and provincial-level EPI officers that no vaccine

297

215

370

450

0

100

200

300

400

500

cIYCF MCCM Total individuals receiving

any training

Annual Target

(Oct 2011-Sep 2012)

Nu

mn

be

r o

f V

HW

s tr

ain

ed

IND. 3.2 Number of VHWs trained, by type

88%99%

92% 93%

75%

90% 95%

0%

20%

40%

60%

80%

100%

120%

FY 11

(Oct 2010 -

Sep 2011)

FY 12 Q1

(Oct -Dec

2011)

FY 12 Q2

(Jan -Mar

2012)

FY12 Q3 (Apr-

June 2012)

FY 12 Q4 (Jul -

Sep 12)

12 monthly

Avg

(Oct 2011-Sep

2012)

FY 12 Annual

target

(Oct 2011-Sep

2012)

% o

f ch

ild

ren

<1

ye

ar

IND. 4.1 Percent of children <1 year who received Penta 3 in Manicaland Province


shortage for Penta occurred in Q4. Another explanation could be that various districts did report disruptions

in outreach services during the quarter due to shortages of vehicles and fuel, but this needs to be further

investigated given that measles coverage for the quarter appeared to be normal (see below). We will cross

check the Penta 3 coverage data with OPV 3 data, to see if there was a similar decrease in OPV 3 coverage

during Q4 (as Penta 3 and OPV 3 are given to children at the same time). If OPV 3 coverage appears normal,

then we suspect the Q4 data for Penta 3 could reflect reporting errors. Again, this will be explored further.

Despite curious Q4 data, overall at the end of FY12, MCHIP generally performed well in this indicator, though

it is acknowledged that issues with data quality and population denominator figures still persist. In FY13,

MCHIP plans to intensify its support for RED supportive supervision and implementation, data quality

improvement activities, training in basic immunization practices for health workers, and training for EPI mid-

level managers. The aim of all of these activities is to continue to improve health worker knowledge and

skills in EPI, in order to further increase EPI coverage rates.

* Notes on data: Q3 data was incomplete at the time of the Q3 report submission but has since been updated

in this report to include all data for April – June 2012. For Q4, all districts reported EPI data in July and

August, and 6 districts reported for September (all except Mutasa).

As of the time of writing, EPI data for the province was complete for July and August 2012 but one district’s

data was missing for September 2012*. Once complete data is received, it is anticipated that Q4 will show

similar coverage as previous quarters. Overall, by the end of FY12, MCHIP performed well in this indicator,

though it is acknowledged that issues with data quality and population denominator figures still persist. In

FY13, MCHIP plans to intensify its support for RED supportive supervision and implementation, data quality

improvement activities, training in basic immunization practices for health workers, and training for EPI mid-

level managers. The aim of all of these activities is to continue to improve health worker knowledge and

skills in EPI, in order to further increase EPI coverage rates.

* Notes on data: Q3 data was incomplete at the time of the Q3 report submission but has since been updated

in this report to include all data for April – June 2012. For Q4, all districts reported EPI data in July and

August, and 6 districts reported for September (all except Mutasa).

97%96% 96%

83%

95%

92%

95%

75%

80%

85%

90%

95%

100%

FY 11

(Oct 2010 -

Sep 2011)

FY 12 Q1

(Oct -Dec

2011)

FY 12 Q2

(Jan -Mar

2012)

FY12 Q3 (Apr-

June 2012)

FY 12 Q4 (Jul -

Sep 12)

12 monthly

Avg

(Oct 2011-Sep

2012)

FY 12 Annual

target

(Oct 2011-Sep

2012)

% o

f ch

ild

ren

< 1

ye

ar

IND. 4.2 Percent of children< 1 year who received measles vaccination in

Manicaland Province


M&E/HMIS: to improve the quality, availability, and timely usage of health information for

internal and external decision-making and learning

• MCHIP continues to support health management information systems (HMIS) strengthening at

national, provincial, district, facility, and community levels. In July, MCHIP supported the MOHCW to

conduct a data verification exercise for the period October 2011 to June 2012 in six sites in Mutare

and four sites in Chimanimani. The main objective of this exercise was to assess whether data

reported at facility-level mirrors what is being tallied in primary data collection tools (i.e., registers

and tally sheets). The assessment generally found that there is no standard data collection and

reporting system in most sites, particularly as there is no dedicated health information person within

health facilities. A resultant recommendation is to have national routine data verification standard

operating procedures and to develop national reporting guidelines.

• In mid-July, the MCHIP M&E Officer supported HMIS training of 31 HWs from Buhera district. The

main objective of this training was to enhance HW skills in health information management,

reporting, and use. Anecdotally speaking, it appears that there has been some improvement in

Buhera already, in terms of timely reporting by facilities in that district. Following MCHIP-supported

M&E trainings, Buhera’s reporting has improved significantly, from 62% completion in 2011 to 94%

T5 submission and 100% timely reporting on the weekly routine disease notification system (RDNS).

The Buhera training marked the end of MCHIP-supported HMIS trainings in Manicaland, as all seven

districts have now been trained; supportive supervision will be prioritized in FY13.

• MCHIP provided technical support to the District Health Information Officers (DHIO) in Q4, for

example in conducting supportive supervision (SS) visits in 7 SBM-R facilities in Chimanimani in

September. Data for MCHIP indicators for July and August was collected during these SS visits.

Issues noted during SS include: general difficulties with completing the T3, T5, and T12 forms, as well

as confusion on how to handle data submitted by VHWs (especially now that they are treating

malaria). Some facilities were noted as adding VHW data onto to the health facility T5 data whereas

according to the DHIO, VHW data should be submitted separately but attached to the facility T5.

• Finally during the quarter, Vikas Dwivedi, the MCHIP/Washington M&E Advisor visited the project.

Mr. Dwivedi visited the Harare office as well as sites within Mutare, assessed FY12 progress, made

recommendations for the FY13 workplan, and developed an action plan for next steps.

4. Management, Finance, and Administration

MCHIP has had a productive quarter with the following management and administration accomplishments:

• During Q4, the MCHIP team developed its FY13 workplan and budget and refined the project’s Year

3 performance targets. The FY13 workplan and budget have since been reviewed and approved by

USAID/Zimbabwe and USAID/Washington. In FY13 Q1, MCHIP will share the workplan with

counterparts at national, provincial, and district levels in order to inform them about the types of

support MCHIP plans to provide during the year.

• As part of the FY13 workplanning process, the MCHIP senior management team developed ideas for

a new staffing configuration in MCHIP’s learning districts. Full details of the staff restructuring and

envisioned benefits of the new configuration are included in the FY13 workplan document. In

addition to staff restructuring, during Q4, senior management reviewed current office

spaces/locations at Harare and district levels, and has decided to relocate its Harare office based on

cost-cutting and other considerations. An office move is planned for the first quarter of FY13.

• The MCHIP Finance and Administration (F&A) team conducted an internal F&A review in early

September 2012. The MCHIP/Zimbabwe team, assisted by Meghan Anson, reviewed the project’s


internal systems and processes as well as assessed (via survey) the MCHIP/Zimbabwe team’s

understanding of F&A functions, procedures, and products. The F&A team briefed senior

management about the findings of the assessment and action items identified are already being

carried forward.

• In September, the MCHIP Project Administrator attended a presentation on audit and fraud, held by

the USAID Regional Inspector General’s office.

5. Challenges and Opportunities

5.1 Challenges

• Inappropriate cadres being selected for participation in MCHIP-supported trainings and TOTs –

MCHIP invests significant resources each quarter in building the capacity of health workers through

clinical trainings, workshops, and meetings. During Q4, in response to specific requests from

MOHCW counterparts at Mutare provincial/district level, MCHIP provided support for a “mop-up”

BEmONC training for health workers in Mutare. MCHIP had received earlier feedback from the

province/district that some major facilities (e.g., Mutare Provincial Hospital (MPH), Sakubva District

Hospital, and a few Mutare polyclinics) had few providers trained in BEmONC; these facilities

requested extra support to train more of their providers, in order to increase the proportion of

skilled health workers available for duty at any one time. In response to this request, MCHIP

supported a mop-up BEmONC training in September 2012, but was disappointed by the specific

individuals who were selected for training. In this case, relevant participants selected for BEmONC

training would have included nurses and midwives who actually deliver hands-on clinical maternal

and newborn care, for example in labor/maternity wards. In contrast, actual participants selected

for training included providers from male wards and eye care units, who are not likely to put new

knowledge or skills to good use and who present a challenge in terms of post-training follow up and

ongoing supportive supervision. In addition, inclusion of inappropriate cadres means that training

resources are reduced for those who could actually benefit from training and who could provide a

return on training investments. Besides trainings, MCHIP has also faced similar challenges in terms

of inappropriate cadres being identified for TOTs (e.g., people being trained as trainers who are not

based in facilities, who do not have any clinical exposure in their daily jobs/duties, and/or who are

unable to be independent when it comes time to actually deliver training or post-training follow up

effectively). To combat this challenge, MCHIP has and will continue to advocate strongly among

stakeholders to identify appropriate participants for training and TOT activities. However, this is a

persistent and difficult issue which is motivated by issues outside of the project’s control.

5.2 Opportunities

• Collaboration between MOHCW, University of Zimbabwe (UZ), and MCHIP in support of provincial-

level public health research – during the quarter MCHIP finalized discussions between the MOHCW

and the UZ School of Public Health regarding MCHIP support for public health research in

Manicaland. UZ students in the Master’s of Public Health program are required to conduct research

as part of their degree program. At the request of the MOHCW and UZ, MCHIP has agreed to

provide technical and nominal financial support to one Master’s student (who will be based in

Mutare) as he conducts MNCH-related research projects of interest to the Provincial Health

Executive and to MCHIP. The student has already prepared several concept notes/proposals on

research related to intermittent preventive treatment (IPT) for malaria in pregnancy, the effects of

maternal nutrition on pregnancy outcomes in Mutare district, and the analysis of maternal and

perinatal mortality data in Manicaland province. MCHIP support for these studies is envisioned as a

“win-win opportunity” whereby the MOHCW will benefit from extra research assistance, a Master’s

Mrs. Joyce Nyamunda, a VHW serving Rubatso Village in

Mutare District. Motivated by support she has received from

the MOHCW and MCHIP, Joyce is committed to providing the

best service she can to mothers and children in her

catchment area.

student will gain valuable research experience, and MCHIP will further its learning agenda

objectives.

• Adoption of a new “non-residential” per diem schedule – in the past MCHIP’s per diem schedule has

generally followed a “residential” system, whereby travelers receive meals and incidental expenses

and MCHIP pays for hotel accommodations. This system is expensive (as hotel accommodations are

costly), requires more effort for MCHIP to administer, and is less preferred by travelers who often do

not require hotel-based lodging. In FY13, MCHIP will shift as much as possible to a “non-residential”

per diem system, where travelers will receive a flat amount of per diem each day, to cover meals,

incidentals, and lodging as they choose. The non-residential system follows the published Ministry

of Finance schedule, and offers the advantage of being much less expensive to the project (the costs

of an activity can be reduced by 50% or more). It is also easier to administer, is preferred by

participants, and is fostering more creativity in terms of venue selection, as people are encouraged

away from the “hotel-based training” model of the past.

6. Success Story: Motivating VHWs to better performance – a little

support goes a long way

Mrs. Joyce Nyamunda is a village health

worker who lives in Rubatso Village in the

Marange Hospital catchment area of

Mutare district. She is one of the VHWs

with whom MCHIP has been working on

community MNCH and performance

quality improvement (PQI) activities.

Joyce was visited by MCHIP and MOHCW

staff during the VHW baseline assessment

that was conducted in August 2012. As

part of that assessment, Joyce was

assessed in conducting a postnatal care

home visit (traditionally done on the third

and seventh day after a baby is born) to a

recently-delivered mother and her baby.

On the 16th

of September 2012, baby

Enock Timbe was born to Patience

Mangwana (not their real names) at

Marange Hospital. Enock was Patience’s

first baby and he weighed 2500g at birth.

The nurses at the hospital experienced communication challenges with Patience (who is from Mozambique

but is married to a Zimbabwean), and so decided to keep her at the hospital for a few days to teach her

about kangaroo mother care and to monitor her progress before discharging her to return home. Patience

and the baby were discharged on the 19th

of September and went home to Rubatso Village. On that very

day, VHW Joyce paid mother and baby a postnatal home visit, to check on their progress. Both the mother

and baby were fine and Joyce reinforced the need for Patience to continue with kangaroo care, to

exclusively breastfeed the baby, and to return to the hospital for her Day 7 postnatal check up.

On the 20th

of September, VHW Joyce went away for a workshop but returned on the 24th

. On the 25th

of

September, she paid another follow up visit to Patience and the baby, to remind Patience to go back to the


hospital for her Day 7 postnatal care visit if she had not already done so. On arrival at Patience’s house

however, Joyce discovered that things were not right. There were many people in the house, including a

traditional birth attendant. Joyce asked for permission to see the mother and baby. She discovered that

Patience’s legs were swollen and that the baby was not breathing well or breastfeeding. Joyce noted that

the traditional birth attendant had been invited to the house because the baby was not breastfeeding and

that this was considered a bad omen for the family.

Immediately Joyce told the husband to find money to take Patience and Enock to the hospital because the

baby needed hospitalization. Joyce told the family that she would go to the hospital ahead of them to

inform the nurses and would wait for them there. Fortunately, the husband took heed of Joyce’s advice and

brought his wife and baby to the hospital around 1300hrs that day. The nurses assessed the baby and

classified it as having severe disease. A call for an ambulance was made. The ambulance arrived about two

hours later and the baby was transferred to Mutare Provincial Hospital (MPH).

Very sadly, baby Enock died the next day at MPH but VHW Joyce had done her best to save the life of the

mother and baby (Patience survived and is making a full recovery). When asked by the MCHIP District

Community Officer what motivated Joyce to conduct such regular postnatal home care visits and to follow

up with Patience and her baby, Joyce mentioned the MCHIP-supported VHW PQI baseline assessment in

which she had participated. Joyce said that she had never had an experience like that of having people

accompany her into the community and observe her doing her work. The experience challenged her to do

her work better and to document what she is doing in the community. The baseline assessment experience

also raised Joyce’s profile in the community and she now feels motivated because the community now

values her advice. Joyce’s hope is that when the next PQI assessment is done, she will have improved her

skills in conducting antenatal and postnatal care home visits and identifying danger signs in mothers and

newborns.

7. Visitors/International Travel

During the reporting period, MCHIP/Zimbabwe received several headquarters staff for short-term technical

assistance (STTA). Individual trip reports are available upon request.

Name of

Consultant/STTA

Scope of Work Approx. Dates

Vikas Dwivedi, M&E

Advisor

Reviewed the project’s overall M&E and HMIS-related technical activities

and progress to date, as well as helped the team develop its FY13 workplan

activities in the M&E/HMIS areas.

.29 July – 4 August,

2012

John Varallo, MNH

Advisor

Assisted the team in the areas of clinical training, supportive supervision,

and implementation of MNH activities, as well as helped the team develop

its FY13 workplan activities in the MN health technical areas.

20 August – 14

September, 2012

Pat Taylor, MCHIP

Country Team Leader

Participated in a review of the team’s overall progress during FY12 and

assisted the team to develop its FY13 workplan.

20-31 August, 2012

Meghan Anson,

MCHIP Program

Coordinator

Participated in a review of the team’s overall finance and administrative

systems and procedures, as well as assisted the team to develop its FY13

workplan.

26 August – 13

September, 2012

In addition to STTA, MCHIP/Zimbabwe staff traveled internationally during the quarter as follows:


Name of Traveler Scope of Work Approx. Dates

Rose Kambarami, CD Traveled to the US to attend the JSI International Division Meeting. 16-30 July 2012

Adelaide Shearley,

CH/I Advisor

Traveled to Malawi to provide STTA to the MCHIP/Malawi team in

immunization. NOTE: this trip is being fully funded by MCHIP/Malawi and

therefore does not technically “count against” the trips budgeted in the

Zimbabwe budget.

4-25 August 2012

Hillary Chiguvare,

Technical Director

Traveled to Mozambique to participate in an MCHIP SBM-R workshop. 25-28 September

2012

Short-term technical assistance visits expected during FY13, Quarter 1 are shown below:


No travelers

anticipated at this

time

MCHIP/Zimbabwe staff international travel expected during FY13, Quarter 1 is shown below:


No travelers

anticipated at this

time

MC

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CH

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ab

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: S

up

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s

1.1

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revis

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h

MC

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me

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me

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of

ne

wb

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corn

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7

3

Fo

r d

eta

ils

of

oth

er

act

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un

de

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is

sect

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, se

e t

he

de

scri

pti

on

ab

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un

de

r O

bje

ctiv

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1.

OB

JEC

TIV

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: Im

pro

ve

th

e q

ua

lity

of

ma

tern

al,

ne

wb

orn

an

d c

hil

d h

ea

lth

se

rvic

es

pro

vid

ed

at

he

alt

h f

aci

liti

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in l

ea

rnin

g s

ite

s a

nd

su

pp

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na

tio

na

l le

ve

l sc

ale

up

pla

ns

2.1

# o

f

he

alt

h

faci

liti

es

rece

ivin

g

MC

HIP

sup

po

rt f

or

MN

CH

inte

rve

nti

on

s

# o

f h

ea

lth

faci

liti

es

rece

ivin

g

MC

HIP

-

sup

po

rte

d

MN

CH

inte

rve

nti

on

s.

0

20

S

BM

-R

sup

po

rte

d H

Fs

79

HF

s (1

00

% i

n

Mu

tare

an

d

Ch

ima

nim

an

i)

sup

po

rte

d w

ith

oth

er

act

ivit

ies

28

3 H

Fs

(10

0%

in M

an

ica

lan

d

sup

po

rte

d w

ith

EP

I a

ctiv

itie

s)

22

SB

M-R

sup

po

rte

d

HF

s

79

HF

s

(10

0%

in

Mu

tare

an

d

Ch

ima

nim

an

i) s

up

po

rte

d

wit

h o

the

r

act

ivit

ies

28

3 H

Fs

(10

0%

in

Ma

nic

ala

nd

sup

po

rte

d

wit

h E

PI

act

ivit

ies)

22

SB

M-R

sup

po

rte

d H

Fs

79

HFs

(10

0%

in M

uta

re a

nd

Ch

ima

nim

an

i)

sup

po

rte

d

wit

h o

the

r

act

ivit

ies

28

3 H

Fs

(10

0%

in M

an

ica

lan

d

sup

po

rte

d

wit

h E

PI

act

ivit

ies)

22

SB

M-R

sup

po

rte

d H

Fs

79

HF

s (1

00

%

in M

uta

re a

nd

Ch

ima

nim

an

i)

sup

po

rte

d w

ith

oth

er

act

ivit

ies

28

3 H

Fs

(10

0%

in M

an

ica

lan

d

sup

po

rte

d w

ith

EP

I a

ctiv

itie

s)

22

SB

M-R

sup

po

rte

d H

Fs

79

HF

s (1

00

% i

n

Mu

tare

an

d

Ch

ima

nim

an

i)

sup

po

rte

d w

ith

oth

er

act

ivit

ies

28

3 H

Fs

(10

0%

in

Ma

nic

ala

nd

sup

po

rte

d w

ith

EP

I a

ctiv

itie

s

22

SB

M-R

sup

po

rte

d H

Fs

79

HF

s (1

00

% in

Mu

tare

an

d

Ch

ima

nim

an

i)

sup

po

rte

d w

ith

oth

er

act

ivit

ies

28

3 H

Fs

(10

0%

in M

an

ica

lan

d

sup

po

rte

d w

ith

EP

I a

ctiv

itie

s

20

SB

M-R

sup

po

rte

d

HFs

79

HF

s (1

00

%

in M

uta

re

an

d

Ch

ima

nim

an

i)

+ o

the

rs T

BD

sup

po

rte

d

wit

h o

the

r

MN

CH

act

ivit

ies

28

3 H

Fs

(10

0%

in

Ma

nic

ala

nd

sup

po

rte

d

wit

h E

PI

act

ivit

ies)

All

22

SB

MR

sup

po

rte

d s

ite

s

rece

ive

d

sig

nif

ica

nt

sup

po

rt f

rom

MC

HIP

thro

ug

ho

ut

the

qu

art

er,

in

th

e

form

of

tra

inin

g,

sup

po

rtiv

e

sup

erv

isio

n,

ma

teri

al

sup

po

rt,

etc

. M

CH

IP a

lso

pro

vid

ed

tech

nic

al

ass

ista

nce

to

10

0%

of

no

n-

SB

MR

sit

es

in t

he

form

of

tra

inin

g

an

d m

ate

ria

l

sup

po

rt f

or

are

as

incl

ud

ing

imm

un

iza

tio

n a

nd

MC

HIP

/Z

imb

ab

we

Qu

art

erl

y R

ep

ort

(Ju

l-S

ep

t 2

01

2)

Pa

ge

28

HM

IS.

To

be

dis

ag

gre

ga

ted

: #

of

SB

M-R

su

pp

ort

ed

HFs

in l

ea

rnin

g d

istr

icts

(M

uta

re a

nd

Ch

ima

nim

an

i):

22

# o

f H

Fs

rece

ivin

g o

the

r M

CH

IP s

up

po

rt i

n l

ea

rnin

g d

istr

icts

(M

uta

re a

nd

Ch

ima

nim

an

i):

79

(in

clu

din

g t

he

22

SB

M-R

sit

es)

# o

f H

Fs

rece

ivin

g E

PI

sup

po

rt i

n 7

dis

tric

ts o

f M

an

ica

lan

d:

28

3

To

tal

# o

f H

Fs

in l

ea

rnin

g d

istr

icts

(n

=7

9 H

Fs)

: 7

9

To

tal

# o

f H

Fs

in 7

dis

tric

ts o

f M

an

ica

lan

d (

n=

28

3 H

Fs)

: 2

83

2.2

# o

f

tra

ine

rs

tra

ine

d in

MN

CH

# o

f tr

ain

ers

tra

ine

d i

n

MN

CH

wit

h

MC

HIP

su

pp

ort

0

15

4

74

0

2

56

(18

3 f

em

ale

s,

73

ma

les)

15

6

(10

7 f

em

ale

s a

nd

49

ma

les)

41

2

50

T

OT

s in

Q4

we

re

he

ld i

n H

BB

, a

nd

WH

O g

row

th

sta

nd

ard

s

(NB

: cu

mu

lati

ve

fig

ure

ma

y n

ot

be

the

su

m t

ota

l o

f

Q1

-Q4

, a

s so

me

ind

ivid

ua

ls m

ay

ha

ve

re

ceiv

ed

mo

re t

ha

n o

ne

typ

e o

f tr

ain

ing

.)

To

be

dis

ag

gre

ga

ted

by g

en

de

r (m

ale

/fe

ma

le)

2.3

# o

f

he

alt

h

wo

rke

rs

tra

ine

d in

MN

CH

# o

f h

ea

lth

wo

rke

rs t

rain

ed

in M

NC

H

tra

inin

g

pa

cka

ge

s w

ith

MC

HIP

su

pp

ort

0

39

8

(fro

m l

ea

rnin

g

site

s, o

the

r

dis

tric

ts,

na

tio

na

l le

ve

l)

28

9

19

9

(12

8 f

em

ale

s

an

d 7

1 m

ale

s)

50

4

(36

0 f

em

ale

s,

14

4 m

ale

s)

16

8

10

12

50

0

Tra

inin

gs

for

HW

s

in Q

4 w

ere

he

ld i

n

Em

ON

C/H

BB

,

WH

O g

row

th

sta

nd

ard

s, a

nd

HM

IS/M

&E

(N

B:

cum

ula

tiv

e f

igu

re

ma

y n

ot

be

th

e

sum

to

tal

of

Q1

-

Q4

, a

s so

me

ind

ivid

ua

ls m

ay

ha

ve

re

ceiv

ed

mo

re t

ha

n o

ne

typ

e o

f tr

ain

ing

.)

To

be

dis

ag

gre

ga

ted

by g

en

de

r (m

ale

/fe

ma

le)

MC

HIP

/Z

imb

ab

we

Qu

art

erl

y R

ep

ort

(Ju

l-S

ep

t 2

01

2)

Pa

ge

29

2.4

%

of

MC

HIP

SB

M-R

sup

po

rte

d

faci

liti

es

ach

ievi

ng

se

t

targ

et

for

MN

H c

lin

ica

l

sta

nd

ard

s fo

r

the

ye

ar

# o

f M

CH

IP

SB

M-R

sup

po

rte

d

faci

liti

es

ach

ievin

g t

he

set

an

nu

al

pe

rfo

rma

nce

an

d q

ua

lity

imp

rov

em

en

t

targ

et

for

MN

H

clin

ica

l

sta

nd

ard

s,

div

ide

d b

y t

ota

l

# o

f M

CH

IP

SB

M-R

sup

po

rte

d H

Fs.

0

41

% o

f H

Fs

(7/1

7)

re

ach

ing

at

lea

st 6

0%

of

MN

H s

tan

da

rds

(n=

17

HFs

in 2

lea

rnin

g

dis

tric

ts)

n/a

n

/a

n/a

n

/a

4/1

7 =

24

% H

Fs

rea

che

d a

t le

ast

80

% o

f M

NH

sta

nd

ard

s

(Oct

20

11

-Se

p

20

12

)

10

0%

of

HFs

rea

chin

g a

t

lea

st 8

0%

of

MN

H

sta

nd

ard

s

(n=

17

HF

s in

2

lea

rnin

g

dis

tric

ts)

2.5

%

of

MC

HIP

SB

M-R

sup

po

rte

d

faci

liti

es

ach

ievi

ng

se

t

targ

et

for

CH

clin

ica

l

sta

nd

ard

s fo

r

the

ye

ar

# o

f M

CH

IP

SB

M-R

sup

po

rte

d

faci

liti

es

ach

ievin

g t

he

set

an

nu

al

pe

rfo

rma

nce

an

d q

ua

lity

imp

rov

em

en

t

targ

et

for

CH

clin

ica

l

sta

nd

ard

s,

div

ide

d b

y t

ota

l

# o

f M

CH

IP

SB

M-R

sup

po

rte

d H

Fs.

0

5%

of

HF

s (1

/20

)

rea

chin

g a

t le

ast

60

% o

f C

H

sta

nd

ard

s

(n=

20

HFs

in 2

lea

rnin

g

dis

tric

ts)

n/a

n

/a

n/a

n

/a

6/2

1=

29

% H

Fs

rea

che

d a

t le

ast

60

% o

f C

H

sta

nd

ard

s

(Oct

20

11

-Se

p

20

12

)

10

0%

of

HFs

rea

chin

g a

t

lea

st 6

0%

of

CH

sta

nd

ard

s

(n=

20

HF

s in

2

lea

rnin

g

dis

tric

ts)

2.6

#

of

pre

gn

an

t

wo

me

n

rece

ivin

g f

irst

AN

C v

isit

# o

f p

reg

na

nt

wo

me

n

rece

ivin

g f

irst

AN

C v

isit

in

MC

HIP

le

arn

ing

dis

tric

ts.

17

,21

5

(n=

79

HF

s

in 2

lea

rnin

g

dis

tric

ts)

(Ja

n –

De

c

10

,46

7

(n=

17

SB

M-R

sup

po

rte

d H

Fs

in 2

le

arn

ing

dis

tric

ts)

2,6

27

(n=

22

SB

M-

R s

up

po

rte

d

site

s)

2,5

10

(n=

22

SB

M-R

sup

po

rte

d

site

s)

(Ja

n –

Ma

r

20

12

)

2,3

35

n=

22

SB

M-R

sup

po

rte

d

site

s)

(Ap

r–Ju

ne

20

12

)

2,3

80

(da

ta f

rom

22

SB

M-R

sup

po

rte

d s

ite

s)

(Ju

l-S

ep

20

12

)

9,8

52

(da

ta f

rom

SB

M-R

sup

po

rte

d

site

s)

(Oct

20

11

–

Se

pte

mb

er

21

,50

0

(n=

79

HF

s in

2 l

ea

rnin

g

dis

tric

ts)

Fir

st A

NC

ra

tes

are

tra

dit

ion

all

y

hig

h i

n Z

imb

ab

we

an

d M

CH

IP i

s o

n

tra

ck t

o m

ee

t it

s

an

nu

al

targ

et

in

this

are

a.

MC

HIP

MC

HIP

/Z

imb

ab

we

Qu

art

erl

y R

ep

ort

(Ju

l-S

ep

t 2

01

2)

Pa

ge

30

20

09

da

ta;

sou

rce

:

MO

HC

W,2

0

09

)

18

,94

6

(n

=7

9 H

Fs

in 2

dis

tric

ts)

(fo

r M

uta

re a

nd

Ch

ima

nim

an

i

rep

ort

ing

pe

rio

d

is O

ct 2

01

0-A

ug

20

11

)

(NB

: 1

8,9

46

=

14

,54

5 w

om

en

in M

uta

re f

rom

Oct

20

10

-Au

g

20

11

plu

s

4,4

01

wo

me

n i

n

Ch

ima

nim

an

i

fro

m O

ct 2

01

0-

Au

g 2

01

1

4,8

94

(3,6

91

in

Mu

tare

an

d

1,2

03

in

Ch

ima

nim

an

i)

n=

as

de

scri

be

d i

n

no

te a

bo

ve

5,3

82

(4,0

34

in

Mu

tare

an

d

1,3

48

in

Ch

ima

nim

an

i)

(Ja

n –

Ma

r

20

12

)

n=

as

de

scri

be

d i

n

no

te a

bo

ve

5,0

17

3,7

95

in

Mu

tare

an

d

1,2

22

in

Ch

ima

nim

an

i)

(Ap

r –

Jun

e

20

12

)

4,9

47

3,5

57

in

Mu

tare

an

d

13

90

in

Ch

ima

nim

an

i

(Ju

l-S

ep

20

12

)

20

12

)

20

,24

0

(15

,07

7 in

Mu

tare

an

d

5,1

63

in

Ch

ima

nim

an

i)

(Oct

20

11

–

Se

pte

mb

er

20

12

)

is a

lso

wo

rkin

g t

o

imp

rov

e t

he

qu

ali

ty o

f ca

re

pro

vid

ed

du

rin

g

AN

C v

isit

s.

To

tal

# o

f e

xpe

cte

d q

ua

rte

rly p

reg

na

nci

es

for

MC

HIP

le

arn

ing

dis

tric

ts (

Mu

tare

an

d C

him

an

ima

ni)

: 3

,39

0 (

22

SM

B-R

su

pp

ort

ed

sit

es)

; 7

,01

5 (

5,3

14

in

Mu

tare

an

d 1

,70

1 in

Ch

ima

nim

an

i d

istr

ict-

wid

e).

T

he

exp

ect

ed

nu

mb

er

of

pre

gn

an

cie

s w

as

ob

tain

ed

fro

m Z

IMST

AT

20

11

ce

nsu

s p

roje

cte

d f

igu

res

for

SB

M-R

su

pp

ort

ed

sit

es

an

d Z

IMST

AT

20

12

ce

nsu

s

pro

ject

ed

fig

ure

s fo

r th

e d

istr

ict

wid

e d

ata

.

% o

f p

reg

na

nt

wo

me

n r

ece

ivin

g f

irst

AN

C i

n M

CH

IP l

ea

rnin

g d

istr

icts

Q4

: 2

,38

0/3

,39

0=

70

% (

22

SM

B-R

su

pp

ort

ed

sit

es)

; 4

,94

7/7

,01

5=

71

% (

Mu

tare

an

d C

him

an

ima

ni)

. N

um

era

tor

for

SB

M-R

sit

es

rep

rese

nts

10

0%

of

site

s.

De

no

min

ato

rs f

or

bo

th f

igu

res

are

lik

ely

un

de

rest

ima

tes

be

cau

se t

he

y a

re b

ase

d o

n Z

IMS

TA

T 2

01

1 c

en

sus

pro

ject

ed

fig

ure

s.

Fig

ure

s

sho

uld

be

in

terp

rete

d w

ith

ca

uti

on

.

To

tal

# o

f live

bir

ths

in M

CH

IP le

arn

ing

dis

tric

ts f

or

Q4

: 3

,79

4 t

ota

l (3

,06

4 l

ive

bir

ths

in

Mu

tare

an

d 7

30

liv

e b

irth

s in

C

him

an

ima

ni;

n

=a

s d

esc

rib

ed

in

no

te a

bo

ve

)

% o

f li

ve b

irth

s to

th

e n

um

be

r o

f w

om

en

re

ceiv

ing

fir

st A

NC

in

MC

HIP

le

arn

ing

dis

tric

ts f

or

Q4

: 3

,79

4/4

,94

7 =

77

% (

bo

th M

uta

re a

nd

Ch

ima

nim

an

i).

Nu

me

rato

r a

nd

de

no

min

ato

r

fig

ure

s fr

om

th

e T

5.

n=

as

de

scri

be

d i

n n

ote

ab

ov

e.

2.7

#

of

pre

gn

an

t

wo

me

n

rece

ivin

g a

t

lea

st f

ou

r

AN

C v

isit

s

# o

f p

reg

na

nt

wo

me

n

rece

ivin

g a

t

lea

st f

ou

r A

NC

vis

its

in M

CH

IP

lea

rnin

g

dis

tric

ts.

9,1

39

(ca

lcu

late

d

giv

en

71

%

uti

lisa

tio

n

rate

fo

r

AN

C 4

+

rep

ort

ed

in

ZD

HS

20

05

/06

,

mu

ltip

lie

d

by Z

IMS

TA

T

11

,20

9

(n=

17

SB

M-R

sup

po

rte

d H

Fs

in 2

le

arn

ing

dis

tric

ts)

17

,19

8

(n=

79

HFs

in 2

lea

rnin

g

dis

tric

ts;

rep

ort

ing

pe

rio

d

2,9

70

(n=

22

SB

M-

R s

up

po

rte

d

site

s)

4,9

95

(3,8

22

in

Mu

tare

an

d

1,1

73

in

3,7

09

(n=

22

SB

M-R

sup

po

rte

d

site

s)

(Ja

n –

Ma

r

20

12

)

4,9

23

(3,8

58

in

Mu

tare

an

d

1,0

65

in

2,4

46

n=

22

SB

M-R

sup

po

rte

d

site

s)

(Ap

r –

Jun

e

20

12

)

4,7

29

(3,5

37

in

Mu

tare

an

d

1,1

92

in

2,5

95

(da

ta f

rom

22

SB

M-R

sup

po

rte

d s

ite

s)

(Ju

l-S

ep

20

12

)

4,6

17

3,3

67

in

Mu

tare

an

d

12

50

in

11

,72

0

(n=

22

SB

M-R

sup

po

rte

d

site

s)

(Oct

20

11

-Se

p

20

12

)

19

,26

4

14

,58

4 i

n

Mu

tare

an

d

4,6

80

in

19

,70

0

(n=

79

HF

s in

the

2 l

ea

rnin

g

dis

tric

ts)

MC

HIP

/Z

imb

ab

we

Qu

art

erl

y R

ep

ort

(Ju

l-S

ep

t 2

01

2)

Pa

ge

31

20

11

exp

ect

ed

pre

gn

an

cie

s

for

Mu

tare

an

d

Ch

ima

nim

a

ni)

for

bo

th M

uta

re

an

d

Ch

ima

nim

an

i is

Oct

20

10

– A

ug

20

11

)

(NB

:

17

,19

8=

12

,86

2

wo

me

n i

n

Mu

tare

fro

m

Oct

20

10

-Au

g

20

11

plu

s 4

,33

6

wo

me

n i

n

Ch

ima

nim

an

i

fro

m O

ct 2

01

0-

Au

g 2

01

1)

Ch

ima

nim

an

i)

n=

as

de

scri

be

d i

n

no

te a

bo

ve

Ch

ima

nim

an

i)

n=

as

de

scri

be

d

in n

ote

ab

ove

(Ja

n –

Ma

r

20

12

)

Ch

ima

nim

an

i)

n=

as

de

scri

be

d

in n

ote

ab

ove

(Ap

r -J

un

e

20

12

)

Ch

ima

nim

an

i

(Ju

l-S

ep

20

12

)

Ch

ima

nim

an

i)

n=

as

de

scri

be

d

in n

ote

ab

ove

(Oct

20

11

–S

ep

20

12

)

To

tal

# o

f e

xpe

cte

d q

ua

rte

rly p

reg

na

nci

es

for

MC

HIP

le

arn

ing

dis

tric

ts (

Mu

tare

an

d C

him

an

ima

ni)

: 3

,39

0 (

22

SM

B-R

su

pp

ort

ed

sit

es)

; 7

,01

5 (

5,3

14

in

Mu

tare

an

d 1

,70

1 in

Ch

ima

nim

an

i d

istr

ict-

wid

e).

T

he

exp

ect

ed

nu

mb

er

of

pre

gn

an

cie

s w

as

ob

tain

ed

fro

m Z

IMST

AT

20

11

ce

nsu

s p

roje

cte

d f

igu

res

for

SB

M-R

su

pp

ort

ed

sit

es

an

d Z

IMST

AT

20

12

ce

nsu

s

pro

ject

ed

fig

ure

s fo

r th

e d

istr

ict

wid

e d

ata

.

% o

f p

reg

na

nt

wo

me

n r

ece

ivin

g a

t le

ast

4 A

NC

vis

its

in M

CH

IP le

arn

ing

dis

tric

ts in

Q4

: 2

,59

5/3

,39

0=

77

% (

for

22

SB

M-R

su

pp

ort

ed

sit

es)

; 4

,61

7/7

,01

5 =

66

% (

Mu

tare

an

d

Ch

ima

nim

an

i d

istr

ict-

wid

e).

D

en

om

ina

tors

fo

r b

oth

fig

ure

s a

re l

ike

ly u

nd

ere

stim

ate

s b

eca

use

th

ey a

re b

ase

d o

n Z

IMS

TA

T 2

01

1 c

en

sus

pro

ject

ed

fig

ure

s.

Fig

ure

s sh

ou

ld b

e

inte

rpre

ted

wit

h c

au

tio

n.

To

tal

# o

f live

bir

ths

in M

CH

IP l

ea

rnin

g d

istr

icts

fo

r Q

4:

3,7

94

to

tal

(3,0

64

liv

e b

irth

s in

M

uta

re a

nd

73

0 l

ive

bir

ths

in C

him

an

ima

ni;

n

=a

s d

esc

rib

ed

in

no

te a

bo

ve

)

% o

f li

ve b

irth

s to

th

e t

ota

l n

um

be

r o

f w

om

en

re

ceiv

ing

at

lea

st 4

AN

C v

isit

s in

MC

HIP

le

arn

ing

dis

tric

ts:

3,7

94

/4,6

17

=8

2%

(C

him

an

ima

ni

an

d M

uta

re d

istr

ict-

wid

e;

n=

as

de

scri

be

d

in n

ote

ab

ove

).

Nu

me

rato

r a

nd

de

no

min

ato

r fi

gu

res

fro

m t

he

T5

.

2.8

%

of

pre

gn

an

t

wo

me

n

rece

ivin

g

ma

lari

a I

PT

2

du

rin

g A

NC

# o

f p

reg

na

nt

wo

me

n

rece

ivin

g

ma

lari

a I

PT

2

du

rin

g A

NC

,

div

ide

d b

y #

of

pre

gn

an

t

wo

me

n

rece

ivin

g f

irst

AN

C i

n M

CH

IP

lea

rnin

g

dis

tric

ts.

14

%

(So

urc

e:

na

tio

na

l

est

ima

te,

MIM

S

20

09

)

Ne

w i

nd

ica

tor

intr

od

uce

d i

n

Ye

ar

2

1,7

51

/4,8

94

=3

6%

1,3

90

(Mu

tare

)

an

d 3

61

(Ch

ima

nim

a

ni)

n=

as

de

scri

be

d i

n

no

te a

bo

ve

2,9

42

/5,3

82

=

55

%

22

34

(M

uta

re)

an

d 7

08

(Ch

ima

nim

an

i)

(Ja

n –

Ma

r

20

12

)

2,3

60

/5,0

17

=4

7%

17

27

(M

uta

re)

an

d 6

33

(Ch

ima

nim

an

i)

(Ap

r –

Ju

ne

20

12

)

2,3

91

/4,9

47

=4

8

%

1,7

61

Mu

tare

an

d 6

30

Ch

ima

nim

an

i

(Ju

l-S

ep

20

12

)

9,4

44

/20

,24

0=

47

%

(Mu

tare

an

d

Ch

ima

nim

an

i)

(Oct

20

11

- S

ep

20

12

)

50

%

(n=

79

HF

s in

the

2 l

ea

rnin

g

dis

tric

ts)

A d

ecr

ea

se

be

twe

en

Q2

an

d

Q3

co

uld

be

du

e

to t

he

fa

ct t

ha

t

du

rin

g t

he

rep

ort

ing

pe

rio

d

it w

as

no

t a

ma

lari

a s

ea

son

.

MC

HIP

/Z

imb

ab

we

Qu

art

erl

y R

ep

ort

(Ju

l-S

ep

t 2

01

2)

Pa

ge

32

2.9

# o

f

de

liv

eri

es

wit

h a

ski

lle

d

bir

th

att

en

da

nt

(SB

A)

# o

f d

eli

veri

es

wit

h a

SB

A i

n

MC

HIP

le

arn

ing

dis

tric

ts.

"S

BA

"

incl

ud

es

me

dic

al

off

ice

rs,

nu

rse

s,

or

mid

wif

e.

10

,46

0

(n=

79

HF

s

in t

he

2

lea

rnin

g

dis

tric

ts)

(Ja

n –

De

c

20

09

da

ta;

sou

rce

:

MO

HC

W,2

0

09

)

9,3

10

(n=

17

SB

M-R

sup

po

rte

d H

Fs

in 2

le

arn

ing

dis

tric

ts)

8,9

52

(n=

79

HFs

in 2

dis

tric

ts)

(fo

r M

uta

re

rep

ort

ing

pe

rio

d

is J

an

-Se

p 2

01

1;

for

Ch

ima

nim

an

i

pe

rio

d i

s O

ct

20

10

-Au

g 2

01

1)

(NB

:

8,9

52

=7

,03

6

de

liv

eri

es

in

Mu

tare

fro

m J

an

–S

ep

20

11

plu

s

1,9

16

de

live

rie

s

in C

him

an

ima

ni

for

Oct

20

10

-Au

g

20

11

)

3,0

32

(n=

22

SB

M-

R s

up

po

rte

d

site

s)

3,1

33

2,3

79

(Mu

tare

)

an

d 7

54

(Ch

ima

nim

a

ni)

n=

as

de

scri

be

d i

n

no

te a

bo

ve

3,2

16

(n=

22

SB

M-R

sup

po

rte

d

site

s)

(Ja

n –

Ma

r

20

12

)

3,6

66

2,9

52

(Mu

tare

) a

nd

71

4(C

him

an

im

an

i)

(Ja

n –

Ma

r

20

12

)

3,4

64

(n=

22

SB

M-R

sup

po

rte

d

site

s)

(Ap

r –

Jun

e

20

12

)

3,9

02

3,0

54

(M

uta

re)

an

d 8

48

(Ch

ima

nim

an

i)

(Ap

r –

Jun

e

20

12

)

3,3

70

(da

ta f

rom

22

SB

M-R

sup

po

rte

d s

ite

s)

3,8

58

3,1

18

(M

uta

re

an

d

74

0

Ch

ima

nim

an

i)

(Ju

l –

Se

p 2

01

2)

13

,08

2

(n

=2

2 S

BM

-R

sup

po

rte

d

site

s)

(Oct

20

11

–S

ep

20

12

)

1

4,5

59

11

,50

3

(Mu

tare

) a

nd

3,0

56

(Ch

ima

nim

an

i)

(Oct

20

11

–S

ep

20

12

)

11

,00

0

(n=

79

HF

s in

the

2 l

ea

rnin

g

dis

tric

ts)

To

tal

ho

me

de

live

rie

s fo

r th

e

22

SB

M-R

sup

po

rte

d s

ite

s

for

the

pe

rio

d J

ul

- S

ep

20

12

is 1

69

;

this

me

an

s th

at

the

% o

f S

BA

fo

r

the

se s

ite

s in

to

tal

is

3,3

70

/(3

,37

0+

16

9

) =

95

%.

Dis

tric

t-w

ide

, #

of

ho

me

de

live

rie

s

rep

ort

ed

th

rou

gh

the

HM

IS f

or

Q4

is

37

5 (

NB

: th

is i

s

lik

ely

an

un

de

rest

ima

te o

f

the

tru

e #

of

ho

me

bir

ths

occ

urr

ing

in

th

e

com

mu

nit

y).

Ba

sed

on

th

is,

the

% o

f d

eli

veri

es

wit

h a

SB

A f

or

the

two

dis

tric

ts i

s

3,8

58

/

(3,8

58

+3

75

) =

91

%.

Inst

itu

tio

na

l

de

live

ry r

ate

s a

re

rela

tive

ly h

igh

in

Zim

ba

bw

e (

65

%

ove

rall

; 2

01

0/1

1

ZD

HS).

MC

HIP

/Z

imb

ab

we

Qu

art

erl

y R

ep

ort

(Ju

l-S

ep

t 2

01

2)

Pa

ge

33

2.1

0 %

of

MC

HIP

SB

M-R

faci

liti

es

me

eti

ng

se

t

pe

rfo

rma

nce

an

d q

ua

lity

imp

rov

em

en

t

targ

ets

fo

r

AM

TS

L

# o

f M

CH

IP

SB

M-R

sup

po

rte

d

faci

liti

es

ach

ievin

g t

he

set

an

nu

al

pe

rfo

rma

nce

an

d q

ua

lity

imp

rov

em

en

t

targ

et

for

AM

TS

L, d

ivid

ed

by #

of

MC

HIP

SB

M-R

sup

po

rte

d H

Fs.

0

76

% (

13

/17

)

(n=

17

fa

cili

tie

s

in 2

le

arn

ing

dis

tric

ts)

n/a

n

/a

n/a

n

/a

11

/17

=6

5%

HF

s

(Oct

20

11

-Se

p

20

12

)

10

0%

(n=

17

HF

s in

2

lea

rnin

g

dis

tric

ts)

.

2.1

1 %

of

wo

me

n w

ith

va

gin

al

bir

ths

rece

ivin

g a

ute

roto

nic

imm

ed

iate

ly

aft

er

bir

th

# o

f w

om

en

giv

ing

bir

th w

ho

rece

ive

d a

ute

roto

nic

du

rin

g t

he

th

ird

sta

ge

of

lab

or

in

MC

HIP

SB

M-R

sup

po

rte

d

faci

liti

es,

div

ide

d b

y t

ota

l

# w

om

en

giv

ing

bir

th i

n M

CH

IP

SB

M-R

sup

po

rte

d H

Fs.

72

%

(n=

17

SB

M-

R

sup

po

rte

d

HF

s in

2

lea

rnin

g

dis

tric

ts)

(So

urc

e:

MO

HC

W,

Oct

20

10

)

87

%

(n=

17

SB

M-R

sup

po

rte

d H

Fs

in 2

le

arn

ing

dis

tric

ts)

n/a

n

/a

n/a

n

/a

2,8

72

/3,2

19

=8

9%

(da

ta c

am

e

fro

m 1

7 S

BM

-R

sup

po

rte

d

site

s)

95

%

(n=

17

SB

M-R

sup

po

rte

d

HF

s in

2

lea

rnin

g

dis

tric

ts)

Da

ta c

oll

ect

ed

fo

r

FY

12

Q4

.

2.1

2 %

of

LBW

ne

wb

orn

s

ad

mit

ted

in

KM

C

# o

f LB

W

ne

wb

orn

s

(be

low

2.5

kg

)

ad

mit

ted

in

KM

C,

div

ide

d b

y

tota

l #

of

LBW

ne

wb

orn

s b

orn

in M

uta

re a

nd

Ch

ima

nim

an

i.

0

71

9

(Ab

solu

te f

igu

re

no

t %

du

e t

o

mis

sin

g

de

no

min

ato

r

da

ta)

12

/32

8 =

4%

(Mu

tare

an

d

Ch

ima

nim

an

i d

istr

icts

)

29

/38

2 =

8%

(Mu

tare

an

d

Ch

ima

nim

an

i

dis

tric

ts)

(Ja

n –

Ma

r 2

01

2)

92

/37

7=

24

%

(Mu

tare

an

d

Ch

ima

nim

an

i

dis

tric

ts)

(Ap

r-

Jun

e 2

01

2)

82

/31

4=

26

%

(Mu

tare

an

d

Ch

ima

nim

an

i

dis

tric

ts)

(Ju

l-

Se

p 2

01

2)

21

5/1

,40

1=

15

%

(Mu

tare

an

d

Ch

ima

nim

an

i

dis

tric

ts)

(Oct

20

11

– S

ep

20

12

)

50

%

(n=

4 K

MC

sup

po

rte

d

HF

s in

2

lea

rnin

g

dis

tric

ts)

All

4 K

MC

un

its

in

the

tw

o d

istr

icts

are

no

w f

ull

y

fun

ctio

na

l.

# o

f LB

W n

ew

bo

rns

ad

mit

ted

in

KM

C i

n M

CH

IP l

ea

rnin

g d

istr

icts

fo

r Q

4:

82

(6

6 in

Mu

tare

an

d 1

6 i

n C

him

an

ima

ni;

n=

4 K

MC

un

its)

.

To

tal

# o

f LB

W n

ew

bo

rns

bo

rn i

n M

CH

IP l

ea

rnin

g d

istr

icts

fo

r Q

4:

31

4 (

26

6 i

n M

uta

re a

nd

28

in

Ch

ima

nim

an

i; n

=a

s d

esc

rib

ed

in

no

te a

bo

ve

).

MC

HIP

/Z

imb

ab

we

Qu

art

erl

y R

ep

ort

(Ju

l-S

ep

t 2

01

2)

Pa

ge

34

2.1

3 #

of

con

firm

ed

case

s o

f

ma

lari

a

in

child

ren

un

de

r 5

ye

ars

at

he

alt

h

faci

lity

le

ve

l

# o

f co

nfi

rme

d

case

s o

f m

ala

ria

in c

hil

dre

n

un

de

r 5

ye

ars

of

ag

e a

t h

ea

lth

faci

lity

le

ve

l in

MC

HIP

le

arn

ing

dis

tric

ts.

3,5

85

(n=

79

HF

s

in t

he

2

lea

rnin

g

dis

tric

ts)

(Ja

n –

De

c

20

09

da

ta;

sou

rce

:

MO

HC

W,

20

09

)

5,1

29

(n=

17

SB

M-R

sup

po

rte

d H

Fs

in 2

le

arn

ing

dis

tric

ts)

13

,00

3

(n=

79

HFs

in 2

dis

tric

ts;

for

Mu

tare

rep

ort

ing

pe

rio

d

is J

an

-Se

p 2

01

1;

for

Ch

ima

nim

an

i

pe

rio

d i

s O

ct

20

10

-Au

g 2

01

1)

(NB

:

13

,00

3=

10

,18

9

case

s in

Mu

tare

fro

m J

an

-Se

p

20

11

plu

s 2

,81

4

case

s in

Ch

ima

nim

an

i

fro

m O

ct 2

01

0-

Au

g 2

01

1)

36

4

( n

=2

2SB

M-

R s

up

po

rte

d

site

s)

82

2

35

0

(Mu

tare

)

an

d 4

72

(Ch

ima

nim

a

ni)

n=

as

de

scri

be

d i

n

no

te a

bo

ve

1,1

47

(n=

22

SB

M-R

sup

po

rte

d

site

s)

(Ja

n –

Ma

r

20

12

)

2,2

73

1,3

71

(Mu

tare

) a

nd

90

2

(Ch

ima

nim

an

i)

(Ja

n –

Ma

r

20

12

)

73

2

(n=

22

SB

M-R

sup

po

rte

d

site

s)

(Ap

r –

Jun

e

20

12

)

1,8

30

1,0

70

(M

uta

re)

an

d

76

0(C

him

an

im

an

i)

(Ap

r –

Ju

ne

20

12

)

44

2

(da

ta f

rom

22

SB

M-R

sup

po

rte

d s

ite

s)

(Ju

l-S

ep

20

12

)

72

6

39

5 in

Mu

tare

an

d

33

1 in

Ch

ima

nim

an

i

(Ju

l-S

ep

20

12

)

2,6

85

(n=

22

SB

M-R

sup

po

rte

d

site

s)

(Oct

20

11

–S

ep

20

12

)

5,6

51

3,1

86

(M

uta

re)

an

d 2

,46

5

(Ch

ima

nim

an

i)

(Oct

20

11

–S

ep

20

12

)

17

,50

0

(n=

79

HF

s in

the

2 l

ea

rnin

g

dis

tric

ts)

Low

er

fig

ure

s

rep

ort

ed

fo

r Q

3

rela

tive

to

Q2

ma

y b

e d

ue

to

th

e

fact

th

at

ma

lari

a

sea

son

en

de

d i

n

ea

rly Q

3.

To

tal

# e

xpe

cte

d n

um

be

r o

f ch

ild

ren

un

de

r 5

ye

ars

of

ag

e i

n M

CH

IP le

arn

ing

dis

tric

ts:

85

,70

1 (

20

,54

4 in

Ch

ima

nim

an

i a

nd

65

,15

7 i

n M

uta

re).

T

his

is

an

an

nu

al

fig

ure

ba

sed

on

ZIM

ST

AT

pro

ject

ed

fig

ure

s.

To

tal

# o

f su

spe

cte

d m

ala

ria

ca

ses

in c

hil

dre

n u

nd

er

5 y

ea

rs i

n M

CH

IP l

ea

rnin

g d

istr

icts

fo

r Q

4 (

as

rep

ort

ed

on

th

e T

5):

1

,20

5 (

n=

22

SB

M-R

su

pp

ort

ed

sit

es)

; 2

,03

8 (

91

0 in

Mu

tare

an

d 1

,12

8 i

n C

him

an

ima

ni;

n=

as

de

scri

be

d i

n n

ote

ab

ove

).

2.1

4 #

of

case

s o

f

dia

rrh

oe

a

see

n i

n

child

ren

un

de

r 5

ye

ars

at

he

alt

h

faci

lity

To

tal

# o

f ca

ses

of

dia

rrh

ea

se

en

in c

hil

dre

n

un

de

r 5

ye

ars

at

he

alt

h f

aci

lity

lev

el in

MC

HIP

lea

rnin

g

dis

tric

ts.

1,7

46

(n=

79

HF

s

in t

he

2

lea

rnin

g

dis

tric

ts)

(Ja

n –

De

c

20

09

da

ta;

sou

rce

:

MO

HC

W,2

0

6,4

12

(n=

17

SB

M-R

sup

po

rte

d H

Fs

in 2

le

arn

ing

dis

tric

ts)

12

,90

0

(n=

79

HFs

in 2

dis

tric

ts;

for

Mu

tare

2,9

37

(n=

22

SB

M-

R s

up

po

rte

d

site

s)

5,8

09

1,9

80

(n=

22

SB

M-R

sup

po

rte

d

site

s)

(Ja

n –

Ma

r

20

12

)

40

64

2,9

49

(Mu

tare

)

2,7

10

(n=

22

SB

M-R

sup

po

rte

d

site

s)

(Ap

r –

Ju

ne

20

12

)

6,2

38

4,8

46

(Mu

tare

)

an

d

2,8

38

(da

ta f

rom

22

SB

M-R

sup

po

rte

d s

ite

s)

(Ju

l-S

ep

20

12

)

5,9

75

4,6

06

in

Mu

tare

10

,46

5

(n=

22

SB

M-R

sup

po

rte

d

site

s)

(Oct

20

11

–S

ep

20

12

)

17

,30

0

(n=

79

HF

s in

the

2 l

ea

rnin

g

dis

tric

ts)

“Ca

ses

see

n"

me

an

s ca

ses

“wit

h

de

hyd

rati

on

” p

lus

case

s w

ith

“n

o

de

hyd

rati

on

” o

n

the

T5

fo

rm.

MC

HIP

/Z

imb

ab

we

Qu

art

erl

y R

ep

ort

(Ju

l-S

ep

t 2

01

2)

Pa

ge

35

09

) re

po

rtin

g p

eri

od

is J

an

-Se

p 2

01

1;

for

Ch

ima

nim

an

i

pe

rio

d i

s O

ct

20

10

-Au

g 2

01

1)

(NB

:

12

,90

0=

9,7

13

case

s in

Mu

tare

fro

m J

an

-Se

p

20

11

plu

s 3

,18

7

case

s in

Ch

ima

nim

an

i

fro

m O

ct 2

01

0-

Au

g 2

01

1)

4,5

49

(Mu

tare

)

an

d 1

,26

0

(Ch

ima

nim

a

ni)

n=

as

de

scri

be

d i

n

no

te a

bo

ve

an

d

1,1

15

(Ch

ima

ni

ma

ni)

(Ja

n –

Ma

r

20

12

)

1,3

92

(Ch

ima

ni

ma

ni)

(Ap

r –

Jun

e

20

12

)

1,3

69

in

Ch

ima

nim

an

i

(Ju

l-S

ep

20

12

)

22

,08

6

16

,95

0

(Mu

tare

) a

nd

5,1

36

(Ch

ima

nim

an

i)

(Oct

20

11

–S

ep

20

12

)

2.1

5 %

of

MC

HIP

SB

M-R

faci

liti

es

me

eti

ng

se

t

pe

rfo

rma

nce

an

d q

ua

lity

imp

rov

em

en

t

targ

ets

fo

r

dia

rrh

ea

ca

se

ma

na

ge

me

nt

# o

f M

CH

IP

SB

M-R

sup

po

rte

d

faci

liti

es

ach

ievin

g t

he

set

pe

rfo

rma

nce

an

d q

ua

lity

imp

rov

em

en

t

targ

et

for

dia

rrh

ea

ca

se

ma

na

ge

me

nt,

div

ide

d b

y t

ota

l

# o

f M

CH

IP

SB

M-R

sup

po

rte

d H

Fs.

Ne

w

ind

ica

tor

intr

od

uce

d

in Y

ea

r 2

Ne

w i

nd

ica

tor

intr

od

uce

d i

n

Ye

ar

2

n/a

n

/a

n/a

n

/a

8/2

1 =

38

% H

Fs

(Oct

20

11

-Se

p

20

12

)

60

%

(n=

20

HF

s in

2

lea

rnin

g

dis

tric

ts)

2.1

6 #

of

case

s o

f

pn

eu

mo

nia

tre

ate

d i

n

child

ren

un

de

r 5

in

he

alt

h

faci

liti

es

# o

f ca

ses

of

pn

eu

mo

nia

tre

ate

d i

n

chil

dre

n u

nd

er

5 y

ea

rs o

f a

ge

at

faci

lity

le

ve

l

in M

CH

IP

lea

rnin

g

19

,00

2

(n=

79

HF

s

in t

he

2

lea

rnin

g

dis

tric

ts)

(Ja

n –

De

c

20

09

da

ta;

14

,45

8

(n=

17

SB

M-R

sup

po

rte

d H

Fs

in 2

le

arn

ing

dis

tric

ts)

36

,06

6

(n=

79

HFs

in 2

5,2

10

(n=

22

SB

M-

R s

up

po

rte

d

site

s)

10

,08

5

7,6

18

5,6

78

(n=

22

SB

M-R

sup

po

rte

d

site

s)

(Ja

n –

Ma

r

20

12

)

95

73

4,5

21

(n=

22

SB

M-R

sup

po

rte

d

site

s)

(Ap

r –

Jun

e

20

12

)

11

,59

9

9,1

20

(Mu

tare

)

5,3

73

(da

ta f

rom

22

SB

M-s

up

po

rte

d

site

s)

(Ju

l-S

ep

20

12

)

20

,78

2

(n=

22

SB

M-R

sup

po

rte

d

site

s)

(Oct

20

11

–S

ep

20

12

)

30

,00

0

(n=

79

HF

s in

the

2 l

ea

rnin

g

dis

tric

ts)

“Ca

ses

tre

ate

d”

me

an

s “m

od

era

te

(pn

eu

mo

nia

)”

plu

s “s

eve

re

(pn

eu

mo

nia

)” o

n

the

T5

fo

rm.

MC

HIP

/Z

imb

ab

we

Qu

art

erl

y R

ep

ort

(Ju

l-S

ep

t 2

01

2)

Pa

ge

36

dis

tric

ts.

sou

rce

:

MO

HC

W,2

0

09

)

dis

tric

ts;

for

Mu

tare

rep

ort

ing

pe

rio

d

is J

an

-Se

p 2

01

1;

for

Ch

ima

nim

an

i

pe

rio

d i

s O

ct

20

10

-Au

g 2

01

1)

(NB

:

36

,06

6=

27

,06

3

case

s in

Mu

tare

for

Jan

-Se

p 2

01

1

plu

s 9

,00

3 c

ase

s

in C

him

an

ima

ni

for

Oct

20

10

-

Au

g 2

01

1)

(Mu

tare

)

an

d 2

46

7

(Ch

ima

nim

a

ni)

n=

as

de

scri

be

d i

n

no

te a

bo

ve

7,3

08

(Mu

tare

)

an

d

2,2

65

(Ch

ima

ni

ma

ni)

(Ja

n –

Ma

r

20

12

)

an

d

2,4

79

(Ch

ima

ni

ma

ni)

(Ap

r –

Jun

e

20

12

)

13

, 0

49

(10

,52

4 i

n

Mu

tare

an

d

2,5

25

in

Ch

ima

nim

an

i)

(Ju

l-S

ep

20

12

)

44

,30

6

34

, 5

70

(Mu

tare

) a

nd

9,7

36

(Ch

ima

nim

an

i)

(Oct

20

11

–S

ep

20

12

)

2.1

7 %

of

MC

HIP

SB

M-R

faci

liti

es

me

eti

ng

se

t

pe

rfo

rma

nce

an

d q

ua

lity

imp

rov

em

en

t

targ

ets

fo

r

pn

eu

mo

nia

case

ma

na

ge

me

nt

# o

f M

CH

IP

SB

M-R

sup

po

rte

d

faci

liti

es

ach

ievin

g t

he

set

pe

rfo

rma

nce

an

d q

ua

lity

imp

rov

em

en

t

targ

et

for

pn

eu

mo

nia

ca

se

ma

na

ge

me

nt,

div

ide

d b

y t

ota

l

# o

f M

CH

IP

SB

M-R

sup

po

rte

d H

Fs.

Ne

w

ind

ica

tor

intr

od

uce

d

in Y

ea

r 2

Ne

w i

nd

ica

tor

intr

od

uce

d i

n

Ye

ar

2

n/a

n

/a

n/a

n

/a

9/2

1 =

43

% H

Fs

(Oct

20

11

-Se

p

20

12

)

60

%

(n=

20

HF

s in

2

lea

rnin

g

dis

tric

ts)

OB

JEC

TIV

E 3

: Im

pro

ve

th

e c

ov

era

ge

an

d q

ua

lity

of

hig

h-i

mp

act

MN

CH

/FP

in

terv

en

tio

ns

pro

vid

ed

by

he

alt

h c

are

wo

rke

rs i

n t

he

co

mm

un

ity

, in

clu

din

g V

HW

s a

nd

oth

er

ag

en

ts

MC

HIP

/Z

imb

ab

we

Qu

art

erl

y R

ep

ort

(Ju

l-S

ep

t 2

01

2)

Pa

ge

37

3.1

#

of

VH

W

tra

ine

rs

tra

ine

d in

MN

CH

# o

f V

HW

tra

ine

rs t

rain

ed

in M

NC

H w

ith

MC

HIP

su

pp

ort

.

Da

ta w

ill b

e

dis

ag

gre

ga

ted

by s

ex

(ma

le/f

em

ale

)

wh

en

re

po

rtin

g.

0

0

0

23

(16

fe

ma

les

an

d 7

ma

les)

0

0

23

(16

fe

ma

les

an

d 7

ma

les)

10

(to

be

sele

cte

d f

rom

MC

HIP

sup

po

rte

d

dis

tric

ts i

n

Ma

nic

ala

nd

)

No

TO

Ts

we

re

he

ld f

or

VH

W

tra

ine

rs d

uri

ng

Q3

an

d Q

4.

To

be

dis

ag

gre

ga

ted

by g

en

de

r (m

ale

/fe

ma

le)

3.2

# o

f V

HW

s

tra

ine

d in

com

mu

nit

y

MN

CH

# o

f V

HW

s

tra

ine

d i

n

com

mu

nit

y

MN

CH

se

rvic

es

(e.g

., c

IMN

CI)

wit

hin

MC

HIP

sup

po

rte

d

dis

tric

ts.

Da

ta

wil

l b

e

dis

ag

gre

ga

ted

by s

ex

(ma

le/f

em

ale

)

wh

en

re

po

rtin

g.

0

0

29

7

(24

8

fem

ale

s a

nd

49

ma

les)

21

5

(19

7 f

em

ale

s

an

d 1

8 m

ale

s)

0

0

37

0

45

0

(to

be

sele

cte

d f

rom

catc

hm

en

t

are

as

of

the

17

SB

M-R

sup

po

rte

d

HF

s in

2

lea

rnin

g

dis

tric

ts)

Th

ere

we

re n

o

VH

W t

rain

ing

s

du

rin

g Q

3 a

nd

Q4

.

To

be

dis

ag

gre

ga

ted

by g

en

de

r (m

ale

/fe

ma

le)

3.3

#

of

pre

gn

an

t

wo

me

n

rece

ivin

g a

t

lea

st t

wo

AN

C h

om

e

vis

its

# o

f p

reg

na

nt

wo

me

n

rece

ivin

g a

t

lea

st t

wo

AN

C

ho

me

vis

its

fro

m M

CH

IP

sup

po

rte

d

VH

Ws

in M

CH

IP

lea

rnin

g s

ite

s.

0

Ne

w i

nd

ica

tor

intr

od

uce

d i

n

Ye

ar

2

17

9

(n=

4 o

ut

of

22

SB

MR

sup

po

rte

d

site

s)

71

4

(n=

18

ou

t o

f

22

SB

MR

sup

po

rte

d

site

s) (

Jan

–

Ma

r 2

01

2)

59

3

(n=

15

ou

t o

f 2

2

SB

MR

sup

po

rte

d

site

s) (

Ap

r-Ju

ne

20

12

)

72

8

(da

ta f

rom

17

SB

M-R

sup

po

rte

d s

ite

s)

2,2

14

(n=

4 o

f 2

2

SB

MR

sup

po

rte

d s

ite

s

for

Oct

20

11

-

De

c 2

01

1;

n=

18

of

22

SB

MR

sup

po

rte

d s

ite

s

for

Jan

–M

ar

20

12

; n

=1

5 o

f

22

SB

MR

sup

po

rte

d s

ite

s

for

Ap

r –

Jun

e

20

12

)

(Ju

l –

Se

p 2

01

2)

2,4

00

(fro

m

catc

hm

en

t

are

a o

f 1

7

SB

M-R

HFs

in

the

2 l

ea

rnin

g

dis

tric

ts)

MC

HIP

/Z

imb

ab

we

Qu

art

erl

y R

ep

ort

(Ju

l-S

ep

t 2

01

2)

Pa

ge

38

3.4

# o

f

ne

wb

orn

s

rece

ivin

g a

po

stn

ata

l

ho

me

vis

it

wit

hin

th

e

firs

t 3

da

ys

of

de

liv

ery

# o

f n

ew

bo

rns

vis

ite

d w

ith

in

the

fir

st 3

da

ys

of

life

by

MC

HIP

sup

po

rte

d

VH

Ws

in M

CH

IP

lea

rnin

g s

ite

s.

0

Ne

w i

nd

ica

tor

intr

od

uce

d i

n

Ye

ar

2

61

(n=

4 o

ut

of

22

SB

M-R

sup

po

rte

d

site

s)

17

0

(n=

18

ou

t o

f

22

SB

MR

sup

po

rte

d

site

s(Ja

n –

Ma

r

20

12

))

23

4

n=

15

ou

t o

f 2

2

SB

MR

sup

po

rte

d

site

s) (

Ap

r-Ju

ne

20

12

)

47

9

(da

ta f

rom

17

SB

M-R

sup

po

rte

d s

ite

s)

94

4

(n=

4 o

f 2

2

SB

MR

sup

po

rte

d s

ite

s

for

Oct

20

11

-

De

c 2

01

1;

n=

18

of

22

SB

MR

sup

po

rte

d s

ite

s

for

Jan

–M

ar

20

12

; n

=1

5 o

f

22

SB

MR

sup

po

rte

d s

ite

s

for

Ap

r –

Jun

e

20

12

)

(Ju

l –

Se

p 2

01

2)

2,4

00

(fro

m

catc

hm

en

t

are

a o

f 1

7

SB

M-R

sup

po

rte

d

HF

s in

th

e 2

lea

rnin

g

dis

tric

ts)

3.5

# o

f ca

ses

of

ma

lari

a

tre

ate

d b

y

VH

Ws

in

child

ren

un

de

r 5

# o

f ca

ses

of

ma

lari

a t

rea

ted

by V

HW

s in

chil

dre

n u

nd

er

5 i

n M

CH

IP

lea

rnin

g

dis

tric

ts.

0

Ne

w i

nd

ica

tor

intr

od

uce

d i

n

Ye

ar

2

0

0

49

9

71

9

(da

ta f

rom

17

SB

M-R

sup

po

rte

d s

ite

s)

1,2

18

1

,08

0

(fro

m

catc

hm

en

t

are

a o

f 1

7

SB

M-R

sup

po

rte

d

HF

s in

th

e 2

lea

rnin

g

dis

tric

ts)

Th

e Q

3 a

nd

Q4

fig

ure

s in

clu

de

bo

th c

hild

ren

<5

an

d a

du

lts

tre

ate

d f

or

ma

lari

a b

y V

HW

s.

Da

ta f

or

child

ren

<5

on

ly w

ill

be

pro

vid

ed

in

FY

13

.

OB

JEC

TIV

E 4

. In

cre

ase

ro

uti

ne

im

mu

niz

ati

on

co

ve

rag

e i

n M

an

ica

lan

d p

rov

ince

an

d s

up

po

rt t

he

na

tio

nw

ide

in

tro

du

ctio

n o

f p

ne

um

oco

cca

l v

acc

ine

by

20

12

an

d r

ota

vir

us

va

ccin

e b

y 2

01

3

4.1

% o

f

child

ren

le

ss

tha

n 1

2

mo

nth

s o

f

ag

e w

ho

rece

ive

d

Pe

nta

3

# o

f ch

ild

ren

less

th

an

12

mo

nth

s w

ho

rece

ive

d P

en

ta

3 i

n M

CH

IP

sup

po

rte

d

dis

tric

ts,

div

ide

d b

y #

chil

dre

n <

12

mo

nth

s in

MC

HIP

sup

po

rte

d

dis

tric

ts.

52

.1%

(So

urc

e:

Ma

nic

ala

nd

pro

vin

cia

l

est

ima

te,

ZD

HS

20

10

/11

)

6,9

10

/76

63

=

90

%

(n=

17

SB

M-R

HF

s;

de

no

min

ato

r =

ZIM

ST

AT

20

11

pro

ject

ion

)

16

,32

3/1

8,2

14

=

90

%

(n=

79

HFs

in 2

dis

tric

ts;

for

Mu

tare

rep

ort

ing

pe

rio

d

2,1

35

/2,2

14

=9

6%

(n=

22

SB

M-

R s

up

po

rte

d

site

s)

4,7

97

/4,5

54

=1

05

%

3,7

55

/3,5

46

= 1

06

%

(Mu

tare

)

an

d 1

,04

2/

1,0

08

=1

03

%

(Ch

ima

nim

a

1,9

28

/2,2

14

=8

7%

(n=

22

SB

M-R

sup

po

rte

d

site

s)

(Ja

n –

Ma

r

20

12

)

4,5

84

/4,5

54

=

10

1%

3,5

38

/3,5

46

=

99

% (

Mu

tare

)

an

d

1,0

46

/1,0

08

=

1,9

34

/2,2

14

=

87

%

(n=

22

SB

M-R

sup

po

rte

d

site

s)

(Ap

r –

Jun

e

20

12

)

4,7

33

/4,5

54

=

10

4%

(3,6

77

/3,5

46

=

10

4%

in

Mu

tare

an

d

1,0

56

/1,0

08

=

1,6

28

/2,2

14

=7

4

%

(n=

22

SB

M-R

sup

po

rte

d s

ite

s)

(Ju

l –

Se

p 2

01

2)

3,7

32

/4,5

54

=8

2

%

(2,7

54

/35

46

=7

8

% i

n M

uta

re

97

8/1

00

8=

97

%

in C

him

an

ima

ni)

7,6

25

/8,8

56

=

86

%

(n=

22

SB

M-R

sup

po

rte

d

site

s)

(Oct

20

11

–S

ep

20

12

)

17

,06

5/1

8,2

16

=9

4%

;

12

,94

3/1

4,1

84

=

91

% (

Mu

tare

)

an

d

4,8

26

/4,0

32

=

95

% b

ase

d

on

ce

nsu

s

pro

ject

ed

da

ta a

nd

60

%

ba

sed

on

RE

D

he

ad

co

un

t

da

ta

(n=

10

0%

of

Ma

nic

ala

nd

HF

s; 2

lea

rnin

g

dis

tric

ts +

5

ad

dit

ion

al

In t

he

pre

vio

us

qu

art

erl

y re

po

rt,

Q2

co

ve

rag

e

sta

tist

ics

we

re

calc

ula

ted

usi

ng

ZIM

ST

AT

20

11

pro

ject

ed

fig

ure

s

in t

he

de

no

min

ato

rs.

In

this

qu

art

er,

ZIM

ST

AT

20

12

pro

ject

ed

fig

ure

s

we

re o

bta

ine

d,

an

d s

o t

he

MC

HIP

/Z

imb

ab

we

Qu

art

erl

y R

ep

ort

(Ju

l-S

ep

t 2

01

2)

Pa

ge

39

is J

an

-Se

p 2

01

1;

for

Ch

ima

nim

an

i

pe

rio

d i

s O

ct

20

10

-Au

g 2

01

1)

49

,72

2/5

6,5

54

=

88

%

(n=

7 d

istr

icts

;

rep

ort

ing

pe

rio

d

for

all

7 d

istr

icts

is O

ct1

0-A

ug

11

;

de

no

min

ato

r =

ZIM

ST

AT

20

11

pro

ject

ion

)

ni)

n=

as

de

scri

be

d i

n

no

te a

bo

ve

14

,05

6/1

4,1

39

=

99

%

(7 d

istr

icts

in

Ma

nic

ala

nd

)

(Oct

–D

ec

20

11

)

10

4%

(Ch

ima

nim

an

i)

(Ja

n –

Ma

r

20

12

)

14

,52

2/1

5,7

32

=9

2%

(7 d

istr

icts

in

Ma

nic

ala

nd

;

Mu

tasa

(Ja

n –

Ma

r

20

12

)

10

5%

in

Ch

ima

nim

an

i

(Ap

r-Ju

ne

20

12

)

14,

610/1

5,7

32

=9

3%

(7 d

istr

icts

in

Ma

nic

ala

nd

;

(Ap

r –

Jun

e

20

12

)

(Ju

l- S

ep

20

12

)

11

,34

6/1

5,1

03

=7

5%

(7 d

istr

icts

in

Ma

nic

ala

nd

Ju

ly-

Au

gu

st 2

01

2 a

nd

6 d

istr

icts

fo

r S

ep

20

12

)

(Ju

l –

Se

p 2

01

2)

12

0%

(Ch

ima

nim

an

i)

(Oct

20

11

-Se

p

20

12

)

54

,53

4/6

0,7

06

=9

0%

(7 d

istr

icts

in

Ma

nic

ala

nd

)

(Oct

20

11

-Se

p

20

12

)

dis

tric

ts i

n

Ma

nic

ala

nd

)

cove

rag

e s

tati

stic

s

for

Q2

we

re

reca

lcu

late

d u

sin

g

the

20

12

de

no

min

ato

r

fig

ure

s.

Q3

cove

rag

e s

tati

stic

s

we

re a

lso

calc

ula

ted

usi

ng

the

ne

w 2

01

2

ZIM

ST

AT

pro

ject

ion

s.

He

ad

cou

nt

da

ta f

or

the

pro

vin

ce is

stil

l

no

t a

va

ila

ble

.

Q3

fig

ure

s h

av

e

sin

ce b

ee

n

up

da

ted

.

4.2

% o

f

child

ren

le

ss

tha

n 1

2

mo

nth

s o

f

ag

e w

ho

rece

ive

d

me

asl

es

va

ccin

ati

on

# o

f ch

ild

ren

<1

2 m

on

ths

wh

o r

ece

ive

d

me

asl

es

va

ccin

ati

on

in

MC

HIP

sup

po

rte

d

dis

tric

ts,

div

ide

d

by #

ch

ild

ren

<1

2 m

on

ths

in

MC

HIP

sup

po

rte

d

dis

tric

ts.

64

.5%

(So

urc

e:

Ma

nic

ala

nd

pro

vin

cia

l

est

ima

te,

ZD

HS

20

10

/11

)

6,7

46

/76

63

=

88

%

(n=

17

SB

M-R

HF

s in

2 l

ea

rnin

g

dis

tric

ts;

de

no

min

ato

r =

ZIM

ST

AT

20

11

pro

ject

ion

)

16

,29

4/1

8,2

14

=

89

%

(n=

79

HFs

in 2

dis

tric

ts;

for

Mu

tare

rep

ort

ing

pe

rio

d

is J

an

-Se

p 2

01

1;

for

Ch

ima

nim

an

i

pe

rio

d i

s O

ct

20

10

-Au

g 2

01

1)

2,0

04

/2,2

14

=9

1%

(22

SB

M-R

sup

po

rte

d

site

s)

4,4

53

/4,5

54

=9

8%

;

3,3

99

/3,5

46

=9

6%

(Mu

tare

)

an

d

1,0

54

/1,0

08

=1

05

%(C

him

an

ima

ni)

n=

as

de

scri

be

d in

no

te a

bo

ve

2,1

80

/2,2

14

=

98

%

(22

SB

M-R

sup

po

rte

d

site

s)

(Ja

n –

Ma

r

20

12

)

5,2

09

/4,5

54

=

11

4%

;

4,0

00

/3,5

46

=

11

3%

(Mu

tare

) a

nd

1,2

09

/1,0

08

=

12

0%

(Ch

ima

nim

an

i)

(Ja

n –

Ma

r

20

12

)

1,6

90

/2,2

14

=

76

%

(22

SB

M-R

sup

po

rte

d

site

s)(A

pr

–

Jun

e 2

01

2)

4,8

55

/4,5

54

=

10

7%

3,4

09

/3,5

46

=9

6%

in

Mu

tare

an

d

1,4

46

/1,0

08

=

14

3%

in

Ch

ima

nim

an

i

(Ap

r-Ju

ne

20

12

)

1,8

89

/2,2

14

=8

5

%

(n=

22

SB

M-R

sup

po

rte

d s

ite

s)

(Ju

l –

Se

p 2

01

2)

4,3

62

/4,5

54

=

96

%

3,2

57

/3,5

46

=9

2

%

In M

uta

re

11

05

/10

08

=1

10

%

Ch

ima

nim

an

i

(Ju

l –

Se

p 2

01

2)

7,7

63

/8,8

56

=

88

%

(22

SB

M-R

sup

po

rte

d

site

s)

(Oct

20

11

–S

ep

20

12

)

17

,95

5/1

8,2

16

=

99

%;

13

,14

1/1

4,1

84

=

93

%

(Mu

tare

) a

nd

4,8

14

/4,0

32

=1

1

9%

(Ch

ima

nim

an

i)

(Oct

20

11

–S

ep

20

12

)

95

% b

ase

d o

n

cen

sus

pro

ject

ed

da

ta a

nd

75

%

ba

sed

on

RE

D

he

ad

co

un

t

da

ta

(n=

10

0%

of

Ma

nic

ala

nd

HF

s; 2

lea

rnin

g

dis

tric

ts +

5

ad

dit

ion

al

dis

tric

ts i

n

Ma

nic

ala

nd

)

In t

he

pre

vio

us

qu

art

erl

y re

po

rt,

Q2

co

ve

rag

e

sta

tist

ics

we

re

calc

ula

ted

usi

ng

ZIM

ST

AT

20

11

pro

ject

ed

fig

ure

s

in t

he

de

no

min

ato

rs.

In

this

qu

art

er,

ZIM

ST

AT

20

12

pro

ject

ed

fig

ure

s

we

re o

bta

ine

d,

an

d s

o t

he

cove

rag

e s

tati

stic

s

for

Q2

we

re

reca

lcu

late

d u

sin

g

the

20

12

de

no

min

ato

r

fig

ure

s.

Q3

an

d

MC

HIP

/Z

imb

ab

we

Qu

art

erl

y R

ep

ort

(Ju

l-S

ep

t 2

01

2)

Pa

ge

40

54

,59

1/5

6,5

54

=

97

%

(n=

7 d

istr

icts

;

rep

ort

ing

pe

rio

d

for

all

7 d

istr

icts

is O

ct1

0-A

ug

11

;

de

no

min

ato

r =

ZIM

ST

AT

20

11

pro

ject

ion

)

13

,52

5/1

4,1

39

=

96

%

(7 d

istr

icts

in

Ma

nic

ala

nd

)

(Oct

–D

ec

20

11

)

15

,05

6/1

5,7

32

=9

6%

(7 d

istr

icts

in

Ma

nic

ala

nd

)

(Ja

n –

Ma

r

20

12

)

13

,08

4/1

5,7

32

= 8

3%

(7 d

istr

icts

in

Ma

nic

ala

nd

,

Ap

r –

Jun

e

20

12

)

14

,34

5/1

5,1

03

95

%

(7 d

istr

icts

in

Ma

nic

ala

nd

Ju

ly-

Au

gu

st 2

01

2 a

nd

6 d

istr

icts

fo

r S

ep

20

12

)

(Ju

l –

Se

p 2

01

2)

56

,01

0/6

0,7

06

=9

2%

(7 d

istr

icts

in

Ma

nic

ala

nd

)

(Oct

20

11

-Se

p

20

12

)

Q4

co

ve

rag

e

sta

tist

ics

we

re

als

o c

alc

ula

ted

usi

ng

th

e n

ew

20

12

ZIM

ST

AT

pro

ject

ion

s.

He

ad

cou

nt

da

ta f

or

the

pro

vin

ce is

stil

l

no

t a

va

ila

ble

.

Q3

fig

ure

s h

av

e

sin

ce b

ee

n

up

da

ted

.

4.3

. #

of

dis

tric

ts

rece

ivin

g

MC

HIP

sup

po

rt f

or

stre

ng

the

nin

g

imm

un

iza

tio

n

serv

ice

s

# o

f d

istr

icts

rece

ivin

g

MC

HIP

sup

po

rte

d

imm

un

iza

tio

n

act

ivit

ies

0

7

(10

0%

of

Ma

nic

ala

nd

dis

tric

ts)

7

(10

0%

of

Ma

nic

ala

nd

dis

tric

ts)

7

(10

0%

of

Ma

nic

ala

nd

dis

tric

ts)

7

(10

0%

of

Ma

nic

ala

nd

dis

tric

ts)

7

(10

0%

of

Ma

nic

ala

nd

dis

tric

ts)

7

(10

0%

of

Ma

nic

ala

nd

dis

tric

ts)

7

(10

0%

of

Ma

nic

ala

nd

dis

tric

ts)

MC

HIP

pro

vid

ed

sup

po

rt f

or

tra

inin

g o

f h

ea

lth

wo

rke

rs a

s w

ell

as

sup

po

rt f

or

rou

tin

e

imm

un

iza

tio

ns

act

ivit

ies

No

tes:

1.

MC

HIP

“le

arn

ing

sit

e”

dis

tric

ts a

re C

him

an

ima

ni

an

d M

uta

re.

2.

“MC

HIP

-su

pp

ort

ed

” m

ea

ns

an

y H

F h

avin

g r

ece

ive

d a

ny

typ

e o

f tr

ain

ing

, m

ate

ria

l, o

r o

the

r su

pp

ort

or

tech

nic

al

ass

ista

nce

fro

m M

CH

IP.

3.

“SB

M-R

su

pp

ort

ed

” m

ea

ns

an

y H

F h

avin

g r

ece

ive

d s

pe

cifi

c M

CH

IP s

up

po

rt f

or

SB

M-R

qu

ali

ty i

mp

rove

me

nt

imp

lem

en

tati

on

.

4.

Fo

rme

r in

dic

ato

r #

G3

(“U

nd

er

5 d

ea

th r

ate

in

MC

HIP

-su

pp

ort

ed

fa

ciliti

es”

) w

as

de

lete

d d

ue

to

la

ck o

f a

va

ila

bilit

y o

f th

is d

ata

in

th

e c

urr

en

t H

MIS

. M

CH

IP w

ill

ad

vo

cate

fo

r in

clu

sio

n o

f U

5

mo

rta

lity

da

ta i

n H

MIS

fo

rms

in Y

ea

r 2

.

MCHIP Zimbabwe FY12 Q4 Report - 30Oct12 finalpdf.usaid.gov/pdf_docs/PA00JSW4.pdf · MCHIP/Zimbabwe...

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Transcript of MCHIP Zimbabwe FY12 Q4 Report - 30Oct12 finalpdf.usaid.gov/pdf_docs/PA00JSW4.pdf · MCHIP/Zimbabwe...