ATTACHMENT 4- USAID CIHO_Final Report_JHUCCP.pdf

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Attached to: USAID Improved Maternal, Newborn, Child Health, Immunization and Nutrition Activity
Opportunity number: 72065623APS00001
Issued by: US Agency for International Development Mozambique

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Written by GovTribe AI · Dec 20, 2023

This government file provides details on a federal grant opportunity from the US Agency for International Development Mozambique. The grant opportunity is for USAID's Improved Maternal, Newborn, Child Health, Immunization and Nutrition Activity with a solicitation number of 72065623APS00001. The attached PDF file is a final report on the USAID CIHO project conducted by Johns Hopkins University Center for Communication Programs. The federal grant program under which this opportunity is assigned is USAID Foreign Assistance for Programs Overseas with identification number 98.001. The file contains information on the grant opportunity, including the involved federal agency, applicable federal grant program, and an attached final report on a related previous project.

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ATTACHMENT 4- USAID CIHO_Final Report_JHUCCP

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AMENDMENT 02.pdf	PDF	Oct 10, 2023
ATTACHMENT 3 - Moz MCH, and Nutrition Gender Assessment.pdf	PDF	Sep 20, 2023
ATTACHMENT 2_REVISED APS MCH, RI, N.pdf	PDF	Sep 20, 2023
ATTACHMENT 1 - QUESTIONS AND ANSWERS.pdf	PDF	Sep 20, 2023
Amendment 01 - APS 72065623APS00001 - Improved MNCH, RI, N.pdf	PDF	Sep 20, 2023
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FINAL REPORT (2017-2021),

JHU.CCP, MOZAMBIQUE

COMMUNICATION FOR

IMPROVED HEALTH OUTCOMES,

CIHO/RUMOS

USAID

FROM THE AMERICAN PEOPLE

APS 72065623APS00001ATTACHMENT 4- USAID

CIHO Final Report_JHUCCP

CONTENTS

ACKNOWLEDGEMENTS

We would like to thank the USAID team for allowing us to implement this project. We have received immense technical support from our respective agreement officer representatives and activity managers. We would specifically like to recognize the support of Julio Machava, Shaditt

Murargy, Eunice Chichava, and the Health Office

Chief, Monique Mosolf.

We also thank our main partners Fundação para o

Desenvolvimento da Comunidade, Tchova Tchova

Programas de Comunicação, and the Polytechnic

University that have been an integral part of this project. We also thank all partners and community-based organizations that have contributed to this project.

A special mention also needs to be made to acknowledge the support received from different government entities and from parliament. Without the support of the Ministry of Health and National

AIDS Council, this project would not have had the same results.

Lastly, we want to thank the whole Johns Hopkins

Center for Communication Programs team in

Baltimore and in the Maputo and provincial offices.

This report is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of USAID/JHU Cooperative Agreement No. 656-A-17-00005.

The contents do not necessarily reflect the views of USAID or the United

States Government.

Acronyms and Abbreviations

EXECUTIVE SUMMARY

1. CIHO Overall objectives and approach

2. Overview of CIHO interventions

2.1. HIV Prevention, Testing, ART Male Retention and VMMC

2.2. Maternal, neonatal and child health (MNCH) and Family Plan-ning (FP)

2.3. Nutrition: The First 1,000 Days a Window of Opportunity

2.4. Malaria: National Malaria Communication Strategy and Stan-dardization of messages and tools to combat malaria

3. Strengthening Capacity for Social and Behavior Change Com-munication

3.1. Strengthening SBC skills of the Government of Mozambique

3.2. Strengthening SBC skills of Health Providers and of the Media

4. COVID-19 SBC Activities

5. Close-out of CIHO

6. Lessons Learned and Way Forward

CONTENTS

ACKNOWLEDGEMENTS

Murargy, Eunice Chichava, and the Health Office

Chief, Monique Mosolf.

We also thank our main partners Fundação para o

Desenvolvimento da Comunidade, Tchova Tchova

Programas de Comunicação, and the Polytechnic

University that have been an integral part of this project. We also thank all partners and community-based organizations that have contributed to this project.

A special mention also needs to be made to acknowledge the support received from different government entities and from parliament. Without the support of the Ministry of Health and National

AIDS Council, this project would not have had the same results.

Lastly, we want to thank the whole Johns Hopkins

Center for Communication Programs team in

Baltimore and in the Maputo and provincial offices.

The contents do not necessarily reflect the views of USAID or the United

States Government.

Acronyms and Abbreviations

EXECUTIVE SUMMARY

1. CIHO Overall objectives and approach

2. Overview of CIHO interventions

2.1. HIV Prevention, Testing, ART Male Retention and VMMC

2.2. Maternal, neonatal and child health (MNCH) and Family Plan-ning (FP)

2.3. Nutrition: The First 1,000 Days a Window of Opportunity

2.4. Malaria: National Malaria Communication Strategy and Stan-dardization of messages and tools to combat malaria

3. Strengthening Capacity for Social and Behavior Change Com-munication

3.1. Strengthening SBC skills of the Government of Mozambique

3.2. Strengthening SBC skills of Health Providers and of the Media

4. COVID-19 SBC Activities

5. Close-out of CIHO

6. Lessons Learned and Way Forward

EXECUTIVE SUMMARY

04 05

ART Antiretroviral Therapy APSS/PP Psychosocial Support/Positive Prevention CCP Centers for Communication Programs CCS Consultation of Healthy Children CDC Centers for Disease Control and Prevention CECS Center of Excellence in Health Communication CIHO Communication for Improved Health Outcomes CNCS National Aids Council DEPROS Department of Health Promotion DNSP National Directorate of Public Health DPEDH Provincial Directorate of Education and Human Development DPS Provincial Directorate of Health ECHO Efficiencies for Clinical HIV Outcomes ENPSII National Health Promotion Strategy FCC Child and Community Strengthening FDC Fundação para o Desenvolvimento da Comunidade FP Family Planning FY Fiscal Year GBV Gender Based Violence HC3 Health Communication, Capacity, Collaborative HCD Human-Centered Design HIV Human Immunodeficiency Virus HTC HIV Testing and Counseling ICSM Health Science Institute I-Kit Implementation Kits INAS National Institute for Social Welfare INS National Institute of Health INTIC National Institute of Technologies IPCC Interpersonal Communication and Counselling IRS Indoor Residual Spraying ISCISA Health Sciences Higher Institute JHU Johns Hopkins University K4health Knowledge for Health LTFU Loss to Follow-Up MCSP Maternal and Child Survival Program M&E Monitoring and Evaluation MGCAS Ministry of Gender, Child, and Social Action MINEDH Ministry of Education and Human Development MISAU Ministry of Health MNCH Maternal, neonatal and child health NMCP National Malaria Control Program OVC Orphaned and Vulnerable Children PLWHA People Living With HIV/AIDS SAAJ Youth and Adolescent friendly services SBC Social and Behavior Change SDSMAS District Health, Women, and Social Action Services SOP Standard Operating Procedure SRH Sexual and Reproductive Health STI Sexual Transmitted Infections TTPC Tchova Tchova Communication Programs TWG Technical Working Group USAID United States Agency for International Development VMMC Voluntary Medical Male Circumcision WASH Water, Sanitation, and Hygiene

The Communication for Improved Health Outcomes (CIHO) project was designed to strengthen Mozambique's capacity to implement state-of-the-art social and behavior change (SBC) programs. It was implemented over four years, between

March 2017 and March 2021, and led by the Johns Hopkins Center for Communi-cation Programs (CCP).

CIHO followed a series of systematic and mutually-reinforcing steps at the health facility, community, family, and individual levels working with the Funda-ção para o Desenvolvimento da Comunidade, Tchova Tchova Programas de

Comunicação, and Polytechnic University to implement activities. CIHO worked closely with the Ministry of Health (MISAU), including the Department of Health

Promotion and specific technical working groups (TWG), the National AIDS Coun-cil, and the Center of Excellence in Health Communication (CECS) at Polytechnic

University and contributed to their strengthened capacity to design, implement, and evaluate SBC programs. CIHO also collaborated with other government insti-tutions such as the Ministry of Education and Human Development, Ministry of

Gender, Child, and Social Action, National Institute for Social Welfare, and several other implementing partners.

CIHO implemented activities in Maputo, Zambezia, Tete, Manica, and Sofala cove-ring four main health areas: 1) HIV, 2) maternal, neonatal and child health

(MNCH) and family planning (FP) initiatives, 3) nutrition, and 4) malaria. Several interventions were implemented under each of these areas.

HIV prevention, testing, ART retention, and voluntary medical male circumcision

(VMMC)

CIHO improved the systematic approaches of community pediatric screening for orphans and vulnerable children (OVCs) to measure the risk and vulnerability of

OVCs to HIV and expanded the reach of community HTC for OVCs. A total of

63,199 OVCs were tested, reflecting a 107% reach of the annual target (58,800) and the positivity rate was approximately 1% (571 OVCs). CIHO linked positive cases to ART services. After CIHO ended implementation in Zambezia, training was provided for the scale-up of community pediatric screening by World Visi-on's COVida program and World Education's Força à Comunidade e às Crianças program in five provinces (Gaza, Manica, Sofala, Zambezia, and Maputo).

Community dialogues, "Tchova Tchova Rumos", were implemented in Zambezia to engage families and men in health seeking behaviors. Local leaders were key in supporting mobilization of participants, especially in places where men usu-ally gathered (mosques, churches, soccer teams, and student homes). A total of

13,234 people were reached, of whom, 78% were men. Furthermore, as a result of CIHO referrals, 2,531 people accessed health services (77% accessed HIV tes-ting and counseling), of whom, 63% were men.

ACRONYMS AND ABBREVIATIONS

EXECUTIVE SUMMARY

04 05

March 2017 and March 2021, and led by the Johns Hopkins Center for Communi-cation Programs (CCP).

Comunicação, and Polytechnic University to implement activities. CIHO worked closely with the Ministry of Health (MISAU), including the Department of Health

Promotion and specific technical working groups (TWG), the National AIDS Coun-cil, and the Center of Excellence in Health Communication (CECS) at Polytechnic

Gender, Child, and Social Action, National Institute for Social Welfare, and several other implementing partners.

CIHO implemented activities in Maputo, Zambezia, Tete, Manica, and Sofala cove-ring four main health areas: 1) HIV, 2) maternal, neonatal and child health

(MNCH) and family planning (FP) initiatives, 3) nutrition, and 4) malaria. Several interventions were implemented under each of these areas.

HIV prevention, testing, ART retention, and voluntary medical male circumcision

(VMMC)

CIHO improved the systematic approaches of community pediatric screening for orphans and vulnerable children (OVCs) to measure the risk and vulnerability of

OVCs to HIV and expanded the reach of community HTC for OVCs. A total of

13,234 people were reached, of whom, 78% were men. Furthermore, as a result of CIHO referrals, 2,531 people accessed health services (77% accessed HIV tes-ting and counseling), of whom, 63% were men.

ACRONYMS AND ABBREVIATIONS

Nutrition interventions for the first 1,000 days of life

A multimedia intervention was developed in collaboration with the Nutrition

Department from the National Directorate of Public Health. A toolkit comprised of printed materials, radio programs, and radio debates was produced. CIHO implemented activities in Zambezia under the theme "nutrition is health, love your child", in collaboration with the community-based organization, AMUONA, and World Education's FCC program. Activities included community dialogues reaching 2,679 women and health fairs reaching 9,586 people.

In addition, a rapid exploratory assessment on nutrition and water, sanitation, hygiene was conducted in Nampula. This activity was co-designed with USAID to inform SBC activities by its country-level implementing partners. CIHO presen-ted the results to the Transform Nutrition and Advance Nutrition projects and recommended that interventions need to consider structural/economic-social aspects and behavior factors to overcome environmental conditions that influ-ence the nutritional status of children.

Standardization of malaria messages and tools with the National Malaria Control

Program (NMCP)

CIHO worked at the central level on three main areas: (1) technical support to the

NMCP and the communications TWGs for the development of the National Mala-ria Communication Strategy; (2) development of materials to support NMCP's campaigns, focusing on the "Zero Malaria" Campaign and Malaria Day celebrati-ons; and (3) technical support for the development and dissemination of the

Indoor Residual Spray Communication.

CIHO contributed to strengthening the capacity of the Government of Mozambi-que, health providers and media in SBC.

CIHO supported the health sector to create consistent, coordinated, effective, and evidence-based SBC to improve the health and well-being of the people of

Mozambique. CIHO helped to reactivate the Communication TWG created by the

Department of Health Promotion and developed a training module called Relati-onship with the Press in Promoting Health, focusing on interpersonal communi-cation and counseling skills and media relationships. Also, CIHO supported the

Polytechnic to conduct the 4th edition of the course on Leadership in Strategic

Health Communication (LSHC), which was introduced through a previous CCP project (PACTO, funded by USAID). It was attended by 14 participants from public and private institutions. The project worked closely with MISAU and part-ners to create a website to document and share communication materials and training tools related to research, training, and strategic health communication.

CIHO also collaborated with three academic institutions, ICSM, ISCISA, and Poly-technic, to increase the knowledge and practical skills of future health professio-nals in interpersonal communication and counseling and health promotion. Furt-hermore, building on the capacity strengthening work conducted by PACTO pro-ject, CIHO invested in strengthening the capacity of CECS (of Polytechnic Univer-sity), to provide community radio stations trainings and support materials.

These radios contributed in turn to disseminate messages on health seeking behaviors to wider audiences.

Informed by formative research, Tchova Tchova Rumos was refined in Sofala to increase male engagement. A social and behavior change communication (SBCC) package was developed to deliver meaningful male-sensitive messages to elicit emotions, inspire change, and trigger action. Between January 2019 and Septem-ber 2020, a total of 4,233 men were reached by a network of skilled community lay counselors and health facility focal points. By November 2019, CIHO incorpora-ted the standard operating procedures from the newly approved National Com-munity Psychosocial Support and Positive Prevention package into the male enga-gement activities. As a result, a functional community referral system was esta-blished and early retention rates among CIHO male beneficiaries was close to

100%.

Another important intervention with males was VMMC. CIHO supported MISAU to create a VMMC demand generation TWG, strengthening coordination between demand generation activities and service delivery. CIHO implemented community strategies which successfully raised awareness, generated demand, and tracked

VMMC services. The project implemented community activities in Tete, Manica, Sofala, and Zambezia Provinces supporting a reach of approximately 80% of

USAID target goals.

School and community MNCH and FP and the National Family Planning Communicati-on Strategy.

A community intervention, Tchova Tchova Couples, stimulated shared MNCH deci-sion making, through community dialogues for couples 18 years or older with a focus on pregnant women. A total of 1,825 people were reached, including 887 couples. Five hundred and thirty-three people accessed health facility services as a result of CIHO referrals (including 67% related to MNCH services).

The intervention, Avante Adolescentes, was implemented in schools to address key sexual and reproductive health issues for adolescents, namely FP, premature marriages, HIV, and sexual violence. Classroom sessions were given by class direc-tors and were complemented by a competition "Isto é Show de Talentos" with pri-zes for different types of talents. CIHO also strengthen the monitoring system to track referrals and access to services at the Serviço Amigos dos Adolescentes e

Jovens (SAAJs) and Cantos Escolares (youth health clubs) and developed a mobile application where adolescents could get more information about sexual and reproductive health, play virtual games, and find the location of nearby SAAJs.

At the central level, CIHO worked closely with the National FP Department of

MISAU to develop the National Communication Strategy for Family Planning. The main objective of this strategy is to guide the social and interpersonal communi-cation processes and activities to promote and offer FP to Mozambicans through the national health system, FP partner program, and community health actors.

Media materials were also developed, including two video spots and CIHO broad-casted existing radio spots and a TV spot on FP during the COVID-19 pandemic at the request of the FP Department.

Nutrition interventions for the first 1,000 days of life

A multimedia intervention was developed in collaboration with the Nutrition

Standardization of malaria messages and tools with the National Malaria Control

Program (NMCP)

CIHO worked at the central level on three main areas: (1) technical support to the

Indoor Residual Spray Communication.

CIHO contributed to strengthening the capacity of the Government of Mozambi-que, health providers and media in SBC.

CIHO supported the health sector to create consistent, coordinated, effective, and evidence-based SBC to improve the health and well-being of the people of

Mozambique. CIHO helped to reactivate the Communication TWG created by the

Polytechnic to conduct the 4th edition of the course on Leadership in Strategic

These radios contributed in turn to disseminate messages on health seeking behaviors to wider audiences.

100%.

VMMC services. The project implemented community activities in Tete, Manica, Sofala, and Zambezia Provinces supporting a reach of approximately 80% of

USAID target goals.

School and community MNCH and FP and the National Family Planning Communicati-on Strategy.

At the central level, CIHO worked closely with the National FP Department of

Media materials were also developed, including two video spots and CIHO broad-casted existing radio spots and a TV spot on FP during the COVID-19 pandemic at the request of the FP Department.

CIHO OVERALL OBJECTIVES

AND APPROACH

Building on the success of initiatives led by the Johns Hopkins Center for Commu-nication Programs (CCP) in Mozambique over the past two decades, the Commu-nication for Improved Health Outcomes (CIHO) project continued to use the power of communication to inspire healthy behaviors.

CIHO was designed to strengthen Mozambique's capacity to implement state-of-the-art social and behavior change (SBC) programs, including, but not limited to social and behavior change communication (SBCC) activities. In the first 18 months of the project (up to end of FY 2018), CIHO focused on the following areas:

n HIV testing and counseling (HTC) for orphaned and vulnerable, children (OVCs);

n Priority population prevention for HIV vulnerable groups, including OVCs, youth, adult men, and mothers;

n Voluntary medical male circumcision (VMMC) for HIV prevention;

n Maternal, neonatal and child health (MNCH) and family planning (FP) initiati-ves;

n Nutrition initiative;

n Malaria SBC standardization.

CIHO continued to work in the areas of malaria, VMMC, FP, and nutrition during FY 2019, and also started a new male retention in HIV treatment services. These areas lasted until the end period of CIHO implementation.

During the start-up period, the CIHO team met with the health teams at USAID for guidance on the gaps and priorities in each of CIHO health topic areas. CIHO also conducted a literature review for scoping evidence for communication and program planning related to those health areas.

CIHO adopted the Human-Centered Design (HCD) and a strategic framework to develop solutions to problems by involving the human perspective in all steps of the problem-solving process (see figure 1).

Additional funds were provided to CIHO to work on specific COVID-19 activities:

setting-up two call centers and supporting MISAU's PENSA hotline. These activiti-es complemented CCP's Breakthrough ACTION project, also funded by USAID. CIHO and Breakthrough ACTION's joint efforts delivered comprehensive SBC activities related to the COVID-19 response pillar of risk communication and community engagement.

The principal lessons learned from CIHO show that:

n A combination of engaging the government and community structures and the media were fundamental to creating an enabling environment and setting sup-porting norms to generate demand for health services.

n Use of evidence and data are critical both at programmatic and at management level. Evidence used to prepare the male retention intervention highlighted that an innovative approach was needed. Data from VMMC shared by a collabo-rative leadership team enabled a broad understanding among staff about the purpose of the data and how to use it for decision-making.

n CIHO's work contributed to improve provider's behavior through the strengthe-ning of providers' health communication skills, namely in addressing underl-ying assumptions based on cultural norms and personal beliefs that could lead to biases in care.

n Adapting towards an integrated health approach remains a challenge due to the long-standing vertical approach in the public health ecosystem.

n Consistent collaboration is key, especially for interventions combining efforts to ensure the supply of services meets the demand, and the demand meets tar-gets.

CIHO, implemented by its project partners, has strengthened CCP's role as an inter-national organization with SBC expertise in various health areas. Also, CIHO has worked closely with its local organization, Tchova Tchova Programas de Comuni-cação, and with MISAU contributing to USAID Journey to Self-Reliance.

CIHO OVERALL OBJECTIVES

AND APPROACH

n HIV testing and counseling (HTC) for orphaned and vulnerable, children (OVCs);

n Priority population prevention for HIV vulnerable groups, including OVCs, youth, adult men, and mothers;

n Voluntary medical male circumcision (VMMC) for HIV prevention;

n Maternal, neonatal and child health (MNCH) and family planning (FP) initiati-ves;

n Nutrition initiative;

n Malaria SBC standardization.

CIHO adopted the Human-Centered Design (HCD) and a strategic framework to develop solutions to problems by involving the human perspective in all steps of the problem-solving process (see figure 1).

Additional funds were provided to CIHO to work on specific COVID-19 activities:

The principal lessons learned from CIHO show that:

n Adapting towards an integrated health approach remains a challenge due to the long-standing vertical approach in the public health ecosystem.

n Consistent collaboration is key, especially for interventions combining efforts to ensure the supply of services meets the demand, and the demand meets tar-gets.

CIHO staff in the HCD workshop

FIGURE 1:The Human Centered Design Model

FIGURE 2: The Circle of Care Model (HC3, CCP, 2017)

CIHO utilized the HCD approach to improve human well-being, health service user satisfaction, accessibility and sustainability, building upon participatory action research to move beyond participant's mere involvement and move to a more col-laborative process. This approach was key to identifying need, improve upon exis-ting materials, and develop new ones.

CIHO developed strategic, evidence-based health communication programs, sup-ported by theory, capacity strengthening, and local participation. For example, the male retention program was inspired by the P-process and took into account the social-ecological model's multiple levels of influences. CIHO followed a series of systematic and mutually-reinforcing steps at the health facility, community, family, and individual levels.

CIHO also demonstrated how to put into practice the Circle of Care Model develo-ped by the Health Communication, Capacity, Collaborative (HC3) project (see figu-re 2). This model recognizes the value of SBC interventions, particularly strategic communication, used along the service delivery continuum - before, during, and after services. It also highlights SBC's value in understanding the needs, perspecti-ves, and desires of both clients and providers. The model focuses on service inte-ractions: the use of SBC to motivate clients to access services (before services), to improve the client-provider interaction (during services), and to boost adhe-rence and maintenance (after services).

This model includes considerations of social and cultural norms that impact ser-vice use (or non-use) and delivery, the physical environment in which services are delivered, and the communication that takes place between a client and pro-vider. CIHO's interventions addressed four major technical areas: 1) HIV, 2) MNCH and FP, 3) nutrition, and 4) malaria. CIHO interventions focused on generating demand for services, creating an enabling environment with supportive norms and supporting service delivery. CIHO focal point at the health facility which gre-atly helped to build trust and help people navigating the health system and accessing the care they needed. CIHO also continued to use SBC after people accessed services to ensure they scheduled follow-up appointments and conti-nued to engage participants at the community level, supporting behavior main-tenance for sustained positive health outcomes.

51110

DEFINE IDEATE PROTOTYPE TESTOBSERVEEMPATHISE

Generates Demand

Creates Enabling

Environment

Reiforces Linkages

Supports Behavioral

Maintenace

Enhances Follow-up Buids

Trust

Improves Provider Behavior

Empowers Clients

Sets Supportive

Norms

DURING

Services:

SBC improves the client-provider interaction

AFTER

Services:

SBC boots adherence and maintnance

Improved Health

Outcomes

BEFORE

Services:

SBC motivates clients to acess services

CIHO staff in the HCD workshop

FIGURE 1:The Human Centered Design Model

FIGURE 2: The Circle of Care Model (HC3, CCP, 2017)

51110

DEFINE IDEATE PROTOTYPE TESTOBSERVEEMPATHISE

Generates Demand

Creates Enabling

Environment

Reiforces Linkages

Supports Behavioral

Maintenace

Enhances Follow-up Buids

Trust

Improves Provider Behavior

Empowers Clients

Sets Supportive

Norms

DURING

Services:

SBC improves the client-provider interaction

AFTER

Services:

SBC boots adherence and maintnance

Improved Health

Outcomes

BEFORE

Services:

SBC motivates clients to acess services

OVERVIEW OF CIHO INTERVENTIONS

CIHO reinforced linkages between communities and health services, targeting the general population as well as specific population groups in certain interventions, such as teachers, health providers, community influencers, and decision makers.

For the decision makers, besides the work conducted at the community level, CIHO greatly contributed to strengthen the capacity for SBC of the Ministry of Health

(MISAU), including the Department of Health Promotion (DEPROS) and specific technical working groups (TWG), as well as the National AIDS Council (CNCS) and of the Center of Excellence in Health Communication (CECS) of the Polytechnic Uni-versity. CIHO collaborated with other government institutions such as the

Ministry of Education and Human Development (MINEDH), Ministry of Gender, Child, and Social Action (MGCAS), National Institute for Social Welfare (INAS), and several other implementing partners. CIHO made a great effort to learn from expe-rienced organizations in the various health areas that the new CIHO interventions would address.

Supervision and coaching was provided to field staff by CIHO, involving the Dis-trict Health, Women, and Social Action Services (SDSMAS) as much as possible in joint visits to the communities where CIHO's interventions were implemented.

For each of the health areas, CIHO implemented the following interventions:

1. HIV Prevention, Testing, ART Male Retention and VMMC n Community Pediatric Screening for OVCs - Scaling-up HTC and improving refer-rals.

n Tchova Tchova Rumos - Families and men-centered programming to promote health seeking behaviors.

n Male Retention - Increasing Antiretroviral Therapy (ART) adherence.

n VMMC - Increasing demand and uptake of VMMC services among 15-29-year-old males.

2. MNCH and FP n Tchova Tchova Couples - Shared maternal and child health decision making.

n Avante Adolescents - Addressing Sexual and Reproductive Health (SRH) within the classroom.

3. Nutrition - The First 1,000 Days, a Window of Opportunity.

4. Malaria - National Malaria Communication Strategy and standardization of messages and tools to combat malaria.

Achievements, deliverables, and a program description are presented for each intervention in the next sections of this chapter. Most of the community work was conducted in the province of Zambezia, which was designated as a small scale "laboratory" to implement interventions and approaches that addressed entrenched behaviors and barriers that keep people from seeking health servi-ces.

Other community work was conducted in Sofala, Tete, and Manica under VMMC, and male retention in HIV services was implemented in Sofala.

CIHO established a monitoring system that allowed CIHO health facility focal points to identify individuals referred to the health facility by CIHO demand gene-ration activities. The experience from Zambezia was then applied in Sofala where the intervention aimed to ensure that men in anti-retroviral therapy

(ART) remained in treatment and attended their appointments on time - the role of the focal point was essential.

As illustrated on the map on page 14 (figure 3), a total of 11 districts were rea-ched in Zambezia (covering 69% of the total number of districts of the province), with different levels of intensity, with the province capital Quelimane, and the districts of Maganja da Costa and Namacurra being those with the biggest num-ber of interventions (five in total). It should be noted that Namacurra was cho-sen as the only district where the nutrition intervention was implemented beca-use it presented a favorable environment including community-based organiza-tion (CBO) capacity, agriculture intensive activities, health services engage-ment, and community health workers availability.