Attachment_V_-_SDSH_Annual_Report_2009.pdf

This publication was produced by Management Sciences for Health for review by the United States Agency for International Development. The views expressed herein do not necessarily reflect the views of USAID or those of the United States Government.

Projet Santé pour le Développement et la Stabilité d’Haïti — SDSH Annual Progress Report October 1, 2008 – September 30, 2009

Attachment V - SDSH Annual Report 2009

PY2 Annual Report SDSH / October 2008 – September 2009 Page 2

PY2 Annual Report SDSH / October 2008 – September 2009 Page 3

PY2 Annual Report SDSH / October 2008 – September 2009 Page 4

SDSH Map with Hotspots and Watersheds, Project Year 2 –––– October 2008 – 30 September 2009

PY2 Annual Report SDSH / October 2008 – September 2009 Page 5

Table of Contents

About The Project‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 1 Services Provided in SDSH‐Supported Sites‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 2 SDSH Project Partners: Operational Partners‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 3 Matching Funds Partners‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 4 Partnership with the MSPP: Improved Management Systems‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 5 The Critical Partnership: Community and Facility‐Based Services‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 7 Community Mobilization‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 8 Maternal Health‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 9 Family Planning‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐11 HIV/AIDS and Tuberculosis‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐13 Voluntary Counseling and Testing‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐14 PMTCT‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐15 Palliative Care‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐16 ARV Treatment‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐17 Tuberculosis‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐18 Child Health‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐19 HIGHER Project Nutrition Activities‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐20 Medical Waste Management‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐21 SDSH Project Priorities for Year 3‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐22

PY2 Annual Report SDSH / October 2008 – September 2009 Page 1

In August 2007, the US Agency for International Development (USAID) awarded Management Sciences for Health (MSH) a contract for the implementation of a new 3‐year task order, in line with the 2006–2009 USAID country program for Haiti. The Santé pour le Développement et la Stabilité d’Haïti (SDSH) Project contributes to the Priority Objectives of USAID, specifically to that of increased access to quality basic social services.

The technical assistance delivered under recently extended, now 5‐ year, $81.4 million SDSH Project targets approximately 50 percent of the Haitian population to increase their access to and use of a package of integrated basic health services that includes maternal and child health care, including nutrition, family planning services, and prevention and control of infectious diseases, including HIV & Acquired Immunodeficiency Syndrome (AIDS) and tuberculosis.

Demographic targets for SDSH are (a) children and youth under 25 years of age, (b) women, and (c) special concerns groups, such as persons living with HIV and AIDS (PLWHAs) and Tuberculosis (TB) patients. Geographic targets include all 10 departments (but SDSH is not a national program).

Both public and private, nonprofit sector health care delivery will be strengthened as well as the Haitian health ministry’s ability to carry out its executive functions at the central and departmental levels.

The SDSH team focuses efforts in three areas:

Service Delivery—to increase access to and use of the Government of Haiti’s basic healthcare package.

Support to the Government of Haiti—by strengthening the leadership of the Ministry of Public Health and Population ‐ Ministère de la Santé Publique et de la Population (MSPP) for health care services delivery and strategic management of resources for the health sector.

Partnerships with other local and international organizations—to increase program impact by leveraging funding from the private sector and other donors.

MSH implements project activities through Performance Based Financing sub‐contracts with 26 local NGOs (non‐governmental organizations), operating 74 health facilities and 1843 community “rally posts”; and, through the MSPP in 29 targeted geographical areas known as “Zones Ciblées”, including 73 health facilities and 2098 “rally posts”. The project currently covers 43% of the Haitian population or approximately 4,000,000 people.

Overarching strategies for SDSH project implementation include:

Strategic partnerships engaging stakeholders at all levels;

Continuous focus on measurable results and sustainable impact;

Linkages, synergies and operational collaboration among groups, sectors, and organizations;

Mentoring and accompaniment by SDSH of local partners and between partners;

Focus on systems strengthening and governance: through performance based financing and direct technical assistance Integration of services to provide a continuum of care to all clients.

About the Project: 3 years become 5.

SDSH is implemented through an MSH‐led partnership of Johns Hopkins Bloomberg School of Public Health/Center for Communications Programs (CCP), AIDS Healthcare Foundation (AHF), JHPIEGO, and Fondation pour la Santé Reproductrice et l’Education Familiale ( Foundation for Reproductive Health and Family Education—FOSREF)

Department

# of Sites:

NGO or Public Sector

(ZS)

Population Maternal Health

Child Health

Family Planning

VCT Palliative care

ARV PMTCT TB

Treat and test

TB

Treat only

Acute malnutrition care (HIGHER)

Artibonite 6 NGO 322,762 6 6 6 4 2 2 3

11 ZS 310,000 11 11 11 3 2

Centre 4 NGO 45,245 4 4 4 1 1 1

8 ZS 148,390 8 8 8 5 2

Grand’Anse 5 NGO 239,899 5 5 3 3 2 1 3 2

2 ZS 42,676 2 2 2 2

Nord 8 NGO 376,481 8 7 8 3 3 1 3 6 1 1

8 ZS 104,195 8 8 8 3 1

Nippes 9 ZS 113,276 9 9 9 5 3 Nord Est 4 NGO 161,820 4 4 4 2 2 2 2 4 1

6 ZS 78,307 6 6 6 3 3

Nord Ouest 1 NGO 22,190 1 1 1 1 1 1 1 1

14 ZS 79,903 14 14 14 4 1 2

Sud 6 NGO 102,789 6 6 6 3 2 2 1

2ZS 38,311 2 2 2 2 2

Sud Est 1 NGO 30,909 1 1

7 ZS 66,134 7 7 7 1 1

Ouest 28NGO 1,407,151 28 25 26 10 5 1 5 11 6

7 ZS 299,450 7 7 7 1 3 1

Total 26 NGO:

74 sites 2,709,246

“Zones Ciblés”:

73 sites

1,280,642

147 sites 3,989,888 149 144 144 29 17 6 19 57 12 16

Services Provided in SDSH ‐Supported Sites

MSPP

“Targeted Zones” or “Zones Ciblés (ZS)

Artibonite: Gonaïves; St Michel; Marmelade; Grande Saline

Centre : Belladère ; Cercle la Source ; Savanette

Grand’Anse : Abricot ; Corail

Nippes : L’Azile; Petit Trou; Anse à Veau

Nord : Acul ; Borgne

Nord’Est: Mombin Crochu; Ste Suzanne ; Vallières

Nord’Ouest : La Tortue ; Baie de Heine ; Anse à Foleur

Ouest : Belle Fontaine ; Cornillon ; Bel Air ; St Martin ; Trou d’Eau/Crochu ; Tayfer

Sud : Les Anglais ; Ile à Vache

Sud’Est : Bainet

29 targeted zones; 73 fixed service delivery sites, 1,281,000 population

NGO Partners

Albert Schweitzer Hospital; Hôpital Claire Heureuse; Pierre Payen Health Center

Save the Children

Haitian Health Foundation; Ste. Hélène; Léon Coicou H.C.;

AEADMA (Association d’Entr’Aide des Dame‐Mariens)

Comité Bienfaisance de Pignon ; Dugué Clinic ; Centers for Development and Health (CDS); Konbit Santé CDS Nord’Est

Beraca Medical Center

St. Paul Clinic; CSNRR ; Food for the Hungry; FONDEFH, FOSREF ;

Fermanthe Hospital ; Grace Children’s Hospital; OBCG, SADA, Lucelia Bontemps Health Center, CDS Ouest

MEBSH

Sacré Cœur de Thiotte Health Center

26 NGOs; 74 fixed service delivery sites; 2,709,000 population

SDSH Project Partners

Operational partners implement key program activities.

USAID challenged Management Sciences for Health to leverage at least an additional $8.5 million in 3 years in non‐US government (USG) funds to complement the initial US Government $42.5 million 3‐year budget for SDSH. The project team had serious doubts about the feasibility of reaching this target. However, realizing that MSH’s recognized ability to achieve results in Haiti had always been built on establishing successful partnerships with local organizations, the entire project staff was mobilized to identify and contact Haitian and international organizations having complementary mandates and working in the same geographical areas as SDSH. Meetings were then organized to explore how complementary activities could be developed to increase the synergistic impact of the activities of both SDSH and the potential partners. The results were dramatic. By the end of September, 2009, the total project budget reached over $51.4 million, including two USAID‐approved modifications. At the end of September, 2009, SDSH had leveraged material, financial and technical support totaling over $10 million from 32 partners ranging from a local bank, to local and international NGOs and multilateral agencies. Major contributions in this past project year have included:

Pure Water for the World : Installation of bio‐sand filters in over 550 schools, 90 health centers and 400 homes in

6 Departments, serving over 200,000 children;

Direct Relief International and Konbit Santé: Donations of medical and surgical materials, equipment and supplies; training, technical assistance to Justinian University Hospital in Cap Haitian and other partner institutions in the North;

Merci Hospital and Haitian Medical Association: Donation of 15 anesthesia machines to12 MSPP and SDSH partner institutions;

CARIS Foundation: Technical Assistance for early pediatric AIDS diagnosis in newborns;

ACDI/PADESS and PALIH Projects (Canadian International Development Agency): Support to the MSPP for integrated departmental and communal planning; and MSPP executive functions of governance and leadership strengthening and decentralization;

MSPP strengthening in health information and data management systems;

Feed the Children and Deworm the World: Medication and other support for a deworming campaign targeting school children;

Dance Company AYKODANS: Training and mentoring vulnerable youth to better protect their health by understanding and mastering their bodies, discovering and exposing their talents, and becoming stability and development catalysts in their communities;

World Food Program and UNICEF: Support of SDSH nutrition interventions, including dry rations and Ready to Use Therapeutic Food.

Matching Funds Partners contribute over $10 million to SDSH success.

The SDSH Project works closely with other donors and other USAID Projects to promote synergy and complementarity of Project activities.

Principal among these collaborators are UNFPA, UNICEF and the World Food Program, each of which provide materials and supplies as well as technical collaboration in support of SDSH activities. A close working relationship is also maintained with the USAID‐funded LMS and SCMS Projects for logistics management and with PSI, CHAMP, CDC and others for Family Planning , HIV/AID and related activities.

PY2 Annual Report SDSH / October 2008 – September 2009 Page 5

SDSH Project activities follow MSPP Directives, guidelines and standards in all components.

SDSH also provides specific support to the MSPP to strengthen executive functions at both the national and Departmental levels. The project coordinates closely with other donors, including the Canadian‐funded PADESS and PALIH projects, and other USAID projects to strengthen MSPP financial management, logistics systems, strategic planning and other management functions.

Principal Accomplishments:

To strengthen the Ministry’s financial and accounting management systems, SDSH provided the ministry with a copy of Financial Accounting and Fleet Management Guidelines developed by MSH under a previous USAID‐financed project in Haiti. Meetings were held with the Chief of Cabinet and also with the Director of the DAP (Administration and Budget Directorate) to discuss financial management interventions. A coordination meeting has been proposed with The Ministry of Finance, a key actor in the implementation of new government financial and accounting systems. At the request of the MOH General Director, technical assistance was provided to the DPM/MT (Direction of Pharmacy and Medication/Traditional Medicine) for its accounting and financial system. The system was designed using Quick Books software and is expected to be functional by the end of 2009, allowing the DPM to prepare the financial report by general ledger codes, by technical components and by donors. Payroll will be managed on Excel.

SDSH is a key participant in numerous MSPP national working groups, including: the consultative group for human resources management (to align donor salary and per diem rates for Ministry personnel); the sub‐committee of the CONASIS (Information Management System) on financial resources and the national health sector supplies distribution network working (RNDI) group. During the workshop held in April 2009 on contractual management, SDSH staff shared MSH international experience in these areas; SDSH senior staff participates in the donor coordination group as observers.

The concept paper for the introduction of Performance Based Financing into the management of public sector health activities has been finalized and provided to the MSPP. SDSH will initiate this approach in 4 Departments in the coming months.

In collaboration with PADESS, the electrical system in the central MSPP office building was repaired and internet capacity was installed and secured.

SDSH staff provided technical assistance to the “Zones Ciblées” to strengthen the management of user fees.

Partnership with the MSPP leads to improved management systems.

PY2 Annual Report SDSH / October 2008 – September 2009 Page 6

SDSH supports the effort of the MSPP to deconcentrate critical planning and implementation responsibilities to the Departmental level. To this end, an SDSH Technical Advisor and Financial Officer have been assigned to each Department to support the Departmental Directorates. While their primary responsibility is to work with Departmental staff to support SDSH‐funded initiatives, especially in the “Zones Ciblées”, they also participate in other Department‐wide activities.

Principal Accomplishments:

6 Departments have developed and are implementing integrated Departmental strategic plans (PDI) for 2009‐2010 (Artibonite, Grand’Anse, les Nippes, Centre, Nord’Est and Sud’Est.); These plans include activities funded by SDSH and by the MSPP and other donors.

These same six departments have a donor coordination mechanism in place;

65 Communal Integrated plans(PCI) have been developed covering all communes where the SDSH project supports either public or private sector interventions;

Departmental supervisory plans have been developed and are being implemented in all 10 departments, systematically in 5 of the 10

(Artibonite, Nord’Est, grand’Anse, Centre and Nippes); Departemental staff participates actively in the supervision and monthly follow‐ up of the “Zones Ciblés”.

The process of installing a new financial management and accounting system has been initiated in 5 departments (Atibonite, Nord, Nord’Est, Ouest, and Centre). MSPP Departmental financial and accounting staffs in North, South and Artibonite Departments were trained in Quickbooks.

Future Challenges:

Initiation of Performance Based Financing in 4 Departments;

Implication of MSPP Departmental Directorates in the performance monitoring of the NGOs;

Support to Departmental Directorates in the implementation of the PDI and CPI and refinement of the planning process for greater concordance between budget availability and planned activities;

Continued advocacy and collaboration with the MSPP to reform financial and accounting standards, as well as to implement current receipts management and fleet management procedures at the central level;

Facilitation of the establishment of mechanisms for closer collaboration with the Ministry of Finance in the process of financial and accounting practices strengthening with the MSPP;

Development of a costing data‐base and model for more accurate contracting of health services and better financial management planning and implementation at departmental and central level.

Departmental level takes on increased program management responsibilities.

PY2 Annual Report SDSH / October 2008 – September 2009 Page 7

The Critical Partnership: Community‐ and Facility‐ based Services

Community Rally Points

Trained Traditional Birth Attendants

Community Health Agents Community Clubs and Support Groups

Trained Matrones

Fixed Facilities

PY2 Annual Report SDSH / October 2008 – September 2009 Page 8

Use of health services is severely limited in Haiti by logistics constraints, isolation and poverty. This reality continues to retard access to basic facility‐based primary care services. In response, the SDSH project has worked collaboratively through its implementing partners to rapidly expand integrated community‐based service provision and prevention activities.

Community‐based services: The project pays salaries for almost 4000 community health agents employed by it public and private sector partners and supports the services of another just over 4000 trained traditional birth attendants (“matrones”). SDSH additionally pays salaries for over 1150 facility based health providers who train, supervise and collaborate with these community‐based providers. Together, they have implemented community‐based mobile services at almost 4000 “rally points”. Community health agents and matrones, conduct home visits, work with a variety of community clubs and support groups (i.e. mothers’ clubs, fathers’ clubs, youth clubs, satisfied FP users’ clubs, HIV support groups), conduct educational activities, provide basic care, and, as needed, refer and accompany clients for care to health facilities in order to help families prevent and respond to basic priority health issues affecting women and children and key vulnerable groups (HIV/AIDS and TB). While SDSH has a very limited budget for the support of educational activities and production of educational materials, the project supports events organized directly by communities as possible.

BCC/IEC Material: Existing educational materials have been distributed in response to specific requests as supply allowed. In addition, a set of maternal health and PMTCT educational supports were developed: an awareness‐raising card, 10 radio spots and a radio soap opera of 30 episodes, but have not yet been published or broadcast due to budgetary constraints. Production of nutrition education materials to be completed through a partnership with the USAID‐funded IYCN Project has been delayed.

Local Health Task Forces: As of early September, 2009, 14 community level organizations were identified to manage grant funding at the Commune level for the implementation of community‐level health improvement activities. Proposals of community health actions will be developed by Community Health Councils and submitted to SDSH for funding.

Technical Assistance to the MSPP: was provided for the standardization and coordination of behavior change communications and community mobilization activities. This led to the implication of community members in the conception, planning and implementation of

Much of the success of the SDSH Project during Project year 2 (2008‐ 2009) has been attributable to the rapid expansion of community based prevention and service delivery activities in family planning, maternal health, child health and HIV/AIDS. The partnership between community‐based health agents and trained traditional birth attendants (matrones) has led to rapid increases in family planning use, anti and post natal visits, births attended by qualified personnel ( whether a matrone or a facility based provider);

improved prophylaxis of HIV+ mothers and their newborns, and improved follow up of patients on ARV or TB therapy.

Community Mobilization achieves dramatic results.

PY2 Annual Report SDSH / October 2008 – September 2009 Page 9 the campaign to promote maternal health and PMTCT. Coordination of several donor agencies resulted in the realization of the campaign in 7 departments.

PY2 Annual Report SDSH / October 2008 – September 2009 Page 10

Principal Accomplishments:

Renewed integration of trained matrones (Traditional Birth Attendants‐TBA) as a vital part of the maternal health team: To improve pre and post natal care, develop more effective responses to obstetrical emergencies and integrate PMTCT into community based services, SDSH worked closely with the Ministry of Public Health (MSPP) Division of Family Health (DSF), the Departmental Directorates and other partners, to strengthen community based maternal health interventions through the development of close partnership and collaboration between health facility staff and trained TBAs. The introduction and rapid scale‐ up to all SDS‐supported health facilities of the systematic use of a birth plan negotiated between the TBA, the health facility staff, the pregnant woman and her family as part of the pre‐natal consultations has been an important tool to anchor and make effective this collaboration: 78% of pregnant women in the SDSH network used the birth plan tool this year; 45% benefitted from 3 prenatal visits; 44,000 or 40% received a post‐natal visit at home within 3 days of giving birth;

Revision of Norms and Standards for Maternal Health and Family Planning: SDSH collaborated with the MSPP Directorate of Family Health (DSF) and other partners to revise, validate and revitalize the use of MSPP family planning and maternal health norms and standards, playing a leadership role in the series of workshops and meetings which led to the finalization and official publication of these norms in November, 2009.

Future Challenges:

Dissemination and use of the maternal health and family planning norms and standards to the facility level;

Use of the emergency obstetrics protocols in all SDSH‐supported communal maternities;

Scaling up of community‐based PMTCT and revision, validation and distribution of PMTCT norms and standards with the DSF;

Creation of at least one committee for the surveillance of maternal mortality and management of obstetrical emergencies in each project‐supported commune;

Development of a pool of reproductive health trainers in each department.

Maternal Health: Rapid Increases in Pre‐ and Post‐natal Consultations

PY2 Annual Report SDSH / October 2008 – September 2009 Page 11

41,370

49,332 44,250

55,582

10,000

20,000

30,000

40,000

50,000

60,000

Year 2008 Year 2009

Number of deliveries with traditional birth attendant (TBA) SDSH: Years 2008 - 2009

Target

Result

65%

28%

40% 40%

0%

10%

20%

30%

40%

50%

60%

70%

Year 2008 Year 2009

% of pregnant women in first prenatal visit during the first trismester of pregnancy

SDSH: Years 2008 - 2009

Target

Result

47,670

27,977 30,000

44,019

10,000

20,000

30,000

40,000

50,000

Year 2008 Year 2009

Number of postpartum / newborn visits in USG-assisted programs in 3 days after delivery

SDSH: Years 2008 - 2009

Target

Result

65%

52%

68% 69%

0%

10%

20%

30%

40%

50%

60%

70%

Year 2008 Year 2009

% of pregnant women having received a 2nd dose or booster of anti-tetanus vaccine

SDSH: Years 2008 - 2009

Target

PY2 Annual Report SDSH / October 2008 – September 2009 Page 12

Principal Accomplishments:

Increased utilization of modern family planning methods from 21% to 26% in the SDSH target areas: In September 2007, private sector sites supported by the USAID‐funded HS2007 Project implemented by MSH had achieved a contraceptive us rate of 32%, with public sector sites attaining 8%. The integration of additional public sector sites into SDSH resulted in an overall use rate of 21% in the SDSH‐supported network of sites in 2008. SDSH’s intensive effort to increase access to family planning in public sector sites over the past two years has resulted in an overall increase in the FP utilization rate of nearly 24% (to 26%) over the course of Project Year 2 (PY2).

Appropriation of the family planning program by MSPP departmental staff: Through training, technical support and intensive collaboration, Departmental nurses in all 10 departments have taken responsibility to plan, execute, and supervise public sector FP activities in their departments, including facility‐ and community‐based activities.

Mobilization of 1035 community‐based health agents (HA) to implement family planning activities in communities served by all 73 of public sector sites supported by SDSH: Community health agents have been trained to provide family planning information, counseling, and distribution of three family planning methods including condoms, pills and injectables, and referral. The addition of injectables was the result of intensive discussions leading to approval from the MSPP for the delivery of this method by trained community Health Agents. One result of this approach is the increase of the number of Dep‐Provera users who return for their next injection at the appropriate time from 73% to 91%. The introduction of community‐based family planning services was primarily responsible for the dramatic overall increase in FP use in SDSH‐supported areas. Increased usage rates of up to 300% in 6‐8 months in some communities, demonstrate de existence of considerable unmet need in these communities

Launch of an intensive expansion of the use of long term and permanent FP methods through mobile training units which provide services while training providers: An SDSH mobile team has provided surgical and other long term contraceptive methods at 58 sites, an equivalent of 41% of SDSH supported sites over the past year. Site visits are made after local FP staff reports a sufficient number of clients resulting from local educational and mobilization efforts. The mobile team often works far into the night to satisfy client demand.

This effort is made possible in part through the provision of kits supplied by UNFPA. The team has provided training to departmental service providers in 4 departments‐ Grande‐Anse, North‐East, North and Nippes ‐leading to certification after about 6 months. So far 94 departmental providers have been certified in the delivery of long‐term methods.

Family Planning: 24% Increase in Modern Methods Use

PY2 Annual Report SDSH / October 2008 – September 2009 Page 13

Maintenance and expansion of the Community Based Distribution strategy, including continued assurance of contraceptives availability in collaboration with the LMS Project at the facility and community levels;

Expansion of the Long Term Methods training and service provision component, including availability of materials and supplies in collaboration with UNFPA;

Continued motivation and quality improvement at departmental, facility and community levels;

Support to the MSPP for the delivery of family planning services in departmental hospitals;

Integration of family planning service provision into other components of the priority package on integrated services, including especially obstetrical care, maternal health, HIV/AIDS (PMTCT and other services);

Expansion of community‐based family planning services through alternative networks, such as agricultural and income‐generating activities, starting with integration in the USAID‐financed WINNER Project;

Increased coordination with other family planning efforts, especially with UNFPA and the USAID‐funded CHAMP project;

Development of communications materials and approaches for the community and institutional levels.

Indicator 2009 Target

Result

Number of Couple years of protection

232,000 251,194

Number of people trained in FP

400 1035

Number of people trained in the provision of long term methods

50 94

Number of service delivery sites offering long term methods counseling or service delivery

20 58

% of sites offering at least 5 FP methods including at least 2 long term methods

25% 41%

% persons of reproductive age using a modern family planning method

27% 26%

% of Depo users who respect the reprovisioning delay

75% 91%

Number of new family planning users

134,200 159,801

% of people of reproductive age using a modern family planning method in USG assisted programs

SDSH: Years 2008 - 2009

26% 26% 27% 27%

21%

26%

21% 22%

0%

6%

12%

18%

24%

30%

Sem 1, 2008 Sem 2, 2008 Sem 1, 2009 Sem 2, 2009

Target

PY2 Annual Report SDSH / October 2008 – September 2009 Page 14

Overall Accomplishments:

MSH’s vision and philosophy is to look at the HIV/AIDS problem comprehensively and see the person living with the virus as a “whole”, while recognizing the need for additional, innovative and varied approaches to the disease. This includes integration with Family Planning, Maternal and Child Health, and Tuberculosis (TB) services. In program year 2008‐2009, SDSH made important strides towards implementing this vision.

Services specific to the HIV+ population and HIV prevention are not neglected, but rather made stronger through the integrated approach. The four strategies known as VCT “Eclaté”: “opt‐out” approach to testing and PMTCT, a treatment approach emphasizing patient monitoring and adherence, involvement of all categories of providers, and reducing stigma and discrimination are implemented throughout the entire network.

SDSH exceeded nearly all of its HIV‐related objectives during the 2008‐2009 program year. Twenty‐nine (29) sites provide Voluntary Counseling and Testing. This year, 6 sites began offering Prevention of Mother to Child Transmission (PMTCT) services with SDSH assistance, bringing the total number of full‐service PMTCT sites in the network up to 19. SDSH also added the AEADMA site to its ARV network, bringing the total number of ARV sites to 6. Program areas needing increased attention in PY2009‐2010 include testing TB patients for HIV and follow‐up of HIV+ pregnant women for prophylaxis through birth.

Shortly before October 2008, Haiti was struck by four hurricanes, causing severe damage to public and private sites supported by USAID through SDSH. SDSH led a rapid assessment of network sites in collaboration with the MSPP departmental directorates, elected officials and local post‐ disaster teams coordinated by the Office of Civil Protection in the Ministry of Interior. Medical infrastructure, supply and use of services provided, including care and treatment for Persons Living with HIV/AIDS (PLWHA’s), were immediately assessed. Assistance was provided to the partners in order to minimize interruption of the complete package of health services, including HIV/AIDS.

HIV/AIDS and Tuberculosis: integrated services increase.

Training of HIV Counselors

PY2 Annual Report SDSH / October 2008 – September 2009 Page 15

Access to testing and VCT is a challenge in Haiti. In 2006 in Haiti, only 25% of HIV‐positive individuals knew their HIV status (31% of HIV+ women and 16% of HIV‐positive men) and only 11% of Haitian men and 18% of Haitian women had ever had an HIV test. In project year 2008‐ 2009, SDSH put the highest priority on HIV testing and counseling, as it is the essential gateway to HIV services. SDSH’s strategic approach to VCT focuses on including VCT and referral to VCT within the entire health system, emphasizing an “opt out” approach. SDSH also encourages Provider Initiated Counseling and Testing (PICT): in all centers, outreach is the responsibility of all health staff to encourage all individuals to be tested for HIV. In addition, SDSH emphasizes making VCT easy and accessible to promote early testing for HIV‐positives. SDSH currently supports Voluntary Counseling and Testing in 29 sites at the institutional and community levels (9 of these sites offer VCT services only). SDSH sites exceeded this year’s project target of 60,000 people tested by 58%, testing a total of 94,907, not including the 49,196 pregnant women tested in PMTCT program. As shown in the adjoining table, HIV positivity among tested individuals was 5.85% for men and 5.31% for women. The fact that this is higher than the general prevalence in Haiti is likely because individuals seek testing (or are referred to testing) after they are symptomatic.

Future Challenges:

Attracting men to be tested is an important program challenge. In the SDSH network, 65% of the total tested (not including PMTCT clients) were women. Being male has been associated with later testing and lower CD4 count and poorer health on entry to care. Innovative strategies will be implemented by SDSH to make testing more “male‐friendly”. Continued roll‐out of PICT is another challenge. Referral to HIV testing and counseling by non‐HIV services is far from universal. Another key challenge is lack of higher‐level services in many VCT sites. SDSH believes it is important to provide a minimum package of palliative care to identified HIV+ individuals at all VCT sites. Referral systems must also put in place for more complex laboratory monitoring and care. Currently, only 20 SDSH‐ supported VCT sites offer complete palliative care and PMTCT services and only 6 offer a complete range of testing and treatment. Many low‐ income patients do not have the resources to access services once they have tested positive.

SDSH VCT Program HIV Seroprevalence

SDSH #’s positive

SDSH

Prevalence

Haiti Prevalence

Men 1,961 5.85% 2.0%

Women 3,261 5.31% 2.3%

Source SDSH Data through Sept 30, 2009 DHS 2005‐2006

Fig. 1. SDSH 2008-2009 VCT Results

60,000 94,907

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

Objective Results of te st s Voluntary Counseling and Testing targets exceeded by 58%.

**This does not include the 49,196 tested in the PMTCT program

PY2 Annual Report SDSH / October 2008 – September 2009 Page 16

In 2006, only 20% of women in Haiti had received HIV testing when pregnant. While 85% of pregnant women in Haiti access at least one antenatal check up, only 20% of births occur in a health facility. SDSH addresses this challenge through integrating PMTCT into every antenatal visit and through community‐based PMTCT. During the first prenatal visit the majority of pregnant women receives HIV/AIDS information and is systematically tested. A birth plan, jointly elaborated during this visit, is reviewed at each visit. For those who are found to be HIV+, an “adherence plan” for PMTCT prophylaxis is developed. The woman is strongly encouraged to choose a buddy companion (“accompagnateur ) who can be a traditional birth attendant (Matrone), a community health worker, a health agent, a family member, or even simply a friend. If the woman chooses to deliver at home, prophylaxis medication is given to the “accompagnateur” or to the woman herself for safekeeping 15 days before the expected delivery date. The importance of having the newborn seen at the health center no more than 72 hours after birth is emphasized at each contact.

Of the 29 SDSH‐supported VCT sites, 19 offer complete package of PMTCT at institutional and community levels (deliveries and ART prophylaxis).

SDSH has surpassed its expected objective of 25,000 for the year and tested a total of 49,196 pregnant women. 1372 were found to be HIV+ (2.8%). Of these, 1,105 were enrolled in PMTCT, surpassing the objective of 1,000 by 11%. Of the 1,105 enrolled, 562 completed prophylaxis (51%). This is 70% of SDSH’s target of 800 for the year. At the beginning of this project year, SDSH conducted an evaluation of PMTCT sites to identify weaknesses and to ensure compliance with community‐based PMTCT. Based on the evaluation findings, procedures for subsidizing HIV+ pregnant women have been adapted, and community tools to monitor pregnant women and forms for utilization of subsidy funds have been revised. The birth planning form has been simplified.

Linkages between institutional and community levels have been strengthened to ensure better follow up and monitoring of all diagnosed HIV+ pregnant women and lactating mothers. Community‐based PMTCT allowed 106 HIV+ pregnant women to deliver at home while having benefited from prophylaxis for themselves and their newborns before 72 hours of postpartum. All the newborns are being followed in the child survival program and will be tested at 12 months and at 18 months.

25,000

40,341

25,000

49,196

10,000

20,000

30,000

40,000

50,000

Year 2008 Year 2009

Number of pregnant women who received HIV counseling and testing for PMTCT and received their test results

SDSH: Years 2008 - 2009

Target Result

Fig 3. 2008-2009 SDSH PMTCT Results

# HIV+ # enrolled in

PMCTC

# received prophylaxis

Pr eg na nt

W om en

Objectives Results

1,105 HIV+ women enrolled in PMTCT services.Attachment V - SDSH Annual Report 2009

PY2 Annual Report SDSH / October 2008 – September 2009 Page 17

SDSH’s approach to palliative care includes support to HIV‐positive individuals and their children and integration with other HIV and non‐HIV services. SDSH works with local health task forces to sensitize communities regarding stigma and discrimination. Services to PLWHA are organized through support groups at both government (target zone) and NGO sites. In addition, psychosocial care is offered at the sites. Social workers, health agents, and trained PLWHA make home visits to clients. Support for orphans and vulnerable children (OVCs) is a new area of technical assistance for SDSH. Services for OVCs include support groups, psychosocial support, school fees, and annual back‐to school kits. Linkages to other HIV services, such as VCT, PMTCT, and treatment are critical. SDSH supports 27 sites offering a minimum package of care and support and 17 of these are full service palliative care sites including the home based care.

From October 2008 to September 2009, the support provided by SDSH to partners aimed to reinforce service organization for the provision of community care and support particularly through the support groups and home based care. 21 nurses and auxiliaries were trained in care and support and 20 social workers in psychosocial care. Following site visits and analysis of submitted reports, SDSH adapted operational strategies and approaches to support a greater involvement of PLWHA’s (Based on GIPA principles elaborated by UNAIDS) in the provision of care and support services at community level. Mechanisms to ensure better monitoring of home visits were also strengthened. Many exchanges with Institut Haitien de Santé Communautaire (INHSAC) and partners have contributed to strengthened competencies and provision of better psychosocial support to PLWHA

SDSH palliative care sites and community mobilization projects reached 11,133 individuals (39% more than the objective of 8,000): 3,919 (35%) were male and 7,214 (65%) were female; 660 (6%) were children age 14 and under; 1,861 participated in support groups; 3,317 were newly integrated into palliative care in the 2008‐2009 program year (253% of the annual program objective of 1,312); of the new palliative care clients, 270 were children ages 14 and under.

SDSH involvement in OVC services began in June, 2009. By September, 2009, SDSH had rolled out OVC services in two (2) ART sites (CBP Pignon & Grace ICC) and two (2) PMTCT sites (Sada & CS Finca). To ensure compliance with MSPP and USG norms and concept regarding OVC, SDSH participated in a training session conducted by the USG team on the standardization of the interventions including criteria to identify OVC.

Number of people provided with HIV-related palliative care SDSH: Year 2008 and 2009

2,000

4,000

6,000

8,000

10,000

12,000

Sem 1, 2008 Sem 2, 2008 Sem 1, 2009 Sem 2, 2009

Target

Result

Palliative Care reached over 11,000 HIV+ individuals.

PY2 Annual Report SDSH / October 2008 – September 2009 Page 18

SDSH’s approach to ARV technical assistance is in sync with integration with other HIV and non‐HIV services. ART care is conducted in coordination with other services at the hospital as a part of primary care services, but ART itself is a specialty practice. Care is provided by expert staff, clinical teams who receive training and ongoing mentoring through SDSH. SDSH’s approach includes ongoing information exchange between members of the treatment teams with clinical experts in order to promote mastery of the management of both simple and complex cases. This is particularly important in Haiti, where most patients report to clinic for the first time in late stages of disease, when opportunistic infections (OI’s) are already established. SDSH coordinates PEPFAR resources to ensure that clinical teams have the necessary supplies and tools to provide excellent clinical care, including uninterrupted supplies of ARV drugs and drugs for OIs, well‐functioning laboratories with proper capacity to run CD4 monitoring and other lab‐work required by ART. SDSH has also been active in the development of national standards and guidelines.

During the period of October 08 – September 09, technical assistance was provided to 15 institutions within the network to sustain continuity of care and treatment services to adults, adolescents, HIV‐positive pregnant women and their babies, as well as children affected or infected with the HIV virus. 5 Lab technicians were trained in CD4 count in collaboration with MOH National Laboratory. HIV‐QUAL, a methodology using chart reviews with the clinical team and tracking critical indicators over time, was piloted in Ft. Liberté and in Grace Children’s Hospital.

SDSH was providing ART services in 6 sites. This year, 973 patients newly received ART, 39% more than the objective of 700 patients. The number of patients who had ever received ART in the network, 2,834 patients, was 6% above the target and 2,077 patients were under active ART (9% lower than the target). Many variables keep extremely low‐income patients from being adherent to therapy and attending clinic: distance, transportation costs, and opportunity costs, high migration, low education. SDSH has advocated the transfer of responsibility for established, non‐complex patients to lower‐level facilities as well as for longer than one‐month supplies of drug when necessary to facilitate adherence. SDSH also advocates for service flow solutions that reduce time and resource demands on patients, including providing up to 6 months of ARV drugs to clients who migrate to the Dominican Republic for work.

Fig. 5 SDSH 2008-2009 ART Results

2,686

2,835

New ART Patients Ever Received ART Patients Active

ART

P er so ns o n

AR

T

Objectives Results

ARV Treatment was provided in 6 Sites with 973 new patients

PY2 Annual Report SDSH / October 2008 – September 2009 Page 19

Haiti has the highest TB incidence rate in the Latin America and Caribbean (LAC) Region. SDSH supports a total of 71 sites with TB interventions. Of these, 58 provide a complete service, while 8 provide only treatment services. Integration between HIV/AIDS and TB services is a key aim of the SDSH program: an estimated 29% of PLWHA have TB, making TB the most common opportunistic infection (OI) of HIV. 24 of SDSH’s 29 HIV sites are also in SDSH’s network of 56 TB detection and treatment sites; as are 19 of the 29 sites offering PMTCT services. All six sites offering HIV/AIDS treatment, also offer TB detection and treatment.

SDSH has had great success in ensuring that its ART and basic HIV sites screen all patients for TB: Over 2700 HIV+ patients were tested for TB in SDSH sites. Those HIV sites that do not provide TB detection and treatment are encouraged to refer all HIV + individuals to the nearest TB detection and treatment site.

However, TB sites which do not have HIV testing on‐site have faced challenges with patient follow‐up to referrals to HIV testing. Only 34% (1,310) of TB patients were tested for HIV, representing just 66% of the SDSH goal of 2009. SDSH believes that distance, costs of travel, and opportunity costs of travel for patients is largely responsible for this gap.

TB results have been negatively affected by the paucity of available funding, both within SDSH and through the Global Fund, which ceased providing support for TB as September, 2009. Case detection within the SDSH network was only 66% of expected cases. This should improve with the implementation of the new PIMUD (Integrated case management in poor urban areas) strategy.

Laboratory support through the National Laboratory Service has been poor. Only 2 SDSH sites received a quality control visit from the National Laboratory. SDSH has had limited capacity to influence the quality of TB services managed by Central and Departmental MSPP personnel, limiting its role to technical support at the site level. Limited funding has been provided by USAID through the LMS Project.

Key HIV/AIDS Successes for Project Year 2008‐2009

Objective Target Result % of Target

Persons received palliative care

8,000 11,133 139%

Persons treated for HIV and TB

600 730 122%

Test for HIV, TB, and Syphilis

159,500 263,035 165%

Tests for HIV 60,000 94,907 158%

New ART Patients 700 973 139%

Persons ever on ART 2,686 2,834 106%

Patients with HIV tested for TB

1,700 2,765 163%

HIV+ women enrolled in PMTCT

1,000 1,105 111%

Over 2700 HIV Patients tested for Tuberculosis.

Child Health: Principal Accomplishments:

Child health interventions within SDSH build on a sustained effort to improve community level surveillance and intervention for the integrated package of priority services which include, in the area of child health, vaccination coverage, management of diarrheal diseases, acute respiratory illnesses and child and maternal malnutrition. Training of community health agents, home visits, education through mothers’ clubs and other community level organizations, delivery of health services through regular community level rally posts (mobile services) and effective collaboration between community and facility‐based services:

Significant improvements have been noted in the increasing level of vaccination coverage in SDSH‐supported target communities, with results for DPT3 coverage surpassing annual project goals by more than 28%.

The number of cases of pneumonia treated with antibiotics surpassed project targets, but this may reflect an overestimation of pneumonia cases.

Vitamin A therapy was provided to 314,419 children, just over the project annual target.

Safe drinking water was provided to over 550 schools, 90 clinics, and 400 homes – serving more than 125,000 people and children and their families in the targeted communities are learning safe hygiene practices through a unique collaboration between the SDSH Project and the international NGO Pure Water for the World.

Future Challenges Include:

Integration of zinc therapy into standard diarrheal disease treatment protocols; and Promotion of community‐based antibiotic therapy for pneumonia case management.

300,131

280,579

314,100 314,419

260,000

270,000

280,000

290,000

300,000

310,000

320,000

Year 2008 Year 2009

Number of children under 5 years of age who received Vitamin A from USG-supported programs

SDSH: Years 2008 - 2009

Target

Result

Child health and nutrition services reach more children.

86,070 92,563 90,000

116,451

20,000

40,000

60,000

80,000

100,000

120,000

Year 2008 Year 2009

Number of children of less than 12 months of age who received DPT3 in a given year from USG-supported programs

SDSH: Years 2008 - 2009

Target

Result

Bio sand filters in school

Post‐cyclone emergency relief funding under the HIGHER Program has permitted SDSH to expand its existing nutrition activities to include care and rehabilitation of severely malnourished women and children. The goal of this expanded program is to identify and treat acute malnutrition among pregnant and lactating women and children under five in communities that were hardest hit by the 2008 hurricanes and to reduce and prevent chronic malnutrition in these communities. SDSH is supported in these efforts by UNICEF, which has provided “plumpy nut”, a peanut‐based ready‐to use‐therapeutic food (RUTF) and the World Food Program, which has provided dry rations.

Principal Achievements:

Despite a slow start up due to funding and supplies constraints, this program has progressed rapidly and, in combination with the on‐going routine nutrition activities provided in all SDSH sites, produced significant results:

Site rehabilitation completed in 9 sites and ongoing in 5 others;

16 service delivery sites providing treatment services for acutely malnourished children (45% over target) 431,946 children were reached by USG‐supported nutrition programs (33% over annual target);

1,381 children received nutritional…