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STANDARD PROGRESS REPORT

By Jason Bennett,2014-05-14 14:42
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STANDARD PROGRESS REPORT

    Abstract: thUNFPA provided support for 2008 Anural Work Plan of the 4 Country Programme Action Plan

    2008-2010 to MOHS, implemented by the RH/FP Programme; targeting specifically two “Model

    Districts” for Emergency Obstetric and Neonatal Care, nationally for family planning and HIV

    prevention services.

    Results:

    11,615 obstetric admissions, 5,503 obstetric complications, 2,083 caesarean sections, 6,621

    hospital deliveries were reported in13 districts; Makeni Government Hospital attained case fatality rate of 1.85% (lowest), 77% increase in access to obstetric complications and 174% increase in access to caesarean sections compared to 2007. PCH Hospital performance was not

    outstanding.1,459 maternal deaths were recorded in referral public hospitals, private facilities in

    Freetown, 13 districts PHUs and Communities; 1,264 obstructed/prolonged labour cases reported

    in public hospitals. 88% of all health facilities had family planning commodities with 56% increase in the number of contraceptive acceptors.

    Conclusion:

    The capacity of primary and secondary health facilities including professional capability of nationals

    must be strengthened simultaneously and Midwife-led maternity units made operational at PHUs and in the community in order to uphold standards and sustainability in reducing maternal and infant mortality and morbidity rates.

     RH/FP Programme (MOHS) Progress Report - 2008

    Table of Content

    ===========================================================

     Page

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

    Executive Summary …………………………………………. 3

    I. INTRODUCTION …………………………………………. 5

    a) Purpose …………………………………………. 5

    b) Resources …………………………………………. 5

    II. RESULTS …………………………………………. 7

    III. DATA ANALYSIS …………………………………………… 12

    IV. FACILITATING FACTORS ……………………………………………. 27

    V. PROGRESS ……………………………………………. 27

    VI. FINANCIAL IMPLEMENTATION …………………………………………. 29

    VII. LESSONS LEARNT ………………………………………….. 29

    VIII. MAJOR CONSTRAINTS ………………………………………. 30

    IX. RECOMMENDATIONS ……………………………………….. 31

    X. FUTURE WORK PLANS ………………………………………….. 32

    XI. CHALLENGES …………………………………………… 33

XII. CONCLUSION …………………………………………. .. 34

    Table 1 ...…..……………………………………… 7 Table 2 ……………………………………………. 12 Table 3 …………………………………………….. 13 Table 4 …………………………………………….. 14 Table 5 …………………………………………….. 15 Table 6 …………………………………………….. 15 Table 7 …………………………………………….. 16 Table 8 ……………………………………………… 18 Table 9 ……………………………………………… 19 Table 10 ……………………………………………….. 19 Table 11 ……………………………………………….. 21 Table 12 ………………………………………………… 23 Table 13 ………………………………………………… 24 Table 14 …………………………………………………. 26

    Figure 1 …………………………………………………. 13 Figure 2 ………………………………………………….. 13 Figure 3 ………………………………………….............. 15 Figure 4 ………………………………………………….. 17 Figure 5 ………………………………………………….. 18 Figure 6 …………………………………………………… 20 Figure 7 ……………………………………………………. 20 Figure 8 ……………………………………………………. 22 Figure 9 …………………………………………………….. 23 Figure 10 …………………………………………………….. 25

    REPRODUCTIVE HEALTH DIVISION, P.C.M. Hospital, Fourah Bay Road, Freetown Contact: Programme Manager: 078-449-420; Data Coordinator: 076-674-422; E-mail: rhdivmohs@yahoo.com

    Page 1 of 34

    RH/FP Programme (MOHS) Progress Report - 2008

    ACRONYMS

    AIDS Acquired Immune Deficiency Syndrome ARH Adolescent Reproductive Health AWARE-RH Action for West Africa Region Reproductive Health AWP Annual Work Plan

    BCC Behaviour Communication Change BEmONC - Basic Emergency Obstetric and Newborn Care CBO Community-Based Organisation CCM Country Commodity Manager

    CEmONC - Comprehensive Emergency Obstetric and Newborn Care CHCs Community Health Centres

    CHOs Community Health Officers

    CMA Community Motorised Ambulance CO Country Office

    CPAP - Country Programme Action Plan CPR Contraceptive Prevalence Rate

    CCS Contraceptive Commodity Security CST Country Technical Support Team DP&I Directorate of Planning and Information, MOHS EmONC - Emergency Obstetric and Newborn Care EU European Union

    GBV Gender Based Violence

    GoSL Government of Sierra Leone

    HIV - Human Immuno-deficiency -Virus ICPD PoA - International Conference on Population and Development Plan of Action

    IEC Information Education Communication IT Information Technology

    IRC - International Rescue Committee IUCD Intrauterine Contraceptive Device LSS - Life Saving Skills

    M&E Monitoring and Evaluation

    MCH-Aides Maternal Child Health Aides

    MOFED Ministry of Finance, Economic Planning and Development MOHS Ministry of Health and Sanitation NA Not Available

    NGO Non-Governmental Organisation OF Obstetric Fistula

    PCMH Princess Christian Maternity Hospital PHU Peripheral Health Unit

    PMTCT Prevention of Mother-to-Child Transmission PSU Programme Support Unit

    RCHP Reproductive and Child Health Programme RH Reproductive Health

    RH/FP - Reproductive Health/Family Planning RHCS Reproductive Health Commodity Security SOPs - Standard Operating Procedures SP Strategic Plan

    SRH - Sexual Reproductive Health

    STIs - Sexually Transmitted Infections

    TBAs Traditional Birth Attendants

    TV Television

    UN United Nations

    UNFPA United Nations Population Fund USAID United States Agency for International Development VCCT Voluntary Confidential Counselling and Testing VVF Vesico-Vaginal Fistula

    WAHO/WHO - West African Health Organisation, WHO World Health Organisation

    REPRODUCTIVE HEALTH DIVISION, P.C.M. Hospital, Fourah Bay Road, Freetown Contact: Programme Manager: 078-449-420; Data Coordinator: 076-674-422; E-mail: rhdivmohs@yahoo.com

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    RH/FP Programme (MOHS) Progress Report - 2008

    EXECUTIVE SUMMARY

    The Reproductive Health Programme was established in 1997 with its main focus on Maternal Mortality Reduction and specific emphases on supporting Emergency Obstetric and Newborn Care, Family

    Planning and STIs Prevention and Management. It is the principal implementing agency for UNFPA

    funded activities particularly in the Ministry of Health and Sanitation and implemented the 2008 Annual thWork Plan of the GOSL and UNFPA 4 Country Programme Action Plan (CPAP), 2008-2010.

The operational goal was “to provide men, women and adolescents in Sierra Leone with quality

    reproductive health information and services and thus contributing to reduction of poverty” and to the

    MOHS goal, “to provide quality, affordable and accessible health care services to the people of Sierra

    Leone”.

    The CPAP 2008-2010 expected outcome for UNFPA support is “Increased access to and utilization of reproductive health information and services and reduced risk of HIV infections and sexually transmitted

    infections among young people, women and vulnerable groups”; the two expected Programme outputs

    are “Improved access to skilled birth attendants and reproductive health information and services, with

    stress on family planning, emergency obstetric care, neonatal care and HIV prevention”, and “Improved

    availability and choice, at all levels of the health system, of high-quality, reproductive health commodities, including male and female condoms”.

To achieve the expected outcome and output results, the Programme in 2008 initiated the following key

    output activities:

? conduct an assessment of health facility infrastructure, human resources and equipment needs

    ? implement reproductive and child health strategic plan

    ? provide support for the strengthening of referral system

    ? promote institutionalisation of maternal mortality reviews/audits ? integrate HIV, STIs into RH and Family Planning services

    ? develop and implement a reproductive health behaviour change communications strategy including

    a component on HIV/AIDS stigma and discrimination

    ? refurbish health facilities in selected districts

    ? carryout in-service training for skilled birth attendants and family planning providers ? review and define minimum standards and protocols for care in maternal and neonatal health, print

    and disseminate, protocols, manuals and standards nationwide ? collaborate on the safe blood initiative with WHO and UNICEF ? print and disseminate Reproductive Health Commodity Security (RHCS) data collection tools to 13

    districts

    ? distribute reproductive health commodities to 13 districts

    ? support to inter-agency national RHCS

In 2008, these key output activities were funded mainly by UNFPA, and USAID, WHO, UNICEF and

    GOSL.

Although UNFPA in 2008 supported the provision of Emergency Obstetric and Newborn Care (EmONC)

    activities as first priority in two “Model Districts”, namely Western Area and Bombali District at hospital

    and PHU levels, yet the UNFPA support covered all districts particularly for family planning and HIV

    prevention services.

The following key output results were obtained:

     EmONC assessment conducted for five (5) and fifteen (15) PHUs in Bombali District and Western

    Area respectively for BEmONC and Makeni Government Hospital Maternity Unit and PCM Hospital

    REPRODUCTIVE HEALTH DIVISION, P.C.M. Hospital, Fourah Bay Road, Freetown Contact: Programme Manager: 078-449-420; Data Coordinator: 076-674-422; E-mail: rhdivmohs@yahoo.com

    Page 3 of 34

    RH/FP Programme (MOHS) Progress Report - 2008

     were assessed for CEmONC

     RCH Strategic Plan implemented as per the 2008 AWP and auditors’ report

     PCM Hospital, Makeni Government Hospital, MSSSL and Motorised Community Ambulances

    referral systems supported.

     80 participants including CSOs sensitised on Maternal Death Reviews

     Three (3) new Static STIs Clinics and fifteen (15) community-based condoms distribution outlets

    established in the Western Area

     Aired 4,544 slots at six (6) Radio Stations on FP and EmONC in five (5) local languages at national

    level; disks and cassettes containing 12 local languages supplied to districts.

     Refurbished five (5) PHUs and Makeni Government Hospital Maternity Unit in Bombali District and

    six (6) PHUs and PCM Hospital in the Western Area with improved water, sanitation and electrify

    facilities.

     170 participants trained in EmONC and RHCS

     293 copies of RH Standards and Norms printed and distributed in “Model District” facilities

     1,160 blood bags and 1,360 Sangofix were distributed to PCM Hospital and Makeni Government

    Hospital

     1,500 Standard Operating Procedures Manuals and RHCS data collection tools were distributed to

    the 13 districts

     Reproductive health commodities including drugs, consumables, equipment, three Ambulances

    and five (5) Motor Bikes were distributed to 13 districts.

     115 stakeholders including CSOs, Media practitioners, traditional leaders, religious leaders, youth

    and women’s groups participated in sensitisation and advocacy sessions for repositioning family

    planning and RHCS in Sierra Leone.

At outcome and impact results levels, 11,615 obstetric admissions, 5,503 obstetric complications, 2,083

    caesarean sections, 6,621 hospital deliveries were reported in the 13 districts in 2008; case fatality rate

    at the Makeni Government Hospital was the lowest, 1.85%; 77% increase in access to obstetric

    complications and 174% increase in access to caesarean in the Makeni Government Hospital in 2008

    compared to 2007. In the area of family planning, 88% of all health facilities had commodities in 2008;

    56% increase in the number of total contraceptive acceptors compared to 2007. In 2008, 1,459 maternal deaths were recorded in referral public hospitals, private facilities in Freetown, 13 districts PHUs and Communities; 1,264 obstructed/prolonged labour cases treated in public hospitals, which led to 95 deaths; attributing to about 40.1% of public hospital maternal deaths. RH data management and reporting system was remarkably improved. Collaboration specifically with

    Marie Stopes Society Sierra Leone was very rewarding in 2008 for Family Planning in particular.

The key challenges included operationalising PCM Hospital as the main referral facility in the Western

    Area; provision of adequate technical assistance, drugs, equipment and medical supplies; capacity of

    nationals to effectively supervise and monitor BEmONC and CEmONC facilities.

    Building institutional capacity at primary and secondary care level for implementing the RCH Strategic plan as already outlined in the National Health Strategic Plan is the strategic way forward. The RH/FP Programme2008 Annual Progress Report is focused on the strategic directions of the

    MOHS/RCH Directorate and output results are contained in this report; impact level results will be

    measure by appropriate population-based surveys.

     REPRODUCTIVE HEALTH DIVISION, P.C.M. Hospital, Fourah Bay Road, Freetown Contact: Programme Manager: 078-449-420; Data Coordinator: 076-674-422; E-mail: rhdivmohs@yahoo.com

    Page 4 of 34

    RH/FP Programme (MOHS) Progress Report - 2008 I. INTRODUCTION

The Reproductive Health Programme was established in 1997 in the Ministry of

    Health and Sanitation in fulfilment of the International Conference on Population

    and Development Plan of Action (ICPD PoA). The RH/FP Programme focuses on

    reducing maternal and newborn mortality with emphasis on supporting Emergency

    Obstetric and Newborn Care, Family Planning and STI Prevention and

    Management. It is the principal implementing agency for UNFPA funded activities

    particularly in the Ministry of Health and Sanitation. The Programme thus

    contributes to the MOHS goal, which is “to provide quality, affordable and accessible health care services to the people of Sierra Leone”.

Purpose th2008 was the first year of implementation of the 4 UNFPA Country Programme

    Action Plan (CPAP), 2008-2010. In 2008, UNFPA supported the provision of

    Emergency Obstetric & Newborn Care (EmONC) activities in two “Model Districts”,

    namely the Western Area and Bombali District and as well as the provision of

    Reproductive Health Information and Services in general but with emphasis on

    Family Planning, STIs/HIV Prevention nationwide; targeting public and private

    health facilities including NGOs and CBOs. Previous project districts were

    continually supplied with specialised drugs, equipment and data collection

    materials.

The expected outcome for UNFPA support in CPAP 2008-2010 is “Increased

    access to and utilization of reproductive health information and services and

    reduced risk of HIV infections and sexually transmitted infections among young

    people, women and vulnerable groups”; and the two expected Programme outputs

    are “Improved access to skilled birth attendants and reproductive health

    information and services, with stress on family planning, emergency obstetric care,

    neonatal care and HIV prevention”, and “Improved availability and choice, at all

    levels of the health system, of high-quality reproductive health commodities,

    including male and female condoms.

Resources

    In 2008 UNFPA was the principal funding agency of the activities implemented by

    the RH/FP programme. The overall UNFPA contribution of resources to the

    achievements made in 2008 can be estimated at 90%. UNFPA provided support

    for Output 1 (SLE4R211A) and Output 4 (SLE4R211D) from UNFPA Core and

    Non-Core funds.

USAID supported Reproductive Health Commodity Security activities through the

    AWARE-RH Project, Ghana until the project closed in mid 2008. However, USAID

    continued to support the procurement of modern contraceptive commodities.

The WHO Country Office supported the adaptation of the Integrated Management

    of Pregnancy and Childbirth (IMPAC) Manual and review of the Family Planning

    Manual.

    REPRODUCTIVE HEALTH DIVISION, P.C.M. Hospital, Fourah Bay Road, Freetown Contact: Programme Manager: 078-449-420; Data Coordinator: 076-674-422; E-mail: rhdivmohs@yahoo.com

    Page 5 of 34

    RH/FP Programme (MOHS) Progress Report - 2008

    WAHO and WHO co-financed capacity building (overseas travels). WAHO

    specifically provided seed money for advocacy on Repositioning Family Planning

    in Sierra Leone.

The Government of Sierra Leone through MOHS contributed human and

    infrastructural support, policy guidelines, political stability and commitment

    throughout the programme implementation in 2008.

These collective supports strengthened the programme management and

    implementation apparatus to initiate the implementation of Reproductive and Child

    Health Strategic Plan in 2008 by the RH/FP Programme.

The RH/FP Programme supported the following key RH information and service

    components and activities in 2008:

    1. EmONC: “Model Districts” facilities were the first priority and focus; previous

    project districts and non-project districts were second and third priorities

    respectively.

    2. Family Planning services: Nationwide coverage

    3. Prevention and Management of STIs in more than 35 facilities 4. Collaboration and partnership in other Reproductive Health Components:

    National

    5. Technical Assistance: National

    REPRODUCTIVE HEALTH DIVISION, P.C.M. Hospital, Fourah Bay Road, Freetown Contact: Programme Manager: 078-449-420; Data Coordinator: 076-674-422; E-mail: rhdivmohs@yahoo.com

    Page 6 of 34

    RH/FP Programme (MOHS) Progress Report - 2008

    II. RESULTS

The output results contained in this report were obtained mainly from

    implementing the UNFPA Annual Work Plans (Outputs 1 and 4), UNFPA non-core

    Japanese funds; implementation of RHCS Strategic Plan by USAID; and WHO

    supported activities. Details of results are found in the quarterly reports of 2008,

    obtainable by request from the RH/FP Programme.

A. The following key activities were supported by UNFPA in 2008:

    Table 1. Activities and output results

    Activity Result

    1. Conduct an assessment of health Report: Five (5) BEmONC facilities in Bombali

    facility infrastructure, human resources District (Batkanu, Kalangba, Kagbere, Binkolo

    and equipment needs and Kamabai); and Makeni Government i) Western Area CHCs for BEmONC Hospital Maternity Unit assessed. ii) Makeni Government Hospital Report: 15 BEmONC facilities in the Western

    iii) Bombali District CHCs for BEmONC Area assessed. iv) PCMH Hospital for BEmONC and Report disseminated and used to upgrade CEmONC PCMH

    2. Implement reproductive and child Motivated staff: Makeni Government Hospital health strategic plan: Maternity Unit provided free EmONC services;

    i) Support local personnel retention 15 Nurse Anaesthetists supported countrywide;

    (PSU, Clinical staff, M&E and Nurse 13 district M&E Officers and 15 PSU

    Anaesthetists) supported.

    ii) Procure office equipment and Offices of Logistics Officer equipped to operate maintenance services relevant Software (Channel, Pipeline) iii) Support vehicles maintenance and Data Coordinator equipped to store large

    provision of lubricants quantum of service data iv) Provide Per Diem and fuel for field PSU equipped with 1 Laser Printer 4250, HP

    visits (Data collection, supervision and Laser Printer 1020, 1 Canon Photocopier PC

    monitoring) 340, 2 UPS 1,000VA and 4 UPS 650 VA; v) Procure office stationery efficient Programme Support Secretariat; vi) Procure Office IT and communication Supervision, on-site training conducted; RH services data available and show performance vii) Audit and miscellaneous Internet service obtained for 11 computers

    viii) Support Directorate of Hospitals including those in the Reproductive Health

    and Laboratory Services Resource Centre

     Audit report available; status - unqualified

     Secretarial services supported

    REPRODUCTIVE HEALTH DIVISION, P.C.M. Hospital, Fourah Bay Road, Freetown Contact: Programme Manager: 078-449-420; Data Coordinator: 076-674-422; E-mail: rhdivmohs@yahoo.com

    Page 7 of 34

    RH/FP Programme (MOHS) Progress Report - 2008

Activity Result

    3. Provide support for the strengthening Makeni Ambulance, ACK 569 maintained for

    of the referral system emergency

    i) Maintenance of 2 Ambulances and PCMH Ambulance AAG 252 maintained for

    utility vehicle at PCMH and Makeni emergency

    Government Hospital Community Motorised Ambulances (Women in

    ii) Support to Community Motorized Agriculture): Health - EmONC referral training; Ambulances Agriculture - Mechanization of 62 Acreage in 7

    iii) Support to MSSSL for EmONC districts and referred emergency cases. services to vulnerable groups Specialised equipment, obstetric services for

    iv) Procurement of RH commodities vulnerable groups (MSSSL - Pulse Oxymeter

    and Operating Table); three ambulances for

    Bombali District (1) and Western Area (2)

    provided

    4. Promote institutionalization of Facilitated request for Technical Assistance on

    maternal mortality reviews/audits Maternal Death Reviews from WHO; Concept

    Paper; TOR for consultant; Draft data

    collection tools; Minutes of meetings; Report

    on Sensitisation: 80 Participants including Civil

    Society Organizations, senior medical

    practitioners sensitized on maternal death

    reviews

    5. Integrate HIV, STIs into RH and RHD-based HIV/AIDS Coordinator for Grantees

    Family Planning services appointed, available for Technical Assistance i) Integrate HIV, STIs into three (3) new Three new STI Centres established and made

    and nine (9) existing STI clinics functional (Calaba Town, Waterloo and Tombo

     CHCs)

     Fifteen (15) community based condoms

     distribution outlets established and 216,000 and

     6,000 pieces of male and female condoms

     respectively distributed in the Western Area.

     Remittances to eleven (11) UNFPA HIV CBOs/ ii) Support to Grantees contributing to Grantees in accordance with respective MOUs; HIV Prevention work supervised.

    6. Develop and implement a Radio discussion programmes in local

    reproductive health behaviour change languages SLBS; CTN; UN Radio. communications strategy including a Aired 4,544 slots (pre-paid air time) of FP and component on HIV/AIDS stigma and EmONC Jingles by six (6) Radio Stations

    discrimination. (Radio Citizen, SLBS, Sky Radio, Radio Mount

     Aureol, and Voice of Islam in Krio, Mende,

     Temne, Fullah and Limba) from March to May

     2008.

    i) Develop and disseminate IEC/BCC 400 Booklets of Safe Motherhood data

    materials on SRH/EmONC/FP/STIs/ collections materials; 50 booklets of Summary

    HIV/GBV/ARH (Jingles, etc.) Delivery Forms produced and distributed

     REPRODUCTIVE HEALTH DIVISION, P.C.M. Hospital, Fourah Bay Road, Freetown Contact: Programme Manager: 078-449-420; Data Coordinator: 076-674-422; E-mail: rhdivmohs@yahoo.com

    Page 8 of 34

    RH/FP Programme (MOHS) Progress Report - 2008

    Activity Result

    7. Refurbish health facilities in selected Priority results: Water (Tank), Sanitation

    districts (Toilet) and Electricity (Stand-by i) 15 CHCs in Western Area for Generator): Moyeba, Waterloo, Tombo and BEmONC Newton, George Brook and Wilberforce

    ii) Makeni Government Hospital Community Health Centers; PCM Hospial in

    iii) 5 CHCs for BEmONC in Bombali the Western Area;

    District Batkanu, Kalangba, Kabgere, Binkolo and

     Kamabai Community Health Centres in

    Bombali District.

    8. Carry out in-service training for skilled Twenty (20) Community Health Centre staff

    birth attendants and family planning were orientated in BEmONC in the Western

    providers. Area.

     Thirty (30) midwives trained in BEmONC in the

    Western Area

     Thirty (30) nurses in Western PHUs trained in

    integrated RH services (FP/STIs/HIV/AIDS)

     Sixty (60) MCH Aides trained in basic care of

    women in labour (Orientation in BEmONC)

     Thirty (30) storekeepers trained in logistics

    management system

    9. Review and define minimum 293 copies of RH Standards and Norms printed

    standards and protocols for care in and distributed in “Model District” facilities. maternal and neonatal health, print and

    disseminate protocols, manuals and

    standards nationwide.

    10. Collaborate on the safe blood 400 single Blood Bags of 450mls and 360 of

    initiative with WHO and UNICEF 250 mls; 760 Sangofix supplied to PCMH i) Support the PCMH Blood Bank 200 single Blood Bags of 450 mls and 200 of

    ii) Support to Makeni Government 250mls; 600 Sangofix supplied to Makeni

    Hospital Blood Bank Government Hospital Blood Bank. 11. Print and distribute Reproductive Following quantities printed for onward

    Health Commodity Security (RHCS) distribution: SOPs 1,500 copies; 10 books data collections tools to 13 districts Waybill; 1,000 books - Requisition, Issue and

    Receipt Voucher; 900 Pads - Daily Activity

    Register for FP; 250 Pads - Daily Activity

    Register for EmONC; 10,279 pcs - Stock

    Cards; 600 Pads - Monthly Report Forms;

    20 Pads Quarterly Reporting;

    250 pcs Inventory Control Card; and

    20 Pads Claim Form

    REPRODUCTIVE HEALTH DIVISION, P.C.M. Hospital, Fourah Bay Road, Freetown Contact: Programme Manager: 078-449-420; Data Coordinator: 076-674-422; E-mail: rhdivmohs@yahoo.com

    Page 9 of 34

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