table of content - PDF Server - USAID

2

TABLE OF CONTENT

I- EXECUTIVE SUMMARY .......................................................................................................................................................... 5

II- INTRODUCTION ...................................................................................................................................................................... 8

III- MAIN ACHIEVEMENTS DURING YEAR 2 ............................................................................................................................ 8

III- 1 IR 1: ENHANCED COORDINATION AMONG THE PUBLIC, NONPROFIT, AND COMMERCIAL SECTORS FOR RELIABLE SUPPLY AND

DISTRIBUTION OF QUALITY HEALTH PRODUCTS ..................................................................................................................................................... 8 III- 2 IR2: STRENGTHENED CAPACITY OF THE GOM TO SUSTAINABLY PROVIDE QUALITY HEALTH PRODUCTS TO THE MALAGASY PEOPLE

15 III- 3 IR 3: EXPANDED ENGAGEMENT OF THE COMMERCIAL HEALTH SECTOR TO SERVE NEW HEALTH PRODUCT MARKETS ACCORDING TO

HEALTH NEEDS AND CONSUMER DEMAND ......................................................................................................................................................... 41 III- 4 IR 4: IMPROVED SUSTAINABILITY OF SOCIAL MARKETING TO DELIVER AFFORDABLE, ACCESSIBLE HEALTH PRODUCTS TO THE

MALAGASY PEOPLE ............................................................................................................................................................................................. 52 III- 5 IR5 - INCREASED DEMAND FOR AND USE OF HEALTH PRODUCTS AMONG THE MALAGASY PEOPLE ................................................ 58

III- 6 CROSS-CUTTING ACTIVITIES ................................................................................................................................................................ 69

III- 6.1 Monitoring, Evaluation, Research, Learning .....................................................................................................................69 III- 6.2 Gender and Social Inclusion .....................................................................................................................................................80

IV- ADAPTIVE APPROACH/METHODOLOGY DURING COVID-19 CONTEXT ................................................................... 83

V- PROGRAMME MANAGEMENT ........................................................................................................................................ 84

VI- FINANCIAL SUMMARY ...................................................................................................................................................... 84

ANNEXES ......................................................................................................................................................................................... 85

ANNEX A - PERFORMANCE MONITORING PLAN (PMP) ................................................................................................................................ 86

ANNEX B – YEAR 2 WORKPLAN UPDATE ...................................................................................................................................................... 119 ANNEX C - ENVIRONMENTAL MITIGATION AND MONITORING REPORT AND CLIMATE RISK MANAGEMENT REPORT .............................. 129

ANNEX D - SUCCESS STORIES ................................................................................................................................................................... 154

ANNEX E – STOCK INVENTORY AS OF SEPTEMBER 2020 (USAID AND PMI FUNDED) .............................................................. 178

ANNEX F – STOCK STATUS BY END OF SEPTEMBER 2020 ............................................................................................................... 179 ANNEX G - DESCRIPTIONS OF THE SEVEN QUALITY DIMENSIONS FOR THE RDQA ..................................................................................... 180 ANNEX H - DETAILS OF TRAINING SESSIONS FOR PA AND PARC DURING QUARTER 3 AND QUARTER 4 .................................................. 181

ANNEX I - LIST OF 49 PHA-G-DIS EQUIPPED WITH COMPUTERS FOR LMIS ............................................................................................... 182 ANNEX J - RDQA RESULTS ............................................................................................................................................................................ 183 ANNEX K - COVID-19 ANNEXES .................................................................................................................................................................... 186

ANNEX L - SUMMARY OF SMS SENT DURING QUARTER 4 .......................................................................................................................... 192 ANNEX M – REDEPLOYMENT OF FP PRODUCTS ........................................................................................................................................... 193

3

ACRONYMS

A2F Access to Finance

ABM AccèsBanque Madagascar

ADDO Accredited Drug-Dispensing Outlet

AFD Agence Française de Développement

A2F Access to Finance

AMM Agence de Médicaments de Madagascar

AQUALMA Aquaculture de Mahajamba

BNI Banque Nationale pour l’Industrie

cCD Community-based Continuous

Distribution

CCDS Comité Communale pour le

Développement Social

CGL Comité de Gestion Logistique

CHV Community Health Volunteers

CILCMIM Comité Interministériel de Lutte contre le

Marché Illicite des Médicaments

CISCO Circonscription Scolaire

CMS Credit Management System

CNFM Conseil National des Femmes de

Madagascar

CSR Corporate Social Responsibility

CSB Centre de Santé de Base

CoAg Cooperative Agreement

COGS Cost of Good Sold

CPT Certified Peer Trainer

DCA Development Credit Authority

DEPSI Direction des Etudes de la Planification et

du Système d’Information

DFC United States International Development

Finance Corporation

DGFS Direction Générale de Fourniture des

Soins

DGMP Direction Générale de la Médecine

Préventive

DHIS-2 District Health Information System - 2

DPS Direction de la Promotion de la Santé

DLMT Direction de Lutte contre les Maladies

Transmissibles

DRENETP Direction Régionale de l’Education

Nationale et de l’Enseignement

Technique et Professionnelle

DPLMT Direction de la Pharmacie, des

Laboratoires et de la Médecine

Traditionnelle

DRSP Direction Régionale de la Santé Publique

DSFa Direction de la Santé Familiale

DSS Division Santé Scolaire

DSSB Direction des Services de Santé de Base

EDM Electricité de Madagascar

EFOI Entreprendre au Féminin Océan Indien

LLIN Long Lasting Insecticide-treated Net

RLA Regional Logistic Advisor

LMIS Logistic Management Information System

MEL Monitoring, Evaluation and Learning

MCH Maternal and Child Health

MNCH Maternal Newborn and Child Health

MDA Market Development Authority

MEL Monitoring, Evaluation and Learning

MENETP Ministère de l’Education Nationale et de

l’Enseignement Technique et

Professionnel

MERL Monitoring Evaluation Research and

Learning

MOPH Ministry of Public Health

MSH Management Sciences for Health

MYS Ministry of Youth and Sport

NGO Non-Governmental Organization

NHMIS National Health Management

Information System

NMCP National Malaria Control Program

NSP National Supply Plan

ONP Ordre National des Pharmaciens de

Madagascar

PA Point d’Approvisionnement

PAIS Plan d’Action d’Intégration des Intrants

de santé

PARC Point d’Approvisionnement Relais

Communautaire

PBO Pyrethroid and Piperonyl Butoxide

PDPN Plan Directeur Pharmaceutique Nationale

PMI President’s Malaria Initiative

PMP Performance Monitoring Plan

PPR Performance Plan and Report

PPN Politique Pharmaceutique Nationale

PSHP Private Sector Humanitarian Platform

PSI/M Population Services

International/Madagascar

Pha-G-Dis Pharmacie de Gros de District

Pha-Ge-Com Pharmacie à Gestion Communautaire

RBM Roll Back Malaria

RH Reproductive Health

RDT Rapid Diagnostic Test

SBCC Social and Behavior Change

Communication

SGM Société Générale de Madagascar

SHOPS Plus Sustaining Health Outcomes in the

Private Sector Plus

SILC Savings and Internal Lending

Communities

4

EMMP Environmental Mitigation Monitoring

Plan

FANOME Financement pour l’Approvisionnement

Non-stop en Médicaments

FEFO First Expiry – First Out

FP Family Planning

GAS Gestion des Approvisionnements et des

Stocks

GBV Gender Based Violence

GESI Gender Equality and Social Inclusion

GFEM Groupement des Femmes Entrepreneurs

de Madagascar

GF Global Fund

GHSC-PSM Global Health Supply Chain –

Procurement and Supply Management

GOM Government of Madagascar

HPN Health Population and Nutrition

HRD Health Regional Director

IMPACT Improving Market Partnerships and

Access to Commodities Together

IR Intermediate Result

IPC Interpersonal Communication

IPTp Intermittent Preventive Treatment

during pregnancy

ISM Integrated Social Marketing

SLRC Service de la Législation, de la

Réglementation et du Contentieux

SMSR Santé Maternité Sans Risque

SP Sulfadoxine Pyriméthamine

SPD Superviseurs de Point de Distribution

STTA Short-term Technical Assistance

TA Technicien Accompagnateur

TCA Total Cost Analysis

TELMA Telecom Malagasy

TMA Total Market Approach

TMI Total Market Initiative

ToT Training of Trainers

TWG Technical Working Group

UCP Unité de coordination des Projets

UHC Universal Health Coverage

UNFPA United Nations Population Fund

UTGL Unité Technique de Gestion Logistique

USAID United States Agency for International

Development

VSLA Village Savings and Loan Association

WHO World Health Organization

ZAP Zone d’Administration Pédagogique

5

I- EXECUTIVE SUMMARY

IMPACT is working with and through the Government of Madagascar (GOM) and relevant stakeholders to build on mechanisms in place in the country and global best practices to implement a Total Market Initiative (TMI) that will improve the capacity of the Malagasy health system, ensuring that quality pharmaceuticals and health commodities are available and accessible to all Malagasy people on a sustainable basis.

The vision for IMPACT is to achieve a more efficient, equitable, and sustainable Malagasy health system where a robust mix of public, nonprofit, and commercial actors are harmonized and incentivized to deliver a broad range of quality health products. IMPACT’s interventions are aligned with GOM and USAID health priorities and aim to strengthen the supply chain for USG funded maternal, newborn, and child health (MNCH), malaria, and family planning/reproductive health (FP/RH) commodities.

Year 2 of the project was adversely affected by the unexpected spread of the COVID-19 virus in Madagascar, leading to some activities and strategic approaches being delayed. However, the project was able to use this time to engage with the Ministry of Public Health (MOPH) to form technical working groups (TWGs), particularly focused on the Total Market Approach (TMA) and strengthening ties with private sector actors. IMPACT was still able to achieve notable successes in Year 2, including a detailed malaria market assessment and a product portfolio analysis for FP products.

IMPACT ensured the ongoing continuity of supply of community agents through the efficient and effective distribution of essential FP/RH and MNCH products through the network of 71 Points d’Approvisionments Relais Communitaries (PARC) at the district level, and 919 Points d’Approvisionments (PA) at the community level across 13 regions supported by USAID. In Year 2, IMPACT began strategizing approaches for how this delivery channel will be returned to the responsibility of the public sector through the Pha-G-Dis (Pharmacie de Gros de District) and Pha-Ge-Com (Pharmacie à Gestion Communautaire). Of particular note, IMPACT delivered 366,542 Long Lasting Insecticide-treated Nets (LLINs) at the household level in 12 districts during the year as part of the ongoing community level distribution of LLINs that covers the gap between the mass distribution campaigns that happen every three years.

In addition, with a rapid mobilization of resources from USAID, IMPACT was able to leverage its nationwide capacity to provide vital support to the GOM’s COVID-19 response. IMPACT provided procurement and logistical support for lifesaving preventive products, including surgical masks and hand gels that were distributed to Direction Regional de Sante (DRS) across the country in response to local requirements. IMPACT also provided protection to the district and community level supply points (PA and PARC) and private sector outlets, including private pharmacies and drug shops, which helped ensure the continuity of service provision at a time of great uncertainty. IMPACT delivered communications messages supporting prevention approaches including mass SMS messaging and the rapid development and dissemination of educational posters.

IMPACT was able to incorporate at least one major innovation through the introduction of unmanned drones to deliver vital health products to remote sites up to 100km from a central stocking point. Over 71 flights were operated in Year 2. This project has the potential to transform the way a country such as Madagascar resupplies health commodities to remote community workers in the future, and this potential will be evaluated by USAID in Year 3 prior to a potential scale-up.

Using PSI’s four-stage market development approach (MDA), during the past two years the IMPACT team has galvanized stakeholders to:

1) Diagnose where and how the market is failing: IMPACT has planned separate market assessments covering the three priority health areas (malaria, FP/RH, and MNCH). In Year 2, IMPACT completed the malaria market assessment that provided a detailed overview of: (i) availability issues (including examples of overstock or stockout) of six key malaria products, (ii) the lack of coordination between the public and the private sector for the sale and distribution of malaria commodities (in particular around artemisinin combined therapy (ACT) and LLINs), (iii) the higher than expected willingness to pay by some clients for certain products (in particular LLINs) that are generally distributed for free, (iv) the non-adherence to the appropriate treatment protocol per national guidelines in both the public and private sectors (for example the continuing over-use of injectable quinine and under-use of injectable artesunate in the treatment of severe malaria), and (v) the high dependence of the program on donors. At the beginning of Year 3 a roadmap will be developed with stakeholders, led by the MOPH based on the recommendations from this market assessment. The FP/RH and MNCH market assessments could not be implemented during Year 2 due to the restrictions imposed by COVID-19 (for example restrictions on face-to-face interviews) and will be conducted as early as is feasible and safe in Year 3.

In Year 2, a detailed evaluation of the MOPH’s current Logistics Management Information System (LMIS) was completed to help identify strengths and weaknesses in performance. Key findings will be disseminated in Quarter 1

6

Year 3 during a workshop led by the MOPH that will develop a detailed roadmap for a suitable long-term solution to improve logistics data flow for the three health sectors supported by IMPACT, but which will also strengthen the general public health system.

2) Plan where in the market IMPACT should focus: IMPACT successfully advocated for the MOPH to create and lead the TMA TWG to gather actors from public, nonprofit, and commercial sectors in Madagascar for detailed consultation on the barriers to the availability of heath commodities in Madagascar. The TMA TWG identified three main blockages: (i) the lack of communication around the national pharmaceutical policy in both the public and private sectors, (ii) the availability and quality of data, and (iii) the application of regulatory texts (for example, those that determine what products can and cannot be stocked at different levels of outlets). The three main blockages identified by the stakeholders have been translated into a TMA roadmap to be implemented by the TMA TWG. Officialization of the TMA TWG with the roadmap by the MOPH will be obtained in Quarter 1 Year 3.

One example of the success of the TWG approach was the fact that private importers were able to share their experiences of the process of registering and importing medications with the Direction de l'Agence des Médicaments de Madagascar, which is now looking at refining and improving procedures. It is through this level of constructive engagement that the confidence of the private sector in the TMA can be strengthened.

3) Design how exactly the IMPACT team will work in the market: IMPACT designed interventions that support both the private sector and public sector in Year 2.

In the private sector, IMPACT completed a portfolio analysis for FP products using existing available external research and internal programmatic data to identify strategies through which the existing product portfolio can be made more sustainable. This analysis looked at key marketing elements including price (willingness to pay, and price elasticity of demand), consumer preferences, and product attributes. Key recommendations from the analysis were that prices for most products should be raised in Year 3 and can already achieve up to 50% cost recovery in the case of condoms and injectables. IMPACT will measure progress towards sustainability over the remaining years of the project and continue to move towards achieving full cost recovery over time.

IMPACT strengthened the capacity of MOPH through the development of the Supervision, Performance Assessment, and Recognition Strategy (SPARS) to enhance the public health system supply chain specifically through Pha-G-Dis. The SPARS tool was created and tested in Year 2 on 77 Pha-G-Dis resulting in the following classifications: 36% Pha-G-Dis were rated as performing, 51% as moderately performing, and 13% as showing poor performance with frequent stock outs, inappropriate storage conditions, and low rate of LMIS reporting. From Year 3, IMPACT will support the MOPH to use the SPARS tool to improve performance in the underperforming Pha-G-Dis, which will also strengthen the impact of other USAID funded projects such as ACCESS, which relies on Pha-G-Dis to deliver commodities for service delivery through community agents and Centres de Santé de Base (CSB).

IMPACT reinforced the capacity of the MOPH to conduct and lead the national quantification of health products. At these meetings, the private sector was well represented by four pharmaceutical wholesalers in Quarter 4 and this resulted in the wholesalers being better positioned to plan their importation in reaction to the quantities of product that the public and non-profit sectors were planning to import. In Year 3, IMPACT expects increasing participation of the private sector in the quantification exercises for the three priority health areas in order to minimize gaps in the market for the overall importation of health products.

IMPACT has developed public and private partnerships to identify sustainable solutions for the transportation of health products. During the first two years of IMPACT, 13 companies (26% of the five-year target) formalized their engagement through MOUs on the transportation of commodities and for private sector support for the dissemination of health-related TV and radio spots and SMS broadcasts. In Year 2, IMPACT reached 3,269,176 people with SMS messages around the subject of FP.

On the commercial side, IMPACT developed new loans to facilitate the Access to Finance (motorbike loan and pharmaloan for drug shop inventory) for private health commodities supply chain stakeholders: 46 loans worth over 175,000 USD were disbursed to businesses in Year 2.

4) Deliver the execution and monitoring of interventions created under the Design stage

• IMPACT contributed to Disability-adjusted life years (DALYs) averted and Couple Years of Protection (CYPs) against unwanted pregnancy as presented in the table below:

Achievement Y1 Achievement Y2 Cumulative

Achievement Y1&Y22 Target Y1&Y21

% Achieved

DALYs averted 472,849 981,662 1,454,511 3,120,529 46.6%

7

Achievement Y1 Achievement Y2 Cumulative

Achievement Y1&Y22 Target Y1&Y21

% Achieved

CYPs 629,698 784,313 1,414,011 1,466,659 96.4%

1 Target for the three health areas (malaria, FP/RH, and MNCH) in the public, non-profit, and commercial sectors. 2 Achievements are only for the public and non-profit sectors, and commercial sector performance is expected to be included from Year 3.

While performance increased between Year 1 and Year 2, despite the impact of COVID-19, the main reason for the overall under-performance in DALYs in Year 2 was the relatively late introduction of the continuous distribution of LLINs at the community level in the 12 IMPACT districts, though this is expected to catch up quickly in Year 3, and the low achievement on the distribution of SP within public sector.

Perspectives for Year 3

Building on the foundation established in Year 2, but delayed due to the COVID-19 pandemic, IMPACT expects to see the following activities integrated into the Year 3 workplan to ensure the program achieves its wider objectives by Year 5:

Strengthening the capacity of the public sector:

• Finalizing and implementing a clear strategy with full stakeholder engagement in the overall transfer of responsibility of the distribution of commodities to the community agent channel from the system of PARC and PA managed by IMPACT to the public sector system of Pha-G-Dis and Pha-Ge-Com.

• An assessment and review of regulations surrounding the registration of drugs and to obtain an autorisation de mise sur le marché (AMM).

• Support for the implementation of the strategic plan for the fight against the illicit market and counterfeiting of medicines

• Building the capacity of the MOPH staff and the TMA Champions from the public sector to sustaining the implementation of the TMA works after the completion of the IMPACT project.

Building the capacity of the private sector:

• The development of more sustainable, social enterprise strategies that will allow for the transfer of certain socially marketed products to the private sector.

• The development of a strategy for Madagascar that builds on the experience of countries such as Tanzania for the accreditation by the GOM of community level dépôts de médicaments (drug shops), which have the potential to transform the quality of private sector care at the community level.

• To facilitate the collection of data from private sector pharmacies and drug shops, using an electronic data collection tool developed by IMPACT to manage both stock and finances in small outlets.

Finally, a major contribution of the IMPACT project in Year 3 will be the support to the national distribution campaign for LLINs that expects to deliver approximately 14 million LLINs to vulnerable households across the country. IMPACT will support the logistics and distribution activities of 3,677,000 LLINs procured under PMI/USAID funding in 22 out of the 106 targeted districts.

8

II- INTRODUCTION

Improving Market Partnerships and Access to Commodities Together (IMPACT) is funded by the United States Agency

for International Development (USAID) and led by PSI/Madagascar as the prime recipient and its consortium partners

for five years from September 4, 2018 until September 3, 2023.

IMPACT supports the Government of Madagascar to improve the capacity of the Malagasy health system to ensure

that quality pharmaceuticals and health commodities are available and accessible to all Malagasy people on a

sustainable basis. IMPACT’s expected outcome is to increase total market performance for and use of health products

and sustained health system performance. IMPACT has five intermediate results such as (i) enhanced coordination

among the public, nonprofit, and commercial sectors for reliable supply and distribution of quality health products ;

(ii) strengthened capacity of the Government of Madagascar (GOM) to sustainably provide quality health products to

the Malagasy people; (iii) expanded engagement of the commercial health sector to serve new health markets

according to health needs and consumer demand; (iv) Improved sustainability of social marketing to deliver

affordable, accessible health products to the Malagasy population; (v) Increased demand for and use of health

products among the Malagasy people.

This report summarizes the activities carried out during Year 2 (October 2019 – September 2020) and provides

accomplishments, challenges, solutions, and recommendations for the next fiscal year(Y3) .

During Year 2, IMPACT also implemented activities for the fight against COVID-19 approved by USAID under a

redirection of funding from cancelled and/or postponed activities ($610,300) during Year 2 and supplemental funding

($700,000). The purpose of the two funding streams is to (i) help the GOM to purchase and transport health and

expendable commodities (infection prevention products) from the central level to districts and communes, (ii)

sensitize Malagasy people in the 13 USAID-supported regions on COVID-19, and (iii) train hygienists and health

workers at the regional health facilities on waste management and infection prevention and control (IPC). The COVID-

19 project is lasting for six months counted from May 2020. Monthly reports were submitted to USAID with a summary

of the achievements reported in this annual Year 2 report.

III- MAIN ACHIEVEMENTS DURING YEAR 2

III- 1 IR 1: Enhanced coordination among the public, nonprofit, and commercial sectors for reliable supply and

distribution of quality health products

Sub-IR 1.1 The total market for health products in Madagascar is understood and documented

IR1.1.1: Support the implementation, monitor and evaluate the overarching TMA roadmap for all health products

based on the discussions and decisions taken during the TMA

During Year 2, the implementation of the TMA roadmap and operational plan has enhanced the engagement of the

TMA TWG members to improve the pharmaceutical sector and to coordinate the different stakeholders from various

organizations in order to improve access to commodities.

Through the three TMA subcommittee meetings, the percentage of participation from the for-profit private sector is

assessed as (i) 19 out of 48 (39.58%) participants at the Politique Pharmaceutique Nationale and Plan Directeur

Pharmaceutique National meetings subcommittee, (ii) 5 out of 38 (13.16%) participants at the texts and regulations;

and (iii) 14 out of 31 (45.16%) at the LMIS subcommittee.

The three subcommittees have achieved the following:

• The texts and regulations subcommittee has digitalized 134 texts released by the MOPH governing the

pharmaceutical sector (pharmacy profession, health commodities management, medicine quality control, etc.)

which were disseminated to the TMA TWG members via USB drives and through a link to Google drive for their

information and as a working tool for the subcommittee with support from IMPACT. The Service de la Législation,

9

de la Réglementation et du Contentieux (SLRC) of the MOPH joined the 'Texts and regulations’ subcommittee to

provide support and legal advice on text development and review. Ninety six (96) out of the 134 digitalized texts

impacting the pharmaceutical environment have been identified and classified into (i) the pharmaceutical

regulatory function (45 texts), (ii) pharmacy profession (30 texts), and (iii) commodities (21 texts).

• The PPN PDPN subcommittee has decided to add a paragraph for priority actions in the PDPN document under

the specific objective #10 on the ‘Intensification of protection measures of the population against dangers

induced by the illicit market, and the counterfeit of health products’ to stress the importance of the

implementation of the MEDICRIME1 convention to fight against the illicit sale of medicines by sensitizing the

population to file complaints. The revision of the two documents included the periodic collection and analysis of

logistical data (data related to distribution and sales) from the public, private nonprofit, and for-profit sectors. A

text on the management of the distribution circuit has been added to encourage pharmaceutical wholesalers to

set up an efficient tracking system of health products at all levels and ensure that their products are not

contributing to the illicit market and to trace where the products in the illicit market are coming from. The

implementation of this text will be led by the DPLMT, in close collaboration with the Comité Interministériel de

Lutte contre la Contrefaçon et le Marché Illicite de Médicaments (CILCMIM). These documents will be enforced

by DPLMT (the lead of the subcommittee) with the support of the subcommittee members who see the

importance of its implementation, and other involved ministries (the Ministry of justice and the Ministry of

Finance and Budget) and entities such as the parliament. IMPACT supports DPLMT and the subcommittee to : (i)

update and review the PPN and PDPN documents; (ii) disseminate the revised documents; and (iii) implement

the recommendations raised during the review and update process. As part of the activities in the operational

plan of the TMA roadmap, IMPACT also continues to support DPLMT and the subcommittee to ensure that these

documents will be enforced by all the entities mentioned above.

• The LMIS subcommittee organized a virtual meeting on September 10, 2020 with 16 pharmaceutical wholesalers

led by three directorates of the MOPH (Direction de l’Agence de Médicaments de Madagascar (DAMM), Direction

des Etudes de la Planification et du Système d’Information (DEPSI), and Direction de la Pharmacie, des

Laboratoires et de la Médecine Traditionnelle (DPLMT)) to highlight the importance of data reporting from

pharmaceutical wholesalers and the importance for pharmaceutical wholesalers to participate at the national

quantification exercises in order to know and estimate the health product needs in Madagascar. Following this

meeting, four pharmaceutical wholesalers have taken part in the national quantification of MNCH commodities

and are interested in the actual quantity needed by the country, the gaps, market opportunities, and how to

start exploring the market opportunity to register new brands of MNCH products.

Table 1: Number of new people trained in TMA: all sectors included (public, commercial, private non-profit) and

number of TMA TWG meetings held in Year 2

Indicator Achievement

Y1

Achievement vs target Year 2

Quarter 1 Quarter 2 Quarter 3 Quarter 4 Total Target

IR1.1.2 - Number of companies / commercial actors and private sectors associations trained and implementing the TMA (Total Market Approach)

10 5 2 0 3 10 14

IR 1.1.4 - Number of TMI workshops with public, nonprofit, and commercial stakeholders

0 7 5 5 10 27 24

IR1.1.7 - Number of people trained in TMA 101 (TMA 101 is a training on the basic definition of TMA as well as the

116 58 38 2 10 106 80

1 The "Medicrime Convention" is the first international criminal law instrument to oblige States Parties to criminalize the manufacturing of counterfeit

medical products; supplying, offering to supply and trafficking in counterfeit medical products; the falsification of documents and the unauthorized

manufacturing or supplying of medicinal products and the placing on the market of medical devices which do not comply with conformity requirements.

The Convention provides a framework for national and international co-operation across the different sectors of the public administration, measures for

coordination at national level, preventive measures for use by public and private sectors and protection of victims and witnesses. Furthermore, it foresees

the establishment of a monitoring body to oversee the implementation of the Convention by the States Parties.

https://www.coe.int/en/web/medicrime/the-medicrime-convention

https://www.coe.int/en/web/medicrime/the-medicrime-convention

10

principles of implementation of TMA and the relevant actors to be involved) during workshops (not unique trainees)

IR1.1.9 - GOM-led TMI TWG (Technical Working Group) meets at least four times a year as a forum for consultations and roundtables between public, non-profit, and commercial stakeholders

3 0 1 0 0 1 3

• Due to the COVID-19 pandemic and given the number of members in the TMA TWG, IMPACT could not hold new

TMA TWG meetings starting from Quarter 3 due to the unavailability of MOPH staff, including TMA Champions,

who were busy managing the pandemic. Therefore, only one TMA TWG meeting was organized in Quarter 2 of

Year 2. From Quarter 3, as some staff from the MOPH became more available, subcommittee activities resumed

through virtual meetings.

• Despite COVID-19, IMPACT has convinced 10 new commercial actors (out of 14 targeted) to implement TMA

activities through joining TMA TWG meetings and participating in TMA subcommittee workshops. Seven of them

were convinced during the TMA TWG meeting and three during subcommittee virtual meetings. These actors

have been trained in TMA and expressed their willingness to be part of the process through the letters of

participation for the TMA. A private for-profit company is considered to be “implementing TMA” if it is embedded

into at least one of the three steps of the TMA process such as: 1) Step 1- Engaging the stakeholders: the private

sector is actively involved in the development and the implementation of the TMA roadmap and the

subcommittees. The private sector has also signed the letter of participation as the first step of involvement in

TMA; 2) Step 2- Using evidence: in Year 2, IMPACTmotivated the private sector to participate in the national

quantification of MNCH commodities and the private sector also showed great interest in the malaria market;

and 3) Step 3- Developing actions: since Year 1 the private sector has actively participated in the development

and implementation of the TMA roadmap and the interest in the development of the TMA malaria roadmap

• Throughout Year 2, 125 new members joined the TMA TWG and the TMA subcommittees in addition to the 116

members in Year 1. The new members were trained in TMA 101 (TMA 101 is a training on the basic definition of

TMA as well as the principles of implementation of TMA and the relevant actors to be involved). 96 of these new

members are new representatives from associations, organizations (NGOs, donors, companies), and ministries

that were involved in Year 1. 29 of the new members come from new organizations, including 16 from the private

sector. The breakdown by sector of new people trained in TMA during Year 2 is as follows:

Table 2: Breakdown by sector of new members and entities trained in TMA during Year 2

Sectors Public sector Private sector Associations NGOs Donors

New members in Year 2

71 24 12 13 5

New organizations in Year 2

- Ministry of Justice

- Ministry of Agriculture, Livestock, and Fisheries

- SK Pharma

- AMIT

- DIPROPHARM

- NAJMI PHARMA

- MADASOPHAR

- PHARMATEK

- FARMAD

- UBIPHARM

-DICOPROPHAGI - OPHAM

- Académie Nationale de Médecine de Madagascar - Syndicat des Pharmaciens de Madagascar - Conseil National des Femmes de Madagascar - Groupement des Femmes

-USAID/ACCESS

- EKAR SANTE

- Dispensaire Adventiste

- USAID/HP+

- USAID/Shops Plus

- WHO

11

Entrepreneures de Madagascar

• The signature and publication of the ministerial decision on the formalization of the TMA TWG was delayed due

to the new appointment of the Minister and his Secretary General. Contact with the new upper management of

the MOPH to will be established to report about TMA activities and achievements.

IR1.1.2: Support the development and implementation of the malaria TMA roadmap and monitor and evaluate its

progress to ensure the availability of quality malaria products at all levels

• The malaria market assessment was completed in Year 2. The National Malaria Control Program (NMCP) played

an important role in the assessment, the development of the report, and in the presentation of the findings to

the Roll Back Malaria (RBM) group.

• The malaria market assessment report highlighted the following:

Table 3: Malaria Market Assessment Key Results

Malaria Products

LLINs Sulfadoxine

Pyriméthamine (SP):

mRDTs ACTs Injectable

Artesunate Injectable Quinine

Availability during the survey period

2.8% of outlets2 had LLINs

56.5% of outlets had SP

46.9% of outlets had mRDTs

25.9% of outlets had ACTs

15.8% of outlets had Artesunate injectable

54.5% of outlets had Artesunate injectable

TMA Recommendations

• As the malaria program is heavily dependent on donors, the government should explore funding options that would make financing for all malaria products more sustainable to efficiently prevent malaria.

• Expanding the involvement of actors from the private for-profit sector and encouraging consumers who can pay for products will generally increase consumer participation in the local economy, even if marginally.

• Consider leveraging or incentivizing private sector distributors and their networks (pharmaceutical and commercial distributors) to sell products with margins ensuring availability of malaria commodities in remote areas for segments of the population that can afford higher priced products.

• Government encouragement for the increased involvement of the private for-profit sector could be beneficial in improving the supply in the total malaria market. Measures from the public sector that would benefit the private sector include that the private sector would share their data on distribution and importation, and in return the public sector would share information and data regarding the market (i.e. potential market share) and opportunities.

1 Outlets of private for-profit sector include: pharmacies, drug shops, independent doctors, private clinics, groceries, commercial

wholesalers; Outlets of the public sector include: Centre Hospitalier Régional, Centre Hospitalier District, Centre de santé de base

niveau 1, Centre de santé de base niveau 2, Community health volunteers ; Outlets of the private non-profit sector include:

SAF/FJKM, SALFA and catholic clinics.

• The malaria TMA subcommittee was established in Quarter 1 through the inclusion of the private sector in the

RBM group. The members identified together three main barriers related to malaria health commodities in

Madagascar: i) the lack of behavior change communication campaigns for malaria commodities users and

providers; (ii) the non-integration of private health facilities data into the national health information system

and non-harmonization of database management at the national level (standardization of public-private use);

and (iii) the non-application of existing laws on the illegal sale of medicine and drugs. The entities that are

involved in enforcing the laws are (i) the Ministry of Public Security/Gendarmerie/Customs and the Ministry of

Justice for any legal proceedings on non-compliance with laws; (ii) the Comité Interministériel de Lutte contre le

Marché Illicite des Médicaments (CILCMIM) for all the aspects of the illegal sales of medicines; (iii) the Ministry

12

of Finance and Budget for the application of the tax exemption on health commodities; and (iv) any department

at the MOPH that initiated the development of the laws.

• Following the presentation of the findings of the malaria market assessment and the establishment of the

malaria TMA subcommittee within the RBM group, stakeholders will start establishing the malaria roadmap for

the opening of the malaria market to all sectors, starting in early Quarter 1 of Year 3 if approved.

• IMPACT is analyzing and applying key lessons from the malaria market assessment process to the FP and MNCH

market assessments. The experience from the malaria market assessment process has helped improve the

design for FP and MNCH market assessments. However, the COVID-19 pandemic slowed down the study process

for both assessments as in-person data collection was not possible.

o For FP: IMPACT has submitted key stakeholder analysis questionnaires and the framework document to

USAID.

o For MNCH: the research framework is being finalized and will be submitted to USAID in early Quarter 1 of

Year 3.

• In order to be more efficient, the FP and MNCH studies will be completed simultaneously. This will also help to

accelerate the implementation of the FP and MNCH findings and their roadmaps in collaboration with the private

sector.

IR1.1.3: Collaborate with relevant actors and stakeholders for the evaluation of the 'Roadmap to accelerate the

reduction of maternal and neonatal morbidity and mortality 2015-2020'

This activity was removed from Quarter 3 and its sub-activities were revised and re-centered to the IMPACT mandate,

which is to ensure health commodity security.

The implementation of this activity with the MOPH is challenging and has no specific achievement in Year 2.

Part of the evaluation of the 'Roadmap to accelerate the reduction of maternal and neonatal morbidity and mortality

2015-2020 was already initiated by the MOPH with UNFPA in December 2019. To support its implementation, the

DSFa Director, a TMA Champion, with the support of IMPACT, is working on the involvement of all stakeholders

including the private sector to create an enabling environment for the FP market. Although the private sector (the

healthcare providers and the pharmaceutical channel) plays a key role in the provision of health care and health

commodities, they are not explicitly written in the initial CARMMA roadmap as part of the health system in

Madagascar. IMPACT is part of the evaluation committee of the CARMMA roadmap and will ensure that the next

iteration of the roadmap will include the private sector’s role by ensuring health commodity security including

procurement.

In Year 3, IMPACT will follow up on the evaluation of the roadmap to ensure the introduction of health commodity

security as well as to revitalize the subcommittee.

IR1.1.4 : With the MOPH , build the capacity of TMA Champions to successfully steward and lead the TMA TWG and subcommittees

• Five new TMA Champions joined the TMA TWG (3 female and 2 male): the President of the Health Commission

from Parliament; the director of DSFa; the national coordinator of the NMCP; and two private sector

representatives; the President of the Order of Pharmacists and the President of the Association of Pharmacists.

• All eight of the TMA Champions, three who joined in Year 1 and the five new Champions in Year 2, and two

directors from the MOPH who are not TMA Champions but who support the implementation of the TMA process

(the director of DPLMT leading the PPN PDPN subcommittee and the director of DPS overseeing the

subcommittee for communication and demand creation of the TMA TWG) received a leadership training to

strengthen their professional leadership and influence in their respective positions. It will also help them in the

implementation of the subcommittee activities.

• As a leadership post-training follow-up, the Champions were asked to facilitate TWG meetings and TMA TWG

subcommittee meetings. The DAMM director and one of the private sector TMA Champions facilitated the “Text

and Regulations” subcommittee meeting. The former Secretary General of MOPH attended and gave a speech

13

at the TMA TWG meeting on March 18th, which was facilitated by the DSFa director. The NMCP coordinator

facilitated the first session with the RBM and the private sector on November 14th, 2019.

• IMPACT planned to hold an in-person advocacy training for the Champions in Year 2, but COVID-19 prevented

this due to restrictions on international travel (for the trainers from Senegal and Kenya) and gatherings. However,

seven Champions and the DPLMT director attended an overview session on the introduction to advocacy where

they were presented with the importance of an advocacy strategy. They discussed the case of a request for an

increase of the health budget for each program (malaria, MNCH, and FP) as one example of the need for advocacy

skills. The training will also equip them with capacities towards advocating with donors, the government, and

the private sector. A full advocacy training will be planned early in Year 3 for the Champions either in-person or

virtually.

• Malaria market assessment results and recommendations were presented to the TMA Champions for comments

before finalizing the document in order to gain their input through their questions and points to be applied to

the document.

Table 4: Number of TMI Champions trained in TMA and stewardship skills in Year 2


Y1



IR1.1.8 Number of TMI Champions/people, trained in TMA & stewardship skills (not unique trainees).

3 8 7 10 7 10 8

IR1.1.5: Disseminate the official TMI roadmap documents (overarching, Malaria, FP and MNCH) signed by representatives of the public, private and non-profit sectors

On September 15, 2020, IMPACT held a 20-minute sessionduring the weekly RBM group members meeting (MOPH,

donors, and implementing partners) to present the findings of the malaria market assessment. The outcomes of this

meeting were that IMPACT received comments from the RBM group members that helped to finalize the presentation

for the TMA TWG meeting in terms of the programmatic aspects of the findings and decided on the date of the public

dissemination of the report.

Sub-IR 1.2: GOM leads TMI stakeholders to coordinate health product quantification and forecasting, procurement,

and distribution according to market assessments and segmentation

IR1.2.1 : Organize meetings to revise and validate the Terms of Reference (ToR) of the UTGL to ensure its updated

tasks and responsibilities.

The coordination of all stakeholders is key to leverage available resources and increase efficiency in operations aiming

at building a strong and resilient public supply chain in Madagascar. Members of UTGL are appointed officially through

a ministerial decree for a period of two years, and the last decree was valid up to August 2018, and needs to be

renewed.

• IMPACT supported the UTGL to review the membership of the UTGL, organization of different committees, and

prepare a draft of the ministerial decree to officially appoint new members of the UTGL. Per the new decree, the

UTGL will be composed of 24 members representing various directorates and services of the MOPH and 10

representatives of the Technical and Financial Partners (TFPs) (USAID, UNICEF, UNFPA, WHO, World Bank, the

Principal recipient of the Global Fund, the European Union, IMPACT, ACCESS, and ACCESS Collaborative). The

committee is appointed to run under a three-year mandate.

• The ministerial decree was submitted to the Prime Minister for legal review. The decree to appoint the UTGL

members was approved in September 2020 by the Government Council. Then after, the UTGL members will be

oriented to ensure all members understand their roles and responsibilities and develop an annual action plan of

the UTGL.

14

IMPACT collaborated with PSI and the Unité de coordination des Projets (UCP) (Global Fund Principal Recipients) to

support the Secretariat General Office of the MOPH, DGFS, DPLMT, and PNLP in the process of redefining roles and

responsibilities of all actors of the public sector supply chain at all levels. This activity was conducted in five phases:

• A literature review of all documents, guidelines, legal texts, and standard operating procedures related to the

management of medicines and medical supplies related to selection, quantification, procurement, logistics,

rational use, information system, regulation, and Human Resources.

• A first workshop was conducted from November 4th to 8th with 40 participants from the central directorates of

the MOPH, EMAR and EMAD, district and regional hospitals, CSBs (basic health centers), CHVs, and TFPs to review

the current Terms of Reference (TOR).

• In Quarter 2, a draft of the revised TOR was developed in compliance with other texts related to the management

of FANOME, SALAMA, Pha-G-Dis, Pha-Ge-Com, hospitals, CSBs, and community health policy.

• In Quarter 3, the draft of the revised TOR was shared with all central level directorates, the 22 Regional Health

Directorates, and 114 District Public Health services for feedback in Quarter 3.

• The draft integrating feedback and input will be ready for validation by the MOH in October.

The review process took longer than planned to involve all actors of the supply chain at all levels (central, region,

districts). The inclusion of all actors in the process will increase ownership of the document developed. The revised

TOR includes the roles and responsibilities of the hospital pharmacists, the President COGE (Comité de Gestion) at

commune level, the mayor of communes, the creation and functioning of Gestion des Approvisionnements et stocks

(GAS) committees under vertical programs, regions, and districts.

IR1.2.2: Organize quarterly meetings (UTGL, CGL, and GAS committee) to analyze routine data on key indicators in

public hospitals, such as stock-out, LMIS issues, etc. for learning and adapting the use of DHIS2 in collaboration with

the MERL team.

The UTGL will increase involvement of pharmacists at regional and district hospitals in streamlining both the

distribution and management of free health commodities from vertical programs within hospitals.

In Year 2, IMPACT supported the Direction de la Pharmacie, des Laboratoires et de la Médecine Traditionnelle (DPLMT)

to organize a one-day meeting on February 20th to discuss and define the distribution flow and process for hospitals

to order commodities for malaria, FP, MNCH, tuberculosis (TB), HIV/AIDS, and correct use of analgesic

medicines(analgesics medicines are not managed under vertical programs but the meeting combined both vertical

programs and analgesics medicines).

As results of this workshop:

• Twenty (20) out of 38 hospitals, representing 53% of hospitals, ordered malaria commodities on a quarterly basis

and reported on monthly consumption and stock status.

• Roles and responsibilities of the pharmacists were included in the revised TOR documents.

• Pharmacists attended the quantification workshops for malaria in June and MNCH commodities in September.

• Seven (7) out of 15 pharmacists, representing 47% of pharmacists, collected and shared historical data on

consumption of malaria commodities (artemisinin-based combination therapies [ACTs], rapid diagnostic tests

[RDTs], and Sulfadoxine-Pyrimethamine [SP]) from 2018-2020 for forecasting.

• Pharmacists committed to monitor the rational use of malaria commodities and analyze the number of patients

reported in the register and treated in compliance with the Standard Treatment Guidelines. In case of non-

compliance, as agreed in the meeting, pharmacists will disseminate the Standard Treatment Guidelines and work

with PNLP for a proper training of hospital staff.

15

There is still a need to strengthen the collaboration between hospitals, MoPH at the central level (DPLMT, DAMM,

PNLP, DSFa, DLMNT, DLMT, DLIS, DPEV, DEPSI), and SALAMA for the management of commodities from vertical

programs.

III- 2 IR2: Strengthened capacity of the GOM to sustainably provide quality health products to the Malagasy

people

Sub-IR 2.1: Health commodities and pharmaceuticals are continuously accessible and available in the public sector

IR2.1.1: Provide capacity building through trainings and consistent coaching to GOM and partner members of UTGL

on forecasting and supply planning, including the use of Quantimed

In Year 2, IMPACT trained and mentored a total of 112 staff from the DPLMT, the NMCP, and the DSFa to build their

capacity on forecasting and supply planning:

• Two five-day workshops were held in December 2019 and June 2020 with financial and technical support from

IMPACT. An international expert in quantification, Andualem Oumer, provided capacity building to 52

professionals (in person in December and virtually in June) on quantification concepts, data analysis, making

assumptions and projections, use of Pipeline and Quantimed software to generate multi-year forecasting, and

supply planning of malaria commodities. During the December workshop, the Senior Supply Chain Advisor from

PMI Washington and the PMI Madagascar Resident Advisor participated in the quantification process for malaria

commodities and provided PMI guidance and perspective.

• A three-day workshop was jointly organized in May 2020 with UNFPA for the quantification of FP/RH

commodities. Capacity building was provided for 24 people through a mentoring process and hands-on support

as well as an orientation on the use of the Pipeline and Reality Check (for FP) software tools.

• A three-day workshop was organized in September 2020 for MNCH commodities. Thirty six (36) representatives

from SALAMA, the university (CHU) and regional hospitals (CHRD) , district (SDSP) health teams, CSBs, and some

private sector (pharmaceutical wholesalers) attended the workshop and were capacitated oriented to analyze

data to project future needs in excel workbooks.

Graph 1: Participants in various quantification workshops

Despite the trainings provided to the MOPH technical staff, only 50% of them are able to analyze and use existing

data, lead a team in making assumptions, and conduct forecasting and supply planning using the appropriate tools.

Indeed after the quantification workshops, most of the trained staff no longer use the process and tools on a regular

basis. Few of the participants are working in supply chain and most are normally in charge of duties other than

quantification, such as M&E, case management, etc. The DPLMT shared ToR for the quantification workshop with all

entities prior to the workshop to guide the selection of their representatives.

16

In the next fiscal year, IMPACT will focus on coaching a core team of 10 people (3 NMCP, 3 DSFa,1 DPLMT, 1 DEPSI,

and 2 SALAMA) who are involved in the quantification, distribution, and monitoring of supply chain activities on a

daily basis and can practice the use of tools appropriately. The core team will lead the future quantification process

with remote support from the international expert in quantification, and train others as needed.

IR2.1.2: Assist the GOM and UTGL members in leading the annual system wide forecasting exercises for the public

and private sector for FP/RH, MNCH, and malaria commodities and support UTGL and SALAMA to help mobilize

resources to procure commodities in the supply plans

The goal of the different workshops organized and described in section IR2.1.2 was to generate multi-year forecasting

and supply plans for 2020-2022 to mobilize necessary financial resources to procure malaria, FP, and MNCH

commodities:

Malaria Commodities

• From December 9th to 13th, 2019, a quantification review workshop organized under the leadership of the UTGL,

identified gaps in quantities of malaria commodities for 2020. To cover the gap, PMI and the Global Fund

proceeded with an emergency procurement of RDT, ACTs, and Arthemeter Lumefantrine.

• From April to June 2020, the malaria GAS committee developed a multi-year quantification plan that allowed

PMI to secure funding through the Malaria Operational Plan and reprograming process. Also, the quantification

results have been used during the grant making process under the new funding mechanism 3 (NFM-3) submitted

to Global Fund by the GOM for 2021- 2023.

• In September 2020, PMI committed to a total of $4,951,875 in funding out of a total budget needed of

$7,494,595 to cover the needs of malaria commodities for 2021 as estimated through the IMPACT supported

quantification exercises.

• There is still a gap of $2,542,720 to be mobilized from the Global Fund and the Government of Madagascar to

secure the necessary commodities. IMPACT will continue to support the NMCP to organize call-to-action

meetings to advocate and mobilize resources to fill this gap.

• In September, the NMCP and GAS committee organized a meeting with SALAMA to explore the transition of

Quinine to Artesunate injectable for the severe malaria case management. Existing stocks of Quinine at SALAMA

will continue to be distributed through FANOME together with Artesunate injectable. Meetings will continue to

inform medical doctors both in the public and private sector on this transition, through the professional

associations.

Table 5: PMI contribution to cover malaria commodities in 2021

Product Specifications Total Quantity

Needed in 2021 PMI Quantity

Procured Gap to Cover

Rapid Diagnosis Test Kit 10,681,097 7,162,105 3,518,992

ASAQ 25/ 67.5 mg (2-11m), treatment 263,020 194,830 68,190

ASAQ 50/135mg (1-5a), treatment 1,833,895 1,354,497 479,398

ASAQ 100/ 270mg (6-13a), treatment 1,220,772 847,066 373,706

ASAQ 100/ 270mg (>=14a), treatment 1,254,487 879,923 374,564

Artesunate 60mg injectable, vial 905,398 411,000 494,398

Rectal artesunate 100 mg, Box of 2 16,839 16,839

Quinine 300 mg tablet, Box of 100 4,511 4,511

Sulfadoxine Pyrimethamine 500/25 mg tablet, Box of 150

40,183 23,000 17,183

Gloves pieces, Box of 100 213,622 103,242 110,380

FP/RH Health Commodities

• IMPACT technically supported the FP/RH products quantification workshop organized from June 29th to July 2nd,

2020 to forecast the commodities needed to be distributed through the public and subsidized distribution

17

channels for the period of 2021 and 2022. Twenty four representatives of various directions from the MOPH,

ACCESS, IMPACT, Mahefa Miaraka, UNFPA, and ACCESS Collaborative attended the workshop

• The MoPH presented the forecasting and supply plans to USAID and UNFPA to secure funding and proceed with

procurement.

• The MoPH organized a separate meeting to present results of the quantification to private sector representatives

as they were not present at the quantification workshop.

• The forecast and supply plans will be presented to the CGL for validation in November, and then DSFa can

organize a meeting with all TFPs for resource mobilization to cover all needs for 2021.

Table 6: Quantification Forecasts for Family Planning Commodities 2021

PRODUCT Quantity/ PUBLIC SECTOR

Quantity/ MSM Quantity/ SOCIAL

MARKETING

Quantity/ Fianakaviana

Sambatra (FISA)

TOTAL

Oral contraceptives 1 506 542 183 977 3 013 637 65 690 4 769 846

Progestin-only oral contraceptive

180 944 - - 2 974 183 918

DMPA-IM 2 048 125 54 545 1 017 458 172 507 3 292 635

DMPA-SC 1 483 125 170 565 678 184 47 098 2 378 972

IUD 8 084 81 825 2 975 1 322 94 206

Implanon 101 173 314 371 36 559 18 260 470 363

Rojo 2 500 - 7 070 9 570

Condoms - Protector Plus

45 749 4 601 615 4 647 364

Condoms- Yes 1 796 052 1 796 052

Pillule Contraceptive d’Urgence

15 000 172 15 172

This table showcases the needs for the public sector, non-profit organizations (FISA, MSM), and for the social

marketing sector.

MNCH Commodities

• IMPACT supported DSFa to set up a Logistics TWG composed of representatives from DSFa, UNPFA, UNICEF,

ACCESS, IMPACT, Mahefa Miaraka, SALAMA, and DPLMT to coordinate and improve the management of the

MNCH commodities procured by SALAMA and donors.

• IMPACT provided technical and financial support to the DSFa/Service de Santé Maternité Sans Risque (SMSR) to

organize the annual quantification exercise of MNCH commodities from September 22nd to 24th, 2020. During

this meeting, participants analyzed demographic and service data to project cases and quantities needed.

• The quantification report will be validated by the CGL in November and will then be shared with SALAMA for

procurement as USAID will not procure MNCH commodities in FY 2021.

Although quantification exercises have been successfully conducted, the following challenges remain:

• Resource mobilization is needed to cover the gaps for malaria and FP commodities in order to avoid stockout.

• Need to engage SALAMA and the private sector in the procurement of MNCH commodities based on the

quantification results as currently SALAMA has only procured FANOME’s needs.

IR2.1.3: Coordinate orders, deliveries generation and pipeline monitoring according to agreed upon supply plan

with SALAMA, PSM, GOM institutions and USAID

IMPACT collaborated with PSM, SALAMA, and the GAS committees to generate orders in ARTMIS and track the

commodity procurement in Pipeline to ensure that deliveries of commodities in Year 2 are compliant with the

validated supply plans.

18

During Year 2, IMPACT:

• Placed orders in ARTMIS using validated forecasting and supply plans. The table 9 shows the delivered quantities

of malaria commodities funded by PMI.

• Continued to sub-contract SALAMA for storage and transportation services to distribute malaria commodities to

districts.

The following tables highlight the status of FP and malaria commodities delivered as there was no planned

procurement of MNCH commodities for this fiscal year.

Table 7: Family Planning Commodities Delivered in 2020

Product specifications Unit Quantity Ordered

Quantity Delivered

Comments

Depot (IM) Medroxyprogesterone Acetate 150 mg/mL (1 mL) Vial, SR, 1 Vial [PT Tunggal] [Triclofem]

1 vial 2,999,900 2,999,900 Delivery completed

Etonogestrel 68 mg/Rod, 1 Rod Implant, 1 Each [Implanon NXT]

1 rod implant

16,676 16,676 Delivery completed

Levonorgestrel/Ethinyl Estradiol 150/30 mcg + Fe 75 mg, 28 Tablets/Cycle (SM), 1 Cycle [Zinnia-F]

Cycle 1,052,352 1,052,352 Delivery completed

Levonorgestrel/Ethinyl Estradiol 150/30 mcg + Fe 75 mg, 28 Tablets/Cycle (SM), 1 Cycle [Zinnia-F]

1 Cycle 948,696 948,696 Delivery completed

Standard Days Method Color-Coded Plastic Beads, 1 Each [Cycle Technologies] [CycleBeads]

Each 21,000 20,994

Delivery completed with six pieces missing. The incident has been reported to PSM.

Pregnancy test, test 200,000 200,000 Delivery completed

Table 8: Status of 2020 orders - Family Planning

Product Unit Quantity Ordered

Quantity delivered

Quantity remaining

Comments

Etonogestrel 68 mg/Rod, 1 Rod Implant, 1 Each

piece 35,064 35,064 0 Delivery completed

Standard Days Method Color-Coded Plastic Beads, 1 Each

piece 17,000 16,998 2

Delivery completed with two pieces missing. The incident has been reported to PSM.

Depot (IM) Medroxyprogesterone Acetate 150 mg/mL (1 mL) Vial, w/ AD Syringe, 1 Each

vial 1,600,000 1,600,000 0 Delivery completed

Levonorgestrel/Ethinyl Estradiol 150/30 mcg + Fe 75 mg, 28 Tablets/Cycle (PS), 1 Cycle

Cycle 3,200,400 3,200,400 0 Delivery completed

Pregnancy test test 400,000 0 400,000

Pre-alert shipment received on September 24th and is planned to arrive in October

Male Condom (Latex) Lubricated, Protector Plus v2, 53 mm, 48

Piece 5,002,560 0 5,002,560 Pre alert shipment notice received on

19

Product Unit Quantity Ordered

Quantity delivered

Quantity remaining

Comments

Pcs/Dispenser, 90 Disp/Case, 4320 Pieces

September 30th. Estimated arrival date of October 2020

Table 9: Status of 2020 orders – PMI-funded malaria commodities

Product specification Quantity

ordered/ unit

Quantity delivered/

unit

Quantity remaining

Comments

Artemether/Lumefantrine (5kg-15kg)20/120 mg Dispersible Tablet/ 30x6x1, treatment

29,280 29,280 - Delivery completed

Artemether/Lumefantrine (15kg-25kg)20/120 mg Dispersible Tablet/30x6x2 treatment


Artemether/Lumefantrine (25kg-35kg)20/120 mg Dispersible Tablet/30x6x3 treatment

64,800 64,770 30

Delivery completed. One box was sampled for quality control.

Artesunate/Amodiaquine 25/67.5 mg Tablet,25x3 blister, treatment


Artesunate/Amodiaquine 50/135 mg Tablet, 25x3 blister, treatment


Artesunate/Amodiaquine 100/270 mg Tablet, 25x3 blister pack, treatment


Artesunate/Amodiaquine 100/270 mg Tablet, 25 x 6 Blister Pack, treatment


Examination Gloves (Latex) Small, Powder Free, Non-Sterile, 100 Each [Top Glove]

4,581,000 4,579,000 2,000

Delivery completed by GHSC-PSM. 2,000 gloves were missing upon receipt. SALAMA is proceeding with reimbursement.

Malaria Rapid Diagnostic Test (RDT) HRP2/pLDH (Pf/PAN) Cassette, 25 Tests

2,290,325 2,290,325 - Delivery completed

Artesunate powder for injection, 60 mg, vial 25,000 25,000 - Delivery completed

Sulfadoxine/Pyrimethamine 500/25 mg Tablet, 50 x 3 Blister Pack Tablets

10,000 - 10,000 Delivery planned in January 2021

Due to the COVID-19 pandemic, deliveries of commodities have been impacted by the lockdown imposed globally.

IMPACT continued to receive weekly updates from PSM on the status of orders and share information with the GAS

committee to adapt in-country distribution plans, prepare for custom’s clearance once the commodities arrived in

country, and organized reception and storage at SALAMA and PSI warehouses. Despite the lockdown imposed due to

COVID-19, IMPACT supported SALAMA to clear and receive the products on time into SALAMA and PSI warehouses,

while respecting distancing measures and all security measures to protect storekeepers. This was important to assure

delivery of essential health commodities even during the pandemic, as it is essential to maintain routine health

services.

IR2.1.4: Provide technical assistance to support the central level GAS Committees to develop quarterly distribution

plans for malaria, MNCH, and FP/RH products based on quarterly stock status obtained from district/GAS

committees

20

A. Malaria Commodities

• IMPACT supported the central malaria GAS committee to collect and analyze quarterly requisitions and LMIS

data to generate accurate, efficient, and timely distribution plans. Once quarterly distribution plans were

validated, IMPACT closely monitored the transport of the commodities to Pha-G-Dis through routine

distribution and emergency distribution when required.

• Throughout Year 2, IMPACT supported the malaria GAS committee to plan shipments to 114 districts (and

115 Pha-G-Dis in total including Tsaratanàna North and South) for both PMI and Global Fund funded

commodities on a quarterly basis. As shown in table 10, PMI procured and distributed treatment for

uncomplicated and severe malaria cases (all ages), while Global Fund procured and distributed more rapid

diagnostic tests kits.

Below is a table summarizing the quantities of commodities shipped to districts every quarter per donor funding.

Table 10: Distribution of malaria commodities in FY20 from SALAMA to 115 Pha-G-Dis per donor

PRODUCTS

Quantity delivered to Pha-G-Dis in

Quarter1


Quarter2


Quarter3


Quarter4

Total Qty delivered to Pha-G-Dis during FY20

PMI GF PMI GF PMI GF PMI GF Total

Artemisinin-based combination therapy (ACT) Newborn

-

67,300

-

13,775

31,775

11,800

7,750

500

132,900

Artemisinin-based combination therapy (ACT) Infant

-

188,675

-

10,475

185,875

-

71,950

-

456,975

Artemisinin-based combination therapy (ACT) Adolescents

145,225

1,850

86,450

-

154,900

47,850

66,700

-

502,975

Artemisinin-based combination therapy (ACT) Adult

127,425

-

158,125

-

132,050

17,825

67,250

75

502,750

Artemether/Lumefantrine (5kg-15kg)20/120 mg Dispersible Tablet/ dose

-

-

-

26,610

23,940

5,010

600

-

56,160


-

-

-

-

85,980

5,940

-

-

91,920


-

-

-

-

-

29,910

-

-

29,910

Artemether/Lumefantrine (35kg et plus)20/120 mg Dispersible Tablet/ dose

-

-

-

-

20,010

-

8,460

28,470

Artesunate 60 mg-inj-BTE/ 1

39,643

-

61,969

-

22,600

48,121

1,800

-

174,133

Rapid diagnostic tests (RDTs)

-

1,010,000

709,100

379,500

286,725

1,734,000

508,875

172,650

4,800,850

Sulfadoxine-pyrimthamine (SP) tablets

252,100

-

1,276,800

-

838,300

1,474,550

-

513,900

4,355,650

Challenges/Solutions:

21

a. The quantity of Sulfadoxine-Pyrimethamine distributed was less than predicted and could potentially lead to

expiration and waste. To correct this situation, IMPACT:

• Supported technically and financially the NMCP and its partners, including the DSFa, to organize a workshop on

March 19th and 20th, 2020, to discuss and adopt strategies to increase the use of SP during pregnancy and

estimate excess of stock approximately 5,713,800 tablets at risk of expiration.

• In April, IMPACT collaborated with GHSC-PSM to explore a transfer of the excess of SP stock to Zambia to avoid

wastage. This option was abandoned due to the GOM decision to use the SP for a mass drug administration.

• On April 27th, the GOM decided to distribute the excess stock of SP through a mass administration in 9 districts

with high prevalence of malaria (Bekily, Befotaka, Marolambo, Iakora, Ivohibe, Ikalamavony, Manja, Beroroha,

and Vondrozo). The mass SP administration was conducted in May and June and a total quantity of 2,619,575

tablets was distributed.

• In July and August, IMPACT supported the GAS committee and NMCP to track and monitor the management of

the leftover quantity of 3,094,225 tablets of SP after the mass drug administration and plan a redistribution to

cover the needs at the district level in the first quarter of Year 3 (October to December).

• In September, IMPACT funded the transportation and redeployment of 885,150 tablets from the districts of

Vondrozo, Betroka, and Ikalamavony to supply the necessary quantities in 37 Pha-G-Dis of Atsimo Antsinanana,

Vatovavy Fitovinany, Anosy, Androy, Atsimo Andrefana, Ihorombe, Haute Matsiatra, Amoron’i Mania, and

Vakinankaratra. The quantity redeployed was from the stock procured by PMI. The redeployment activity will

continue with the Global Fund procured stock in the coming months.

• Due to coordinated efforts of all RBM members to conduct a push distribution of SP to all districts and sensitize

health centers to order and use the SP correctly, consumption of SP has increased by 75% (the rapport- bon de

commande reported by districts show an increase in consumption) and there is no longer a risk of expiration.

IMPACT will continue to support the NMCP to define realistic targets based on consumption to forecast as accurately

as possible and plan future orders.

b. Difficulty of SALAMA to respond to emergency distribution of malaria commodities;

Due to COVID-19, the delay in the delivery of malaria commodities has impacted in-country stock status and

districts have reported an increase in malaria cases in Madagascar since January 2020. To face the insufficient

stocks at the central level and the inability to fulfill all requisitions submitted by the Pha-G-Dis, IMPACT supported

the malaria GAS committee to:

• Mobilize resources from Global Fund and PMI for an emergency procurement of Arthemeter –Lumefantrine (AL)

to treat simple malaria cases: 214,320 doses by the Global Fund and 185,760 doses by PMI (all different

formulations).

• Develop and disseminate guidelines to use both AS/AQ and AL to treat simple malaria cases. An instruction letter

was signed by the MOH Secretary General and disseminated with a job aids on the correct use of AL.

• Impose a rationing system of distribution based on quantities available at SALAMA by which districts can only

receive the minimum stock level of 3 months.

• Limit the use of ACT and RDT to routine case management of patients at health facilities (CSB, hospitals) and

community levels. The MOH Secretary General signed a notice to instruct districts on this temporary measure.

• Organize emergency transportation to the 114 districts to face the increase of malaria cases and critical

shortages.

• IMPACT Regional Logistic Advisors (RLAs) supported the district GAS committees and regional UTGL to organize

redeployment of overstock of drugs at district and commune levels in the 13 USAID supported regions. Table 11

summarizes the quantities of malaria commodities redeployed in Year 2.

From July, PMI and Global Fund orders were being delivered in-country and the normal distribution system resumed

by allocating the maximum stock of 6 to 9 months to districts in Quarter 1 of Year 3.

22

Table 11: Malaria commodity redeployed in all 78 districts during Year 2

Product specifications Quarter 1 Quarter 2 Quarter 3 Quarter 4

Total quantity

redeployed in FY20

ASAQ 25/ 67.5 mg of 3 tabs(2-11M), treatment

16,279 11,806 34 687 28,806

ASAQ 50/135mg of 3 tab(1-5Y), treatment

36,536 6,806 300 250 43,892


20,291 11,015 3,970 6,054 41,330


20,257 9,274 4,738 2,018 36,287

Artesunate powder for injection, 60 mg, vial

9,097 1,737 1,300 3,015 15,149

Malaria Rapid Diagnostic, Test 45,952 52,566 8,125 21,800 128,443

Sulfadoxine-pyrimethamine (SP) 500/25 mg, tablets

100,673 48,215 9,050 894,150 1,052,088

The high quantity of SP redeployed in Quarter 4 is related to the leftover SP from the mass distribution. The redistribution also constituted a strategy to avoid expiration of commodities in districts with overstock to the districts that ordered SP at the central level. The central level distribution will be suspended while redistributing leftover quantities available at the community level. The RLAs will continue to work with the Pha-G-Dis , EMAD and ACCESS to ensure SP is used appropriately at the health center level to maintain consumption and avoid expiration.

Table 12: Malaria commodity redeployed from 26 CSB to Pha-G-Dis

Product specification Quarter 1 Quarter 2 Quarter 3 Quarter 4 Total quantity redeployed in

FY20

ASAQ 25/ 67.5 mg of 3 tabs(2-11M), treatment

- 894 279 68 1,241


- 351 6 286 643


- 431 31 91 553


- 593 33 53 679

Artesunate powder for injection, 60 mg, vial

- 152 4 45 201

Malaria Rapid Diagnostic, Test - 3,954 508 187 4,649

Sulfadoxine-pyrimethamine (SP) 500/25 mg, tablets

- 14,950 92,700 1,800 109,450

The commodities were brought back with the five Pha-G-Dis within their respective districts to then be redistributed

according to the need.

c. MNCH Commodities:

In Quarter 2, IMPACT supported DSFa to set up a TWG to improve coordination of stakeholders involved in the supply

chain of MNCH commodities. IMPACT reinforced the capacity of the SMSR to organize three meetings of the Logistics

TWG that led to:

• Identification of all TFPs involved in the MNCH commodities supply chain.

• Development of a dashboard for monitoring stock status of MNCH commodities at the central level, which allows

for the detection of stock imbalances and the ability to identify corrective measures.

23

• Development and validation of a report format that will be used by districts while reporting on logistics data

(consumption, stocks available, days of stock out, expiration dates, etc.) to the central level.

In June, IMPACT supported the MNCH TWG to collect requisitions, analyze consumption data reported, and plan for

SALAMA distribution of Oxytocin, MgSO4, Gentamycin 20 mg, and Gentamycin 80mg to 95 districts and seven national

and regional hospitals who submitted requisitions. These districts were prioritized as the other 9 districts had been

supplied with the MNCH commodities by the PARN project and had sufficient stocks. The other hospitals had ordered

sufficient MCH commodities from SALAMA and not through DSFA, which highlights the importance of unifying the

supply chain for these commodities. The table below summarizes the second shipment of MNCH commodities to

districts in August and September 2020.

Table 13: Distribution of MNCH commodities funded by USAID in 2020.

PRODUCT SPECIFICATIONS Quantity distributed in Quarter1

Quantity distributed in Quarter2



Total Quantity distributed during FY20

GENTAMICINE 10MG/ML INJ - AMPOULE 2ML - (20MG)

- - - 76,100 76,100

GENTAMICINE 40MG/ML INJ - AMPOULE 2ML - (80MG)

- - - 35,900 35,900

MAGNESIUM SULFATE 50% INJ.AMPOULE .10ML

- 600 400 11,590 12,590

OXYTOCINE 10UI/ML INJ. AMPOULE. 1ML -

- - - 298,150 298,150

MISOPROSTOL 200 Mcg tablets, box of 4 tablets

17,904 17,904

The MNCH commodities have been distributed to the 95 Pha-G-Dis and 7 hospitals that submitted an order to SALAMA

and DSFa.

At the district level, the RLAs supported the district GAS committees to integrate stock status analysis of MNCH

commodities in their quarterly meetings and plan for redistribution to minimize the risk of expiration.

The tables below summarize the quantities of MNCH commodities that have been redistributed in Year 2, through

the support of the RLAs, to the district GAS committees.

Table 14: MNCH commodity redeployed from 6 districts in FY20

Product Specification Quarter 1 Quarter 2 Quarter 3 Quarter 4

Total quantity redeployed in FY20

CHLORHEXIDINE 7.5%, solution

0 0 1,320 - 1,320

MISOPROSTOL 200 Mcg tablets

0 0 480 920 1,400

OXYTOCINE 10UI/ML INJ. AMP. 1ML

0 0 - 1,040 1,040

MAGNESIUM SULFATE 50% INJ.AMP.10ML

0 0 - 30 30

GENTAMICINE 10MG/ML INJ - AMP 2ML - (20MG)

0 0 - 200 200

Chlorhexidine is donated by UNICEF to the district of Vavatenina and was redeployed to the districts of Brickaville,

Vatomandry, and Antanambao Manampotsy because these districts had low stock.

24

Table 15: MNCH commodity redeployed at the commune level in Year 2

Product specification Quarter 1 Quarter 2 Quarter 3 Quarter 4 Total quantity

redeployed in FY20

OXYTOCINE 10UI/ML INJ. AMP. 1ML

0 59 0 53 112

MAGNESIUM SULFATE 50% INJ.AMP.10ML

0 17 0 485 502

GENTAMICINE 10MG/ML INJ - AMP 2ML - (20MG)

0 5 0 0 5

MISOPROSTOL 200 Mcg tablets

0 0 0 130 130


Risk of expiration of a stock of 634,000 units of Oxytocin:

In Year 2, IMPACT supported DSFa to reassess the consumption of Oxytocin and identified a risk of expiration of huge

quantities of the product. To minimize the risk of waste as the product is due to expire in May and June 2021, IMPACT:

• Collaborated with GHSC-PSM to explore opportunities for transferring certain quantities to other countries. In

August, Malawi agreed to receive a donation of 650,000 blisters. The quantity was reduced to 260,000 ampoules

due to unavailability of funds to transport the product from Madagascar to Malawi. The transfer process is still

ongoing.

• Explored the opportunity to distribute Oxytocin through other sectors (faith-based organizations, NGOs, and the

private sector).

• Followed up with UCP on the arrival of cold chain equipment to allow Pha-G-Dis and CSB to store Oxytocin

properly. Currently, 37 Pha-G-Dis (out of the 78 supported districts) use the available district cold chain system

for vaccines which can result in a limitation to consumption and use of Oxytocin.

IMPACT will advocate for more involvement of SALAMA in the MNCH TWG to streamline the procurement and better

manage MNCH commodities. The plan is to gradually transition the procurement of MNCH commodities previously

procured with USG funds to SALAMA and distribute them through the FANOME channel.

Family Planning Commodities

The RLAs support the district GAS committees to analyze monthly inventory of stocks and identify actions to avoid shortage or expiration of FP commodities. Below are tables that summarize the quantities of FP commodities that were redeployed at the district and commune level in Year 2.

Table 16: FP commodity redeployed from 14 districts to 18 other districts in need in FY20

Product specification Quarter 1 Quarter 2 Quarter 3 Quarter 4 Total quantity redeployed in

FY20

Microlut 0 612 - 900 1,512

Etonogestrel 68 mg/Rod, 1 Rod Implant

0 370 - - 370

Sayana Press 0 210 - 2,600 2,810

Male condoms 0 576 - 7,200 7,776

DIU 0 - - 10 10

Depot (IM) Medroxyprogesterone Acetate 150 mg/mL (1 mL) Vial

0 6,690 - - 6,690

Levonorgestrel/Ethinyl Estradiol 150/30 mcg + Fe 75 mg, 28 Tablets/Cycle (PS),

0 30 - 2,016 2,046

25

The commodities were redeployed to other 18 districts in need. Details of districts are presented in Annex M – Table

1

Table 17: FP commodity returned from 18 CSB to their respective Pha-G-Dis in FY20

Product specification Quarter 1 Quarter 2 Quarter 3 Quarter 4

Total quantity

redeployed in FY20

Microlut 0 0 123 81 204

Etonogestrel 68 mg/Rod, 1 Rod Implant

0 0 28 57 85

Sayana Press 0 0 379 80 459

Male condoms 0 0 626 0 626

DIU 0 0 24 12 36

Depot (IM) Medroxyprogesterone Acetate 150 mg/mL (1 mL) Vial

0 0 450 71 521

Standard Days Method Color-Coded Plastic Beads,

0 0 6 12 18

Levonorgestrel/Ethinyl Estradiol 150/30 mcg + Fe 75 mg, 28 Tablets/Cycle (PS),

0 0 18 174 192

Details of CSB are presented in Annex M – Table 2

Implementation of the Last Mile distribution strategy: as an interim measure to resolve the issue of transportation

of malaria commodities from Pha-G-Dis to CSB/Pha-Ge-Com, IMPACT has provided targeted support to resolve some

of the bottlenecks identified. Throughout Year 2, the RLAs have:

• Collaborated with Assistants Techniques Régionaux (ATRs) from UCP to collect and validate invoices and

supporting documents submitted by districts and CSBs which the SDSP send to the UCP to request payment.

• Status of payment: 41 out of 78 Pha-G-Dis (52%) have already received payment for the storage costs, and 221

out of 1,762 CSBs (12%) have already received reimbursement for transport costs. This is still very low and RLA

will collaborate with UCP/ATR to move forward implementation of this strategy.


• Districts submit late and incomplete documents to request reimbursement for storage and transportation fees.

To overcome these issues, IMPACT collaborated with UCP-ATR to orient the EMAR and EMAD on how to do a

check-list and complete the documentation required by UCP.

• IMPACT will organize a meeting with UCP at the central level to coordinate on providing feedback to districts to

improve the completion of the required documentation.

• IMPACT coordinated with ACCESS to support CSBs by filing and submitting requests for reimbursement.

IMPACT will continue to collaborate with UCP to ensure that reimbursement of storage fees and transportation for

Global Fund supported commodities are paid on time to better implement the last mile distribution strategy.

IR2.1.5: Leverage efforts and funding with the Global Fund, ACCESS, Mahefa Miaraka and other partners to conduct capacity buildings( TOT, cascade trainings, on-the-job trainings) for supply chain management at all levels of the supply chain, in collaboration with the UCP/Global Fund, ACCESS, Mahefa Miaraka and other partners

At the district level, the RLAs continued to reinforce the capacity of the 13 regions and 78 district staff in supply chain

management and ensure that malaria, FP, and MNCH commodities are available at the CSB through the last mile

distribution.

Establishment of coordination forums at regional and district levels.

26

• Creation of 13 regional UTGLs (3 in Year 1 and 10 in Year 2) and 78 districts GAS committees (22 in Year 1 and 56

in Year 2)

• Supported 163 district GAS committees and 34 regional UTGL meetings. The agenda of these meetings was

focused on reinforcing capacity of members on stock analysis of malaria, FP, and MNCH commodities and how

to adopt corrective actions to correct stock imbalances.

Graph 2: Establishment of remaining Regional UTGL and District GAS committees in Year 2

Supervision of Pha-G-Dis, CHRD, and Pha-Ge-Com in FY20:

• During Year 2, the RLAs conducted on-the-job supervision visits in all the 78 Pha-G-Dis (out of 78) with an average

of one visit per quarter and 679 (out of 1,792) Pha-Ge-Com and three (out of 78) Centre Hospitalier De Reference

de District (CHRDs) to reinforce stock managers’ capacities to: 1) update the Average Monthly Consumption

(AMC), 2) estimate real needs and proceed with ordering, 3) fill out management and LMIS tools including

CHANNEL, 4) manage the stock in compliance with best storage practices, 5) reconcile the physical inventory

with CHANNEL data, and compare data reported on available stock and consumption at health centers in DHIS2

to detect inconsistencies and proceed with corrections.

6

3

0

1

10

33

19

2

2

56

0 10 20 30 40 50 60 70

Quarter1

Quarter2

Quarter3

Quarter4

FY20

Establishment of Regional UTGL and District GAS Committee

UTGL Commitee GAS

27

• The RLAs identified areas of weaknesses, defined corrective measures during Pha-G-Dis and Pha-Ge-Com visits,

and assessed performance and improvement during the next supervision visit. The most common weaknesses

are:

✓ Average monthly consumption (AMC) are not regularly updated and don’t consider malaria seasonality

during the ordering process.

✓ Distribution plan of commodities from Pha-G-Dis to CSB (basic health center) is not available or not

followed.

✓ The template of Reporting- Ordering is not systematically used by CSB to report and order commodities

(Rapport- Bon de commande) to Pha-G-Dis.

Corrective measures defined are:

✓ AMC were updated to take into consideration the malaria seasonality.

✓ Distribution plans for commodities from Pha-G-Dis to CSB were developed.

✓ Pha-G-Dis were urged to adhere to the distribution plan.

✓ Print copies and support the CSB to fill the Rapport- bon de commande.

Graph 3: Percentage of Pha-G-Dis and Pha-Ge-Com supervision visits in 2020

• In Quarter 3 and Quarter 4, the RLAs pretested the SPARS tool that is being developed with remote support from

the central level. The following results were achieved:

o Tools were harmonized with the existing guides (supervision, EMMR).

o Data was collected during the supervision visits to allow the supervisor and supervisee to visualize scoring

through a graph and to agree upon a plan to reinforce capacity building and define corrective measures for

improved performance in commodity management.

o SPARS tools were pretested in 77 Pha-G-Dis (out of 78) and supervision grid applied to 683 Pha-Ge-Com

(out of 1,734), supervised by the RLAs, supervised by the RLAs, in collaboration with regional (EMAR) and

district (EMAD) teams and finalized in Quarter 4 and will be used for future supervision visits.

o In Quarter 4, the RLAs ranked the performance of their respective districts according to the SPARS grid,

which showed that:

- 36% of Pha-G-Dis (28 Pha-G-Dis) were classified as performing,

- 51% as moderately performing (40 Pha-G-Dis)

- 13% still in poor performance (9 Pha-G-Dis with frequent stock outs, inappropriate storage conditions,

low rate of LMIS reporting).

77%86%

68%

90%

10% 12%7% 10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Quarter1 Quarter2 Quarter3 Quarter4

Supervision visits of PHA-G-DIS and Pha-Ge-Com

PHA-G-DIS supervised (N=78) Pha-Ge-Com visited (n=1792)

28

Training/refresher training on stock management and use of CHANNEL software:

• Coordinated with ACCESS, Mahefa Miaraka, and various directorates of the MOPH (DSSB, DSFa, DPLMT, DEPSI,

Service de Formation Professionnelle, and DLMNT) to review/update the training curriculum and materials on

stock inventory management for the CSB. The updated training curriculum has been validated by the Service de

Formation Professionnelle of the MOH in January 2020.

• In Year 2, IMPACT rolled out training/refresher training on stock management for the EMAR and EMAD teams,

and CSB staff. Trainings for the Basic health center (CSB) staff were jointly organized with ACCESS:

o 1,195 personnel (560 male, 635 female) of district and CSB staff have been trained on stock inventory

management.

o 110 (66 male, 44 female) district staff were trained on the LMIS Channel software.

Disaggregation per level is found in the graphic below.

Graph 4: Participants at training sessions on stock inventory management and LMIS Channel

Collaboration with other USAID Implementing partners: Mahefa Miaraka, ACCESS, and Institut Pasteur de

Madagascar (IPM)

352

717

58

491

636

0

11556

93 78

0

100

200

300

400

500

600

700

800

Face-to-face trainings on-the-job trainings Online/virtual trainings Men Weman

Participants at the trainings sessions on stock inventory management and LMIS Channel

Stock inventory management LMIS (Channel)

147

45

58 56 54 626 679

211

734

0 0 0

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Training in stockmanagement-Face to face

On the jobtrainings in stock

management

Online/virtualtrainings on stock

management

Online training onChannel

On the jobtraining on

Channel

Men Women

District Staff CSB Staff

29

• The RLAs organized meetings monthly with representatives of Mahefa Miaraka, ACCESS, and ATR/UCP to share

stock status levels and analyze issues around availability of malaria, FP, and MNCH commodities to better

coordinate transportation of commodities. Dashboards on the stock statuses of Pha-G-Dis were discussed, as

well the status of shipments from SALAMA, detection of CSBs at high risk of stock outs, and proposing corrective

measures.

• Provided technical assistance to IPM in preparation of the extension of malaria Community Case Management

study (mCCM) being implemented in Farafangana district and sponsored by USAID PMI. IMPACT has:

o Contributed to weekly meetings to identify activities to ensure that necessary commodities (ACTs, RDT) are

available on time for the study since June 2020.

o Supported technically and financially the supervision visit by the NMCP in July 2020. As an outcome of this

supervision visit, EMAD, in close collaboration with IPM and INTERAIDE, has analyzed data and estimated

the needs (including a 3-months security stock), submitted an order to NMCP, and planned refresher

trainings on stock management for IPM, INTERAIDE, districts, CSBs, and CHVs staff.

o Coordinated with SALAMA to the supply to IPM of a 3-month stock of ACT, RDT, gloves that will serve as a

security stock.

o Trained three IPM staff and one INTERAIDE staff on the management of health commodities from

September 30th to October 2nd, 2020.

• A second supervision visit will be conducted in October to contribute on the startup of the study including in the

job trainings of CSB staff and CHVs.

Equipment and Materials

IMPACT leveraged resources from UCP-Global Fund, the World Bank, districts, and the private sector to equip Pha-G-

Dis with basic equipment to upgrade storage conditions and improve their working space.

• Purchased and distributed 40 laptops for 40 Pha-G-Dis districts. UCP distributed 9 laptops in 2020 (List in Annex

I). As of now, all the 78 Pha-G-Dis have a laptop to collect logistics data, update CHANNEL, and report to DPLMT

on a monthly basis.

• Purchased 67 thermometers for 41 Pha-G-Dis to monitor temperature and humidity of the storage rooms. The

37 other districts have received a donation of thermometers from DPLMT.

• Cost-shared with districts on the purchase of shelves to improve storage conditions in the Pha-G-Dis of Tulear I

(December 2019), Isandra (June 2020), and Vohibato (June 2020).

• Mobilized a local private sector transportation company (ANDRIAMBOLOLONA Solofoson) to repair refrigerators

donated by DPLMT and connect the Pha-G-Dis of Vohibato to the electrical system. The refrigerator donated by

DPLMT is now functioning and can properly store heat-sensitive medicines.


• The functioning of the regional UTGL and district GAS committees is still dependent on IMPACT technical

assistance in 38 districts (out of 78 districts). In Year 3, IMPACT will continue to assist the regional and district

authorities for the organization and leadership of the meetings .

• 38 Pha-G-Dis still need equipment to comply with best storage practices since boxes are placed directly on the

ground, lack of refrigerators to store Oxytocin and other thermosensitive products, etc. IMPACT is looking for

opportunities through private sector partnerships and the UCP (Global Fund and World Bank) to support the

renovation and equipment for the district pharmacies.

• Logistics data inconsistencies have been identified in 19 Pha-G-Dis visited and require further investigation.

Quantities delivered by SALAMA or districts were not recorded on stock cards or in the CHANNEL software. This

is leading to inaccuracy of data and wrong quantification and causes an issue with traceability. The analysis will

continue with IMPACT support through regional UTGL and district GAS committees who will implement

corrective actions.

30

IR2.1.6: Assist the MOPH in creating a five-year LMIS strengthening roadmap and developing and testing a new

LMIS software using results from the LMIS in-depth evaluation

In Year 1, IMPACT collaborated with DPLMT and DEPSI to conduct an in-depth assessment of the existing LMIS and

collect the evidence for improvement (infrastructure and equipment, architecture of CHANNEL, human resources

capacity, interoperability with DHIS2, etc.) in the public, private, and social marketing sectors. The report was finalized

in Year 2 and disseminated to DPLMT and DEPSI in preparation of a larger dissemination workshop. Based on the

findings, the DPLMT has agreed to replace Channel with a more performant software which will be selected based on

criteria established and discussed in the upcoming workshop. The plans were made to organize the dissemination

workshop in March 2020 to share the findings and support the MOH in establishing a five-year consensus-based

strategic roadmap for the implementation of a comprehensive and efficient LMIS in Madagascar. The workshop was

postponed until November 2020 due to COVID-19 and the restrictions on gathering people.

IR2.1.7: Generate evidence through a national supply chain assessment and End User Verification surveys to develop adequate strategies, policies, and SOPs for securing commodities and strengthening the public supply chain

To generate the evidence necessary to develop appropriate strategies related to the supply chain, IMPACT conducted

the first End User Verification (EUV) survey in Year 2 under the MOH leadership and with technical assistance from

the GHSC-PSM project:

• In September 2019, GHSC-PSM provided guidelines and questionnaires on how to conduct the updated EUV

survey, develop training curriculum, define sampling methodology, as well as on the new software

recommended to collect data (Survey-CTO), and determine 18 key indicators related to stock management (10

indicators), facility and storage management (3 indicators), and malaria case management (5 indicators).

• From January 13th to 31st, 2020, data collection was conducted in 77 CSBs, three CHRD, 30 Pha-G-Dis, and the

central medical store (SALAMA).

• Reports were shared and validated by USAID, PMI, GHSC-PSM, and the MOH.

• Key findings of the EUV are highlighted below and implementationrecommendations. by the district GAS

committees and the regional UTGLs with the support from the RLAs.

1. Key findings:

1. 96% (77/80) of SDPs visited were stocked with any World Health Organization (WHO) pre-qualified AS-

AQ formulation, and 94% with RDTs. However, only 64% (51/80) of SDPs were stocked with at least one

formulation of ACTs to treat children under five years;

2. 100% of malaria cases were diagnosed and confirmed positive using RDTs;

3. No ACT was administered to children under five years not diagnosed with malaria;

4. 60% of health facilities have staff trained in malaria case management, but only 46% possess the updated

treatment guidelines on malaria case management; and

5. A majority of the health facilities assessed did not regularly update stock cards for anti-malarials (AS-AQ:

43%, RDTs: 38%, and SP: 45%).

2. Recommendations:

1. Continue periodic supportive formative supervision by strengthening staff capacities on inventory

management and best practices for warehouse and stock management.

2. Work with all stakeholders to improve the availability of all presentations of anti-malarials at all levels

(central-SALAMA, districts, and facilities) within the required max-min levels and to ensure orders are

filled with adequate quantities.

3. Distribute copies of the updated malaria treatment guidelines to all levels.

3. Actions taken after EUV:

1. Dissemination of the findings and recommendations to the EMAR, EMAD, and RLAs to rectify the

situation with the GAS committees by determining appropriate corrective actions.

2. Refresher training of service providers at Pha-G-Dis and Pha-Ge-Com on inventory management and

storage management procedures.

3. Systematic follow-up of orders and delivery of antimalarial drugs from SALAMA by the district GAS

Commitees.

4. Redeployment of antimalarial drugs depending on the situation.

31

In addition, IMPACT started preparatory work to conduct a National Supply Chain Assessment (NSCA) in Madagascar:

• Sponsored IMPACT staff to attend the training of NSCA organized by the GHSC-PSM in November 2019.

• Developed a road map to plan activities and a timeline to implement a NSCA in February 2020.

• Discussed with GHSC-PSM the technical assistance needed to conduct the assessment in March 2020.

• Preparatory activities were suspended due to COVID-19 and will resume in Year 3.

IR2.1.8.1: Conduct continuous distribution of LLINs in 12 targeted districts. Malaria remains a public health challenge in Madagascar and it is the third most common reason for consultation at

health facilities, and the fifth leading cause of death in hospitals. One of the proven effective strategies for malaria

prevention is the use of Long-Lasting Insecticide Impregnated Nets (LLINs).

One of the objectives of the National Strategic Plan (NSP) 2018-2022 is to "Protect with LIINs at least 90% of the

population of the targeted areas, including key populations, by the end of 2022." The implementation of the LLINs

continuous community distribution (cCD) in 2020 is one of the interventions to reach this goal.

The strategy adopted by the CNC is based on successes and lessons learned from previous community-based LLIN

distribution campaigns with the collaboration from MENETP for SBCC activities through the “Child-community”

approach, which aims to educate parents on the need to sleep under an LLIN every night by educating their children

at school and the children take the information home to their parents and family.

The adopted LLIN supply chain uses a “push strategy” to PARC and PA and a “pull strategy” at the community level. A

community level committee called “Kom’Lay“ comprised of CHVs, teachers, and school directors, is in charge of

ordering and picking up their needed LLINs from PAs and will distribute to targeted households.

Coordination committees have been revitalized at every level (community, commune, district, region and central with

the CNC) to support thes activity by organizing regular meetings. The LLIN implementation reporting scheme respects

the information circuit of the national health system. IMPACT supports the stakeholders at the district and community

level with technical agents (TA supervisors and TA).

Scheme 1: Implementing scheme

The implementation of the cCD strategy during last two years relied on:

• Ensuring coordination through the National Coordination Committee (NCC).

32

• Providing cascade training on technical, logistics, M&E/reporting, distribution, and sensitization activities to

actors at different levels: central, district, and community level (Chiefs of CSB were the trainers who provided

the training to CHVs).

• Ensuring social mobilization.

• Strengthening the data reporting system and monitoring of field activities

Achievements for cCD activities:

• Revitalization of cCD coordination committees at the central level composed of the MoPH, MENETP, RBM

committee members:

o Malaria prevention monthly cCD coordination meeting under the lead of the NMCP with RBM partners and

including the School Health Division of the MENETP through the NCC.

o Participated with USAID implementing partners, including ACCESS, Mahefa-Miaraka, and Jhpiego TIPTOP

to coordinate i) training, monthly coordination, and joint supervision ii) data collection and reporting iii)

allowances at the community level for CHVs.

• Set up 2,917 Kom’Lay in 2,917 fokontany in cCD selected areas.

• Recruitment and orientation of eight Supervisors (SupTA) and 57 Support Technicians (TA) to support the

Kom’Lay for cCD activities.

• Establishment of a payment strategy for cCD actors through mobile money:

o Developed the SOPs.

o Launched the procurement process to select the mobile money companies.

o Hired a mobile money focal point as part of IMPACT team.

• 924,700 standard LLINs were received in December 2019 and 75,300 PBO LLINs arrived in January 2020. IMPACT

financially supported the storage of the LLINs at the central level, district, commune, and Fokontany levels.

Table 18: Reception status of LLINs

ORDER RECEPTION

LLIN

specification Period Ordered Quantity Period

Received

Quantity Comments

Standard White

LLIN July 2019 924,700

December

2019 924,700

- This quantity covers the needs of 11

targeted districts (excluding Boriziny

district)

PBO nets July 2019 75,300 January

2020 75,300

- The quantity of PBO nets is for the

pilot district in Boriziny

TOTAL 1,000,000

1,000,000

Logistics can be categorized into two parts:

1) The storage of LLINs at four levels: central, district, commune, and Fokontany

2) Transportation of LLINs from central to Fokontany level

Table 19: Number of LLINs transported from PARC and PAs to Kom’Lay for Group 1 and 2

PARC level PA level Kom’Lay level

Households level (% achievement compared to # of LLIN received by

Kom’Lay)

Districts Number of PARC

Targeted LLINs to

be transpor

LLINs transported to PARC

% Targeted LLINs to

be

LLINs received

by PA %

Targeted LLINs to

be received

LLINs received

by Kom’Lay

% LLINs

distributed by Kom’Lay

%

33

ted to PARC

received by PA

by Kom’Lay

Group 1

TOAMASINA II 1 69 500 55 600 80 55 600 55 600 100 55 600 53 900 97 52 411 75

BRICKAVILLE 1 59 500 47 600 80 47 600 47 600 100 47 600 46 940 99 40 612 68

TOLIARA II 1 99 000 79 200 80 79 200 79 200 100 79 200 79 200 100 75 340 76

MANAKARA 1 134 500 107 600 80 107 600 106 250 99 106 250 90 689 85 79 414 59

VOHIPENO 1 43 500 34 800 80 34 800 34 800 100 34 800 33 940 98 32 794 75

MANANJARY 1 112 500 90 000 80 90 000 90 000 100 90 000 89 930 100 85 971 76

TOTAL Group1 06 518 500 414 800 80 414 800 413 450 100 413 450 394 599 95% 366 542 93

Group 2

ANTANAMBAO MANAMPOTSY

1 17 850 12 750 71 12 750 8 700 68 8 700 3 600 41 0 0

MAHANORO 1 85 750 49 000 57 49 000 29 350 60 29 350 17 100 58 0 0

FARAFANGANA 1 116 550 66 600 57 66 600 66 000 99 66 000 21 827 33 0 0

VANGAINDRANO

1 112 350 64 200 57 64 200 58 000 90 58 000 12 520 22 0 0

BEKILY 1 61 950 34 950 56 34 950 30 100 86% 30 100 16 495 55% 0 0%

BORIZINY 1 72 450 42 000 58 42 000 41 400 99 41 400 13 895 34 0 0

TOTAL Group2 06 466 900 269 500 58 269 500 233 550 87 233 550 85 437 37 0 0

TOTAL of all 12 districts

12 985 400 684 300 69 684 300 647 000 95 647 000 480 036 74 366 542 37

During Year 2, 366,542 LLINs out of 985,400 have been distributed to households since February 2020 for Group 1

districts.

The COVID-19 travel ban impacted the community LLIN distribution for Group 1 and also delayed the preparation of

the cCD activities for the Group 2 (Antanambao Manampotsy, Mahanoro, Farafangana, Vangaindrano, Bekily, and

Boriziny). As a result, the LLINs distribution for this group have been postponed to Year 3, Quarter 1 instead of Year

2, Quarter 3.

In order to move forward with cCD activities during COVID-19 IMPACT has distributed 3,000 hand washing stations at 2,949 LLIN distribution points and provided 8,800 washable masks to the community actors (CHV distributors and CHV mobilizers).

Graph 5: Monthly LLINs distribution compared to target

• In February 2020, 43% of the monthly target has been achieved as only three of the six targeted districts from

Group 1 were able to start distribution,

51

,85

0

51

,85

0

51

,85

0

51

,85

0

51

,85

0

51

,85

0

51

,85

0

51

,85

0

22

,43

8

47

,23

5

42

,19

2

46

,86

4

52

,85

4

61

,56

4

48

,43

7

44

,95

8

43%

91%81%

90%102%

119%

93%87%

0%

20%

40%

60%

80%

100%

120%

140%

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

MONTHLY LLIN DISTRIBUTION FOR cCD

MONTHLY TARGET

# of LLIN DISTRIBUTED

% Distribution

34

• From March to May, due to the COVID-19, an average of 87% was obtained as the travel ban impacted the

distribution in Tamatave II and Brickaville.

• A catch-up plan has been implemented which explains the results of more than 100% for June and July.

• For September, only 87% of the completeness were received and reported.

Organize cascade trainings of key actors involved in the continuous distribution of LLINs

The cCD training curriculum has been reviewed and validated by NCC. The implementation of cascade trainings in the

12 targeted districts took place at three levels: central, district, and commune. The cascade training sessions focused

on the approaches to cCD, social mobilization by community actors, activities at the school level, LLIN orders, supply

plan logistics, and the use of management tools and reporting. The table below provides details on the number and

type of actors trained.

Table 20: Cascade training achievements in Year 2

Level Target Male Female

Total of Trained % Comments

Central 90 55 33 88 98%

TOT: 11 EMAR, 23 EMAD, 12 from DRENETP (Direction Régionale de l’Education Nationale, de l’Enseignement Technique et Professionnel), 24 from CISCO, and 18 IMPACT staff

District 763 488 260 748 98%

414 Chiefs of CSB, 275 Chiefs of ZAP, and 59 technical support staff from IMPACT

Community 17 332 9,325 4,611 13 936 80%

2,840 Chiefs of Fokontany, 5,726 CHV Mobilizers, 2,907 CHV distributors, 939 School Directors, and 1,524 teachers of 8th grade

PARC and PA

291 152 134 286 98%

12 PARC and 274 PA were trained. The 5 absent PAs were trained on site. Topics covered include: knowledge about malaria, supply chain adopted, use of the management tools, storage conditions, the roles of the PARC and PA, and the different storage and transport allowances linked to their commitments.

10,020

5,038

15 058

cCD M&E System

Graph 6: Group 1 Kom’Lay report completeness rate from February to September 2020 using excel file

35

• The average reporting rate from February to September 2020 for the 06 Districts was 84%.

• The average reporting rate in DHIS2 was 9%. Data entry only started from September2020 because of technical

development that needed to be completed before entering cCD components to the national system. Data entry

will continue in Year 3.

cCD Social Mobilization activities:

The cCD was officially launched on February 13, 2020 in Foulpointe, district of Toamasina II.

Communication activities for social and behavioral change took place at the community and public primary school

level under the leadership of the Kom'Lay. Two radio spots were broadcasted 6,860 times through 16 radios stations

in the 12 districts.

Table 21: Recapitulation of SBCC tool produced and distributed by districts in Year 2

District

Advocacy

one

pagers

Job ‘Aids on

cCD

CCD

Community

posters

School

posters

Sticky

tables

Multi

pocket

board

Fuchsia

bracelets

Green

bracelets Stickers

TOAMASINA II 50 502 688 480 240 240 5 094 5 094 60 000

BRICKAVILLE 50 516 708 402 240 240 4 255 4 255 50 256

TOLIARA II 50 743 1 212 529 270 270 6 645 6 592 68 182

MANAKARA 50 930 1 276 702 351 351 8 741 8 741 87 756

VOHIPENO 50 397 544 366 183 183 4 673 4 673 45 756

MANANJARY 50 761 1 044 712 356 356 5 284 5 284 89 004

MANAMPONTSY 50 141 181 127 70 70 989 933 1 603

MAHANORO 50 550 808 318 159 159 10 500 10 200 39 750

FARAFANGANA 50 612 1 220 868 404 404 6 519 6 519 108 500

VANGAINDRANO 50 534 1 068 768 356 356 6 553 6 553 96 000

BEKILY 50 944 1 888 459 191 191 6 876 6 876 61 884

PORT BERGÉ 50 538 1 363 269 180 180 6 480 6 480 58 320

CENTRAL 100 1 332 17 391 17 800 2 989

TOTAL of

produced items 700 8 500 12 000 6 000 3 000 3 000 90 000 90 000 770 000

36

Challenges:

The main challenges for this period is the impact of COVID-19:

• Logistics activities in Year 2: PAs had difficulties in ensuring the

transportation of LLINs from the district to commune (regional

public transport was suspended because of COVID-19);

• Kom’Lay members were less enthusiastic on the recovery of

LLINs at the commune level;

• Cascade trainings (physical meeting) were postponed for the

extension in the six districts of group2;

• Difficulty in carrying out household visits by CHV Mobilizers

following confinement and reluctance from households to

engage with people in-person

Solutions/Recommendations for Year 3:

• Community actors continue to respect social distancing during

cCD activities.

• Review the cCD strategy to include the COVID-19 context. This

review aims to update the cCD strategy in order to correct any

issues during the Year 2 implementation and integrate

preventive measures against COVID-19.

• Sensitize the community to ensure the transition between cCD and the LLIN mass campaign distribution.

• Implement the catch-up plan for the distribution of LLINs in the six districts of the Group 2.

IR2.1.8.2: Provide technical and financial support to the NMCP to develop and implement activities for the preparation of 2021 LLIN campaign including the procurement of LLIN

In terms of the preparatory activities for the 2021 LLIN mass distribution campaign:

Regarding the preparatory activities for the 2021 LLIN mass distribution campaign, the review of documents and

working sessions with AMP consultants for the implemention strategies were carried out based on the lessons learned

from the previous LLIN mass campaign, AMP guidance, and the epidemiological context of the districts.

In the review of implemention strategies, two action plans were proposed to the NCC : the first plan is the result of

adjustments to be made from the lessons learned from the 2018 LLIN mass campaign, and the second considers the

budget restrictions.

Procurement of LLINs

• Participated in the LLIN quantification exercises and submitted it to RBM committee for validation.

• Submitted the LLIN order of 3,677,000 LLINs under PMI funding to GHSC-PSM for procurement.

• Monitored the current orders. The expected date for the arrival of LLINs is October 2020.

Mass Campaign Preparation meetings

The following activities have been achieved during Year 2:

• Revitalization of the CNC committee and participation in all meetings related to the preparation of the LLIN mass

campaign with all stakeholders (RBM members, the Global Fund, and the AMP consultants).

• Participation in various teleconference working sessions with the three AMP consultants and the PSI Washington

malaria department team on:

o Development of strategies

o Budgeting and mobilization of resources

o Macroplanning

SBCC Tools

Advocacy one pager: This is a printed document

explaining the cCD and its objectives

Job ‘Aids: This is a guidance tool for the use of the

community actors

cCD community poster: Poster for the community

sensitization on the need of LLIN and cCD activities

School posters: Poster for the sensitization of

children at school

Sticky tables: Tool used by teachers for SBC

activities with the 8th grade chlidren at school

Multipocket board: Tool used by teachers for SBC

activities with the 8th grade chlidren at school

Fuchsia bracelets: Tool to identify children who are

in need of an LLIN

Green bracelets: Tool to identify and award

children who have received LLIN from cCD

Stickers: Tool used by teachers for SBC activities

with the 8th grade chlidren at school

37

LLINs micro planning meeting:

The micro-planning training did not take place due to COVID-19. As a result, the AMP experts provided remote support

through virtual meetings with the Madagascar actors and these meetings served to develop the strategy and detailed

budget, establish the LLINs macro quantification, and review the action plan document. Madagascar has three AMP

consultants to support on SBCC, logistics, and M&E.


• Working sessions with the NCC and AMP consultants were held through teleconference.

• The main challenge for the mass campaign is the funding gap of $3,763,000 for a total forecasted budget of

$13,020,000. Discussions between the stakeholders (RBM committee members, UCP, Global Fund, and the

MOPH) are ongoing to mobilize local and international resources to fill the gap.

Distribution of emergency LLINs and communication to address malaria outbreak

In Quarter 3, IMPACT responded to the MOPH request for additional activities due to the upsurge of malaria cases in

41 districts (including 12 USAID districts) with the NMCP by:

• Broadcasting 02 radio spots for 6,860 times on the use LLINs to prevent malaria

• Ensuring the transportation of 85,000 LLINs to the 30 targeted districts with support from UNICEF.

For the 11 remaining districts:

• 10 districts are covered by LLINs through cCD strategy.

• The last district is Antananarivo Renivohitra which is not targeted by the LLIN distribution because it is a malaria

elimination area.

IR2.1.10: Procurement of PPE and expandable equipment/commodities

From May to September, IMPACT procured and distributed expandable equipment and commodities to 83 hospitals

in Atsinanana, Boeny, Analanjirofo, Haute Matsiatra, and Atsimo Andrefana regions, 82 drug shops, and 28

pharmacies in Boeny, Atsinanana and Analanjirofo regions. Details are presented in Annex K/Table 1

IR2.1.11: Transportation of Covid-19 expendable equipment and supplies (following cyclic shipment of malaria,

FP/RH, and MNCH commodities)

IR2.1.11.1: Transportation of Covid-19 expendable equipment and supplies from PSI central warehouses to District

• IMPACT participated in COVID-19 meetings led by the CCO at central and regional levels.

• IMPACT supported the logistics committee on the quantification and forecast exercises on COVID-19

commodities by developing a stock and shipment tracking application adopted and used by the CCO logistics

committee.

• IMPACT supported the transportation of PPE donated by the Chinese Government from the CCO Ivato

warehouse to five USAID-supported regions, including Vakinankaratra, Haute Matsiatra, Atsinanana, SAVA, and

Atsimo Andrefana as summarized in the table below:

Table 22: COVID-19 expendable equipment and supplies transported by IMPACT from central to districts (May – September 2020)

Month Details of supplies transported per region

June 1,872 hand washing devices to 11 PSI regional warehouses (Diego, Sambava, Mahajanga, Antsohihy, Toamasina, Antsirabe, Maintirano, Fianarantsoa, Manakara, Morondava, and Toliary). These devices will be distributed to CCOR/DRSP (780) and PA/PARC (1,092).

38

Month Details of supplies transported per region

July -Expendable equipment and supplies procured centrally to Boeny, Haute Matsiatra, Atsinanana,

Analanjirofo, and Atsimo Andrefana hospitals (CHU, CHRR)

-Communication tools and WASH equipment as donations for hospitals, PA/PARC, and pharmacies to 10 warehouses of PSI/IMPACT (Antsirabe, Fianarantsoa, Tulear, Sambava, Antsohihy, Diego, Majunga, Tamatave, Manakara, and Morondava).

August Expendable equipment and supplies from eight regions to 24 districts for CCOR/DRSP in Analanjirofo (1 district), Boeny (3 districts), Sofia (5 districts), Atsimo Andrefana (2 districts), Diana (1 district), Sava (2 districts), Vakinankaratra (6 districts) and Melaky (4 districts). The expandable equipment and supplies are donated from IMPACT/USAID.

September USAID/IMPACT donations of expandable equipment and supplies (handwashing gels, handwashing devices, Javel, liquid soaps, water containers, Sur’Eau, thermometers) and communication tools (stickers for handwashing), from Antananarivo to 06 hospitals, 50 Pharmacies and 43 drugs shops in Atsinanana, Boeny, Analanjirofo and SAVA, 1,090 PA and 77 PARC in 13 USAID/IMPACT supported regions, 3 PARN regions, and 12 cCD districts, 12 Pha-G-Dis in Analanjirofo, Antsirabe, Antsohihy, Antsiranana, Fianarantsoa, Maintirano, Majunga, Manakara, Morondava, Sambava, Toamasina, and Toliara ,12 CCOR/DRSP located in Analanjirofo, Antsirabe, Antsohihy, Antsiranana, Fianarantsoa, Maintirano, Majunga, Manakara, Morondava, Sambava, Toamasina, and Toliara and one Communication Field Team (Analanjirofo).

IR2.1.11.2: Transportation of Covid-19 expendable equipment and supplies from District to Commune

IMPACT financially supported the transportation of COVID-19 expendable equipment and supplies (provided by the

MOPH and USAID/IMPACT) from regions to districts or communes. The table below summarizes transportations

supported by IMPACT from May to September.

Table 23: Summary of transportation supported by IMPACT from regions to districts

Month Place of departure Destination Supplies

May Antsiranana Ambilobe and Nosy Be COVID-19 EPI

Antsiranana Antananarivo Drugs

June Antananarivo DRSP Atsimo Andrefana and DRSP of Alaotra

Mangoro through Rano WASH and Diorano

4,000 masks

Toamasina Fenerive-Est, Soanierana Ivongo, Mananara

Nord, Sainte-Marie, Vavatenina and

Maroantsetra

USAID/IMPACT

second donations

July From six (06) CCOR/DRSP 19 districts in Analanjirofo (5), Melaky (3),

Atsinanana (4), and Diana (3), Sofia (3)

IMPACT/USAID

donations

August From eight (08) CCOR/DRSP 24 districts in Analanjirofo (1), Boeny (3), Sofia

(5), Atsimo Andrefana (2), Diana (1) , SAVA (2),

Vakinankaratra (6) and Melaky (4)

IMPACT/USAID

donations

September From five (5) CCOR/DRSP 15 districts of Melaky (4), Vakinankaratra (5),

Boeny (4), Atsimo Andrefana (1), and Diana (1)

Expendable

equipment provided

by MOPH

IR2.1.12: Providing technical and financial support on Covid-19 to the MOPH depending on MOPH central and DRS request • From May to September, IMPACT regional staff participated in the weekly meetings within CCOR (members of

various committees: Logistics/Communication/WASH).

39

• IMPACT donated eight Sim Cards (including airtime and Internet data) to each CCOR/DRSP of the 13 supported

regions to facilitate data transfer and communication between CCOR and DSRP staff. In total, 104 Sim cards were

distributed and used from May to October.

• IMPACT financially supported the cost of car rental and fuel for the transportation of samples or specimens for

PCR or GeneXpert from districts to regions or from regions to Antananarivo:

o PCR specimens from Soanierana Ivongo, Fenerive-Est, Maroantsetra, and Mahanoro to Toamasina; from

Fianarantsoa to IPM Antananarivo, and GeneXpert specimens from Bealanana to Antsohihy in July.

o GeneXpert specimens from Bealanana to Antsohihy and from Manakara to Ifanadiana; and from Sainte-

Marie by boat, Maroantsetra by moto, Vavatenina and Soanierana Ivongo to Fenerive-Est, PCR specimens

from Fianarantsoa, Toliara and Morondava to IPM Antananarivo in August.

o Specimens for PCR from Toliara, Ambositra, Fianarantsoa and Diego to IPM Antananarivo, specimens for

GeneXpert from Analalava to Antsohihy, from Mananjary and Manakara to Ifanadiana, from Sainte-Marie

to Fenerive-Est in September. Details in Annex K/Table 2.

o Car rental of 10 days on behalf of DRSP SAVA for investigations of suspected cases (patients with suspected

symptoms or contact cases) in July.

o Payment of fuel for the Analanjirofo DRSP vehicle to transport the DRSP team who were convened by the

Minister in Antananarivo to attend an urgent meeting at the MOPH concerning the COVID-19 outbreak in

August.

o Cost of one rental car for 10 days to help the DRS in SAVA region for the surveillance, supervision, and local

transportation of supplies to districts or delivery of COVID-19 samples collected from districts to the DRSP

in August.

IR2.1.12.1: Ensure preventive measure against Covid-19 among DRS and IMPACT staff IMPACT conducted disinfection of PSI/IMPACT offices, vehicles, and warehouses by external providers on a weekly basis. Details are provided in Annex K/Table 3. IR2.1.12.2: Provide PPE (personal preventive equipment) to DRS and IMPACT staff against Covid-19 by distributing expendables and equipment IMPACT ensured donations of health commodities (infection prevention products) and equipment, including

washable protective masks to the 13 DRSP via CCOR and to IMPACT partners and staff. Details are provided in Annex

K/Table 1.

IR2.1.13: Train hygienists and health workers at the regional health facilities on waste management

From May to September, 1,062 hygienists and health workers from five districts (Toamasina I & II, Fianarantsoa I,

Toliary I, Fénerive-Est, and Antsiranana I) have been trained on waste management, infection prevention, and control

in response to COVID-19.

Table 24: Summary of trainings of hygienists and health workers

Month Participants details per region and districts

June 451 (274 female and 177 male), including 25 hygienists, 264 health workers, and 162 cleaning

workers on the use of PPE and on effective and appropriate waste management in the regions of

Atsinanana (170), Diana (143), and Haute Matsiatra (138).

July 211 additional MOPH staffs (111 female and 100 male), including 9 hygienists, 150 health workers,

and 52 cleaning workers, on the use of PPE and on effective and appropriate waste management in

the regions of Diana (40), Atsinanana (101), and Atsimo Andrefana (70).

August 380 additional MOPH staff (200 female and 180 male), including 9 hygienists, 366 health workers,

and 5 cleaning workers or other hospital personnel identified by EMAR/EMAD in Sakaraha (20),

Morondava (20), Vatomandry (60), Mahanoro (63), Tanambao Manampotsy (30), Brickaville (60),

Mananara (31), Maroantsetra (40), Soanierana Ivongo (26), and Vavatenina (30) districts

40

Month Participants details per region and districts

September 20 additional MOPH staff and health workers in Morombe (12 female and 8 male): 17 from CSBs, (1)

representative from health providers in the prison of Morombe, (1) from CHRD Morombe, and (1)

from a private hospital.

Challenges and Solutions:

Challenges Solutions

Suppliers did not respect the lead time delivery due to a

high demand for PPE and expandable equipment

(inadequacy between supply and demand)

Split orders and search many suppliers and negotiate

partial deliveries.

Transporters under the LTA (Long Term Agreement)

refused to transport products to the Atsinanana region

because of the high number of COVID-19 cases in this

region.

Used “Colis Express” company to transport COVID-19

expandable equipment and other health commodities to

the Atsinanana region.

The transport company did not respect procedures

(packaging and deadlines) for the transportation of

specimens of PCR tests from districts to IPM.

Used DRSP vehicle to transport specimens of PCR tests.

Procurement of latex surgical gloves: the delivery time was

too long (3 months proposed by the suppliers).

Cancelled procurement of surgical gloves and replaced it

with expendable equipment and supplies.

Sub-IR 2.2: The public-sector supply chain achieves financial sustainability

IR2.2.1: Conduct a total cost analysis of the public supply chain and propose an alternative and more efficient supply

chain model by establishing at least two scenarios with the MOH to improve SALAMA's financial sustainability

The total cost analysis (TCA) aims to analyze current costs of all elements of the public supply chain in Madagascar in

order to study the efficiency of the supply chain and consider alternative models. The analysis will inform progressive

integration of commodities managed by vertical programs through SALAMA and will reduce the dependence on donor

funding for different cost categories of the supply chain.

Throughout Year 2, IMPACT implemented the following activities:

In December 2019, mobilized one international MSH expert for Short Term Technical Assistance and recruited one

national consultant to assist the MOPH/DPLMT on developing the methodology of the TCA, sampling size, and TOR

for the TCA steering committee, questionnaires and data collection tools. With technical and financial support from

IMPACT, the steering committee is responsible for defining the methodology and sampling, supervising data

collection in facilities selected, analyzing data, and developing and disseminating the Total Cost Analysis report.

• In January, set up of a TCA committee made up of 17 representatives from the Directorate General for Healthcare

Supplies (DGFS), the Directorate General for Resources (DGR), the DPLMT, the DSSB, UNICEF, and IMPACT.

• From February 24th to 25th, 2020, organized a two-day workshop with the TCA committee members to orient

them on the study objectives, the TCA framework, the sampling method, the implementation process, the study

sites, and the data collection tools.

• From February 27th to 28th, 2020, organized a training of 24 surveyors on the TCA methodology, and data

collection forms for pharmacies and districts.

• In September, data collection completed in selected three CHU Pharmacy Units, four CHRR Pharmacy Units, 11

CHRD Pharmacy Units, 16 Pha-G-Dis, and 46 Pha-Ge-Com, as well as SALAMA.


41

• Data collection was delayed due to travel restrictions and the imposed lockdown due to COVID-19. This resulted

in a long delay between training and data collection.

• Data analysis will be completed in Quarter 1 of Year 3 and then after, preliminary results will be shared with

USAID. Once the report is validated, a workshop to disseminate the findings of the TCA will be organized.

IR2.2.2: Strengthen management of FANOME at Pha-G-Dis and PhaGeCom levels to increase transparency and good governance.

This activity has been postponed to Year 3 pending the completion of the TCA.

III- 3 IR 3: Expanded engagement of the commercial health sector to serve new health product markets

according to health needs and consumer demand

Sub-IR 3.1: Commercial actors are incentivized to expand into new health product markets

In Year 2, IMPACT continued to integrate and sensitize the private and commercial sectors to commit and contribute

to improve the public health sector in Madagascar.

IR3.1.1: Create partnerships with PSHP and non-PSHP members to collaborate in generating innovative solutions on transportation, data collection, and health-focused CSR and CSV.

The objective for Year 2 was to integrate new private sector members and to encourage them to support the MOPH

in health product transportation, LMIS data collection, and participation in TMA TWG activities. On June 29 and July

7, one-on-one meetings were conducted with 10 private companies to sensitize them on how to be engaged in

IMPACT project activities. Eight companies have formalized their partnership with the PSHP as follows:

• 4 pharmaceutical importers and wholesalers: Interpharma, SK Pharma, Pharmatek, Najmi Pharma.

• 4 private companies: Nutrizaza, Hotel le Louvre, CNAPS, Vitafoam.

• 2 associations (CNFM: Conseil National des Femmes de Madagascar, EFOI: Entreprendre au Féminin, Océan

Indien) expressed their willingness to participate in IMPACT activities but their formal inclusion is still pending

due to COVID-19.

Table 25 : New PSHP members in Year 2

Table 26 : Activities of new members during Year 2

New Members Sector Implemented activities Perspectives

Interpharma, SK Pharma, Pharmatek, Najmi Pharma

Pharmaceutical importers and wholesalers in Madagascar

- Contributed to the review of PPN PDPN document through the text and regulation sub-committee.

- Continued to participate in the TMA TWG.

- Committed to submitting LMIS data to the MOPH / DEPSI.

Will continue to actively participate in the TMA TWG meetings.

Nutrizaza Social business fighting against malnutrition in children

Joined PSHP just before COVID-19 and activities were focused on COVID-19 response.

The next step is to specify their contribution in IMPACT activities related to CSR focused on health. Hotel Louvre Hotel

CNAPS Public establishment with industrial and commercial nature for social protection

The next step would be that CNAPS will support diffusion of IMPACT spots on FP and malaria in their agencies.


Y1



Number of new private sector companies supporting the MOPH and integrated the Private Sector Humanitarian Platform (PSHP)

5 4 3 1 0 8 9

42

Vitafoam Company specializing in the manufacturing of foam

Next step would be to conduct a meeting to discuss and finalize the contribution in the transportation of health commodities.

Observations: Despite COVID-19 and its impact on businesses, the private sector continued to collaborate with IMPACT.

In Year 2, IMPACT developed partnerships with SOMAPHAR, AQUALMA, EDM, BNI, SGM, INTER AIDE, and Akbaraly

Foundation.

Table 27: Partnerships developed in Year 2

Private Sector Area of activity Type of Partnership Perspectives

SOMAPHAR Pharmaceutical

wholesaler Transportation contract

Contract was signed with IMPACT in Quarter 4 to transport social marketing products and the next step is its implementation.

AQUALMA Aquaculture

MOU signed with IMPACT for the transportation of health commodities

Aqualma will continue to transport social

marketing health products and ensure the

supply health commodities to the CSB II in

Besalampy and Mahajamba.

EDM

Renewable energy supply

MOU signed with IMPACT to formalize their CSR focused on health/transportation

EDM will provide free transportation of health commodities which will start in Vatomandry district.

BNI and SGM Bank CSR focused health commodities

Continue to broadcast FP TV spots in their agencies where customers are the target audience.

TELMA Telecommunication

INTER AIDE

Development programs with particularly poor rural families (wash, agriculture, health)

MOU signed with IMPACT to ensure the availability of health commodities in Vohipeno and Manakara districts

The implementation of the MOU will continue. In addition, INTER AIDE shares stock status of health commodities with CHVs and contributes to the quantification of FP, MNCH, and malaria commodities in Vohipeno and Manakara districts.

Observations: The signature of the MOU focused on social mobilization, demand creation, and use of health commodities between IMPACT, Akbaraly Foundation, and MOPH is still ongoing due to MOPH staff turnover.

IR3.1.2: Organize quarterly meetings to monitor and assess the progress of health commission action plan. In Year 2, three quarterly meetings were held to monitor the achieved versus the planned health commission activities. Table 28: Activities Planned, Achievement, and Perspectives of health commission

Activity Planned Achievements/Outcomes Perspectives

Mobilize health commission members in Universal Health Coverage (UHC)

- The action plan of the Universal Health Coverage (UHC) was presented by the CACSU including the activities piloted in Vatomandry.

- The private sector members are willing to financially support the DPS/CACSU in the implementation of UHC and in the transportation of products.

In Quarter 4 of Year 2, the UHC document was updated (a draft of financial strategy, monitoring framework of UHC) and will be validated by the MoPH This document will be shared with the Health Commission to specify the support needed from the private sector in its implementation.

Create partnerships with the private sector

- 8 new members joined the PSHP - 6 partnerships (transport, CSR focused on

health) were developed and implemented in Year 2.

These new members will continue to participate in IMPACT activities (joining the TMA TWG, implementing MOU on transport, CSR focused on health)

43

Activity Planned Achievements/Outcomes Perspectives

Transport solutions - Three transportation partnerships between IMPACT and the private sector were developed in Year 2: 1) MOU between IMPACT and Aqualma; 2) MOU between IMPACT and EDM and 3) Contract between IMPACT and Somaphar (detailed in table above).

- Meeting between IMPACT and SALAMA (represented by the new CEO) focused on transportation of heath commodities and the potential upcoming partnership between PSHP and SALAMA.

The partnership was formalized by an MOU and the implementation of the MOU will continue in Year 3. SALAMA expressed concern about the emergency transport of health commodities due to the restriction of its truck pooling and strongly urged the private sector to assist SALAMA in this operation. The contract is managed between SALAMA and transporter companies.

Support IMPACT in collecting LMIS data and organizing capacity building of drug shop owners

- Identification of 25 drug shops per region in Atsinanana, Boeny, Diana, and Sava regions.

- Training of 70 (41 men, 29 women) drug shop owners on financial and stock management in Atsinanana, Boeny, and Diana.

Outlet identification and drug shop trainings completed in four additional regions (Sofia, V7V, Atsimo Andrefana, and Menabe).

On March 18th, over 60 members of the PSHP participated in a meeting with WHO, focused on exchanging knowledge

and context about COVID-19. Flyers were provided by the health commission to PSHP members and SMS were

broadcasted to the general population to raise awareness about COVID-19 supported by the PSHP.

IR3.1.3: Conduct mapping exercise to present IMPACT and LMIS data submission among the representative sample

pharmacies and drug shops in the 13 USAID-supported regions.

The process of identifying outlets to partner with IMPACT on LMIS reporting was completed in four regions of Madagascar (Atsinanana, Boeny, Diana, and SAVA) and 148 agreement letters (48 pharmacies and 100 drugs shops) were signed to confirm their commitment to report LMIS data to MOPH/DEPSI. Table 29: Number of pharmacies and drug shops signing agreement letter to share LMIS data

Regions Pharmacies Drug shops

ATSINANANA 14 25

BOENY 13 25

DIANA 12 25

SAVA 9 25

TOTAL 48 100

Figure 1: Findings from the identification of outlets

Pharmacies Drug shops

Sex disaggregation of Pharmacies owners

In general, 55% of pharmacy owners are men and 45% are women. However, in Atsinanana and SAVA women are the majority.

Sex disaggregation of drug shops owners

In general, 62% of drug shop owners are men and 38% are women.

Education profile of Pharmacies owners

Education profile of drug shops owners

38

7562

445562

2538

5645

0

20

40

60

80

100

Antsinanana DIANA Boeny SAVA ENSEMBLE

%

Homme Femme

44

7656

726256

2444

2838

020406080

100


%

Homme Femme

44

100% of pharmacy owners have a university degree

42% of drug shop owners have a university degree.

Use software on stock management by pharmacies

65% of pharmacies are using electronic tools and “Pharmaplus” is the most used software.

Use software on stock management by Drug shops

The use of software is still low for drug shops and most of them are using paper-based systems (books/notebooks) to manage their stock.

Figure 2: Additional findings among drug shop

Internet coverage area

More than 75% of drug shops have access to internet networks which facilitates the LMIS data submission.

More than 50% of drug shops are affiliated with financial institutions (microfinance and banks). In Atsinanana, 72% are affiliated with banks.

During the exercise to identify pharmacies and drug shops, it was noted that 30% of pharmacies use Pharmaplus

software. Therefore, Pharmaplus and Maisha med were tested by IMPACT, DPLMT, and a representative from the

LMIS TMA TWG. As result:

• “Pharmaplus” and “Maishamed” have the capacity to be used as stock management tools, financial tools, and

LMIS tools for drug shops.

4 0 0 4 2412 8 12 9

4452 52

404748

36 40 44 42

0

20

40

60

80

100


%

Primaire Secondaire I Secondaire II Univesitaire

100

63 64

10082

0

37 36

0

18

0

20

40

60

80

100

Antsinanana Diana Boeny SAVA Ensemble

%

Livre/cahier Eléctronique

80

88

88

72

82

50 60 70 80 90 100

Antsinanana

DIANA

Boeny

SAVA

Ensemble

%

72

56

36

6858

0

20

40

60

80

100

Antsinanana DIANA Boeny SAVA Ensemble

%

45

• Parameters and functionality of these tools are compatible and interoperable with DHIS2.

A competitive tender was launched for companies to propose the best solution/tool for LMIS data collection especially

for drug shops in order to ensure full transparency on the selection. In Quarter 4, SUNRISE (provider of Pharmaplus)

was selected to develop Pharmaplus including the software for LMIS data collection.

The next step will be to develop and operationalize the tools in four regions before scaling up in all IMPACT regions.

IMPACT is expecting to reach the 13 regions by Year 4.

IR3.1.4: Ensure that the Health Commission members of the PSHP participate in the TWG and follow up on the roadmap as a way to engage the commercial sector to identify barriers in the health sector and provide solutions Two champions from the private sector were identified and are motivated to participate and lead the TMA process.

Table 30: Targets vs achievements during Year 2

Indicator Year 1

Achievement Target Year 2

Y2 Achievement

Observations

Percent of TWG meetings attended by private sector members of the health commission

100% 80% 94.74 %. 18 TWG meetings out of 19 were attended by the private sector members of the health commission during Year 2

Despite COVID-19, the health commission remains active in the TMA TWG activities and the TMA road map process.

Virtual meetings were adopted during Quarter 3 and Quarter 4 to maintain this activity.

IR3.1.5a : Revitalize regional drug shop associations in preparation of the ADDO pilot phase to be conducted in Year

3

In order to prepare the Accredited Drug-Dispensing Outlet (ADDO) pilot project for Year 3, IMPACT sought to raise

awareness and guide drug depot owners to group together in regional associations with the aim of constituting

themselves as representative and credible interlocutors of the profession.

In Year 2, IMPACT worked with drug shops in the Analanjirofo, Atsinanana, and Boeny regions to help them establish

regional associations:

• The Association des Dépôts de Médicaments de la Région d’Atsinanana (ADMERA) was officially registered in

Quarter 2 of Year 2.

• The registration of one drug shop association in Analanjirofo is almost complete. The bylaws and internal

regulation have been finalized and submitted to the district office, and future board members will undergo a

morality check in October 2020 before final approval from the district.

• As of September, drug shops in the Boeny region have finished preparing a General Assembly to validate the

official documents to formally establish their regional association.


• Difficult to regroup future board members scattered in

different districts of the region

• Difficult to initiate the process of formalizing

association

• Administrative lockdown and travel ban due to COVID-

19 created obstacles to formal registration

• IMPACT/DPLMT awareness-raising sessions provide an

opportunity for drug shop owners to meet in person and

exchange contact information, facilitating organization of

future meetings

• IMPACT identifies dynamic drug shop owners, encourages

them to be part of the committee, and provides templates

for starting documents

• Ongoing follow-up to encourage committee members to

take advantage of any administrative offices opening

46

IR3.1.5b : Develop curriculum for training of peer trainers with simplified materials and tools, to be used in piloting a sustainable mechanism for business strengthening program of drug shops In Year 2, IMPACT planned to identify drug shop owners who have the capacity and interest to learn and train their

peers in order to offer business trainings for a cost at which drug shops are both able and willing to pay. The objective

was to pilot a sustainable program of Certified Peer Trainers (CPT) for drug shops.

IMPACT identified 11 potential peer trainers during in-person business trainings in Atsinanana (5 candidates) and

Boeny (6 candidates). The curriculum materials for the training of peer trainers has been drafted and will be finalized

in Year 3.

Table 31: Number of Potential Peer Trainers Identified in Year 2

Achievement vs Target Year 2


Men 3 3 0 0 6 N/A

Women 2 3 0 0 5 N/A

TOTAL 5 6 0 0 11

10 (110% achieved)



- Travel ban due to COVID-19 prevented the IMPACT team

to meet potential trainer candidates in person in Diana and

Sava regions and the business training was offered by

video.

- One to two day in-person awareness-raising sessions

with the DPLMT are being scheduled in these regions

for Year 3 Quarter 1.

Increase access to finance for private health commodities supply chain stakeholders

IR3.1.6 : Strengthening partner banks and other financial institutions' capacity to better serve private health

commodities supply chain.

IMPACT continued to work with financial institutions including partners AccèsBanque Madagascar (ABM) and Baobab

Banque Madagascar to facilitate access to finance for micro and small health enterprises by building the institutions’

capacity to meet the needs of health enterprises.

• Bank staff training materials now include information about gender and social inclusion issues. The new

material will be used to train regional bank staff during Year 3, and bank HQ staff will also be trained because

product conception and development is done at HQ.

• During Year 2, IMPACT trained a total of 106 staff (57 men, 49 women) from ABM and Baobab, 88% of the Year

2 target of 120. The training focused on how to work with the health sector, and the financing needs and market

potential of pharmacies and drug shops. Ninety of the staff were trained in Quarters 1 and 2 at the banks’

branches in Atsinanana and Boeny. In Quarter 4, an online distance learning session was organized for 16 ABM

staff from HQ, Toamasina, Ambositra, Antsiranana, Mahajanga, Diego, and Sambava. Although the COVID-19

travel restrictions prevented IMPACT from achieving its full Year 2 target, the online training tested in Quarter 4

was a good alternative.

Table 32: Loans Disbursed to Private Health Commodities Enterprises in Year 2

47

Indicator Achievemen

t Y1


Q1 Q2 Q3 Q4 Total Y2 Target Y2

Number of loans disbursed to businesses (excluding service providers)

7 14 8 11 13 46 50

Value of loans disbursed to businesses (excluding service providers)

$21,865 $57,281 $19,728 $27, 291 $70,911 $175,211 $90,000

• 11 of the loans disbursed ($72,336) were placed under the DFC guarantee.

• 21 of the loans disbursed ($96,086) were made to women-owned health enterprises, and five of these loans

($41,042) were placed under the DFC guarantee.

• Although the partner banks suspended lending to most economic sectors during the pandemic, with the support

of IMPACT and the DFC guarantees, both ABM and Baobab continue lending to health enterprises. The pandemic

increased the population’s needs for health commodities, and drug shops and pharmacies were comfortable

requesting new loans.

• Pharmaloan. The product has been designed, and an MOU

between SOPHARMAD, ABM, and IMPACT was drafted and is

awaiting signature by SOPHARMAD. IMPACT and ABM are

considering expanding the product to other wholesalers.

• PA Motorbike Loan. Due to pandemic restrictions, ABM limited

the coverage zone to 15 km from its branches. Three loans were

disbursed, and the motorbikes were delivered to PAs in

Ambanja, Fandriana, and Toliara II. As pandemic restrictions are

lifted, the coverage zone will be expanded to the planned 50 km

radius from branches to reach more PAs.

• ACCES SALAMA Loan. Health enterprises were reluctant to import

large quantities of PPE supplies until the government’s

distribution strategy was clear. As of the end of Year 2, there was

no demand for this loan product.

• Restructuring loans due to COVID-19. In Year 2, no loans under

IMPACT needed to be restructured.

• The report on the preliminary evaluation of the feasibility of a

new financing mechanism was presented in Year 2, but the next

steps of gathering detailed information, defining, and beginning

to structure a financing instrument were postponed to Year 3 due to pandemic travel restrictions.

• Collaboration with additional financial institutions. IMPACT drafted an MOU with the KRED microfinance

branch of BNI to collaborate on improving access to finance for drug shops.


• Difficulty obtaining gender-disaggregated data for the

local banking and health commodities sectors

• Identification of banks’ needs in terms of GESI

• Close collaboration with ONP and DPLMT in

order to get the last available official statistics

• Training contents oriented to the benefits for

banks of incorporating GESI concerns

• Regional bank trainings cancelled due to travel ban • Offer online training

• Private health enterprises were hesitant to apply for

loans during crisis

• IMPACT team informed health enterprises of

availability of bank support to meet financial

needs

Mariama, PA in the Commune of Ankatsaka, Ambanja district, with her new motorbike

48

Strengthen the business management of enterprises in health products supply chain IR3.1.7 : Provide business strengthening capacity building to enterprises in health commodities supply chain and develop partnership with private companies to sustain the training.

In Year 2, IMPACT worked to strengthen the business and finance management capacity of health commodities

enterprises, along with their knowledge of the legal and regulatory framework, to help them sustainably expand their

offerings of affordable, high quality products to the population.

• All business training materials were translated into Malagasy.

• Obtained co-sponsoring of trainings from COFARMA and SOMAPHAR in Year 2.

• In Quarters 1 and 2, IMPACT completed two in-person regional business training sessions for drug shops in

Atsinanana and Boeny.

• In Quarter 4, the team made video recordings of the training slides with audio narration and explanation by the

IMPACT training facilitators.

• IMPACT prepared distance learning kits for drug shops in Diana and Sava. The kits include the collection of

legislative texts prepared by DPLMT, the participant training manual, and the video recordings on DVD and flash

drive.

• Of the 22 legally registered drug shops in the Diana, only 19 picked up the video training kit from IMPACT’s

regional office. The three remaining candidates were not available due to connection issues. Of the 19

participants, at the end of September 16 had finished the video training and took the test.

• For the Sava region, validation of the list of eligible drug shops by DPLMT took longer than expected due to a

large number of illegal drug shops, delaying the business training planned for Year 2. Distribution of the video

kits will start early October 2020.

Table 33: Drug Shops Receiving Business Training or Coaching in Year 2

Indicator

Achievement Year 1


Activity Quarter 1 Quarter 2 Quarter 3 Quarter 4 Total Target Achievement

Business Training

Number of people trained in business and financial management

22 27

(15 men, 12 women)

27 (16 men,

11 women)

0

16 (10 men,

6 women)

70 (41 men, 29 women)

80

70 (88%)

One-on-one

Coaching

Number of drug shops receiving

coaching 5

3 (2 men, 1 woman)

3 potential

CPTs

2 (1 man, 1 woman)

16 (9 men,

7 women)

5

potential CPTs

0

21 (12 men, 9

women)

10 potential

CPTs

10

21 (210%)

• During the COVID-19 lockdown, IMPACT supported drug shops to ensure that they had commodities available,

conducting a mini-survey in Quarter 3 to identify any problems drug shops were facing during the lockdown

such as problems with supply shipments due to transportation restrictions, stock outs of products, or limitations

on order quantities due to insufficient wholesaler inventory (malaria products, flu medicines, and Vitamin C), and

to determine their need for financing (primarily for inventory purchases) and protective equipment.

In Quarters 3 and 4, to respond to COVID-19 and to support private enterprises in the health supply chain IMPACT

provided masks, hand sanitizer, and hand-washing equipment to pharmacies and drug shops already working with

the project. A total of 118 COVID-19 protection kits have been distributed so far as detailed below

Table 34: Beneficiaries of COVID-19 Protection Kits Distributed by IMPACT

49

Drug Shops Pharmacies Comments

Atsinanana 28 15

Boeny 18 13

Diana 19 8 Shipment combined with video training kits

Analanjirofo 17 0

TOTAL 82 36

• In Quarter 4, IMPACT drafted an MOU with FORMASANTE, a private training firm which offers technical and

management training modules to pharmacies. IMPACT and the firm will collaborate to develop customized

modules for drug shops

• SOMAPHAR, the pharmaceutical wholesaler which co-sponsored the drug shop training in Boeny in Quarter

2, also expressed its interest in creating a training partnership with IMPACT.


• Identify and select the most effective alternative

remote learning method customized to drug shops

needs and means.

• The video learning method was identified as the

most cost effective and the quickest alternative to

be developed.

• DPLMT refuses to provide awareness-raising

sessions or training to drug shops operating

illegally.

• Continue persuading DPLMT that informal drug

shops that want to formalize should also be

included in the process.

• Participants do not follow instructions for the video

training, especially regarding the tests.

• Managing the video training is time consuming

(multiple follow-up calls required).

• Clarify written (and video) instructions, organize

regular check-ins.

• Conduct a cost-effectiveness analysis of the video

vs. in-person training

Recommendations for Year 3

• Based on initial follow-up calls to drug shops who received the video training, most (74%) would prefer in-person

training in the future. Some trainees did state that they liked the video training because they could manage the

time spent on the course, resulting in cost savings for them.

• An evaluation of the cost-effectiveness of the video training method compared with the in-person training should

be conducted in Year 3 to determine how IMPACT can optimize the use of resources for strengthening the

business management of health commodities enterprises.

• According to regulations, drug shops should only be run by the licensed owner; officially, no additional staff are

authorized. Drug shop owners find it difficult to simultaneously fill out the book-keeping and inventory

management tools provided by IMPACT, while also operating their business alone. This feedback confirms that

in Year 3, IMPACT should continue to pursue the establishment of an ADDO-style system, which would allow

drug shops to operate with a dispenser and a manager/owner.

Mr. Baly, President of ADEMERA (Atsinanana region)

Mr. Jimmy, member of preparatory committee for the drug shop association in Boeny region

50

• In Year 3, IMPACT will begin testing a digital inventory management application for use by drug shops, and the

A2F team should incorporate this tool into its business trainings.

Sub-IR 3.2: GOM facilitates the work of the commercial sector

IR3.2.1 : Facilitate high-level advocacy meetings involving the MOPH, Ministry of Commerce, customs services,

Ministry of Economy and Finance, the National Board of Physicians and the National Board of Pharmacists to

develop policies and regulations that will favor importation and commercialization of a packet of vital Essential

medicines, including contraceptives, anti-malarial, and key MNCH products.

In order to facilitate the commitment of the commercial sector to supply new health products, IMPACT continued to

support high-level advocacy meetings for the tax exemption of essential medicines, such as contraceptives,

antimalarials, MNCH products, and health commodities.

• The National List of Essential Medicines and Commodities was revised, updated, and signed by the MOPH in

November 2019. This list serves as a basis for procurement of medicines in all hospitals and CSBs to treat patients,

and for tax exemption of imported essential medicines and commodities to increase their access.

• On March 16, 2020, IMPACT organized a workshop with parliamentarians from the Health Commission of the

National Assembly to present the objectives and main activities of IMPACT, with the aim of soliciting their

support and collaboration to achieve these objectives in the interest of the Malagasy population and public

health. The parliamentarians expressed interest and willingness to support the IMPACT project, particularly in

the areas of regulatory reform, the ADDO initiative, and combating counterfeit markets.

• IMPACT supported the DAMM and DPLMT to prepare for a meeting with the Ministry of Economy and Finance,

as well as tax and customs experts, to share the new list of Essential Medicines and engage in an open dialogue

and collaboration to advocate for tax exemption for medical devices. The existing customs code and tariff law

stated that all Essential medicines must be tax exempt.


The MOPH must remain collaborative and maintain relations with the customs and tax authorities to carry out

constant advocacy in favor of the exemption of essential drugs and health products.

IR3.2.2 : Support DAMM and MOH to put in place strong regulatory processes related to the registration, importation, and distribution of medicines based on reviews of the Common Technical Document, New Law on Regulatory Body in Africa, and experience from other countries through study tours.

The purpose of this activity is to support the DAMM to undertake updating and reforming drug regulations in

accordance with the most recent international guidelines and recommendations, particularly in the areas of drug

registration and quality assurance procedures:

• To enhance the document review of the 128 regulatory texts inventoried in 2019, a TWG of the TMA regulatory

texts sub-committee workshop was organized on February 4, 2020, with the participation of an international

expert in pharmaceutical regulation, Marie Paule Fargier. During this workshop, participants agreed on

classification criteria according to themes (regulatory functions, exercise of the profession, professional orders,

health products, policies), current status (valid or not) compared to the new Health Code from 2011, and public

health priorities (quality assurance, inspection, availability and accessibility of drugs, sanitation of the

pharmaceutical sector). Gaps and/or need for updates were identified by the consultant, particularly in the

following areas: registration procedures, illicit markets and counterfeit medicines, medical devices,

pharmaceutical inspection, the distribution channel, and the absence or insufficiency of manuals for technical

and financial procedures and of directives relating to standards of good practice (good distribution practices,

good dispensing practices, good storage practices, good pharmacy practices, good laboratory practice, and good

clinical practice).

• The technical report developed by Dr. Fargier was shared with USAID, DAMM, and the DPLMT and finalized in

Quarter 3. An action plan with immediate and mid-term activities to implement was developed and shared with

51

USAID and UCP-Global Fund for resources mobilization. In Year 3, IMPACT will support the DAMM to share the

findings of the report and action plan with other key partners to mobilize funds and necessary technical

assistance to improve the functioning of the DAMM.

• As a next step, with support from IMPACT, the AMT/Regulation subcommittee will use recommendations to

review and update the existing legislative and institutional laws and decrees governing the pharmaceutical sector

in Madagascar to comply with the latest international guidelines. Comparative analysis of existing texts with the

New African Union Model Law on the Regulation of Medical Products shows that Malagasy legislation must still

include provisions relating to the classification and prescription of medicines; the fight against the illicit market,

counterfeit, and substandard medicines; the obligation of declaration of conflict of interest for the members of

the National Registration Commission; and the appeal procedures applicable in the event of litigation. The report

also notes that basic technical skills already exist at the DAMM level, but the technical team needs to better

structure its procedures and archiving system to be more efficient and transparent. To this end, it is

recommended to develop clearly defined guidelines for best practices and to establish a computerized archiving

system.


Priority issues or challenges for the DAMM include the lack of standard operating procedures for each technical

service to upgrade the functioning of the DAMM, as well as the relaunch of the pharmaceutical inspection.

IR3.2.3 : Support DAMM in streamlining the registration and importation procedures for medicines based on the latest WHO recommendations.

In order to upgrade the DAMM efficiency and performance in terms of drug quality assurance, the DAMM drug

registration procedures are updated and streamlined in accordance with the WHO and African Union latest

recommendations and drug quality assurance procedures are harmonized between the DAMM, SALAMA central

medical stores, and the TFPs who contribute to the supply of drugs for national health programs. During Year 2,

IMPACT recruited an international expert, Dr Fargier, to work with the in-country Regulatory expert in the following

activities:

• From January 27th to February 7th, 2020, provided technical assistance to the DAMM to use the results of the

self-assessment that DAMM completed using the WHO Global Benchmarking Tool (GBT). The GBT tool assesses

the functioning of the regulatory authority in registration and quality assurance, regulatory reform, and

inspection.

• Provided assistance in defining short-term and long-term strategies to improve the functioning of the DAMM.

• Facilitated a meeting between the DAMM and UCP-Global Fund in February to explore opportunities for raising

funds to support the WHO prequalification process for the DAMM laboratory quality control.

• Facilitated a working session in March to familiarize DAMM, DPLMT, and SALAMA staff on the Common Technical

Document (CTD) of the WHO for the registration of medicines, and to identify the needs for adapting national

regulations to the African Union Model Law on Medicines.

• Facilitated the development of two MOUs between the DAMM and SALAMA central medical stores, and DAMM

with MOPH and TFPs related to the harmonization of quality assurance procedures.

• Developed a draft of a new registration guidance for medicines in accordance with the CTD format in Quarter 3.

The draft will be shared with DAMM for discussion and validation.


The digitalization of the DAMM, and in particular of its registration system, is a challenge because it requires a renewal

of its IT equipment and training of its staff. IMPACT will continue to support resources mobilization activities to engage

multiple partners to support the new strategies developed for DAMM. Currently, IMPACT is engaging UCP to support

IT equipment, training on basic computer skills, and networking as part of its support towards the WHO

prequalification process of the DAMM quality control laboratory.

52

IR3.2.4 : Support the MOPH and the professional associations to revitalize the inter-ministerial committee to fight

counterfeit and illegal medicines. A strategy will be defined through a mid-term evaluation of the Stratégie de Lutte

Contre le Marché Illicite and the Contrefaçon des Medicaments et Intrants de Santé and an action plan will be

developed.

In 2011, Madagascar created an inter-ministerial committee to fight counterfeit medicines and illicit market

(CIMLCCVI), hosted by the Prime Minister. In 2017, the Committee defined strategies to fight counterfeit and illegal

medicines for 2017-2021, but to date no strategy has been implemented due to the lack of recognition of the

Committee by the Prime Minister and unavailability of both human and financial resources.

Throughout Quarter 1 and Quarter 2, IMPACT continued discussions with the Executive Secretary of the inter-

ministerial committee to review the implementation statuses of strategies developed in 2017. While waiting to

secure a meeting with the Prime Minister on the restructuring of the Committee, some activities were identified to

be implemented with DAMM and DPLMT:

• Dissemination of existing laws, ministerial decrees, and notes governing the pharmaceutical sector to all actors

involved in the pharmaceutical sector to contribute to combating illicit markets. This will be done under the

leadership of the TMA sub-committee.

• Close collaboration with DPLMT to monitor the destruction of all expired medicines to combat illicit market will

be a continuous activity.


• A mini workshop to prepare the mid-term review of the implementation of the strategic plan for the fight against

the illicit market and counterfeit medicines was planned in collaboration with the DPLMT and DAMM in Quarter

4 but could not take place because of COVID-19 lockdown measures.

• A review of the strategy to combat the illicit market and counterfeit medicines must be carried out by all

stakeholders with the MOPH to redefine leadership and reorient priority activities.

III- 4 IR 4: Improved sustainability of social marketing to deliver affordable, accessible health products to the

Malagasy people

Sub-IR 4.1.1: Socially marketed products are continuously available at convenient and accessible locations

IR4.1.1: Distribution of socially marketed products across 10 regions for MNCH and FP/RH products and distribution of only FP/RH products in three PARN Regions through PARCs and PAs.

In Year 2, IMPACT:

• Received eight off-road vehicles (4x4) and five motorbikes in Quarter 1 used for the delivery of commodities from IMPACT’s warehouses to PARC and also for supervision of PA and PARC. Vehicles are assigned to Sambava, Antsiranana, Antsohihy, Tamatave, Maintirano, Fianarantsoa, Tuléar, and Antsirabe and the motorbikes have been assigned to SPD based in Antsiranana, Antsohihy, Tamatave, Farafangana, and Tuléar.

• Stored all FP and MNCH commodities received for 2020 at the central level before distributing them to the regional warehouses.

• Distributed FP and MNCH commodities to the 13 regions of IMPACT.

• Supervised 71 PARC and 919 PA in the 13-USAID supported regions on the correct completion of the

management tools, physical stock status, expiry dates, and proper storage of commodities.

• Provided on-the-job refresher training to 919 PA and 71 PARC on supply chain management based on the

average monthly consumption, calculation of the quantity to order, safety stock, completion of the

management tools, and storage standards.

• Collected monthly data related to the stock status at PA and PARC.

Achievements: FP Commodities

53

Table 35: Distribution of FP commodities in Year 2

YEAR 2

FP PRODUCTS Year 2 Target

Quarter 1 Achievement




Year 2 Cumulative

% of Year 2 Target

Achieved

OC (Community Channel)

1, 724,880 484,152 748,871 647,659 407,629 2,288,311 133%

Injectable I.M (Depo-Provera/TRICLOFEM) (Community Channel)

1,473,355 513,453 567,313 450,623 501,989 2,033,378 138%

FP condom Protector Plus (Community and Commercial Channels)

1,633,794 557,904 445,488 332,928 316,848 1,658,168 101%

FP Youth Condom Yes (Commercial Channel)

671,689 N/A N/A N/A N/A

Sayana Press (Community Channel)

474,355 6,601 N/A 63,008 65,445 135,054 28%

Pregnancy Test (Community Channel)

100,000 4,245 20,604 2,525 3,662 31,116 31%

• Oral Contraceptive (Microgynon, Combination 3, Zinnia-F): The annual target of distribution of Oral

Contraceptives has been exceeded by 33% due to an increase of regular users from Mahefa Miaraka since

Quarter 2. It will be impacted in the Average Monthly Consumption and on the future orders, so IMPACT does

not anticipate stockout. Stock out of Oral Contraceptives was 0% for Quarter 1, 2, and 3 and 1.9% at PARC and

2.7% at PA during Quarter 4, versus a target of 5%.

• Intra-muscular Injectable Contraceptive (Depo-Provera/Triclofem): The annual target of the Intra-muscular

Injectables has been exceeded by 38% as some consumers chose to use Triclofem when Sayana Press was not

available.

• Sub-cutaneous Injectable Contraceptive (Sayana Press): From June to September 2020, only 28% of the annual

target has been achieved. From Quarter 3 to Quarter 4, distribution at CHVs shows that 88% of the regular users

have adopted Triclofem and 12% have adopted Sayana Press. The low uptake is due to the fact that Sayana Press

is a new product

• Yes With You Male Condom: The portfolio analysis recommends maintaining Yes condoms by introducing new

flavors (banana or vanilla) depending on the consumer choice. However, the procurement of this product will be

initiated in Year 3 when the transition plan to the private commercial sector is finalized between IMPACT and

private pharmaceutical wholesalers.

• Protector Plus Male Condom: IMPACT achieved 101% of the annual target, mainly due to high performance by

the commercial circuit, as the product was continuously available and appreciated by targets.

• Pregnancy Test Kit: 31% of the annual target was achieved as distribution was only done in SOFIA and Menabe

regions. The pregnancy test kits should be distributed in the 13 regions which is how the 2020 targets were set.

However, trainings were conducted only in the Sofia and Menabe regions by Mahefa Miaraka. Trainings by

Mahefa Miaraka and ACCESS in other regions, such as SAVA, DIANA, and Melaky will be planned in Year 3 when

the next procurement order of pregnancy tests arrives. The scale up of trainings will allow IMPACT to achieve

the target.

Achievement: MNCH commodities

54

Table 36: Distribution of MNCH commodities in Year 2

YEAR 2

MNCH PRODUCTS Target Quarter 1

Achievement Quarter 2



Achievement Year 2

Cumulative

% of Year 2 Target

Achieved

ORS/Zinc DTK (Community)

58,906 21,008 28,838 21,230 18,662 89,738 152%

Sur Eau 150 ml (Commercial)

904,910 N/A N/A N/A 6,914 6,914 1%

Sur Eau Pilina (67mg Tablet) (Community)

3,620,780 703,300 289,200 206,820 25,920 1,225,240 34%

Arofoitra (CHX 7,1%) (Community)

30,378 12,946 1,871 7,548 3,175 25,540 84%

Pneumox (amoxicilline) (Community)

219,635 48,182 18,352 28,878 80,932 176,344 80%

• ORS/Zinc: 152% of the annual target was achieved. This is because the use of ORS/Zinc has increased during the

rainy season and also as a result of communication activities conducted by IMPACT Communication field team.

• Sûr’Eau 150 ml (commercial): Pending the order of Sur’Eau Pilina, IMPACT distributed 6,914 Sur’Eau 150 ml to

the community channel. Therefore, the total quantity of Sur’Eau 150 ml distributed at the commercial circuit

represented only 1% of the forecasted annual target. Sûr’Eau 150 ml will be shifted to the commercial circuit as

soon as the Sûr’Eau Pilina order is received.

• Sûr’Eau Pilina (community): From May to September 2020, Sûr’Eau Pilina was in stock-out as the arrival of the

next shipment was delayed due to COVID-19. Start-up kits of 12,515 pockets of 20 dispersible tablets of Sûr’Eau

Pilina were provided to 2,503 CHVs in Vatovavy Fito Vinany, Atsimo Andrefana, and Atsinanana in Quarter 1,

which may explain low sales of Sûr’Eau Pilina at the PA level since Quarter 2. Each CHV in the three regions

received five packets of Sûr’Eau Pilina. Only 33.83% of the annual target was achieved and IMPACT will organize

a promotion session through the Mobile Field Communication teams from October 2020 when the new order of

Sûr’Eau Pilina arrives in September 2020 and will be available in the PA and PARC.

• Arofoitra (Chlorhexidine 7.1%): Despite the forecast during the national quantification exercises established by

ACCESS and Mahefa Miaraka projects, the consumption of Arofoitra at the CHV level remains relatively low as

only 84% of the annual target was achieved. IMPACT allocated 7,689 tubes in Quarter 1 and 3,519 tubes in

Quarter 3 as start-up kits for ACCESS for 3,736 CHVs revolving funds in the regions of Vatovavy Fito Vinany,

Atsimo Andrefana and Atsinanana. Each CHV received 3 tubes of Arofoitra. IMPACT is collaborating with ACCESS

and Mahefa-Miaraka to conduct an investigation to understand this low consumption of Arofoitra at the CHV

level

• Pneumox: Only 80% of the annual target was achieved due to the stock out reported in Quarter 2 and Quarter

3.

Challenges:

Performing field visits was challenging due to security issues and the bad road conditions, especially during the rainy

season and health products are mainly distributed by trucks, Taxi-Brousses, and boats.

55

Recommendations :

• CHVs refresher training on the importance and use of Sûr’Eau Pilina, Arofoitra, and Protector Plus has been

suggested to ACCESS and Mahefa Miaraka. Communication teams in the field will promote these products.

• Extend distribution of pregnancy tests to more regions than SOFIA and MENABE by ACCESS and Mahefa Miaraka

to boost the use.

IR4.1.2: Establish a motivation system for PAs and PARCs and follow up on their quarterly performance to address supply chain inefficiencies in social marketing in order to prevent stockout.

IMPACT has continually addressed supply chain inefficiencies in social marketing in order to prevent stock out.

• From January 27th to 31st, 2020 workshops with the regional supervisors SRD were held in Antananarivo.

Previously planned every quarter, the workshops with SRD were held by conference call due to the COVID-19

pandemic.

• Only 24 out of the 57 trainings sessions planned for PA and PARC were completed due to COVID-19. The objective

is achieved at 42% compared to the total of trainings planned. These trainings focused on how to quantify needs,

define the average monthly consumption, better monitor management tools, recall standards of good storage,

and manage expiration dates. IMPACT distributed 458 training manuals of all the topics discussed during the

training to 431 PA and 27 PARC.

• The training objective was partially achieved as the classroom trainings had to be stopped. Even though the SPD

built the capacity of PAs as much as possible during the field supervision, this could not fully replace the in-

classroom sessions, given the limited time combined with the supervision. The training will resume in Quarter 2

of Year 3 with updates.Increased the number of PA and PARCs from 925 (PARC: 66 and PA: 859) to 990 (PARC:

71 and PA: 919) due to the extension of ACCESS and Mahefa Miaraka intervention zones.

Graph 7: Evolution of the number of PA and PARC

56

• 27 PARC and 431 PA ( 195 males and 263 females) have

been trained. The table showing details of the training

during Quarter 3 and Quarter 4 is in Annex H

• On April 27th and July 22nd, a ToT by Visio conference for SRDs was held on GESI in order to introduce GESI concepts to the community channel. The final curriculum in French on GESI is available. The curriculum to be used for the training of PARC and PA in Malagasy is available as well for the future trainings.

• The expectation is to introduce GESI concepts to PA and PARC so that they are aware of equity in performance in their volunteering as PA and PARC. For example, it was observed that ome female PA had difficulties in allocating the appropriate amount of money to purchase health commodities due to their relationships and financial difficulties at home.

Achievements

• PA and PARCs assessment results o Quarter 1: 15 PARC and 244 PA

o Quarter 2: 35 PARC and 463 PA



IMPACT promotional items (pens) were distributed to the PARC and PA who had good scoring.

Graph 8: Evolution of PARC and PA receiving incentives per Quarter

IR4.1.3: Expand last-mile distribution and emergency distribution through a pilot to deliver health products using drones. Achievements:

• From October 2019 to September 2020, 71 drone flights were successful (65 in Maroantsetra and 6 in Mananara Nord). The payload increased from 2.5L to 12L for a short flight distance. The volume of health products transported has increased and the needs of 24 PA can be delivered in one flight.

• For long flight distance (100 km), only 3L per flight is authorized to not overload the drone.

• Drones can deliver health commodities in remote areas from 50km to 100km from the take off point.

• The criteria used in making the decision to use drones for the delivery of health commodities are: 1) the needs identified by the PA to restock quantities and ensure that the level of stock is normal to maximum, formulated in order and 2) to solve the issues of access in geographically remote areas.

• The determinant of the number of flights are the quantity of health products ordered by the PA, the weight and volume of the products to be delivered, and the distance of the flight. For instance, if the PA is located more than 50 km away and the order is more than 6 liters, the delivery must be more than one flight.

• The main objective was to test the drone and its feasbility.

PARC and PA in Ambatolampy after the training

57

• Even though the stock out in Maroantsetra was already very low, the stock-out rate reached 0% since the delivery by drone.

Table 37: List of flights and number of products delivered to PA

Date Number of successful

flights in Quarter 1 Year 2

Number of flights aborted

Distance

Oct-Dec 2019 15 1 PA<25 km Flight aborted due to the high wind speed

January-March 2020

19 1 PA<25 km Flight aborted due to the drone’s hold did not open

January-March 2020

1 1 25km<PA<50km

Flight aborted due to several mobile phone pylons that were not previously recorded

July-August 21 0 PA<25 km

July-August 8 0 25km<PA<50km

September 7 0 50km<PA<100km

Flights were suspended in Quarter 3 because batteries could not be received from the supplier due to COVID-19.

Table 38: Number of FP and MNCH products delivered to PA by drone

PRODUCTS TRANSPORTED DURING the 71 drone flights

Triclofem (Dose)

Syringe (Piece)

Sayana Press (Dose)

Microgynon (Blister)

Combination 3 (Blister)

Zinnia (Blister)

Condom male Plus (display of 48 condoms)

Pneumox (Blister)

Arofoitra (Tube)

Sur'Eau Pilina (pouch)

ORS (Sachet)

2440 1268 300 826 210 3185 9 277 111 160 160

Recommendations:

• Organize flights to other districts: Andapa, Antalaha, Mandritsara, Antsohihy

• Update of the process (continuous activity) because the flight process changes for each flight

From Year 3, drone coverage areas will be extended to Andapa, Antalaha, Mandritsara, and Antsohihy districts.

IR4.1.4: Transition the community distribution model from select PAs and PARCs to the Pha-Ge-Com and Pha-G-Dis in coordination with DDS/DPLMT/DSFa/ACCESS/Mahefa Miaraka. The performance of Pha-G-Dis and Pha-Ge-Com needs to be improved progressively prior to ensuring the transfer of the PAs and PARCs. Due to the COVID-19 pandemic, activities were slowed down and the missions to audit the Pha-G-Dis by DPLMT could not be conducted as scheduled. A workshop planned to define the criteria of the transfer with the MOH was postponed because of the COVID-19 pandemic and unavailability of MOH staff that were involved in the COVID-19 response. Therefore, the transfer process will be postponed to Year 3. A committee will be set up to define an action plan and all the transfer criteria. IR4.1.5 : Select and introduce socially marketed products across 10 IMPACT regions and 3 PARN regions through the

private sector (pharmaceutical and commercial channels) pending the results of the COGS analysis.

58

Achievements:

• COGS analysis was completed, and the FP portfolio products were analyzed.

• FP market potential was presented to the pharmaceutical private sector through a conference call meeting

sensitizing the private sector to participate in the national quantification exercise.

• DMPA-SC (Injectable Sub-Cutaneous) and Yes With You condoms have been identified and recommended to be

introduced into the private sector according to the portfolio analysis. It means that the distribution of those

products will be transferred to the private sector as per the portfolio analysis.

Recommendations/adjustment for the next fiscal year:

Clear discussions between non-profit and private sector should be led to identify the commitment of the private

sector to satisfy all the segments of the market in FP commodities.

IR4.1.6 : Define the needs for a product monitoring system and conduct a study of a product tracking system. Find

technological solutions which allow IMPACT to earn and grow brand loyalty while protecting the brand from supply

chain fraud, including counterfeiting and theft.

National and international suppliers were prospected in order to gather proposals and quotes to study the feasibility

of setting up the product tracking system. Local suppliers did not complete the requirements of the tender, so the

tender had to be open internationally. An international supplier (Sproxil) has been identified and contacted.

Challenges:

Development and implementation of the barcode system is delayed to Year 3 due to the COVID-19.

Sub-IR 4.2: Socially marketed products achieve cost recovery at an affordable price for consumers IR4.2.1 : Leverage TMA findings from IR1 to analyze COGS and continue to propose options for the optimization of

financial sustainability for the current socially marketed products portfolio and explore brand extension of Yes With

You condoms and introduce a new brand of pharmaceutical products depending the results of the COGS analysis.

• The product portfolio analysis and COGS analysis demonstrates large trade margins for FP products.

• The optimization of the financial sustainability of FP products includes reducing this trade margin and slightly

increasing the prices of FP products (except Rojo). The adjusted prices take into account the ability of end users

to pay by observing market dynamics or by responses from the willingness to pay survey that was already

conducted.

• Positioning of condoms in the market shows the possibility to extend the Yes With You brand. Two new scents,

Vanilla and Banana, were to be explored and IMPACT has requested samples from the supplier. Due to COVID-

19 pandemic, the supplier was not able to send the samples in Year 2.

• DMPA-SC and Yes With You condoms stand out as priority products to be reintroduced into the private sector

according to the products portfolio analysis and according to the gap recognized in the market. IMPACT will

engage the private sector to take over of these products. In the meantime, IMPACT will start the distribution

through the private sector in order to facilitate the transition.

Recommendations/adjustment for the next fiscal year:

Dialogues with the pharmaceutical private sector will be held in order to introduce DMPA-SC and Yes With You

condoms into the private sector.

III- 5 IR5 - Increased demand for and use of health products among the Malagasy people

IR5.1.1 : In collaboration with the demand creation subcommittee of the TMA TWG, develop and implement

activities to increase demand and use of health products

At the beginning of Year 2, a demand creation subcommittee of the TMA TWG was set up under the lead of the Health

Promotion Directorate (Direction de la Promotion de la Santé - DPS) of the MOPH, including 25 stakeholders from all

59

sectors, such as the MOPH (Agence des Médicaments de Madagascar (AMM), Direction de la Pharmacie, des

Laboratoires et de la Médecine Traditionnelle (DPLMT), National Malaria Control Program (NMCP), pharmaceutical

wholesalers from the private sector, and from NGOs.

The main objectives of this subcommittee are to increase demand creation on health products for public, private, and

nonprofit sectors, and to develop and implement a communication plan on the safe and rational use of health

commodities.

Five meetings of the TMA TWG demand creation subcommittee were held under the lead of the DPS of the MOPH,

with the participation of AMM, DPLMT, DGFS, the private sector, and NGOs. The table below summaries the results

of the meeting.

Table 39 : Summary of the results of the meeting

Meeting Date Results of the meeting

1 October

2nd, 2019

- The concept of demand creation for health commodities and the interests

in building a subcommittee were explained to the stakeholders.

- Barriers and opportunities in terms of communication on health

commodities were identified.

2 December

13th, 2019

- The National Strategy for the Fight against Counterfeiting and the Illicit Drug

Market (Stratégie Nationale pour la Lutte contre la contrefaçon et le marché

illicite des medicaments) was presented by the executive secretary of the

inter-ministerial committee to fight against the illicit drug market.

- Revision and improvement of the regulatory texts on the promotion of

health commodities.

- Identification of the capacity building needs in communication for the

members of the subcommittee, such as media training, advocacy, and

photography.

3 March 17th,

2020

- According to the main barriers identified, which were self-medication and

lack of awareness about proper use of medicines, a draft communication plan

on the safe and rational use of health commodities and self-medication was

developed.

- The DPS provided training on the development of a communication plan and

on the basic principles of health communication.

- Participants were also trained on photography basics.

4 (virtual meeting) July 15th,

2020

Continue to develop the communication plan with the steering committee

composed of the MOPH (DPS, AMM, DPLMT) and IMPACT. The different parts

of the communication plan were finalized and tasks were distributed

between the steering committeemembers for completing the document

5 (virtual meeting) September

18th, 2020

- Integration of the concept of rational use of drugs into the communication

plan.

- Finalization of the draft of the communication plan on the safe and rational

use of health commodities.

Table 40: Achievement on indicator IR5.5: Number of GOM and commercial sector employees trained in developing

a national communication plan on demand creation during TMI meetings and IR5.6: National Product Promotion

Communication Plan developed and implemented

Achievement

Y1



IR.5.5 Number of GOM and commercial sector

8 19 21 0 4 21

60

employees trained in developing a national demand generation strategy during TMA meetings

15

Male 4 10 5 0 1 5

Female 4 9 16 0 3 16

GOM 8 12 17 0 4 17

Private Sector 0 3 3 0 0 3

NGO 0 4 1 0 0 1

IR.5.6 National health Product Promotion Communication Plan developed and implemented

1 0 1

A draft of a communication plan on the safe and rational use of health commodities was developed, but this activity took longer than expected because meetings and trainings in Quarter 3 were cancelled due to COVID-19 and staff from the MOPH were very busy with the pandemic and were not available to attend meetings. The MOPH staff also had a lack of internet connection to be able to attend virtual meetings so during Quarter 4, IMPACT provided data for internet connectivity to the staff from the MOPH to enable virtual meetings and to finalize the draft of the communication plan. The validation and the implementation will be completed in Year 3. In order to maintain the interest of subcommittee members, IMPACT will hold in-person meetings and trainings

respecting COVID-19 health safety measures in Year 3. The steering committee members recommend holding in-

person meetings to better engage other members.

IR5.1.2 : Provide technical and financial support to contribute to communication activities of the MoPH

IMPACT participated in:

• the workshop organized by the DPS and the WHO to review and develop a new Policy and Strategy on Health

Promotion of the MOPH for 2020-2024 from December 16th to 21st, 2019

• the mid-term review of the National Malaria Control Program from March 9th to 13th, 2020 for the

communication component.

• the review of the Malaria National Strategic Plan 2018-2022 through a virtual meeting from June 16th to 23rd,

2020 for the communication component.

IMPACT’s participation contributed to strengthened collaboration with the MoPH and helped to adjust IMPACT

activities according to MoPH strategies.

For instance, the Policy and Strategy on Health Promotion isfocused on behavior change, which is the reason why a

demand creation subcommittee of the TMA TWG, led by DPS and technically and financially supported by IMPACT,

was set up to address the communication on health commodities.

Based on the review of the National Malaria Control Program, IMPACT broadcasted TV and radio spots on ITPt and

case management because there was a lack of sensitization to promote these two commodities.

IMPACT provided technical and financial support to MOPH communication activities that are linked to the IMPACT

mandate, including:

• The celebration of World Malaria Day by broadcasting SMS messages targeting 2,614,443 people. Messages were

sent to women and men over 15 years old in the 10 USAID-supported regions, in collaboration with the NMCP

on April 25, 2020. The content of the messages focused on sensitizing people to avoid self-medication and to

encourage them to go to the health center to seek treatment.

61

• The celebration of the month of the child in June by broadcasting SMS messages targeting 3,219,776 people

(women and men over 15 years old) who use Telma, Airtel, and ORANGE networks in the 10 USAID-supported

regions. The content of the message was to educate parents to give ORS to children to replace the loss of water

during diarrhea.

• The celebration of World Contraception Day on September 26, 2020 through Facebook posts with messages on

the different FP methods and where to procure them. 3,322,661 SMS messages were sent to target people

(women and men over 15 years old) who use the Telma, Airtel, and ORANGE networks in the 13 USAID-supported

regions.

• The media coverage of the donation of 2 million malaria RDTs and nearly 2 million courses of treatment made

by the U.S. Government, through the President’s Malaria Initiative (PMI) and USAID, to the MOPH, for the

celebration of World Mosquito Day on August 20th. A video with the remarks from the U.S Ambassador and the

MOH was produced and aired on Facebook and on national TV stations.

COVID-19 response

IMPACT attended 26 meetings organized by the Commission for Communication on Risk and Community Engagement

(CCRCE) led by DPS at the central level, including:

• Nine virtual meetings to coordinate COVID-19 communication activities led by DPS with the communication staff

from the Ministry of Communication and TFPs. The main discussions during these meetings were on the

development of a national communication plan for the COVID-19 response with the corresponding estimated

budget and the financial and technical contribution to be provided by each TFP according to their intervention

area. Additionally, this meeting monitored the communication activities implemented.

• Fifteen virtual meetings with the mass communication subcommittee where IMPACT is an active member. The

main results of these meetings were: (i) development and revision of COVID-19 messaging according to the

evolution of the context and based on the information collected from the field, (ii) development of

communication support (TV, radio spot, printed media, etc.), (iii) development of a new communication strategy

using humorists, bloggers, and influencers on Facebook.

• Two virtual meetings led by DPS with the local communication team from DRSP. The main target was to present,

share best practices, and assess the communication activities planned and conducted by each region to the

central level (DPS and the TFPs), in order to refocus actions if needed (for instance: the need to elaborate new

messages according local context).

Due to COVID-19, most meetings were held virtually and official celebrations such as World Malaria Day and World

Contraception Day were cancelled and replaced by other activities, such as SMS broadcasts sent to target populations

or publications on Facebook with messages from the MOPH to raise awareness about malaria and FP. In collaboration

with MoPH, IMPACT took the opportunity of the two World Days to send SMS broadcasts to target populations and

post publications on Facebook with messages from the MOPH to raise awareness about malaria and FP.

IMPACT collaborates closely with MOPH and will maintain the relationship by continuing to financially and technically support the celebration of various World Days (international and national health events), inter-regional workshops, and other MOPH needs according to the IMPACT mandate, relative to the demand creation of health commodities for the three priority health areas (malaria, FP, and MNCH) in the 13 USAID-supported regions. IR5.1.3 : Conduct communication campaigns for promoting health products of the three prioritized health areas (Malaria, FP and MNCH) through radio, TV spots, job aids, and digital communication incorporating gender messaging to promote and use health commodities for population and providers Communication campaigns aim to promote health products in the three priority health areas (malaria, FP, and MNCH)

through mass media, social media, and print media in order to increase demand for health commodities.

During Year 2, IMPACT conducted different communication activities, including the broadcast of TV spots, radio spots,

SMS, and printed media as follows:

• Production of a new TV spot on FP in Quarter 3 focused on the several methods of FP (oral contraceptives,

condoms, injectables), and where to get them (health centers, CHVs, and drug stores). The script of the TV spot

was validated by DSFA and DPS.

62

• Production of printed media (in Quarter 1):

o With a limited budget, only 2,000 posters were produced to promote the Protector Plus brand. These have

been distributed to PA (924), PARC (71), and CHVs (1,005).

o 10,000 flyers for the community and 100 posters for providers were produced to inform providers that ORS

without Zinc was available, the price, and the indication of the packaging including the product and the

instructions.

• Broadcast of TV and radio spots (in all Quarters of Year 2). See Table 41 below.

• SMS broadcasts (in all Quarters of Year 2), see details below.

• Sensitization of the community in the field using mobile sound systems.

Broadcast of Radio and TV spots

During Quarter 4, IMPACT aired the new FP TV and radio spots. 825 TV spots and 7,990 radio spots were broadcasted

from July 6th to August 30th in the 13 USAID supported regions. These new TV and radio spots were developed in the

previous quarters.

IMPACT broadcasted 1,512 messages on IPTp uptake, 1,512 messages on malaria case management, and 1,830 messages on LLIN cCD beginning in Quarter 3 and continuing into Quarter 4. Details are included in the table below.

Table 41: Radio and TV spots aired during Quarter 4

Health Area Communication Campaign

Period Region Number of district

Number of spots aired

District covered by the TV and radio station

FP

Broadcasting of FP TV

spots

July 6th to

August 27th

2020

Boeny 2 110 Mahajanga I /II

Diana

2 110 Antsiranana I / II

Sava 2 110 Sambava/Antalaha

Atsinanana 3 110 Toamasina I/ II /Vatomandry

Haute Matsiatra

2 55 Fianarantsoa I /II

Menabe 1 55 Morondava

Vakinakaratra 2 55 Antsirabe I /II

Sofia 1 55 Antsohihy

Vatovavy Fitovinany

2 110 Mananjary/Manakara

Atsimo Andrefana

2 55 Toliara I /II

Total TV spot TV on FP

19 825

Broadcast of FP radio spot

July 6th to

August 27th

2020

Boeny 3 705 Mahajanga I/II /Marovoay

Diana 5 705 Antsiranana I/ II / Ambilobe/ Nosy Be

/Ambanja/

Sava 4 705 Sambava/Antalaha/Andapa/ Vohémar/

Atsinanana 7 1410 Toamasina I/ II

/Vatomandry/Brickaville/Mananara Nord/Maroantsetra/Marolambo

Analanjirofo 3 705 Soanierana Ivongo/Ste Marie/Fenerive

EST

Haute Matsiatra

4 705 Fianarantsoa I /II/ Vohibato/ Lalangina

Amoron'i Mania

1 235 Ambositra/Fandriana/Ambatofinanrahan

a/ Manandrina

Menabe 3 235 Morondava/Beloha sur

Tsiribihina/Mahabo

63

Health Area Communication Campaign

Period Region Number of district

Number of spots aired

District covered by the TV and radio station

Melaky 1 235 Morafenobe

Vakinakaratra 7 470 Antsirabe I/ II Mandoto/Betafo

Faratsiho/Antanifotsy/ Ambatolampy

Sofia 4 470 Antsohihy/Mampikony/

Analalava/Bealalana

V7V 5 470 Mananjary/Manakara/Vohipeno/Ifanadia

na/Ikongo

Atsimo Andrefana

4 940 Toliara I / II /Sakaraha/Ampanihy

Total radio spot on FP

51 7990

Malaria

Broadcast of LLIN

cCD Radio Spots

July 1st to

August 31st

2020

Atsimo Atsinanana

2 1098 Vangaindrano Farafangana

Atsinanana 2 732 Tanambao Manampotsy /Mahanoro

Total radio spot on LLIN cCD

4 1830

Broadcast of IPTp

uptake Radio Spots

July 1st to

August 31st

2020

Sofia 2 108 Antsohihy/ Mampikony

Diana 4 162 Antsiranana I / II/Nosy Be/ Ambanja

Boeny 2 108 Mahajanga I/II

V7V 4 108 Manakara/Vohipeno/Farafangana


Sava 4 216 Sambava/Antalaha/Vohémar

Atsinanana 7 432 Toamasina I/II / /Marolambo/

/Mahanoro/Vatomandry/Brickaville Tanambao Manampotsy

Analanjirofo 4 162 Maroantsetra/ Mananara Nord

/Vavantenina/Fenerive Est

Atsimo Andrefana

3 162 Toliara I/ II/Ampanihy

TOTAL radio Spot Radio on IPTp

31 1512

Broadcast of malaria case

management radio Spots

July 1st to

August 31st

2020

Sofia 2 108 Antsohihy/ Mampikony

Diana 4 162 Antsiranana I / II/Nosy Be/ Ambanja

Boeny 2 108 Mahajanga I/II

V7V 4 108 Manakara/Vohipeno/Farafangana


Sava 4 216 Sambava/Antalaha/Vohémar

Atsinanana 7 432 Toamasina I/II / /Marolambo/ /Mahanoro/Vatomandry/Brickaville

Tanambao Manampotsy

Analanjirofo 4 162 Maroantsetra/ Mananara Nord /Vavantenina/Fenerive Est

Atsimo Andrefana

3 162 Toliara I/ II/Ampanihy

TOTAL radio spot on malaria case management

31 1512

64

Table 42 : Achievement on indicator IR.5.4 Number of mass media spots aired during Year 2


Y1


Quarter 1 Quarter 2 Quarter 3 Quarter 4 Total Target %

achievement

IR.5.4 - Number of mass media spots aired

MALARIA 2,555 0 2,640 5,754 4,854 13,248 10,000 132,5%

FP 4,750 0 0 0 8,815 8,815 10,000 88,2%

MNCH 8,317 1,650 8,437 1,271 0 11,358 15,000 75,7%

• Malaria: The target was achieved at 132.5%. Due to many cases of malaria reported by the NMCP there was

an additional broadcast of 3,194 radio spots on malaria case management in the 10-USAID supported

regions. The focus of these spots is to encourage population to go to the health center to be tested with an

RDT to confirm if they had malaria and to receive the appropriate treatment.

• FP: The target of 10,000 spots broadcasted was not reached and the achievement was 88.2% at the end of

Year 2. Broadcasts of TV spots for YES With You were scheduled initially, but the product was not available,

so the broadcasts were cancelled. Furthermore, the stock of Protector Plus was low in Year 2 so promotion

was not required.

• MNCH: The achievement was 75.7% for the spots broadcasted and the target of 15,000 spots broadcasted

was not reached. In Quarter 4, there was a stock out of Sur'Eau Pilina, so IMPACT did not need to promote

this product and the scheduled broadcasts were cancelled.

Promote health products in the field with communication teams using mobile sound systems

IMPACT continued the social mobilization at the community level to increase the demand of CHX, Sur’Eau Pilina, and

Protector Plus condoms in the 10 USAID-supported regions Atsinanana, Analanjirofo, Diana, Sava, Sofia, Boeny,

Menabe, Melaky, Atsimo Andrefana, Vatovavy Fitovinany). About 1,405 sensitizations were held in the field. Fifty

three of the 60 districts in the 10 USAID-supported regions were sensitized by the IMPACT communications team.

Seven districts (Sainte Marie, Tanambao Manampotsy, Marolambo, Ikongo, Nosivarika, Ankazoabo, and Beroroha)

didn’t benefit from sensitization due to inaccessibility.

In Year 2, there were 10 field communication teams based in the 10 USAID-supported regions (Atsinanana,

Analanjirofo, Diana, Sava, Sofia, Boeny, Menabe, Melaky, Atsimo Andrefana, Vatovavy Fitovinany), six of the teams

were funded by IMPACT and four were funded by ACCESS. In Year 3, communication teams under IMPACT will conduct

social mobilization in the three PARN regions on FP.

Table 43: Percentage of sales of social marketing products made by communication teams in the field and CHVs

during Year 2

Year 1 Q1 Q2 Q3 Q4

Total Year 2

Target Y2

% achievement

Sales of Sur'Eau Pilina* (from PSI warehouse)

2,299,680 703,300 289,200 206,820 25,920 1 225 240

Quantity of products sold to CHVs during sensitization by Communication Teams

749,600 129,000 43,360 127,480 29,980 329,820

720,000 45,81%

% of sales through Communication Teams to CHVs

33% 18.3% 15% 61.6% 115.7% 26.9%

Sales of CHX (from PSI warehouse)

22,120 N/A 1,871 7,548 3,175 12,594 N/A

65

Year 1 Q1 Q2 Q3 Q4

Total Year 2

Target Y2

% achievement

Quantity of products sold to CHVs during sensitization by Communication Teams

N/A N/A 98 314 300 712 1200 59,33%


N/A N/A 5.2% 4.2% 9.4% 5.7% N/A

Sales of Protector Plus (rural) (from PSI warehouse)

868,896 557,904 445,488 332,928 316, 848 1,653,168 190%

Quantity of products sold to CHVs sensitization by Communication Teams

8,277 3,976 4,296 13 772 11 817 33,861 48,000 70,54%


1% 1% 1% 4.1% 3.7% 2%

Communication teams in the field increase demand creation through:

• Flash sales made in collaboration with CHVs. Of the total sales made by IMPACT during Year 2, communication

teams in the field contributed to 26.9% for Sur'Eau Pilina, 5.7% for CHX, and 2% for Protector Plus.

• Sensitizations on Sur’Eau Pilina, Protector Plus and Arofoitra which aimed to increase awareness and use of the

product. 1,405 sensitizations were held which reached 173,939 people.

Communication field teams did not reach the sales target for Year 2. Due to COVID-19, the gathering of people was

prohibited in some regions (Atsinanana and Analanjirofo) and this impacted the sales made by the communications

teams in the field. Sur’Eau Pilina was also not available from May to September 2020.

It was noted that during sensitizations, the communities showed more interest in buying Sur'Eau Pilina than the other

products such as CHX or Protector Plus due to the ease of use and the perceived benefits. To address this, IMPACT

will increase efforts in the promotion of other products.

Sales of CHX are challenging because the target is pregnant women. For Protector Plus, rural communities are

embarrassed to buy condoms in front of their community.

The mass media campaigns depend on the product availability to be promoted. The products can’t be promoted if

the product is in low stock or stocked out.

IR5.1.3a: Increase demand creation of health products, and raise awareness of the population on Covid-19 on the field with communication teams using mobile sound systems

In the 10 USAID-supported regions, IMPACT conducted sensitization activities using mobile sound systems to raise

awareness among the population about COVID-19 under the coordination of the CCOR/DRS. Communication teams

in the field delivered messages on preventive measures (social distancing, wearing masks, handwashing, etc.).

To respect regulations on social distancing, the communication teams avoided gathering people. Twenty awareness

raising tarpaulin were produced with pictograms on COVID-19 preventive measures (social distancing, wearing masks,

handwashing, etc.) and they were hung on each side of the vehicles used by the communication teams in the field so

that the community could see the messages.

During Year 2, 965 sensitization sessions were conducted in 53 districts in the 10 USAID supported regions by the

communication teams. The districts were selected according to different criteria, including:

66

- in coordination with distribution teams according to their needs to increase demand creation,

- the security in the district.

IR5.1.3b: Produce and broadcast Radio and TV spot on Covid-19 According to the communication plan for COVID-19 response developed under the leadership of DPS of MOPH, IMPACT has supported:

• Production of three TV spots adapted for radio.

• Broadcast of 4,477 TV spots and 14,229 radio spots through 23 TV and 40 radio stations in the 13 USAID-

supported regions from August to September 2020.

• Production of 15 Clash Infos composed of sketches and songs created to convey key COVID-19 messages. From

July 18th, these were broadcasted twice a week, every Wednesday and Saturday, through 29 TV and 68 radio

stations across all of Madagascar. To better target youth, Clash Info. were adapted to be broadcasted on

Facebook with famous influencers (Lionnel Myree, Aaron en parle, and Page de tefi). The podcasts were aired

every Tuesday and Friday and the first one was aired on July 24th. The youth who do not use Facebook were

reached through national TV and radio messaging.

IMPACT carried out media coverage through publications on Facebook, TV, and radio broadcasts of:

• Regular donation ceremonies of expendable equipment and supplies for hygiene offered to CCOR/DRSP

conducted in the 13 USAID-supported regions.

• Donation of 2,500 and 1,500 face masks from U.S. Department of Defense via USAID in Tulear and

Ambatondrazaka respectively.

IR5.1.3c: Produce and distribute/disseminate Job aids on Covid-19 IMPACT produced and distributed:

• 214,000 posters on different topics, including: handwashing (10,000), COVID-19 symptoms, prevention, and the

use of masks (180,000), and on COVID-19 prevention messages for schools (24,000).

• 238,000 flyers on COVID-19 prevention were distributed to the households by the DRSP in the 13 USAID-

supported regions and by IMPACT through the field communication teams.

• 6,600 job aids on COVID-19 with information on prevention, symptoms, and transmission were distributed to

6,000 Kom’Lay (committee volunteers in charge of the cCD composed of the Chief of Fokontany, community

mobilizers, and LLIN distributors) in the 12 selected cCD districts and 600 staff and partners in the field (PA, PARC,

Pha-G-Dis).

IR5.1.4 : Provide technical and financial support to the Ministry of Youth and Sport (MYS) to develop and implement Youth activities in collaboration with Telma Foundation based on the Human Centered Design (HCD) study and support training for youth on health, leadership, communication, etc. IMPACT’s youth program aims to increase demand and use of health commodities among youths and encourages

them to adopt healthy behaviors, such as to going to CSBs/CHVs and using FP products to avoid early pregnancy.

IMPACT collaborates with the Ministry of Youth and Sport (MYS) and NGOs, such as Blue Ventures, to implement its

Youth program. The peer education approach was used and the MYS Youth center should be revitalized. Training

sessions with Youth leaders were scheduled to be organized in Atsimo Andrefana. Trainers from MYS and PSI were

scheduled to hold trainings in Tulear in Quarter 3, but due to the COVID-19 restrictions these trainings were cancelled.

IMPACT integrated a module on gender and social inclusion into the Youth training curriculum. Three training sessions

on GESI took place virtually with trainers from Blue Venture and MYS.

Due to COVID-19, IMPACT could not implement its Youth activities as expected because it required physical

interaction during training sessions, interpersonal communication, and in-person events. Virtual meetings were only

organized for the trainers on GESI.

67

IR5.1.5: Leverage new technology to drive demand for malaria, FP/RH and MNCH health commodities.

Support the 910-call center in partnership with ACCESS During Year 2, IMPACT transferred the management of the "910" call center to ACCESS. The cost of communication

for the call center was supported by IMPACT until the end of December 2019 and the hotliners salaries were supported

until the end of June 2020 under the COVID-19 supplemental funding.

Table 44: Summary of the number of hotline calls received during Year 2

Quarter 1 Year 2 (October -December 2019)

Quarter 2 Year 2 (January-March 2020)

Quarter 3 Year 2 (April- June 2020)

Number % Number % Number %

Hotline calls received on Malaria (% of total)

27,810 24% 17,642 14% 1,615 0.4%

Hotline calls received on Family Planning (% of total)

9,928 9% 843 1% 27 0.30%

Hotline calls received on Maternal, Child, Health (% of total)

14,820 13% 9,238 8% 523 0.30%

Hotline calls received on other (% of total)* *Calls for diseases: measles, COVID-19, plague, etc.

64,126 55% 95,331 77% 420,187 99%

Total hotline calls received

116,684 100% 123,054 100% 422,352 100%

Graph 9: Evolution of calls during Year 2 and by health area

Note: The calls labeled “Other” included calls for diseases such as measles, COVID-19, the plague, etc. The majority of calls received in this category were on COVID-19. With the announcement of the COVID-19 pandemic, from February to April 2020, the number of calls steadily

increased (in April, the calls tripled compared to February). After the peak in April, the number of calls decreased.

The number of calls received on the three priority health areas (malaria, FP, and MNCH) were very low compared to

the calls received on COVID-19.

IR5.1.5a: Support the 910 call center in partnership with ACCESS (including recruitment, training, and supervision of the new hotliners) Due to COVID-19 and the increase of the calls received by the “910” call center, IMPACT increased the number of hotliners from 18 to 30 until the end of June 2020. The hotliners also received training from the MOPH and WHO.

Evolution of calls during Year 2 Total calls received by health area during Y2

68

Graph 10 : Evolution of calls received on COVID-19 from March to June 2020

Send SMS broadcast to target populations

IMPACT conducted an awareness campaigns through SMS messaging to the public in the 13 USAID-supported

regions. From Quarter 1 to Quarter 3, six different messages were sent through SMS broadcast on malaria, FP, GESI,

and MNCH. And during Quarter 4, one message for the celebration of World Contraception Day was sent. 3,065,363

SMS broadcasts were broadcasted to targeted people (women and men over 15 years old) who use the Telma, Airtel,

and ORANGE networks in the 13 USAID-supported regions. The SMS were sent in collaboration with the MOPH (DSFa

and DPS) and focused on the use of FP and to encourage people to go to the health center or to CHVs for counselling.

Targeted SMS were also sent to PA, PARC, CHV, and Pha-G-Dis on several topics, including EMMP, stock management,

and COVID-19. Details are presented in Annex L

Table 45: Summary of the number of messages sent through SMS for each health area during Year 2

During Year 2, two SMS per health area were planned to be sent. For FP, one message was sent on GESI for the World Women’s Day and the other one for World Contraception Day. IMPACT increased the use of electronic platforms and the number of messages sent through SMS to the general population doubled from three in Year 1 to six in Year 2. IMPACT contracted with a mobile phone operator (Orange) to establish an internal platform enabling IMPACT to send SMS to PA, PARC, Pha-G-Dis, and CHVs to inform them that the products are availabile and a reminder onproper stock management related to the correct storage, expiration date, etc.


Y1 Achievement vs target Year 2

Target Y2

% of Achievement

Quarter 1 Quarter 2 Quarter 3 Quarter 4 Total

Number of SMS disseminated for population

MALARIA 2 0 2 2 2 100%

FP 1 0 0 1 1 2 50%

MNCH N/A 1 0 1 2 2 100%

World Women's Day – GESI

N/A N/A 1 N/A N/A 1 0

Number of SMS disseminated for providers (CHV, PA, PARC, Pha-G-Dis)

MALARIA 1 5 6

FP 1 2 1 4

MNCH 2 4 6

EMMP 1 2 1 4

COVID-19 N/A N/A 3 3

Calls received on COVID-19 from March to June

69

IR5.1.5b: Send SMS broadcast to the targeted population (on the 3 health areas including Covid-19) Ten SMS messages on COVID-19 prevention were sent each Wednesday from July 9th, 2020 to September 9th, 2020 in the 13 USAID-supported regions. The messages were developed and validated by the CCRCE and the DPS of the MOPH. A summary of SMS sent during Quarter 4 are presented in Annex K/Table 4 IR5.1.6: Develop a strategy for youth on the use of vouchers for youth health coverage and implementation of a voucher pilot. Due to COVID-19, the implementation of this activity could not be held because training sessions on the field were

cancelled.

After the reorientation of the communication activities, this activity will be more focused on the involvement of health

care providers who are key to promoting the use of health commodities. Consequently, strategy for youth on the use

of vouchers will be removed.

III- 6 Cross-Cutting Activities

Cross-cutting activities focus on five aspects: Monitoring, Evaluation, Research, Learning, and Gender/Social Inclusion.

III- 6.1 Monitoring, Evaluation, Research, Learning

6.1.1. Monitoring and Evaluation

CC2.1: Strengthen LMIS/HMIS (all sectors: public, private, non-profit, and commercial) including formative

supervision, capacity building of data senders, and supporting implementation of the LMIS roadmap with

consideration of DHIS2 as the main LMIS electronic tool.

To improve the reporting rates from Pha-G-Dis to DPLMT (which was at 56% in Year 1), a provisional roadmap was

developed and implemented at the beginning of Year 2 based on a quick analysis of barriers identified during

formative supervision by the key stakeholders composed of DPLMT (lead), DEPSI, DSFa, PNLP, IMPACT, and Measure

Evaluation.

Table 46: The main barriers identified and the achievements following the actions implemented

Barriers Identified Solutions/Achievements

49 Pha-G-Dis (among the 78 SDSP

supported by USAID) did not have a

computer available for LMIS

(CHANNEL)

Equipped the 49 Pha-G-Dis with computers

- 40 laptops from IMPACT (list of Pha-G-Dis in Annex I).

- 9 laptops from UCP (list of Pha-G-Dis in Annex I).

44 Pha-G-Dis (among the 78 SDSP

supported by USAID) did not have

Internet connection to submit LMIS

data

- Collaboration with USAID funded projects ACCESS and Mahefa-Miaraka to use

their Internet connection for LMIS data submission.

- An MOU was signed between ACCESS, Mahefa-Miaraka, and IMPACT to

streamline the coordination of the activities in the field. As part of the MOU, the

Pha-G-Dis providers collaborated with ACCESS and Mahefa-Miaraka to use their

Internet connection to submit LMIS data.

21 Pha-G-Dis providers (among the

78 Pha-G-Dis supported by USAID)

were not trained on CHANNEL

- IMPACT and the DPLMT organized on-the-job training of 06 Pha-G-Dis providers

and 06 district focal points on CHANNEL during formative supervision by the

central team (DPLMT, DEPSI, DSFa, NMCP), regional and district teams

(EMAR/EMAD), and RLA: 77 SDSPs were supervised in MHP (Management of

Health Products) and LMIS

- During the confinement period for COVID-19, a remote training on CHANNEL was

given by the central team to 15 EMAR, 17 EMAD, and RLA through Microsoft

Teams

4 Pha-G-Dis (Antsalova, Vavatenina,

Betioky, and Manakara) had staffing

issues because there was either no

provider and/or providers were not

- In Antsalova, the EMAR decided to stay at Pha-G-Dis 20 days per month from July

to September 2020 to ensure data entry and data submission to DPLMT.

- In Vavatenina, there was a reorganization and coordination within the association

working with the provider. The association will have to propose another person

70

Barriers Identified Solutions/Achievements

motivated to ensure LMIS data entry

and submission to DPLMT

to assist the current provider especially during the periods of order processing of

CSBs.

- In Betioky and Manakara providers were identified and trained by EMAR/RLA

5 Pha-G-Dis (Toliara II, Manakara,

Mandoto, Isandra, Vohibato)

experienced electrical/power cuts

issues

- Toliara II: relocated the Pha-G-Dis store to the DRSP warehouse where there is

electrical power.

- Manakara: connected the Pha-G-Dis with electrical power from the DRSP.

- Mandoto: used solar power installed for the ACCESS office.

- Isandra and Vohibato: Pha-G-Dis stayed in Fianarantsoa with electrical power,

while waiting for their new buildings to be equipped with electrical power (in

Isandra and Vohibato).

These barriers and identified solutions presented in the table above were used to develop a provisional roadmap

implemented at all levels: central (DPLMT, IMPACT, and UCP), regional, and district (RLA, EMAR, and EMAD).

Additionally, a helpdesk platform was set up at PSI offices where unlimited and high-speed Internet connection is

available.

• The helpdesk used the reporting rates presented in the IMPACT Intranet to identify the Pha-G-Dis that did

not submit LMIS reports.

• The helpdesk (managed by two people) is used to remind the Pha-G-Dis providers to submit LMIS data to

DPLMT. Additionally, the Pha-G-Dis can call the helpdesk when they have LMIS problems (mainly the use of

CHANNEL software) that need to be communicated to the technical team as tickets.

Reporting Rates

Graph 12: Reporting, completeness, timeliness, and completeness + timeliness rates from CHANNEL (October 2019

to August 2020)

71

Completeness: means that the reports for the three health areas are received at the central level

Timeliness: The reports are submitted to the DPLMT central office by 27th of the month.

• As a result of the LMIS provisional roadmap, through technical support to DPLMT by the helpdesk and with

formative supervision by EMAD/RLA, previous reports not processed or not submitted by Pha-G-Dis providers

have been recovered.

• The timeliness was 64% in Year 2 compared to 53% as a target defined for Year 2. The helpdesk is an

effectivegood tool to improve timeliness of the report submission, but it remains a challenge for some Pha-

G-Dis. The reports are received progressively so the system still receives reports from previous months due

to late submissions which explains the higher reporting rates for the previous months compared to the more

recent periods.

Graph 13: Reporting and timeliness rates in DHIS2 (data from CSB)

Reporting rate Timeliness

Completness Completeness + Timeliness

0%

20%

40%

60%

80%

100%

Oct

-19

No

v-1

9

Dec

-19

Jan

-20

Feb

-20

Mar

-20

Ap

r-2

0

May

-20

Jun

-20

Jul-

20

Au

g-2

0

Reporting rate Target Y2

0%

20%

40%

60%

80%

100%

Oct

-19

No

v-1

9

Dec

-19

Jan

-20

Feb

-20

Mar

-20

Ap

r-2

0

May

-20

Jun

-20

Jul-

20

Au

g-2

0

Actual reports on time Rate Target Y2

0%

20%

40%

60%

80%

100%

Oct

-19

No

v-1

9

Dec

-19

Jan

-20

Feb

-20

Mar

-20

Ap

r-2

0

May

-20

Jun

-20

Jul-

20

Au

g-2

0

Timeliness Target

0%

20%

40%

60%

80%

100%

Oct

-19

No

v-1

9

Dec

-19

Jan

-20

Feb

-20

Mar

-20

Ap

r-2

0

May

-20

Jun

-20

Jul-

20

Au

g-2

0

Timeliness&Complete Target

0%

20%

40%

60%

80%

100%

Oct

-19

No

v-1

9

Dec

-19

Jan

-20

Feb

-20

Mar

-20

Ap

r-2

0

May

-20

Jun

-20

Jul-

20

Au

g-2

0

Completeness Target

0%

20%

40%

60%

80%

100%

Oct

-19

No

v-1

9

Dec

-19

Jan

-20

Feb

-20

Mar

-20

Ap

r-2

0

May

-20

Jun

-20

Jul-

20

Au

g-2

0

Reporting rate Target

72

The reporting rates from DHIS2 were stable at around 92% (while the planned Y2 target is 70%). The data entries are

ensured by the Commodity Health Manager based at SDSP who is mainly dedicated to DHIS2. The deadline (The 27th

of each month to submit LMIS data to the DPLMT) is at 90% metby the SDSPs, which is significantly greater than the

target of 53% set for Year 2. Similarly, to the Pha-G-Dis, reporting for the recent period is slightly lower, which is

linked to the timeliness issue (reports are received progressively).

Recommendations and Next Steps to Improve the LMIS

• Continue to use the helpdesk and start the transfer to the MOPH

• Accelerate the development of the LMIS roadmap for five years based on the LMIS evaluation report conducted

in 2019, with consideration of lessons learned during the implementation of the provisional roadmap.

• Ensure Internet connection at DRSPs and SDSPs. IMPACT will ensure the donation of Internet connection to three

DRSP (Melaky, Boeny, and Atsimo Andrefana) and their respective 20 SDSP. The sustainability plan of this

Internet donation after IMPACT will be discussed with the IPs and MOPH.

CC2.2: Support the exercise of identification of pharmacies and drug shops for LMIS data.

Technical support from the M&E team to partners on (see details of the achievements in the IR3.1.3 section):

• Sampling of outlets for mapping to identify pharmacies and drug shops for LMIS data.

• Development of questionnaires and data collection tools for the mapping process.

• Conducting mapping exercises by IMPACT team.

CC2.3: Support technically and financially the DPLMT to conduct Routine Data Quality Assessment (RDQA) at all

levels and sectors

The tool used for the RDQA exercise was adapted from the Measure Evaluation RDQA tool to fit with the LMIS context

in Madagascar.

Following the COVID-19 restrictions, the central team was unable to carry out the RDQA exercises since Quarter 3.

The RLAs were asked to conduct the RDQA among Pha-G-Dis and Pha-Ge-Com in the regions where they travel for

formative supervision.

Table 47: Breakdown of Pha-G-Dis , Pha-Ge-Com, PARC, and PA visited and evaluated in Year 2

Sites Q1 Q2 Q3 Q4 Year 2

Pha-G-Dis 9 6 7 15 25*

Pha-Ge-Com 18 12 10 21 45*

PARC 6 5 N/A N/A 11

PA 9 7 N/A N/A 16

*: 9 Pha-G-Dis and 14 Pha-Ge-Com were visited twice in Year 2

N/A: not applicable since no RDQA was conducted during the confinement period of COVID-19 pandemic

Graph 14: Summary of the results of RDQA conducted in Year 2 among Pha-G-Dis and Pha-Ge-Com (details per

region are provided in Annex J/Table 1)

73

Pha-G-Dis (n=25)

Pha-Ge-Com (n=45)

1: Average on overall data verification score for the seven quality dimensions (availability,

completeness, timeliness, integrity, confidentiality, precision, accuracy)

2: Qualitative system assessment of the strengths and weaknesses of the functional areas of the

data management and reporting system. A series of questions are used to calculate the average

score based on the responses.

3: Average score on data quality: “Overall Data Verification Score” + “System Assessment Score.”

Legend (Average score)

90% and above

80% - 89%

Below 80%

- The overall data quality score among the 25 Pha-G-Dis assessed on routine data quality is around 88%.

- The overall of data quality among the 45 Pha-Ge-Com assessed on routine data quality in Year 2 is on average 81%.

Table 48: The main issues affecting data quality at the Pha-G-Dis level

Main issues Definition Resolutions

Accuracy:

- Stock cards are not up to date and are

confusing: movements not recorded in the

stock card but shown in Channel, wrong

calculations

- Channel is not used as a Logistics

Management Information System (LMIS)

tool, but as a reporting tool. Purchase

Orders and Delivery Orders not entered on

time (or are even omitted) in Channel.

The degree to which the data

correctly reflects what they were

intended to measure. Accurate

data correctly measures actual

events, cases, units, etc.

Matching is made between the

data found in the stock sheets,

the monthly reports, and those

entered in the LMIS system

CHANNEL

- Capacity building through practical

cases on how to manage and to create

the stock monitoring sheet per

product.

- Processing of purchase orders and

delivery orders using CHANNEL on the

day of the reception and delivery of

the products.

- Perform a monthly inventory to check

physical stock available versus the

inventory sheet for each product.

93%

97%

81%

96%86%

95%

74%

Availability

Completeness

Timeliness

IntegrityConfidentiality

Precision

Accuracy

Data quality parameters

89% 87% 88%

0%

20%

40%

60%

80%

100%

Overall DataVerification 1

SystemAssessment 2

Overall DataQuality 3

Summary

84%77% 81%

0%

20%

40%

60%

80%

100%


SystemAssessment 2


Summary

87%

84%

94%

95%72%

82%

81%

Availability

Completeness

Timeliness

IntegrityConfidentiality

Precision

Accuracy


74


Timeliness:

- Delayed sending and processing of

logistics reports

The extent to which data is up to

date (current) and is made

available on time

- Reminder to send logistic reports (Pha-

G-Dis) before the deadline mentioned

in the contract (before the 10th of the

month).

Confidentiality

- Electronic free access to PC or laptop

- No closed storage for all documentation

The extent to which clients’

personal information is protected

and kept secure

- Password creation from the main

access of the Pha-G-Dis laptop.

- Classification of the stock monitoring

sheet according to the health

commodity management standard

operating procedure.

- Classification of the purchase orders

and delivery orders, etc. in a locked

cabinet.

Recommendation and Next Steps to Improve data quality for Pha-G-Dis

• Provide a software that is easy to use and maintain by the providers: online software to enable remote

maintenance and repair. The software will be determined during the LMIS strategic plan workshop.

• Reinforce post-training supervision and formative supervision for the health commodity management and

LMIS.

Table 49: The main issues affecting data quality at the Pha-Ge-Com level


Confidentiality

- Physical management tools: the different

registers and stock cards, RMA, RUMER are

not classified and stored in adequate and

secure places (closed cupboards)

The extent to which clients’

personal information is protected

and kept secure.

- Keep the management tools

(registers, RUMER (Registre

d’Utilisation des Médicaments et

Recettes), and RMA (Rapport

Mensuel d’Activité), in a locked

cabinet.

Accuracy



stock card but shown in RMA and DHIS2 (or

vice versa).

- Wrong data entry in DHIS2

The degree to which the data

correctly reflects what they were

intended to measure. Physical

sources (RMA, stock monitoring

sheets) vs DHIS2.

Formative supervision/on-the-job

training on how:

- To correctly complete the RMA

and the stock monitoring sheet.

- To ensure correct data entry using

DHIS2.

Precision

- No use of standard management tools such

as stock cards, purchase order/delivery.

Therefore, lack of details on the movement

of products.

The extent to which data is

collected with the level of detail

required to measure the indicator

- Separate stock monitoring sheet

per product (e.g: Mycrogynon,

Combination 3, Zinnia F.).

- Use standard tools as per the

manual instead of creating another

tool.

Completeness



stock card but shown in RMA and DHIS2 (or

vice versa)

Complete means that the

document contained all the

required entries of the indicator

as appropriate: Initial stock,

quantity received, quantity used

or issued, stock available

- Capacity building on how to keep

the stock monitoring sheet with

the required information using

formulas to check the coherences:

(Initial stock + quantity received) -

quantity used or issued = stock

available.

75


Availability

Lack of management tools: stock card, RMA,

purchase order

The extent to which data and its

supporting documentation are

available: stock sheet, RMA, PO

- Recommend the EMARs and

EMADs to provide management

tools (stock monitoring sheet,

RMA, and purchase order/delivery

order) to the CSBs

At the end of each RDQA exercise, a list of recommendations was provided to the DRSP and the SDSP who will ensure

the implementation of the recommendations.

Recommendation and Next Steps to Improve data quality to Pha-Ge-Com

• Conduct on-the-job training of Pha-Ge-Com led by the EMAD to reinforce the correct use of management

tools considering the seven quality dimensions.

• Raise awareness of the Pha-Ge-Com through formative supervision on the use of cleaned data with good

quality to calculate AMC, stock status, preparing orders, etc. to facilitate self-monitoring of the stock

management at their level. This would raise the Pha-Ge-Com interest to ensure quality of the data used for

their work. The EMAR and EMAD will ensure follow-up with RLA support.

Graph 16: Summary of the results on RDQA conducted in Year 2 among PARC and PA (details per region are provided

in Annex J/Table 3)

PARC (n=11)

PA (n=16)

1: Average on overall data verification score for the seven quality dimensions

(availability, completeness, timeliness, integrity, confidentiality, precision, accuracy)

Legend (Average score)

90% and above

80% - 89%

Below 80%

97%88% 93%

0%

20%

40%

60%

80%

100%


SystemAssessment 2


sumarry

99%99%

100%

95%95%

100%

93%

Availability

Completeness

Timeliness

IntegrityConfidentiali

ty

Precision

Accuracy


97%89% 93%

0%

20%

40%

60%

80%

100%


SystemAssessment 2


Summary

97%

97%

99%

100%97%

98%

90%

Availability

Completen…

Timeliness

IntegrityConfidentia…

Precision

Accuracy


76

2: Qualitative system assessment of the strengths and weaknesses of the functional

areas of the data management and reporting system. A series of questions are used to

calculate the average score based on the responses

3: Average score on data quality: “Overall Data Verification Score” + “System Assessment

Score”

Among PARC and PA the results of the RDQA were above 90%, which will be maintained through the steps mentioned

above.

CC2.4 Implementing monitoring and evaluation system on continuous distribution, including creating M&E tools,

training, data collection and supervision, RDQA (budget included in the continuous distribution activities)

The M&E team is coordinating the collection of the monthly cCD activity reports from the TA Supervisors

(see details of the achievements in the cCD section IR2.1.8).

6.1.2. Research

CC2.5: Conduct market assessment studies for FP and MNCH, including key informant interviews, outlet surveys,

and routine data in collaboration with IR1.

In Year 2, IMPACT was not able to conduct in-person data collection due to the restrictions from the COVID-19

pandemic. The main activities were focused on the design of the study protocols for the outlet and household survey,

and the key informant interviews to be used as data collection tools to feed the FP and MNCH market assessments

based on the market assessment framework. The data collection has been rescheduled to 2021.

Table 50: Summary of the study protocols for the three data collection tools

Data Collection Tools Study Population Sampling Study Area

Key informant interviews for FP and MNCH

Government, donors, implementing partners, the private/commercial sector (importers/wholesalers/ distributors, pharmacists, drug shops), and supply chain actors (SALAMA, CHVs). Specifically, for MNCH: public and private hospitals

49 participants Mainly in Antananarivo

Outlet survey for FP and MNCH

Potential outlets for FP and MNCH products including: public health facilities (CHU, CHRR, CHD, CSB2, CSB1, etc.), private not-for-profit health facilities, private for-profit facilities, pharmacies, drug shops, CHVs, and general retailers for condoms

1,546 outlets will be interviewed

Urban and rural areas

Household survey for FP and MNCH

Women of reproductive age, caregivers of children under five, women who were pregnant or have given birth within the last 12 months preceding the survey

2,500 households will be visited

Urban and rural areas

CC2.6.1 Elaborate study design of the archetypes/Segmentation study, recruit agency to implement the study from

creation/finalization of the survey tools to the dissemination of the results

• This research activity is focused on FP among youth using three methods, including literature reviews, key

informant interviews, and journey mapping to identify different segments of youth.

• A literature review and the key informant interview were conducted in Year 2. However, due to the budget

constraints, the journey mapping was cancelled and rescheduled for Year 3.

The literature review and the key informant interviews were implemented in-house.

77

Table 51: Results from the literature review

Sources Main results

National reference survey (MICS 2018, TRAC

FP 2017, etc.)

National policy document (Politique nationale

de la jeunesse 2016)

National Strategic Plan (Plan Strategique

Integré en PF et Securisation des produits SR

2016-2020)

Other surveys conducted internally or by

partners (Health Communication Capacity

Collaborative, Les jeunes à Madagascar –

UNICEF, Enquête maison des jeunes, Focus on

Rural Youth, Recueil des archetypes jeunes,

etc.)

- In general, the literature review showed that young men are

not using condoms. However, rich young men with multiple

partners are using condoms to prevent HIV.

- Young women are informed about FP/RH services at the CSB

and once they get married, they use FP modern methods.

There is a misconception that FP is for married women with

children and no single women.

- Due to the lack of information and sexual education, young

women are not exposed to messages on FP/RH services and

FP methods.

- Low rates of young women vs young men visiting youth

centers.

- The main barriers for young people to access health care are

unfriendly service, lack of trust about confidentiality, out of

stock products, and lack of promotion.

Table 52: Results from key informant interviews

Participants Results Recommendations

- Youth experts

within UN

institutions,

- MOPH

- Private institutions

and associations,

youth program

manager within

international NGO,

etc.

- A snap shot from the results showed that the

main FP/RH concerns among young people are

undesired pregnancy, abortion, and early

pregnancy.

- Young people are aware of the existence of

contraceptive methods at health centers (CSB,

private clinics).

- The main barriers on FP use among young people

are financial, misinformation about the side

effects from FP methods, the belief that

contraceptive methods are intended for married

women, distance from health centers, lack of

awareness and trust of FP efficiency.

- Increase awareness of

contraceptive methods and

the benefits: instruction on

use, provide accurate

information on side effects,

discuss the advantages of

using contraceptive methods.

- Reinforce training among

providers on youth case

management and quality of

care to overcome barriers on

health facility seeking

services.

The full results on the key informant interviews will be finalized and available in Quarter 1 of Year 3.

CC2.6.4 Formulate research needs and share with USAID that will recruit an external agency to evaluate the pilot

phase of the introduction of drone as last mile distribution

The study protocol designed to evaluate the pilot activity on the last mile distribution using drones at the community

level was finalized in Quarter 2 and submitted to USAID. Implementation of this evaluation has been postponed to

Year 3 due to the COVID-19 pandemic.

CC2.6.5 Elaborate study design of the qualitative study to understand knowledge, attitude and practice on IPTp use.

Recruit the agency that will implement the study from creation/finalization of the survey tools to the dissemination

of the results.

The study aims to understand barriers and motivations on ANC and IPT uptake. Since face-to-face interviews were not authorized due to COVID-19, IMPACT focused on the design of the research activity. The study protocol has received comments from USAID and was sent for final review by USAID at the end of September 2020.

To avoid duplication and to use this study as complementary information with studies conducted by other partners,

secondary data sources were consulted, such as MICS 2018, Tiptop study report on ITPp, various publications, etc.

78

Table 53 : Summary of the Methodology

Sampling Target group

Qualitative 111 participants will be

interviewed

- Women who have given birth in the last 12 months who used SP during

their pregnancy and those who did not use SP.

- Health providers in public and private health facilities.

- Supply chain actors (Pha-G-Dis, Pha-Ge-Com)

- CHV and traditional birth attendants

- Responsible at MOPH (PNLP/DSFA)

Quantitative 563 participants will be

interviewed,

representative of urban

and rural areas

Women who have given birth in the last 12 months

The study protocol was approved by PSI’s Institutional Review Board (IRB) in Washington, D.C. Data collection is

rescheduled to 2021.

6.1.3. Knowledge Management

CC2.7: Knowledge Management: Support partners in developing and collecting success stories and documenting

IMPACT's innovations in the field.

CC2.7.1 : Organize field visits to collect success stories and project's innovations (Ex: last mile distribution using

drones, achievements of the TWG, youth program, ect.) every quarter

• IMPACT staff has collected success stories and lessons learned through discussions with target audiences using

a success story template with guidelines and writing tips during field supervisions.

• Field staff were trained in identifying potential success stories based on performance indicators and

improvement per activity (e.g.: level of commodities out of stock, data reporting rates, commodity distributions,

etc.).

The table below summarizes the success stories collected during Year 2 per Quarter.

Table 54: Summary of success stories collected per Quarter

Quarter List

Quarter 1 (7)

- Development of a Total Market Approach Roadmap to Improve Availability of life-saving

health commodities for the Malagasy population (IR 1)

- Accurate commodity forecasting helps Brickaville to be prepared for a malaria outbreak (IR 2)

- Strengthening organizational capacity of Pha-G-Dis in Menabe, Atsimo Andrefana, and Boeny

Regions (IR 2)

- Electrification of a Pha-G-Dis in Haute Matsiatra (IR 2)

- Public and private sector work together to support health commodities supply chain in

Madagascar (IR3)

- Availability of birth control products helps meet the needs of women in rural communities of

Brickaville (IR4)

- Using Sur’Eau Pilina save lives in remote communities of Brickaville (IR4)

Quarter 2 (7)

- Vohipeno district : Coaching Pha-G-Dis service providers increases data reporting rate from

health facilities (IR2)

- Sakoana: a model health facility that has never experienced stock-out of antimalarials due to

careful adherence to guidance of stock management (IR2)

- Mananjary: IMPACT and ACCESS join efforts to improve the availability of malaria products in

remote rural to help save lives (IR2)

- Applying the Training: Lessons Learned from Financial and Operational Management Training

(IR3)

79

Quarter List

- Maroantsetra: Devotion of Point d’Approvisionnement Relais Communautaire (PARC) manager

and support from IMPACT helps prevent stockouts of family planning and maternal and child

health supplies (IR4)

- Joffre Ville: Collaboration among IMPACT Point d’Approvisionnement (PA), Mahefa Miaraka,

and health facilities to help satisfy family planning needs (IR4)

- Tapping into innovation for family planning: applying drone technology to bring contraceptives

to remote Communities in Madagascar (GESI)

Quarter 3 (8)

- Menabe region: Redistributing medicines from private to public health facilities to treat

children with malaria (IR2)

- Menabe region: Targeted, coordinated, and efficient supervision: Health stakeholders join

efforts to fight malaria (IR2)

- Atsimo Andrefana region: Engagement of a primary school teacher helps to continue

Community Continuous Distribution activities during the COVID-19 Pandemic (cCD)

- Toliara II: Using locally made handwashing devices to prevent COVID-19 spread during the

continuous LLIN distribution campaign (cCD)

- Maintaining the private sector’s commitment to providing health commodities during the

COVID-19 Pandemic (IR3)

- Commune of Sakoana: Supply Point (PA), Health Facility Head and Community Health

Volunteers work together to protect newborns from umbilical cord infections (IR4)

- The use of Helpdesk improves data reporting rate from district pharmacies to the DPLMT (CC

LMIS)

- Innovation in the time of COVID: How remote capacity building will help advance equitable

health commodity supply chain distribution in the social marketing sector (GESI)

Quarter 4 (6)

- District of Toliara II: LLIN Community-based Continuous Distribution contributes in decreasing

the malaria positivity rate from 53% to 5% in the commune of Milenaky (cCD)

- District of Brickaville: Joint efforts of community leaders enabled success of the LLIN

Community-based continuous distribution at the Fokontany level (cCD)

- Pha-G-Dis of Benenitra: Operationalization of district inventory and stock management

committee help reconstitution of months of missing logistic data from 0% in May 2019 to

100% in July 2020 (IR2)

- Motorbike Loans increase remote communities’ access to vital health commodities (IR 3 and

IR4)

- Drug delivery by drone : An innovation in bringing life-saving commodities to remote

Communities in Madagascar (IR4)

- Advancing GESI Through Virtual Opportunities: Capacity Building for Health Commodities

Success through Video-based 2020 GESI Refresher Training Series (GESI)

Total (28)

Details of success stories collected are presented in Annex D

In Year 3, IMPACT will update and improve the template used to collect success stories by IMPACT staff during field

supervision missions based on lessons learned from Year 2. The updated template will be an easy tool for all staff and

will include guiding questions to collect quotes from beneficiaries and will indicate progress against key indicators to

better highlight the project’s positive results.

CC2.7.2: Post success stories through the project’s online platforms (Website and Social media), to USAID

Madagascar and to Consortium partners platform

This sub-activity aims to increase IMPACT’s visibility through the dissemination of the project achievements on USAID

online platforms. In Year 2, four success stories from IMPACT (one per Quarter) were published on USAID’s website

and Facebook page to highlight IMPACT’s accomplishments as presented in the table below.

80

Table 55: List of IMPACT success stories published on USAID’s website and Facebook

Title of the success story Main contents

- During Word Entrepreneurship Week (October

18-24, 2019), IMPACT’s story on Business and

Financial Training to Drug Shops.

- This story describes IMPACT’s innovative approaches to

provide business and financial training to drug shops.

- For International Women’s Day (March 8),

IMPACT’s story of a woman working in the

public supply chain.

- The success story illustrates how new IT skills help to

improve supplies of health commodities.

- For World Health Volunteer Week (April 5-11),

IMPACT’s story of a CHV in Ambohimanarivo

village, Brickaville district.

- This story features the important role played by CHVs in

remote villages that are far from health facilities and how

IMPACT supports them in supplying essential life-saving

products like Sur’Eau Pilina.

- For World Contraception Day (September 26),

IMPACT’s success stories of women working in

the supply chain (PARC of Maroantsetra and

PA of Joffre Ville).

- These stories illustrate the PARC’s and PA’s devotion and

commitment to supply essential health products such as FP

products to their communities.

CC2.7.3: Identify with the consortium partners the appropriate tools to disseminate IMPACT results (market

assessment and studies, TMA Roadmap, LMIS Assessment and roadmap, supply chain assessment, End User

Verification).

In Quarter 4, IMPACT finalized the following knowledge management products:

- Developing a brochure on key results of the LMIS evaluation to be distributed during the strategic planning LMIS

workshop scheduled in Quarter 1 of Year 3. The brochure will be finalized in October 2020 (prior to the workshop)

by the committee composed of DPLMT, Measure Malaria, DSFa, NMCP, DEPSI, and IMPACT.

- Developing a one pager showing the results of the provisional roadmap developed by the committee composed

of DPLMT (lead), Measure Malaria, DSFa, NMCP, DEPSI, and IMPACT. The one pager will be distributed during the

LMIS workshop scheduled in Quarter 1 of Year 3.

III- 6.2 Gender and Social Inclusion

CC1.1: Target women and human rights associations to serve as strategic partners of IMPACT and to play an active

role in the Total Market Approach

Selected Partners and Strengthened Partnerships:

• Engaged with key GESI partners, CNFM and GFEM, identified in Year 1 and

began outreach to a third partner, EFOI. Set focus on CNFM and EFOI as

the more strategic and active partners for continuing TMA promotion.

• Facilitated participatory dialogues (via phone and video conferencing

platforms) to strengthen collaboration which centered around IMPACT

program objectives, defining the TMA, the role of gender and social inclusion in achieving UHC, and the

importance of women’s and socially marginalized groups’ voices within the TMI TWG.

CC1.2: Ensure the participation of key GESI partners in TMI TWG

Facilitated Coordination Meetings for GESI Partner Integration into TMI TWG and PHSP Subcommittees:

GESI Partner Status

CNFM Active partner

EFOI Active partner

GFEM Partnership dissolved

GESI Partner

TMI TWG & PHSP Committee Members (nominated)

CNFM 5

81

• Facilitated four small group and one large working group meetings between

CNFM, EFOI, and IMPACT team leads managing Public and Private

Partnership, PSHP, and A2F areas to better understand each GESI partner

organization’s mission and target groups, confirm commitment to the TMI

TWG and PHSP platforms, and highlight the GESI partners’ roles and responsibilities in elevating the voices of

women and marginalized groups through the TMA-related committee and subcommittee meetings.

CC1.3: Produce and distribute SBCC tools on GESI for different target groups

Brochures, Articles, and Factsheets:

• Engaged in a roundtable discussion organized by the Ministry of

Population and UNFPA on gender equality and social inclusion to

coordinate activism against GBV. Highlighted integration of a

gender equality and social inclusion lens to improve health

commodity access across all distribution sectors - public, private,

and social marketing. Distributed 150 brochures outlining key findings from the program’s GESI analysis.

• Published four articles focused on GESI-related themes, including GBV, women’s access to finance, and gender

and health in three daily newspapers (Midi Madagascar, Express de Madagascar, and Les Nouvelles).

• Initiated the development of a factsheet to highlight GESI integration in TMA.

Other:

CC1.4: Integrate GESI-informed messaging into family planning & MNCH communication campaigns

Campaigns:

• Integrated gender and social inclusion-based themes in all key health messages for the malaria and MNCH SBCC

campaigns. The GESI-influenced messages pulled from evidence gathered during IMPACT’s gender analysis.

Newly crafted messages supported the roles of men, women, and all parental figures to promote wholistic family

health. Key messages were also developed to sensitize providers about equal rights for all patients without biases

or discrimination.

• Partnered with ACCESS and MAHEFA

MIARAKA projects for World Contraception

Day. Developed FP messages for campaign

(September 26 to October 3) which were

broadcasted across TV, radio, and social

media (Facebook, Youtube, SMS) reaching

national and regional audiences including

men and women, pregnant women and girls,

health providers, and contraceptive

distributors. Coordinated with GESI

partners (CNFM and EFOI) to inform and

validate messages.

CC1.5: Raise awareness of IMPACT stakeholders

on GESI integration into a TMA through meetings and an annual workshop

GESI Integration and TMA

• Engaged in Roll Back Malaria with GESI partners where they contributed their expertise to identify socio-cultural

challenges related to availability and accessibility of malaria commodities in Madagascar.

• Led access to finance and GESI integration for improved access to health services and commodities events for

International Women’s Day which highlighted innovative strategies such as the use of drones to distribute

EFOI 5

TOTAL 10

GESI Analysis Keys

Findings Brochure

150 distributed

GESI Newspaper

Articles

4 published

Select Messages

• Health commodity distributors provide critical products to community members. Keep doors open to reach all types of clients with key medications

• People of all ages have the right to information and consultation in reproductive health and family planning products and services

• Men, you have family planning options. Visit a health provider today to learn more and check your local pharmacy or drug shop to get your suitable method

• Every woman has the right to decide freely the number of children she wishes to have and the spacing between births, independently of her partner.

82

essential health commodities to remote communities. Collaborated with the Ministry of Population to provide

300 LLINs for distribution to six select health centers and 100 mosquito nets to vulnerable households.

• Became a member of the newly formed Gender TWG led by the Ministry of Population. The group, which gathers

gender focal points from across the public and private sectors including NGO and technical and financial partners,

will be the key platform for promoting gender equality and social inclusion in the country.

CC1.6: Build the capacity of IMPACT staff to serve as GESI champions

Capacity Building:

• Facilitated follow-up knowledge check-in session building on the Year 1 GESI training and learning. Training

groups developed action plans (for how their planned activities can integrate gender and social inclusion

considerations) to inform work planning.

• Conducted a GESI training workshop focused on identifying opportunities for advancing gender equality through

program activities. 53 stakeholders (32f, 21m) from the Ministry of Population, USAID, IMPACT, and CNFM

attended the workshop.

• Worked with SRDs and SPDs to update social marketing training curriculum and prepare roll out to PAs and

PARCs. Applied innovative training of trainers iterative co-design capacity building approach with the regional

supervisors that included a series of remote training, teach back, and incorporation of feedback into final training

content. Following TOT, coordinated (with SRDs/SPDs) to cascade GESI trainings for PAs and PARCs. One session

conducted with 31 PAs/PARCs (16 male, 15 female) prior to suspension due to COVID-19 restrictions.

• Partnered with the Ministry of Youth and Sport and private-sector partner Blue Ventures to develop youth-

focused FP/RH training curriculum to be delivered by youth supervisors to girls and boys across Madagascar.

Conducted three virtual training of trainers, training 13 staff (5 men, 8 women).

• Integrated GESI considerations into training workshops for regional branches of banks partner which serve to

sensitize bank staff to the market potential of drug shops, pharmacies, and other health commodity/supply chain

businesses.

• Developed and delivered four-part virtual GESI refresher

series. The video-based training included five videos (four

technical), four knowledge-based quizzes, and a final

evaluation with prompts for practical application. The

training was made available in French and English. 56

IMPACT staff members completed the full series (an

additional 2 started but did not compete all four units).

Key challenges Solutions

Challenges related to COVID-19

Activities not carried out or postponed during the quarter vs

planned activities due to COVID-19 (meetings, integration of

To address these challenges, the GESI team applied

several adaptive management techniques including,

remote work, planning more frequent but smaller and

Unit Participants

Understanding gender and Gender Equality 58

Understanding Social inclusion and the

Impacts to Health

57

Understanding Gender-based Violence 57

Applying a Gender Lens: Strengthening

Awareness and Program Management

56

8073.7 75.1

68.2

0

10

20

30

40

50

60

70

80

90

100

GenderEquality

SocialInclusion

GBV Applying aGender Lens

Average Quiz Score

83

GESI partners into TMI TWG, and annual staff capacity

building related to gender and social inclusion).

separate meetings with key GESI partners, and

rescheduling select activities for Quarter 4.

Due to health risks associated with the COVID-19 global

pandemic, all activities requiring physical meeting were

discouraged. This included the planned GESI refresher

training.

Key themes for the training were identified and

planned for to use with a virtual video-based training.

Due to health risks associated with the COVID-19 global

pandemic, all activities requiring physical meeting were

discouraged. This included the GESI-influenced FP/RH ToT for

youth supervisors.

Key themes for the training were identified and the

curriculum was developed. The training was delivered

over three virtual conference sessions.

Due to budget, travel, and large event restrictions, the

planned events in celebration of World Contraception Day

needed to be adjusted. The events were planned in

partnership with ACCESS and MAHEFA MIARAKA projects.

The partner planning team reevaluated what could be

done and selected specific impactful activities with

wide reach. IMPACT focused on a media

communication campaign which incorporated key

GESI messages.

Other challenges

In Year 1, IMPACT identified Groupement des Femmes

Entrepreneurs de Madagascar (GFEM) as one of the strategic

women’s associations to partner with IMPACT and to play a

role in the TMA. GFEM’s leadership is less interested and

available to engaged and IMPACT does not anticipate they will

be a key partner moving forward.

IMPACT identified another women’s business

network, Entreprendre au Féminin Océan Indien

(EFOI), that is strategically focused on women’s

economic empowerment in Madagascar and is also

part of a regional network of women business owners.

IMPACT began outreach and engagement with them

during Year 2 Quarter 2.

Recommendations:

• GESI Partners: Continue to move forward with the two strategic GESI partners, EFOI and CNFM, to support a

variety of TMA-related activities including through engagement in the TMI TWG and PHSP subcommittees.

• Learning Materials: Continue to produce and share learning products with general public and relevant TMA

actors including, but not limited to, the TMI TWG and PHSP committee and subcommittees through

communications channels.

• Gender Technical Working Group: Engage with newly established Gender TWG to expand IMPACT visibility in

promoting the TMA and promote UHC, while also advocating among gender champions the importance of equal

access to quality health commodities for all.

• Youth: Work with Ministry of Youth and Sport and Blue Ventures, as required, to cascade youth reproductive

health and family planning training.

• GESI Training: Incorporate IMPACT regional staff into GESI capacity building efforts such as GESI refresher series.

IV- ADAPTIVE APPROACH/METHODOLOGY DURING COVID-19 CONTEXT

Activity Adaptive approach during COVID-19 Context

Ccd Since the SPD (Superviseur de Distribution) were not able to travel to collect logistic data they use phone calls to collect the information.

LMIS data collection among PARC and PA/supervision visits specifically for Atsinanana region

The SPD alternate the supervision visits for every two months: - One month the SPD use phone call to collect LMIS data

with PARC and PA. - The second month, the SPD conduct supervision visits

to collect LMIS data within PARC and PA. SPD conduct check on the accuracy of the LMIS data collected through phone call: DHIS2 data versus manual stock management tools. If the data do not match then the

https://www.facebook.com/efoimadagascar

84

SPD proceed to the modification, notify the database manager and document the modification that will be communicated to the Distribution Manager.

RDQA The RDQA among Pha-G-Dis and Pha-Ge-Com were conducted by the RLA (if it was conducted by the central team before COVID-19 context). The central team prepared a video to show and train the field teams on how to conduct RDQA.

Reporting rate among Pha-G-Dis With less supervision visits, IMPACT with the MOPH reinforced the use of helpdesk to monitor data submission using phone call

Meetings Virtual meetings instead of face-to-face meetings

Trainings Remote trainings

V- PROGRAMME MANAGEMENT

Recruitments (Modification of contracts from Consultant to permanent):

• 1 Supervisor for the communication teams in the field

• 6 communication teams in the field each composed of one animator and one driver. The staff will be based in

regions: Diana, Boeny, Melaky, Atsimo Andrefana, Analanjirofo, Vatovavy, and Fito vinany

• 1 Supervisor for the helpdesk

• 1 Hotline Operator for the helpdesk

Development of IMPACT Year 3 Workplan:

IMPACT started the development of the project Year 3 Workplan in Quarter 3 and Quarter 4. The Workplan was based

on USAID Vision and aligned with MoPH strategies in the Plan de Développement du secteur Santé (PDSS 2020 -2024).

IMPACT Year 3 Workplan was submitted to USAID for approval.

VI- FINANCIAL SUMMARY

Table 56: Financial summary

Description Y1 Budget Y2 Budget Total

Budget Obligated Amount

Expenditures Y2

Total Expenditures as of sept-20

Estimated remaining

Funds as of sept-20

Malaria 2,340,671.35 3,278,821.05 5,619,492.40 5,421,500.00 3,346,361.34 4,882,295.07

539,204.93

MCH 2,428,007.95 2,957,198.34 5,385,206.29 4,695,795.00 2,993,980.37 4,711,795.02 -

16,000.02

FP/RH 2,369,438.96 3,032,919.04 5,402,358.00 5,079,520.00 2,912,083.98 4,563,403.56

516,116.44

COVID-19 -

- - 700,000.00 400,120.63 400,120.63 299,879.37

TOTAL 7,138,118.26 9,268,938.42 16,407,056.68 15,896,815.00 9,652,546.32 14,557,614.28 1,339,200.72

85

ANNEXES

86

ANNEX A - Performance Monitoring Plan (PMP)

Note:

- PMI Quarterly report is attached in an Excel File sent with this Annual Performance Report

- HPN Quarterly report is available on DHIS2 website https://data.mis-psimada.org/

https://data.mis-psimada.org/

87

USAID IRs and Sub-

IRs

Reporting to

Indicator Measure of Unit

Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2

(%) AchievementY2/targe

t Y2

Explanations

Intermediate Outcomes/Outputs

Short-term Outcomes

SO1 PMP

IMPACT

Disability-adjusted life years (DALY) averted

Number

Public sector

Total public sector 22,045 253,358 570,50 1,327,090 43%

FP 0 108,521 34,340 49,220 70%

The need from the public sector (DSFa) stopped at 70% of the FP products procured for the emergency distribution. The DSFa did not order emergency distribution from Quarter 3. Therefore, the remaining products will be distributed using social marketing channel.

MALARIA 22,045 144,837 455,648 1,277,870 36%

The objective has a link to the distribution of malaria products (ACT and SP) at the public sector level (SALAMA to Pha-G-Dis). However, the SP distributed is only 41% of the planned target. The objective considers the National Strategic Plan for the Malaria Control and must be adapted to the quantity purchased by PMI. The SP shipped to the SDSPs is nearly 77% of the quantity purchased by PMI. The DALY calculated for ACTs and SP represent respectively 30% and 06% of the target.

MCH N/A N/A N/A N/A N/A DALY coefficients are not available for the MNCH products

Private for nonprofit sector

Total private for nonprofit sector 598,737 219,491 411,312 419,765 98%

FP 251,683 175,004 319,139 278,725 114%

The number of regular users of oral and injectable contraceptives (excluding Sayana Press) increased, which explained the increase of the quantity distributed and the DALYs.

88

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

MALARIA 275,601 0 16,415 43,947 37%

The DALY calculation is based on the cCD LLIN distribution within 12 districts. In Year 2, only six districts started the cCD distribution (distribution started in February 2020) due to COVID-19 restrictions. Additionally, COVID-19 caused a decrease in distribution in the first six districts.

MCH 71,453 44,487 75,758 97,093 78%

The Year 2 results were obtained based on the following health products: ORS/Zinc DTK, Sur Eau Pilina, Sur'Eau 150 ml, Arofoitra (CHX 7,1%), and Pneumox. Stock out at PSI warehouse (central level) of the following products explains the low achievement in Year 2: - Sur'Eau Pilina from Quarter 2 to Quarter 4 - Sur'Eau 150 ml from Quarter 1 to Quarter 3 - Pneumox in Quarter 2 and Quarter 3

Commercial sector

Total commercial sector 69,288 N/A N/A 101,380 N/A

FP N/A N/A N/A 27,872 N/A Convincing the pharmaceutical wholesalers to share LMIS data is a long process, which has been delayed due to the COVID-19. Through the TMA TWG, IMPACT started the meeting with the pharmaceutical wholesalers led by the MOPH in Quarter 4 and shared the template for data sharing, but no one has responded yet. IMPACT will continue the process using a one-to-one approach.

MALARIA 69,288 N/A N/A 73,508 N/A

MCH N/A N/A N/A N/A N/A

SO2 (IR 2.9)

PPR USAID

Couple Year Protection (CYP) in USG supported programs

Number

560,247 629,698 784,313

679,47 115%

Public sector N/A 241,306 75,875 109,697 69%

The need from the public sector (DSFa) stopped at 70% of the FP products procured for the emergency distribution. The DSFa did not order an emergency distribution from Quarter 3. Therefore, the remaining products will be distributed using the social marketing channel.

89

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

Private for nonprofit sector 560,247 388,392 708,438 679, 147 104%

Commercial sector N/A N/A N/A N/A N/A

Convincing the pharmaceutical wholesalers to share LMIS data is a long process, which is also delayed due to COVID-19. Through the TMA TWG, IMPACT started the meeting with the pharmaceutical wholesalers led by the MOPH in Quarter 4 and shared the template for data sharing. However, no one has responded yet. IMPACT will continue the process using a one-to-one approach.

IR1: Enhanced coordination among public, non-profit, and commercial sectors for supply and distribution of health products IR1.1. The total market for health products in Madagascar is understood and documented

IR1.1.1 PMP

IMPACT

Number of companies with CSR (Corporate Social Responsibility) action plans developed and implemented to increase the provision of WASH or health services

Number

1 2 8 8 100%

Action Plan

Developed 1 2 8 8 100%

Implemented 1 2 6 8 75%

Two action plans were not implemented due to COVID-19 and activities will be reported in Year 3. Two activities are related to the implementation of EDM and SOMAPHAR activities.

IR1.1.2 PMP

IMPACT

Number of companies / commercial actors and private sectors associations trained and implementing the TMA (Total Market Approach)

Number 0 10 10 14 71%

25 members of the private sector were trained in TMA, but only 10 of those trained in TMA expressed their willingness to be part of the process through the letters of participation for the TMA.

IR1.1.3 PMP

IMPACT

Number of market assessments conducted by health areas

Number

0 0 1 3 33% FP and MNCH market assessments are postponed to Year 3. Data collection using face-to-face interviews, including the outlet survey, household survey, and key informant interviews, that will be used for the market assessment design were not allowed due to COVID-19.

Health area Malaria 0 0 1 1 100%

FP 0 N/A 0 1 0%

90

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

MCH 0 N/A 0 1 0%

IR1.1.4 PMP

IMPACT

Number of TMI workshops with public, nonprofit, and commercial stakeholders

Number 0 0 27 24 113% In Quarter 4, IMPACT was able to organize many virtual meetings.

IR1.1.5 PMP

IMPACT

Percentage of female participants in GOM-led TMI TWG

Percent 0% 51% 45% 50% 90%

There is a higher representation of male participants among the commercial sector (100% men) and the donors (100% men). IMPACT presented this to GESI team and will work with them to engage women in these sectors.

IR1.1.6 PMP

IMPACT

Percentage of GOM-led TMI TWG leadership positions held by women

Percent 0% 50% 66,7% 50% 133% In the public sector, many women in leadership positions (chief of service and above) participated in the TMA TWG.

IR1.1.7 PMP

IMPACT

Number of people trained in TMA 101 during workshops (not unique trainees)

Number

0 116 106 80 156%

These are newly trained people (new persons exposed to TMA messages) and the reason the target has been exceeded is mainly due to efforts from the subcommittee members to engage new actors in the health sector.

Sex

Male 0 N/A 58 N/A N/A Disaggregation is among the changes made to this indicator by the Year 2 update. This year the objective of this disaggregation is not defined (applicable). Female 0 N/A 48 N/A N/A

IR1.1.8 PMP

IMPACT

Number of TMI Champions/people, trained in TMA & stewardship skills (not unique trainees).

Number

0 3 10 8 125%

8 TMA Champions received trainings and 2 additional directors from MOPH were added to the training sessions (Director of DPLMT and Director of DPS)

Sex

Male 0 2 4 N/A N/A Disaggregation is among the changes made to this indicator by the Year 2 update. This year the objective of this disaggregation is not defined (applicable) Female 0 1 6 N/A N/A

91

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

IR1.1.9 PMP

IMPACT

GOM-led TMI TWG (Technical Working Group) meets at least four times a year as a forum for consultations and roundtables between public, non-profit, and commercial stakeholders

Number 0 3 1 4 25% Due to the COVID-19 pandemic, in-person meetings were highly restricted and only one meeting was organized in Quarter 1.

IR1.1.10

PMP USAID (GNDR

8)

Number of persons trained with USG assistance to advance outcomes consistent with gender equality or female empowerment through their roles in public or private sector institutions or organizations Number

59 N/A N/A N/A N/A This is a new indicator related to gender and will be reported starting in Year 3

Sex Male 27 N/A N/A N/A N/A

Female 32 N/A N/A N/A N/A

IR1.2. GOM leads TMI stakeholders to coordinate health product quantification and forecasting, procurement, and distribution according to market assessments and segmentation

IR1.2.1(IR 2.3.2)

PMP USAID

Percentage of difference between forecasts previously made for a year and the actual consumption (national level)

Percent

- This indicator is calculated for the following periods (with data available for the comparison): October 2019 to August 2020; January – August 2019

- For the public sector, forecasts for malaria and FP products are calculated at the national level (not available for the 13 regions of USAID).

- For the public sector, the forecast for MNCH is calculated for the 10 USAID-supported regions

- For social marketing, the forecasts and consumption are available for the 13 USAID-supported regions.

Public sector FP

Implantable Contraceptives 0,44% 76% 17% 10% N/A3 Achievements during this period are at 17% which do not significantly exceed the annual target of 10%.

Injectable Hormonal Contraceptives (Depo provera)

4% 38% 1% 10% N/A

Compared to the reported period, consumption exceeded the forecast by 1%. However, the objective was not reached because stock out rate close to 7% was recorded during this period at Pha-Ge-Com

3 % of achievement is set as N/A due to difficult interpretation of the value provided between achivements and targets.

92

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

Injectable Hormonal Contraceptives (Sayanna Press)

N/A N/A N/A 10% N/A The consumption report of this product is not yet available in the RMA and DHIS2

Intra Uterine Devices 38% 69% 17% 10% N/A The demand of IUD was very low and CSB were not trained on time to correctly perform the service.

Oral Hormonal Contraceptive. Microgynon

64% 30% 102% 10% N/A The stock-out rate at the Pha-Ge-Com level is low. Low attendance of regular users due to COVID-19 affects consumption.

Oral Hormonal Contraceptive. Microlut

60% 34% 9% 10% N/A

Malaria

ACT New born 7% 49% 64% 10% N/A The forecasts were for the coverage of routine distribution: CSB, hospitals (CHRD, CHRR, CHU), community. However, only the consumption reports of the CSBs are available in DHIS2. The consumption of Hospitals (CHRD) and communities are not taken into account. Shortage was noted due to shipment delays caused by COVID-19 from Quarter 2.

ACT Infant 112% 25% 180% 10% N/A

ACT Adolescents 50% 41% 30% 10% N/A Consumption at Hospitals (CHRD, CHRR, CHU) are not reported in DHIS2. Shortage due to shipment delay caused by COVID-19 from Quarter 2 were noted ACT Adult 42% 36% 25% 10% N/A

Rapid Diagnostic Test (RDT) 82% 18% 55% 10% N/A

Shortage was noted due to shipment delays caused by COVID-19 from Quarter 2. Consumption at hospitals and the community level are not reported in DHIS2.

93

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

Sulfadoxine-pyrimethamine (SP)

230% 1% 24% 10% N/A

Forecast was based on the Malaria National Strategic Plan (NSP). The use of SP for ITP is low at the health facility level. The forecast is over estimated, and assumptions have been adjusted for the next quantification. Collaboration is strengthened with other Implementing partners to increase communication for ITPs and promotion of use of SP for ITPp.

Injectable Artesunate 62% N/A N/A 10% N/A The use report for this product is not yet reported in RMA CSB and DHIS2

MCH

Oxytocin (10 IU Injection) 8,9% N/A 260% 10% N/A

Supply plan did not consider the contributions of other partners (World bank through PARN, UNFPA). Health facilities also procure from SALAMA through FANOME. Their consumptions are not reported to DHIS2

Magnesium Sulfate (500mg Inj)

6% N/A 786% 10% N/A Use of MgSO4 as referral is very low at health facilities

Gentamincin (20mg inj) 7,5% N/A 2643% 10% N/A Quantity procured was over estimated and didn’t consider quantities directly procured by SALAMA. Health facilities also procure from SALAMA through FANOME. furthermore Consumptions of FANOME products are not reported to DHIS2. Gentamicin (80mg inj) 0,6% N/A 23% 10% N/A

Private for nonprofit sector FP OC Community Percent 4% N/A 59% 10% N/A

Distribution by PA is based on average monthly consumption by CHVs. To constitute the required level of stock at each level of circuit, PARC and PA constitute systematically the maximum of their stock. The remaining stock at PA level corresponds to the security stock after distribution to CHV.

94

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

Injectable (Depo-Provera/TRICLOFEM) Community

10% N/A 40% 10% N/A

Distribution by PA is based on average monthly consumption by CHVs. To constitute the required level of stock at each level of circuit, PARC and PA have the maximum of their stock. The remaining stock at PA level corresponds to the security stock after distribution to CHV.

FP Condom Protector Plus (Community)

46% N/A 1147% 10% N/A

The forecast during National Quantification includes commercial and community-based distribution targets. The achievement concerns only consumption at PA. This explain the difference. Moreover, CHVs do not supply many condoms though PARC and PA have the maximum of level of stock as required.

FP Youth Condom Yes (Commercial)

53% N/A N/A 10% N/A This product was not yet available

Sayana Press 16% N/A 719% 10% N/A

Sayana Press was in stock out during Quarter 1, 2, and 3. Distribution at PARC level started from June 2020 and from July 2020 at the PA level, which explains the huge difference between forecast and consumption.

MCH

ORS/Zinc DTK (Community) 34% N/A 71% 10% N/A

Sur Eau 150 ml Commercial 22% N/A N/A 10% N/A This product was not yet available

Sur Eau Pilina (67mg tablet) (Community)

67% N/A 200% 10% N/A

CHVs had a low supply of the product which explains the low consumption. Sûr'Eau Pilina needs to be advertised through demonstrations to the population with the Communication field team when the new shipment arrives.


73% N/A 993% 10% N/A

The forecast during the national quantification was based on services offered using Arofoitra (from ACCESS and Mahefa Miaraka) and was very high: 6,883 tubes for 1 month, but the consumption by CHVs was very low. This explains the difference between the forecast and consumption at PA.

95

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

Pneumox (amoxycilline) (Community)

18% N/A 164% 10% N/A

Pneumox was in stock out in Quarter 2 and part of Quarter 3 (April and May) which explains the difference between the forecast and consumption at PA.

Pregnancy Test (Community)

N/A N/A 2341% 10% N/A

Initially the forecast was calculated for the 13 regions, but the pregnancy tests were only distributed in the SOFIA region with scale up in Menabe in Quarter 4. This explains the low consumption compared to the quantification.

Commercial sector

Malaria

ACT

Percent

N/A 0% 50% 0%

Convincing the pharmaceutical wholesalers to share LMIS data is a long process and the COVID-19 context delayed the process. Through the TMA TWG, IMPACT started the meeting with pharmaceutical wholesalers led by the MOPH in Quarter 4 and shared the template for data sharing. However, no one has responded yet. IMPACT will continue the process using a one-to-one approach. - LMIS data collection through pharmacies and drug shops was not started in Year 2.

SP N/A 0% 50% 0%

RDT N/A 0% 50% 0%

FP

Oral contraceptive N/A 0% 50% 0%

Injectable contraceptive N/A 0% 50% 0%

Condom N/A 0% 50% 0%

MCH

Oxytocin (5 IU Injection) N/A 0% 50% 0%


N/A 0% 50%

0%

Gentamincin (20mg inj) N/A 0% 50% 0%

Gentamicin (80mg inj) N/A 0% 50% 0%

IR2: Strengthened capacity of the GOM to sustainably provide quality health products to the Malagasy people

IR2.1. Health commodities and pharmaceuticals are continuously accessible and available in the public sector

IR2.1.14 (IR2.4.1 IR3.1.3)

PMP USAID

Average stockout rate at service delivery points (SDP) of tracer essential drugs (MCH, malaria)

Percent N/A

Public sector Pha-G-Dis Malaria

ACT New born

Percent

11,5% 17% 28% 10% N/A - In Quarter 3 and Quarter 4, the stock of malaria commodities was insufficient at the SALAMA central level. This was a result of delays in shipments of ACT (AS/AQ) and RDT due to global logistics and manufacturing issues due to COVID-

ACT Infant 11,5% 10% 32,9% 10% N/A


96

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

ACT Adolescents 11,5% 13% 15,7% 10% N/A

19. - PMI and Global Fund procured an emergency stock of the available Arthemeter Lumefantrine to correct the country stock situation, and shipments were delivered between February and May. - The GAS committee applied a rationing system and shipped to districts with only enough stock to cover the maximum of 3 months, without any safety stock. The quantity to be distributed to CSB was not enough, that is why many Pha-G-Dis were stocked out after May. - At the beginning of July, a stock of 1,784,475 treatments of ACT (AS/AQ) that was purchased by PMI arrived and was delivered at SALAMA to allow for the resupply to Pha-G-Dis and to correct the situation. A million rapid tests were also delivered in the same quarter. As the distribution to districts is done on a quarterly basis, the stock levels will be increased at the Pha-G-Dis level in the next quarter (Quarter 1, Year 3).

ACT Adult 15,4% 17% 17,5% 10% N/A

Rapid Diagnostic Test (RDT) 4,2% 8% 5,1% 10% N/A


12% 18% 13,1% 10% N/A

Injectable Artesunate 35% 30% 20,3% 10% N/A

MCH

Oxytocin (10 IU Injection) 47% 25% 32,1% 21,15% N/A - Stock out is calculated based on the tracer products for the program. - Since the SDSP have the same products under the FANOME system then the Pha-G-Dis do not send procurement orders to SALAMA and DSFa for resupply. There was confusion at the district level on the distribution circuit. - A second push distribution was organized by the TWG group led by DSFa and technically supported by IMPACT in Quarter 4.


100% 35% 68,4% 45% N/A

Gentamicin (20mg inj) 100% 36% 80,5% 45% N/A

Gentamicin (80mg inj) 88% 36% 80,8% 39,6% N/A

Pha-Ge-Com

Malaria

ACT New born 6% 19% 8,3% 10% N/A Despite the insufficient stocks at the central and Pha-G-Dis levels, the RLA supported the GAS committees at the district level to organize a redeployment/redistribution of stocks available at

ACT Infant 4,5% 13% 11,5% 10% N/A

ACT Adolescents 6% 15% 11,5% 10% N/A

97

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

ACT Adult 7,2% 17% 11,5% 10% N/A the community levels. The stock out rate at facility level is close to the target defined

Rapid Diagnostic Test (RDT) 6,6% 12% 6,9% 10% N/A


16,6% 39% 9,8% 10% N/A

Injectable Artesunate 84,5% N/A N/A 10% N/A The use report for this product is not yet reported in RMA CSB and DHIS2

MCH

Oxytocin (10 IU Injection) 52,1% 75% 64% 26,05% N/A

- The CSB have FANOME products which is the reason why they do not systematically submit procurement requests to the Pha-G-Dis

- This indicator is only calculated based on the stock of commodities distributed by DSFa and its partners (free of charge).


66,6% 76% 73% 33,3% N/A

Gentamincin (20mg inj) 77,6% 47% 83% 38,8% N/A

Gentamicin (80mg inj) 81% 72% 86% 40,5% N/A


PARC MCH

ORS/Zinc DTK (Community)

Percent

0% 62% 4,7% 5% N/A

Stockout rate for these products is under the benchmark of 5% which is a good result to be maintained.


0% 3% 4,4% 5% N/A


7% 77% 1,6% 5% N/A


3% 62% 12,5% 5% N/A Pneumox was in stock out at PSI’s central and regional warehouses in Quarter 2 and part of Quarter 3


100% 5% 1,7% 5% N/A

PA MCH

ORS/Zinc DTK (Community) 3% 43% 4,7% 5% N/A

Stockout rate for these products is under the benchmark of 5% which is a good result to be maintained.


0% 1% 1,2% 5% N/A


93% 80% 1,1% 5% N/A


32% 61% 7,1% 5% N/A Pneumox was in stock out at PSI’s central and regional warehouses in Quarter 2 and part of Quarter 3

98

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations


100% 10% 1,1% 5% N/A

IR2.1.2 5(HL7.1.3)

PPRUSAID

Average stockout rate of contraceptive commodities at Service Delivery Points by family planning methods

Percent

Public sector

Pha-G-Dis

Implantable Hormonal Contraceptives

Percent

14% 32% 42,5% 10,5% N/A - Throughout Year 2, SALAMA stock was sufficient to ship enough quantities to districts. - There is a problem of quantification at the district level which explained stock out rate for Implant and IUD. The RLA will continue to reinforce the capacity of districts teams in quantification exercises -Due to the lockdown imposed due to COVID-19, SALAMA delayed transportation of commodities at Pha-G-Dis due to limited staff in warehouse to respect distancing and to prepare orders, reduced working hours to respect the lockdown measures, delays in validation process of district orders by DSFa. - IMPACT will continue to monitor with DSFa and SALAMA to ship commodities on time for the next quarter.


48% 29% 18,5% 36% N/A


43% 28% 32,6% 32,3% N/A

Intrauterine Devices 38% 35% 32,1% 28,5% N/A


19% 26% 27,4% 14,3% N/A


38% 37% 19,5% 28,5% N/A

Pha-Ge-Com


29% 5% 8,5% 5% N/A Stock status at CSB level is very good. The RLA will continue to work with EMAR, EMAD, and GAS committees at districts to ensure that commodities are delivered from Pha-G-Dis to CSB and organize redeployment/redistribution to avoid stock imbalances in case of delays of central level shipments The stock out rate of the oral contraceptives Microgynon is higher than the defined target due to logistics issues encountered during the lockdown imposed due to COVID-19. Despite the fact that products were available to SALAMA,


15% 3% 7,1% 5% N/A


N/A N/A N/A 5% N/A

Intrauterine Devices 52% 5% 3,3% 5% N/A


18% 5% 9,6% 5% N/A


99

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations


33% 14% 5,2% 10% N/A transportation was very difficult to ship the commodities to Pha-G-Dis and to Pha-Ge-Com


PARC

Oral Contraceptive (Community)

Percent

0% 2% 0,8% 5% N/A Stockout rate for the main FP products is under the benchmark of 5% which is a good result to be maintained

Injectable (Community) 0% 2% 0,8% 5% N/A


0% 2% 1,6% 5% N/A

Sayana Press 0% 3% 13,6% 5% N/A

Sayana Press was in stock out in Quarter 1 till May. From Year 2, Sayana Press was no longer purchased by USAID, it was purchased with UNFPA funding. For this purchase transfer, a process needed to be followed for PSI to receive the donation from UNFPA. This process took a long time. Additionally, IMPACT was informed only in May 2020 on the product arrival and its availability at SALAMA warehouse.

PA

Oral Contraceptive (Community)

1% 2% 2,1% 5% N/A

Stockout rate for the main FP products is under the benchmark of 5% which is a good result to be maintained

Injectable (Community) 1% 1% 1% 5% N/A


7% 1% 1% 5% N/A

Sayana Press 2% 3% 9,5% 5% N/A Sayana Press was in stock out in Quarter 1 till May in Quarter 3, in central and regional warehouses. The product arrived end of May 2020

IR2.1.3 PMP

IMPACT

Percent of targeted Pha-G-Dis in the 13 supported regions with at least 5 points improvement in composite SPARS scores over baseline or previous year (or reach 90% of the composite score).

Percent 0% 0% 0% 80% 0%

During Year 2, the evaluation of performance was not started. IMPACT just developed the methodology and adapted the supervision guide to SPARS concept. The baseline data collection with composite SPARS has been carried out in Quarter 4. The follow-up is planned in Year 3 that will be used to assess performance.

IR2.1.3a (CBLD-9)

PPR USAID

Percent of USG-assisted organizations with improved performance

Percent 0% N/A 0% 50% 0%

100

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

IR2.1.5 (IR 2.4.2 or HL 3.1-1)

PPR USAID

Number of artemisinin-based combination therapy (ACT) treatments purchased with United States Government (USG) funds

Number

106,000 1,092,050 1,970,435 1 784,475 110%

The targets for these products are achieved by referral to the MOP. However, the targets of the PMP are not up to date according to the RPP and the MOP: - ACT 1,970,435 /1,784,475, i.e. a 110% achievement rate - RDT 2,290,325/ 2,290,235, i.e. 100% achievement rate - SP 1,500,000/ 1,500,000, ie 100% achievement rate

By weight

ACT New born 0 57,600 136,334 42,2%

ACT Infant 106 000 0 962,880 736,810 130%

ACT Adolescents 0 475,925 461,805 435 412 106%

ACT Adult 616,125 488,150 475,919 102%

IR2.1.6 (IR 2.4.3 or HL 3.1-2)

PPR USAID

Number of malaria rapid diagnostic tests (RDTs) purchased with United States Government (USG) funds

Number 1,000,000 1,000,000 2,290,325 2 290 325 100%

IR2.1.7 (IR 2.4.4)

PMP USAID

Number of sulfadoxine-pyrimethamine (SP) tablets purchased with USG funds

Number 0 900,000 1,500,000 1,500,000 100%

IR2.1.8 (IR 2.4.5 or HL 3.2-1)

PPR USAID

Number of insecticides treated nets (ITNs) purchased with United States Government (USG) funds

Number

Distribution Type Mass campaign Number 4,650,000 0 3,677,000 1,677,000 219%

Target was defined based on the quantity distributed during the mass campaign distribution in 2018 in USAID-supported districts with consideration of 3% growth rate per year as annual population increase defined in the general census 1993).'- According to the MOP, the amount due by PMI is 1,677,000 LLINs of which 677,000 LLINs are for continuous distributions and 1,000,000 LLINs for the mass campaign in 2021. '- The quantity to be procured by PMI is 3,677,000, ie 367.7% for mass campaign.

Continuous distribution Number 0 N/A 0 0 N/A

IR2.1.9 (IR 2.4.6)

PMP USAID

Number of artemisinin-based combination therapy (ACT) treatments purchased by other partners that were distributed with USG funds

Number 0 0 0 791,151 0% During Year 2, no products procured by other partners are transported with US government funds.

101

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

IR2.1.10 (IR 2.4.7)

PMP USAID

Number of ACT treatments purchased in any fiscal year with USG funds that were distributed in this reported fiscal year

Number 78,150 513,440 1,345,395 791,151 170%

PMI contribution to procurement of malaria commodities increased in Year 2. PMI procured more ACTs in this FY. The target has been defined assuming the same trends as the previous year.

IR2.1.11 (IR 2.4.8)

PMP USAID

Number of RDTs purchased in any fiscal year with USG funds that were distributed in this reported fiscal year

Number 945,675 249,075 1,508,350 3,903,011 39%

Global Fund procured and distributed more tests kits and IMPACT has completed the national needs. Target needs to be updated and take into consideration the one million RDTs procured and to be distributed to districts.

IR2.1.12 (IR 2.4.9)

PMP USAID

Number of ITNs purchased by other partners that were distributed with USG funds Number

Donors Global Fund (GF) 271,149 0 0 0 N/A

IR2.1.13 (IR 2.4.10)

PMP USAID

Number of ITNs purchased in any fiscal year with USG funds that were distributed in this reported fiscal year

Number

6,745,000 0 373,502 1,000,000 N/A

Through distribution type

Campaigns 6,745,000 N/A 0 0 N/A

Continuous distribution 0 0 373,502 1,000,000 37,4%

In Year 2, only six districts started the cCD distribution (distribution started in February 2020) due to the COVID-19 restrictions. Additionally, COVID-19 caused a decrease of the distribution in the first six districts.

IR2.1.14 (IR 2.4.11)

PMP USAID

Number of SP tablets purchased in any fiscal year with USG funds that were distributed in this reported fiscal year

Number 0 753,700 2,367,200 13,365,690 17,7%

The target was defined taking into consideration the Malaria National Strategic plan and needs to be adjusted to the quantity procured by PMI. In this FY, the quantity of SP shipped to Pha-G-Dis is almost 77% of the quantity procured by PMI.

IR2.1.14a PMP

USAID

Number of facilities where USAID provided support for IPC and/or WASH for COVID-19, by type of support (training and commodities)

Number

102

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

Receiving health

commodities

Supplemental funding

Hospital 0 N/A 7 6 117% In addition to the 6 hospitals, one additional hospital in Boeny due to COVID-19 cases identified in the second hospital.

Vehicle COVID-19 0 N/A 73 70 104% Following a resurgence of cases in the 3 regions, 3 vehicles (ambulances) are added: 2 in Haute Matsiatra, 1 in Atsinanana.

Redirection funding

DRS\CCOR offices 0 N/A 26 26 100%

DRS\CCOR vehicles 0 N/A 26 26 100%

IMPACT Regional Offices and Warehouses

0 N/A 22 22 100%

IMPACT Regional vehicles 0 N/A 23 11 209% 2 vehicles per region were disinfected on a regular basis.

PA and PARC 0 N/A 1 167 960 122%

Following the initiative of the distribution department, the PAs and PARCs in the 3 cCD districts (Farafangana, Vangaindrano and Bekily) outside the IMPACT regions have been equipped. 196 in addition to the 970 in the 13 regions.

Drug shops 0 N/A 143 143 100% 143 Drug shops concerned Atsinanana, Analanjirofo, Boeny, Diana and Sava regions.

Training on waste

management


CSB Number 0 N/A 354 340 104%

Public hospital Number 0 N/A 119 48 248%

Due to the resurgence of COVID-19 cases, the DRS requested support for the training of CHRD staff (extension to the district level, instead of to the regional headquarters level only). A second wave of training was conducted

IR2.1.14b PMP USAID


Number of health workers and hygienists who received COVID-19 training on waste management

Number 0 N/A 823 846 97%

IR2.1.15 (IR 3.1.3)

PMP USAID

Percentage of USG supported districts that submit timely and complete reports through LMIS

Pha-G-Dis To DPLMT Reports submitted Percent 34% 61% 96% 70% 137%

103

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

Public sector

Reports submitted on time 20% 58% 65% 53% 123% - These are the results of the LMIS provisional roadmap and the use of helpdesk to support the Pha-G-Dis on data submission, under the lead of DPLMT.

Reports that are complete 26% 31% 89% 70% 127%

Reports that are complete and submitted on time

18% 18% 51% 53% 96%

Pha-Ge-Com to Pha-G-Dis

Reports submitted 23% 90% 90% 70% 128% The reporting rates from DHIS2 were stable. The data entries are ensured by the Commodity Health Manager based at SDSP who is dedicated to DHIS2. The deadline of the 27th of the month after receipt of the RMAs is respected by most of the SDSPs.

Reports submitted on time 18% 70% 93% 53% 175%



15% 69% 93% 53% 175%

Private for nonprofit

sector

Data from PARC submitted to central

server (DHIS2) by the SPD

Reports submitted

Percent

94% 98% 100% 100% 100%




94% 98% 100% 100% 100%

Data from PA submitted to central

server (DHIS2) by the SPD

Reports submitted 98% 98% 100% 100% 100%




98% 98% 100% 100% 100%

IR2.1.16 PMP

IMPACT

Number/Percentage of required supply plans submitted to GHSC-PSM during the quarter.

Number

N/A 3 4 12 33,3%

Malaria NA 2 3 4 75% Due to COVID 19, only 3 supply plans could be submitted in Year 2.

FP/RH NA 1 1 4 25% Only one supply plan has been submitted for the 2021 procurement plan

MCH NA 0 0 4 0% The supply plan of MNCH is not required and no longer applies since commodities will be fully integrated into the SALAMA system.

104

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

IR2.2. The public-sector supply chain achieves financial sustainability

IR2.2.16 PMP

IMPACT

Percent of product that is unusable due to expiry or damage

Percent

SALAMA Expiry

Percent 0% 0% 0% 1% N/A Damaged

Pha-G-Dis Expiry

Percent 5% 3,2% 0,8% 5% N/A Damaged

PhaGeCom

Expiry

Percent 4% 2,7% 6,1% 5% N/A In the RMA CSB and DHIS2, they put in the same cell the expired, damaged, and redeployed products Damaged

IR2.2.3 (IR 3.3.3)

PMP USAID

Percent of medicines from vertical programs integrated into SALAMA distribution system

Percent

SALAMA

MALARIA

ACT 100% 100% 100% 100% 100%

Malaria commodities are fully integrated into SALAMA distribution system. Functions related to reception, storage, inventory management and distribution are completed by SALAMA.

Rapid Diagnostic Tests (RDT)

100% 100% 100% 100% 100%


100% 100% 100% 100% 100%

Injectable Artesunate 100% 100% 100% 100% 100%


0% 0% 0% 4% 0% Transfer of PA to Pha-Ge-Com and PARC to Pha-G-Dis were postponed in Year 3 as the performance of Pha-Ge-Com needs to be improved progressively prior to ensuring the transfer

Injectable Contraceptive 0% 0% 0% 4% 0%

IUD 0% 0% 0% 4% 0%

Oral Contraceptive 0% 0% 0% 4% 0%

MCH

Oxytocin (10 IU Injection) 100% 100% 100% 100% 100% MNCH commodities are fully integrated into SALAMA distribution system. Functions related to reception, storage, inventory management and distribution are completed by SALAMA.


100% 100% 100% 100% 100%

Gentamincin 100% 100% 100% 100% 100%

ORS/Zinc DTK (Community) 0% 0% 0% 4% 0% Transfer of PA to Pha-Ge-Com and PARC to Pha-G-Dis were postponed in Year 3. In Year 2, IMPACT in collaboration with the MOPH started to identify


0% 0% 0% 4% 0%

6 % of achievement is set as N/A due to difficult interpretation of percentage between achivements and targets.

105

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations


0% 0% 0% 4% 0% the criteria of transfer. The activity to define the criteria was not completed in Year 2 as the MOPH was not always available for related meetings due to COVID-19, which was their top priority. As a result, the whole process for the transfer was postponed to Year 3.


0% 0% 0% 4% 0%

IR2.2.4 PMP

IMPACT

Percent of total product procurement conducted through integrated public-sector supply chain system (including USAID-funded commodities)

Percent

0% 0% 0% 0% 0%

PUBLIC

MALARIA

ACT New born 0% 0% 0% 0% 0%

Procurement of malaria commodities is totally covered and funded by PMI and Global Fund.

ACT Infant 0% 0% 0% 0% 0%

ACT Adolescents 0% 0% 0% 0% 0%

ACT Adult 0% 0% 0% 0% 0%

Rapid Diagnostic Tests (RDT)

0% 0% 0% 0% 0%


0% 0% 0% 0% 0%

injectable Artesunate 0% 0% 0% 0% 0%

FP\RH

Other male condoms 0% 0% 0% 0% 0%

Procurement of malaria commodities is totally covered and funded by USAID and UNFPA

Yes condom 0% 0% 0% 0% 0%

Oral contraceptive 0% 0% 0% 0% 0%

Injectable Hormonal Contraceptives

0% 0% 0% 0% 0%


0% 0% 0% 0% 0%

Intrauterine Devices 0% 0% 0% 0% 0%

MCH

Oxytocin (10 IU Injection) 0% 0% 0% 0% 0%

MNCH commodities are both procured by SALAMA (for FANOME distribution) and donors (USAID and UNFPA). Starting in Year 3, the MNCH commodities will be fully procured by SALAMA and distributed through the FANOME system. Quantification done in Year 2 will serve as a basis to procurement of SALAMA and will include MgS04 which is not currently distributed through the FANOME system.


0% 0% 0% 0% 0%

Gentamicin (20mg inj) 0% 0% 0% 0% 0%

Gentamicin (80mg inj) 0% 0% 0% 0% 0%

106

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

IR2.2.5 (IR 3.3.4)

PMP USAID

Number of individuals trained in logistics, supply chain, forecasting, registration, regulatory activities, and budgeting

Number

Logistic 830 399 268 234 114,5% Target is met and more people have been trained at the district level. There are new people recruited and on-boarded at the district level that were trained on supply chain and logistics as part of GAS Committee members Supply Chain 830 399 268 234 114,5%

Quantification and Forecasting 25 35 112 120 93,3%

The target defined was taking into consideration people to be trained on supply plan review conducted in Quarter 1. The annual target met is at 93% with 54 persons trained in supply plan review and 58 persons trained on forecasting. The target is not 100% due to low participation of the private sector representatives as planned. In the next FY, IMPACT will continue to sensitize the private sector to increase their participation in the quantification training

Registration 0 N/A 0 78 0% The training has been delayed due to process of review of texts and regulations which is still ongoing and not yet completed. IMPACT planned to train the 78 supported districts on budgeting and finance management, but the training curriculum is still under review and validation process by the Service de Formation Professionnelle (SFP). The training is scheduled in Year 3

Regulatory 0 N/A 0 78 0%

Budgeting 0 N/A 0 78 0%

IR2.2.6 (HL 1)

PPR USAID

Number of universal Health Coverage (UHC) areas supported by USG investment

N/A 1 0 1 0%

This indicator has been archived and will no longer be reported for the PPR. (USAID) HL-1.0.2

Number of UHC areas - TA provided for improving quality of health services

Number (1=Yes;0

=No) 1 N/A 0 1 0%

HL-1.0.3

Number of UHC areas - TA provided to strengthen pharmaceutical system and making safe, quality and affordable medicines and vaccine available, reducing adverse reactions and antimicrobial resistance

Number (1=Yes;0

=No) 1 N/A 0 1 0%

107

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

IR3: Expanded engagement of the commercial health sector to serve new health product markets, according to health needs and consumer demand

IR3.1. Commercial actors are incentivized to expand into new health product markets

IR3.1.1 PMP

IMPACT

Number of new private sector companies participating in public health coordinating bodies, such as Private Sector Humanitarian Platform (PSHP)

Number

0 5 8 9 88,9%

Target is not achieved due to COVID-19. IMPACT was not able to visit the private sector to explain IMPACT face to face rather than a virtual meeting.

Type of sector

NGO 0 1 0 2 0%

Bank, Insurance, other sector 0 2 4 2 200%

Commercial: Pharmaceutical wholesaler, Pharmacy, Drugs Shop

0 2 4 5 80%

IR3.1.2 PMPIM

PACT Number of loans (in general) disbursed to businesses (excluding service providers)

Number 0 5 46 50 92%

Year 1 achievement was 7 loans out of a target of 2 loans. In Year 2, lending slowed mid-year due to the COVID-19 pandemic, so only 92% of the target was achieved for number of loans.

IR3.1.3 PMP

IMPACT

Value of loans (in general) disbursed to businesses (excluding service providers)

USD 0 20,245 175,211 90,000 194,7%

Year 2 achievement reached 195% of target, with several larger than projected loans. As drug shops and pharmacies learn more about the financial products proposed by partner banks, they are becoming more confident in requesting larger loans.

IR3.1.4 PMP

IMPACT

Number of people trained in business and financial management

Number 0 22 70 80 87,5%

The Year 2 target could not be reached because of the COVID-19 travel ban. In-person training was only completed in 2 of the 5 planned regions, with video training being developed for a third region in Q4.

IR3.1.6 PMP

IMPACT

Percent of market share for commercial sector for specific health products

Percent

Malaria

ACT N/A N/A 0% 10% 0%

The LMIS system for the commercial sector was not implemented yet. As a result, IMPACT does not have LMIS data (Sales at pharmacies and drug shops) to do the market share analysis.

SP N/A N/A 0% 10% 0%

RDT N/A N/A 0% 10% 0%

FP

Oral contraceptive N/A N/A 0% 10% 0%

Injectable contraceptive N/A N/A 0% 10% 0%

Condom N/A N/A 0% 10% 0%

108

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

IR3.1.7

PMP USAID (GNDR

2)

Percentage of female participants in USG-assisted programs designed to increase access to productive economic resources (assets, credit, income or employment) related to health products

Percent 41 N/A N/A N/A This is a new indicator related to GNDR 2 and will be reported in the next coming years

IR3.2. GOM facilitates the work of the commercial sector

IR3.2.1 PMP

IMPACT

Percent of targeted GOM (Direction de la Pharmacie, des Laboratoires et de la Médecine Traditionnelle and DAMM) staff trained in improved regulatory processes

Percent 0% 0% 0% 100% 0% The training has been delayed due to process of review of texts and regulations which is still ongoing and not yet completed.

IR3.2.2 PMP

IMPACT

Percent of existing drug shops that achieve accreditation in pilot area

Percent 0% 0% 0% 0% 0%

IR3.2.3 PMP

IMPACT

Percent of TWG meetings attended by commercial actors

Percent NA 100% 95% 80% 118,8% 18 TWG meetings out of 19 were attended by the commercial actors during Y2.

IR3.2.4 (IR 4.1.1)

PMP USAID

Number of laws/decree/ministerial order, policies, or regulatory frameworks drafted, amended (including reglementation), approved, or implemented with project support that expand access to or availability of health products or services

Number

Malaria

Drafted, Amended 0 0 1 1 100%

Containment measures linked to COVID-19 pandemic and frequent changes in ministerial staff have slowed down the validation and implementation process

Approved 0 0 0 1 0%


FP


Approved 0 0 0 1 0%


MCH


Approved 0 0 0 1 0%


IR3.2.5 PMP

IMPACT

Percentage of USG supported districts that submit timely and complete reports through LMIS

LMIS system for commercial sector was not yet implemented

Reports submitted Percent N/A N/A 0% 50% 0%

109

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

Commercial sector

Pharmacy to IMPACT server

Reports submitted on time N/A N/A 0% 25% 0%

Reports that are complete N/A N/A 0% 50% 0%


N/A N/A 0%

25% 0%

Drug Shops to IMPACT server

Reports submitted N/A N/A 0% 50% 0%

Reports submitted on time N/A N/A 0% 25% 0%

Reports that are complete N/A N/A 0% 50% 0%


N/A N/A 0%

25% 0%

IR4: Improved sustainability of social marketing to deliver affordable, accessible health products to the Malagasy people IR4.1. Socially marketed products are continuously available at convenient and accessible locations

IR4.1.1 PMP

IMPACT

Percent of PAs/PARCs that are converted into PhaGeCom/Pha-G-Dis

Percent

0% 0% 0% 4% 0%

PA to Pha-Ge-Com 0% 0% 0% 4% 0%

Transfer of PA to Pha-Ge-Com is postponed in Year 3 as the performance of Pha-Ge-Com needs to be improved progressively prior to ensuring the transfer

PARC to Pha-G-Dis 0% 0% 0% 4% 0%

Transfer of PARC to Pha-G-Dis is postponed in Year 3 as the performance of Pha-G-Dis needs to be improved progressively prior to ensuring the transfer

IR4.1.2 PMP

IMPACT

Number of socially marketed products distributed

Number

10,281,346 6,481,522 7,664,803 10,912,681 70,2%

FP

OC Community 1,564,517 1,382,159 2,288,311 1,724,880 132,7% The annual target exceeded by 33% due to an increase of regular users from Mahefa Miaraka since Quarter 2

Injectable (Depo-Provera/TRICLOFEM) Community

1,336,376 926,044 2,033,378 1,473,355 138% The annual target exceeded. Some of the regular users of Sayana Press used Triclofem when Sayana Press was in stock out.


410,304 868,896 1,653,168 1,633,794 101,2%

FP Youth Condom Yes (Commercial) 1,304,250 269,100 0 671,689 0% Yes With You was not available in Year 2.

110

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

Sayana Press 430,254 221,017 135,054 474,355 28,5%

Sayana Press was out of stock at PSI warehouses since Quarter 1 till May in Quarter 2. The product was received in May. Distribution resumed from June 2020

MCH

ORS/Zinc DTK (Community) 57,190 2,873 89,738 58,906 152,3% The use of ORS/Zinc increased significantly during rainy season which explained the high achievement.

Sur Eau 150 ml Commercial 1,171,405 344,595 6,914 904,910 0,8%

Product delivered in June 2020 and distributed to the community channel as replacement to Sûr’Eau Pilina temporarily. As the date of arrival of the Sûr'Eau Pilina had delayed many times and was not known because of COVID-19 pandemic, to avoid stock out at PARC and PA, Sûr'Eau 150 ml has been reserved for the community-based distribution and taken into account the quantity in stock, distribution to commercial circuit was temporarily suspended. Sûr’Eau 150 ml will be distributed to the commercial circuit as soon as the new arrival of Sûr’Eau Pilina will be received


3,829,660 2,299,680 1,225,240 3,620,780 33,8% PSI’s warehouses ran out of stock from Quarter 2.

Arofoitra (CHX 7,1%) (Community) 22,120 16,109 25,540 30,378 84,1%

CHV do not supply much Arofoitra though ACCESS and Mahefa Miaraka had defined the forecast of service highly. Forecast of services by Mahefa Miaraka and ACCESS was taken as target in the National Quantification thus here.

Pneumox (amoxycilline) (Community) 155,270 102,404 176,344 219,635 80,3%

Pneumox was out of stock at PSI central and regional warehouses in Quarter 2 and partially in Quarter 3 which explain the non-achievement of the target.

111

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

Pregnancy Test (Community) 0 48,645 31,116 100,000 31,1%

Mostly distribution in Sofia and lately in Menabe region for the scale up in Quarter 4 by Mahefa Miaraka. It is noted that the target defined in Year 2 included quantity for scale up in the 13 regions, which was not implemented in the other 11 regions.

IR4.1.2a (HL.7.1-2)

PPR USAID

Percent of USG-assisted service delivery sites providing family planning services

Percent N/A 100% 100% 100% 100%

IR4.1.3 PMP

IMPACT

Number of products sold at 100% cost recovery or greater

Number

FP

Condom Yes Strawberry 1 1 0 1 0% The process of transfer to private sector did not start yet

Condom Yes Banana 0 0 0 1 0% The process of transfer to private sector did not start yet

Condom Yes Vanilla 0 0 0 1 0% The process of transfer to private sector did not start yet

Protector Plus 0 0 0 0

MCH

Sur Eau 150 ml Commercial 1 1 0 1 0%

The supplier increased the price production of Sûr'Eau 150 ml during COVID 19 pandemic. So the 100% COGS recovery cannot be achieved with the new arrival of the product at the end of June 2020

Sur'Eau Pilina 0 0 0 0 N/A

Arofoitra (CHX 7,1%) 0 0 0 0 N/A

Pneumox (amoxycilline) 0 0 0 1 0%

Pneumox is maintained at the same price as MNCH product might not be procured anymore. So the increasing of the price for COGS recovery did not take place.

IR4.2. GOM facilitates the work of the commercial sector

IR4.2.1 PMP

IMPACT

Product sustainability plan developed, updated, and implemented for socially marketed products (by product)

Number FP=4

112

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

FP

Injectable hormonal contraceptives (Confiance)

N/A 0 1 1 100%

Oral hormonal contraceptives (Microgynon)

N/A 0 1 1 100%

Condom (Yes and Protector Plus) N/A 0 1 1 100%

Sayana Press N/A 0 1 1 100%

MCH

ORS/Zinc DTK (Community) N/A 0 0 0 N/A

Activity are not planned in Year 2 for this product.

Sur Eau 150 ml Commercial N/A 0 0 0 N/A


N/A 0 0 0 N/A

Arofoitra (CHX 7,1%) N/A 0 0 0 N/A

Pneumox (amoxycilline) N/A 0 0 0 N/A

IR4.2.2 PMP

IMPACT

Costing analysis of selected socially marketed products conducted

Number 1 (Yes

condom) 1 3 2 150%

Costing analysis of Injectables, Oral contraceptives and condoms were conducted during FP products portfolio analysis.

IR5: Increased demand for and use of health products among the Malagasy people/Output/Activity

IR5.1 PMP

IMPACT

Market size increased for specific health products in term of percentage

Percent

This indicator is calculated using the following periods (with data available for valid comparison):

• baseline: September 2019 – February 2020

• evaluation of the performance: March – August 2020

FP

Injectable contraceptive N/A N/A 6,4% 5% 128%

Oral contraceptives N/A N/A 1,3% 5% 26%

YES N/A N/A 0% 4,5% 0% This product was not available in Year 2.

Protector Plus N/A N/A 7,2% 4,5% 160%

MALARIA Rapid Diagnostic Tests for malaria (RDT)

N/A N/A 10,3% 2,5% 412% Due to malaria outbreak

113

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

Sulfadoxine-Pyrimethamine (SP)

10% N/A 25,9% 5% 518%

The good results may be linked to impact of radio spot broadcasted from June to August 2020. The main message was to encourages pregnant women to complete their antenatal consultation (ANC) and receive SP to protect her and her unborn child from malaria.

MNCH

Oral Rehydration Therapy (with or without zinc) (or Hydrazinc / Viasur in time)

N/A N/A 76,8% 4% 1000%

The periods considered to measure the performance (March to August 2020) were during the peak of diarrheal disease, as a result of high consumption of Oral Rehydration Therapy with or without Zinc.

Sur'Eau 150 ml N/A N/A 0% 3,7% 0% This product was only available from June 2020; so data available for comparison.

Sur'Eau Pilina N/A N/A -22,8% 3,7% 0% Sur’Eau Pilina was in stock out from Quarter 2.

Chlorhexidine (or Arofoitra) N/A N/A 49,7% 3% 1000%

Despite the low consumption of this product at community level, we obtained a significant increase in terms of market size between the two periods where analysis was conducted.

IR5.2 PMP

IMPACT

Percentage of target group who know where to get a specific health product

Percent

No target defined for Year 2

FP

Female

FP Product (Injectable contraceptive or Oral contraceptive)

85% N/A 0% N/A N/A7

Condom (Yes or Protector Plus)

59% N/A 0% N/A N/A

Male Condom (Yes or Protector Plus)

77% N/A 0% N/A N/A

Rural FP Product (Injectable contraceptive or Oral contraceptive)

83% N/A 0% N/A N/A


114

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations


56% N/A 0% N/A N/A

Urban


86% N/A 0% N/A N/A


75% N/A 0% N/A N/A

Malaria

Rural


40% N/A 0% N/A N/A

Bednet 92% N/A 0% N/A N/A

Urban


37% N/A 0% N/A N/A


MCH

Rural


44% N/A 0% N/A N/A

Sur'Eau Pilina 27% N/A 0% N/A N/A

Urban


41% N/A 0% N/A N/A

Sur'Eau 150 ml 80% N/A 0% N/A N/A

IR5.38 PMP

IMPACT

Percentage of target group who perceived a specific health product to be relevant

Percent N/A N/A 0% N/A N/A No target defined for Year 2


115

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

FP

Female


55% N/A 0% N/A N/A


25% N/A 0% N/A N/A

Male Condom (Yes or Protector Plus)

35% N/A 0% N/A N/A

Rural


54% N/A 0% N/A N/A


23% N/A 0% N/A N/A

Urban


55% N/A 0% N/A N/A


36% N/A 0% N/A N/A

Malaria

Rural


36% N/A 0% N/A N/A


Urban


33% N/A 0% N/A N/A


MCH Rural


38% N/A 0% N/A N/A

Sur'Eau Pilina 22% N/A 0% N/A N/A

116

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

Urban


32% N/A 0% N/A N/A

Sur'Eau 150 ml 51% N/A 0% N/A N/A

IR.5.4 PMP

IMPACT

Number of mass media spots aired

Number

628 15,622 33,421 35,000 95,5%

Health area

MALARIA 0 2,555 13,248 10,000 132,5% Due to the increase cases of malaria reported by the NMCP, there was an additional broadcast of 3,194 radio spots on malaria case management.

FP 0 4,750 8,815 10,000 88,2% Broadcasting of radio spot on Yes With You was initially scheduled. However, the product was not available, and promotion was not required.

MCH 628 8,317 11,358 15,000 75,7% In Quarter 4, Sur'Eau Pilina was out of stock and related broadcasts through mass media were cancelled

IR5.4a PMP

USAID

Number of people reached through USAID-supported mass media, including social media (disaggregated by channel, sex, and age).

Number

0 N/A 4,753,036 10,485,464 45% .

Supplemental Funding

Type of channe

l Mass media

Radio 0 N/A 2,775,893 2,719,862 102%

TV 0 N/A 529,162 771,149 69%

The objective is based on the TV stations that collaborated with IMPACT in Year 1 with coverage of 30 districts. However, during the implementation of the activity in Year 2, it was noticed that the geographic coverage was reduced which was not the number initially agreed with some TV stations. This explains the number of districts targeted from 30 to 22.

15-24 years old 0 N/A 1,454,224 1,536,045 95%

117

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

25-49 years old 0 N/A 1,850,831 1,954,966 95%

Female 0 N/A 1,550,053 1,657,941 93%

Male 0 N/A 1,755,003 1,833,070 96%

Social Media Facebook 7

017 N/A 12,004 12,431 97%

Printed media Posters, Jobaids, and Flyers 0 N/A 4,729,028 5,274,388 90%

Posters in the PARN regions are not yet counted because the poster report has not yet been received due to the lack of communication teams in the field.

IR5.4b PMP

USAID Number of COVID-19 radio spots developed/adjusted

Number 0 N/A 18 15 120%

Production of 15 Clash info broadcasted also through radio channels and additionally there were 3 new TV spots as requested by DPS of the MOPH.

IR5.4c PMP

USAID Number of COVID-19 radio spots disseminated Number 0 N/A 16,389 14,085 116%

There was an additional broadcast of 2,160 radio spots due to the shows of clash info also aired on radio

IR5.4d PMP

USAID Number of COVID-19 TV spots disseminated Number 0 N/A 5,407 5,985 90%

Broadcast of 1,223 TV spots will continue until the end of October. 930 shows of clash info were aired on TV during Quarter 4.

IR5.4e PMP

USAID Number of IEC/BCC printed tools distributed

Number

0 N/A 458,600 464,000 99%

Type of material support

Job Aids 0 N/A 6,600 12,000 55% All job aids initially planned were produced except the production of job aids for schools that was cancelled after school closure

Posters 0 N/A 214,000 214,000 100%

Flyers 0 N/A 238,000 238,000 100%

IR5.4f PMP

USAID Number of messages disseminated through electronic platforms (SMS)

Number 0 N/A 10 10 100%

IR5.5 PMP

IMPACT

Number of GOM and commercial sector employees trained in developing a national demand generation strategy during TMI meetings

Number N/A 8 21 15 140%

There were additional participants who attended to the meeting. They were invited by MOPH to benefit from the training. Additional participants are staff from DPLMT, DAMM, and from Ordre national des Pharmaciens.

118

USAID IRs and Sub-

IRs

Reporting to


Baseline Achievemen

t Y1 Achieveme

nt Y2 Target Y2


t Y2

Explanations

IR5.6 PMP

IMPACT

National Product Promotion Communication Plan developed and implemented

Number 0 1 0 1 (Health area TBD)

0

A communication plan on the safe and rational use of health commodities was developed. However, due to COVID-19 its finalization and validation took longer than expected and implementation is rescheduled to Year 3.

IR5.7 (HL.7.2-3)

PPR USAID

Number of individuals in the target population reporting exposure to USG funded Family Planning (FP) messages through/on radio, television, electronic platforms, community group dialogue, interpersonal communication or in print (by channel/# of channels)

Number

N/A N/A 4,885,099 8,870,194 55%

Channel

Radio 0 N/A 2,674,382 3,701,628 72% Initially, for radio channels, the number of districts to cover was 64 that was reduced into 56 for budget constraints. Same issue for TV channel where IMPACT reduced the districts to be covered from 30 to 22.

Television 0 N/A 529,162 639,280 83%

Poster 0 N/A 63,572 715,511 8,9%

There is a low rate at 9% of the population reached because only 2,000 PROTECTOR + posters were produced and distributed to the 971 PAs, 71 PARCs, and 958 CHVs. The posters on FP scheduled for the CHVs in the 13-USAID supported regions are postponed for Year 3 due to budget constraints

Electronic platforms (SMS) 0 N/A 3,269,176 3,813,775 86%

Not all the SMS sent by the mobile companies were received by the targeted population. A SMS is only valid for 48 hours. In rural areas, people are not always connected due to network and battery issues.

119

ANNEX B – Year 2 Workplan Update Activity

Code SA Code Description of the Activity Status Comments

Intermediate Result 1 Enhanced coordination among public, non-profit, and commercial sectors for supply and distribution of health products

1.1 The total market for health products in Madagascar is understood and documented

IR1.1.1

Support the implementation, monitor and evaluate the

overarching TMA roadmap for all health products based on

the discussions and decisions taken during the TMA Technical

Working Group (TWG) meetings in Year 1

Continued activity

IMPACT continued to support the implementation of the TMA

roadmap and its operational plan through the 3

subcommittees till the evaluation of the TMA roadmap

(planned in Quarter 3 of Year 3)

IR1.1.2

Support the development and implementation of the malaria

TMA roadmap and monitor and evaluate its progress to

ensure the availability of quality malaria products at all levels

Continued activity

The malaria market assessment was completed in Year 2. The

development of the malaria roadmap is planned in Quarter 1

of Year 3.

IR1.1.3

Support the development and the implementation of the FP

and MNCH TMA roadmap to ensure the availability of quality

FP and MNCH products at all levels and monitor and evaluate

its execution

Postponed in Year 3

The COVID-19 situation slowed down the study process for

both FP and MNCH assessments as in- person data collection

was not possible in Quarter 3 and Quarter 4.

IR1.1.4

With the MOPH , build the capacity of TMA Champions to

successfully steward and lead the TMA TWG and

subcommittees (including the study tour to a country that has

successfully implemented the TMA) Continued activity

Eight TMA Champions and two directors from the MOPH were

trained in leadership. Seven TMA Champions and one director

from the MOPH attended the introduction to the advocacy

training session. The full advocacy training will be finalized in

Quarter 1 of Year 3 due to facilitators unavailability to perform

the training in person (travel restrictions due to the COVID-19)

IR1.1.5

Through the IMPACT Knowledge Management platform and

dissemination meetings, ensure that TMA results from

roadmap analyses, studies and market assessments are

known to all key stakeholders

Postponed in Year 3

The key findings of the malaria market assessment were

presented in a virtual meeting with the partners in the RBM

group (MOPH, donors, and implementing partners). The public

dissemination of the report is planned in Quarter 1 of Year 3

after receiving USAID’s approval.

1.2 GOM leads TMI stakeholders to coordinate health product quantification and forecasting, procurement, and distribution according to market assessments and segmentation

IR1.2.1

Organize meetings to revise and validate the Terms of

Reference (ToR) of the UTGL to ensure its updated tasks and

responsibilities.

Continued activity

Validation is planned in Q1FY21, and then after dissemination

will follow to ensure that all actors are aware and adhere to

the ToR

IR1.2.2 Organize quarterly meetings (UTGL, CGL, and GAS

committee) to analyze routine data on key indicators in public Completed Completed

120

Activity


hospitals, such as stock-out, LMIS issues, etc. for learning and

adapting the use of DHIS2 in collaboration with the MERL

team.

Intermediate Result 2 Strengthened capacity of the GOM to sustainably provide quality health products to the Malagasy people

IR 2.1 Health commodities and pharmaceuticals are continuously accessible and available in the public sector

IR2.1.1

Provide capacity building through trainings and consistent

coaching to GOM and partner members of UTGL on

forecasting and supply planning, including the use of

Quantimed and Pipeline (NMCP, DSFa, DPLMT, SALAMA)

Completed Completed

IR2.1.2

Assist the GOM and UTGL members in leading the annual

system wide forecasting exercises for the public and private

sector for FP/RH, MNCH, and malaria commodities and

support UTGL and SALAMA to help mobilize resources to

procure commodities in the supply plans

Completed Completed

IR2.1.3

Coordinate orders , deliveries generation and pipeline

monitoring according to agreed upon supply plan with

SALAMA, PSM, GOM institutions and USAID

Completed Completed

IR2.1.4

Provide technical assistance to support the central level GAS

Committees to develop quarterly distribution plans for

malaria, MNCH, and FP/RH products based on quarterly stock

status obtained from district/GAS committees

Completed Completed

IR2.1.5

Conduct TOT and cascade trainings for supply chain

management at all levels of the supply chain, in collaboration

with the UCP/Global Fund, ACCESS, Mahefa Miaraka and

other partners

Completed Completed

IR2.1.6

Assist the MOPH in creating a five-year LMIS strengthening

roadmap and developing and testing a new LMIS software

using results from the LMIS in-depth evaluation

Completed Completed

IR2.1.7

Generate evidence through a national supply chain

assessment and End User Verification surveys to develop

adequate strategies, policies, and SOPs for securing

commodities and strengthening the public supply chain

Completed Completed

121

Activity


IR2.1.8 Conduct continuous distribution of LLINs in 12 targeted

districts. Continued activity

Group 1 : 398, 279 LLIN distributed (73% of annual target)

Group 2 : Distribution ongoing

IR2.1.9

Provide technical and financial support to the NMCP to

develop and implement activities for the preparation of 2021

LLIN campaign including the procurement of LLIN

Continued activity

Review of mass campaign strategy, preparatory activities

ongoing

IR2.1.10 Procurement of PPE and expandable

equipment/commodities Completed

Completed

IR2.1.11 Transportation of Covid-19 expendable equipment and

supplies (following cyclic shipment of malaria, FP/RH, and

MNCH commodities)

Continued activity This activity will continue in October until end of COVID-19

funding

IR2.1.11.1 Transportation of Covid-19 expendable equipment and

supplies from PSI central warehouses to District Continued activity

IR2.1.11.2 Transportation of Covid-19 expendable equipment and

supplies from District to Commune Continued activity

IR2.1.12 Providing technical and financial support on Covid-19 to the

MOPH depending on MOPH central and DRS request Continued activity

This activity will continue in October until end of COVID-19

funding

IR2.1.12.1 Ensure preventive measure against Covid-19 among DRS and

IMPACT staffs Continued activity

IR2.1.12.2 Provide PPE (personal preventive equipment) to DRS and

IMPACT staffs against Covid-19 by distributing expendables

and equipment

Continued activity

IR2.1.13 Train hygienists and health workers at the regional health

facilities on waste management Completed

Completed

IR 2.2 The public-sector supply chain achieves financial sustainability

IR2.2.1

Conduct a total cost analysis of the public supply chain and

propose an alternative and more efficient supply chain model

by establishing at least two scenarios with the MOPH to

improve SALAMA's financial sustainability

Continued activity

- The TCA protocol, questionnaires and sampling have been

finalized. Pretest of the questionnaires has been completed.

- Data collection was completed in September

- Data analysis will start in October to have a draft of the TCA

analysis by December.

IR2.2.2

Strengthen management of FANOME at Pha-G-Dis and Pha-

Ge-Com levels to increase transparency and good

governance.

Postponed in Year 3

This activity depends on the TCA analysis completion.

Furthermore, funds for this activity were redirected to fight

COVID-19

122

Activity


Intermediate Result 3: Expanded engagement of the commercial health sector to serve new health product markets, according to health needs and consumer demand

IR 3.1 Commercial actors are incentivized to expand into new health product markets

Review the scope of the private sector humanitarian platform to engage businesses in health product markets

IR3.1.1

Create partnerships with PSHP and non-PSHP members to

collaborate in generating innovative solutions on

transportation, data collection, and health-focused CSR and

CSV.

Continued activity New members joined the PSHP: 8/9

This activity will continue in Year 3

IR3.1.2 Organize quarterly meetings to monitor and assess the

progress of health commission action plan. Completed Completed

IR3.1.3

Conduct mapping exercise to present IMPACT and LMIS data

submission among representative sample of pharmacies and

drug shops

Continued activity

4 regions have been done in Year 2, implementation will

continue in Year 3

IR3.1.4

Ensure that the Health Commission members of the PSHP

participate in the TWG and follow up on the roadmap as a way

to engage the commercial sector to identify barriers in the

health sector and provide solutions

Continued activity 18 TWG meetings out of 19 were attended by the commercial

actors during Year 2

IR3.1.5a

Revitalize regional drug shop associations in preparation of

the ADDO pilot phase to be conducted in Year 3 Continued activity

2 of 5 target regions completed.

DIANA, SAVA and Melaky postponed to Year 3 due to COVID-

19 lockdown

IR3.1.5b

Develop curriculum for training of peer trainers with

simplified materials and tools, to be used in piloting a

sustainable mechanism for business strengthening program

of drug shops

Continued activity

11 potential peer trainers identified (Atsinanana 5, Boeny 6)

out of target of 10.

Materials to be finalized by end Q1Y3.

Increase access to finance for private health commodities supply chain stakeholders

IR3.1.6

Strengthening partner banks and other financial institutions'

capacity to better serve private health commodities supply

chain.

Continued activity

IR3.1.6 IR3.1.6.1

Revise capacity building plans and training curricula for DCA

partner banks to incorporate GESI issues and, as needed, to

take into account newly identified needs.

Completed Completed

123

Activity


IR3.1.6 IR3.1.6.2 Train and support DCA partner banks in credit analysis and

loan structuring for health commodities businesses. Continued activity

- 106 staff (88% of 120 target) from the two partner banks

trained. Target number not reached due to travel ban in

regions.

IR3.1.6 IR3.1.6.3

Develop and adapt loan products and financial tools for small

and micro health enterprises in health commodities sector

(e.g., scoring, nano loans, pharma loans, motorbike loans).

***

Continued activity

- “PA/PARC- Motorbike Loan” operational with ABM; 3 PA

beneficiaries, ACCES SALAMA Loan product launched

responding to COVID-19

- “Pharmaloan” product ready to be launched, MOU awaiting

signature by SOPHARMAD

IR3.1.6 IR3.1.6.4

Design and develop new financial mechanism (e.g. risk sharing

facility), following principles of USAID's Blended Finance

Roadmap for Global Health, possibly including additional

financial institution partners, to facilitate A2F within the

pharmaceutical supply chains and other stakeholders.

Postponed to Year 3 Initiated during HQ A2F specialist visit in Sep 2019.

Presentation of initial evaluation to USAID Dec 2019.

Postponed to Y3 due to ban.

Strengthen the business management of enterprises in health products supply chain

IR3.1.7

Provide business strengthening capacity building to

enterprises in health commodities supply chain and develop

partnership with private companies to sustain the training.

Continued activity

IR3.1.7 IR3.1.7.1 Develop and adapt business-strengthening training curricula

for drug shops. Completed Completed

IR3.1.7 IR3.1.7.2 Provide initial business-strengthening training to drug shops.

Continued activity

- 70 drug shops trained (88% of target of 80) from Atsinanana,

Boeny and Diana regions (60% of target of 5)

- Target not achieved due to COVID-19 travel ban

IR3.1.7 IR3.1.7.3

Provide one-to-one coaching on business strengthening to

enterprises/individuals identified as potential peer trainers in

health commodities supply chain.

Completed Completed

IR3.1.7 IR3.1.7.4

Identify potential partnerships with private training

companies to expand and sustain options for business

training to enterprises in the health commodities supply

chain.

Continued activity

85% of annual target; FORMASANTE identified as potential

partner. MOU prepared with FORMASANTE, feedback received

and negotiation in progress. Will continue in Year 3

IR3.1.7 IR3.1.7.5

Explore digital inventory management applications for use by

private health commodities enterprises and which would be

incorporated into future business training.

Completed Completed

124

Activity


IR 3.2 GOM facilitates the work of the commercial sector

IR3.2.1

Facilitate high-level advocacy meetings involving the MOPH,

Ministry of Commerce, customs services, Ministry of

Economy and Finance, the National Board of Physicians and

the National Board of Pharmacists to develop policies and

regulations that will favor importation and commercialization

of a packet of vital Essential medicines, including

contraceptives, anti-malarial, and key MNCH products.

Continued activity

The National List of Essential Medicines (NLEM)has been

signed by the Minister of Health and being reproduced and

ready to be disseminated. Ongoing discussions with Customs

and Ministry of Budget and Finances to update the Code de la

Douane et Impôts to accommodate the new NEML

IR3.2.2

Support DAMM and MOPH to put in place strong regulatory

processes related to the registration, importation, and

distribution of medicines based on reviews of the Common

Technical Document, New Law on Regulatory Body in Africa,

and experience from other countries through study tours.

Completed Completed

IR3.2.3

Support DAMM in streamlining the registration and

importation procedures for medicines based on the latest

WHO recommendations.

Completed Completed

IR3.2.4

Support the MOPH and the professional associations to

revitalize the inter-ministerial committee to fight counterfeit

and illegal medicines. A strategy will be defined through a

mid-term evaluation of the Stratégie de Lutte Contre le

Marché Illicite and the Contrefaçon des Medicaments et

Intrants de Santé and an action plan will be developed.

Continued activity

Continued discussions with the Executive Secretary of the

inter-ministerial committee to review the implementation

statuses of strategies developed in 2015. Identified immediate

activities identified will be implemented in Year3

Intermediate Result 4 Improved sustainability of social marketing to deliver affordable, accessible health products to the Malagasy people

IR 4.1 Socially marketed products are continuously available at convenient and accessible locations

IR4.1.1

Distribution of socially marketed products across 10 regions

for MNCH and FP/RH products and distribution of only FP/RH

products in three PARN Regions through PARCs and PAs.

Continued activity Routine distribution of socially marketed products across 10

regions for MNCH and FP/RH products

IR4.1.2

Establish a motivation system for PAs and PARCs and follow

up on their quarterly performance to address supply chain

inefficiencies in social marketing in order to prevent stockout.

Continued activity

Motivation system for PAs and PARCs established through

incentives (Motorbike loan and distribution of goodies based

on their quarterly performance)

125

Activity


IR4.1.3

Expand last-mile distribution and emergency distribution

through a pilot to deliver health products using drones. Continued activity

Flight tests scheduled in Year 2 were not completed as flights

were on standby during Quarter 3 due of battery problem and

to COVID-19 lockdown. To be continued in Year 3

IR4.1.4

Transition the community distribution model from select PAs

and PARCs to the Pha-Ge-Com and Pha-G-Dis in coordination

with DDS/DPLMT/DSFa/ACCESS/Mahefa Miaraka.

Postponed to Year 3 The performance of Pha-G-Dis and Pha-Ge-Com needs to be

improved progressively prior to ensuring the transfer of the

PAs and PARCs. Thus, the transfer process will be postponed to

Year 3.

IR4.1.5

Select and introduce socially marketed products across 10

IMPACT regions and 3 PARN regions through the private

sector (pharmaceutical and commercial channels) pending

the results of the COGS analysis.

Postponed to Year 3

Activity pending the result of the market assessment and

product portfolio analysis final approval

IR4.1.6

Define the needs for a product monitoring system and

conduct a study of a product tracking system. Find

technological solutions which allow IMPACT to earn and grow

brand loyalty while protecting the brand from supply chain

fraud, including counterfeiting and theft.

Continued activity An international supplier has been identified and contacted

This activity will be continued in Year 3.

IR 4.2 Socially marketed products achieve cost recovery at an affordable price for consumers

IR4.2.1

Leverage TMA findings from IR1 to analyze COGS and

continue to propose options for the optimization of financial

sustainability for the current socially marketed products

portfolio and explore brand extension of Yes With You

condoms and introduce a new brand of pharmaceutical

products depending the results of the COGS analysis.

Continued activity Continued activity

IR4.2.1 IR4.2.1.1

Continue to explore optimization of financial sustainability for

the current socially marketed products portfolio and explore

brand extension of Yes With You condoms Continued activity

Prices of FP products were analyzed and were recommended

to be increased in the product portfolio.

In Year 3, dialogue with the private sector and the FP market

assessment will determine action about YES With You condom.

IR4.2.1 IR4.2.1.2 Explore introduction of new brand of Pharmaceutical

products pending the results of the COGS analysis Postponed to Year 3

Activity pending the result of the market assessment and

product portfolio analysis final approval

Intermediate Result 5 Increased demand for and use of health products among the Malagasy people

126

Activity


IR5.1.1

In collaboration with the demand creation subcommittee of

the TMA TWG, develop and implement activities to increase

demand and use of health products

Continued activity

A draft of a communication plan on the safe and rational use of

health commodities had been developed. The validation and

the implementation will be held in Year 3

IR5.1.2 Provide technical and financial support to contribute to the

activities of the MoPH Completed

Completed

IR5.1.3

Conduct communication campaigns for promoting health

products of the three prioritized health areas (Malaria, FP and

MNCH) through radio, TV spots, job aids, and digital

communication incorporating gender messaging to promote

and use health commodities for population and providers

Completed

Completed

IR5.1.3a Increase demand creation of health products, and raise

awareness of the population on Covid-19 on the field with

communication teams using mobile sound systems

Continued activity

Activity will be continued until the end of October, the end of

the supplemental fund on COVID-19

IR5.1.3b Produce and broadcast Radio and TV spot on Covid-19 Completed Completed

IR5.1.3c Produce and distribute/disseminate Job aids on Covid-19 Completed Completed

IR5.1.4

Provide technical and financial support to the Ministry of

Youth and Sport (MYS) to develop and implement Youth

activities in collaboration with Telma Foundation based on

the Human Centered Design (HCD) study and support training

for youth on health, leadership, communication, etc.

Continued activity Due to COVID-19, training sessions and revitalization of youth

centers will be held in Year 3

IR5.1.5 Leverage new technology to drive demand for malaria, FP/RH

and MNCH health commodities. Completed

Completed

IR5.1.5a Support the 910-call center in partnership with ACCESS

(including recruitment, training , and supervision of the new

hotliners)

Completed

Completed

IR5.1.5b Send SMS broadcast to the targeted population (on the 3

health areas including Covid-19) Completed

Completed

IR5.1.6

Develop a strategy for youth on the use of vouchers for youth

health coverage and implementation of a voucher pilot. Cancelled

Due to COVID-19, training sessions for Youth leaders have been

cancelled as well as the strategy for youth on the use of

vouchers.

Cross Cutting Gender

127

Activity


CC1.1

Target women and human rights associations to serve as

strategic partners of IMPACT and to play an active role in the

Total Market Approach. Continued activity

CNFM and EFOI are key IMPACT GESI strategic Partners. They

are aware of IMPACT's objectives and interventions,

manifested their willingness to support IMPACT's GESI

interventions. In Year 3, the partnership will be continued and

strengthened

CC1.2

Ensure the participation of key GESI partners in TMI TWG.

Continued activity

CNFM and EFOI nominated their representatives to integrate

the TMA Technical Working Group. In Year 3, those

representatives will be an active part of TMA-TWG

subcommittees to be voice and ears of IMPACT and advocate

on GESI integration in TMA approach

CC1.3

Produce and distribute SBCC tools on GESI for different target

groups.

Continued activity

In Year 2, produced GESI SBCC tools including 4 articles in

newspaper for general population, 3 GESI success stories, have

been duplicated and distributed GESI brochures for journalists,

women, men, youth. In Year 3, factsheets for bankers and

stakeholders, and needed GESI tools for private and public

sector will be developed.

CC1.4

Integrate GESI-informed messaging into family planning &

MNCH communication campaigns. Continued activity

During the World Contraception day, within the Family

Planning Campaign, GESI messaging were included in all the

messages vehicled through SMS, YouTube, Facebook. Article

on GESI WCD was produced and put-on websites.

CC1.5

Raise awareness of IMPACT stakeholders on GESI integration

into a TMA through meetings and an annual workshop.

Continued activity

During year 2, due to Covid-19 restriction, only virtual meetings

were conducted with GESI partners. In addition a TMA

factsheet was developed. In Year 3, regular meetings are

planned for experience sharing and GESI orientation, the TMA

factsheet will be printed, duplicated and distributed to

stakeholders.

CC1.6

Build the capacity of IMPACT staff to serve as GESI champions.

Continued activity

Online training sessions were conducted among 9 Distribution

Teams ( Director, Coordinator, SRD, SPD) who in their turn will

continue the cascade training among PA and PARC. A series of

4 videos for refreshing courses for IMPACT staff was produced

and 57 Staff members followed the series.

Cross Cutting MERL

128

Activity


CC2.1

Strengthen LMIS/HMIS ( all sectors: public, private, non-

profit, and commercial) including: formative supervision,

capacity building of data senders, and supporting

implementation of the LMIS roadmap with consideration of

DHIS2 as the main LMIS electronic tool.

Continued Activity

Part of this activity (Supporting the Implementation of LMIS

roadmap) is to be continued in Year 3

CC2.2 Support the mapping exercise to identify and train

pharmacies and drug shops for LMIS data.

Completed Completed

CC2.3

Support technically and financially the DPLMT to conduct

Routine Data Quality Assessment (RDQA) at all levels and

sectors.

Completed Completed

CC2.4

Implementing monitoring and evaluation system on

continuous distribution, including: creating M&E tools,

training, data collection and supervision, RDQA (budget

included in the continuous distribution activities)

Completed Completed

CC2.5

Conduct market assessment studies for FP and MNCH,

including key informant interviews, outlet surveys, and

routine data in collaboration with IR1. Continued activity

FP and MNCH framework was sent to USAID for approval. The

study protocol of the three data collection tools to feed the

market assessment for both health areas which are: key

informant interview, outlet survey with routine data analysis

and household survey will be finalized in Year3.

CC2.6

Implement additional studies, including: archetype

study/segmentation, journey mapping, assessment of

pharmacies and drug shops on products supply, KAP study on

IPTp use, and an evaluation on the introduction of the last

mile distribution strategy (drones) at the community level. Continued activity

The study protocol on IPTp use study was designed during

Year2. After USAID approval the study protocol will be

finalized, and study implemented in Year3.

Archetype including literature review and key informant

interview among youth implementers partners study was

implemented during Year2. Results from key informant

interview will be finalized in the beginning of Year3

CC2.7

Knowledge Management: Support partners in developing and

collecting success stories and documenting IMPACT's

innovations in the field.

Completed

Completed

129

ANNEX C - Environmental Mitigation and Monitoring

Report and Climate Risk management report Summary of the outlets visited in Year 2 on environmental monitoring and climate risk management

EMMR for non-profit sector (social marketing)

Using supervision checklist, the environmental monitoring for non-profit sector was conducted within 71 PARCs, 905 PA

and 15 warehouses.

During supervisions, the following positive points were observed:

- Number of expired products at central warehouse decreased from 118,275 in Year 1 to 25,844 in Year 2.

- All PAs and PARCs were trained on storage and expiry management. Thus, surplus and obsolete products

observed in Quarter 1 and Quarter 2 were addressed and were not an issue in Quarter 3 and Quarter 4.

Use of wooden pallets in dry, ventilated, and secure areas were observed in warehouses and PARC in order to

manage access and to prevent theft of the health products.

However, some challenges were identified:

- Travel restriction due to COVID-19 from Quarter 2 limited the number of field supervision visits.

- There was still a significant quantity of expired products at warehouses, a total of 25,844 health commodities.

- Within PA and PARCs levels, there was surplus of health products of 9,771 and 835 respectively.

The following actions were taken to address the identified issues:

- From Quarter 3 to Quarter 4, warehouses were visited by the field communication teams.

- Management of expired products was included in training curriculum used to train warehouse teams, PARC,

and PA (including regional assistant and stock keeper). A virtual meeting was organized in July 2020.

- Initiate the creation of an alarm system for expiry management with MERL team.

- Prepare for annual incineration of expired products following national guidelines.

- Organized remote supervision every two months for PARC and PA to manage the surplus and obsolete

products.

- During PARCs and PA supervision, the SPD will systematically ensure that the communication tools on storage

conditions are displayed and visible.

General recommandations :

Type of Outlet

Number of entities/outlets visited during Year 2 Number of

entities/outlets

visited at least once

during Year 2

Total existing

entities/outlets Q1

Q2 Q3 Q4

Public Sector

SALAMA/Central

Warehousing

0 0 0 0 0 6

Pha-G-Dis 39 40 44 43 73 78

Pha-Ge-Com 85 130 103 81 399 1,734

Social Marketing

PSI Warehouse 6 1 5 4 11 15

PARC 60 67 70 71 71 71

PA 779 887 891 905 905 905

130

- Maintain supervision by local teams until onsite visits are possible.

- When appropriate, reinforce the training on expiry management during field supervision.

- Organize a refresher training on expiry management. Additionally, implement the alarm system for the

management of expiry products.

- Maintain the high storage quality through regular supervisions (at least one per year).

- Ensure that warning signs on LLIN storage are in displayed for all warehouses.

EMMR for the public sector

EMMP questionnaire has been applied through supervisions visits conducted by the Regional Logistics Advisors (RLA) in

the 13 supported regions. For the public sector, the RLA used the supervision checklist designed to monitor

environmental mitigation plan. However, from Quarter 3, the supervision checklist was integrated into the SPARS tool.

At the end of Year 2:

- 73 out of 78 Pha-G-Dis / district warehouses have been visited. Among the 73 Pha-G-Dis visited, 64

warehouses (88%) have enough and cleaned space to store medicines

- 94% of professionals working in the Pha-G-Dis have been trained on best storages conditions and stock

inventory management of commodities including the management of temperature sensitive products and

expired drugs

Challenges encountered through the supervision visits were:

- 49 Pha-G-Dis (out of the 73 visited) have expired medicines in the warehouses/Pha-G-Dis that need to be

destroyed and not stored in a quarantined space

- 41 Pha-G-Dis (out of the 73 visited) have no thermometer to control temperature of the warehouses.

- 37 Pha-G-Dis have no cold chain to store sensitive medicines such as Oxytocine

Recommandations :

- Conduct resources mobilization activities to procure material and equipment necessary to upgrade storage

conditions of the Pha-G-Dis (thermometer, pallets, cold chain, etc.)

- Continue training and supervision of the service providers on stock management including expired medicines

- Advocate to Pha-G-Dis to quickly destroy the expired medicines and store them in a secure quarantine space

while waiting for destruction

131

ACTIVITY MITIGATION MEASURES SUMMARY FIELD MONITORING/ISSUES/RESOLUTION OUTSTANDING ISSUES, PROPOSED

RESOLUTION

1. Capacity building through technical workshops and training to enhance coordination and distribution of quality health products.

1. Technical assistance, trainings, workshops, and tools developed must include appropriate management practices for facilities of health commodities and integrate sound procedures to manage and properly dispose of health care waste (including expired health products).

1.1.1. Training of CSB (Centre de Santé de Base) providers on proper storage, use and disposal of commodities. Training supports may include communication materials and packaging (Job Aids)

Number of CSB providers trained :

Male Female Total

72 107 179

The criteria of proper storage and disposal of commodities:

• Proper Storage: - stored on pallets or shelves - stored at least 30 cm away from walls and other piles - stored in a functional refrigerator - protected from direct sunlight - storage rooms dry and adequately ventilated

• Proper Disposal of Commodities: - expired or damaged stored in a separate location

Number of CSB not respecting proper storage:

Proper Storage 189

Medium 19

Improper Storage 3

Issues: 12% of CSB visited are not respecting best storage practices Resolution: Advocated to the CSB, DPLMT and DSSB to procure the necessary equipment and material to upgrade storage conditions

Outstanding Issues: None Recommendations: . The 22 CSB that do not meet storage conditions should raise resources to procuring the pallets and shelves in order to upgrade . IMPACT will explore opportunities to engage DPLMT, DSSB, and TFPs to mobilize resources and contribute to donation of necessary equipment to upgrade storage conditions

Number of CSB not respecting proper disposal of commodities:

Proper Disposal of Commodities

162

Medium N/A

Improper Disposal of Commodities

49

Issues: the CSB don’t store the expired medicines in a separate and quarantine space. Destruction of expired medicines took longer than planned.

Outstanding Issues: CSB are not quickly destroying the expired medicines and don’t store those expired medicines in a separate quarantine space. Recommendations: - Continue training and supervision of CSB

staff to emphasize on best storages practices and the management of expired medicines

- Sensitize the districts teams (EMAD) to monitor destruction of expired medicines

132


RESOLUTION

Resolution: the situation has improved in this FY2, from 70% of CSB visited in Year 1 to 30% in year 2 of CSB with improper disposals of commodities. The improvement is due to regular supervisions done by the RLA and training conducted on stock management in collaboration with ACCESS

1.1.2. Provide supervision of CSB providers by using Rapid Monitoring Tool to assess infrastructure and equipment for handwashing, infection prevention (decontamination and containers for infectious waste), waste cans, safety boxes, etc.

Infrastructure and non-medical equipment for infection prevention: - handwashing device with a bucket to catch - soap for washing hand - tissue for cleaning - chlorinated water

-316 CSB equipped with non-medical equipment for infection prevention

-20% (83/399) of CSBs visited in Year 2 without non-medical equipment to prevent infection and contamination. Issues: Consumption of the non-medical equipment has increased due to COVID -19 situation which led to stock out. Resolution: The CSB agreed to quickly organize purchase of those non-medical equipment.

Outstanding Issues: The system of tracking and monitoring consumption of commodities and stock levels is still weak. The resupply process is not done timely. Recommendations: - The CSB were trained on stock

management including the calculation of a safety stock of the non-medical equipment to avoid stock out.

- The CSB agreed to closely monitor consumption and detect possible shortage and proceed with procurement as soon as possible

- Plan a meeting with ACCESS staff at the commune level to share findings and plan on supporting the CSB to improve the resupply process

1.1.3. Provide CSB providers with: garbage cans & gloves for ordinary waste; sharps containers and gloves; handwashing device with a bucket to catch handwashing water

Medical equipment for infection prevention: - Safety box - Sharps containers - Gloves - Garbage disposal

-373 CSB equipped with-medical equipment for infection prevention -26 CSB visited in Year 2 are not equipped with medical equipment for infection prevention. Issues: The CSB did not resupply on time those medical equipment

Outstanding Issues: The CSB does not always give proper attention to the purchase of medical equipment for infection prevention to ensure resupply on time. The CSB have budget to procure the medical equipment. Recommendations: - PMI has procured gloves for malaria

diagnosis that were delivered in Quarter 4 and distributed to Pha-G-Dis. The RLA will work with Pha-G-Dis to resupply the CSB in need

133


RESOLUTION

Resolution: The CSB agreed to quickly organize purchase of those non-medical equipment.

- IMPACT will alert ACCESS to support CSB in estimating correct quantities to procure and avoid shortage/stock outs

1a (Activity type 1: Support to healthcare facilities and systems [1.2] ) Support or provide technical assistance to develop processes, SOPs, and standards for aspects of healthcare such as waste management, disinfection, and service delivery

1) Use of host country developed processes, SOPs and standards will be promoted; however, these processes must be assessed to evaluate whether they adequately address potential health and safety and environmental impacts of the operation of healthcare services and generated wastes. 2) If no SOPs exist or gaps are identified, develop and implement SOPs in accordance with best management practices 3) When adequate waste management procedures are not available, develop and implement a WMP that addresses management of waste streams associated with healthcare services. See USAID’s Integrated Waste Management Plan for additional guidance.

1a1) Review of the adequacy of existing SOP: Results and issues: At the beginning of the COVID-19 activity in May 2020, it was noticed that there was no SOP available. Resolution: IMPACT with the MOPH created the operational documents for the training using the contingency plan from the MOPH.

Outstanding Issues: No SOPs available. Recommendations: Support the MOPH to create SOPs for all epidemic diseases (not only for COVID-19). When the SOP is created, verify that the document adequately addresses the potential health and safety and environmental impacts of the operation of healthcare services and generated wastes.

1a2a) Verification of the development and implementation of SOP: Result: IMPACT and the MOPH implemented the operational document developed. Issues: None Resolution: None


1a2b) Accordance of the operation with the SOP Result: The operational document created through the contingency plan was aligned to the best management practices of the hospitals targeted to the training of the waste management. Issues: None Resolution: None


1a3) Verification of the development and revision of WMP Result and issues: There is no waste management plan available. Resolution: IMPACT and the MOPH used training curriculum developed by the MOPH composed of the Infectious diseases manager and hygienist manager working at hospitals targeted for the waste management training.

Outstanding Issues: No WMP available. Recommendations: Support the MOPH to create WMP for all epidemic diseases (not only for COVID-19).

134


RESOLUTION

1b (Activity type 1: Support to healthcare facilities and systems [1.3]). Support to healthcare facilities and systems: training, technical assistance, and capacity building of health care workers, waste workers, staff, community health care workers, and volunteers in areas of PPE use, waste management, procurement, storage, and disposal of commodities, and disinfection

1) Training/curricula/ supervision that creates waste as part of the training will address appropriate best management practices concerning the proper management of healthcare waste, sample handling and disposal, and PPE use. PPE must be provided to trainers, if dictated by the type of training. 2) Trainers will be equipped with PPE, as dictated by the type of training. 3) Training on waste management, storage of commodities, disinfection, and PPE use must be in accordance with the USAID guidance and best standard of practice promoted by local authorities at the time of the training. PPE for healthcare and waste workers depends on the setting, personnel, and type of activity. See WHO’s Rational Use of PPE for COVID-19.

1b1) Respect for best appropriate management practices during training and supervision Result: IMPACT followed the recommendation and instruction from MOPH as per the contingency plan during preparation and training. The supervision activity after the training was assigned to the MOPH. Issues: None Resolution: None

Outstanding Issues: None Recommendations: None

1b2) PPE provided and used by trainers: Result: The trainers wore PPE and brought some for the PPE exercise used for the training. All (11) trainers are equipped with PPE. Issues: None Resolution: None


1b3a) Interview with participants to verify training was conduct: Result: 11 interviews conducted Issues: None Resolution: None


1b3b) Use of the supervision checklist developed from the training curricula to ensure compliance by health care workers. Result: Supervision is assigned to the MOPH, that did not use supervision checklist, but prefer using verbal approach. Issues: None Resolution: None

Outstanding Issues: No supervision checklist used during supervision. Recommendations: IMPACT to create the supervision checklist using the training curricula.

2. Social Marketing, Education, & Social Behavior Change Communication (SBCC).

135


RESOLUTION

2. “Programs involving nutrition, health care, or population and family planning services” These activities promote the use of commodities such as condoms, drugs, and insecticide-treated nets. Improper disposal of these items by end-users (the targets of the marketing messages)

2.1.1 Include messages on proper storage, use and disposal of commodities in the communication campaigns using various channels such as mass-media. Messages will be tested with a diverse audience (differences in sex, age, literacy level and socio-economic status).

Number of communication materials or radio spots or TV spots with instructions on proper storage, use, and disposal of commodities by end-users broadcasted: Result:

• Instructions on proper use of commodities were included in the radio spot. During Year 2, 3,999 radio spots on Sur’Eau Pilina, 7,359 radio spots on CHX, 3,194 radio spots on TPI were aired for end-users.

• Pictogram on disposal of Protector Plus was inserted in the Poster of Protector Plus.

• Four (4) SMS broadcasted were sent to the PA, PARC, CHVs and Pha-G-Dis on proper storage of commodities.

Issues: Integrating instructions on proper storage and disposal of commodities using radio spot increases the length of the messages to be memorized by the end users, which is not efficient. Resolution: Instructions on proper storage and disposal need to be more visual, so pictogram was integrated on visual communication materials (posters, TV spot, etc.)

Outstanding Issues: None Recommendations: Integrate instructions on proper storage and disposal of commodities into the Communication Plan on the safe, rational use and rational prescription of health commodities to be elaborated by the demand creation subcommittee of the TMA TWG.

Percent of target groups who know and respect the proper disposal of commodities and the old LLINs. Result: 3.2% according the Household Survey malaria market assessment done in 2019. Issue: General population does not know the process for proper disposal of commodities and old LLINs Resolutions: Setup a plan/activities to integrate communication on proper disposal of commodities and the old LLINs in Year 3

Outstanding Issues: General population does not know the process for proper disposal of commodities and old LLINs. Recommendations: In Year 3, plan to integrate the proper disposal of commodities and old LLINs in all communication channels targeting the general population such as mass media, posters, and SMS.

2a (Activity type 1: Communication, outreach, planning -

1) Stay informed about ways to prevent COVID-19 transmission over the course of the activities, including where

2a1) Updates made to activities and training procedures to include COVID-19 best practices as appropriate Result:


136


RESOLUTION

[1.1]). Social behavior change: communications, outreach, planning

appropriate, training staff and beneficiaries on social distancing, PPE use, and disinfection. Guidance can be found from local authorities or at the following websites: ●CDC’s Coronavirus Disease Site ●WHO Getting your Workplace Ready for COVID-19 ●UNICEF, WHO, IRCF Key Messages and Actions for COVID-19 Prevention and Control in Schools 2) Where appropriate and available, remote training and other non-face to face communications will be utilized when possible until the risk of infection passes. 3) Local COVID-19 regulations on the size of gatherings and travel advisories will be followed.

Teams on the field are regularly sensitized on the methods to prevent COVID-19 and on the systematic use of PPE, SHA gel during the activities and respect of social distancing

➔ Commodities (mask and SHA gel) have been made available

➔ Production of 6,600 Job aids on preventive measures on COVID-19 for the staff and partners on field (PA, PARC, Pha-G-Dis; KomLay cCD )

➔ Regular disinfection of offices and vehicles were realized

➔ Three (3) SMS broadcasted were sent to the PA, PARC, CHVs and Pha-G-Dis to remind them preventive measures. Issue: no non-compliance noted Resolutions: None

2a2) Use of remote training and meetings. Result: IMPACT applied teleworking then all meeting is through virtual conference. The communication commission held its weekly coordination meeting through virtual conference as well. Issues: bad quality of Internet connection and unavailability of Internet access for MOPH team. Resolution: Partner support the communication fees for Internet access for MOPH


2a3) Local regulations on the size of gatherings and travel advisories incorporated into activities Result: - For sensitization activities, communication team avoided

gathering people. - Communication team also respected instruction set by the local

DRSP-CCOR:

• In June, no travel between the different district of Atsinanana to avoid the risks of spread of COVID-19

• In August, the driver of the team in Melaky needed to make COVID-19 test before entering the region

Issues: Sensitize people without organizing meetings


137


RESOLUTION

Resolution: - Field communication team delivered messages through mobile sound system across the city (using vehicle to respect regulation on distancing). - 20 awareness tarpaulin for the communication teams on field were produced with pictogram on preventive measures. There are hanged on each side parts of the vehicles so the community can see the messages when the mobile sound system pass around the city-

3. Storage, management, distribution, transportation & disposal of public health commodities & equipment.

3. Storage, Management, Distribution & Disposal of Public Health Commodities & Equipment

3.1.1. Include in training curriculum how to properly manage expired (properly logged), obsolete or surplus commodities for PSI central warehouse, PARC, Supply Point and public sector (SALAMA/central warehousing, PhaGDis, PhaGeCom and CSB). A disposal plan will be created and will be available for the trainees following the national guidelines. Curriculum will be adapted to different literacy or education levels to ensure effective understanding

Nonprofit sector

Number of PSI central warehouse, PARC, PA trained on expired, obsolete, and surplus commodities:

Type Male Female Total

Warehouse 10 5 15

PA 21 50 71

PARC 379 526 905

Some of warehouse had more than two people trained

- - All employees at PSI central warehouse, PARC, PA visited were trained on management of expired, obsolete or surplus commodities except 2 warehouses.

- Issues: During Year 2, on-the-job training was limited, then onsite training of 2 warehouses was not completed. Resolution: Remote training was provided to all warehouse team members in July to ensure all workers are on the same level of knowledge.

Outstanding Issues: Despite the fact that trainings were performed, spot check cannot be scheduled to verify whether the training was effective. Recommendations: When possible, perform onsite visits to supervise warehouses to ensure that either the on-the-job or remote trainings are efficient.

Public sector

Number of public sector persons trained:


SALAMA 0 0 0

Pha-G-Dis 32 41 73

CSB/Pha-Ge-Com

82 152 234

Some of Pha-G-Dis and Pha-Ge-Com had more than two people trained

Outstanding Issues: New staff need to be trained on stock management (including management of expired commodities) as part of the onboarding program. Recommendations: - IMPACT to conduct training of Pha-G-Dis

staff in need

138


RESOLUTION

- - In 73 Pha-G-Dis supervised in Year 2, 94% (69/73) were trained on

management of expired, obsolete and surplus commodities. -

-In 399 Pha-Ge-Com supervised in Year 2, 50% (234/399) were trained on management of expired, obsolete and surplus commodities.

- Issues: New staff recruited and on boarded at Pha-G-Dis and Pha-Ge-Com are not trained on management of stocks including expired, obsolete and overstocks of commodities. Resolution: Plan training of people not yet trained at Pha-G-Dis and collaborate with ACCESS to conduct training of CSB staff

- Collaborate with ACCESS to plan training of CSB staff.

3.1.2. Regularly check expiry date of commodities during monthly visit of PSI central warehouse, PARC, Supply Point and public sector (SALAMA/central warehousing, PhaGDis, PhaGeCom and CSB). “If there are expired products in the warehouse, the supervisor will take appropriate action to rectify the practice"

Nonprofit sector

Number of expired, obsolete, and surplus products at PSI central warehouse, PARC and Supply Point :

Product Expiry Surplus Obsolete

Warehouse 25,844 0 0

PARC 0 1,891 0

PA 0 7,880 835

Issues: For PARC and PA, surplus and obsolete mentioned in the summary above occurred in Quarter 1 and Quarter 2. This was addressed in Quarter 3 and Quarter 4. Thus, Supervision in Quarter 3 and Quarter 4 did not mention any surplus of products nor obsolete anymore. Resolution: Management of surplus of products at PARC and PA is now included in the scope of the SPD during the supervision visits as reported in Quarter 2, and continuously monitored. Remote supervision of PARC and PA was organized every 2 months to monitor health products management in order to prevent surplus and obsolete products.

Outstanding Issues: None Recommendations: As mentioned in point 3.1.1, training will be reinforced in Year 3 during onsite supervision and spot checks to prevent expired products.

Public sector

Number of expired, obsolete, and surplus products at Public sector :

Product Expiry Surplus Obsolete

Outstanding Issues:

139


RESOLUTION

SALAMA 0 0 0

Pha-G-Dis 46,175 37,465 0

Pha-Ge-Com 10,186 1,410 104

- Expired, obsolete and surplus commodities were detected at

Pha-G-Dis and Pha-Ge-Com visited. Issues: During the supervision visits, the RLA noticed expired malaria commodities (ACT, RDT, SP) in the Pha-G-Dis and Pha-Ge-Com. Resolution: Conduct training, mentoring and coaching activities to track and monitor stocks at the end of each month to identify risk of expiry and organize redistribution to avoid expiries

The stock status is not analyzed at the end of every month to detect the risk of expiration and plan for redistribution to other facilities in need. Recommendations: The established GAS committees in the 73 districts will strengthen the stock status analysis to detect risk of surplus/overstock. The district team will organize redeployment/redistribution as quick as possible - The district teams will take the

opportunity of monthly meetings with CSB to emphasize on the management of stock to avoid expiries

- The expired medicines should be destroyed quickly to avoid deterioration

3.1.3. Provide guidelines and appropriate communication tools on storage conditions for each product by following standard guidelines for Proper Storage and distribution of Health Commodities for PSI central warehouse, PARC, Supply Point and public sector (SALAMA/central warehousing, PhaGDis, PhaGeCom and CSB)

Nonprofit Sector

Number of PSI central warehouse, PARC, PA that have guidelines and communication tools:

Warehouse 10

PARC 71

PA 905

- 91% (10/11) warehouse visited was equipped with guidelines

and communication tools. - All the PARC and PA visited had guidelines and communication

tools in their storage rooms. Issues: None Resolution: None

Outstanding Issues: Due to travel restrictions, all warehouses were not equipped with guidelines and communication tools. Recommendations: Continue to share and update if needed guidelines and communication tools to all 15 warehouses During PARCs and PAs’ supervision, SPD will systematically ensure that the communication tools on storage conditions are displayed and visible.

Public Sector

Number of public sector that have guidelines and communication tools :

SALAMA 0

Pha-G-Dis 50

Outstanding Issues: Absence of copies of guidelines is still an issue. Recommendations:

140


RESOLUTION

CSB/Pha-Ge-Com 105

- - - 50 out of 73 Pha-G-Dis (68%) and only 105 out of 399 Pha-Ge-Com

(26%) in Year 2 had guidelines and appropriate communication tools on storage condition. Issues: Copies of communication tools lack at Pha-G-Dis and Pha-Ge-Com while they serve as reference document to comply with best storages conditions. Resolution: All the Pha-G-Dis have a laptop. The communication tools can be shared through email to get a reference documents with guidelines for proper storage of commodities

- The RLA will disseminate through email the communication tools and guidelines to Pha-G-Dis

- The RLA will print hard copies and disseminate it through supervision visits

- IMPACT is working with ACCESS to disseminate the tools at CSB level

3.1.4. Follow and share WHO guidelines for Safe Disposal of unwanted pharmaceuticals and enhance collaboration with MOH: - Collect and deliver expired pharmaceutical waste and plastic medical supply at Supply Points and warehouses and deliver them to the CSB/SSD for incinerating according to the National Medical Waste Management Policy issued in 2014

Number of reports on expired-pharmaceutical waste and plastic medical delivered to CSB/SSD for incinerating Result: This indicator has been added and will be monitored in Year-3 Issues: None Resolution: None

Outstanding Issues: None Recommendations: Closely monitor on the reporting of expired pharmaceuticals and organize collection by the SSD during the supervision visits.

3.1.5. Distribution of safety boxes to be used by the CHV and CSB at all Supply Points and CSB

Non stock‐out rate of safety box at CSB: 93% [ 76 CSB/Pha‐Ge‐Com among the 81 CSB/Pha‐Ge‐Com visited] IMPACT collaborated with MAHEFA-Miaraka to distribute safety boxes in CSB in this fiscal year. Issues: None Resolution: None

Outstanding Issues: None Recommendations: Collaborate with SSD and other technical partners to ensure distribution of safety boxes

3.1.6. Submit to Malaria SBCC working group all LLIN communication and training materials in line with the malaria national communication plan (2018-2022) to align with the malaria national strategic plan (NSP 2018-2022): job aids, training curricula, scope of work, and radio

Number of SBCC communication materials produced, including all materials produced by other partners. With the lead of the MOPH, IMPACT will organize a meeting with other partners to collect SBCC communication materials produced. That indicator has just been added. It will be addressed during Year 3, particularly for mass distribution activities.


141


RESOLUTION

messages to ensure proper disposal of LLIN bags is addressed.

Issues: None Resolution: None

3a (Activity type 3: Procurement and training [3.1]). Procurement or logistics support (distribution and transport) for healthcare commodities, diagnostic kits, PPE, and equipment for response to emerging threats

1) Procure health commodities that comply with host country and international regulatory, shipping, and packaging requirements to ensure that only appropriate products enter the supply system. This includes products that are manufactured at facilities that meet good manufacturing practice (GMP) certification requirements, as recommended by the WHO or are pre-qualified by WHO 2) Develop and implement an inspection and quality assurance process for assessing and monitoring product quality. Considerations include, but are not limited to: ●Selecting reliable and vetted suppliers: ●Using existing quality assurance mechanisms established by WHO ●Establishing a system to report poor quality, expired, or defective products; and ●Performing regular pre- and post-shipment testing. 3) Develop and implement SOPs for the safe distribution of health commodities being transported in bulk in motorized vehicles. 4) Develop and implement SOPs for the safe transport of samples and supplies being transported in bulk in motorized vehicles.

3a1a) Review of product specifications to ensure they meet host country and international regulatory, shipping, and packaging requirements. Result: All procured medical materials (thermometers) and healh products ( sur’eau) meet the country and international requirements Issues: None Resolution: None

Outstanding Issues: None Recommendations: Continue performing the review of product specifications for all upcoming ethical commodities during Year 2

3a1b) Maintain copies of procurement records (e.g., manufacturing records, Certificate of Analysis, test data, regulatory certificates, etc.) and copies of quality documentation on file. Result: A copy of all procurement records and quality documentation file were maintained for procurement performed during Year 2. Issues: None Resolution: None

Outstanding Issues: None Recommendations: Continue to maintain copies of quality documentation for the next fiscal years.

3a2) Verification of the development and implementation of the quality assurance process Result: Quality assurance process for procurement is part of the routine process. Pre- shipment testing is effective for locally purchased product for Sur’Eau liquid. Issues: None Resolution: None


3 and 4) Verification of the development of the SOP and comparison with the standard SOP developed by WHO/USAID Result: Training on safe transportation and distribution of health commodities has been performed at warehouse and PA/PARC levels following WHO/USAID recommendations.

Outstanding Issues: None Recommendations:

- Conduct regular trainings (on safe transportation and distribution of health commodities) to ensure effectiveness of the training

142


RESOLUTION

Tools (posters) on safe transportation of supplies have been created. The posters will be installed in all IMPACT motorized vehicles in October Year 3. Issues: None Resolution: None

- Ensure distribution of posters to all IMPACT vehicles

3b (Activity type 3: Procurement and training [3.2]). Training, capacity building, technical assistance of health workers responding to COVID-19

Activities will be conducted following guidelines and must comply with local, national, USAID, or its own organizational environmental policies.

3b) Site visits to verify that SOPs were implemented. Include dates of visits, findings, and any non-compliance issues. Result: The supervision activity was assigned to the MOPH. They have included the supervision with their regular supervision. Issues: In Year 2, some supervision were not performed due to the COVID-19 restriction related travel. The MOPH did not use supervision checklist during supervision activity. They used verbal approach to remind the staffs in case of non-compliance. Resolution: Some supervision will be conducted in October.

Outstanding Issues: No supervision checklist used during supervision visit Recommendations: Sensitize the use of supervision checklist during supervision. This tool will document the non-compliance and the recommendation.

4. Storage and distribution of LLIN

4.1. Insecticide quality and resistance

4.1.1.1. Use pre-approved WHOPES brands of LLINs to ensure the quality and efficacy of the LLINs purchased, that they contain effective pyrethroid levels.

Post-campaign 2018 Net durability study on DawaPlus® 2.0. results

of 12 months after distribution.

LLIN brand Bekily Farafangana Maintirano

No. of LLIN tested 30 30 22

KD (%) 58.3 62.6 65.14

Average mortality

rate (%) 45.9 43.3 50.8

KD: Knock Down

The bioassay analysis (one of the three

components of the Net durability study) of

the DawaPlus 2.0 net collected in August 2019

or 12 months after the mass distribution in

three districts (Bekily, Maintirano, and

Farafangana) provided the following results:

- The average knocks down was 62%, which

is under the WHO threshold of 95% for the

three districts studied.

- The average mortality rate was 47% which

is under the WHO threshold of 80%.

The final report for the net durability study

will be available in 2021 after the

implementation of the 36 months. These

143


RESOLUTION

results will be used as evidence for the

upcoming LLIN procurement of the mass

campaign distribution scheduled in 2021.

4.2. Storage of LLIN 4.2.1.1. Store LLINs in wooden pallets, dry, ventilated, and secure areas to prevent theft or unauthorized access.

Number of PSI warehouses that meet storage quality:

Level number

Central warehouse 6

PARC 71

6 among the 11 visited warehouses meet the storage quality for MID storage

Issues: Warehouses did not meet the storage quality because lack of tinted glass or curtain or lack of maintenance and servicing. Resolution: Warehouse workers were trained on storage norms to be respected and windows configuration did not allow direct sunlight of products,

A reminder of maintenance and servicing of facilities was sent to warehouse keepers.

Outstanding Issues: There are still 5 out of 11 warehouses visited that did not meet the quality storage. Recommendations: Reinforce message on storage quality during supervision visit

4.2.1.2 Post guard or use barred windows as needed

Number of PSI warehouses and field storage areas with post guard or barred windows :

Level Post Guard Barred Windows

Warehouses 11 4

PARC 6 0

All warehouses are post guarded and 4 among 11 had barred windows Issues: None Resolution: None

Outstanding Issues: None Recommendations: During Year 3, identify option to ensure protection of windows for non-compliant warehouses. Ensure during supervision visit of PARC that LLIN are continually secured.

4.2.1.3. Post visible warning signs on doors and windows in local language to alert people that pesticide products are stored inside

Number of PSI warehouses and field storage areas equipped with warning signs:

Level Having warning signs

Central warehouse 4

PARC 9

Only 4 warehouses among the total 11 visited have warning signs.

Outstanding Issues: Only 4 warehouses out of 5 evaluated for these criteria were equipped with warning signs due to the fact that LLINs were only stored in a few warehouses.

144


RESOLUTION

Issues: Warning signs were not installed because no LLINs stock were identified during visit for 7 warehouses. Resolution: A reminder of the necessity of warning sign installation was sent to all warehouses to ensure compliance to this requirement

Recommendations: Make sure the warning signs are put in place when LLINs are stored in the warehouse

4.2.1.4. Do not store LLINs with food, feed, or potable water supplies

The net durability conducted 12 months after the mass campaign in

2018 provided that 25% of households surveyed did not store food

and potable water in the room where they slept, which is

recommended for the use of LLIN (need to be far from food, potable

water).

Outstanding Issues: 75% of households stored food and potable water with the LLIN which is not recommended. Recommendations: All communication

channel such as mass media, printings, SMS,

IPC (Inter-personal communication) to be

used for the mass distribution campaign that

will happen in 2021 will include correct

storage and use of LLIN, which need to be

used/stored far from food and potable water.

4.2.2.1. Ensure provision of gloves and instruction on their use

Number of workers equipped with gloves and the instruction of their use (disaggregated by sex) Result: All Kom’Lay used gloves when manipulating the bulk and LLIN Issues: None Resolution: None


4.2.2.2. Provide worker training on the proper handling and display of LLINs. The training materials will include messages related to malaria prevention and proper use of LLINs using mass-media and interpersonal communication (by Mahefa-Miaraka and ACCESS) Curriculum will integrate messages on EC & CRM.

Number of workers trained on proper handling and display of LLINs (disaggregated by sex) Result: For cCD strategy, 13,936 LLIN management committee members are trained (9,325 M and 4,611 female). Issues: None Resolution: None


Percent of target group who know malaria prevention and proper use of LLIN.

Outstanding Issues: The proportion of target group who know malaria prevention/proper storage of LLIN is low (22%). Recommendations: The communication well include this indicator in the messages to be

145


RESOLUTION

Result: The malaria household survey designed for the market assessment provided that 22% of households know the malaria prevention/proper use of LLIN (sleeping under LLIN every day).

broadcasted during the mass campaign in 2021 and the cCD activity.

4.3. LLIN washing 4.3.1.1. Ensure that SBCC materials and outreach activities are coordinated with net distribution activities during campaigns, and include guidelines on how to properly wash and maintain LLINs (e.g., discourage disposal of wash water in sensitive ecosystems, discourage washing and rinsing LLINs in bodies of water)

Percent of net properly washed and maintained Result: The Net durability survey conducted 12-month post distribution provided the following results: - Nets properly washed (not used detergent or bleach for last

wash): 64,2%. - Nets not dried on bush or fence for last wash: 48,1% - Nets properly maintained (ever repaired): 39,2% Issues: None Resolution: None

Outstanding Issues: There is still a challenge on net washing and net care, that did not conform to the recommended methods. Recommendations: Communication activities on net washing and net care will be reinforced during the cCD activity and the mass campaign distribution scheduled in 2021.

4.4. Packaging 4.4.1.1. Ensure that SBCC messages inform campaign distributors and local communities about the potential harm to human health and the environment if bags and baling materials are reused and are in line with the malaria national communication plan (2018-2022)

Number of campaign distributors and community leaders trained on potential harm (disaggregated by sex): Result: For cCD strategy, 13 936 LLIN management committee members are trained (9,325 M and 4,611 W). Issues: None Resolution: None


4.4.1.2. Support the NMCP in the development of the national malaria communication plan 2018-2022) which will provide guidance, best practices for handling and disposing of bags and baling materials. Messages need to be adapted for literacy or education levels.

Number of communication tools (job aids, pamphlets) created and distributed on how to handle and dispose bags and baling materials (communication tools will include details of the disposal plan) Result: For cCD strategy (how to handle and dispose bags and baling materials including details of the disposal plan), 8,500 jobs aids are produced and distributed to community actors (CHV, Kom’Lay, CSB) Issues: None Resolution: None


Number of campaign distributors and community leaders trained on how to handle and dispose bags and baling materials (disaggregated by sex)

Outstanding Issues : None Recommendations : None

146


RESOLUTION

Result: For cCD strategy, 13 936 LLIN management committee members are trained (9,325 M and 4,611 W) Issues: None Resolution: None

4.4.1.3. Encourage the MOH and the RBM (Roll Back Malaria) committee to procure LLINs with bulk packaging. The project will coordinate with NMCP to create a waste management plan.

Minutes on decision of bulk packaging during RBM meeting Result: Technical specifications including bulk packaging validated by NMCP and RBM committee Issues: None Resolution: None


Waste management plan developed Result and issue:, We do not have waste management plan of LLIN developed for cCD. Resolution: For cCD, LLIN waste management was included in the training tool.

Outstanding Issues: None Recommendations: For 2021 mass campaign, the LLIN waste management plan will be developed.

4.5. Misuse of LLINs (nets used for non-public health purposes such as fishing)

4.5.1.1. If there is evidence of misuse of LLINs (from surveys such as Malaria Indicator Survey, Net durability study), assess the extent of misuse and collaborate with different ministries (Ministries of health, environment, agriculture) to develop locally relevant solutions, and proceed with implementation.

Based on net durability study conducted twelve months after the

mass campaign distribution, no net (0%) was used for other

purposes.

Issues: None Resolution: None

Outstanding Issues : None Recommendations: Continue communication activity on the main purpose of net use

4.6. Waste management

4.6.1.1. Ensure that the disposal of LLINs comply with the WHOPES & NMCP guidelines. If LLINs and packaging are collected, the option for disposal will be high-temperature incineration. If this is not possible, the other option will be burial, away from water sources.

Burial report stated the consideration of the following criteria: controlled access, soil with low permeability, away from residences, at least 100m away from any wells and surface water sources and at 1.5m above the water table. Result: 274 burial reports available from 06 districts in cCD areas Issues: None Resolution: None


147


RESOLUTION

Incineration report stating temperature of the incineration Result: not recommended at community level for cCD Issues: None Resolution: None


5. Climate Risk Management

5.1. Proper storage and transportation of commodities and LLIN

5.1.1.1. The storage and transportation of the commodities and LLIN should be : - away from humidity, - protected from evapotranspiration - in a high area to avoid damaged or

deterioration by flood, - stored in a robust building (made with

burnt brick, cement or modern materials) to avoid deterioration of the warehouse by cyclone and landslide,

- in area with temperature controlled, including transportation from central warehouse to the Pha-G-Dis, Pha-Ge-Com, and to the LLIN distribution sites

The storage and transportation meet the following criteria :

• Standard Storage:

- SS1: Dry and ventilated - SS2: High - SS3: Robust - SS4: Temperature controlled - SS5: Away from moisture - SS6: Heat - SS7: Direct sunlight

• Standard transportation conditions: - ST5: Away from moisture - ST6: Heat - ST7 : Direct sunlight

Nonprofit sector

Number of Warehouse meeting the criteria of storage and transportation of products:

Storage

Warehouse PARC PA

SS1 5 71 905

SS2 5 67 871

SS3 5 NA NA

SS4 5 20 212

SS5 5 NA NA

SS6 5 NA NA

SS7 5 NA NA

Transportation

Outstanding Issues: None Recommendations: The safety instructions given by the BNGRC and its representative need to be followed in case of flood and cyclone.

148


RESOLUTION

ST5 5 71 905

ST6 5 71 905

ST7 5 71 905

- Thermometers are available in chosen regions namely DIANA,

Menabe and Atsimo Andrefana that are with high temperature.

Issues: 4 PARC and 34 PA are located in low geographical area. Resolution: The 4 PARC and 34 PA located in low geographical area are recommended to follow the safety instructions given by the BNGRC and its representatives in case of flood/cyclone.

Public sector

Number of Public Sector meeting the criteria of storage and transportation of products:

Storage

SALAMA Pha-G-Dis Pha-Ge-

Com/CSB

SS1 0 70 203

SS2 0 71 197

SS3 0 70 203

SS4 0 17 30

SS5 0 NA 198

SS6 0 NA 191

SS7 0 NA 198

Transportation

ST5 0 NA 198

ST6 0 NA 191

ST7 0 NA 198

Issues: the temperature control is very weak Resolution: IMPACT procured thermometer for Pha-G-Dis to be donated in Year 3

Outstanding Issues: The Pha-G-Dis and PhaCeCom must meet all the criteria for appropriate storage conditions. Recommendations: - Donate the thermometers to Pha-G-Dis - Advocate to DPLMT, ACCESS, and other

partners to procure necessary equipment and renovation of Pha-G-Dis and Pha-Ge-Com.

Nonprofit

149


RESOLUTION

5.1.1.2. Organizing capacity building through technical workshops and training to enhance coordination and distribution of quality health products: among PSI central warehouse, PARC, Supply Point and public sector (SALAMA/central warehousing, PhaGDis, PhaGeCom and CSB), and those responsible for sending commodities and LLINs.

Number of persons from PSI central warehouse, PARC, PA:


Warehouse 9 4 13

PARC 21 70 71

PA 379 526 905

- 81% (9/11) warehouse were trained on distribution management of commodities - All employees at PARC, PA visited were trained on coordination and distribution of quality health products. Issues: None Resolution: None

Outstanding Issues: Due to COVID-19 travel restrictions, training was done remotely using virtual conference. Recommendations: Include in the training curricula the distribution management and coordination. Maintain virtual meeting if there is still restriction of travel due to COVID-19.

Public sector

Number persons from public sector trained :


SALAMA 0 0 0

Pha-G-Dis 31 37 68

CSB/Pha-Ge-Com 85 162 247

- - - 93% (62/73) of Pha-G-Dis providers and 48 % (215/399) Pha-Ge-

Com providers supervised in Year 2 were trained -

Issues: trainings of providers is necessary Resolution: trainings of Pha-Ge-Com providers are being organized jointly with ACCESS

Outstanding Issues: None Recommendations: - Coordination committees are set up at

district and regions to enhance coordination on stock management

- Quarterly stock status analysis are being held at district to analyze consumptions and distribution of commodities

5.1.2.1 Include messages to end-users to address improper storage of commodities and LLIN linked to climate risk management (CRM: flood, cyclone, landslide, evapotranspiration, humidity, and increased temperatures) in the communication campaigns using mass-media.

Number of communication materials or radio spots or TV with instructions on proper storage, of commodities and LLIN to avoid CRM issue. Result: Four (4) SMS broadcasted were sent to the PA, PARC, CHVs, and Pha-G-Dis on proper storage of commodities to avoid CRM issue. Issues: None Resolution: None


150


RESOLUTION

Percent of target group who know and respect the proper storage of commodities and LLINs to address CRM issue Result: 07% according the household survey malaria market assessment conducted by IMPACT in 2019 Issues: None Resolution: None


5.2. Activity Type 1 — Communication, outreach, planning.

(Rating risk: Low) 5.2.1.1 Not applicable for low risk activities. The project should be scheduled during dry season. Accepted risk and opportunities: An opportunity is to integrate climate and weather into support for disease surveillance, disease reporting, and information dissemination. An opportunity is to integrate how the environment and climate contribute to pandemics and infectious disease occurrence during trainings. An accepted risk is that infrastructure may be damaged by extreme weather events where trainings, research, IT, etc occur. The project should be included in national or regional contingency plan if any.

Percentage of communication activities scheduled planned for COVID-19 conducted during dry season Result: 100% all communication activities scheduled planned for COVID-19 was conducted during dry season (May-October) Issues: None Resolution: None


5.3. Activity Type 1 — Support to healthcare facilities and systems

(Rating risk: Moderate) 5.3.1.1 Programs that address climate and weather sensitive diseases should consider conducting surveillance on the periphery of disease ranges, or where diseases are likely to spread due to change in weather or climate.

COVID-19 supports have been reviewed and organized in accordance with the evolution of the number of cases in the regions: Results: - Monthly donation for July and August was grouped in one

month either July or August for the 13 regions due to the increase of cases.


151


RESOLUTION

If COVID-19 is being directly considered, then revisit at a later date when we know how the spread of COVID-19 is, or isn’t, affected by weather and climate.

- Additional request was received from DRSP in terms of quantity

and type of items: trash bin, trash bag rolls, surgical gloves,

increased quantity on virucide, hydroalcoholic gels, and

disinfectant products.

- Three treatment COVID-19 centers closed in September in

Atsinanana, procurement of medical equipment (personal

weighing machine and blood pressure monitor) were cancelled

and replaced by supplies destined to SDSP.

- Only 1 vehicle was used due to decrease cases in Atsinanana in

September.

- Increased transport of covid-19 expendable equipment and

supplies including PCR specimen since June in all regions.

Issues:

- Delay on delivery from suppliers

- Verbal demand from DRSP due to emergency situation

Resolution:

- Procurement organized by regional team

- Officialize demand from DRSP.

(Rating risk: Moderate) 5.3.2.1 If construction is included that requires a design team or engineer, then construction activities should consider climate risks during the design phase and be approved by relevant design engineers or firms. The equipment and infrastructure in this activity should not be exposed to climate risks (landslides, floods) and should also be resilient to evapotranspiration, cyclones, dust / sand infiltration, to corrosion). A water tank system and a temperature stabilization system for logistics products and equipment should be considered.

This activity did not happen during the implementation of the COVID-19 program under IMPACT.

Outstanding Issues: None Recommendations: None Activity of equipment and infrastructure’s construction is not included on COVID-19 support under IMPACT

152


RESOLUTION

Accepted risk and opportunities: While potentially likely in some areas, supply chain disruption, and supply demand increase, due to extreme climate and weather events is an accepted risk in many instances. Delivery and logistic teams should consider climate and weather as best as possible as highlighted in previous columns.

5.4. Activity Type 3 — Procurement, training

(Rating risk: Low) 5.4.1.1 Not applicable for low risk activities... Accepted risk and opportunities: While potentially likely in some areas, supply chain disruption, and supply demand increase, due to extreme climate and weather events may be an accepted risk in some instances. Delivery and logistic teams should consider climate and weather as best as possible as highlighted in previous columns.

Number of supply chain disrupted due to extreme climate change and weather events. Result: during Year 2, all PA and PARC could arrange themselves to supply commodities before the extreme rainy season by constituting “Stock Asara” which is stock during heavy rainy season, so no disruption was noticed except stock out due to unavailability of products at central and regional warehouses of PSI Issues: None Resolution: None


153

Photos illustrating COVID-19 preventive measures during trainings

Use of protective masks during training, Ambilobe Handwashing device at the entrance of

training venue, Ambanja

Participants distancing during Community-based Continuous Distribution (cCd) Training of Trainers in Mahanoro

154

ANNEX D - SUCCESS STORIES Quarter 1:

Collaboration between the three sectors in developing a Total Market Approach Roadmap with the

aim to Improve Availability of Health Commodities

The Malagasy health sector contains a wide array of products with varying price ranges and outlets where they are

offered. The public sector, private sector, and NGOs all provide products with specific price points for the Malagasy

population. However, despite the variety available in the provision of health commodities, the health market is still

hindered by recurrent shortages, frequent failures to meet quality requirements for health commodities, and a chronic

lack of coordination in the health sector.

To address these issues, the IMPACT program is

working to bring all of the actors in the health sector

together in order to improve the availability and

accessibility of quality health products for the

Malagasy population in the next four years.

Throughout Year 1 of the IMPACT program, three

workshops were organized to bring together the

different health actors in Madagascar, including the

public sector, the private sector, non-governmental

organizations, associations, and technical and

financial partners. During the first workshop on July

16th, 2019, participants included representatives

from donors (USAID, UNFPA, EU), executives from

the private sector, representatives from health-related NGOs, and representatives from learning societies and

associations, under the leadership of the Government of Madagascar through the Secretary General of Ministry of Public

Health. Together, they formed the Total Market Approach Technical Working Group (TMA TWG) which has around 100

members, stewarded by three TMA Champions who are high-level individuals from the Ministry of Health. The workshop

had the objective of bringing together a variety of actors from different sectors so that they can identify and agree on

the three main issues encountered in the health sector. After conducting an analysis in groups, the TMA TWG selected

the following as the main issues: (i) the lack of communication around the national pharmaceutical policy, (ii) the

availability and quality of data and (iii) the application of regulatory texts.

During the second workshop, representatives from the TMA TWG proposed solutions to address the three issues

identified by breaking up into three different groups related to each issue. The TMA TWG came up with a draft solution,

which was then detailed into specific action items. Together, the solutions found for each issue, and the specific action

item for each solution will be developed further to form the roadmap and the operational plan.

These workshops, as well as the establishment of the TMA TWG are considered unique and valuable opportunities in a

country where each sector has always worked separately to address the same market. The roadmap and its action plan

are stronger since they have taken into consideration the expectations of each sector. The process has been greatly

beneficial since it has encouraged the involvement and engagement of the members of the TWG and they have been

consistently present and have actively taken part throughout the process, especially executives and decision-makers

from the private sector. Moreover, the members from the private sector have volunteered to co-lead each activity with

the Champions from the public sector.

Participants during the second workshop working on the Total Market Approach Roadmap

155

Public and private sector work together to support health commodities supply chain in Madagascar

Drug shops are a crucial part of the health commodities supply chain in Madagascar. Well-functioning drug shops can

help ensure reliable availability of pharmaceuticals, especially in rural and remote areas. To provide needed support to

drug shops, this year IMPACT and the Ministry of Public

Health (MOPH) have launched a public-private program in

five regions (Antsinanana, Boeny, Diana, Melaky, and

Menabe). The program aims to improve drug shops’

understanding of legal and regulatory requirements for their

activities and to strengthen their business management

capacity.

The first drug shop program was held in Toamasina on

November 13 and 14, 2019, and was considered a great

success by everyone involved. The program started with a

half-day information session conducted by the MOPH’s

Direction de la Pharmacie, des Laboratoires et de la

Médecine Traditionnelle (DPLMT), followed by an optional

one-and-a-half-day business training by the IMPACT

Access to Finance (A2F) team. All drug shops in the

Antsinanana region were invited to attend DPLMT’s

information session, but participation in the business training was voluntary, based on self-selection. In order to

encourage self-reliance and program sustainability, IMPACT is not paying per diems or transportation costs to drug shops

attending the business training.

The DPLMT information session was designed around the following objectives:

- to raise the awareness of drug shop owners on laws and regulations pertaining to their profession;

- to update the database of drug shops in the region;

- to renew licenses for drug shops that have been operating for over ten years;

- to encourage drug shop representatives to create a regional association to liaise with DPLMT; and

- to allow drug shops to meet and interact directly with MOPH central staff.

The IMPACT A2F team created a simplified curriculum for the 1.5-day business and financial management training,

considering the educational level of drug shops managers (IMPACT surveys found that 58% have less than a high school

diploma). The business training curriculum includes four modules: (i) Business financial and operational diagnostic, (ii)

Regulatory compliance and drug usage, (iii) Inventory management, and (iv) Financial book-keeping.

Public Sector Engagement - Information Session

The IMPACT team worked closely with DPLMT central and regional staff to prepare and organize the half-day session. It

was attended by representatives from 43 drug shops (21 women, 22 men) out of 71 existing in the five districts of the

Antsinanana region (61% participation rate).

Private Sector Engagement – Business Training

IMPACT also collaborated with a range of different stakeholders from the private health commodities sector for the drug

shop program.

Engagement of drug shops: A total of 27 representatives (12 female and 15 male) from drug shops in all the districts in

the Antsinanana region attended the training. The training’s objective was to strengthen the business capacity of drug

shop owners and managers, providing practical exercises and simple management tools in stock management and book-

keeping. The DPLMT also contributed to the training by providing guidance and advice to participants during the sessions.

Opening remarks during the information session: (left to right)

Dr Raymond RAKOTOARIMANANA (DRSP), Dr Nicole

MAHAVANY (DPLMT), Herinjaka Rahamalivony (IMPACT)

156

Patrick JEREMY, a drug shop owner from Antsampanana, said, “This was the first time I learned about the proper, safe

procedures for disposing of expired drugs! Previously, I just threw them in the garbage.”

Engagement of Pharmaceutical Wholesalers: IMPACT negotiated with COFARMA, a pharmaceutical wholesaler and a

member of the Plateforme Humanitaire du Secteur Privé (PHSP), to co-finance half of the cost of the business training for

the drug shops (venue rental, lunch and refreshments for participants). This demonstrates COFARMA’s commitment to

serving rural communities and gives the company the opportunity to reach out to new clients and markets. The CEO said

that COFARMA is committed to partnering with IMPACT and the MOPH to support the drug shop program in other

regions.

Engagement of USAID partner banks: The two partner banks,

AccèsBanque Madagascar and Baobab Banque Madagascar,

each had 30 minutes to present their financial services and

products to the drug shops during the training session. This

was to let drug shops know that they are eligible to apply for

loans from these two banks. This financing could support the

growth of drug shops and help them expand the availability of

quality health commodities in their communities. Both banks

appreciated these sessions as an opportunity to develop a new

customer base in more remote areas

At the end of the information session and the business

training, the participants expressed their thanks to IMPACT. Lanto from Mahanoro said, “I really appreciated and valued

this comprehensive two-day program. We had chance to interact with the ministry representatives and got updated

information on our profession. IMPACT gave us the opportunity to meet with wholesalers and banks but also provided

us the tools to manage our business.” With the combined strength of public and private sector support, IMPACT and the

DPLMT can help drug shops work better and improve the health commodities supply chain throughout Madagascar.

Accurate commodity forecasting helps

Brickaville to be prepared for a malaria outbreak

Late in the afternoon, Isaac is still in his office focused on

his computer. He is uploading the monthly product

consumption and orders data into the software Channel to

send to the central Ministry of Health. Every month, this

activity is one of his priorities. “Sending our logistic data on

time means that we will receive our commodities on time

so that health facilities needs are met,” he says.

In the district pharmacy of Brickaville, Isaac has served as

stock manager for five years. As Madagascar enters the

high peak transmission period, the district is getting

prepared to face an outbreak of malaria. “It is very

important to have enough stock of malaria products to

avoid any product shortages. In the district of Brickaville malaria is still a public health issue, especially after the passage

of cyclones, which cause flooding and allow for the reproduction of mosquitos. Last year, malaria claimed the lives of

four children in the district of Brickaville. Isaac and his colleagues are striving to avoid any fatalities this year.

Patrick JEREMY, the owner of a drug shop in

Antsampanana

Razafitrimo Isaac, District stock manager of Brickaville showing

proudly the calculation formula to estimate commodity needs,

displayed in the pharmacy wall

Photo: IMPACT

157

In April 2019, Isaac received on-the-job training provided by IMPACT on how to correctly estimate commodity needs,

especially for malaria commodities since the consumption needs evolve according to the season. “Before this training,

our calculations were based on consumption data sent by health facilities and we frequently experienced stockouts. After

the training, we learned that we need to consider the consumption data during malaria high transmission periods to have

the right quantity to order. Accurate quantification of needs is very important to avoid overstock or stock outs.” Isaac is

confident that malaria will be controlled in the district this year. From October to December 2019, the district of

Brickaville has not experienced any stockout of malaria commodities and after calculation of their accurate needs for the

period, they could even redeploy malaria commodities to the neighboring districts. The district pharmacy of Brickaville is

reporting complete and on-time data (100%) and the district is among the most high-performing in terms of data

reporting.

PA efforts help maintain enough stock of FP products

to supply CHVs in rural communities of Brickaville

Harimalala Sandrine lives in the village of Ambodivonta, a rural

community about 10 kilometers from Vatomandry. She is 20

years old and a mother of a 10-month-old baby girl. With her

husband, Sandrine is running a commerce of local products.

Today, Sandrine woke up early to get her DepoProvera shot at

BAO Euphrasie’s house, who is a Community Health Volunteer

(CHV) in the village. “My husband and I wanted to space the birth

of our children; I chose DepoProvera because it prevents me from

the hassle of using a daily birth control method like the pill.” Just

after giving birth to her baby, Sandrine started the contraceptive

by injection. “DepoProvera is highly effective and accessible. We

are very lucky to have it available at community health volunteers,

so we do not need to walk long distances to health facilities in

town,” she says.

IMPACT, through the distribution of social marketing products,

ensures the continuous supply of a large range of Family Planning

products at the community level so that CHVs like BAO Euphrasie

are able to meet the needs of women in their communities.

“Thanks to the continuous availability of family planning products at the supply points, we have rarely experienced

shortages. As a result, I was always able to serve women coming for contraception,” said BAO Euphrasie.

“Accessing birth control allows me to expand our livelihood and make savings. Moreover, I can devote time to my

daughter and appreciate every step of her childhood,” says Sandrine.

Sur’Eau Pilina save lives in remote communities of

Brickaville

Philomène is living in the village of Ambohimanarivo, a village of

about 548 households. The mother of four children, she has

served as a Community Health Volunteer (CHV) for more than ten

years. Philomène’s role as a CHV consists of sensitizing and

mobilizing people in all health-related initiatives and providing the

first level of care to people in her remote village far from health

facilities.

One afternoon, Philomène and other villagers are assisting in the

monthly public sensitization conducted by the IMPACT team in her

Harimalala Sandrine, beneficiary of family planning in the village of Ambodivonta, Vatomandry

Photo: IMPACT

BAO Euphrasie, CHV preparing DepoProvera injection Photo: IMPACT

Soazara Philomène, Community Health Volunteer, Ambohimanarivo, Brickaville

Photo: IMPACT

158

village. As the mobile sound system begins to play, people come out slowly from their houses and gather in the large

yard of the village to listen to what is being said. That day, the IMPACT communication team came to sensitize the village

on the use of the water treatment pill “Sur’Eau Pilina” and organize a flash sale of the product.

“In our village, unsafe drinking water is one of the leading causes of disease,” says Philomène. “In the village, there is no

drinking water, so women and children travel long distances to fetch water from the river. After fever, diarrhea is the

second reason for consultation and it can cause death, especially for children under five,” she says. As a CHV, Philomène

encourages people to use Sur’Eau to avoid the use of

contaminated water. “Sur’Eau Pilina is a fast and

cost-effective method of treating household drinking

water. Thanks to this product, people have access to

drinking water even in areas with no running water

infrastructure like in our village,” she adds.

Cases of diarrhea decreased considerably in the

village as the sale of Sur’Eau increased. “Access to

safe drinking water reduced diarrhea especially for

children under five. Before, I received about eight

patients a day due to diarrhea. Now, only one or two

cases are recorded,” says Philomène.

IMPACT, through its social marketing products, make

sure that CHVs like Philomène are continuously

supplied with essential life-saving products like

Sur’Eau.

Strengthening organizational capacity of Pha-G-Dis in MENABE, ATSIMO ANDREFANA, and BOENY

Regions

The organization of Pha-G-Dis (Pharmacie de Gros du district) is critical for ensuring efficient and effective supply chain

management--pharmacy store rooms must be well organized so that commodities can be well tracked, inventoried,

allocated, and distributed correctly to health facilities within the district, and so that expiration dates can be monitored.

An overcrowded and disorganized pharmacy makes it difficult for pharmacy managers to know when certain

commodities are out of stock, overstocked, or expired.

For example, the Manja district pharmacy (Pha-G-Dis) in Menabe was built according to standards with two storerooms.

Due to the remoteness of this district, SALAMA makes deliveries to this pharmacy only twice a year--as opposed to four

times a year, as is the case in most other districts--which means that these deliveries are twice as large as normal, and

therefore require significant storage space. However, during the renovation of the Manja district referral hospital (CHRD)

in 2009, one of the storage rooms in the pharmacy was used to store CHRD supplies and commodities. Reducing the Pha-

G-Dis storage space from two rooms to one led to overcrowding and disorganization of products. This temporary situation

was only supposed to last the length of the renovation but has been continuing for ten years. As a result, IMPACT took

the lead and organized a supply and stock management (GAS) committee meeting to identify and discuss solutions to

the situation. Consequently, the team identified storage space in the CHRD and facilitated the transfer of products from

the Pha-G-Dis to the CHRD, creating necessary additional storage space in the Pha-G-Dis. The Manja Pha-G-Dis now has

enough room to receive, store, and organize large quantities of commodities delivered twice a year by SALAMA.

In Atsimo Andrefana, similar problems were identified surrounding inadequate storage standards, inefficient file

management, and unavailability of commodities. IMPACT worked with MOPH regional and district teams to discuss

solutions to these issues surrounding access to essential medicines, particularly focusing on the Pha-G-Dis in Toliara,

Ankazoabo, Beroroha, Ampanihy, and Morombe. Teams worked to clean and organize each district pharmacy room to

effectively monitor malaria, family planning, maternal, and child health commodities to make sure they were being

inventoried, tracked, and dispensed properly. Furthermore, in the Beroroha district, IMPACT engaged the GAS committee

IMPACT communication team doing a sensitization on the use of Sur'Eau Pilina in the village of Ambohimanarivo

Photo: IMPACT

159

to address proper management of health inputs, including ensuring that supplies are routinely distributed to remote

health centers and that overstocked commodities are redistributed to other districts in need.

In addition, a district pharmacy in Boeny had large quantities of expired products and a hole in the ceiling that leaked

during the rainy season. IMPACT worked with the MOPH to complete an inventory of each product in the pharmacy, and

then proceeded to repair the hole in the ceiling and to organize the store to streamline operational efficiencies.

These efforts by the IMPACT team alongside regional and district MOPH teams have contributed to the improved

functioning of Madagascar’s public sector supply chain. Once essential medicines and other commodities reach district

pharmacies, the pharmacies now have the capacity to manage and organize all the inputs to ensure a) proper storage

according to standards, and b) distribution to health facilities according to need.

Electrification of a Pha-G-Dis in Haute Matsiatra

The Vohibato/Isandra district pharmacy (Pha-G-Dis) in Haute Matsiatra was experiencing challenges in the cold storage

of certain essential medicines, including oxytocin, because this Pha-G-Dis was not equipped with a refrigerator. The

MOPH procured a refrigerator for this Pha-G-Dis,

however, this would only resolve part of the

problem, because the Pha-G-Dis did not have

electricity to power the refrigerator. Consequently,

IMPACT regional logistics advisor in Haute Matsiatra

negotiated with a private sector company to help

bring electricity to the pharmacy. The private sector

company covered the installation of equipment and

labor to electrify the pharmacy. As a result, the Pha-

G-Dis now has a functioning refrigerator, which

means that heat-sensitive medicines can now be

properly stored and safely used.

Quarter 2:

Vohipeno district : Coaching Pha-G-Dis service providers increases data reporting rate from health

facilities

Twenty-seven-year-old Sandra Raharimalala works as a service provider at the District Pharmacy (Pha-G-Dis) of Vohipeno.

During the annual malaria peak season from October to January, the

Pha-G-Dis play an important role in supplying health facilities and

community health volunteers (CHVs) with health commodities to

treat malaria .

Sandra

received

training

and

continuous coaching from the IMPACT project on commodity

and inventory management. During these trainings, Sandra

learned that obtaining accurate, complete, and timely

logistics data from the health facilities is very important for

her to be able to supply them correctly. Consequently, Malaria commodities at the Pha-G-Dis in Vohipeno

Photo : IMPACT

RAHARIMALALA Sandra, service provider, District Pharmacy (Pha-G-Dis) of Vohipeno.

Photo : IMPACT

160

Sandra has taken the initiative to call health facilities herself every month so that they submit their reports. "Without

health facilities consumption and order reports, I cannot calculate the correct and sufficient quantity of health supplies

we need, which is the reason why I am trying to remind them on a specific date so that it becomes a habit for them,"

says Sandra. Her perseverance and devotion to her work paid off. In March 2019, only 17% of health facilities sent

complete and on-time reports, but by January 2020 this rate increased to 96% (RMA Report, Vohipeno) which enabled

her to have the right information to order health supplies at the central level. Thanks to her efforts and advices from

IMPACT, the Pha-G-Dis was able to maintain enough stock (three to six months stock) of antimalarials, including Rapid

Diagnosis Tests (RDTs), Artemisinin Combination Therapy (ACT), and Injectable Artesunate during the period of high

malaria transmission. “Having enough stock enabled us to face the outbreak. When products are available, patients can

get the right treatments,” she said.

IMPACT provides continuous support to the Vohipeno MOPH team to ensure that health supplies are available at all

levels of the supply chain.

161

Sakoana: a model health facility that has never experienced stock-out of antimalarials due to

careful adherence to guidance of stock management

Sakoana is a rural commune located ten kilometers from

Manakara. In this municipality, malaria remains a public health

issue and still claims many lives every year, especially during the

malaria peak period. From November 2019 to February 2020, the

local health facility received an average of 195 weekly

consultations, 63% of which were confirmed malaria cases

according to the Rapid Diagnostic Tests (RDTs) administered.

Randriamamonjy Fidèle is the head of the health facility (CSB) of

Sakoana. Known for his devotion and passion for his work, Fidèle

is committed to serving his community.

Despite the increased of the number of malaria cases during the

period of high malaria transmission, the health facility has never

experienced stock-out and has even been able to treat cases from

other health facilities that were experiencing stock-out. "We are

trying to carefully follow the guidelines by correctly calculating our needs, sending our reports on time, managing

medicines well at the community pharmacy level (PhaGeCom), and following good storage practices. Except in the case

of shortage or insufficient of products from the central level,

the CSB of Sakoana has never experienced stock shortages

in RDTs and anti-malarial, ” explains Fidèle.

Thanks to the leadership and dedication of Fidèle, 100% of

patients that tested positive for malaria were properly cared

from November 2019 to February 2020.

The IMPACT project supports health facilities like Sakoana in

the improving the availability of health commodities through

periodic supportive supervision visits and supporting

commodity transportation in case of emergency.

Mananjary: IMPACT and ACCESS join efforts to improve

the availability of malaria products in remote rural to

help save lives

Eight-year-old Sergio lives in the rural village of Ambohimiarina in

the southeastern district of Mananjary with his family.

One day very early in the morning he went with his father to the

Community Health Volunteer (CHV) of the village for a medical

consultation as he felt his symptoms worsening.

As a CHV, Randrianasolo is a trusted member of the community.

Sergio had a high temperature and was tested with Rapid Diagnostic

Test (RDT), which came back positive for malaria.

FRandriamamonjy Fidèle, Head of Sakoana CSB, Manakara health district

Photo : IMPACT

Randriamahazomanana Serge, Regional Logistic Advisor, Vatovavy Fitovinany region during supportive supervision in

Sakoana Photo : IMPACT

Randrianasolo and Sergio using RDT Photo: IMPACT

162

Sergio was very lucky as he could be tested and treated with Artemisinin Combination Therapy (ACT) rapidly without

having to reach the health facility, which is a five kilometer walk away. “We are delighted to have malaria products

available so that we can test people on the spot and treat them rapidly,” said Randrianasolo. In remote villages like

Ambohimiarina, the distance of health facilities encourages people to go to traditional healers, which may lead to death

due to delay in getting the right treatment.”

In order to address such challenges, the USAID-funded projects IMPACT and ACCESS have set up a collaboration

agreement to support the Ministry of Public Health in improving the availability of medicines and health products up to

the last mile, including in very rural villages. While the IMPACT project ensures the availability of products at the district

level and provides coaching to regional and district MOPH staff, ACCESS follows up on IMPACT’s recommendations at

health facilities and works with the CHVs who are present at

the community level. “IMPACT and ACCESS interventions are

very complementary. Before, the needs of the CHVs were not

considered in orders sent to districts. After the

implementation of this collaboration, they are gathered with

those of the health facilities and the latter are supplied

correctly,” says Freddy Alphonse, Community Health Assistant

of ACCESS project, based in Mananjary.

Freddy works in 5 out of the 31 communes of Mananjary, 90%

of which are in remote areas. As a result of the IMPACT and

ACCESS collaboration, the 78 CHVs within the five communes

are correctly supplied with antimalarials and other essential

products for family planning and maternal, newborn, and child

health.

Maroantsetra: Devotion of Point d’Approvisionnement Relais Communautaire (PARC) manager

and support from IMPACT helps prevent stockouts of family planning and maternal and child

health supplies

The district of Maroantsetra is only accessible during three months of the year, making transportation of health products

to this district very difficult.

Rasoanilova Juliette owns a clothing shop in Maroantsetra.

Since June 2019, Juliette has been volunteering in holding the

Point d’Approvisionnement Relais Communautaire (PARC) in

Maroantsetra district. The PARC supplies 20 community-

based Point d’Approvisionnement (PAs) with health products

for family planning and maternal, newborn and child health.

Even though Juliette is a volunteer, her commitment to serve

her community is very remarkable. Juliette takes the initiative

to pick up the products at the port of Maroantsetra so that

essential health products are available in her community. PSI

does not have an office or staff in Maroantsetra, so Juliette is

the one who takes care of the reception of the products at the

port and the transport to her home, which serves as a

warehouse. Juliette is very involved and serious in carrying out her work as a PARC despite her other occupations.

Juliette’s capacity has been enhanced by technical training and advice from the IMPACT team during supervision visits.

Thanks to the quality of her work and the IMPACT supervision, there was no product stock-out and products are always

available to meet the needs of the district, except Sayana Press, which is also in shortage at the national level. "Thanks

Rasoanilova Juliette, Community Relay Supply Point (PARC) in Maroantsetra district

Photo: IMPACT

IMPACT and ACCESS team in Mananjary

163

to IMPACT, I can help my community. I was able to acquire knowledge, particularly in the management of stocks, and I

can apply it in my own business as well," she said.

IMPACT supports the availability of essential commodities and health products in the Maroantsetra region by training on

stock management and capacity building of the PARC during each supervision.

Joffre Ville: Collaboration among IMPACT Point

d’Approvisionnement (PA), Mahefa Miaraka, and health

facilities to help satisfy family planning needs

Thirty-year-old Angelette Herimalala, mother of four, lives in the

commune of Joffre Ville in the district of Antsiranana II, Diana region.

Together with her husband, they earn their livelihood from farming. In

addition, she is also the manager of the community-based Point

d’Approvisionnement (PA) in the commune.

As a volunteer, she has stood out among the other PA managers in the

region through the quality of her work, including storage standards,

proper use of management tools, reporting, availability of products, and

her relationship with other stakeholders in her community.

Since 2018, Angelette has ensured the availability of health products

in her community. Six Community Health Volunteers (CHVs) from

three villages (Fokontany) in the commune regularly come to buy

products from her supply point. Monthly, she participates in the

meeting of CHVs at the health facility (CSB) in the Joffre Ville commune

to share information with the CHVs, the CSB head, and the USAID-

funded Mahefa Miaraka team.

“The collaboration between CHVs, the CSB head, and the PAs of the

Joffre Ville commune is very good. There has never been shortages of

products and the CHVs are satisfied in the purchase of the products

and collaboration with PAs because their orders are honored

especially for family planning products. Every month, Angelette

participates in the meeting of the CHVs and CSB and during this

meeting she shares the situation of available products and collects the orders of the CHVs,” said Ginet SOLOZANDRY,

District Coordinator of Mahefa Miaraka.

Clementine, a CHV in the village of Morafeno, also confirms Angelette’s devotion to her work. “Since Angelette is

responsible for PAs our orders are always satisfied and in line with the number of regular users for family planning, as

well as for maternal and child health products. She is always available when we go to her place to buy the products. My

customers are also satisfied because I have always enough stock,” she said.

While population supply needs vary according to the season, all health products are still available at the supply point

level. As a result, orders from CHVs are always satisfied, whether for family planning products or supplies for child health

(treatments for diarrhea, pneumonia, etc.). The head of the CSB, Razanamalala Volatiana, appreciates IMPACT’s support

in supplying the commune with low cost products. “With IMPACT’s support, the 681 children under five in the commune

are protected and correctly treated for diseases and women are protected from unintended pregnancies,” she said.

According to Angelette, the capacity building she received has enabled her to acquire new knowledge that she can apply

in her daily life, such as financial management which helps her improve her income.

HERIMALALA Angelette and her family Photo: IMPACT

HERIMALALA Angelette, PA of Joffre Ville Photo: IMPACT

164

Applying the Training: Lessons Learned from Financial and Operational Management Training

The USAID-funded IMPACT Program partnered with

the Government of Madagascar’s Ministry of Public

Health (MoPH) to engage the private sector in order to

strengthen the health supply chain system and serve

new health markets. Drug Shops, especially those in

remote areas, are a crucial link in the health supply

chain in Madagascar, albeit a somewhat forgotten and

unregulated one. Officially, the number of drug shops

in Madagascar is 1,600, but the national president of

the Association of Drug Depots of Madagascar (ADDM)

claims that there are more than 3,000 drug shops in

operation. These illicit drug shops can pose a threat to

the health of the Malagasy population for several

reasons: 1) Illicit drug shops may not report the data

of their stock and sales to national systems like DHIS2.

The low rate of reporting makes it difficult to quantify

the essential medicine that a territory or region may

need. 2) Illicit drug shops may not always be compliant with authorized practices or sale activities. 3) Illicit drug shops

may not be connected with official drug wholesalers and therefore may purchase products from unlicensed drug

dispatchers. 4) Illicit drug shops may not store medicine correctly as they have not taken the internship required for

licensed drug shops. Overall, drug shops which are not operating with the proper MoPH license have more difficulties in

selling health commodities in a safe and professional manner, leading to inefficiencies in ensuring the supply of quality

medications for the population.

To remedy this, the IMPACT Access to Finance (A2F) team has worked with the MoPH to provide half-day information

sessions for drug shop owners on the laws and regulations governing drug shop licensure. These sessions are followed

by optional training to strengthen capacity in financial and operational management of one’s shop. Trainings in the

Atsinanana and the Boeny regions have already been carried out in November 2019 and February 2020 respectively.

Following the training, the IMPACT A2F team provides coaching for owners wishing to benefit from a deeper

understanding and more tailored approach for the management of their shop. So far, the A2F team has coached five drug

shop owners, teaching them the management method and tools that should be used by the all drug shops and how to

adapt and integrate these methods and tools to their shops.

Mr. Jeremy Patrick, an owner of a drug shop in Toamasina (Atsinanana region), talked about his experience after using

the tools for a month and a half following his

training/coaching: "Before, I only used a registry where

everything was intertwined and not systematic. After the

training I wanted to apply the tools, and they have allowed

me to understand the financial situation of my shop.” Thanks

to the training, Mr. Patrick told the IMPACT Team that he was

seeing:

1. A significant reduction in debtors: By keeping a

debtor book, he has recorded and been able to

follow up with people when repayment is due.

2. Improved inventory management: Each product is

inventoried appropriately and considers the

standard requirements for storage, inventory, sale,

and purchase.

3. Better records and clearer understanding of his shop’s profitability using a daily operations journal.

The IMPACT A2F Team facilitates a financial and operational management training for drug shops in Mahajanga.

Jeremy Patrick in his drug shop in Antsampanana / Brickaville - Atsinanana Region.

165

Now that Patrick is convinced of the importance and relevance of management tools, he is starting to realize that running

a drug shop is not a one-man job. For a drug shop to be most successful, there should be one person who provides

financial and administrative management and another person whose focus is on dispensing medicine and building

customer relations. Unfortunately, because he could not both manage finances and customers, Mr. Patrick was forced

to return his main focus to the sale and dispensation of drugs for the foreseeable future.

Even though Patrick has not succeeded in maintaining everything he learned in training, he has provided some crucial

lessons that can be adapted for future implementation by IMPACT. One lesson learned from recent participants is that it

may not be feasible for a single person to run both the financial and dispensary portions of their drug shop business.

However, due to the Ministerial Decree N° 11092/2016, it may not be possible for drug shops to obtain that needed

support. The decree stipulates: "The owner is obliged to manage the drug shop for which he/she received authorization

under the penalty of permanent closure and the repeal authorizing the drug shop.”9 This decree means that for drug

shops to truly improve their management and in that way improve the pharmaceutical supply chain in their area, it may

be required for IMPACT and the Government of Madagascar to collaborate on how to revise this portion of the decree.

Overall, the lessons drawn from Patrick’s experience are:

- (i) With support from IMPACT, the government of Madagascar should find a way to implement a program similar

to that of the Accredited Drug Dispensing Outlets (ADDOs) Program in Tanzania, which recommends that a drug

shop should be managed by two people: the manager (often the owner) and the provider. Also, each staff of

the drug shop should participate in a training linked to his/her role within the drug shop

- (ii) The IMPACT Program should create computer/tablet tool for drug shop management adapted to the general

level of education and field conditions of drug shops to ensure its professionalization and the systematic

collection of data from the private sector. This data would lead to the national quantification of essential

medicines.

Tapping into innovation for family planning: applying drone technology to bring contraceptives to

remote Communities in Madagascar

Although more women in Madagascar are using modern contraceptives than ever before, their use has hovered at

approximately 35 percent. Certainly, modest improvements in addressing the unmet needs of contraceptive use have

been hailed across the country. But for women and girls living in remote communities of the country, it is a different

story. Women and girls suffer from a double burden given the limitations posed by their physical locations, as well as the

interruptions posed to supply chains. The need for improving access to family planning in rural communities presents the

greatest challenges; and in turn, warrant innovative strategies to help expand access in remote areas. In response, the

USAID IMPACT Project has begun to explore the use of drone technology to deliver family planning resources to respond

to this very issue.

In October 2019, the IMPACT project began exploring how drone technology could be used to improve access to essential

drugs to communities in need. By rolling out drone technology, the IMPACT project has been successful in maximizing

efficiencies to respond to stock out challenges at supply points. Before, it would take 2 to 3 months to make

contraceptives available; but now, the drone technology delivers products in just one hour. After seeing the pilot

experience through the drone use video, the GESI Specialist, Malanto Rabary, realized the potential that drones could

offer in facilitating access to contraceptives for excluded community in remote areas. The use of drone by itself is indeed

reaching four critical objectives (i) expanding the distribution of health commodities among target groups, (ii) addressing

a gender and social inclusive balanced approach, (iii) promoting family planning health among women, girls and whole

community in rural areas and (iv) helping to fill the market in social marketing sector. As the project continues to test out

new ways of using drone technology more consistently in the supply chain, stakeholder partners and rural communities

themselves will stand to benefit from expanded access for priority medications for women in remote, including family

planning and medications for maternal and child health.

9 Determining the Conditions Under which Medicinal Products Intended for Humans are Used and Determining the Allowed Number of Drug Shops by Locality. Ministerial Decree 11092/2016, (2016): Chapter IV, Article 20. Issued by Ministry of Public Health, Madagascar.

166

At this year’s celebrations of International Women’s Day in Tulear, IMPACT collaborated with the Ministry of Population

and the National Women’s Council to showcase the opportunities that drone technology offers to remote communities.

The IMPACT team showed a video which explained how drones could fill a critical gap in access to health products for

marginalized populations in remote communities. Senior representatives from the Ministry of Population as well as the

Chairwoman of the National Women’s Council were very interested in the potential that the drone technology offered,

particularly to give women and girls access from remote communities. Senior level officials shared, “It is good to know

that women from remote areas could get now contraceptives with the use of this drone. Thanks to IMPACT as it helps

improving health status in Madagascar”.

Through the IMPACT project’s signature commitment to gender and social inclusion, interventions continue to be

designed with an express goal of addressing gender-specific dimensions to help strengthen the supply chain systems for

U.S.-funded maternal and child health, malaria, and family planning activities. IMPACT and the GESI team will continue

to collaborate to unlock the solutions to addressing the most critical needs in maternal and child health, malaria and

family planning, so that health services and access can continue to grow more equitable for all.

Quarter 3:

Commune of Sakoana: Supply Point (PA), Health Facility Head and Community Health Volunteers

work together to protect newborns from umbilical cord infections

The rural commune of Sakoana is located 10 kilometers from Manakara, in the Vatovavy Fitovinany region. On average,

the number of births in the health facility (CSB) of

Sakoana is 20 per month, according to data provided

by the head of the Sakoana CSB, Fidèle

RANDRIAMAMONJY. In rural communes of

Madagascar like Sakoana, hygiene and infection

control can be an issue. If untreated, these

infections, especially those related to the umbilical

cord, can cause newborn death.

To encourage the use of Arofoitra chlorhexidine

(CHX), the supply point (PA), CHVs, and the head of

the CSB are working together to protect newborns

from umbilical cord infections. To do this, Sakoana's

PA ensures that the product is always available.

CHVs identify pregnant women in the commune and

sensitize them on the importance of using this

effective antiseptic to prevent infections in

newborns and the need to have a tube of Arofoitra

available before delivery. The CSB head, during the

four prenatal consultations stresses the importance

of the use of Arofoitra and requires the availability of this product at the time of delivery.

Among the CHVs, Marline BAO’s work in the Fokontany (village) of Ranomena is remarkable and the CSB head has

particularly recognized her contribution to increasing the number of pregnant women coming to the maternity ward of

the CSB in Sakoana. “Arofoitra is a very effective antiseptic against neonatal umbilical cord infection. It significantly

reduces the risk of infections. The use of CHX Arofoitra has become systematic after childbirth and we appreciate the

PA's work to ensure the permanent availability of this product," said the head of the CSB.

In March 2020, the consumption of Arofoitra from the PA of the Sakoana commune was at six tubes, but as a result of

the close collaboration between the CSB and the CHVs, there has been an increase in consumption since April. The

average monthly consumption during the last three months (April - June 2020) has increased by 20 tubes.

The IMPACT project, through its distribution team, ensures the continuous availability of life-saving health products for

maternal, newborn, and child health in the Vatovavy Fitovinany region.

From left to right : The Chief of CSB of Sakoana (RANDRIAMAMONJY Fidèle), CHV (BAO Marline) and the PA (RANAIVO Paul)

167

Menabe region: Redistributing medicines from private to public health facilities to treat children

with malaria

Using a Total Market Approach, the IMPACT project works to improve access to health commodities for the Malagasy

population. For example, the IMPACT Regional Logistics Advisors are working to strengthen the capacities of health actors

in both the public and private sector to effectively manage

health commodities within their regions and districts by

assisting them in identifying problems and finding solutions

that fit their local context.

The supply chain in the public sector starts at the Pha-G-Dis

District Pharmacy and health facilities (CSB) order

medicines based on what stock is running low. Once they

place their order, the commodities are moved from the

pharmacy to the health centers. In the Befasy district,

Menabe region, the malaria commodities currently in stock

at the public health facilities are not meeting the

population’s needs.

In June, during a supervision visit conducted by the IMPACT

Logistics Regional Advisor and the Ministry of Public Health

regional staff at the Wanda Blenska Catholic Private

Dispensary in Befasy, the team identified a surplus of

antimalarial medicines that are set to expire in October 2020. The IMPACT Regional Logistics Advisor asked the Pharmacy

Manager to redistribute the antimalarial medicines to the public sector where there was high demand that was not being

met. Despite the private pharmacy buying these commodities with their own funds in 2018, they agreed to donate them

for free to the public sector.

As a result of this re-distribution, 54 doses of infant antimalarial products were redeployed from private to 7 public health

centers in Befasy. With these medicines available at the community level, 54 children infected with malaria were able to

receive antimalarial medicine free of charge.

Menabe region: Targeted, coordinated, and efficient supervision: Health stakeholders join efforts

to fight malaria.

In the Menabe region, the malaria peak season occurs from

June to August with a spike in malaria cases during this period.

During the coordination meeting led by the regional Ministry

of Health and technical partners, including the IMPACT

project, a joint malaria response visit to the health facility of

Lohena, whose malaria cases increased a lot three weeks

prior, was planned. This mission was organized with the

regional management team and it was decided that the

IMPACT project would support the transportation of

Antimalarial supplies from the district pharmacy (Pha-G-Dis)

to the health facility (CSB) which is at 120 km away and to

make a targeted advanced strategy in the fokontany (Village)

of Lohena whose malaria cases were experiencing an upsurge.

In order to ensure the effectiveness of this mission, the USAID-

funded project Mahefa Miaraka who implements community health activities was also solicited. During the response

mission, the tasks were well coordinated. Two MOPH district management teams and the health facility head tested

patients with rapid diagnostic tests (RDT), MOPH district management teams filled in the consultation register, the

Technical Assistant for Mahefa Miaraka and the Medical Inspector sensitized people on the importance of using mosquito

nets, and the IMPACT Regional Logistics Advisor (RLA) supported the dispensing of medicine to people who had a positive

RDT.

A young girl with her little brother going to consult a community health volunteer to test for Malaria in the commune of Lohena

Befasy

Malaria testing in a Fokontany of Lohena

168

As a result of this joint initiative, 540 RDTs were performed, 432 of which were positive (80% positivity rate). All positive

cases received the necessary treatment. This initiative reduced malaria cases during the following weeks. Therefore, the

commodities that the IMPACT project transported have been used directly and have saved lives. This mission was also an

opportunity to further strengthen the coordination of actions between the USAID-funded health projects and the MOPH

that they support.

The use of HelpDesk improves data reporting rate from district pharmacies to the DPLMT

To strengthen the Logistic Management Information System (LMIS) reporting rates from district pharmacies (Pha-G-Dis)

to DPLMT (central office based in Antananarivo), the DPLMT, supported by the IMPACT project through the national LMIS

committee (DEPSI, DSFa, EMAR, EMAD), has set up a HelpDesk in January 2020, which will play the role of a call center

to remind the Pha-G-Dis providers to submit LMIS data.

The HelpDesk is composed of two people who work at PSI’s office where they have unlimited and high-speed Internet

connection available. To identify Pha-G-Dis that did not submit LMIS data, the HelpDesk team checks the reporting rates

using a dashboard presented in the IMPACT Intranet. Then, all Pha-G-Dis which did not send LMIS data are called and

reminded to submit data for

the relevant period. When Pha-

G-Dis providers encounter any

challenges preventing data

submission, they can call the

HelpDesk hotline free of

charge and the HelpDesk will

try to solve the problem. If the

problem is not addressed, a

request management system is

set up and the issue is

transmitted to the CHANNEL

focal point at the DPLMT, the

IMPACT Monitoring and

Evaluation team, and to the

Regional Logistics Advisers

(RLA) involved. These staff will

also try to resolve the issue

remotely and will organize field

visits if necessary.

The use of the HelpDesk has proven to be successful. Before the implementation of HelpDesk, the average data reporting

rate was at 32%, in Year 1. After the implementation of this system and as a result of joint efforts of the MOPH and

IMPACT (donation of laptops, internet connection, and field supportive supervisions), the average reporting rate

increased to 78% during the same time period in Year 2 (October 2019- May 2020). The average data completion rate of

46% in Year 1 also increased to 76% in Year 2.

Atsimo Andrefana region: Engagement of a primary school teacher helps to continue Community

Continuous Distribution activities during the COVID-19 Pandemic

HelpDesk Functioning

169

Jean Nomé LAHINIRIKO is a 31-year-old teacher at

the primary school of Ambohimahavelona, Toliara

II district, in the region of Atsimo Andrefana. Jean

Nomé is a member of the Kom’Lay, which is the

Long-Lasting Insecticide-treated Nets (LLIN)

distribution coordination committee of the

Fokontany. Jean Nomé is considered a model

citizen in his community and is very engaged and

dedicated in his role of Kom’Lay.

In March 2020, a national health emergency was

declared throughout Madagascar due to the

COVID-19 pandemic. Subsequently, schools were

closed and all malaria prevention activities at

schools were also suspended.

Despite this difficult period, Jean Nomé still took the initiative to check in with households to ensure that his students

were protected against malaria. During his visits, he was happy to see that five of his students and their families who did

not previously sleep under a LLIN (identified using fuchsia bracelets) are now sleeping under a LLIN. As a reward, Jean

Nomé gave them each green bracelets.

Despite the closure of schools, Jean Nomé was able to ensure the continuity of his activities. Thanks to his dedication and

dynamism the LLIN community continuous distribution (cCD) activities with students continued. “Even in this time of

pandemic, I would like to ensure that targets are reached by the end of the cCD campaign and ensure that malaria will

not claim any lives in the Fokontany,’’ he said.

The Fokontany of Ambohimahavelona is among the 296 Fokontany of the district of Toliara II where the USAID/PMI-

funded IMPACT project conducted the cCD campaign.

Toliara II: Using locally made handwashing devices to prevent COVID-19 spread during the

continuous LLIN distribution campaign

Like all regions of Madagascar, the Atsimo Andrefana region is working to prevent the spread of COVID-19 and the local

population is working to follow the prevention guidance. The Fokontany

of Ambalaboy is among the 296 Fokontany of the district of Toliara II

which benefited from the Long-Lasting Insecticide-treated Nets (LLINs)

continuous community distribution (cCD) and COVID-19 did not stop the

community from completing the planned distribution activities.

Jean Baptiste RANDRIAMANANTENA is a 58-year-old father of six living

in the Fokontany of Ambalaboy. He is the president of an association

named VOAMAMY. During the LLIN cCD in the Fokontany, Jean Baptiste

offered handwashing devices to cCD beneficiaries and coordination

teams to reinforce the prevention of COVID-19 through his association.

During the distribution, the beneficiaries passed one-by-one to wash

their hands with soap using the handwashing device in a yellow

container before taking their nets. “We offered these devices to ensure

that the LLIN distribution can continue safely, as combatting malaria is

also one of our priorities even during this difficult pandemic period,”

Jean Baptiste said. The devices were passed on to the president of the

Fokontany and used by the cCD coordination team (Kom’Lay).

The cCD activities in the Fokontany were able to continue thanks to the

support from Jean Baptiste and the VOAMAMY association.

LAHINIRIKO Jean Nomé at the right with his student wearing the green bracelet and her family

RANDRIAMANANTENA Jean Baptiste and Kom’Lay members with handwashing device

170

Maintaining the private sector’s commitment to providing health commodities during the COVID-

19 Pandemic

Following the outbreak of COVID-19 infections in Madagascar in early 2020, the government imposed a nationwide

lockdown restricting travel and limiting business activities within the country. Despite these constraints, the IMPACT

team was committed to finding ways to support its private sector partners in continuing to provide vital health

commodities to their communities during the crisis.

Phone survey and coaching

In order to determine how the COVID-19 pandemic is affecting the suppliers of private health commodities in rural

areas, IMPACT conducted phone interviews to survey 71 drug shops in the Atsinanana, Boeny, and Analanjirofo regions.

The major issues identified were:

• Stock outs of malaria products, flu medicines, and Vitamin C, and restrictions on order quantities due to insufficient

wholesaler inventory;

• Need for financing to purchase inventory;

• Requests for protective equipment from IMPACT.

Following the survey, IMPACT gave the partner banks a list of 61 drug shops needing financing. In Quarter 3, five drug

shops received loans thanks to IMPACT’s intervention, and the banks are continuing to contact drug shops on the list. In

addition, as a contribution to the COVID-19 response for the private sector, IMPACT decided to provide masks, hand

sanitizer, and bleach to 143 drug shops and 53 pharmacies in five regions.

To continue helping drug shops improve their management challenges even when it was not possible to meet with

them face to face, the A2F team adapted its coaching method from in-person to over-the-phone sessions, successfully

coaching 16 drug shops in Quarter 3.

Creation of drug shop association

IMPACT’s continued mentorship of drug shops during the

lockdown allowed the project to support the creation of a

regional drug shop association, l’Association de Depôts de

Médicaments (ADEMERA), in the Atsinanana region in April.

Another association is in the process of being created in

Boeny. These professional associations will help coordinate

drug shop activities and improve operational practices as

part of IMPACT’s business training and regulatory

awareness-raising activities and should facilitate the

development of an ADDO system in the future.

Supporting partner banks during COVID-19. The pandemic and the subsequent lockdowns have created significant economic hardship around the world, with banks in many countries cutting off credit to companies which have lost revenue. For pharmacies and drug shops, access to financing is especially important to ensure that they can continue to supply their communities with essential pharmaceuticals and medical supplies during the pandemic. The USAID guarantees, accompanied by technical assistance through the IMPACT program, have been crucial in allowing partner banks AccèsBanque Madagascar (ABM) and Baobab Banque to continue to lend to health commodity enterprises during the pandemic. In a time when the financial sector has been cutting credit to many sectors, the partner banks have been able to continue disbursing loans to the private health sector Despite complications related to COVID-19, IMPACT supported partner banks in increasing the amount of loans disbursed between April and June, with 11 loans disbursed in Quarter 3, an increase of 37% increase from the previous period, and in strengthening the banks’ relationships with drug shops (eight out of the 11 loans disbursed). Additionally, thanks to the coverage of the DFC guarantee, ABM was able to provide offer three health commodity enterprises restructured loan terms that were even longer than the six months recommended by the Government of Madagascar. Finally, IMPACT helped banks develop a new loan product (ACCES SALAMA) to support the health sector in purchasing equipment and supplies to respond to COVID-19.

During IMPACT business training in Mahajanga in February 2020, drug shop owners in Boeny discussed the possibility of

creating their regional association

171

Innovation in the time of COVID: How remote capacity building will help advance equitable health

commodity supply chain distribution in the social marketing sector

Social marketing seeks to address major gaps in access to health commodities. As part of IMPACT’s Total Market Approach

(TMA), social marketing, along with public and commercial sector collaboration, contributes to efforts to attain Universal

Health Coverage (UHC) for all Malagasy people. Specifically, social marketing promotes a community distribution model

for health commodities including malaria, family planning, and maternal, newborn, and child health products, reaching

communities who otherwise may not receive them. Through the model, Regional Distribution Supervisors (SRDs)

distribute products to volunteer district level agents who in turn distribute to community members and consumers,

particularly low and middle-income families. Across the 13 regions where IMPACT operates, six SRDs, 31 Distribution

Point Supervisors (SPDs), 67 district-level volunteers (PARCs), and 887 community-level volunteers (PAs) work together

to deliver affordable, accessible health products to the Malagasy population. Their efforts supplement similar distribution

schemes in the public sector.

Health commodities distribution, particularly on a volunteer basis, is not without its challenges. A rapid analysis (with

SRDs, SPDs, PARCs, and PAs) of influential factors impacting distribution success in May 2020 revealed that at the district

and community levels, PARCs and PAs, and especially women PARCs and PAs, face challenges in decision-making around

using household financial resources to purchase health commodities. Recognizing an opportunity to address barriers and

improve the experience and performance of distributors, IMPACT’s gender and social inclusion (GESI) and social

marketing distribution teams collaborated to integrate GESI concepts into the existing capacity building curriculum for

health commodities distribution agents. The training of trainers (TOT) is offered to supervisors (SRDs and SPDs) who will

in turn share the learning with PARCs and PAs to carry out in their respective areas.

Due to the ongoing COVID-19 pandemic threat,

the teams recognized that travel and in-person

gatherings were limited, which prompted the

development and implementation of an

innovative remote-based training series. After

the initial curriculum development in French,

IMPACT’s gender lead facilitated the first round

of training with a small group of six SRDs and

three SPDs who validated the content, provided

feedback, and offered suggestions for revisions,

including incorporating real distribution case

scenarios from the different regions. In addition,

as the trainers for the upcoming sessions with

PARCs and PAs, the SRD and SPD group played

an active role in translating the materials to

Malagasy, to ensure that the content would be

well understood by all participants. Additional virtual sessions were conducted to allow each new trainer the opportunity

to teach back the content and check their understanding in both languages. The training methodology included

sensitization activities on themes related to gender and social inclusion, content and information sharing, small group

online discussions, and practical activities. The series focused on addressing challenges related to gender and social

inclusion, improving inequities in the community, work, and home spaces, and promoting women’s empowerment.

As of June 30, 2020, two sessions have been conducted with SRDs and select SPDs as part of this innovative co-designed

iterative approach and an additional three sessions are planned in the first month of Quarter 4. The sessions have not

only strengthened the understanding of gender and social inclusion-related concepts among social marketing distribution

team leaders, but through their participatory involvement has also influenced their willingness and ability to apply

learning across job functions. SRDs and SPDs now better grasp the importance of understanding who their customers are

and what products they buy, ordering health products to meet client needs, selling health commodities to all members

of the community without stigma or discrimination, and recognizing the impact of gender roles, responsibilities, attitudes,

and practices at the household and community level that influence consumer access to and utilization of products and

Regional distribution supervisors practice delivering training to PAs and PARCs through virtual simulation.

172

distribution efforts. In the coming months, the SRD and SPD training team will share their learning with other SPDs before

cascading the training out to all 954 PARCs and PAs. The integration of a GESI lens to health commodities distribution

promotes a more inclusive and equitable process within the health supply chain, ensuring all segments of the Malagasy

population benefit from health products and services that meet their needs.

Quarter 4:

District of Toliara II: LLIN Community-based Continuous Distribution contributes in decreasing the

malaria positivity rate from 53% to 5% in the commune of Milenaky

Under the lead of the National Malaria Control Program (NMCP), IMPACT assisted the MoPH in conducting the LLIN cCD

in 12 prioritized districts. The district of Tuléar II is among the first six districts where the NMCP and IMPACT conducted

the cCD. From March to September 2020, 75,340 LLIN were distributed, reaching approximately 37,670 households in

the district.

Melinaky is one of the 26 communes that benefited from the LLIN distribution in Toliara II. Faniriako Marson, the Chief

of the health facility (CSB) of Melinaky understands the

importance of LLIN distribution in his community and is

engaged in the coordination of the campaign. To ensure

quality and accuracy of the campaign activities in the

commune, Marson is committed to the verification of

management tools and ensuring that all data are accurate.

“The LLIN cCD is very important because it really saves lives in

my community. After the LLIN distribution, the malaria

positivity rate decreased from 53% in February 2020 to 5% in

August 2020.” (Source: data from the CSB of Melinaky), he

said.

Gara, a 24 year-old mother of two lives in the rural commune

of Anakao, which is among the 26 malaria-prone communes in the district of Toliara II, with a population of over 3,912

people. Gara received two nets for her family. She said

that after receiving the nets, she and her family can sleep

well and are protected against mosquito bites that can

cause malaria. “Before having the nets, I had to wake up

frequently at night to ensure that my children are not bit

by mosquitos. In the morning, I feel so tired due to lack of

sleep that I cannot manage my business well,” she said.

Gara owns a second-hand clothes shop in her commune.

“We are in better health and none of my children have

been ill from malaria since,” she added. 1,178 nets have

been distributed in the rural commune of Anakao.

From the left to right, Faniriako Marson Chief of the health facility (CSB) of Milenaky, Luc Omer the Supply Point and distribution agents in the commune during verification of

coupons

GARA in the middle with her family during household visits on the correct use of nets

173

District of Brickaville: Joint efforts of community leaders enabled success of the LLIN Community-

based continuous distribution at the Fokontany level

Ambinanifanasana is among the 21 Fokontany in the commune of Fetraomby, in the district of Brickaville, Atsinanana

region who benefited from the LLIN cCD. The last

distribution of LLIN in this Fokontany was in 2018.

“Before the cCD implemented by IMPACT, most of the

LLIN in the Fokontany were in poor condition. In addition,

some households used the LLIN as fishing equipment

because no action was taken by the local stakeholders,”

said Charline Elisabeth, a CHV in the Fokontany. As a

result, an increase of malaria cases, especially among

children under 5 was recorded, from 50% in January

2019 to 100% in January 2020 as reported in the RMA

(community activities reports) submitted by CHVs.

The Kom’Lay of this Fokontany is composed of four

members, including two CHVs who are the distributor

and community mobilizer, the chief of Fokontany, and a

teacher of local primary school. After receiving trainings

on the cCD, the Kom’Lay organized community meetings

to clarify the cCD approach at the community level and

warned of actions to be taken for those who use LLIN for uses other than protection against malaria, such as the payment

of community fine. At each distribution, all Kom’Lay members are always present. “We are very strict on the misuse of

LLIN and we work closely with the Brigade of the gendarmerie. At each distribution, we are always present to transmit

messages related to misuse of LLIN. During last home visits conducted by Kom’Lay members, we noticed that LLIN misuse

is very limited in the Fokontany,” said the Chief of Fokontany.

Convinced of the importance of using LLIN to fight against malaria,

the young scouts of the Fokontany volunteered to transport LLIN by

foot from the commune to the Fokontany. Every day, the scout

ensures that there are enough LLIN to be distributed to the

population. Thanks to their devotion, no delay was noted in the

distribution of LLIN in the Fokontany.

At the start of the cCD campaign, Kom'Lay members prioritized the

most vulnerable households (households without LLIN or LLIN in

poor condition). As a result of joint efforts among local leaders, the

cCD has been a success in this Fokontany. After the LLIN distribution

in May 2020, the malaria positivity rate in the Fokontany decreased

from 100% in January 2020 to 25% in September 2020 (Source: RMA

reports).

Pha-G-Dis of Benenitra: Operationalization of district inventory and stock management committee

help reconstitution of months of missing logistic data from 0% in May 2019 to 100% in July 2020

The district of Benenitra is located in the southwest of Madagascar in the region of Atsimo Andrefana. Due lack of training

and non-functioning of the Channel software, the last data report sent by the Pha-G-Dis to the central DPLMT was in May

2019. Since then, no reports have been sent to the central level, which resulted in inaccurate quantification of

commodities and recurrent stockouts.

Members of the LLIN coordination committee (Kom’Lay) in the Fokontany of Ambinanifanasana

Young scout transporting LLIN to the Fokontany of Ambinanifanasana

174

To address this issue, IMPACT supported the UTGL of the DRSP of Atsimo Andrefana to establish and operationalize the

district inventory and stock management committee (GAS committee) of Benenitra. Under the lead of the regional UTGL,

this committee is composed of MoPH district staff

involved in commodity management and all technical

and financial partners in the district, such as IMPACT.

This committee holds monthly meetings to analyze

monthly inventory of stocks, the logistics

management information system, and to identify

actions to be taken to avoid stockouts.

As a result of the creation of this committee, the

members conducted supportive field visit for the Pha-

G-Dis of Benenitra to improve the LMIS reporting in

order to ensure continuous availability of health

products.

Pha-G-Dis providers received on-the-job training on

the use of CHANNEL by the Regional Manager of

Information and Communication Technology (ICT),

the Regional Manager of GIS (Management of Health

Commodities), and IMPACT Regional Logistics Advisor (RLA). During the training, LMIS data from May 2019 to July 2020

was submitted to DPLMT. Therefore, the LMIS reports from Benenitra are now up to date. MoPH district staff and IMPACT

RLA continue to provide remote monthly supportive assistance to the Pha-G-Dis of Benenitra to ensure that the reporting

continues on a regular basis.

Motorbike Loans increase remote communities’ access to vital health commodities

IMPACT supports health commodity suppliers working

with PSI’s social marketing distribution network in

communities around the country. This supply chain

includes regional hubs (PARCs and PAs) who provide

health commodities to CHVs. The PAs procure

medicines and health supplies from the PARCs at

district level and transport them back to their rural

villages, requiring them to travel long distances (often

between 20 and 50 kilometers) at their own expense.

For PAs without their own means of transportation, it

can be challenging for them to fulfill their role in the

health commodity supply chain.

IMPACT and AccèsBanque Madagascar (ABM) wanted

to find a way to help address this problem. The two

partners collaborated to create a new financial product,

the “Motorbike Loan,” designed to help PAs purchase

an affordable mode of transport. After discussions with

IMPACT and USAID, ABM agreed to leverage a loan

guarantee provided by USAID to reduce the amount of collateral usually required and offer a 40-day grace period for the

first loan payment. IMPACT helped connect eligible PAs with the bank, and once ABM had approved the loan applications

and disbursed loan funds to the motorbike dealership, the project coordinated the delivery of the motorbikes to the

respective PAs. IMPACT was even able to negotiate 24-month warranties on the PAs’ motorbikes from the dealership.

The Motorbike Loans allow PAs to purchase their own means of transportation, which is beneficial for three key reasons:

1. With motorbikes, PAs can more easily travel the long distances to regional supply points and transport vital health supplies back to their local communities. The motorbikes increase the availability of health products in remote areas.

Razafimahatratra Alpher, Points d’Approvisionnement

(PA) from Fandriana, is loading a box of health products

onto his newly procured motorbike

IMPACT Regional Logistic Advisor (RLA) during supportive supervision of the Pha-G-Dis service provider of Benenitra

175

2. PAs can reduce costs incurred by cutting out transportation fees and other intermediary costs, so over time, the motorbikes will help improve PAs’ income.

3. Because the PAs serve volunteers in the health commodity supply chain, they also have separate, income-generating activities, which the motorbikes can also be used to support. For example, a PA/farmer can use the motorbike to transport products to market, saving on the costs of using an intermediary.

In 2020, three PAs procured motorbikes using this new loan product: one in Fandriana, one in Ambanja, and one in Toliara

II. The Motorbike Loan recipients have expressed their appreciation for this opportunity.

Mariama, a PA for the Ankatsaka commune in the Ambanja district since 2012,

explained that before getting the motorbike, travelling to Ambanja to procure

health supplies at the PARCs was challenging. She had to take the bus and wait a

long time at the bus station. In addition, she needed to pay fees for commodity

transportation. She added: “Using the motorbike is more economical and less

time-consuming. I have more time to serve my community and I can also save

money to expand my business.” In addition to serving as a PA of Ankatsaka,

Mariama is also a cocoa and coffee farmer.

Razafimahatrata Alpher the PA for the Alakamisy Ambohimahazo commune in

the Frandiana district, is also very happy with his new method of transportation

and the benefits it provides: “Through the acquisition of motorbike, I can

guarantee the continuous availability of health products in my community and

also use it for my personal needs.”

Due to the COVID-19 pandemic and related travel restrictions, ABM has decided

to limit the geographic zone for piloting the “Motorbike Loan” product to a range

of only 15 km from an ABM bank branch. Moving forward, IMPACT will work with

the bank to increase the geographic coverage area to 50 km from their branches

and to increase awareness of the product to encourage other PAs to apply.

Drug delivery by drone : An innovation in bringing life-saving

commodities to remote Communities in Madagascar

Eighty percent (80%) of Malagasy people live in rural areas. Due to difficult geographical conditions (cyclones, severe

weather, etc.) and the lack of infrastructure, people have to walk several hours, even a whole day to reach health facilities

and get treatments. In addition, the growth of insecurity is also challenging due to the presence of dangerous armed

gangs of bandits called “dahalo” in many parts of the country, including in regions served by the IMPACT project. This

situation has isolated regions in Madagascar making

health supplies delivery extremely challenging. In

response, in October 2019, USAID, through the IMPACT

Project has developed an innovative and effective

concept of delivering health commodities by drones to

ensure availability in the most rural areas of

Madagascar. Maroantsetra was chosen to be the pilot

zone for this drone project because it regroups most of

all the geographical difficulties such as no accessible

roads, lots of mountains, lakes to cross, rainy season all

along the year. For years, IMPACT project Supply Points

(PA) at commune level have to travel many kilometers

and days to reach districts each time they have to

procure key health supplies at PARC (Point

d’Approvisionnement Relais Communautaire) based at district level. Before, it would take 2 to 3 weeks to make health

supplies available; but now, the drone technology delivers products in just one hour. With these drones, the primary

objective of IMPACT is to avoid stock-outs of essential medicines within the 1,200 community supply points supported

by the project.

Mariam, PA for the Ankatsaka

commune in the Ambanja district,

pictured in front of her new

motorbike

The drone ready to deliver medicines in remote communes of Maroantsetra

176

The drone used is a small aircraft with vertical take-off and landing. It is about 3m30 wide and weighs 20 kilos when

empty. It can carry up to 10Kg of goods within a volume of 12 L, and a range of 100km. The flying altitude of the drone is

200m above the ground, with an average speed of 100km/h. The drone can withstand rain and winds.

“Before, we had to travel many kilometers and

days to get the medicines. Now, thanks to the

drone, it only takes few minutes and the

medicines are available. It actually help us

maintain enough stock to serve our

communities”, said RANDRIANASOLO Flavien,

Community Supply (PA) in the commune of

Ankofabe, Maroantsetra.

From October 2019 to September 2020, 71

successful flight tests have been carried out. All

Family Planning and Mother, Neonatal and

Child health products that IMPACT distributed

were transported and delivered to the Supply

Points according to their needs. The community Supply Points to which products are delivered could maintain the

availability of their stock and stock out noticed before the drone project was quickly resolved such as for Arofoitra,

Diarrhea Treatment Kits SRO-Zinc and Pneumox.

With this innovative technology, USAID, through the IMPACT Project expects to revolutionize access to drugs in rural

areas and save more lives at a lower cost.

Advancing GESI Through Virtual Opportunities: Capacity Building for Health Commodities Success

through Video-based 2020 GESI Refresher Training Series

The COVID-19 global pandemic has impacted populations across the globe. In Madagascar, where the state of emergency

resulted in a near “lockdown”, health activities such as those supported by IMPACT faced (and continue to face) setbacks.

With the duration uncertain, organizations and projects across the country were called upon to think strategically on

ways to overcome challenges and continue to work towards planned goals and objectives. One such overarching objective

for IMPACT is to support capacity development for staff to better understand and be able to apply a gender equality and

social inclusion lens to their work to help magnify the results of a total market approach (TMA). Typically carried out

through an in-person multi-day annual training, IMPACT pivoted to a virtual video-based platform reaching diverse

technical teams and leadership while prioritizing the safety of all.

To carry out this initiative, IMPACT’s GESI team produced a series of four

independent and sequential technical content videos – each with

knowledge checks at the end of each video and a final evaluation –

collectively referred to as the 2020 GESI Refresher Training Series. In

planning for the series, it was important to consider many elements of

the training that could impact its efficiency and utility including, language,

video duration, period of time to complete the course, and testing

platforms among others. The training videos were provided in both

French and English to allow staff the option of taking the course in a

language they were more comfortable in or practicing technical concepts in another. The videos were intentionally short

to both serve as a refresher, but also note attention time and content absorption. A three-week window for completion

was offered to maximize opportunities to staff to set their own schedules. Google Forms was selected as the testing

platform for its analytic capabilities (for example, post-test results were automatically recorded and uploaded to the

dashboard after every completion) and to leverage its no-cost option.

2020 GESI Refresher Training Series

• Introductory Video: 1

• Technical Content Videos: 4

• Video Run Time: 10-15 minutes each

• Languages: French, English

• Post-tests: 4

• Final Evaluation: 1

RANDRIANASOLO Flavien, Community Supply (PA) in the commune of Ankofabe, Maroantsetra.

177

As of September 30th, 2020, a total of 56 staff members from

IMPACT’s five consortium partners, including 12 leaders and their

teams, completed the full GESI refresher training.

In addition to the individual unit’s knowledge check results, the training’s final evaluation revealed positive impacts.

54.5% of the respondents strongly agreed (rated 5 out of 5) and 36.4% agreed (rated 4 out of 5) that the GESI trainings

are relevant to achieve the objectives of

IMPACT’s program. Furthermore, after the

refresher training, 90.9% of the respondents (see

graph) shared that they felt comfortable

integrating GESI into their interventions.

Feedback from one team lead supports the

impact of the training, “For our interventions, I

think it is now essential to consider this gender

aspect in our various missions in the provinces.

[We must] adapt each intervention according to

the region, culture, and mode of operation in each

place visited. This will then make it possible to

identify the various barriers and constraints linked to access to health products in certain places in Madagascar”.

Following the success of the refresher training, IMPACT will explore opportunities to expand the training to regional staff

and partners and continue to leverage virtual opportunities to build capacity in gender equality and social inclusion

integration to support programmatic goals and improved TMA.

Unit Participants

Understanding gender and Gender Equality 58

Understanding Social inclusion and the Impacts to

Health

57

Understanding Gender-based Violence 57

Applying a Gender Lens: Strengthening Awareness

and Program Management

56

0%

0%

9.1%

56.4%

34.5%

0 10 20 30 40 50 60 70 80 90 100

1

2

3

4

5

On a scale of 1-5 (with 5 being the highest), I feel comfortable integrating GESI considerations into

IMPACT program interventions

8073.7 75.1

68.2

0

10

20

30

40

50

60

70

80

90

100

GenderEquality

SocialInclusion

GBV Applying aGender Lens

Average Quiz Score

178

ANNEX E – STOCK INVENTORY AS OF SEPTEMBER 2020

(USAID AND PMI funded)

MALARIA COMMODITIES (SALAMA)

ARTICLE Unit Quantity expiry date

ACT 2-11months, tablet Treatment 17,450 1-Aug-22

ACT 1 - 5 years, tablet Treatment 672,400 1-Jan.-22

ACT 6 - 13 years, tablet Treatment 82,825 1-Oct.-22

ACT 14 years and more, tablet Treatment 345,200 1-Jan.-22

Arthemeter Lumefantrine (5kg-15kg)20MG/120MG-tablets -B/6*30

Treatment 2,580 1- Aug -21

Arthemeter Lumefantrine (25KG-34KG)20MG/120MG-tablets -B/18*30

Treatment 64,770 1-Nov.-22

Gloves -pack of 100 pieces Piece 3,560,700 1-Feb.-25

Malaria Rapid Diagnostic Test Kit 491,225 1-Jan.-22

Artesunate injectable 60 MG-vial Vial 600 1-jul.-22

Sulfadoxine/Pyrimethamine 500/25mg tablet Tablet 49,950 1-Apr.-22

MNCH COMMODITIES (SALAMA)

PRODUCT SPECIFICATIONS Unit Quantity Expiry date

MAGNESIUM SULFATE 50% INJ.AMP.10ML - BTE/10 Ampoule 15,110 February and May 2021

OXYTOCINE 10UI/ML INJ. AMP. 1ML - B/10 Ampoule 911,910 June-21

GENTAMICINE 10MG/ML INJ - AMP 2ML - (20MG) - BTE/100 - Ampoule 8,100 Nov.-20

GENTAMICINE 40MG/ML INJ - AMP 2ML - (80MG) BTE/100 - Ampoule 8,800 June-21

179

ANNEX F – STOCK STATUS BY END OF SEPTEMBER 2020

Commodities Unit Stock available Projected AMC (Oct-Dec 2020)

Month of stock

Shipment planned

Procurement agency/funding

source

Estimated arrival date

ACT 2-11months, tablet Treatment 119 430 13 472 9 187 500 GF 01/12/2020

ACT 1 - 5 years, tablet Treatment 672 670 78 156 9

75 000 GF 20/10/2020

717 450 GF 01/12/2020

115 375 PMI 25/01/2021

ACT 6 - 13 years, tablet Treatment 147 615 43 787 3

75 000 GF 20/10/2020

527 525 GF 01/12/2020

67 125 PMI 25/01/2021

ACT 14 years and more, tablet Treatment 345 510 46 175 7 495 475 GF 01/12/2020

67 500 PMI 25/01/2021

Artesunate injectable Vial 142 600 35 663 4 333 300 GF 20/10/2020

100 000 PMI 25/01/2021

Malaria Rapid Diagnostic Test Test 3 344 050 428 677 8

1 426 300 GF 28/10/2020

3 459 325 GF 01/12/2020

2 000 000 PMI 26/02/2021

Sulfadoxine/Pyrimethamine 500/25mg tablet

Tablet 2 511 150 335 498 7 1 500 000 PMI 21/01/2021

Quinine Tablet, 300mg Tablet 326 200 23 285 14 126 000 GF 01/12/2020

Artesunate suppository suppository 12 944 3 663 4 84 500 GF 01/12/2020

Primaquine tablet Tablet 121 200 2 923 41 -

180

ANNEX G - Descriptions of the seven quality dimensions

for the RDQA Data Quality Parameter Descriptions

1- Availability

The extent to which data and its supporting documentation are available. Review availability of the indicator source documents for the selected reporting period. Source documents depends on the indicator but will often refer to client intake forms, registers, cards redeemed vouchers, etc. Specify the name of the documents reviewed.

2-Completeness

Complete means that the document contained all the required entries of the indicator as appropriate. Review completeness of the indicator source documents for the selected reporting period.

3-Accuracy The degree to which the data correctly reflects what they were intended to measure. It is also known as validity. Accurate data correctly measure actual events, cases, units, etc.

4-Timeliness

The extent to which data is up-to-date (current) and is made available on time. Review the timeliness of documents received from the site for the selected reporting period. Reports can either be summary reports or reports of aggregated data that is submitted to the next reporting level e.g. regional or district level.

5-Integrity The extent to which data is protected from unauthorized changes or manipulation. Review the source document for any indication of unauthorized (accidental or deliberate) insertion, modification or destruction of data.

6-Confidentiality The extent to which information or data is protected and kept secure.

7-Precision The extent to which data is collected with the level of detail required to measure the indicator e.g. disaggregation by commodity type, etc.

181

ANNEX H - Details of training sessions for PA and PARC

during Quarter 3 and Quarter 4

TRAINED

DISTRICTS Date of training Number of expected

PARTICIPANTS

PARC PA ATTENDANCE RATE

MALE FEMALE

Nosy Varika 19-20/MAY 20 1 19 100% 9 11

Manakara 18-19/JUN 24 0 21 88% 4 17

Diego I&II 28-29/MAI 24 1 23 100% 9 15

Ambanja 15-16/JUN 32 2 29 97% 8 23

Ambilobe 08-09/JUN 20 2 18 100% 9 11

Manandriana 25-26/MAI 8 1 7 100% 3 5

Ambositra 28-29/MAI 16 1 14 94% 2 13

Fandriana 05-06/JUN 12 1 11 100% 5 7

Sambava 02-03/JULY 29 1 27 97% 14 14

Andapa 13-14/ JULY 23 1 22 100% 16 7

Antalaha 9-10/ JULY 19 1 14 79% 7 8

Vohémar 16-17/ JULY 20 1 18 95% 13 6

Befandriana 06-07/ JULY 16 1 15 100% 5 11

Mandritsara 24-25/ JULY 31 1 30 100% 16 15

Vatomandry 03-04/ JULY 20 1 17 90% 8 10

Mahanoro 06-07/ JULY 19 2 17 100% 9 10

Faratsiho/Antanifotsy 06-07/ JULY 17 2 15 100% 9 8

Antsirabe II 09-10/ JULY 21 1 20 100% 6 15

Betafo/Mandoto 14-15/ JULY 23 2 18 87% 9 11

Ambatolampy 17-18/ JULY 17 1 15 94% 10 6

Ambositra 21-22/ JULY 12 1 10 92% 2 9

Manakara 06-07/ JULY 21 0 21 100% 11 11

Bezaha 06-07/ JULY 14 1 13 100% 5 9

Betioky 10-11/JULY 18 1 17 100% 6 11

476 27 431 96,22% 195 263

182

ANNEX I - List of 49 Pha-G-Dis equipped with computers

for LMIS

Districts

49 Pha-G-Dis no computer

available for LMIS (CHANNEL)

IMPACT (40): Fandriana- Mananara N- Maroantsetra- Sainte Marie – Soanierana Ivongo-

Vavatenina- Beroroha- Betioky- Ankazoabo S- Morondava- Belo Tsiribihina- Antanambao

Manampotsy- Marolambo- Vatomandry- Mahajanga II- Ambanja- Ambilobe- Antsiranana I-

Antsiranana II- Nosy Be- Ambohimahasoa- Ambalavao- Ikalamavony- Ambatomainty- Besalampy-

Maintirano- Morafenobe- Sambava- Antalaha- Antsohihy- Bealanana- Befandriana N-

Mampikony- Port Berge- Mandoto- Ifanadiana- Ikongo- Manakara- Mananjary- Nosy Varika

UCP (9): Ambatofinandrahana- Antanifotsy- Ambatolampy- Antsirabe II- Faratsiho- Vohibato-

Isandra- Lalangina- Betafo

183

ANNEX J - RDQA Results Table 1: Summary of the results of RDQA conducted in Year 2 among Pha-G-Dis

Table 2: Summary of the results on RDQA conducted in Year 2 among Pha-Ge-Com

REGION DISTRICT

Overall Data

Verification

Score¹

System

Assessment

Score²

Overall Data

Quality

Score³

AvailabilityCompletenes

sTimeliness Integrity Confidentiality Precision Accuracy

AMORON ' I MANIA Ambatofinandrahana 80% 65% 72% 50% 100% 67% 100% 100% 50% 93%

AMORON ' I MANIA Ambositra 77% 69% 73% 100% 100% 33% 100% 50% 100% 59%

AMORON ' I MANIA Fandriana 91% 97% 94% 100% 100% 100% 100% 50% 100% 89%

ATSIMO ANDREFANA Morombe 77% 53% 65% 100% 100% 78% 100% 0% 100% 62%

ATSINANANA A. Manampotsy 99% 91% 95% 100% 100% 100% 100% 100% 100% 96%

ATSINANANA Vatomandry 92% 91% 91% 100% 100% 100% 100% 50% 100% 93%

ATSINANANA Brickaville 80% 88% 84% 78% 78% 56% 100% 100% 78% 73%

BOENY Mitsinjo 95% 94% 94% 100% 100% 100% 100% 100% 100% 64%

DIANA Ambanja 94% 81% 87% 100% 100% 100% 100% 100% 100% 56%

DIANA Antsiranana II 93% 100% 96% 100% 78% 100% 100% 100% 100% 73%

HAUTE MATSIATRA Ambalavao 94% 93% 94% 100% 100% 67% 100% 100% 100% 94%

HAUTE MATSIATRA Isandra 82% 77% 79% 61% 99% 100% 100% 100% 50% 65%

HAUTE MATSIATRA Ikalamavony 80% 67% 73% 78% 78% 33% 100% 100% 100% 72%

MENABE Miandrivazo 91% 97% 94% 100% 100% 100% 100% 50% 100% 84%

MENABE Belo T 96% 94% 95% 100% 100% 100% 100% 100% 100% 75%

MENABE Mahabo 96% 97% 97% 100% 100% 100% 100% 100% 100% 73%

SAVA Andapa 92% 85% 89% 100% 94% 100% 100% 100% 100% 49%

SAVA Sambava 70% 88% 79% 89% 89% 0% 50% 100% 100% 59%

SAVA Vohemar 82% 91% 87% 100% 100% 100% 50% 50% 100% 73%

SOFIA Antsohihy 97% 100% 99% 100% 100% 100% 100% 100% 100% 82%

SOFIA Boriziny 93% 100% 97% 100% 100% 100% 100% 100% 100% 73%

SOFIA Mampikony 80% 88% 84% 100% 100% 0% 100% 100% 100% 61%

VAKINANKARATRA Faratsiho 97% 91% 94% 100% 100% 100% 100% 100% 100% 79%

VATOVAVY FITOVINANY Mananjary 97% 94% 95% 100% 100% 100% 100% 100% 100% 79%

VATOVAVY FITOVINANY Ikongo 89% 75% 82% 61% 100% 100% 99% 100% 100% 65%

89% 87% 88% 93% 97% 81% 96% 86% 95% 74%AVERAGE

184

DISTRICT CSB

Overall Data

Verification

Score¹

System

Assessment

Score²

Overall Data

Quality

Score³

AvailabilityCompletenes


Ambositra Volafotsy 89% 81% 85% 100% 100% 100% 100% 50% 100% 75%

Ambositra Ankazoambo 99% 100% 99% 100% 100% 100% 100% 100% 100% 91%

Fandriana Fandriana 100% 67% 83% 100% 100% 100% 100% 100% 100% 97%

Fandriana Milamaina 99% 83% 91% 100% 100% 100% 100% 100% 100% 96%

Morombe Ambalamoa 66% 42% 54% 100% 100% 100% 100% 0% 50% 81%

Morombe Mamono 48% 27% 37% 43% 43% 100% 50% 0% 50% 48%

Morombe Nosy Ambositra 33% 63% 48% 0% 0% 67% 100% 0% 0% 68%

Antanambao Manampotsy A. Manampotsy 91% 73% 82% 100% 50% 100% 100% 100% 100% 90%

Vatomandry Maintinandry 84% 66% 75% 71% 71% 71% 100% 100% 100% 75%

Vatomandry Vatomandry 96% 69% 83% 100% 100% 100% 100% 100% 100% 75%

Mitsinjo Katsepy 99% 92% 95% 100% 100% 100% 100% 100% 100% 91%

Mitsinjo Mitsinjo 93% 83% 88% 100% 100% 67% 100% 100% 100% 83%

Ambanja Antsatsaka 84% 71% 77% 89% 89% 100% 100% 56% 61% 94%

Ambanja Ambodisakoana 99% 79% 89% 100% 100% 100% 100% 100% 100% 95%

Antsiranana II Antanamitarana 87% 79% 83% 72% 100% 100% 100% 100% 56% 81%

Antsiranana II Mahavanona 98% 83% 91% 100% 100% 100% 100% 100% 100% 86%

Ambalavao Ambalavao 93% 79% 86% 100% 100% 100% 100% 50% 100% 100%

Ambalavao Ampanaovantsavony 75% 62% 68% 100% 100% 100% 50% 0% 100% 76%

Isandra Ankarinarivo 92% 54% 73% 100% 100% 100% 99% 50% 100% 96%

Isandra Nasandratony 76% 54% 65% 100% 100% 100% 97% 0% 50% 84%

Belo Tsiribihina Aboalimena 97% 100% 98% 100% 100% 100% 100% 100% 100% 86%

Mahabo Befotaka 90% 95% 93% 100% 100% 100% 100% 100% 100% 59%

Mahabo Ankilivalo 82% 100% 91% 79% 79% 100% 100% 100% 50% 67%

Mahabo Mahabo 97% 94% 95% 100% 100% 100% 100% 100% 100% 76%

Miandrivazo Ambatolahy 95% 88% 92% 100% 86% 100% 100% 100% 100% 88%

Miandrivazo Miandrivazo 87% 75% 81% 100% 50% 100% 100% 100% 100% 57%

Miandrivazo Dabolava 94% 100% 97% 100% 100% 100% 100% 100% 100% 78%

Sambava Sambava 78% 63% 70% 78% 78% 100% 50% 50% 100% 89%

Sambava Nosiarina 68% 67% 67% 100% 100% 0% 50% 50% 78% 98%

Andapa Andrakata 68% 85% 76% 61% 50% 80% 100% 50% 60% 77%

Andapa Marovato 66% 77% 72% 39% 39% 67% 100% 100% 50% 70%

Vohemar Ampanefena 91% 89% 90% 78% 78% 100% 100% 100% 89% 93%

Vohemar Androrona 74% 69% 72% 100% 50% 100% 100% 50% 50% 68%

Mampikony Mampikony 97% 100% 98% 100% 100% 100% 100% 100% 96% 80%

Mampikony Ambohitoaka 74% 88% 81% 50% 50% 100% 100% 100% 67% 53%

Antsohihy Antsohihy 79% 83% 81% 71% 71% 67% 100% 86% 71% 84%

Antsohihy Ampandriakilandy 72% 83% 78% 67% 59% 100% 100% 50% 67% 63%

Boriziny Boriziny 88% 92% 90% 100% 100% 100% 100% 100% 79% 64%

Boriziny Tsarahasina 93% 92% 93% 89% 90% 100% 100% 100% 100% 71%

Faratsiho Faratsiho 93% 79% 86% 100% 100% 100% 100% 50% 100% 100%

Faratsiho Antsampanimahazo 86% 67% 76% 100% 100% 100% 100% 50% 50% 100%

Mananjary Mananjary 70% 50% 60% 50% 50% 100% 100% 50% 50% 87%

Mananjary Tsaravary 79% 50% 64% 93% 93% 100% 100% 50% 50% 67%

Ikongo Ikongo 92% 77% 84% 100% 100% 100% 100% 50% 100% 94%

Ikongo Manampatrana 89% 82% 86% 100% 93% 100% 100% 50% 100% 80%

AVERAGE 84% 77% 81% 87% 84% 94% 95% 72% 82% 81%

185

Table 3: Summary of the results on RDQA conducted in Year 2 among PARC and PA

PA

Overall Data

Verification

Score

System

Assessment

Score

Overall Data

Quality ScoreAvailability

Completenes


Antsohihy 98% 88% 93% 100% 100% 100% 100% 100% 100% 86%

Ampandriakilandy 99% 96% 97% 100% 100% 100% 100% 100% 100% 90%

Mampikony 96% 92% 94% 100% 100% 100% 100% 100% 100% 73%

Ambanja 93% 92% 92% 88% 88% 100% 100% 100% 88% 87%

Mahavanona 95% 96% 95% 94% 94% 100% 100% 94% 94% 86%

Andrakata 90% 83% 86% 94% 94% 100% 100% 50% 100% 88%

Vohemar 99% 96% 97% 100% 100% 100% 100% 100% 100% 94%

Ambalavao 100% 73% 87% 100% 100% 100% 100% 100% 100% 100%

Isandra 94% 65% 80% 89% 89% 89% 100% 100% 89% 100%

Miandrivazo 100% 92% 96% 100% 100% 100% 100% 100% 100% 100%

Mahabo 99% 100% 99% 100% 100% 100% 100% 100% 100% 91%

Ambositra II 98% 92% 95% 100% 100% 100% 100% 100% 100% 89%

Ankazoambo 100% 91% 95% 100% 100% 100% 100% 100% 100% 98%

Milamaina 98% 75% 87% 100% 100% 100% 100% 100% 100% 87%

Tsaravary 100% 96% 98% 100% 100% 100% 100% 100% 100% 100%

Port Berge 93% 96% 95% 89% 89% 100% 100% 100% 100% 76%

AVERAGE 97% 89% 93% 97% 97% 99% 100% 97% 98% 90%

PARC

Overall Data

Verification

Score

System

Assessment

Score

Overall Data

Quality ScoreAvailability Completeness Timeliness Integrity Confidentiality Precision Accuracy

Ambanja 93% 88% 90% 88% 88% 100% 100% 100% 100% 78%

Antsohihy 98% 88% 93% 100% 100% 100% 100% 100% 100% 88%

Fianarantsoa 100% 69% 85% 100% 100% 100% 100% 100% 100% 100%

Andapa 100% 96% 98% 100% 100% 100% 100% 100% 100% 97%

Vohemar 98% 100% 99% 100% 100% 100% 100% 100% 100% 88%

Ambalavao 100% 62% 81% 100% 100% 100% 100% 100% 100% 100%

Ambositra 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Fandriana 97% 88% 92% 100% 100% 100% 100% 100% 100% 81%

Mananjary 100% 92% 96% 100% 100% 100% 100% 100% 100% 100%

Mahabo 99% 100% 100% 100% 100% 100% 100% 100% 100% 94%

Miandrivazo 86% 92% 89% 100% 100% 100% 50% 50% 100% 100%

AVERAGE 97% 88% 93% 99% 99% 100% 95% 95% 100% 93%

186

ANNEX K - Covid-19 Annexes Table 1: Donations provided to CCOR / DRSP, hospitals, vehicles, PA/PARC, drug shops and pharmacies

PLACE RECIPIENT ARTICLES & QUANTITY

ANTANANARIVO 427 private clinics (via SHOPS Plus)

1281 bottles of hydroalcoholic gels 500ml, 450 hand towel rolls, 150 mops, 3375 posters (masks, sensitization, prevention), 1125 hand wahing posters, 317 saftey box, 1060 safety box TDR, 100 safety box Triclofem, 225 hand washing devices.

ANTSIRANANA DRSP/CCOR Diana

630 bottles of hydroalcoholic gels 500ml, 41 cans of bleach 5L, 100 bottles of bleach 1L, 80 bottles of virucid, 88 rolls of trash bag, 300 hand towel rolls, 80 chamois, 340 bottles of hand washing soap, 865 washable protective masks, 1500 posters (masks, sensitization, prevention), 3000 flyers, 30 hand washing devices, 08 Airtel Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS).

DIANA PA/PARC Diana

446 soaps, 76 wall mounted soapdishes, 154 hand washing posters, 160 mops, 428 bottles of bleach 1L, 524 washable protective masks, 77 hand washing devices, 160 white blouses, 76 front thermometers,76 rectangular bowls, 2 jerrycan 20L, 447 bottles of hydroalcoholic gels 500ml, 76 sprayers.

DIANA Drug shops & pharmacies

45 hand washing devices, 90 bottles of Sur'eau 150ml, 45 posters (masks, sensitization, prevention), 45 hand washing posters, 135 washable protective masks.

SAMBAVA DRSP/CCOR Sava

560 bottles of hydroalcoholic gels 500ml, 54 cans of bleach 5L, 59 bottles of virucid (1L & 100ml), 88 rolls of trash bag, 300 hand towel rolls, 76 chamois, 260 bottles of hand washing soap, 865 washable protective masks, 1500 posters (masks, sensitization, prevention), 3000 flyers, 25 hand washing devices.

SAVA PA / PARC Sava

534 soaps, 91 wall mounted soapdishes, 184 hand washing posters, 190 mops, 511 bottles of bleach 1L, 524 washable protective masks, 92 hand washing devices, 190 white blouses, 92 front thermometers,91 rectangular bowls, 2 jerrycan 20L, 537 bottles of hydroalcoholic gels 500ml, 91 sprayers.

SAVA Drug shops & pharmacies

45 hand washing devices, 90 bottles of Sur'eau 150ml, 45 posters (masks, sensitization, prevention), 45 hand washing posters, 131 washable protective masks.

MAHAJANGA DRSP/CCOR Boeny

1280 bottles of hydroalcoholic gels 500ml, 180 cans of bleach 5L, 50 bottles of virucid 250ml, 2220 rolls of trash bag 100L, 3520 rolls of trash bag 30L, 350 hand towel rolls, 70 chamois, 880 bottles of hand washing soap, 120 mops, 30 brush brooms, 25 pastic bucket 20L, 25 cups 1L, 216 soaps, 90 hand washing posters, 865 washable protective masks, 60 hand washing devices, 08 Airtel Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS).

MAHAJANGA CHU PZAGA Mahavoky, CHU Androva

849 bottles of hydroalcoholic gels 500ml, 29 bottles of hydroalcoholic gels 200ml, 712 bottles of bleach 1L, 4000 rolls of trash bag 100L, 535 hand towel rolls, 200 chamois, 176 mops, 24 brush brooms, 24 rasta brushes, 24 pastic bucket 20L, 24 cups 1L, 40 jerrycan 20L, 610 bottles of liquid soap, 200 household gloves, 24 bowls, 24 soubiques, 8 rakes, 8 spade, 8 shovels, 8 weelbarrow metalic, 29 hand washing devices.

BOENY Drug shops & pharmacies

56 bottles of hydroalcoholic gels 500ml, 84 washable protective masks, 164 posters (masks, sensitization, prevention), 56 bottles of Sur'eau, 41 hand washing devices.

BOENY PA / PARC Boeny

1280 bottles of hydroalcoholic gels 500ml, 285 bottles of javel 1L, 74 mops, 285 soaps, 57 hand washing devices, 180 washable protective masks, 114 posters, 36 soapdishes simple, 60 front thermometers, 60 sprayers, 17 rectangular bowls, 120 white blouses.

ANTSOHIHY DRSP/CCOR SOFIA 1610 bottles of hydroalcoholic gels 500ml, 170 cans of bleach 5L, 50 bottles of virucid 250ml, 185 rolls of trash bag 100L, 250 rolls of trash bag 30L, 405 hand towel rolls, 80 chamois, 825 bottles of hand washing soap, 80 mops, 30 brush

187


brooms, 25 pastic bucket 20L, 25 cups 1L, 216 soaps, 865 washable protective masks, 60 hand washing devices, 08 Airtel Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS).

FIANARANTSOA CHU Andrainjato

220 hand towel rolls, 10 brush brooms, 295 bottles of liquid soap 1L, 347 bottles of bleach 1L, 10 rasta brushes, 10 plastic bucket 15L,10 bowls 50L, 10 cups 1L, 10 soubiques, 1 rake, 1 shovel, 1 spade, 1 weelbarrow metalic, 369 sterilized compress, 10 tape 5cm rolls, 10 plastic bucket 20L, 15 bottles of hydroalcoholic gels 200 ml, 10 transfert sheet, 10 plastic sheets, 200 rolls of trash bag 100L, 40 jerrycan 20L, 175 mops, 200 chamois, 200 household gloves, 12 front thermometer, 850 bottles of hydroalcoholic gels 500 ml, 30 hand washing devices.

FIANARANTSOA Vehicle Covid

315 hand towel rolls, 14 brush brooms, 315 bottles of liquid soap 1L, 365 bottles of bleach 1L, 14 rasta brushes, 14 plastic bucket 15L, 14 bowls 50L, 14 cups 1L, 14 soubiques, 7 rakes, 7 shovels, 7 spades, 7 weelbarrow metalic, 252 sterilized compress, 14 tape 5cm rolls, 14 plastic bucket 20L, 14 bottles of hydroalcoholic gels 200 ml, 14 transfert sheets, 14 plastic sheets.

FIANARANTSOA DRSP / CCOR Haute Matsiatra

1030 bottles of hydroalcoholic gels 500 ml, 120 cans of bleach 5L, 430 bottles of liquid soap 250 ml, 30 soap powder 1 kg, 60 mops, 60 houselhold gloves, 60 brush brooms, 625 rolls of trash bag 100L, 1250 rolls of trash bag 30L, 276 hand towel rolls, 480 chamois, 60 hand washing devices, 140 hand washing posters, 865 washable protective masks, 08 Airtel Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS).

AMBOSITRA DRSP / CCOR Amoron'i Mania

1030 bottles of hydroalcoholic gels 500 ml, 116 cans of bleach, 430 bottles of liquid soap 300 ml, 30 soap powder 1K, 60 mops, 60 household gloves, 60 brush brooms, 3250 rolls of trash bag 100L, 3500 rolls of trash bag 30L, 516 hand towel rolls, 480 chamois, 75 hand washing devices, 1595 washable protective masks, 8 Airtel Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS).

MANAKARA DRSP / CCOR Vatovavy Fito Vinany

1030 bottles of hydroalcoholic gels 500 ml, 115 cans of bleach 5L, 430 bottles of liquid soap 300 ml, 30 soap powder 1Kg, 60 mops, 60 household gloves, 60 brush brooms, 625 rolls of trash bag 100L, 1250 rolls of trash bag 30L, 276 hand towel rolls, 480 chamois, 55 hand washing devices, 865 washable protective masks, 8 Airtel Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS).

TOLIARA CHU Mitsinjo Betanimena

52 jerrycan 20L, 265 mops, 30 rasta brushes, 200 chamois, 802 bottles of liquid soap 1L, 932 bottles of bleach 1L, 260 household gloves, 30 brush brooms, 30 plastic bucket 15L, 24 plastic bucket 20L, 24 bowls 20L, 24 cups 1L, 30 soubique, 10 rakes, 8 shovels, 8 shades, 29 bottles of hydroalcoholic gels 200ml, 850 bottles of hydroalcoholic gels 500 ml, 287 hand washing devices, 10 wheelbarrow metalic, 24 betadine yellow 125ml, 255 rolls of trash bag, 26 front thermometers, 4900 hand towel rolls, 131 soap powder 1kg.

TOLIARA DRSP / CCOR Atsimo Andrefana

570 bottles of hydroalcoholic gels 500 ml, 110 cans of bleach 5L, 470 rolls of trash bag, 200 hand towel rolls, 115 chamois, 540 bottles of hand washing liquid soap, 692 washable protective masks, 60 hand washing devices, 1500 posters (masks, sensitization, prevention), 3000 flyers, 95 hand washing posters et 200 posters of definition cases, 8 Orange Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS).

TOLIARA PA / PARC Atsimo Andrefana

427 soaps, 120 front thermometers, 212 white blouses , 360 washable protective masks, 512 bottles of hydroalcoholic gels 500 ml, 153 mops, 425 bottles of bleach 1L, 318 hand washing posters, 24 wall mounted soapdishes, 132 soapdishes simple, 94 hand washing devices.

188


MORONDAVA DRSP / CCOR Menabe

90 cans of bleach 5L, 350 rolls of trash bag, 105 chamois, 390 bottles of liquid soap, 420 bottles of hydroalcoholic gels 500 ml, 190 hand towel rolls, 692 washable protective masks, 60 hand washing devices, 8 Airtel Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS).

MORONDAVA PA / PARC Menabe

305 bottles of hydroalcoholic gels 500 ml, 356 washable protective masks, 53 hand washing devices, 61 mops, 305 bottles of bleach 1L, 102 hand washing posters, 61 soapdishes simple, 5 wall mounted soapdishes, 305 soaps, 122 white blouses, 61 sprayers 1L, and 61 front thermometers.

ANTSIRABE DRSP & CCOR Vakinankaratra

1565 bottles of hydroalcoholic gels 500 ml, 150 cans of bleach 5L, 50 rolls of trash bag 30L, 87 rolls of trash bag 100L, 60 mops, 85 bottles of hand washing liquid soap, 182 hand towel rolls, 190 household gloves, 20 rasta brushes, 25 brush brooms, 865 washable protective masks, 69 hand washing devices, 1590 posters (masks, sensitization, prevention), 10 000 flyers, 8 Airtel Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS).

VAKINANKARATRA

PA/PARC Vakinankaratra

898 bottles of hydroalcoholic gels 500 ml, 236 white blouse, 114 front thermometer, 114 washable protective masks, 122 mops, 1 hand washing devices, 114 sprayers 1L, 640 bottle of bleach 1L, 1 jerrycan 20L, 122 rectangular bowl, 122 soap, 230 hand washing posters, 114 soapdishes simple, 12 wall mounted soapdishes, 114 PA/PARC plaque, 669 soaps.

TOAMASINA DRSP & CCOR Atsinanana

715 bottles of hydroalcoholic gels 500 ml, 200 bottles of hydroalcoholic gels 200 ml, 68 hand towel rolls, 195 bottles of liquid soap, 70 cans of bleach 5L, 60 insecticid sprayers, 100 bottles of virucid 250ml, 60 plastic bucket 10L, 865 washable protective masks, 60 cups 1L, 780 chamois, 850 rolls of trash bag 100L, 1750 rolls of trash bag 30L, 150 mops, 90 soap bar, 3 000 flyers, 8 Airtel Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS).

TOAMASINA CHU Analakininina

86 brush brooms, 97 rasta brushes, 3281 bottles of liquid soap 1L, 3824 bottles of bleach 1L,1100 household gloves, 97 cups 1L, 97 plastic bucket, 97 bowls, 97 soubique, 43 spades, 43 shovels, 43 rakes, 43 wheelbarrow metallic, 48 hand washing devices, 1386 sterilized compress, 77 tape 5cm rolls, 32 bottles of hydroalcoholic gels 250 ml, 77 bottles of hydroalcoholic gels 200 ml, 97 plastic bucket 20L, 5415 bottles of hydroalcoholic gels 500 ml, 22 front thermometers, 77 transfert sheets, 77 plastic sheets, 1100 rolls of trash bag 100L, 3131 hand towel rolls, 13260 chamois, 220 jerrycan 20L, 1050 mops, 85 hand washing posters, 5 rolls of trash bag 50L, 5 rolls of trash bag 120L, 4800 posters (masks, sensitization, prevention), 7000flyers.

FENERIVE-EST CHRR Fenerive-Est

26 brush brooms, 350 bottles of liquid soap 300ml, 464 bottles of liquid soap 1L, 20 cans of bleach 5L,20 plastic buckets 10L, 20 cups 1L, 6 soubique, 6 rakes, 13 wheelbarrow metallic, 127 hand washing devices, 1370 sterilized compress, 20 tape 5cm rolls, 240 bottles of hydroalcoholic gels 250ml, 1291 bottles of hydroalcoholic gels 500ml, 37 front thermometers, 51 transfert sheets, 51 plastic sheets, 380 rolls of trash bag 100L, 40 rolls of trash bag 30L, 2694 hand towel rolls, 480 chamois, 445 mops, 100 hand washing posters, 3 garbage bin 50L, 3 garbage bin 100L, 3600 posters (masks, sensitization, prevention), 25 insecticid sprayers, 190 bottles of virucid 250ml, 565 washable protective masks, 280 soap bar, 150 soap powder 1Kg, 6 plastic bucket 15L, 150 bottles of hand washing soap, 677 bottles of bleach 1L.

FENERIVE-EST DRSP & CCOR Analanjirofo

115 bottles of hydroalcoholic gels 250ml, 45 bottles of liquid soap 300ml, 192 bottles of liquid soap 1L, 10 rolls of trash bag 30L, 4 rolls of trash bag 100L, 1056 hand towel rolls, 10 cans of bleach 5L, 220 bottles of bleach 1L, 60 chamois, 6 hand washing devices, 7 hand washing posters, 32 garbage bin stainless steel with pedal, 12 jerrycan 20L, 90 mops, 60 household gloves, 6 rasta brushes, 2 wheelbarrow metallic, 31 soap powder, 6 plastic bucket, 25 garbage bin plastic with pedal, 8 Airtel Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS).

ANALANJIROFO Drug shops & pharmacies

44 bottles of hydroalcoholic gels 500ml, 66 posters (masks, sensitization, prevention), 44 bottles of Sur'eau, 22 hand washing devices.

189


ANALANJIROFO PA/PARC Analanjirofo

59 mops. 38 rectangular bowls, 105 bottles of bleach 1L, 42 hand washin g posters, 21 soapdishes simple, 105 soaps, 76 white blouses, 38 front thermometers, 90 bottles of hydroalcoholic gels 500 ml, 94 washable protective masks, and 38 sprayers.

MAINTIRANO DRSP & CCOR Melaky

1200 bottles of hydroalcoholic gels 500 ml, 150 cans of bleach 5L, 60 mops, 180 household gloves, 70 hand towel rolls, 865 washable protective masks, 57 hand washing devices, 80 rolls of trash bag 100L, 50 rolls of trash bag 30L, 80 bottles of liquid soap, 20 rasta brushes, 90 hand washing posters, 3 000 flyers, 8 Airtel Sim cards with airtime and 3 GB of data (4 SDSP /4 DRS).

MELAKY PA/PARC Melaky

218 bottles of hydroalcoholic gels 500 ml, 208 bottles of javel 1L, 1 jerrycan 20L, 37 mops, 81 white blouse, 37 front thermometers, 134 washable protective masks, 1 hand washing devices, 37 sprayers 1L, 1 bottle of bleach 1L, 37 rectangular bowl, 97 posters, 37 soap dishes simple, 5 wall mounted soap dishes, 37 PA/PARC plaque, 217 soaps.

Table 2 : PCR transported from regions

Article From To

468 Polymerase Chain Reaction

(PCR) specimens

Soanierana Ivongo (13), Fenerive-Est (1), Maroantsetra (6), Mahanoro (2), Bealanana (3), Fianarantsoa (130), Manakara (28),

Sainte-Marie (4) by boat, Maroantsetra (6) by moto, Vavatenina (6), Soanierana Ivongo (13), Toliara (88), Morondava (37), Ambositra

(127), Diego (23)

Toamasina, Antsohihy, IPM Antananarivo, Ifanadiana,

Fenerive-Est

61 GeneXpert specimens

Analalava (1), Mananjary (2), Manakara (45), Sainte-Marie (13) Antsohihy, Ifanadiana,

Fenerive-Est

190

Table 3: Disinfection of PSI offices, warehouses, and vehicles four times (once per week - From May to September)

Table 4 : Summary of SMS sent during Quarter 4 – Targeting Population in USAID's 13 intervention regions

N° MESSAGES ENGLISH TRANSLATION PERIOD

01 Aretin’ny taovampisefoana mora mifindra @ pitidrora sy ny lelo ary ny fifampikasohana ny Covid-19. Raha mila fanazavana fanampiny : Antsoy ny 910 !

COVID-19 is an airborne disease that is easily transmitted through saliva, nasal secretions, and contact. For more information, call 910.

July 9th

02 Mety hisy fambara na tsia ny olona voan’ny coronavirus. Ho fiarovana anao sy ny ankohonanao, fadio ny manao dokotera tena, araho ny toromarika!

A person with the COVID-19 may or may not show signs. To protect yourself and your family, avoid self-medication, follow the instructions!

July 15th

03 Toy ny marary rehetra ny olona voan’ny coronavirus saingy mila fikarakarana manokana, hajao ireo toromarika natao ho @ izany!

COVID-19 patients are like all patients, they just need specific care, follow the prescriptions for them.

July 22nd

04 Ampahatsiahivo ny mpiarabelona aminao hanamafy ny fihetsika manakana ny fipariahan’ny valanaretina. Malagasy mifampitsinjo, mandresy ny coronavirus!

Remind people living in neighborhood to reinforce their social distancing to prevent the spread of the virus. Malagasy who feel solidarity are winners of the coronavirus!

July 29th

05 Ho fanakanana ny fihanaky ny Covid-19: manaova arotava hatrany, sasao matetika @ rano sy savony ny tanana, hajao hatrany ny elanelana 1 metatra!

To stem COVID-19 spread, always wear your mask, wash your hand frequently with soap and water, respect one meter physical distancing !

August 05th

06 Vava, orona, maso no mety idiran’ny coronavirus. Fadio ny mikasika vava orona maso ary manaova arotava hatrany. Hamafiso hatrany ireo fihetsika sakana hafa!

Mouth, nose, and eyes are the gates of the coronavirus. Avoid touching them, always wear your mask. Reinforce barrier gestures.

August 12th

07 Sasao @rano sy savony ny arotava lamba, atapy @masoandro, pasohina mialoha ny hanaovana azy. Rovitina rehefa tsy ampiasaina intsony ary ariana any @fanariampako

Wash your home-made mask, spread out under the sunlight and iron it before wearing. Tear up your mask and put it in a refuse bin whether used.

August 19th

08 Ny fitiliana no manamarina fa voan’ny coronavirus ny olona iray na tsia. Raha miandry ny valin’ny fitiliana ianao mijanona ao an-trano, araho ny toromarika!

Only testing can certify that someone is infected by coronavirus or not. Stay at home

August 26th

REGION ITEM DISINFECTED PROVIDER

DIANA 1 Office/1 Warehouse

BHL

ATSINANANA 1 Office/1 Warehouse/3 Vehicles

VAKINANKARATRA 1 Office/1 Warehouse

SAVA 1 Office/1 Warehouse

ANALANJIROFO 1 Vehicle

HAUTE MATSIATRA 1 Office/1 Warehouse/2 Vehicles ALEO MISOROKA

VATOVAVY FITOVINANY 1 Office/1 Warehouse/2 Vehicles

MELAKY 1 Office/1 Warehouse RINDRA CONSULTING

DIANA 4 Vehicles KALA AUTO

BOENY 1 Office/1 Warehouse/2 Vehicles ALITIA

SOFIA 1 Office/1 Warehouse/ 2Vehicles RAKOTONIAINA

ATSIMO ANDREFANA 1 Office/1 Warehouse SUD ENVIRONNEMENT

VAKINANKARATRA/ATSIMO ANDREFANA/MELAKY

5 Vehicles STATION SERVICE

MENABE/ SAVA 2 Vehicles DRIVER HIMSELF (with sprayed bleach)

191

N° MESSAGES ENGLISH TRANSLATION PERIOD

while awaiting test results and follow the guidelines!

09 Tsy mamindra intsony ny olona voamarina fa sitrana t@ covid-19 ka afaka miverina eny @ fiarahamonina. Hanaja hatrany ny fihetsika sakana izy ireny ka raiso!

People certified cured of the coronavirus are no longer contagious. They will respect barrier gestures so welcome them in your community.

September 02nd

10 Tsy voatery hitondra ny tsimokaretina ny zanaka sy fianakavian’ny marary ny covid-19. Hamafiso ireo fihetsika sakana. Malagasy mifampitsinjo mandresy ny coronavirus

Family and children of coronavirus patients are not necessarily infected by it. Reinforce barrier gestures. Malagasy people, together we overcome coronavirus.

September 09th

192

ANNEX L - Summary of SMS sent during Quarter 4 HEALTH

AREA MESSAGES ENGLISH TRANSLATION TARGET GROUP NUMBER OF

REACHED PEOPLE PERIOD

COVID-19 Ho fanakanana ny fihanaky ny Covid-19: manaova arotava hatrany, sasao matetika @rano sy savony ny tanana, hajao hatrany ny elanelana 1 metatra @olona raisinao!

To slow the spread of COVID-19, always wear your mask, wash your hands frequently with soap and water, and respect 1 meter physical distance from your visitor!

PARC + PA + AC + PHA-G-Dis

5 467

13/07/2020

MNCH Entano ny vehivavy izay hiteraka hampiasa AROFOITRA hisorohana ny otrikaretina tsy hiditra @ foitrany zazamena -vava

Sensitize pregnant women to use Arofoitra to prevent infection of the umbilical cord of the newborn

AC 4 523

24/07/2020

MNCH Salama e, efa tonga ao @ PA mahazatra anao ny Pneumox. Te hahazo mialoha ? Tongava malaky !

Hi, Pneumxox is now available at your usual PA. First come, first served.

AC 4 840

31/07/2020

COVID-19 EMMP

Asio rano sy savony hanasana tanana manoloana ny fidirana ao aminao. Ampatsiahivo ny mpitsidika hanasa tanana mialoha ny hiditra!

Please install a hand washing device (with soap and water) in front of your entry. Remind your visitors to wash their hands before they come in.


5 454

07/08/2020

MNCH Sûr'Eau ranony dia manadio rano mitovy @Sûr'Eau pilina. 1 sarony manadio rano 20 litatra. 1 tavoahangy mahadio rano h@1500 litatra. Manadio rano, Mahasalama !

Sûr’Eau solution and tablets treat water. One cap can treat 20 liters of water and a bottle can treat 1,500 liters. Treated water is healthy!

PARC + PA + AC 4 484

20/08/2020

EMMP Hajao ny fepetra famoahana entana - ny lany daty aloha, mivoaka aloha - na FIFO mba hisorohana ny fanafody lany daty. Mankasitraka

Please respect the FIFO rule that the closest expiration dates come out first - to prevent expiration of drugs. Thank you.


5 497

28/08/2020

COVID-19 Aretin’ny taovampisefoana mora mifindra @pitidrora sy ny lelo ary ny fifampikasohana ny Covid-19. Ampatsiahivo ny olona raisinao ny fihetsika tsy maintsy ataony !

COVID-19 is an airborne disease that is easily transmitted through saliva, nasal secretions, and contact. Remind your visitors of barrier gestures


5 184 09/09/2020

MNCH Entano ny ray amandreny fa ny fanomezany SRO no manolo haingana ny rano very @ zaza raha vao voan'ny aretimpivalanana.

Sensitize parents that giving ORS to their children quickly replaces water lost during diarrhea episodes.

AC 5 021

15/09/2020

PF Salama, tohizo hatrany ny ezaka efa nataontsika ahazoan'ny mpiaramonina fomba fandrindrana fiainampianakaviana sahaza azy, toy ny pilina, tsindrona, kapaoty

Hi, continue all efforts to offer to your community various contraceptive methods like oral contraceptives, injectables, condoms.

AC 4 865

21/09/2020

PF Ho fanatsarana ny hoavy, arindrao ny fiterahana , makà torohevitra eny @ tobimpahasalamana na eny @ AC. Tohizo ny fiarovan-tena @ Covid-19

For a better future, plan pregnancy. Go to the health center or to CHV for counseling. Continue barrier gestures against COVID-19

General Public 2,927,402

30/9/2020

193

ANNEX M – Redeployment of FP products Table 1: Inter-district redeployments

Districts of origin Districts beneficiaries Period

Manandrina Fandrina Quarter 2

Fianarantsoa 1 Ambatofinandrahana Quarter 2

Ambalavao Ambositra Quarter 2

Isandra Manandrina Quarter 2 Ambohimahasoa Quarter 2

Nosy-Be Ambilobe Quarter 2

Ambanja Ambanja Quarter 2 Ambilobe Quarter 2

Toliara I Beroroha Quarter 2

Ankazoabo Sakaraha Quarter 2

Sakaraha Morombe Quarter 2

TOLIARA II Ifanadiana Quarter 2

TOLIARA I Sakaraha Quarter 2

Morondava Toliara I Quarter 2 ToliaraII Quarter 2

Vavatenina Tamatave 1 Quarter 3 Brickaville Quarter 3 Vatomandry Quarter 3 Antanambao Manapotsy Quarter 3

Diego I Ambanja Quarter 3

Table 2: Redeployments from CSB to Pha-G-Dis

CSB of origin Pha-G-Dis beneficiaries Period

Ramena Pha-G-Dis Diego II Quarter 3

Ambohimena Pha-G-Dis Ambanja Quarter 3

Ambalahonko Quarter 3

Antsakoamanondro Quarter 3

Ampasindava Quarter 3

Ankingameloka Quarter 3

Antsatsaka Quarter 3

Djangoa Quarter 3

Ambodibonara Pha-G-Dis Ambilobe Quarter 4

Anjiabe Pha-G-Dis Diego II Quarter 4

Ambatoharanana Quarter 4

Antsaravibe Quarter 4

Antsohimbondrona Quarter 4

Andranofanjava Quarter 4

Managaoka Quarter 4

CSB Pont Sofia Pha-G-Dis Mandritsara Quarter 4

table of content - PDF Server - USAID

Documents

Transcript of table of content - PDF Server - USAID