APPROVED JULY 04th, 2022 - USAID

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APPROVED

JULY 04th, 2022

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TABLE OF CONTENT

I- EXECUTIVE SUMMARY 5

II- INTRODUCTION 11

III- MAIN ACHIEVEMENTS DURING QUARTER 2 12

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

DISTRIBUTION OF QUALITY HEALTH PRODUCTS 12 III.2. IR2: STRENGTHENED CAPACITY OF THE GOM TO SUSTAINABLY PROVIDE QUALITY HEALTH PRODUCTS TO THE MALAGASY PEOPLE 16 III.3. IR 3: EXPANDED ENGAGEMENT OF THE COMMERCIAL HEALTH SECTOR TO SERVE NEW HEALTH PRODUCT MARKETS, ACCORDING TO

HEALTH NEEDS AND CONSUMER DEMAND 48 III.4. IR 4: IMPROVED SUSTAINABILITY OF SOCIAL MARKETING TO DELIVER AFFORDABLE, ACCESSIBLE HEALTH PRODUCTS TO THE MALAGASY

PEOPLE 57 III.5. IR5 - INCREASED DEMAND FOR AND USE OF HEALTH PRODUCTS AMONG THE MALAGASY PEOPLE 66 III.6. CROSS-CUTTING ACTIVITIES 69 III.7. COVID-19 ACTIVITIES 76

IV- KEY CHALLENGES AND SOLUTIONS 83

V- FINANCIAL SUMMARY 87

ANNEXES 89

ANNEX A - PERFORMANCE MONITORING PLAN (PMP) 90 ANNEX B – YEAR 4 WORKPLAN UPDATE 99 ANNEX C - ENVIRONMENTAL MITIGATION AND MONITORING REPORT 126 ANNEX D - SUCCESS STORIES 147 ANNEX E – STOCK INVENTORY REPORT OF MALARIA COMMODITIES AS OF MARCH 2022 155 ANNEX F – STOCK STATUS BY END OF MARCH 2021 159 ANNEX G: DESCRIPTIONS OF THE SEVEN QUALITY DIMENSIONS FOR THE RDQA 166 ANNEX H: COVID-19 ANNEXES 168 ANNEX I: PUBLICATIONS PRODUCED BY MEDIA 179 ANNEX J: UPDATED SUPPLY PLAN 181

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ACRONYMS ABM Accès Banque Madagascar ADDO Accredited Drug Dispensing Outlets A2F Access to Finance AMM Agence de Médicaments de Madagascar ATR Regional Technical Assistant cCD Community-based Continuous Distribution CGL Comité de Gestion Logistique CHRR Centre Hospitalier de Référence Régional CHU Centre Hospitalier Universitaire CHRD Centre Hospitalier de Référence de District CHV Community Health Volunteer CNFM Conseil National des Femmes de Madagascar CNTS Centre National de Transfusion Sanguine CSB Centre de Santé de Base COC Combination Oral Contraceptive CTC Central Technicians Coaches CYP Couple Years of Protection DALY Disability-adjusted life years DCA Development Credit Authority DFC United States International Development Finance Corporation DGFS Direction Générale de Fourniture des Soins DGR Direction Générale des Ressources DEPSI Direction des Etudes de la Planification et du Système d’Information DGFS Direction Générale de Fourniture des Soins DIRCOM Direction de la Communication DRSP Direction Régionale de la Santé Publique DHIS-2 District Health Information System – 2 DLMT Direction de Lutte contre les Maladies Transmissibles DLMNT Direction de Lutte contre les Maladies Non Transmissibles DPLMT Direction de la Pharmacie, des Laboratoires et de la Médecine Traditionnelle DPS Direction de la Promotion de la Santé DSFa Direction de la Santé Familiale DSSB Direction des Services de Santé de Base DVSSER Direction de la Veille Sanitaire, de la Surveillance Epidémiologique et Riposte EMAD Equipe Management de District EMAR Equipe Management Région EMMP Environmental Mitigation Monitoring Plan EUV End User Verification FANOME Financement pour l’Approvisionnement Non-stop en Médicaments FCT Field Communication Team FP Family Planning HPN Health Population and Nutrition INSPC Institut National de Santé Publique et Communautaire GAS Gestion des Approvisionnements et des Stocks GESI Gender and Social Inclusion GF Global Fund GHSC-PSM Global Health Supply Chain – Procurement and Supply Management GOM Government of Madagascar IMPACT Improving Market Partnerships and Access to Commodities Together IR Intermediate Result IPTp Intermittent Preventive Treatment during pregnancy ISM Integrated Social Marketing ITN Insecticide Treated Net LLIN Long Lasting Insecticide-treated Net LMD Last Mile Distribution LMIS Logistic Management Information System LRA Logistic Regional Advisor MCH Maternal and Child Health

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MNCH Mothers Newborn and Child Health MERL Monitoring Evaluation Research and Learning MOPH Ministry of Public Health MOU Memorandum of Understanding MSH Management Sciences for Health MYS Ministry of Youth and Sport NMCP National Malaria Control Program NGO Non-Governmental Organization NSCA National Supply Chain Assessment ONP Ordre National des Pharmaciens de Madagascar PA Point d’Approvisionnement PARC Point d’Approvisionnement Relais Communautaire PIRS Performance Indicators Reference Sheet PMI President’s Malaria Initiative PNLIS Programme National de Lutte contre le VIH/Sida PNLT Programme National de Lutte contre la Tuberculose PMP Performance Monitoring Plan PPR Performance Plan and Report PSHP Private Sector Humanitarian Platform Pha-G-Dis Pharmacie de Gros de District Pha-Ge-Com Pharmacie à Gestion Communautaire RBM Roll Back Malaria RDT Rapid Diagnostic Test RH Reproductive Health RLA Regional Logistic Advisor SBCC Social and Behavior Change Communication SDSP Service de District de Santé Publique SFP Service de Formation du Personnel SHOPS Plus Sustaining Health Outcomes in the Private Sector Plus SoW Scope of Work STIs Sexually Transmitted Infections SP Sulfadoxine Pyriméthamine SPD Superviseurs de Point de Distribution TCA Total Cost Analysis 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 UTGL Unité Technique de Gestion Logistique UNFPA United Nations Population Fund UNICEF Fonds des Nations unies pour l'enfance USAID United States Agency for International Development WASH Water, Sanitation and Hygiene

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I- EXECUTIVE SUMMARY Management : The MERL Director left the project for a new opportunity in February 2022, the hiring process of the new DMERL is underway and will be completed in April 2022. This quarter, from January to late March 2022, IMPACT has spent $2,150,839 without any major changes on activity implementation. Intermediate Results 1: Enhanced coordination among public, non-profit, and commercial sectors for supply and distribution of health products

- Three meetings were held with the National Malaria Control Program (NMCP) this quarter to monitor the progress of activities related to implementation of the malaria roadmap, during which the following achievements were noted:

o The Ministry of Public Health (MOPH) represented by the Direction de la Pharmacie, des Laboratoires et de la Médecine Traditionnelle (DPLMT), in collaboration with DAJ (Direction des Affaires Juridiques or Legal Affairs Department), are in the process of preparing a biannual meeting according to the action plan in the malaria roadmap. This activity wasn’t started until the MOPH level committee was in place to begin their role. Agence de Médicaments de Madagascar (AMM) and DPLMT are officially the co-leaders of the fight against the illegal drug market at the MOPH level and the first meeting is planned for June 24, 2022.

o The committee in charge of updating the list of drugs authorized for distribution through drug stores within the IMPACT project has agreed on an updated list, which will be provided to the steering committee to be validated. This activity is included in the malaria roadmap action plan but also included in the framework of the ADDO project.

o IMPACT staff met with NMCP to prepare the quantification of malaria commodities. A key topic of discussion was how to encourage active involvement of the private sector to provide their data and to participate in the next quantification session. The preparation meeting with NMCP was held on March 21 and the meeting with the private sector is scheduled for April 29, 2022.

- As mentioned in Objective 2 of the malaria roadmap, IMPACT continues to focus on strengthening the leadership capacity of NMCP managers and technicians to take ownership of TMA and manage coordination of the three sectors.

- USAID ACCESS organized the first session of the Leadership Development Program Plus (LDP+) training to NMCP's central technicians, while the IMPACT project provided logistical support for the training. During the training, various areas for improvement were identified, including daily management functions of NMCP team, the need to improve commodity estimates to resolve unavailability or stockouts of malaria health commodities; methods of calculating orders for malaria products that do not comply with Pha-Ge-Com and Pha-G-Dis standards, and the need to improve stakeholders’ knowledge (such as GAS) about Madagascar’s regulatory framework pertaining to malaria products.

- From March 14th to 17th, IMPACT organized a field visit for 6 project partners, including TMA Technical Working Group members and TMA Champions, to improve understanding and awareness of TMA activities implemented at the national level in order to coordinate the three sectors in implementing TMA activities. The purpose of the field visit is to engage regional stakeholders in the TMA process. The field visit helped the participants better understand issues with product availability in the region and explore problems related to delays in payment from Pha-G-Dis and Pha-Ge-Com to SALAMA for products that SALAMA has supplied to them, as well as explore the problem of products from the illicit market undermining the formal market. No solution was yet taken during the meeting but just a few suggestions such as: include in the finance law a financing for the operation of Pha-G-

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Dis. Twenty-three participants signed a letter of participation in the TMA process during the TWG regional meeting indicating their willingness and commitment to integrate into the TMA process. Their effective participation will then be measured through their participation in the various sessions for coordinating activities between the three sectors; such as TMA sub-committees meetings and product quantification sessions in order to improve the availability at all level.

- During the field visit, IMPACT staff evaluated the stewardship capacity-building needs of two TMA champions. Project staff will continue to conduct similar capacity-building needs assessments for TMA Champions in the next quarter.

Intermediate Results 2: Strengthened capacity of the GOM to sustainably provide quality health products to the Malagasy people

- In Quarter 2, IMPACT supported the GAS central committee and the NMCP to organize six joint virtual validation meetings with 105 districts (increased from 51 in Q1) and 39 hospitals (increased from 17 in Q1) to analyze consumption data, malaria cases and stock on hand at the districts and SALAMA to validate 144 reports/orders submitted to the central level for resupply malaria commodities.

- To secure malaria commodities needed in 2024, IMPACT provided technical and financial support to organize a three-day workshop to fill the gap analysis tables and identify commodities and propose quantities to procure with the MOP FY2023 available funds for Madagascar. During the workshop, 19 representatives of NMCP, UNICEF, Fitovinany region, USAID, IMPACT, SALFA, INTERAIDE and ACCESS were introduced to the PMI stock out reduction initiative, analyzed data reported into DHIS2 for malaria commodity stock out rates for the period of 2020 to 2021, and setup targets to reach in order to reduce the stock outs rate in 2022, 2023 and 2024. Based on the stock outs rates, participants conducted a root cause analysis of factors that led to stock outs and proposed strategies to overcome the situation and reduce the stock outs.

- In Quarter 2 of FY22, IMPACT RLAs continued to technically and financially support the EMAR and EMAD to supervise, mentor and coach Pha-G-Dis, hospitals and Pha-Ge-Com service providers. In total, 529 personnel (200 men and 329 women) of 54 Pha-G-Dis, 40 hospitals and 113 Pha-Ge-Com received on-the-job training on inventory stock management, consumption data analysis to correctly estimate quantities for resupply, and best storage practices. At the end of Quarter 2 FY4, 32 Pha-G-Dis (out of 54 supervised or 59%) reached a SPARS score of 90% and above, and were classified as high-performing Pha-G-Dis compared to 47% in Q1. In Q1 FY4, 22/47 (47%) Pha-G-Dis visited had a score of 90% and above, compared to 32/54 (59%) in Q2. The performance of Pha-G-Dis continues to improve. 24 Pha-G-Dis were not visited in Quarter 2 based on their high scores (90% or above) and received remote coaching.

Response to Cyclones IMPACT supported the NMCP to anticipate and transport malaria commodities to 26 affected districts by the five cyclones that the country experienced in this quarter. 474,800 treatments of ACTs, 741,250 tests of RDT and 72,065 vials Artesunate injectable were transported to anticipate an upsurge of malaria due to floods and cyclones. Also, technical assistance was given to the NMCP and RBM stakeholders to estimate additional quantities of malaria commodities to procure to face the challenges of the post cyclone period. The Global Fund and UNICEF committed to mobilize financial resources and proceed to an emergency procurement. LLIN Distribution Campaigns

- IMPACT continued to support NMCP in the closing and reporting activities of the 2021 LLIN mass campaign: finalization of LLIN distribution report, payment of actors, qualitative evaluation, and the conduct of RDQA. The LLIN distribution was completed by December 2021 in all districts except in the

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Marolambo district. The Marolambo district experienced a delay in starting the LLIN distribution due to transportation challenges related to impassable roads to the district. Despite the challenges related to non-accessibility caused by the passage of cyclones Batsirai and Emnati, the districts of Marolambo, Nosy Varika, Ikongo and Ifanadiana were able to collect and send the deliverables to the central level.

- For the other LLIN distribution channels, especially cCD, mass distribution in elimination districts and routine distribution planned for Year4, this period is marked by the support to NMCP on the preparatory activities: review strategies, identification of districts, analysis of budgets and preparation for the LLINs reception. These activities are on track in terms of the timeline.

COVID-19 Activities Continuous support to the MOPH on all response activities against COVID-19 and vaccination initiatives through: - Logistical support

o Transportation and redeployment of 174,092 doses of vaccines (Johnson & Johnson, Pfizer and AstraZeneca vaccines) from the central and regional offices to regional and district offices, respectively.

o Transportation by drone for 1,015 doses of Johnson & Johnson and 390 doses of AstraZeneca in 3 districts (Maroantsetra, Befandriana Nord, and Toamasina II) with 1,792 vaccinated people.

o Transportation of nasopharyngeal specimens (47) for Polymerase Chain Reaction (PCR) tests from Boeny, Vatovavy Fito Vinany and Analanjirofo to be tested by the Health Watch, Epidemiological Surveillance and Response in Antananarivo or the laboratory Center ValBio Ifanadiana.

With IMPACT’s contribution, 21,454 people were vaccinated from January to March in USAID-supported regions

- Community Engagement and Demand Generation o 9 postings on the PSI Madagascar Facebook page to sensitize vulnerable people (pregnant

women, elderly, and people with co-morbidities) on the benefits of being vaccinated. o Broadcast of 2,954 TV spots and 7,582 radio spots to encourage vaccination against COVID-

19. The radio spots were translated into 7 dialects of DIANA, Atsinanana, Atsimo Andrefana, Boeny, and Haute Matsiatra regions.

o 662 sensitizations carried out by Communication Teams in the Field (ECT), having reached 163,370 people (70,400 men and 92,970 women).

o Produced 5,300 caps and 5,000 masks with inscription of « Za Vita vaksiny » translated to “I am vaccinated”, 2,000 posters and 30,000 flyers on four types of available vaccines

- Planning and Coordination o Technical and financial support for the conduct of all coordination meetings at the central and

regional level to the response of COVID-19 activities and vaccinations. - Monitoring, Evaluation, Learning and Health Information Systems

o Continuing support to the MOPH in vaccination data management. Intermediate Results 3: Expanded engagement of the commercial health sector to serve new health product markets, according to health needs and consumer demand Private Sector engagement

- During Quarter 2, IMPACT continued to develop partnerships by creating shared value: o With TELMA via one SMS campaign that was broadcast to support the MOPH during the

Women’s Day celebration. 1,392,975 people were reached by a message focused on a

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women’s right to have access to health commodities. The collaboration is estimated to save/cost/reduce costs by $1,690 which is a 40% discount for TELMA.

o With AQUALMA by shipping 3 sets of social marketing products for free from Mahajanga to PARC Besalampy.

- In Quarter 2, IMPACT supported the MOPH by following up on the regional mission of drug shops training on the use of the PharmaPlus Lite tool to improve their stock, financial management, and to submit data monthly. 15 drug shops owners in the Vatovavy and Fito Vinany regions were visited, and 11 tablets were purchased. The training was also extended to the Diana region and was delivered to 12 drug shops. Eight of twelve drug shop owners purchased tablets in Diana and agreed to collaborate with the MOPH to submit data. The Ministerial note meant to formalize the submission of LMIS data by the private sector is still being reviewed, as there was some turnover in the DPLMT department.

Access to Finance (A2F)

- IMPACT’s two partner banks disbursed five loans valued at $19,435 disbursed to commercial health commodities enterprises. None of the loans have yet been placed under coverage of the DFC guarantee.

- Two regional drug shop associations were created, in Vatovavy Fito Vinany and Boeny, bringing the number of associations created in Year 4 from one to three, for a total of six associations created over the life of the project.

- A group coaching session, and training on the use of management tools on electronic tablets, was provided to 12 drug shops in DIANA.

Intermediate Results 4 Improved sustainability of social marketing to deliver affordable, accessible health products to the Malagasy people

- IMPACT successfully launched the integration of PARC and PA to the national supply chain through the signature of an MOU between MoPH and IMPACT as well as the Official launch of the delivery by drone project in Antetezambaro, Toamasina II

- The scale up of the delivery by drone began in Quarter 2 (in Befandriana Nord and Toamasina II) with three take-off points (one funded by Twilio) and two drones per take-off point bringing the number of drones and take-off operational respectively from 2 to 6 drones (2 in cost share with TWILIO) and from 133 to 233 flights.

- IMPACT proceeded to the first integration of 1 PARC and 19 PA to the Pha-G-Dis and Pha-Ge-Com of the district of Toamasina 2 with an allocation of two months of stocks of FP and MNCH starter batches for each Pha-G-Dis and Pha-Ge-Com.

- For the continuous availability of vital health products in remote and difficult-to-access areas, IMPACT successfully continued the delivery of Malaria, FP and MNCH commodities by drone through 233 flights delivery by drone, and the distribution of FP and MNCH commodities to the 1,109 supply points of the community-based distribution. Malaria products and 11,054 routine vaccines were delivered to 27 CSB in the 14 regions supported by USAID.

- 28 CSB could benefit from the delivery of 600 doses of AstraZeneca and 1,135 doses of Janssen by drone in Quarter 2.

- IMPACT also ensured the continuous availability of FP and MNCH products for the community-based distribution, having a good stockout rate of FP commodities averaging between 0% and 0.8% at PARC and PA

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Intermediate Results 5 Increased demand for and use of health products among the Malagasy people IMPACT supported the celebration of International Women's Day, in collaboration with GESI by:

- Sending 1,680,001 SMS to TELMA subscribers in the 13 USAID-supported regions on March 8, 2022, in collaboration with Axian Fondation.

- Publishing factsheets and a press release on women's empowerment and producing a video with interviews of CNFM and EFOI staff

- Supporting the MOPH in the execution of the medical caravan which took place from March 2-7, 2022, in the region of Amoron'i Mania. IMPACT also supported in Fitovinany by creating demand through the field communication teams.

- IMPACT organized a press tour, with the participation of 21 journalists including 15 from the national level and 6 from the regional level, on March 22th to 24th in Toamasina. This event was coupled with the official launch of the delivery of commodities by drone and the integration of PA/PARC in the public sector channel distribution.

To stimulate demand for health products, IMPACT broadcasted 4,369 TV and radio spots in the following locations:

- 1,200 radio spots on CHX were aired in 36 districts in 10 USAID-supported regions to reinforce the importance of using CHX to prevent neonatal infections.

- 425 TV spots and 1,352 radio spots on family planning were broadcasted in 47 districts of the 13 USAID-supported regions. The message was to inform the population of product availability and a reminder of the different FP methods.

- 1,392 radio spots on malaria, as part of the post-campaign of LLINS Mass Campaign were broadcasted in 45 districts of the 13 USAID-supported regions. The message was to inform the population of the correct, regular use, and maintenance of LLINS.

IMPACT carried out communication activities related to COVID-19 prevention and vaccination through:

- Social media: Nine posts on the Facebook page of PSI Madagascar were published. - Broadcasting of 954 TV spots and 7,582 radio spots to sensitize about vaccination against COVID-19. - Communication teams in the field using mobile sound systems conducted 662 education activities

reaching more than 163,370 people (70,400 men and 92,970 women) in 46 districts in 11 USAID-regions.

- Production of communication tools (5,300 hats with inscription “Za vita vaksiny” and 5,000 masks translated to “I am vaccinated”, 2,000 posters for Catholic churches, 30,000 flyers on the four kinds of vaccines available.

Cross-Cutting GESI

- Coordinated seven activities for International Women’s Day and organized in-person events in Antsirabe and Manakara between March 2nd and 8th.

- Engaged GESI partners on key IMPACT opportunities, including International Women’s Day. - Drafted partnership agreement with local women’s organizations (CNFM and EFOI) to formalize

collaboration as key IMPACT GESI partners. - Represented IMPACT at seven different gender- and health-related working groups and meetings,

including SIGL, MinPop, presidentially supported initiative, USAID, and the mid-term evaluation. - Drafted GESI coaching slide deck to support IMPACT’s regional staff capacity building efforts.

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Monitoring Evaluation, Research and Leaning - IMPACT supported the implementation of RDQA and formative supervisions in the Atsinanana and

Boeny regions. - Finalized study design, data collectors training and data collection for the Evaluation study of

Communication fieldwork team - Developed 4 abstracts for ASTMH and disseminated the second internal Newsletter to share project’s

quarterly key results Table 1 – a: Activities supposed to be completed in Quarter 2 but not done and postponed to Quarter 3/4

Description of the activity Reason for Postponement in Q2 Next period defined

to complete the activity

IR4

The analysis of Sur’Eau transfer

The elaboration of the Term of Reference about the transfer of Sûr’Eau to the private sector was initiated and the process will be continued in Quarter 3. The team prioritized the transfer of PA/PARC and scale up of drone activities during Q2.

Quarter 3

Define a product monitoring system and conduct a study of a product tracking system.

IMPACT has identified a local provider but decided to re-define the functional scope related to the technical aspect in Quarter 3 for more adequacy between the expectation and the offer by the provider.

Quarter 3

Cross-cutting GESI Quarterly meeting with IMPACT’s GESI partners (CNFM and EFOI)

Currently in the process of finalizing a partnership agreement for Year 4. Once the partnership agreement is signed, then meetings will resume.

Quarter 3

Started work on the GESI mainstreaming manual

GESI activities were only restarted in February (after approval of the TEA increase) and focus on International Women’s Day in February and beginning of March delayed this activity.

Quarter 3

Graph 1: Status of activities planned for Q2

43 . 88%

3 . 6%3 . 6%

Main Activities

Ongoing

Not yet started

Completed

6%

72%

9%

13% Sub-Activities

Postponed

Ongoing

Not yet started

Completed

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Table 1 – b: Progress towards USAID priorities Thematic Progress Q2

Climate adaptation This is a substantial commitment for PSI, and we are planning a phased approach, measuring the carbon footprint of the Washington office and the 10 largest country offices (which includes Madagascar) in the first year and beginning to build out a resulting climate action plan, while bringing the full network into the fold in 2023. During this quarter, PSI Madagascar submitted data to PSI HQ to be used in the carbon measurement tool covering the years 2019 (pre-Covid) and 2020, covering: 1) fuel usage from vehicles owned by PSI or generators/boilers used by PSI that burn fossil fuels 2) electric utilities from our office buildings 3) travel: air travel, ground transportation (taxi, uber), hotel stays, and meals while traveling We are at the very beginning of this process. Once we move beyond the measurement phase, we will want to develop a carbon reduction strategy for PSI and for the USAID/IMPACT project specifically

Diversity, Equity, Inclusion, and Accessibility During this year’s International Women’s Day celebrations, IMPACT arranged for one of the participants (a female motorbike loan recipient) from a rural area in the south of the country to provide first-hand testimony and share her experiences in gaining access to finance and the impact to her life and her community. Engaging an individual from this zone helped provide a platform for them to voice their insights to key decision-making personnel including the country’s First Lady.

Private Sector Engagement The private sector engagement continued with TMA initiatives and the development of partnerships by creating shared value

Internship (promoting youth employment) The approach will be integrated during the review of the Human Resources Manual in Q4

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 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)

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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 will summarize the activities carried out during Quarter 2 fiscal year 2022 by the consortium partners. The narrative provides updates on accomplishments, challenges, and solutions for Quarter 2.

III- MAIN ACHIEVEMENTS DURING QUARTER 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 IR1.1.3A1: Support the development and implementation of the FP and MNCH action plans and conduct the program review of the Malaria TMA roadmap According to the malaria roadmap activity’s follow-up meetings, the main progresses in the activities for the implementation of the malaria roadmap are as follows: Table 2: Progress of activities in the TMA roadmap

SPECIFIC OBJECTIVES PROGRESS REPORT Specific Objective 1: Revitalize the regulatory framework for health products

* The semi-annual meetings between DAJ and MOPH is being prepared with DPLMT, DAMM and NMCP. This meeting should occur in during the Quarter 3. The delay in this activity was over who would be the lead between DAMM and DPLMT. After holding a meeting, it was decided that DAMM will lead the activity and it is now in the preparation stage,which includes committee formation and sub-activity planning. * * The NMCP team works in close collaboration with the IMPACT project team on regular monitoring of the legal framework and the market situation for malaria products (availability, quantity, price) with distributors in different sectors. * The list of drugs authorized for drugstores has been completed at the IMPACT project level and will be reported to the ADDO project steering committee level. . * The development of regulatory texts on the import and dispensing of malaria products according to the national protocol should be integrated into the next meeting of the TMA texts and regulations sub-committee in Quarter 3.

Three follow-up meetings on the implementation of the malaria roadmap were realized with NMCP. Twelve participants from NMCP attended leadership capacity building in collaboration with USAID/ACCESS Thirty nine participants attended TWG meeting in Fianarantsoa, and twenty three participants signed letter of participation of TMA.

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SPECIFIC OBJECTIVES PROGRESS REPORT * A term of reference for an advocacy to the National Assembly for the detaxation of LLINs is being prepared by the NMCP team, , this advocacy should take place during the Quarter3. Currently, we are in the landscaping phase, trying to map importers and taxes. * The revision of the drug registration procedures manual by integrating a section specific to malaria products (in particular by facilitating registration) is to be followed closely by NMCP with the TMA texts and regulations sub-committee. NMCP team should attend the next meeting of the subcommittee during the Quarter 3. The next meeting of the texts and regulations sub-committee will be on May 29, 2022. The main agenda of this meeting will be to update of the registration guide

Specific Objective 2: Improve the coordination, management, delivery, and reporting capacity of all actors in the three sectors (public, private and NGOs) at all levels

* The first training session of Leadership capacity building was provided to the NMCP team according to the specific objective #2 of the Malaria TMA roadmap, in collaboration with USAID ACCESS. The IMPACT project team ensured the logistics of the training. Capacity building from the Leadership Development Program plus (LDP+) were provided by USAID ACCESS to the central technicians of NMCP.

* The provision of reporting tools and communication materials (electronic, SMS, etc.) for data feedback refers to the progress of the LMIS roadmap. This is the LMIS software that is in the process of being chosen at the MOPH level. * The cascade training of health workers from the three sectors (public, private, and NGO) on the prescription and dispensing of malaria products in compliance with the national protocol is being inventoried: The training curriculum has been developed and validated by the MOPH. Through this training, all sectors will have the same understanding of malaria treatment in order to better coordinate the availability of malaria commodities, as IR1 is about coordination of all sectors. .

* The revitalization of the GAS committee, and the SIGS (Système d’Information et de Gestion en Santé) at the district and regional levels is ongoing and will be discussed through the periodic meeting of the members of the committee.

Specific Objective 3: Perform health products quantification exercises.

* The meeting with the private sector to prepare the quantification of malaria products has been scheduled for April 29, 2022. * The NMCP has launched a recommendation to organize a small meeting at the district level before sending the quarterly or half-yearly order form in order to improve the management of the order.

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SPECIFIC OBJECTIVES PROGRESS REPORT Specific objective 4: Strengthen communication for social change towards a behavior of correct use of malaria products.

* All activities relating to the communication campaign to carry out RDT in fever case are completed.

Specific Objective 5: Strengthen the supply chain of malaria products

* The inclusion and updating of injectable artesunate needs will be considered in the next quantification sessions. * The quantification session of malaria products will be held on May 2 to May 6, 2022.

Specific objective 6: Set up an integrated logistics management and reporting system.

* The integration of the private sector in the LMIS and RBM sub-committee is monitored by the NCMP team. * The MOPH is currently in the process of selecting a new LMIS software.

IR1.1.3A2: Continue to support the GOM to disseminate all IMPACT results and TMI decisions in collaboration with MERL team. The drafting of FP and MNCH market assessment reports is finalized, and the dissemination and development of the roadmaps is scheduled in Quarter 3 after the official validation of the reports. IR1.1.8A1: Continue to leverage and strengthen the TMA Champions and GOM’s Total Market Initiative (TMI) stewardship, coordination, and facilitation capacity to sustain TMA activities During Quarter 2, the TMA TWG meeting was held in the Haute Matsiatra Region. Three TMA champions were involved in this mission: - Dr Tidahy Sylvie (former director of family health of MOPH), - Tiana Rabenandrasana (director of SK Pharma), - Dr Lova Herizo RAJAOBELINA (President of the Health Committee within the National Assembly); and three leaders representing three TMA sub-committees from the public sector: - Rahanitriniaina Lantosahondra (from DEPSI), - Dr Christian Rakotondrabe (from DPLMT), and - Dr Volapeno Oliva RAHARINIAINA (from DAMM). This mission presented an opportunity for the TMA champions and the sub-committee leaders to remind the TMA process to the DRSP Haute Matsiatra, Chief SMS (Service Medico-Social or Medico-Social Service), the president of the regional representative of pharmacists, and four Medical Inspectors from four districts of the region (Fianarantsoa, Isandra, Vohibato, Lalangina) during a courtesy visit.

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A TMA TWG meeting with 39 participants was held in Fianarantsoa on March 15, 2022, under the leadership of the DRSP Haute Matsiatra and Dr Lova Herizo RAJAOBELINA who is one of the TMA champions and deputy of Madagascar (member of parliament) and president of health committee of parliament. Twenty-three participants signed a letter of commitment to participate in the TMA TWG, indicating their willingness to integrate into the TMA process. Their effective participation will then be measured through their participation in the various sessions for coordinating activities between all sectors, such as meetings of TMA sub-committees and product quantification sessions.

Some key points discussed during the meeting include : - the district has budget management problems, which

leads to a repeated delay in the payment of products to Salama. One responsible from SALAMA suggested to offer financing to the districts as a finance law start-up funds by the government. The deputy noted that the process will begin when the law proposition comes to Parliament. This point will be discussed at the level of the TMA texts and regulations sub-committee during the proposal to amend the texts, during Q4.

- PhaGeCom providers are often forgotten and suffer from problems related to delayed or forgotten payments. According to the DRSP, the process of finding a solution is in progress and the transfer of the funds to the MOPH needs to be reinforced.

- There are illegal sales of non-quality products in the streets and the ambulatory/door-to-door market. Drug stores help supply remote areas but there are differences in the effectiveness of drugs due to these illicit sales. DPLMT representative noticed that notification should be given in case of drug quality failure. There is a quality control pilot project at MOPH. All are encouraged to report drug quality issues. Two available TMA champions were assessed in their Stewardship capacity during the field visit in Fianarantsoa. This activity will continue for the next quarter and will involve MOPH staff, and the results will be shared at the end of the assessment.

TMA TWG meeting in Haute Matsiatra Region:

Facilitators:

Three TMA champions and 3 MOPH representatives from DAMM, DPLMT and DEPSI.

Key points discussed:

- Presentation of the TMA process, the TMA roadmap progress, and the importance of integrating the region into the process.

- Follow-up process to be supported by the TMA champion, who is also a member of the National Assembly, if the proposed funding for Pha-G-Dis reaches the Assembly,

- The problem of payment to PhaGeCom providers which is being resolved according to the DRSP, but the funds allocated by MOPH should be increased

- Notification should be given in case of drug quality failure, within the fight against the illicit market of drugs according to DPLMT representative.

16

IR1.1.9A1: Review, update, and continue the implementation of the overarching TMA roadmap for all health products No meeting of the texts and regulations sub-committee was organized during this quarter due to the unavailability of the DAMM team, which heads this sub-committee. However, the DAMM team is in the process of validating the updated registration guide at the level of the same team. The PPNPDPN sub-committee did not hold any meetings but mentioned that the updated PPN is still at the government level, awaiting the release of the decree. The terms of reference for a meeting of TMA TWG members with the UTGL have been developed and sent to DPLMT for feedback. This activity is awaiting the availability of DPLMT team. The SIGL sub-committee leader was recently replaced so the meeting did not take place this quarter.

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 IR2.1.3A1: Increase the capacity of the MOPH to provide oversight to public SCM IR2.1.3A1-SA1: Support the GOM and stakeholders to apply the global PMI stock out reduction initiative introduced in 2021. Mobilize technical assistance from GHSC-PSM to facilitate in country discussions to setting stock out rate baselines and targets, understanding the root causes of stock out reduction and developing solutions to address them, and finally designing interventions that target root causes to maximize stock availability at all levels of the public supply chain IMPACT provided technical and logistical assistance to the NMCP to organize a three-day workshop from March 30 to April 1, 2022, with the GAS central malaria committee to analyze data consumption, forecasting and supply plans of malaria commodities developed in December 2021, and identify gaps to mobilize resources to cover through the MOP 2024. In April, nineteen (19) participants representing NMCP, the Regional Health Direction of Fitovinany, UNICEF, USAID, IMPACT, ACCESS, SALFA and INTERAIDE were introduced to the global PMI stock out reduction initiative, using the material developed by PSM, discussed the root causes of commodity stock outs, looked at historical stock out rates reported into DHIS2 for 2019 - 2021 to set up targets for 2022-2024, and identified priority actions to achieve the targets in terms of stock out reduction of malaria commodities across the country. In addition, IMPACT supported the participants by filling in the malaria commodity tables’ gap analysis to secure funding for procuring commodities in 2024 and developed the narrative section of the supply chain to be included in the MOP 2023 document. IR2.1.3A1-SA2: Technically support the central level GAS Committees to collect and analyze consumption and service data in order to develop quarterly distribution plans for malaria and FP/RH products based on reports/orders submitted by Pha-G-Dis. Commodities will be transported to districts through the service contract signed between IMPACT and SALAMA (both routine distribution and emergency distribution)

529 individuals received on-the-job training and coaching through supportive supervision visits carried out by EMAR with technical support of RLAs 47 Pha-G-Dis, 80 CBS/Pha-Ge-Com and 32 hospitals supervised 60% of Pha-G-Dis received a SPARS score of 90% or greater and are classified as high-performing compared to 47% in Quarter 1

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Malaria Commodities From January 6 to February 25, 2022, IMPACT supported the NMCP to organize six joint virtual meetings to validate orders of malaria commodities submitted by 105 districts to complete the Quarter 1 FY22 distribution cycle. Note that the order validation for the nine districts were validated in December 2021. The NMCP, the central GAS malaria committee, the 105 district GAS representatives, and EMAR analyzed data consumption and stock on hand in those districts and at SALAMA as well as malaria cases reported by the districts to project needs for Quarter 2. At the end of the meetings, the average monthly consumption and the quantities of malaria commodities to distribute to each district were validated. A total of 144 orders submitted by 105 districts and 39 hospitals were jointly analyzed and approved during the period. Table 3 below highlights quantities of malaria commodities transported to the 114 districts in this quarter: Table 3: Quantities of malaria commodities shipped to the 114 districts in Q2 FY22

Product specifications Quantity shipped from PMI stock

(units)

Quantity shipped from Global Fund

stock (units)

Total quantity shipped

Artesunate/Amodiaquine 25/67.5 mg Tablet, 25 x 3 Blister Pack Tablets

28,575 1,825 30,400

Artesunate/Amodiaquine 50/135 mg Tablet, 25 x 3 Blister Pack Tablets

236,675 24,925 261,600


201,950 30,100 232,050


275,300 700 276,000

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

799,850 685,175 1,485,025

ARTESUNATE 100 MG SUPPO - BTE/2 7,508 7,508 Artesunate (w/ 1 Amp NaHCO3 5% + 1 Amp NaCl 0.9%) 60 mg Vial, 1 Set

58,135 21,093 79,228

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

415,650 488,700 904,350

Between January and March 2022, Madagascar experienced five cyclones that led to loss of human life, increased floods, and tempests, and destroyed infrastructure in various regions of the country. IMPACT supported the cleaning and tidying up of Pha-G-Dis following the cyclones. Due to the floods, there is a high risk of an increased level of mosquitoes and thus, an upsurge of malaria cases. To face the situation, the NMCP and the central GAS malaria committee decided to urgently transport AS/AQ and RDTs to the 26 affected districts to anticipate this upsurge and have enough stocks of malaria commodities. The Table 4 below summarizes the prepositioned stock shipped to districts to respond to the cyclone aftermath. GF will procure sufficient quantities of malaria commodities to replace this stock in Quarter 3.

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Table 4: Quantities of malaria commodities shipped to 26 districts as a post cyclonic response

Region District ACT. 2-11

m (Dose)

ACT 1-5y (Dose)

ACT 6-13y

(Dose)

ACT > 14y (Dose)

Artesun Inj.

(Vial)

RDT (Test)

ANOSY Amboasary Sud 780 9,360 8,502 9,984 4,967 34,476

ATSINANANA Antanambao Manampontsy

156 1,248 546 390 319 5,928

ANDROY Betroka 780 3,744 3,822 3,744 2,036 20,514 ATSIMO ATSINANANA

Farafangana 3,120 37,908 18,486 13,728 10,369 95,628

ANALANJIROFO Fénerive Est 78 702 390 702 319 9,906 FITOVAVY Ifanadiana 1,872 20,280 18,720 7,800 7,220 78,000 FITOVAVY Ikongo 2,340 19,734 22,074 7,566 7,736 56,160 ATSINANANA Mahanoro 702 4,602 4,992 2,574 2,002 27,300 FITOVAVY Manakara 546 4,134 3,432 2,106 1,554 25,662 ANALANJIROFO Mananara Nord 78 78 156 234 102 12,480 VATOVAVY Mananjary 780 2,964 4,368 1,950 1,595 21,684 ANALANJIROFO Maroantsetra 78 234 468 780 312 3,042 ATSIMO ATSINANANA

Midongy du Sud 1,326 17,940 6,240 6,630 4,492 21,840

ANALANJIROFO Nosy Boraha 78 78 78 78 48 936 V7V Nosy Varika 1,014 4,836 4,212 - 1,242 15,600 ANALANJIROFO Soanierana Ivongo 78 1,092 1,014 1,326 624 10,140 ANOSY Taolagnaro 1,248 14,352 11,232 7,800 5,347 62,400 ATSINANANA Toamasina I 78 78 78 156 68 5,304 ATSINANANA Toamasina II 312 1,482 234 468 319 17,706 BETSIBOKA Tsaratanana Sud 78 546 702 780 380 5,772 ATSIMO ATSINANANA

Vangaindrano 3,900 29,640 27,378 21,372 13,260 109,200

ATSINANANA Vatomandry 156 1,248 1,560 1,248 719 18,564 ANALANJIROFO Vavatenina 234 624 390 390 244 6,240

ATSINANANA Vohibinany (Brickaville)

468 1,014 1,560 468 523 8,736

FITOVAVY Vohipeno 624 4,212 2,886 3,042 1,717 24,336 ATSIMO ATSINANANA

Vondrozo 2,964 16,224 7,915 5,763 4,551 43,680

Total 23,868 198,354 151,435 101,079 72,065 741,234 MNCH Commodities In Quarter 2, the technical advisor assigned to DSFa started his work in January 2022 and supported the DSFa/ Maternité Sans Risque (MSR) department to organize three monthly meetings, from January to March 2022, of the TWG/MSR. The TWG is composed of representatives of IMPACT, ACCESS, UNICEF, UNFPA, and UCP. During the meetings, IMPACT supported the MSR Department to collect stock available of donor-funded commodities, consumption data, and service data reported through DHIS2 to plan distribution of Magnesium sulfate, Misoprostol and Chlorhexidine. In February 2022, 148 reports/order forms were submitted by 113 SDSPs, 14 public hospitals, and 21 private clinics to DSFa, analyzed, and validated by the TWG/MSR. Based on distribution plans developed, IMPACT transported MNCH commodities to 57 Pha-G-Dis, 5 public hospitals, and 20 private clinics in 64 USAID supported districts; UNICEF and UCP transported the commodities in their respective regions of intervention. The partners provided the transportation as an urgent measure to top up supplies of MNCH commodities in the districts, but SALAMA will continue the distribution thereafter. Table 5 presents the total quantities of MNCH commodities validated and transported by each partner.

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Table 5: Total quantities of MNCH commodities transported to districts per partner

Commodity Quantity validated for distribution

Quantity transported by

IMPACT

Quantity transported by UNFPA, PARN, UNICEF

Chlorhexidine sulfate 7,1% tube 104,550 38,250 66,300

Magnesium sulfate 50% inj.amp.10ml vial

19,724 15,310 4,414

Misoprostol 200mcg 4 tablets 99,676 16,590 83,086

IR2.1.3A1-SA3: Provide technical assistance to support 13 regional UTGL and 78 district level GAS Committees to strengthen their leadership to analyze consumption reports from the CSB and plan resupply of malaria, MNCH, and FP/RH products In Quarter 2, the RLAs continued to coach and supervise the UTGL and GAS committees to ensure the proper functioning of these committees, with the objective of holding at least one meeting per quarter. Regional Level: All the 13 regions (100%) organized quarterly coordination meetings to evaluate activities implemented during the period of January to March 2022 and planned activities for the next quarter. Through the meetings, members of the UTGL 1) analyzed the districts’ physical stock inventory reports of malaria, FP, and MNCH commodities; 2) reviewed and ensured that quarterly orders of the districts were correct and submitted to the central level on time; 3) identified stock imbalances and commodities nearing expiry and addressed issues found; and 4) discussed and validated supply chain-related activities and action plans (supervision, audit, inter-district and -regional redeployment, emergency orders, etc.). District Level: During Quarter 2, 71 out of 78 (91%) districts organized GAS committee meetings. The number of GAS committee meetings increased from Quarter 1 of FY22, which had 59 out of 78 or 75% meet. The seven districts that did not meet were Ifanadiana, Mananjary, Vohipeno, Mananara North, Maroantsetra, Vavatenina, and Morafenobe. Due to the overlap of activities at the district level and the unavailability of all members, the seven districts could not organize the meeting and they postponed it to Quarter 3 of this year. The 71 GAS committees analyzed the stock available in their Pha-G-Dis and CSBs to plan distribution at the last mile (CSB and CHV) and redeployment in case of overstock. Redeployment of stock is an emergency measure to ensure commodities do not expire and over the life of the IMPACT project. The amounts being redeployed have gradually reduced, showing the improved stock management practices. However, some adjustments and stock redistribution are unavoidable, and this is now managed by the regional and district teams under IMPACT supervision rather than done by the IMPACT RLAs as in the beginning of the project. The monitoring of distribution to the CSBs and CHVs was also discussed at the GAS meeting, especially for commodities with critical risk of expiry (ACT 1-5y, mRDT, Artesunate injectable). District GAS committees analyzed stock status using LMIS data uploaded from CHANNEL (consumption, stock on hand, number of days out of stock, quantity received, and waste) and determined corrective actions (redeployment, emergency ordering, supervision, audit, and rationing system). Table 6 shows the redeployment organized by the UTGL and the GAS committees during Quarter 2.

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Table 6: Health commodities redeployed during Q2 FY22

Product specifications Type of

commodity Quantity

redeployed Expiry date District supplier

District beneficiary


Malaria 250 April 2022 Vohémar Sambava


Malaria 50 April 2022 Nosy Be Ambanja


Malaria 2,000 July 2022 Mahabo Miandrivazo


Malaria 1,650 July 2022 Manja Morondava


Malaria 100 July 2022 Ambohimahasoa Lalangina


Malaria 100 July 2022 Isandra Fianarantsoa I


Malaria 5,000 September 2022

Manja Miandrivazo


Malaria 1,000 September 2022

Manja Morondava


Malaria 200 July 2022 Ikalamavony Vohibato


Malaria 100 July 2022 Ambohimahasoa Fianarantsoa I


Malaria 1,200 March 2022 Belo sur Tsiribihina Miandrivazo


Malaria 13 February 2022

Nosy_Be Ambanja

21


commodity Quantity



Malaria Rapid Diagnostic Test (RDT) HRP2/pldh (Pf/PAN) Cassette, 25 Test Kits

Malaria 1000 July 2022 Fandriana Ambatofinandrahana


Malaria 2700 July 2022 CHRR Antsohihy Mampikony


Malaria 4050 July 2022 Antsohihy Mampikony


Malaria 5400 July 2022 Antsohihy Analalava


Malaria 2700 July 2022 Manja Miandrivazo


Malaria 2700 July 2022 Manja Belo sur Tsiribihina


Malaria 1575 February 2022

Morombe Toliara I


Malaria 1350 July 2022 Morombe Toliara I (Raolison)


Malaria 3000 August 2022 Vohémar Andapa

Artesunate (w/ 1 Amp nahco3 5% + 1 Amp nacl 0.9%) 60 mg Vial, 1 Set

Malaria 500 July 2023 Marovoay CHU Androva


Malaria 200 July 2023 Manja Miandrivazo


Malaria 300 July 2023 Manja Belo sur Tsiribihina

ARTESUNATE 100 MG SUPPO - BTE/2

Malaria 200 March 2022 Mahabo Belo sur Tsiribihina

22


commodity Quantity




Malaria 550 March 2022 Mahabo Miandrivazo


Malaria 2480 April 2022 Morombe Toliara I (Raolison)


Malaria 750 March 2024 Ambohimahasoa Vohibato


Malaria 750 March 2024 Ambohimahasoa Isandra


Malaria 750 March 2024 Lalangina Fianarantsoa I


Malaria 750 March 2024 Lalangina Ambalavao

COTRASAFE-Amp Family Planning

800 June 2022 Diego I Ambilobe

COTRASAFE-Amp Family Planning

2000 May 2022 Nosy_Be Ambanja

TRICLOFEM - Amp Family Planning

2260 April 2024 Brickaville Toamasina II

SAYANA PRESS 104mg/0.65ml- INJ-B/200

Family Planning

3100 December 2023

Marovoay Majunga I


Family Planning

500 December 2023

Marovoay Majunga II


Family Planning

1000 December 2023

Diego I Mahajanga II


Family Planning

400 December 2023

Diego I Mitsinjo


Family Planning

1600 December 2023

Diego I Mahajanga I


Family Planning

1000 December 2023

Marovoay Mahajanga I

23


commodity Quantity




Family Planning

200 December 2023

Marovoay Mahajanga II


Family Planning

200 December 2023

Soalala Mitsinjo


Family Planning

1000 January 2023 Diego I Ambanja

IMPLANON NXT- UNITE Family Planning

180 October 2024

Marovoay Mahajanga I

IMPLANON NXT- UNITE Family Planning

100 October 2024

Marovoay Majunga II

LEVOPLANT-Amp Family Planning

300 April 2023 Marovoay Mitsinjo


200 April 2023 Marovoay Mahajanga II


500 April 2023 Marovoay Mahajanga I


300 April 2023 Fenerive Est Soanierana Ivongo


150 April 2023 Fenerive Est Tamatave I


150 April 2023 Fénerive Est Tamatave 2


50 April 2023 Lalangina Fianarantsoa 1


150 April 2023 Lalangina Ikalamavony


50 December 2023

Brickaville Toamasina II


50 December 2023

Brickaville Toamasina I

MICROGYNON B/3*28 COMP Family Planning

1000 November 2022

Marovoay Mitsinjo


400 November 2022

Marovoay Soalala

24


commodity Quantity




500 November 2022

Ambalavao Isandra

MICROLUT B/3*35 COMP Family Planning

100 March 2023 Marovoay Ambatoboeny

DISPOSITIF INTRA-UTERIN - UNITE

Family Planning

50 January 2024 Brickaville Toamasina I

DISPOSITIF INTRA-UTERIN - UNITE

Family Planning

50 January 2024 Brickaville Toamasina II

MAGNESIUM SULFATE 50% INJ.AMP.10ML - BTE/10

MNCH 330 March 2022 Antsohihy CHU Androva Majunga


MNCH 20 March 2022 Antsohihy Mitsinjo


MNCH 20 March 2022 Antsohihy Marovoay


MNCH 40 March 2022 Soalala CHU Androva


MNCH 60 March 2022 Mitsinjo CHU Androva


MNCH 10 March 2022 Ambatoboeny Marovoay


MNCH 10 March 2022 Mahajanga I CME CHU Androva


MNCH 12 March 2022 Marovoay CHRD2 Marovoay


MNCH 60 March 2022 Mahajanga II CME CHU Androva


MNCH 5 April 2022 Morombe Toliara I


MNCH 100 May 2022 Antsohihy Befandriana nord

MISOPROSTOL 200mcg - CP -B/4 MNCH 548 May 2022 Ambanja Nosy Be

MISOPROSTOL 200mcg - CP -B/4 MNCH 332 May 2022 Diego I Ambanja

MISOPROSTOL 200mcg - CP -B/4 MNCH 180 May 2022 Diego I Nosy Be

25


commodity Quantity



MISOPROSTOL 200mcg - CP -B/4 MNCH 480 May 2022 Manja Belo sur Tsiribihina

MISOPROSTOL 200mcg - CP -B/4 MNCH 480 May 2022 Manja Miandrivazo

MISOPROSTOL 200mcg - CP -B/4 MNCH 900 May 2022 Manja Morondava

MISOPROSTOL 200mcg - CP -B/4 MNCH 440 May 2022 Antsohihy Befandriana nord

CHLORHEXIDINE SULFATE 7,1% tube

MNCH 300 September 2022

Majunga I Marovoay

CHLORHEXIDINE SULFATE 7,1% tube

MNCH 400 September 2022

Soanierana Ivongo Mahanoro

IR2.1.3A1-SA4: Collaborate and leverage technical and financial assistance with other stakeholders (UCP/GF, UNICEF, and UNFPA) to support 13 regional UTGL and 78 district level GAS Committees to train/coach newly recruited EMAR, EMAD and Pha-G-Dis staff on stock management

Through supportive supervision visits carried out by EMAR with technical support of RLAs, 529 individuals received on-the-job training and coaching in Quarter 2. Details of the participants are shown in Table 7.

The capacity building focused on: - Management of expired, damaged, and surplus products, - Coordination and distribution of quality health commodities, - Good storage practices and conditions for health commodities, - Infection prevention and control and WASH in the context of COVID-19, - Calculation of quantities to order based on average monthly consumption data and specifically

projected cases taking into consideration seasonality of malaria, - Updating of the key modules in the GIS procedure manual, - Refresher training in CHANNEL.

Table 7: Individuals who received training and capacity building during Q2 FY22, by cadre:

Cadre Males Females Total

Pha-G-Dis Service Providers 24 37 61

Pha-Ge-Com service providers 70 177 247

Hospitals service providers 23 47 70

EMAR & EMAD/GAS Committee Members 59 51 110

TFP Personnel 24 17 41

Total 200 329 529

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IR2.1.3A1-SA5: Initiate an e-Learning training program on stock management and collaborate with DPLMT and Service de Formation Professionnelle (SFP) of the MOPH to integrate the training as a requisite for Pha-G-Dis contract process In Quarter 2, IMPACT explored the possibility of setting up an e-learning platform for Pha-G-Dis. A meeting was held with the ACCESS team to learn how they set up a similar online training platform for CSB and CHV. In the next quarter, IMPACT will engage an external training company to develop the platform. IR2.1.3A1-SA6: Strengthen the capacity of 13 Regional (EMAR) and 78 District (EMAD) teams to conduct on-the-job supervision visits using the continuous quality improvement approach with SPARS (Supervision, Performance Assessment, and Recognition Strategy) and start to institutionalize it During Quarter 2, the RLAs continued to provide technical and financial support to the 13 EMAR for supervising the Pha-G-Dis, hospitals, and CSBs/Pha-Ge-Com. In total, 54 Pha-G-Dis, 116 CBS/Pha-Ge-Com and 40 hospitals were supervised. In addition, four Pha-G-Dis (Manakara, Benenitra, Ambatomainty and Mampikony) were audited as part of the contract’s renewal process. The results of the supervision carried out in Quarter 2 are:

- 54 Pha-G-Dis out of 52 targeted (103%) were supervised. 24 Pha-G-Dis were not visited in Quarter 2 based on their high scores (90% or above) and received remote coaching.

- In the 54 Pha-G-Dis visited, the supervisors applied the SPARS checklist and uploaded data into the DHIS2 database currently managed by IMPACT.

- Highlights of Quarter 2 SPARS results include: o 32 (60%) Pha-G-Dis received a SPARS score of 90% or above and are classified as high-performing, o 22 (40%) Pha-G-Dis received scores comprised between 75% and 89% and are classified as average-

performing, o 0 Pha-G-Dis (0%) received scores below 75%, o 19 Pha-G-Dis previously categorized as average-performing moved into the high-performing

category: Diego II, Marovoay, Soanierana Ivongo, Miandrivazo, Manja, Belo sur Tsiribihina, Morondava, Sakaraha, Tuléar II, Mampikony, Antsohihy, Mandoto, Vohibato, Lalangina, Ikalamavony, Fianarantsoa, Ambatofinandrahana, Manandrina, and Maintirano,

o 4 Pha-G-Dis previously in the low-performing category, moved into the average-performing category: Tamatave I, Ankazoabo, Beroroha, and Antsalova.

However, there were four (4) Pha-G-Dis that scored lower in Quarter 2 FY22 compared to Quarter 1 FY22 due to low stock management and commodity security score. In each district the RLA will support the Pha-G-Dis to develop correctives actions:

- Tamatave II: The stock management and availability of commodities score was 69%, but overall, the Pha-G-Dis is classified in the high-performing category (score of 93%). The Pha-G-Dis experienced stock outs of FP commodities due to insufficient stock under the minimum level at the central level. The RLA will support the Pha-G-Dis service provider to monitor with DSFa all upcoming deliveries of FP commodities that are expected to arrive in the country in April-May 2022.

- Ambatoboeny: The stock management and availability of commodities score was 74% and the Pha-G-Dis is classified in the high performing (93% ) due to stock outs of MSR commodities. The RLA will follow up on the orders for other donor funded MSR commodities (Chlorhexidine, Misoprostol and Magnesium sulfate) transported by IMPACT.

27

- Antsirabe I: The Pha-G-Dis service provider’s contract expired in February 2022. The DRSP is planning an audit in May 2022 as part of the contract renewal process. The Pha-G-Dis also reported stock out of Primaquine and Levoplant which led to a commodity security score of 65%. The RLA will support the EMAD to follow up with DSFa and SALAMA on the delivery of Levoplant. Currently, Primaquine is out of stock at SALAMA due to a difficult procurement process to get the product in the country.

- Ambatolampy: The Pha-G-Dis service provider’s contract expired. In addition, the Pha-G-Dis was not reporting on time and experienced stock outs of ACT adult, Primaquine, T Contraceptive injectable, and Chlorhexidine. The commodity security score was 67%. The RLA will support the EMAD to follow up on the orders for the other donor funded MSR commodities transported by IMPACT and follow-up with DSFa and SALAMA on FP commodities. The RLA will continue the coaching of the Pha-G-Dis to update stock movement and report on time.

Table 8: Categorization of the 54 supervised Pha-G-Dis according to SPARS scores in Quarter 2

SPARS score category

# Districts List of districts

High performing (score >90%)

32

Ambilobe, Diego I, Diego II, Tamatave II, Majunga I, Majunga II, Ambatoboeny, Marovoay, Fenerive Est, Soanierana Ivongo, Miandrivazo, Manja, Belo sur Tsiribihina, Morondava, Tuléar I, Sakaraha, Tuléar II, Mampikomy, Antsohihy, Antsirabe I, Antsirabe II, Mandoto, Ambatolampy, Vohibato, Lalanginja, Isandra, Ikalamavony, Fianarantsoa, Ambatofinandrahana, Manandrina, Fandrina, Maintirano

Average performing (75% < score >89%)

22

Brickaville, Antanambao Manapotsy, Tamatave I, Marolambo, Ifanadiana, Vohipeno, Manakara, Sainte Marie, Ankazoabo, Benenitra, Betioky, Beroroha, Ampanihy, Morombe, Befandriana nord, Port Berge, Ambositra, Antsalova, Sambava, Antalaha, Vohémar, Andapa

Low performing (score <75%)

0 -

Table 9: Comparison between Q4FY21 and Q2FY22 SPARS score for the 54 Pha-G-Dis visited in Q2 FY22

# Region Pha-G-Dis

SPARS composite score in Q4

FY21 [])

Current SPARS composite score

in Q2 FY22)

Change in SPARS composite score

(Q2 FY22 compared to Q4 FY21)

1 DIANA AMBILOBE 91% 94% +3%

2 DIANA ANTSIRANANA I 92% 95% +3%

3 DIANA ANTSIRANANA II 82% 93% +11%

4 ATSINANANA BRICKAVILLE 75% 84% +9%

5 ATSINANANA TOAMASINA II 93% 92% -1%

6 ATSINANANA Antanambao Manapotsy 85% 87% +2%

28

# Region Pha-G-Dis


FY21 [])


in Q2 FY22)



7 ATSINANANA TOAMASINA I 70% 82% +12%

8 ATSINANANA Marolambo, 86% 86% 0%

9 V7V Ifanadiana 83% 85% +2%

10 V7V Vohipeno 83% 88% +5%

11 V7V Manakara 84% 88% +4%

12 BOENY Mahajanga II 91% 93% +2%

13 BOENY Mahajanga I 92% 93% +1%

14 BOENY Ambatoboeny 94% 93% -1%

15 BOENY Marovoay 82% 93% +11%

16 ANALANJIROFO Sainte Marie 79% 84% +5%

17 ANALANJIROFO Fénerive Est 93% 93% 0%

18 ANALANJIROFO Soanierana Ivongo 88% 93% +5%

19 MENABE MIANDRIVAZO 86% 91% +5%

20 MENABE MANJA 87% 91% +4%

21 MENABE BELO Sur TSRIBIHINA 85% 90% +5%

22 MENABE MORONDAVA 89% 90% +1%

23 ATSIMO ANDREFANA Tuléar 1 90% 92% +2%

24 ATSIMO ANDREFANA Ankazoabo 72% 87% +15%

25 ATSIMO ANDREFANA Sakaraha 87% 92% +5%

26 ATSIMO ANDREFANA Benenitra 76% 77% +1%

27 ATSIMO ANDREFANA Betioky 77% 88% +11%

28 ATSIMO ANDREFANA Toliara 2 88% 92% +4%

29 ATSIMO ANDREFANA Beroroha 47% 85% +38%

30 ATSIMO ANDREFANA Ampanihy 82% 84% +2%

31 ATSIMO ANDREFANA Morombe 80% 85% +5%

32 SOFIA Befandriana nord 84% 88% +4%

33 SOFIA Port Bergé 87% 89% +2%

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# Region Pha-G-Dis


FY21 [])


in Q2 FY22)



34 SOFIA Mampikony 89% 92% +3%

35 SOFIA Antsohihy 86% 93% +7%

36 VAKINANKARATRA Antsirabe 1 92% 91% -1%

37 VAKINANKARATRA Antsirabe 2 93% 94% +1%

38 VAKINANKARATRA Mandoto 86% 91% +5%

39 VAKINANKARATRA Ambatolampy 92% 91% -1%

40 HAUTE MATSIATRA VOHIBATO 81% 90% +9%

41 HAUTE MATSIATRA LALANGINA 85% 90% +5%

42 HAUTE MATSIATRA ISANDRA 91% 93% +2%

43 HAUTE MATSIATRA IKALAMAVONY 86% 90% +4%

44 HAUTE MATSIATRA FIANARANTSOA 87% 91% +4%

45 AMORON' I MANIA AMBATOFINANDRAHANA 88% 90% +2%

46 AMORON' I MANIA MANANDRIANA 89% 90% +1%

47 AMORON' I MANIA FANDRIANA 91% 92% +1%

48 AMORON' I MANIA AMBOSITRA 75% 80% +5%

49 MELAKY MAINTIRANO 79% 90% +11%

50 MELAKY Antsalova 58% 80% +22%

51 SAVA SAMBAVA 86% 89% +3%

52 SAVA ANTALAHA 84% 87% +3%

53 SAVA VOHEMAR 79% 87% +8%

54 SAVA ANDAPA 80% 87% +7%

During supervision visits and remote coaching, the RLA and EMAR identified improvements in inventory management:

- 100% of the 54 Pha-G-Dis supervised in Quarter 2 correctly filled out the stock cards and stock movements are up to date.

- 100% of the 54 Pha-G-Dis supervised in Quarter 2 complied with good storage conditions (cleanliness of storerooms, oxytocin stored in the cold chain either in the Pha-G-Dis fridge or EPI fridge, temperature controlled, all products stored in shelves and pallets).

- 100% of the 78 supported Pha-G-Dis systematically sent physical inventories at the end of each month to the GAS and UTGL committees.

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- 37 of the 78 IMPACT-supported districts (47%) validated data reported into CHANNEL before submitting the report to DPLMT.

Table 10: Disaggregation of SPARS scores of the 54 districts by domain in Q2 FY22

DISTRICT Human

Resources

Inventory Control System

Stock Manage- ment and

Commodity Availability

Storage Practices

Governance

Orders, Distribution, and Reports

Overall Score

Lalangina 100% 90% 67% 100% 100% 81% 90%

Ikalamavony 85% 94% 63% 95% 100% 100% 90%

Isandra 100% 95% 65% 95% 100% 100% 93%

Vohibato 100% 94% 61% 84% 100% 100% 90%

Fianarantsoa I 95% 95% 67% 96% 100% 94% 91%

Ambositra 90% 75% 63% 82% 100% 69% 80%

Ambatofinandrahana 95% 95% 63% 92% 100% 94% 90%

Fandriana 100% 95% 63% 96% 100% 100% 92%

Manandrina 100% 90% 64% 90% 100% 94% 90%

Antsirabe 1 100% 100% 65% 88% 100% 100% 92%

Antsirabe 2 100% 100% 70% 96% 100% 100% 94%

Betafo 100% 100% 71% 96% 100% 88% 92%

Ambatolampy 95% 100% 67% 100% 94% 88% 91%

Brickaville 100% 90% 59% 93% 92% 73% 84%

Marolambo 86% 100% 63% 94% 100% 73% 86%

Antanambao Manampontsy

91% 90% 59% 93% 100% 85% 87%

Tamatave I 95% 94% 59% 80% 92% 73% 82%

Tamatave II 100% 95% 69% 93% 100% 94% 92%

Majunga I 100% 90% 65% 100% 100% 100% 93%

Majunga II 100% 90% 65% 100% 100% 100% 93%

Marovoay 95% 95% 73% 94% 100% 100% 93%

Ambatoboeny 100% 90% 74% 91% 100% 100% 93%

Ambilobe 100% 100% 68% 96% 100% 100% 94%

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DISTRICT Human

Resources




Storage Practices

Governance


Overall Score

Antsiranana I 100% 94% 76% 100% 100% 100% 95%

Antsiranana II 100% 90% 66% 100% 100% 100% 93%

Soanierana Ivongo 95% 100% 75% 97% 100% 92% 93%

Sainte Marie 91% 100% 64% 100% 100% 50% 84%

Fénerive Est 100% 100% 76% 100% 100% 79% 93%

Ankazoabo 88% 100% 61% 100% 100% 75% 87%

Beroroha 100% 95% 50% 97% 75% 92% 85%

Morombe 74% 95% 57% 100% 100% 81% 85%

Tulear I 100% 100% 68% 100% 100% 85% 92%

Sakaraha 100% 100% 71% 93% 100% 88% 92%

Betioky 90% 100% 72% 93% 83% 88% 88%

Tulear 2 90% 100% 71% 93% 100% 100% 92%

Benenitra 95% 95% 71% 96% 71% 33% 77%

Ampanihy 90% 100% 85% 96% 83% 48% 84%

Belo sur Tsiribihina 95% 100% 69% 100% 100% 79% 90%

Miandrivazo 95% 100% 68% 97% 100% 85% 91%

Morondava 86% 100% 48% 100% 100% 92% 88%

Manja 95% 100% 69% 79% 100% 100% 91%

Antsohihy 95% 100% 74% 96% 100% 92% 93%

Port Bergé 95% 92% 78% 100% 83% 88% 89%

Mampikony 95% 100% 73% 91% 100% 94% 92%

Befandriana Nord 95% 93% 74% 93% 83% 88% 88%

Maintirano 95% 95% 56% 100% 100% 94% 90%

Antsalova 85% 95% 56% 91% 79% 75% 80%

Manakara 90% 86% 68% 100% 88% 94% 88%

Ifanadiana 100% 100% 55% 100% 71% 85% 85%

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DISTRICT Human

Resources




Storage Practices

Governance


Overall Score

Vohipeno 93% 100% 66% 81% 88% 100% 88%

Sambava 95% 100% 48% 89% 100% 100% 89%

Vohémar 100% 100% 48% 100% 100% 75% 87%

Andapa 95% 100% 46% 100% 100% 81% 87%

Antalaha 90% 100% 48% 100% 100% 81% 87%

Average scores by domain 95% 96% 65% 95% 96% 87% 89%

For the SPARS assessments conducted in Quarter 2, the weakest domain was stock management and commodity availability. In the future the RLAs will organize EMAD and Pha-G-Dis trainings on correctly estimating quantities for resupply.

At the commune level, the RLA and EMAD supervisors highlighted that 116 CSBs/Pha-Ge-Com out of 104 targeted (111%) were supervised:

- 100% of the 116 Pha-Ge-Com supervised correctly filled out the stock cards. This is a great improvement that will lead to accurate logistics data and correct estimation of needs for future resupplies.

- 100% of the 40 hospitals supervised in Q2 complied with good storage conditions. At the hospital level:

- 41 out of 46 targeted (86%) hospitals were visited, including ten (10) CHRD I, twenty-one (21) CHRD II, six (6) CHRR, and three (3) CHU.

- The CHU Kabary of Diego, CHRD Mananara Nord, CHRR Sambava, CHRD 2 Morafenobe and CHRD 1 Ambatomainty were not visited due to unavailability of the service providers.

Supervision in Pha-G-Dis Ambatoboeny conducted by Dr Toky, EMAR/GIS Manager of the Boeny

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IR2.1.3A1-SA7: In coordination with DRSP and SDSP, conduct call-to-action meetings to mobilize resources necessary to upgrade the storage standards and conditions of the Pha-G-Dis to the best practice standards in order to maintain good quality of stored commodities (renovation, cold chain, pallets, shelves, thermometers, management tools, etc.) and transportation of health commodities to the CSB

To improve the storage conditions of Pha-G-Dis and enable them to control and monitor temperature, IMPACT purchased 36 thermometers to monitor room temperature. The RLAs will continue to sensitize districts and CSB teams to procure small equipment such as thermometers and pallets and shelves for the storage of commodities. There are other Pha-G-Dis that have roof problems that cause water leakage, etc. These issues will be addressed in the next quarter to upgrade storage conditions of their warehouses.

To improve the CHANNEL reporting rate, IMPACT replaced nonfunctional laptops of Pha-G-Dis of Manakara (Fitovinany Region) and Nosy Be (Diana Region).

IR2.1.3A1-SA8: Organize coordination meetings with key partners (ACCESS, UCP, UNICEF, PIVOT, INTERAIDE, IPM) at central, intermediate, and peripheral levels to plan interventions to support the supply chain of the priority health areas (malaria, FP, and MNCH) at all levels In Quarter 2, IMPACT organized 29 regional coordination meetings and 37 district-level meetings with various stakeholders to coordinate actions aimed at improving the availability of stock of antimalarial, FP, and MNCH products. Results of the meetings include: - IMPACT and ACCESS teams in Atsimo Andrefana discussed how to improve stock management at the

district and CSB levels. They decided to train nine ACCESS staff (6 men and 3 women) on stock management during the supervision missions by district teams. The individuals included: the ATR of UCP Atsimo Andrefana (1 man), the ATR of UNICEF (1 woman), and the Program analyst of UNFPA (1 man).

L

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- The RLAs and ACCESS district teams supported the 78 districts in the 13 regions to analyze service data and estimate quantities to order for FP and MNCH commodities and submit orders to DSFa.

- In DIANA, the ACCESS and IMPACT teams identified activities to implement together: supervision visits of the CSBs, dissemination of job aids in CSBs/Pha-Ge-Com, and coordination of COVID-19 vaccination activities.

- In Vakinankaratra, the IMPACT and ACCESS staff collaborated to support the EMAR in preparing and organizing the 7 district- GAS committee meetings. The 7 GAS committees are currently functional.

- In Menabe (Manja district), the IMPACT and ACCESS teams organized a joint supervision visit with the Regional Malaria Manager and the District Technical Assistant of 3 CSBs and community sites.

IR2.1.3A1-SA9: Integrate civil society membership into the board of the Pha-G-Dis to increase accountability to the population In March 2022, IMPACT conducted a mapping of civil society organizations (CSOs) operating in the 78 supported districts of the 13 regions to determine how to engage those CSOs in the management of the Pha-G-Dis. Currently:

- 12 CSO are operating in the 13 regions and have contributed to past mass LLIN distribution campaigns. - 1 CSO is managing the Pha-G-Dis of Antanambao Manampontsy. - 9 Pha-G-Dis are managed by the EMAR or EMAD due to thefts and mismanagement by the service

providers recruited. - 14 Pha-G-Dis are managed by associations led by Ministry of health staff.

The mapping showed that CSOs can contribute in the management of the Pha-G-Dis. IMPACT will approach the DPLMT and share the idea of engaging the CSOs to oversee the management of the 23 Pha-G-Dis currently managed by the MOPH staff and/or associations led by the MOPH staff as the practice does not comply with existing standards. An approach of engaging the CSOs will be developed together with DPLMT and adopted as a strategy to improve good governance of pharmaceutical products at the peripheral level and ensure that CSO will improve financial management and reduce mismanagement at the Pha-G-Dis level. IR2.1.13A1: Continue to support NMCP in 2021 LLIN mass campaign distribution strategy, its implementation, and the distribution of 620,350 LLIN procured with USAID/PMI’s fund at the 6 remaining districts

- This Quarter 2 is marked by the closing activities of 2021 LLIN mass campaign: finalization of LLINs transportation to distribution sites for the case of late districts such as Marolambo, finalization of payments for actors, qualitative evaluation and conduct of an RDQA.

Joint ACCESS/IMPACT supervision at CSB2 Beharona, SDSP Manja, DRSP Menabe (March 2022)

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- For Marolambo, ODDIT, CSO service provider, in collaboration with SDSP team and community, was

able to finalize the transportation of 110,800 LLINs planned at 172 distribution sites. As it is a hard-to-reach district, the transport was done on men’s back with the mobilization of as many porters as possible to reach these sites. This approach contributed to the realization of one of the strategic axes of PMI to reach inaccessible Fokontany so that the population in remote areas can benefit LLINs.

As for distribution achievements, 13,318,689 LLINs were distributed in all 101 targeted districts during the 2021 mass campaign (results exported from DHIS2 2021 LLIN campaign, March 28, 2022). The achievement in the districts where the 3,677,000 LLINs acquired under USAID/PMI funding are summarized in the table below: Table 11: Distribution achievements

Total of LLIN purchased Total of LLIN delivery at

site in 26 districts %

Total of LLIN distributed in 26 districts

%

3 677 000 LLINs 3 638 479 LLINs 98,9% 3 576 761 LLINs 97,2%

- 98.7% reporting rate - 98.9% of total LLINs purchased were all delivered to 5,055 distribution sites in the 26 targeted districts

of PMI's LLINs - Among the difference, 38,521 LLINs were left in the districts according to the expressed need of

these 26 districts after households' authentication; 39,830 LLINs declared as remaining and returned to attachment CSBs of these sites and the remaining 21,888 LLINs have been distributed but in the process of being reported (waiting for the distribution reports from the sites).

- 97.2% of LLINs purchased under PMI funds were distributed to households in the 26 districts.

Regarding the payment of actors, the strategies adopted by NCC based on lessons learned from 2018 were: - Payment of community actors done by CSO service providers through cash payment at their CSB of

attachment after validation of the reports. It should be noted that the 25,602 community actors in the 26 districts were supported by IMPACT

- Payment of support staff (Technical staff TA, Monitoring Agents and AAF or Administrative Assistant Financial) by NMCP through NMF3 grant. This payment was made either by banks or by collaboration with Paositra Money for districts that do not have banks.

At the end of Quarter 2, the payment achievements of these actors are summarized in the table below. Among the challenges that caused the delay in payment to the realization of activities include:

- The delay in reporting and validation of reports: justification of the effectiveness of the service provided by these actors

- The various anomalies and non-compliance of supporting documents to process the payment - Accessibility and security problems for hard-to-reach CSBs.

To accelerate the process, IMPACT carried out follow-up activities to support the 04 CSO service providers identified as late (ODDIT, ASOS, NY TANINTSIKA, RINDRA consulting) by holding regular meetings to monitor progress with CSOs, descent for follow-up and field supervision by PSI controllers and coaches to see the effectiveness of the payment and resolve with the CSO managers problems encountered.

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Table 12 : Community actors payment

PLANNED PAID % PLANNED in PMI districts

PAID in PMI districts

%

TRAINING ALLOWANCE

91 546 91 510 99,99% 25 609 25 607 99,99%

ALLOWANCE FOR CENSUS AGENTS

39 895 39 859 99,90% 11 010 11 004 99,95%

ALLOWANCE FOR DISTRIBUTION ACTORS

79 331 79 320 99,98% 23 183 23 172 99,95%

These differences are explained by:

- Training: 36 absent during training: 34 GF zones and 2 PMI zones - Census: 36 absent : 30 GF zones and 6 PMI zones - Distribution: 11 absent during payment at PMI zones

The allowance for these community actors absents at the payment made by CSOs is still within IMPACT. After receipt of complaints by these actors and confirmation by the district health responsible, IMPACT team will process with the payment.

Table 13: Support staff at district level payment

Number of documents for support staff’s payment

TOTAL Percentage

Total paid 5 006 80%

Documents being processed at PSI and NMCP level 1 233 20%

TOTAL 6239 100%

As part of the closing of the mass campaign, a qualitative study was conducted during Quarter 2. The objective of this study is to gather information on the successes and lessons learned from 2021 LLIN mass campaign to guide strategies for future campaigns. Interviews of key actors of the campaign were done by telephone. The study was conducted in 8 selected districts (Soalala, Midongy du Sud, Ambanja, Betafo, Benenitra, Nosy Varika, Toamasina I, Vohipeno), based on the following criteria:

- Area of intervention of PMI/GF - Urban (more than 1000 households) / rural areas - Accessible / hard-to-reach areas - Completeness of DHIS-2 data - Use of 2 types of data reporting SMS / Android SMS and

SMS - Geographical balance between areas

The data collection and analysis for this study was carried out jointly by IMPACT and NMCP. After NCC approval, the results of this study will be shared and included in the final report of 2021 LLIN mass campaign.

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Still part of the closing 2021 mass campaign activities, field visits for data quality assurance by indicators were conducted in Quarter 2 in collaboration with DEPSI and NMCP. The objective was to conduct the RDQA in 67 districts dispatched in 7 axes:

- Axe 1 : ALAOTRA MANGORO: Moramanga ; Ambatondrazaka ; Amparafaravola ; Andilamena ; ATSINANANA Mahanoro ; Vatomandry, Brickaville ; Toamasina 1 and 2 ; ANALANJIROFO : Fénerive Est, Vavatenina, Soanierana Ivongo

- Axe 2: SOFIA: Mampikony, Port Bergé; DIANA: Ambanja, Ambilobe, Antsiranana ; SAVA: Vohimarina , Sambava, Andapa, Antalaha)

- Axe3: ANALAMANGA (Ankazobe) BETSIBOKA (Maevatanàna) ; BOENY (Mahajanga 1 and 2, Marovoay, Ambotoboeny) ; SOFIA (Antsohihy, Befandriana Nord, Mandritsara, Bealanana). Mampikony, Boriziny

- Axe 4: HAUTE MATSIATRA: Ambohimahasoa; Fianarantsoa 1, Vohibato, Lalangina, Isandra; IHOROMBE: Ihosy ; ATSIMO ANDREFANA Sakaraha, Betioky Atsimo, Tulear 1 and; Morombe

- Axe 5: ATSIMO ANDREFANA: Ampanihy Ouest; ANOSY: Betroka, Amboasary Atsimo, Taolagnaro ; ANDROY: Ambovombe, Bekily, Beloha, Tsihombe

- Axe 6: ANALAMANGA: Andramasina ; VAKINANKARATRA: Antanifotsy, Betafo, Mandoto ; MENABE: Miandrivazo, Mahabo, Morondava, Belo sur Tsiribihina

- Axe 7: AMORON’I MANIA: Ambositra - Fandriana - Ambatofinandrahana - Manandriana ; ATSIMO ATSINANANA: Vangaindrano, Farafangana, Vondrozo) ; VATOVAVY FITOVINANY: Ifanadiana, Manakara, Vohipeno, Mananjary

After the restitution and analyses, the results of this RDQA will be presented to the NCC and inserted in the final report and the upcoming Quarter 3 report. Quarter 2 is marked by participation in 2022 virtual meeting of AMP’s partners (Alliance Malaria Prevention) from March 28th to 30th. With NMCP, 04 IMPACT staff actively participated in these 3-day workshop organized by AMP. This year, the chosen themes were:

1. Accessibility of LLINs 2. Scaling new generation LLIN types 3. COVID-19 adaptations and results

Madagascar presented the theme “Mobilization of local resources to deal with the late delivery of PPE” presented by Saraha Rabeherisoa (NMCP). IMPACT was technically and financially involved in the preparation and presentation of these results of 2021 LLIN mass campaign to participants and AMP partners. IR2.1.13A2: Support technically NMCP to organize the 2022 LLIN mass distribution at the 10-elimination district

IMPACT continued to hold bi-monthly coordination meetings with NMCP to discuss preparatory activities and progress monitoring. Among the decisions made in the Quarter 2 meetings are:

- Identification of target districts considering the epidemiological situations of the districts in elimination

- Validation of macro quantification of LLINs, management tools and communication support - Strategies adopted for this 2022 mass campaign - Follow-up of LLIN purchases in progress.

Qualitative Study Areas

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Regarding the target districts, 10 out of the 13 districts in elimination will be targeted by 2022 LLINs mass distribution campaign. Among the identification criteria adopted were the incidence rate of malaria and geographical location (bordering districts in control areas).

Table 14: Elimination districts for 2022 LLIN mass campaign

REGION DISTRICT Number of Commune

Number of CSB

Number of distribution

site

Number of Population

Number of estimated LLIN to be distributed

Analamanga Ambohidratrimo 25 37 326 508 520 310 750 Manjakandriana 25 44 312 241 472 147 550 Diana Antsiranana I 1 3 25 146 900 89 750 Itasy Arivonimamo 23 36 287 384 305 234 850

Miarinarivo 14 27 168 323 102 197 450 Soavinandriana 16 22 136 276 194 168 800 Vakinankaratra Ambatolampy 19 25 162 309 340 189 050

Antsirabe I 5 7 60 273 714 167 250 Antsirabe II 20 38 204 491 161 300 150

Faratsiho 9 20 98 244 944 149 700 TOTAL 157 259 1 778 3 199 652 1 955 300

In September 2022, an estimated 1,955,300 LLINs were planned to be distributed for this LLIN mass campaign at 1,778 distribution sites of the 10 elimination districts. To cover these LLIN needs, an order for 1,425,850 LLINs, in addition to the LLINs already available in the country after the 2021 LLIN mass campaign. The order of this quantity was submitted to the PSI/DC level under funding from GF/NMF3 and will be received in August 2022. In addition, for the implementation, after analysis of the provisional budget and the contributions of the partners, a GAP of 629,528 USD was observed. Faced with this GAP, the NCC plans to mobilize local resources with RBM partners to finance this activity and also see the possibility of financing them with the savings identified from the MID 2021 campaign. IR2.1.13A3: Support the NMCP in the implementation of Community-based Continuous Distribution (cCD) of LLIN in targeted districts for an effective distribution in early FY23 (October 2022) 1,100,000 LLINs planned in MOP 2021 for this cCD channel were submitted for procurement to PSM (300,000 PBO LLINs and 800,000 standard LLINs), ETA in April 2022. The process of identifying a warehouse of 1,200 m² of surface area is in progress and will be finalized to be able to contract for the rental from 1st April 2022. Progress monitoring of preparatory activities for the cCD is included in the weekly meeting of internal IMPACT staff and in the agendas of the coordination meeting with NMCP. In addition, since there is involvement of the MEN (Ministry of National Education) team, IMPACT conducted a courtesy visit to the SG and the Director General of Basic Education to strengthen collaboration and have more of their commitment to support for the implementation of the cCD. For the introduction to the target regions and districts, a verbal communication

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will be submitted to the government and a “Standing Instruction” will be sent by MOPH to the decentralized services (regions, districts and CSB). The submission of the verbal communication is expected in June 2022 For the identification of the target districts of the cCD 2022, the criteria below have been adopted and 14 priority districts have been identified which will be supported by IMPACT:

- Epidemiological situations: o Malaria incidence rate o Malaria positivity rate o evolution of number of malaria cases

- Districts included in “exit plan” after IRS - Dynamism of community activities - Pilot districts for the distribution of PBO LLINs (to

continue) - LLIN coverage by district according to the provisional

results of the 2021 campaign Table 15: cCD districts sectorization for 2022

Regions Districts Population Nb Fokontany Nb CSB Zone

Atsimo Atsinanana

Farafangana 447 069 311 38 ex- DCC 2020

Vangaindrano 390 442 281 50 ex- DCC 2020

Atsinanana Mahanoro 312 912 203 31 IMPACT - ex- DCC 2020

Toamasina II 285 436 172 38 IMPACT - pilote PBO ex- DCC 2020

Boeny Marovoay 216 722 159 21 IMPACT

Ihorombe Iakora 60 692 50 8 NO IMPACT

Menabe Belo sur Tsiribihina 141 950 153 17 IMPACT

Miandrivazo 169 964 143 22 IMPACT

Sofia Boriziny (Port Berge) 249 279 267 23 IMPACT - pilote PBO ex- DCC 2020

Fitovinany Vohipeno 158 520 136 26

IMPACT ex- DCC 2020

Ikongo (Fort Carnot) 224 087 179 28 IMPACT

Vatovavy

Mananjary 303 444 261 40 IMPACT ex- DCC 2020

Ifanadiana 191 175 195 21 IMPACT

Nosy Varika 278 739 268 26 IMPACT

Total 3 430 431 2 778 389

Among these 14 identified districts, there will be 03 districts outside the IMPACT intervention area. But after discussion with NMCP, IMPACT will ensure the implementation in these districts as USAID's contribution to reducing the case of malaria in these 03 districts classified as red zones in terms of malaria. Some of the constraints and challenges of these cCD districts include accessibility and the problem of insecurity.

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From March 07 to 11, 2022, the workshop for the review of the national strategy of LLINs Community-based Continuous Distribution was held at HAVANA hotel. The following entities took part in this workshop:

- MOPH represented by the AT / SG and the LAV, communication, M&E, logistics team of NMCP, the EMAR team of the SOFIA region and EMAD of the Port Bergé district.

- The Ministry of National Education representatives - IMPACT team.

The five-days workshop was divided into two parts: the review of the strategy and the revision of management communication and tools. The participants worked in sub-groups, followed by presentation and discussion in plenary. After the workshop, the draft of the strategy, the management tools (logistics and M&E) and the communication supports were finalized and available. A review of cCD allocated budget for implementation activities is necessary. Indeed, only 12 districts were planned, while 14 were selected. Also, only the training of Community actors was provided for in the validated workplan. However, the actors at all levels of the 7 new districts have not yet received initial training. In addition, the involvement of the EMAD team (RPD and CSB chief) in the supervision and monitoring of activities was not budgeted. IR2.1.13A4: Support NMCP to organize the 2022 LLIN routine distribution at the targeted district As planned in MOP 2021, the main activity carried out is the submission of the order for 200,000 LLINs intended for routine distribution at health facilities. The remaining 38,521 LLINs from 2021 mass campaign converted into routine LLINs following the decision of the NCC after approval by USAID/PMI. They are all already sent and received at the CSB level. Following the various working sessions with NMCP, it was agreed that we will distribute these LLINs in the IMPACT intervention districts for better monitoring and traceability of these routine distribution LLINs. It will therefore be in the districts identified for the cCD for better coverage in LLINs.

The assumption for determination of routine LLIN need is estimated based on the number of pregnant women expected in CPN1 at public health facilities and the number of children <1 year fully vaccinated (CSB). The circuit adopted will be the same as the current routine distribution: central (IMPACT) – district (SDSP) – health center (CSB) – Targeted population. The reporting circuit will follow the MOPH health information system, the results will therefore be exported from DHIS2 to DEPSI. Regarding monitoring, IMPACT will enhance the current resources and plan to involve the RLAs, SPDs and TAs of the cCD.

IR2.1.15A1: Support efforts to strengthen the LMIS and SCM M&E systems IR2.1.15A1-SA1: Provide technical and financial support to DPLMT and DEPSI in the deployment process of the new LMIS tools in the public sector. This activity is part of the implementation of the LMIS roadmap validated in March 2021. IMPACT will leverage funding with other donors such as UCP-Global Fund, UNFPA and UNICEF During Quarter 2, the LMIS committee continued preparatory work to transform the existing paper-based LMIS to a web-based platform, with a goal of improving data accuracy and timely reporting. Since last year, the LMIS committee selected two potential software companies that are meeting criteria defined by the country. A tender document describing the requirements of the software to be selected has been developed and submitted to the Global Fund in November 2021 to request for approval to organize an open tender. A

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meeting was held on February 21, 2022, between the LFA and the LMIS committee responding to Global Fund clarifications and questions before approving the LMIS tender document. As of the end of March 2022, the Global Fund has not yet given approval to UCP to publish the tender document. Currently, the country is looking for an open-source software for sustainability and to avoid paying recurring annual fees to access the software. In the next quarter, the LMIS committee will continue to follow up with UCP and Global Fund to speed up the process of selection of the new software. It is expected that the selection process will be completed by the end of September 2022. During Quarter 2, IMPACT supported the LMIS committee and DPLMT to finalize the list of products, product codes, and facility codes that will be uploaded into the new software and ensure interoperability with the existing systems (DHIS2, SAGE SAARI, etc.). The list of products, product codes, and facility codes (Pha-G-Dis, Pha-Ge-Com, PA, PARC, pharmacy unit) include both FANOME and all vertical programs commodities. IR2.1.15A1-SA2: Provide technical and financial support to the DPLMT to review/update the manual for stock management of health commodities as part of introduction of the new LMIS tool During Quarter 2, IMPACT supported the MOPH to finalize the revision of the manual for stock management and the manual of logistics indicators. The two manuals were signed in March by the Minister of Health and will be disseminated to all levels in the next quarter. The revised manual for stock management integrates terms of reference for supply chain actors at all levels, the LMIS flow and reporting formats, formulas to estimate quantities to order, the rationing system, and the supervision system based on SPARS. IR2.1.15A1-SA3: Conduct two End User Verification surveys in randomly selected facilities in the 13 USAID-supported regions and support the MOPH (UTGL or DPLMT, the NMCP, and DSFa) to implement corrective measures addressing previous weaknesses In Quarter 2, IMPACT continued to monitor actions planned to implement key recommendations from the EUV survey conducted in 2021. Below is a table highlighting the status of the implementation: Table 16: Status of the implementation of recommendations

Recommendation status Period of completion

Update and disseminate the GIS procedure manual at all levels Manual signed by MOPH, ready

for dissemination Dissemination completed by June 22

Reproduce and dispatch logistics management tools at all levels (Pha-G-Dis, Pha-Ge-Com, and community sites not yet started as the manual is

signed in March 2022

Reproduction and dispatch by September 2022

Ensure the dissemination of updated guidelines for case management of malaria at all levels.

Ongoing by the PNLP and DRSP Dissemination completed by June 22

USAID programs IMPACT and ACCESS continue to work closely with other partners (mainly UNFPA) to strengthen the DRSPs and SDPSs to train, mentor, and supervise Pha-G-Dis and CSBs with an emphasis on building capacity and best practices in inventory management.

continuous activity throughout the FY: training of staff, coordination meetings and joint supervisions visits conducted Every quarter

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Recommendation status Period of completion

IMPACT is recruiting a technical advisor to support the DSFa in coordinating the interventions of the various partners to improve the availability of commodities at all levels.

Completed, TA recruited and onboard at DSFa starting January 2022

Fully integrate the purchases and distributions of MNCH commodities into FANOME’s cost recovery system. The central medical stores/SALAMA have already integrated products such as ORS Zinc, amoxicillin, gentamicin, misoprostol, oxytocin, and MgSo4 into the 2021 procurement tender process and the rest of the products (Chlorhexidine) will be integrated in 2022.

Completed. The Chlorhexine currently purchased by UNICEF is now stored and distributed by SALAMA and based on distribution plan validated by the TWG/MSR

Furthermore, IMPACT prepared logistics of the fourth EUV survey that will be completed in April 2022. Eight regions have been sampled among the 78 USAID supported districts, with a random selection of 66 CSBs, 3 CHRDs, 18 Pha-G-Dis, 1 central warehouse/SALAMA, and 15 CHVs. A total of 36 products, including 12 malaria, 9 FP/RH, and 15 MNCH, will be surveyed. Data collection will start in April 2022 and the reports will be ready for dissemination in June 2022. IR2.1.15A1-SA4: Collaborate closely with GHSC-PSM, UNFPA, UNICEF, and SALAMA to support MOPH to plan and conduct a NSCA During Quarter 2, IMPACT collaborated with GHSC-PSM to prepare for the NSCA. The following activities were completed:

- Finalization of the RACI matrix to define roles and responsibilities of the key interveners: IMPACT, GHSC-PSM, Ministry of Health, and USAID.

- Developed a formal NSCA SOW to mobilize the technical assistance of the GHSC-PSM and define together timeline of the evaluation.

- Presented the NSCA methodology to engage the new DPLMT Director and key stakeholders (UNFPA, UNICEF, WHO, SALAMA, European Union, UCP) and harmonize the timeline with other supply chain assessments planned in 2022. A maturity model assessment will be conducted in June by UNICEF, followed by the NSCA in July and the SRAT of UNFPA in October2022. With all data collected through those different evaluations, IMPACT will support the DPLMT and all stakeholders to develop a mid-term (6 to 12 months) and a long term five-year strategic plan.

- Developed an estimated budget of the NSCA to mobilize financial resources from other stakeholders. The budget of the NSCA is estimated to be $125,000 USD. Currently, IMPACT has an available budget of $50,000 USD and UNFPA has mobilized $30,000 USD. Resource mobilization will continue in the next quarter to cover the gap of $45,000 USD.

In Quarter 3, IMPACT will engage various committees (Governance team, steering committee, and core assessment team) to adapt the global NSCA tools and formats to Madagascar. Data collection is planned to start in July 2022 and the report will be ready in January 2023.

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IR2.1.16A1: Implement an integrated forecast and supply planning process for the public sector with related tools for commodity needs assessments IR2.1.16A1-SA1: Continue to provide extended technical assistance to build lasting capacity of GOM programs staff (NMCP, DSFa), and SALAMA on quantification and use of Pipeline software and other global supply planning tools (e.g. PPMRm) In Quarter 2, IMPACT collaborated with the GHSC-PSM to prepare and submit the PPMRm and supply plan analytics tools within the deadline. In the next quarter, IMPACT will provide refresher training to DPLMT, NMCP, and DSFa staff on the use of pipeline software in preparation of the malaria, FP/RH and MNCH quantification workshops. IR2.1.16A1-SA2: Provide technical and financial support to the UTGL members to conduct annual quantification exercises and quarterly reviews to ensure adequate resources are mobilized to procure malaria, FP/RH, and MNCH commodities to cover the public sector needs In March 2022, IMPACT supported the NMCP and GAS malaria committee to:

- Analyze the updated malaria commodity supply plan, present the supply gaps at the RBM meeting, and organize a resource mobilization meeting with PMI and GF. Following these meetings, IMPACT placed two additional orders for ASAQ 6-13 years (180,000 doses) and ASAQ 14 years and older (362,000 doses). IMPACT has also obtained PMI’s agreement to move forward with ordering 1,500,000 doses of ACT in line with the approved MOP FY2022 and introduced the orders into the ARTMIS ordering system. These orders are expected to arrive in the country by the end of September 2022.

- Estimate quantities of malaria commodities to respond to the post-cyclone period and mobilize resources for procurement. The Global Fund committed the necessary funds, and the procurement process has started and products are expected to arrive in Q3.

Table 17: Post-cyclone malaria commodity needs quantified

Technical specifications Unit Quantity (unit)


Treatment 23,875


Treatment 198,375


Treatment 151,450


Treatment 101,100

Artesunate (w/ 1 Amp NaHCO3 5% + 1 Amp NaCl 0.9%) 60 mg Vial, 1 Set Vial 72,065

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

Test 741,250

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IR2.1.16A1-SA3: Coordinate with GHSC-PSM on generation of orders and tracking of shipments/deliveries of malaria and FP/RH commodities procured with USG and other donors (Global Fund, UNICEF, UNFPA) funding and according to agreed upon supply plans. Organize delivery/receipt and storage once the commodities are delivered in country

IMPACT continued to track procurement orders in the pipeline from PMI and the Global Fund for malaria commodities. Monthly updates are shared with the NMCP, GAS Committee, USAID, and UCP to inform order status updates and any actions that may be required on delayed orders. Below are tables that showcase orders’ status in the pipeline of malaria and FP/RH commodities.

Table 18: PMI funded malaria commodities delivered in Quarter2 FY22

Item Description Quantity of

treatment/test/vial/tablet

Requested Delivery Date

Delivery Date at SALAMA

Reference MOP


243,425 February 6, 2022 January 21, 2022 MOP 2021


262,750 February 6, 2022 January 21,2022

MOP 2021


422,925 February 6, 2022 January 21, 2022

MOP 2021


70,900 February 6, 2022 January 21, 2022

MOP 2021

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

1,375,475 October 10, 2021 February 2, 2022 MOP 2020

Malaria Rapid Diagnostic test (RDT) HRP2/pLDH (Pf/PAN) Cassette, 25 tests

1,000,000 February 23, 2022 February 28, 2022 MOP 2021

Artesunate 100 mg Suppository, 2 Suppositories [Cipla]

34,560 September 5, 2022 March 31, 2022 MOP 2021

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Table 19: Status of PMI malaria commodities ordered

Item Description Qty (Unit) Requested Delivery Date

Status Estimated

Delivery Date

Reference MOP

Artesunate/Amodiaquine 100/270 mg Tablet, 25 x 3 Blister Pack Tablets 518,750

September 2022

Supplier assignment in progress

TBD MOP 2022


September 2022


TBD MOP 2022

Artesunate/Amodiaquine 25/67.5 mg Tablet, 25 x 3 Blister Pack Tablets 84,000

September 2022


TBD MOP 2022


September 2022


TBD MOP 2022


1,000,000 June 14, 2022 Order placed; GAD

delayed 03/31/2022 June 14, 2022

MOP 2021

Artesunate (w/ 1 Amp NaHCO3 5% + 1 Amp NaCl 0.9%) 60 mg Vial, 1 Set

100,000 February 28,

2022 Order in preparation

November 30th 2022

MOP 2021

Artesunate 100 mg Suppository, 2 Suppositories

46,000 September 30,

2022 Clarifications in

process November 2022

MOP 2022


1,500,000 July 22, 2022 Supplier assignment

in process TBD MOP 2021

(Routine Individual) LLIN 190x180x170 cm (LxWxH), Single Pyrethroid Rectangular (White), 1 Each [Fujian Yamei]

350,000

May 18, 2022 Pre-alert documents

already received May 25th,

2022 MOP 2021


350,000

May 18, 2022

June 28, 2022

MOP 2021


300,000 May 18, 2022 Pre-alert documents

already received June 22, 2022

MOP 2021

(Routine Individual) LLIN 190x180x170 cm (LxWxH), PBO Rectangular (White), 1 Each [VKA Polymers]

300,000 May 18, 2022 July 19, 2022

MOP 2021

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Table 20: Status of orders of USAID funded FP commodities

Item Description Unit Ordered Quantity

Order Entry Date

Requested Delivery

Date Status

Etonogestrel 68 mg/Rod, 1 Rod Implant, 1 Each implant 21,384 2021-07-27 2022-02-21

Delivery date TBD

Levonorgestrel/Ethinyl Estradiol 150/30 mcg + Sugar Placebo, 28 Tablets/Cycle (PS), 1 Cycle

cycle 3,027,072 2021-07-07 2022-06-14

Delivery date TBD

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

vial 1,742,000 2021-07-07 2022-02-21

Delivery date TBD

Male Condom (Latex) Lubricated, Protector Plus v2, 53 mm, 48 Pcs/Dispenser, 90 Disp/Case, 4320 Pieces

piece 4,838,400 2021-07-26 2022-06-20

Delivery date TBD

Sub-IR 2.2: The public-sector supply chain achieves financial sustainability IR2.2.3A1: Based on total cost analysis (TCA) of the public supply chain, prepare evidence to analyze different supply chain alternatives on the total cost to determine progressive integration of commodities managed by vertical programs into SALAMA circuit and reduce dependence to donor funding for different cost categories of the supply chain IR2.2.3A1-SA1: Support the MOPH to implement some of the changes proposed in the roadmap developed as a result of the total cost analysis to increase efficiency in the supply system and to mobilize other sources of support for the options proposed in the roadmap IMPACT finalized the first draft of the TCA report to be disseminated. In Quarter 2, IMPACT conducted the initial briefing sessions with SALAMA, the hospitals and the TCA steering committee. The steering committee, led by the Secretary General Technical Assistant and comprised of various Directions of the Ministry of Health, SALAMA and TFP (UNICEF, WHO, IMPACT), will meet to plan the wider stakeholder dissemination in June and during which a roadmap for corrective actions will be developed. The total cost analysis (TCA) is a retrospective assessment of costs incurred by the public supply chain from the central warehouse/SALAMA up to commune level (CSB). The costs used for this analysis were reported and incurred from 2017-2019. Data collection was done during the period of October 2020 to January 2021 in 80 facilities (3 CHU, 4 CHRR, 10 CHRD, 16 Pha-G-Dis and 47 Pha-Ge-Com) randomly selected in 8 regions and the one central warehouse/SALAMA. The process consisted of listing the resource categories (pharmaceutical and non-pharmaceutical), identifying the costs of the logistics functions (Storage and warehouses management, waste and financial opportunities loss, inventory management and quality control, distribution and transportation, administrative and logistics management, and procurement management), and analyzing the evolution of costs over the 3 years (Acquisition costs of commodities, inventory stock management, and operational costs related to procurement management).

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Key findings are highlighted below: - The total cost of the public supply chain is estimated at $20,886,655 USD per year. 53% of the total

costs are allocated to SALAMA, 31% of the costs allocated to Pha-Ge-Com, 11% to Pha-G-Dis and 2% to hospitals (CHU, CHRR and CRHD together).

- The disaggregation of the total costs of the supply chain is as follow: 1) procurement of commodities (59.6%), 2) distribution and transportation of commodities from SALAMA to Pha-G-Dis and from Pha-G-Dis to Pha-Ge-Com(14.2%), 3) storage and warehouse management (8.9%), 4) facility administrative logistics, and operational costs (5.7%), 5) inventory management and quality control (4.9%), 6) procurement management costs (4.8%) and 6) waste and financial opportunities losses (2.1%).

- The disaggregation of administrative, logistics, and operational costs are allocated as follows: 1) human resources (61%), 2) infrastructure (23%), 3) transportation of commodities (9%), 4) materials and equipment (3%) and 5) utilities and other costs (4%). It was noted that human resources costs are higher at the Pha-Ge-Com level and constitute 73% of total operational costs.

- Efficient procurement and acquisition costs which consist of 59.6% will reduce total costs of the supply chain and increase efficiency of the supply chain, and thus increase access to medicines by the population

- SALAMA costs increased over the 3 years, and the costs were inconsistent at the intermediate and peripheral levels. This shows that SALAMA is more consistent in financial management.

- SALAMA sub-contract private transportation companies for almost 70% of transportation costs currently.

Overall, the public supply chain is financially viable with an average of 8% of net profit margin over the 3 years. However, facilities are not complying with the profit margins applied by the Ministry of Health which impact financial access, and lead to inequities among the beneficiaries. As a next step, IMPACT will organize a dissemination workshop in June 2022 to discuss the findings, make recommendations, and develop a 2 year ‘road map with activities, timeline, indicators, and results expected. IR2.2.3A1-SA2: Support MOPH to develop a new strategic plan for integration of all essential medicines and commodities (PAIS) through the single circuit of SALAMA This activity is dependent on the National Supply chain assessment giving enough information to develop the PAIS. Data collection of the NSCA is scheduled in July 2022 and the report to be disseminated and used for strategic planning earlier in January 2023. The activity is thus postponed to next year. IR2.2.3A1-SA3: Support the MOPH to mobilize technical and financial support to implement the new PAIS strategic plan Postponed to early next FY for the same reason as for activity IR2.2.3A1-SA2 IR2.2.3A1-SA4: Support the MOPH to study the resources used for procurement, possible efficiency gains in the procurement process and consider a gradual transition of procurement process The activity is planned to start in Q4 as next step of the total cost analysis dissemination workshop

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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 IR3.1.1: Continue to promote public and private sector partnerships to engage the private sector in making available health commodities among commercial sector During Quarter 2, IMPACT continued to develop and implement private sector partnerships related to the availability of health commodities. Four activities were implemented as detailed in the table below: Table 21: Activities implemented with private sector partners

Entity Partnership Details Destination Value

TELMA Communication (40% discount)

1 SMS broadcast completed on Women’s Day celebration to support the MOPH

13 IMPACT regions, reaching 1,392,975 people

$1,690 ($1.00$ = 4,053 Ar)

AQUALMA

Three transportations of social marketing products (shipping) for free

1,008 oral contraceptives, 1,860 intra-Muscular injectable, 600 Sayana Press, 480 Protector plus, 250 SRO/Zinc, 8000 Sur’Eau Pilina, 40 Arofoitra

Boeny region: from PSI Mahajanga to PARC Besalampy

Free

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IR3.1.6A1: Expand private sector engagement to ensure availability of malaria, FP, and MNCH health commodities To expand private sector engagement, integrating the private sector in quantification exercises was planned. A meeting was organized with the NMCP to prepare the quantification activities with the private sector. This meeting focused on data collection from the private sector. As a result, it was recommended that the NMCP, in collaboration with DPLMT and DEPSI, participate in the elaboration of the note on data collection from private sector. IR3.1.2-3A1: Increase access to finance for commercial health commodities enterprises/Expand supply-side financing.

IR3.1.2-3A1 SA1: Provide refresher training to partner banks in credit analysis and loan structuring for commercial health commodities businesses and in the utilization of the DFC guarantee.

- During the mission in the DIANA region at the end of March 2022, the access to finance (A2F) team conducted a training session for the Antsiranana branch of partner bank Baobab Banque Madagascar, training 14 staff members (6 men, 8 women). The half-day training provided information on the market potential of commercial health commodities enterprises and how the DFC guarantee can be used to support loans to this sector. NOTE: Training for the Antsiranana branch staff of AccèsBanque Madagascar (ABM) was conducted on April 2, 2022 and will be reported in Quarter 3.

- IR3.1.2-3A1 SA2: Increase utilization of financial products and tools developed with partner banks in previous years (e.g., pharma loans, motorbike loans).

- In Quarter 2, a total of five loans were disbursed by the two partner banks to pharmacies and drug shops, for a total of $19,435.

- Cumulative disbursements for Year 4 total $107,138, representing 107% of the Year 4 target of $100,000.

- Partner banks reported a significant decrease in loans to the health sector this quarter. Both banks have experienced significant staff turnover. Baobab reports that 75% of their staff are new and unfamiliar with the bank’s internal reporting procedures for health loans. The bank has requested training from IMPACT to help familiarize new staff with health loan products and with DFC guarantee requirements. The A2F team will meet with both partner banks in Quarter 3 to better understand the situation and to determine a plan of action to support the banks in lending to the health sector. In addition, some commercial health commodities enterprises are demonstrating reluctance to use borrowed funds to relaunch their activities following the pandemic economic crisis.

- In the past two quarters, none of the loans disbursed by the partner banks to commercial health commodities enterprises have been placed under the DFC guarantee. In some cases, that indicates that the bank is comfortable lending to that health enterprise without the additional guarantee; in

IR3 Main Achievements

Private Sector Engagement Discount of 40% for a SMS campaign Three sets of social marketing products shipped for free 12 new drug shops owners trained on the use of PharmaPlus Lite in the Diana region

A2F

Five loans valued at $19,435 disbursed by the two partner banks to commercial health commodities enterprises. Two drug shop regional associations created (Vatovavy Fito Vinany and Boeny). One in-person group coaching, combined with training on using management tools on electronic tablets, provided to 12 drug shops in DIANA. A2F team leading/co-leading three internal committees for the ADDO program: financial viability, norms and accreditation, and training curricula.

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other cases, it indicates that bank staff require refresher training on the DFC eligibility criteria, so that these loans can be placed under guarantee coverage.

- IMPACT is developing partnerships with additional financial institutions to expand access to finance to a larger number of commercial health commodities enterprises in the project regions. Memoranda of understanding (MOUs) have been drafted with two financial institutions (Première Agence de Microfinance (PAMF) and KRED, the microfinance branch of BNI Madagascar) and are expected to be signed in Quarter 3.

- The project continues to support partner banks expanding their market in the health sector. During the International Women’s Day (IWD) celebration in Manakara on March 8, IMPACT, in collaboration with the Ministry of Population, invited ABM and Baobab to present their financial products to about 30 women entrepreneurs.

Table 22: Loans Disbursed to Health Commodities Enterprises by Partner Banks

Year 1-3 Actual

Year 4

Year 4 Targets Quarter 2 Actual Cumulative

Non-DFC loans DFC loans Total

Loans Non-DFC

loans DFC loans

Total Loans

Non-DFC loans

DFC loans

Total Loans

Total Target

% Achieved

Number of loans disbursed by ABM 34 11 45 4 0 4 11 0 11

Men 15 5 20 2 0 2 8 0 8 Women 18 6 24 2 0 2 3 0 3 Unknown 1 0 1 0 0 0 0 Number of loans disbursed by Baobab

50 8 58 1 0 1 9 0 9

Men 27 4 31 1 0 1 8 0 8 Women 21 4 25 0 0 1 0 1 Unknown 2 0 2 0 0 0 0 0 0

Total number of loans disbursed 84 19 103 5 0 5 20 0 20 60 (33%)

Men 42 9 51 3 0 3 16 0 16

Women 39 10 49 2 0 2 4 0 4 Unknown 3 0 3 0 0 0 0 0 0 Value of loans disbursed by ABM $86 503 $104 006 $190

509 $17,577 $0 $17,577 $46,297 $0 $46,297

Men $38 831 $43 371 $82 202 $2,185 $0 $2,185 $29,588 $0 $29,588

Women $46 761 $60 635 $107 395 $15,392 $0 $15,39

2 $16,709 $0 $16,709

Unknown $911 $0 $911 $0 $0 $0 $0 $0 $0 Value of loans disbursed by Baobab

$342 213 $65 213 $407

426 $1,858 $0 $1,858 $60,841 $0 $60,841

Men $117 400 $28 484 $145

885 $1,858 $0 $1,858 $60,125 $0 $60,125

Women $134 884 $36 729 $171

613 $0 $0 $0 $716 $0 $716

Unknown $89 929 $0 $89 929 $0 $0 $0 $0 $0 $0

Total value of loans disbursed

$428 716 $169 219 $597

935 $19,435 $0 $19,435

$107,138 $0 $107,13

8 $100,00

0 107.1%

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Year 1-3 Actual

Year 4

Year 4 Targets Quarter 2 Actual Cumulative

Non-DFC loans DFC loans Total

Loans Non-DFC

loans DFC loans

Total Loans

Non-DFC loans

DFC loans

Total Loans

Total Target

% Achieved

Men $156 231 $71 856 $228

087 $4,043 $0 $4,043 $89,713 $0 $89,713

Women $181 645 $97 364 $279

008 $15,392 $0 $15,392 $17,425 $0 $17,425

Unknown $90 840 $0 $90 840 $0 $0 $0 $0 $0 $0

IR3.1.4A1: Support professional associations to oversee the functionality of commercial health commodities enterprises IR3.1.4A1-SA1: Formalize new drug shop associations and revitalize the existing regional drug shop associations In Quarter 2, IMPACT helped drug shops formalize their associations in two regions: Boeny (Association des Dépôts de Médicaments de la Région Boeny or ADMRB), and Vatovavy Fito Vinany (Asa Fivarotana Fanafody Manara-penitra or AFIFAM). Three regional drug shop associations have been formalized with IMPACT support so far in Year 4, bringing the total to six associations over the life of the project. Table 23: Number of Regional Drug Shop Associations Formalized

Indicator Year 4

Target Y4 (% Achieved) Quarter 1

Quarter 2

Regional drug shop associations formalized 1 (Menabe)

2 (Boeny, Vatovavy Fito Vinany)

2 (150%)

IR3.1.4A1-SA2: Support the development of business management capacity-building within associations by training potential peer trainers. Before the IMPACT mission to the DIANA region at the end of March 2022, the A2F team worked with three local drug shop owners who had received the IMPACT training of peer trainers in Quarter 1, providing them with refresher sessions over Facebook. O ne of the peer trainers was able to attend the IMPACT training/group coaching in Antsiranana March 30-31. The A2F team provided him with additional tutoring prior to the training, and they supervised him while he led the refresher training session on book-keeping on March 30 for the other drug shops in attendance. The team was pleased with the peer trainer’s performance and will continue to test the model of strong refresher training and tutoring prior to supervising sessions by peer trainers in other regions. Based on the favorable outcome of the more intensive coaching conducted with the peer trainers in DIANA, starting in Quarter 4, the IMPACT team will offer online coaching or tutoring sessions to all peer trainers via Facebook at least once a quarter. This will help keep their training fresh and establish experience-sharing among all the peer trainings, helping to ensure the sustainability of the peer training network, for the future benefit of drug shop members of the regional associations.

IR3.1.4A1-SA3: Facilitate involvement of drug shop associations in MoPH activities (TMA, Association des pharmacies, DPLMT meetings, etc.) IMPACT has informed DPLMT of the creation of these new regional drug shop associations and shared the contact information of the association board members. This will allow the MoPH to contact the associations, to invite them to participate in meetings or for other needs.

A drug shop owner in DIANA receives her IMPACT training certificate

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IR3.1.4A1-SA4: Support existing drug shop associations in planning their first annual meetings and providing thematic training on business management On March 14, the new AFIFAM association held its first General Assembly. With the recommendation of the IMPACT A2F team, AFIFAM was able to contract with two pharmaceutical wholesalers to sponsor this event. The association also notified DPLMT that this General Assembly was being held. In the SAVA region, the association’s General Assembly which was planned for March 30 was rescheduled for June 2022 due to heavy rains. Table 24: Regional Drug shop Associations and General Assembly Meetings

Region

Regional Drug Shop Associations General Assembly Meetings

Name Creation

Date

Number of Members

(as of June 2022)

Constitutive General Assembly

1st General Assembly 2nd General

Assembly

Analanjirofo ADMRA Dec 2020 30 Nov 2020 Nov 2021

Atsinanana ADEMERA Mar 2020 32 Feb 2020 Dec 2021

Boeny ADMRB Mar 2022 15 Feb 2022 Sep 2022 (planned)

Menabe ADMME Dec 2021 51 Dec 2021 -

SAVA ADM SAVA Apr 2021 64 March 2021 Jun 2022 (planned) Dec 2022 (planned)

V7V AFIFAM Mar 2022 90 Dec 2021 May 2022 (planned)

IR3.1.4A2: Provide business strengthening capacity building to commercial health commodities enterprises

IR3.1.4A2-SA1: Provide group business coaching as refresher training for drug shops in region(s) which received video training

For the DIANA region, a session of group coaching, and tablet training was held March 30-31, 2022, under the direction of Dr. Hasina Iarivo of DPLMT and in collaboration with Fondation Axian. Twelve drug shop owners (6 men, 6 women) attended the group coaching/tablet training. The first day was dedicated to group coaching for drug shops which had previously received IMPACT’s video business training. The book-keeping session of the group coaching was led by a supervised peer trainer (described above under IR3.1.4.A1-SA2), and the A2F team covered the refresher sessions on drug shop regulations and inventory management. The second day, led jointly by the A2F and Axian teams, was devoted to using an electronic tablet for data collection and financial management.

Table 24: Number of drug shops having received business training: Group Coaching

Indicator Year 4

Target Y4 (% Achieved)

Quarter 1

Quarter 2

Number of people trained in business and financial management: - Group Coaching

15 (group coaching + tablet training in Vatovavy Fito

Vinany; 8 men, 7 women)

12 (group coaching + tablet training in DIANA; 6 men,06

women)

36 (75%)

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IR3. 1.4A2-SA4: Provide initial business strengthening training to drug shops

In Quarter 2, with the support of the regional team, IMPACT continued to distribute video kits for business training to drug shops in the SOFIA region. About two weeks after video kits have been distributed, the A2F team began to contact the drug shops by telephone to answer any questions the owners have, to confirm whether the video training has been completed, and if so, to collect results from the pre- and post-training tests. In many cases, numerous follow-up calls are needed to find a time when the drug shop owner is ready and available to discuss the training results. Eight additional video kits were distributed to eight drug shops in SOFIA in Quarter 2, and three video training follow-ups were completed. Table 25: Number of drug shops receiving business training

Indicator Year 4

Target Y4 Quarter 1 Quarter 2

Number of people trained in business and financial management:

12 3 30: 50%

- By video 12 (6 men, 6 women) (10 in Sofia: 5 men, 5

women; 2 in Vatovavy Fito Vinany: 1 man, 1 woman)

3 (in Sofia: 1 man, 2 women)

- In person 0 0

NOTE: Following the group coaching/tablet training session March 30-31, the IMPACT team made site visits and conducted one-on-one business coaching with those drug shop owners. These coaching visits took place in April and will be reported in Quarter 3.

Sub-IR 3.2: GOM facilitates the work of the commercial sector IR3.2.1A1: Facilitate high-level advocacy by the commercial sector to expand favorable FP policies and regulations

This activity will be covered under IR1 through TWG/AMT subcommittee in charge of Regulations

IR3.2.1A2: Foster sustainable capacity development in regulatory reforms within the GOM IR3.2.1A2-SA1: Provide technical assistance to ensure medical products prequalified by SALAMA and technical/financial partners (TFP) are registered in line with the MOU between DAMM and SALAMA, and the DAMM and TFPs

IMPACT continued to support the implementation of the MOU signed between SALAMA and DAMM in regard of the harmonization process of prequalification of suppliers and registration applied respectively by SALAMA and DAMM to assure quality of medicines imported in the country. A joint technical committee composed of DAMM and SALAMA staff was created in October 2021 to develop a common evaluation grid of dossiers submitted by vendors to SALAMA as part of the international tendering process. Once the prequalification of suppliers and products was complete, SALAMA encouraged the suppliers to submit a file to request market authorization (MA) to DAMM. In the past, the MA took more than a year to authorize, and this situation led to SALAMA to procure commodities on the local market and at higher prices; thus, reducing financial accessibility of commodities to the Malagasy people.

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Since October 2021, the joint technical committee analyzed 126 dossiers with the common grid: - 2 dossiers were complete and approved. SALAMA can proceed to procurement and DAMM granted

the MA - 44 dossiers were temporarily approved with additional information requested from the vendors.

Prequalified vendors can be consulted to supply products to SALAMA, and DAMM will grant MA once the missing information is provided without further analysis.

- 71 dossiers were not approved as major information was missing to assure quality of products offered (certificate of analysis, samples, list of ingredients and excipients, stability assessment report of the product and its raw material). SALAMA will request the suppliers to complete the missing information but will not consider the vendors for supplying the products until the complete information is analyzed and approved by the committee.

- 9 dossiers were not eligible as critical information on the quality of the raw material and ingredients was missing and the dossiers were considered unreliable. The committee recommended not considering the vendors for SALAMA procurements. A second batch of 74 dossiers will be evaluated in May 2022 with the same process. The joint technical committee will develop a report highlighting the impact of this harmonization procedure on the pricing of commodities. SALAMA is also going to review the international tender document and adapt the technical requirements as agreed upon with DAMM.

During Q2, 92 dossiers were evaluated by the joint committee: 2 were approved, 7 refused, and 83 deferred, pending additional information.

IR3.2.1A2-SA2: Continue to provide technical assistance to the DAMM to improve its registration process and set up an electronic registration database During the quarter, IMPACT continued to prepare a demonstration of the PHARMADEX electronic management information system to the DAMM team which is scheduled in May 2022. Presentations and the content of the demo are being translated in French to facilitate DAMM decisions. IR3.2.1A2-SA3: Support the DAMM to conduct of an organizational and functional evaluation study of the Madagascar Medicines Agency as well as the analysis of its financial viability with a view to reviewing its legal status, identifying its real needs in terms of resources and update the nature and amount of its service fees IMPACT has been coordinating with the PQM Plus project to avoid duplication and getting advice on the legal status of the DAMM. Because of this, the activity has been delayed and is set to begin in Q4. IR3.2.1A2-SA4: Collaborate with the Syndicat des Pharmaciens to provide technical and financial assistance to DAMM, DPLMT and the Inter-ministerial committee in their efforts to conduct targeted actions to fight illicit market. Regional workshops will be organized to sensitize local authorities in fighting illicit market and counterfeits medicines A subgroup is being formed internally within IMPACT to develop a draft action plan to fight against the illicit drug market with the objective of focusing on activities to disseminate current pharmaceutical regulations and to inform and educate the public about the risks associated with drugs of unknown source or unassured quality. The plan will be available in May and be shared with the Sub-committee of the TMA for approval and implementation.

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IR3.2.2A1: Develop and pilot an accreditation program for retail drug shops. IR3.2.2A1-SA1: Finalize the preparation phase of the introduction of the ADDO (Accredited Drug Depot outlets) in selected two regions. The two regions will be selected by the steering committee in place since June 2021

Draft accreditation standards for ADDOs, a revised list of medicines approved for depots, and training topics for owners and dispensers seeking accreditation have been developed and submitted for internal review to expedite the finalization of the ADDO pilot preparatory phase. In addition, the TOR for the recruitment of a consulting firm to develop the ADDO training curricula in coordination with the MOPH technical team is being finalized.

On two occasions (February 28 and March 9), a dozen representatives of pharmaceutical entities (Order of Pharmacists, Pharmacists' Union, Association of Pharmacists of Madagascar, and pharmaceutical wholesalers) requested technical support from IMPACT to discuss the ADDO pilot project in the context of the proposed law on the cohabitation of drug depots and pharmacies. As a result of these meetings, the pharmacists agreed to collaborate on proposals for the ADDO drug list, accreditation standards, and training topics.

The National Order of Physicians has given its support to validate the new list of medicines authorized for drug depots. IR3.2.2A1-SA2: Organize meetings in the two selected regions to inform and mobilize health authorities, pharmacists, and drug depot owners via regional associations of drug shops on the purpose and interest of ADDO project. Sensitize the population on how to recognize an accredited drug deport to ensure demand creation In Quarter 2, IMPACT started to develop appropriate communication tools such as the logo and brand of the accredited depot, the name in Malagasy, and the sign as well as messages on the importance of medicine quality and their proper use to inform the population on how to recognize an accredited drug depot. The tools will be used during the pilot phase of the ADDO once approved by the ADDO steering committee. IR3.2.2A1-SA3: Support the DPLMT and the ADDO steering committee to introduce the ADDO in the two selected regions during a period of 6 months as a demonstration phase Completed in Quarter 1 of FY22. IR3.2.2A1-SA4: Carry out a baseline of sales practices and availability of products in the drug shops prior to introduction of the demonstration phase

The draft baseline study protocol and the client/depot questionnaires developed in February 2022 are being finalized for translation into Malagasy and will be configured in Survey CTO. The pre-testing of the collection tools and recruitment and training of the teams of interviewers and supervisors are scheduled for May 2022 (Quarter 3). Data collection and analysis will take place in May 2022 and the results will be available in June or July 2022. IR3.2.3A1: Reinforce private sector active participation to implement TWG-TMA roadmap

Due to the unavailability and turnover of the MOPH staff, there were no meetings held to discuss the text and regulations, PPN PDPN, and SIGL in Quarter 2. The PSHP Health Commission did hold a meeting to discuss and update its action plan. The topics of Pha-G-Dis renovations and the monitoring and implementation of the transportation of health commodities to support the MOPH were covered in this meeting.

DRSP and Participants of the Diana training on the use of PharmaPlus Lite

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As a result of this meeting, the PSHP Health Commission decided to advocate that all Pha-G-Dis be renovated and they will continue to support the MOPH in developing and extending the transportation of health commodities.

As PSHP is starting to set up its Business Emergency Operational Center in Quarter 3, activities and information related to monitoring health commodities, transportation, drug shop censuses, etc., will be collected at the center going forward.

IR3.2.5A1: Continue to support MOPH for effective private sector LMIS data collection Following the training conducted with the MOPH in Quarter 1, a private, supervised, follow up training on the use of PharmaPlus Lite was delivered to 15 drug shops owners. This training, which focuses on stock and finance management, was also extended to the Diana region in Quarter 2. With the central and regional DPLMT staff, the project goals were completed with the following results:

- 12 drug shops from 3 districts, selected by the MOPH were trained and coached. They accepted and signed letter to submit their LMIS data to the MOPH on a monthly basis.

- 8 drug shop owners purchased tablets equipped with mobile data during the training. - The 4 remaining drug shop owners will purchase tablets for the upcoming follow up training in the

region planned for Quarter 3 To facilitate data collection from commercial actors such as pharmaceutical wholesalers, pharmacies, and drug shops, a document was drafted by the MOPH in Quarter 1. Under the recommendations of the DPLMT, this note will be finalized and validated after all planned training of PharmaPlus Lite are completed.

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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 IR4.1.1A1: In collaboration with IR2, DSFa, DPLMT, and DSSB, develop, finalize, and validate the scored criteria, standard, and process to transition from PARC and PA to Pha-G-Dis and Pha-Ge-Com In Quarter 2, the main objectives of the IR4 were: ✔ to launch and implement the first integration of

PARC and PA to Pha-G-Dis and Pha-Ge-Com ✔ to launch the drone delivery project and to scale

up the drone delivery activity in SOFIA and ATSINANANA regions

- The steering committee of the integration of PARC and PA to the national supply chain led by the central UTGL validated all criteria for the integration at Pha-G-Dis level: existence of NGOs managing the Pha-G-Dis, good stock management, warehouse and storage management, governance (finance), reporting on order and distribution, pricing. The activity of integration of PARC and PA is included in the annual workplan of the MoPH. The central MoPH (SG, DGFS, DPLMT, DSFa, DSSB, CAI, DEPSI) and DRSP in the 14 regions were informed and involved in the integration activity of PA and PARC to Pha-Ge-Com and Pha-G-Dis.

- Before the official launch of the integration of PARC and PA, the committee of integration (composed by the UTGL, SALAMA, IMPACT, ACCESS with EMAR, EMAD, ACCESS and USAID) chose the district of Toamasina II for the first integration of PARC and PA and carried out an information and on-field training of the Pha-G-Dis and Pha-Ge-Com of Toamasina I (CSB-Urban and CSMI – Centre de Santé Maternelle et Infantile) and of Toamasina II on the integration related components during the week of March 7th, 2022.

- The MOU between the MoPH and IMPACT was signed during the official kick off integration of PARC and PA to the Pha-G-Dis and Pha-Ge-Com on March 24th, 2022, in Antetezambaro, Toamasina II.

- From the date of signature of the MOU, the FP and MNCH commodities previously managed by PARC and PA in Toamasina II began to be integrated into the Pha-G-Dis and Pha-Ge-Com.

- Starter batches constituting of two months of stock of FP and MNCH products are allocated to the Pha-G-Dis and Pha-

Official launch of the integration of PARC and PA to the Pha-G-Dis and Pha-Ge-Com through the signature of the MOU between MoPH and IMPACT in Antetezambaro, Toamasina II. Integration of 1 PARC and 19 PA of Toamasina II to the Pha-G-Dis and Pha-Ge-Com with an allocation of 2 months of stock of FP and MNCH products to the Pha-G-Dis and Pha-Ge-Com of Toamasina II Official launch of the delivery by drone project in Antetezambaro and scale up to SOFIA and Toamasina II. Stockout rate of FP and MNCH commodities averaging between 0% and 0.8% at PARC and PA

PA receiving a certificate of recognition

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Ge-Com in Toamasina II. The quantity related to these starter batches will be reported in the Quarter 3 as the distribution period of Quarter 2 was closed on March 20th. The number of products delivered to Pha-G-Dis by IMPACT are reported to the existing system for SM (DHIS2) but will also be reported into the Online Excel sheet of the MoPH as data of the Pha-G-Dis (Entry Balance Stock).

- 1 PARC and 19 PA serving the community of Toamasina II received recognition certificates during the official ceremony of the integration launching.

IR4.1.2A1: Distribution of socially marketed products across ten (10) regions for MNCH and FP/RH products and distribution of only FP/RH products in three (3) PARN Regions through PARCs and PAs. IMPACT continued the distribution of socially marketed FP and MNCH products during Quarter 2. Table 26: Distribution of FP commodities in Q1 and Q2 of Year 4

Year 4

FP PRODUCT Year 4 Target

Quarter 1 Achievemen

t


t

Y4 Achievemen

t

% Of Year4 Target

Achieved

Comments

Oral Contraceptiv

e (Community

Channel)

1,901,680

324,436 504,957 829,393 44%

Increase of 55.6% of the distribution of the Oral Contraceptive in Q2 compared to Q1, allowing the distribution to achieve 44% of the annual target. The distribution of COC is gradually returning to the estimated rate after the high COVID-19 rate pandemic in early Q1 followed by inflation. The supply by the different level of the supply chain was returning to normal. The product stayed available during the Quarter with a stock out rate of 0% at PARC and 0,5% at PA compared to the target which is 5%.

Injectable DMPA-IM

(TRICLOFEM) (Community

Channel)

1,624,373

374,515 422,464 796,979 49%

Increase of 12.8% of the distribution of the Injectable DMPA-IM in Q2 compared to Q1, allowing the distribution to achieve 49% of the annual target. The result is good. The product stayed available during the Quarter with a stock out rate of 0% at PARC and 0,5% at PA compared to the target which is 5%.

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Year 4



t


t

Y4 Achievemen

t

% Of Year4 Target

Achieved

Comments

FP condom Protector

Plus (Community

and Commercial Channels)

1,733,292

447,025 200,400 647,425 37%

Decrease of 55% of the distribution of Protector Plus in Q2 compared to Q1 due to the COVID-19 sanitary situation in early Quarter 2 leading the wholesalers and retailers to achieve less sale. 84% of Protector Plus were distributed in the commercial circuit during the current Quarter. The distribution improved though as soon as the COVID-19 sanitary situation improved from March allowing to achieve 37% of the annual target.

FP Youth Condom Yes (Commercial

Channel)

The procurement of this product is not yet initiated.

DMPA-SC : Sayana Press (Community

Channel)

522,976 99,985 37,619 137,604 26%

The distribution of Sayana Press achieved 26% of the annual target. The distribution is stable in Q2 from January till March, though, a decrease of 62% of the distribution was observed in Q2 compared to Q1 due to a decrease of 39% of the number of Regular Users of Injectable in Q2 (Source ACCESS) and to the fact that the distribution in Q2 was exempt of distribution of free starter batches. As the users of DMPA-IM (Triclofem) increased, thus the decrease was obviously observed at DMPA-SC result. The COVID-19 sanitary situation in January and February had its consequences. The product stayed available during the Quarter with a stock out rate of 0% at PARC and 0,8% at PA

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Year 4



t


t

Y4 Achievemen

t

% Of Year4 Target

Achieved

Comments

compared to the target which is 5%.

Pregnancy Test

(Community Channel)

106,09 44,476 36,819 81,295 79%

The distribution of the Pregnancy test kits achieved 79% of the annual target. The positioning of the products in the 7 regions where ACCESS proceeded the training of the CHW on this product contributed to this achievement. The product stayed available during the Quarter with a stock out rate of 0% at PARC and 0,1% at PA compared to the target which is 5%.

Table 27: Distribution of MNCH commodities in Q1 and Q2 of Year 4

Year 4

MNCH PRODUCTS

Year 3 Target


t


t

Y4 Achievemen

t

% of Year4 Target

Achieved

Comments

ORS/Zinc DTK (Community)

53,440 5,799 9,254 15,053 28%

The distribution of ORS/Zinc kits achieved 28% of the annual target. The ORS was in stockout in central level before the reception of 230,000 donated ORS from UNICEF in mid-February to combine with the Zinc available at PSI warehouse. The distribution of the kit (ORS/Zinc to PARC began in March which caused an increase in the distributed quantity between Q1 and Q2.

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Year 4

MNCH PRODUCTS

Year 3 Target


t


t

Y4 Achievemen

t

% of Year4 Target

Achieved

Comments

Sûr’Eau 150 ml

IMPACT will no longer distribute Sûr’Eau 150 ml as it will be transferred to the private sector.

Sûr’Eau Pilina (67mg Tablet) (Community)

2,778,000

312,800 398,000 710,800 26%

Increase of 27% of the distribution of Sûr’Eau Pilina in Q2 compared to Q1, allowing the distribution to achieve 26% of the annual target which is low as the Average Monthly Consumption is under the estimated forecast. Some projects as Dio Rano wash (USAID), Ny Ranontsika and some associations such as the Islamic, Mauritian associations, Japanese cooperation built modern infrastructures and pumps for access to drinking water, thus less use of Sûr’Eau Pilina by the population.

Arofoitra (CHX 7,1%) (Community)

32,228 1,438 1128 2,566 8%

The distribution of Arofoitra achieved 8% of the annual target. This poor achievement is due to the availability of the free-distributed Chlorhexidine by UNICEF to the public sector and CHW which greatly impacted our achievement.

Pneumox (Amoxicilline) (Community)

131,020

No sales in this quarter, Pneumox was not available during the quarter. The procurement is in progress and the estimated time of arrival is in early June 2022.

- IMPACT (through SRD and SPD) held 62 coordination meetings (14 at the regional level and 48 in the

districts) with ACCESS for community-based distribution activities in Quarter 2 of Year 4.

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Table 28: The Main topics covered are summarized in the table below Main topics covered: Integration of PA and PARC activities in the public sector

● Regional teams of IMPACT and ACCESS were informed according to the evolution of the discussion at central level within the Integration Committee.

● Information and organization about the first integration of PARC and PA to Pha-G-Dis and Pha-Ge-Com of Toamasina II and about the launching of the activity.

● Joint preparation of the mission with the central team (Integration committee) for the information and training of the Pha-Ge-Com and 35 Pha-G-Dis concerned by the integration.

Coordination meeting to ensure the continuous availability of health commodities and to share organizations, actions and innovations that can impact on the continuous availability of health inputs.

● Sharing and update of the number of Regular Users. ● Information about the arrival of products: receipt of SRO by

Impact and the resumption of the distribution of the Diarrhea Treatment Kit: ORS-Zinc in March.

● Information about the training of CHV on Pregnancy Test Kits and the availability of the products at PA and PARC in the regions of Amoron'i Mania, Analanjirofo, Atsinanana, Boeny, Vakinakaratra for the resupply of CHV after the starter kits that IMPACT allocated for them.

● Sharing of the timetable for the review of CHV with the CSB

Coordination in the prevention of COVID-19 and the vaccination effort

● Sharing and coordination of activities related to raising awareness of the importance of barrier practices and vaccination among the whole community, including CHV, and PA and PARC

- The on-field supervision of the 74 PARC and 1,035 PA by the SPD is done every 2 months combined with

every two months remote supervision. 100% of PA/PARC reported data Table 29: Data Collection Evolution in Quarter 2 of Year 4

Jan-22 Feb-22 March-22

Data reporting 1,109 1,109 1,109

Number of PA PARC 1,109 1,109 1,109

IR4.1.2A2: 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 stock out

- To maintain the standardized quality of the health commodity management and storage at PARC and PA, IMPACT evaluated the 74 PARC and 1,035 PA through a personal performance review in early Quarter 2 concerning their performance of Quarter 1 using an evaluation grid assessing the continuous availability of stock.

- 27 PARCs (36.5%) and 465 PAs (44.92%) met all criteria and received incentives: shoulder bags or caps. Those who have missed one or some criteria were encouraged to improve for the next Quarter.

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IR4.1.2A3: Start scale up of drone activity and emergency distribution to deliver health products. - Continuity of delivery in Analanjirofo and SAVA region (take-off point Maroantsetra) - While continuing the delivery by drone to the PA and CSB in Analanjirofo and SAVA with the take-off

point of Maroantsetra, IMPACT started the scale up of the drone delivery activity in SOFIA and Atsinanana regions in January 2022, having respectively the two take-off points in Befandriana Nord and in Toamasina II.

- IMPACT operated 4 drones to cover 6 districts (Maroantsetra, Mananara Nord, Antalaha, Andapa, Befandriana Nord, Toamasina 2) and delivering 39 PA and 35 CSB during this reporting period.

- Authorities in the two new regions were informed and involved. The Governor, the chiefs of the regions of SOFIA and Atsinanana, the chiefs of districts, the mayors, the chiefs fokontany, the DRSP, the Medical Inspector, and the Technical Assistants attended the first flights in Befandriana Nord (Take Off Point in SOFIA) delivering COVID-19 vaccines and Malaria products for the CSB of Morafeno, and in Toamasina II (Take off point in Atsinanana) delivering Malaria products for the CSB Vohitrandiana.

- IMPACT accomplished the official launching of the delivery by drone project, by the Ministry of the Public Health which occurred in Antetezambaro, Toamasina II on March 24th, 2022. This was preceded by two days press tour during which 21 journalists, including 15 journalists from the national level and 6 from the regional level (7 Females and 14 males), were trained on the supply chain circuit. Practice and on field visits including visits of PARC and PA were conducted by IMPACT with the journalists assisting a drone take-off, dropping products, and landing of the drone in Ambodiriana, Toamasina II. In total, the media relayed 10 publications in six national newspapers, 10 video and audio reports on seven national and local media stations with two reports of 26 minutes on one national radio station and one TV station, and six publications on pages and news groups in social networks. Details of the media coverage for the launch are provided in Annex I and details on the orientation of journalists are reported in IR5.

- In Quarter 2, IMPACT achieved 233 flights delivery by drone to six districts: Maroantsetra, Mananara Nord, Antalaha, Andapa, Befandriana Nord and Toamasina II, serving 39 PA and 35 CSB.

- 1 735 doses of COVID-19 vaccine (600 doses of AstraZeneca and 1135 doses of Janssen) were delivered by drone during the quarter to 28 CSB, achieved with 34 flights.

- IMPACT, in partnership with TWILIO transported by drone routine vaccines. Table 30 : Number of flights delivery of FP, MNCH and Malaria products in Quarter 2

Take-Off Points Districts served #PA covered

#CSB covered

Number of flights

Maroantsetra

Maroantsetra 18 16 109 Mananara nord 3 6 Antalaha 2 13 Andapa 2 5

Befandriana nord Befandriana nord 7 8 50

Tamatave Tamatave II 7 11 50

TOTAL 233

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Table 31 : Quantity of products transported and delivered by drone

PRODUCTS UNIT QUANTITY

Zinnia F Blister 9 949

Triclofem Vial 10 245

Syringe Piece 10 245

Sayana press Vial 170

Vaccine Janssen Dose 1 135

Vaccine AstraZeneca Dose 600

Syringe SAB 0,5 Piece 1 515

Diphterie Tetanos Cocquelus (DTC) Dose 1 730

Vaccin Pollio Injectable (VPI) Dose 1 170

Vaccin Pollio Oral (VPO) Dose 1 980

Vaccin Anti Rougeoleux (VAR) Dose 1 360

Vaccin Anti Tetanique (VAT) Dose 1 070

Vaccin Anti Pneumococcique (PCV10) Dose 1 547

ACT 2 - 11 month Blister 105

ACT 1 - 5 year Blister 599

ACT 6 - 13 year Blister 131

ACT +14 year Blister 139

Rapid Diagnostic Test (RDT) Kit 3 825

Sulfadoxine Pyrimethamine (SP) Tablet 1 650

Artesun 60mg Box 147

Artesun suppositoire Piece 4

ORS Unit 100

Zink Kit 50

Arofoitra Unit 31

IR4.1.2A4: Define and implement a product monitoring tracking

Due to the difficulty of finding local provider that meets all the requirements, a new definition of the functional scope of the tracking system related to the technical aspects will be elaborated in Quarter 3.

IR4.1.2A5: Ensure preventive measure against COVID-19

The distribution team of IMPACT, during the field supervision, continued to sensitize the PARC, PA and Wholesalers for vaccination against the COVID-19 pandemic and the respect of the barrier gestures and use of PPE to prevent against COVID-19.

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In Quarter 2, 150 units of disinfecting gel; 750 units of soaps; 300 bottles of 1Liter Liquid bleach; 150 boxes of 50 Surgical mask were distributed to 10 Parc and 140 PA.

Vaccination rate (fully vaccinated) among PARC and PA and the Great Wholesalers working with IMPACT at the end of Quarter 2:

- PARC: 42/74 (56,76%) - PA: 443/1035 (42,80%) - Wholesalers: 31/48 or 64.58 %

Graph 2: Evolution of the vaccination rate of PARC, PA and Great wholesalers at end Quarter 2

Sub-IR 4.2: Socially marketed products achieve cost recovery at an affordable price for consumers IR4.2.1A1: Leverage the findings from IR 1 to optimize the current portfolio of socially marketed products, explore potential additions to the portfolio to enhance sustainability, and adjust marketing strategies accordingly

After the adjustment of price of the FP products, the evolution of the distribution of FP products increased positively in Quarter 2. IMPACT supported this evolution by the TV and radio broadcasting about the availability of FP at the 3 channels of distribution: public, private, and community-based distribution.

IMPACT continued to explore setting up the social business unit by the selection of products which will be distributed in its respective channel (commercial, pharmaceutical, or community-based distribution) according to the segment of population targeted.

197

485

19 310

200

400

600

End Q1Y4 End Q2Y4

Evolution of vaccination rate of PARC and PA and Wholesalers

PA PARC vaccinated Wholesalers vaccinated

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III.5. IR5 - Increased demand for and use of health products among the Malagasy people IR5.1. A1: Provide technical and financial support to MOPH communication activities that are linked to the IMPACT mission

IR5.1. A1- SA1 Technically and financially support the activities related to IMPACT mandate and requested by the GOM (ex: celebration of world health days, etc.)

Celebration of international women's day: IMPACT supported the celebration of International Women's Day, by:

- Sending 1,680,001 SMS to TELMA subscribers in the 13 USAID-supported regions on March 8th, in collaboration with Axian Fondation. The message was: “ Viavy miavotse,miatrika sy mifanampy ho antoky ny fampandrosoana lovain-jafy, zontsika ny mahazo fanafody sy fahasalamana,manatona tobim-pahasalamana akaiky anao”; translated in English as follows: “Resilient and supportive Women, pillar of sustainable development. It is our right to get access to medicines, go to the nearest health center.” The message was validated by the Ministry of Population

- Publishing factsheets, a press release on women's empowerment, and producing a video with interview of CNFM and EFOI staff

- Supporting the MOPH in the realization of medical Caravan which took place from March 2-7, 2022, in the region of Amoron'i Mania by creating the demand through the field communication teams.

IR5.1. A1- SA2 In coordination with IR2 and IR4, provide technical and financial support to the MOPH on the communication activities related to the transition of the supply chain system from PA and PARC to Pha-Ge-Com and Pha-G-Dis; through developing and printing communication tools and SMS broadcasting To support the integration of the PA and PARC in the public sector distribution channel, IMPACT designed posters to be displayed at the PA and PARC level. The official presentation of this project and the signature of the MOU, between the Minister of Public Health and the COP of IMPACT, was held during the drove delivery launch event on March 24th in Antetezambaro, district of Toamasina 2, Atsinanana region. The ceremony was under the leadership of the Minister of Public Health, the General Manager of USAID and Director from central level (DPLMT, DFSA, DPEV, DPS). The PA and PARC also received certificates of recognition.

1,680,001 SMS sent to TELMA subscribers during the celebration of the international women's day 4,369 TV and radio spots broadcasted ( 1,200 radio spots on CHX, 425 TV spots and 1,352 radio spots on Family Planning and 1,392 radio spots on Malaria) 21 Journalists participated to the press tour

For Covid 19 Communication:

Social media: 9 posts on the Facebook page of PSI Madagascar published. 9,54TV spots and 7,582 radio spots broadcasted 662 education activities reaching more 163,370 people (70,400 men and 92,970 women) conducted by communication teams on field using mobile sound system 5,300 hats with inscription “Za vita vaksiny” and 5,000 masks translated by “I am vaccinated”, 2,000 posters for Catholic church, 30,000 flyers on the four (4) kinds of vaccines were produced.

Posters for PA /PARC

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IR5.1. A1- SA3 Support implementation of "ADDO", with labelling package, composed of signage sign and display panel will be provided to ensure the visibility. And local radio spot will be broadcasted to create demand and boost the sales of ADDO. IMPACT/IR5 participated in the internal meeting to implement the ADDO model and led the “Branding and Creation of demand subcommittee”. The labelling (name and branding) of this project is ongoing and will be validated by the Steering Committee. IR5.1. A2: Develop and implement Youth activities, in collaboration with partners (MYS, MOPH, ACCESS, Blue Ventures, etc.) IR5.1. A2- SA1 In collaboration with other partners, following peer education strategy, youth leaders will be trained to be a model among their peers, to have good health behavior, and to increase demand and use of health products. The training of young leaders from Andranoboka in the Boeny region in partnership with the MOPH, the Ministry of Youth, and Blue Ventures was planned in March. However, the activity was rescheduled due to the inaccessibility of the locality during the rainy season. The training will be held in May. IR5.1.A2- SA2 Develop and broadcast online program with bloggers, influencers, famous celebrity on social media to encourage youth to take care of their health and use proper medicines according to rational prescription. IMPACT had begun to produce youth programs with renowned artists, like Tence Mena or Bodo. In Quarter2, shooting continued with Mr. Saida, on the theme of family planning and the risk of early marriage and early pregnancy. The name of the program “Tanora Cool” took time to be validated with the DPS of MOPH. IR5.1. A3: Leverage new technology to drive demand among population and improve prescription of medicines for malaria, FP/RH, and MNCH health commodities PSI/Madagascar created a digital platform “E+zaho” in cost share with other PSI programs, such as NFM HIV and NFM Malaria funded by Global Fund. The presentation meeting for partners was held in Quarter 1, and on March 15th E-zaho was officially launched to the public under the leadership of the General Manager of Caregiving, Director of Health Promotion, and Director Health Communication from the MOPH. This digital platform is dedicated to all people who need free advice and information on the areas of intervention of PSI/Madagascar and IMPACT, such as FP, sexual and reproductive health, HIV/AIDS, malaria, MNCH, and COVID-19. It is accessible on the Facebook page and messenger account "e-zaho madagascar".

Official ceremony with the leadership of the Minister of Public Health

Presentation of certificate of recognition

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IMPACT continued to send targeted SMS to community health providers. On March 30th, 2,213 SMS were sent to 959 PA, 67 PARC, 1,108 CHVs and 79 Pha-G-Dis. The message was: “Salama, Atokany toerana ny fanafody simba na lany daty ary atero eny @ CSB na hopitaly hikarakarana azy. Mampididoza ny fanafody simba na lany daty!” This reminder message was translated to: “Hi, exclude damaged or expired medicines and take them to the CSBs and hospitals so that they can be taken care of. Damaged or expired medicines are dangerous.” This message is taken from National Communication Plan on the rational use of medicines. (IR1.A3) IR5.1. A4: 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 (including social media) incorporating gender messaging to promote and use health commodities for population and providers IR5.1. A4- SA1 Conduct communication activities (broadcast radio and TV spots, produce printed media, organize events, etc.) to different target populations (general population and health service providers, including CHVs) to promote the use of health products for the three prioritized health areas (Malaria, FP, and MNCH), in collaboration with DPS, NMCP, and DSFa In Quarter 2, to stimulate demand for the use of health products, IMPACT broadcasted TV and radio spots as follows:

- For MNCH: from January 10 – 23, 1,200 radio spots were aired in 36 districts in 10 USAID-supported regions to reinforce the importance of using CHX to prevent neonatal infections. 1,654,977 people were reached (Calculated based on the proportion of women and men aged 15-49 who listened /watched Radio/TV at least once a week in a region -by MICS 2018 results- and following the areas covered). Calculated from the proportion of women and men aged 15-49 who listened /watched a Radio/TV at least once a week in a region (by MICS 2018 results) and following the areas covered.

- FP: From January 3 – 30, 425 TV spots and 1,352 radio spots were broadcasted in 47 districts of the 13 USAID-supported regions. The message was to inform the population where products are available (for the public sector at CSBs and health centers; for the private sector at pharmacies; and for social marketing at CHVs) and to remind them of the different FP methods. 2,765,123 people were reached.

- Malaria: As part of the post-campaign of the LLIN mass campaign, 1,392 radio spots were broadcasted in 45 districts of the 13 USAID-supported regions from January 6-24th.The messages informed the population on the correct use and maintenance of LLINS, especially after the cyclones. 1,961,716 people were reached by radio.

IR5.1. A4- SA2 Increase demand creation of health products by using mobile sound systems organized and conducted by the IMPACT field communication team in the 13 USAID-supported regions To reinforce messages communicated through TV and radio broadcasting, sensitization activities using mobile sound systems were carried out at the community level. To increase the demand for health commodities, the six Field Communication Teams (FCT) working in six USAID-supported regions (Diana, Boeny, Melaky, Atsimo Andrefana, Vatovavy Fitovinany and Atsinanana) distributed these messages to the following:

- 116,690 people (69,545 women, 47,145 men) in 30 districts of the 10 supported regions about malaria. Sensitization on malaria was focused on the importance of being tested with RDTs, encouraging pregnant women to go to CSBs to have prenatal consultations to get Intermittent Preventive Treatment of Sulfadoxine Pyrimethamine, and the use of LLINs.

- 14,730 people (7,745 women, 71,805 men) in five districts of the 13 supported regions about FP. - 152,740 people (90,210 women, 62,530 men) in 21 districts of the 10 supported regions about MNCH,

on the use of ORS/Zinc, Sur’Eau Pilina, Sur’Eau 150ml, and CHX (Arofoitra).

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IR5.1. A5: In collaboration with the TMA TWG demand creation subcommittee led by the MOPH (DPS), continue to implement activities to increase the demand for health products and ensure safe use of the products through the National Communication Plan IMPACT continued to support the DPS to implement activities from the National Communication Plan on the rational use of medicines. Targeted SMS on rational management of health commodities were sent to 959 PARC, 67 PA, 1,108 CHVs and 79 Pha-G-Dis. This reminder message was taken from the National Communication Plan. (Details are reported in IR1.A3)

In collaboration with the DPLMT, the DPS and the Directorate of Communication of the MOPH, IMPACT organized a press tour in Toamasina from March 21st to 23rd to explain and show journalists in the field the structure and functioning of the health supply chain in Madagascar and the interventions of the IMPACT project, specifically the innovation of the delivery of health inputs by drone. It was an opportunity to explain to the journalists about the National Communication Plan on the rational use of medicines.

21 journalists, including 15 from the national level and six from the regional level attended the press tour. They were selected according to the database of the Directorate of Communication of the MOPH, and the press tour organized by the US Embassy in Diego in October 2021.

They also received a refresher training course on journalistic reporting provided by the training company Kentia.

After the visit in the field, the pool of journalists has committed to writing news articles. A table summarizing commitments are presented in Annex I.

III.6. Cross-Cutting Activities

1. Gender Equality and Social Inclusion (GESI)

Banyan Global’s leadership of GESI activities was placed on hold for the first quarter of Year 4, and was relaunched in February 2022, following approval of the TEA increase in late January. GESI A1: Reinforce GESI Partnership and Visibility

Engaged IMPACT GESI Partners on Key IMPACT Opportunities - IMPACT coordinated with its key GESI partners (CNFM and EFOI) on several activities related to this

year’s International Women’s Day celebrations. See below for details. Drafted Partnership Agreement with Local Women’s Organizations

- Following recommendations outlined in the project’s GESI Analysis, since Year 2, IMPACT has worked with two local women’s organizations (CNFM and EFOI) as key GESI partners. Building on the success of the collaboration, the organizations requested that the partnerships be formalized in Year 4. IMPACT drafted a partnership agreement in Quarter 2, and it is currently under review by all parties.

Coordinated Activities for International Women’s Day International Women’s Day (IWD) is celebrated annually on March 8th. In Madagascar, a different location is selected each year to be the epicenter of activities. This year, two cities – Manakara and Antsirabe – were chosen to host. IMPACT, through close collaboration with its GESI, Communications, Access to Finance, Distribution, and regionally-based teams, led the following activities from its national office, with specific interventions in Manakara (March 2nd to 6th) and Antsirabe (March 7th and 8th):

- Developed and distributed GESI flyer. Flyer posted to Facebook can be found here. - Updated and distributed GESI and Access to Finance factsheet.

GESI Main Achievements 1 partnership agreement drafted 7 International Women’s Day activities conducted 7 gender- and health- related meetings attended

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- Co-developed newspaper article – The impact of integrating men and women into health commodity access and distribution in Madagascar – in print for Midi Madagascar with IMPACT GESI partners CNFM and EFOI. Newspaper article posted to Facebook can be found here.

- Conducted two video interviews (one in French, one in Malagasy) with IMPACT GESI partners on health commodities and their experiences working with IMPACT. Video, published on YouTube, can be found here.

- Partnered with CNFM, EFOI, the President’s Office, ACCESS, RANOWASH, OIT, MOH, MinPoP, and Ministry of Commerce to distribute GESI materials and disseminate key messages during a health caravan en route from Antananarivo to Manakara.

- Coordinated with ACCESS, the Madagascar Presidency, and MOH on a COVID-19 vaccination sensitization campaign (March 2nd to 8th).

- Worked with MinPop, Ministry of Commerce, International Labor Office, and IMPACT bank partners (Baobab and Access Bank Madagascar) to organize and lead presentations on access to finance for women health entrepreneurs (March 5th).

- Supported the President of CNFM to provide first-hand testimony and advocacy on the topic of equal access to health commodities to audience, including the First Lady, project partners, and the larger public (March 7th). Also aided in the coordination of testimony from a PA motorbike loan recipient. IMPACT’s Communications team also coordinated with two individuals to produce short videos (one each) to complement the testimonies and handover to MinPop post-ceremony.

CNFM President participates in video interview.

Women in Manakara attend presentations by IMPACT bank partners.

First Lady poses with two IMPACT representatives and other testimony presenters in Antsirabe for IWD

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Represented IMPACT at Various Gender- and Health-related Working Groups and Meetings - SIGL Sub-committee Meeting (March 2nd). The purpose of this meeting was to provide updates on

sub-committee achievements and progress to date. - Ministry of Population’s Gender Technical Working Group Meeting (February 11th, 18th, and 25th).

The purpose of these meetings was to identify and solidify intervention ideas for International Women’s Day, as well as to organize collaboration among different projects and entities.

- Presidentially supported Sustainable Development Goals Gender-based Violence Group Meeting (“SDG GBV”; February 24th). The purpose of the meeting was to prepare for International Women’s Day, particularly regarding the health caravan and exploring opportunities for synergy among partner planned interventions.

- USAID GESI Partners Meeting (February 8th). The purpose of the meeting was to prepare for International Women’s Day.

- IMPACT Mid-Term Evaluation Findings Presentation (February 9th). The purpose of the meeting was to hear from IMPACT’s external consultant on the mid-term evaluation findings and discuss strategies to apply learning to Year 4 activities.

GESI A2: Strengthen Capacity of IMPACT Partners In line with the workplan, no relevant activities were conducted during Quarter 2. GESI A3: Provide Technical Leadership to IMPACT Staff and Partners GESI Coaching Slide Deck

- To support capacity building for IMPACT regional staff, the GESI team drafted a set of coaching slides to refresh the understanding of regional staff on key GESI concepts and the importance of GESI integration for the project. The GESI coaching slides are part of a larger project-wide effort to decentralize interventions and keep regional teams updated on IMPACT activities and strategies. In Quarter 3, the GESI coaching slides will be finalized and included in the complete IMPACT regional coaching slide deck.

Factsheet Revisions

- In Year 3, IMPACT developed six factsheets exploring GESI elements and IMPACT themes: TMA, private sector, public sector, and three access to finance (ABM, Baobab, and generic). IMPACT received USAID comment on the materials after GESI activities were originally scheduled to close. Now that GESI activities have resumed following the TEA increase, IMPACT is working to update and further distribute these resources.

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2. Monitoring, Evaluation, Research and Learning (MERL)

MERL1A1: Support financially and technically the MOPH to strengthening the LMIS with the use of DHIS2 as data analysis and dissemination tool for the three sectors: public, social marketing, and commercial (pharmaceutical wholesalers, pharmacy, and drug shops) through the implementation of LMIS roadmap MERL1A1.SA1 Finalize the selection of new LMIS software with the partners and working closely with the company to adapt the country need (respond to the minimum requirements approved by the MOPH) The LMIS committee selected Odoo and OpenLMIS, which are the two open-source software found in the minimum requirements. Since December 2021, UCP sent a request for non-objection on the committee's process, including the organization of the restricted bid, which was not included in the initial plan submitted to Global Fund. In February, the Local Fund Agent (LFA) requested additional documents to support the request for no objection to the tender. The LMIS committee is still waiting for the decision of the Global Fund. To ensure data reporting at the Pha-G-Dis level, the DPLMT with the technical support of IMPACT continues to use and improve CHANNEL.

Graph 3: Progress on reporting rate vs timeliness rate

- The average reporting rate increased from 85% to 94% that is slightly higher than the target defined for Year 4, 90%. The same trend was noted for the timeliness rate which showed on average 52% to

Average reporting rate was increased from 85% to 93% Supported the implementation of RDQA and formative supervision in the Atsinanana and Boeny regions. Finalized study design, data collectors training and data collection for the Evaluation study of Communication fieldwork team Collected six Success Stories Developed 4 abstracts for ASTMH Disseminated the second internal Newsletter to share project’s quarterly key results

90%100% 100% 97% 97% 96%

87%

56% 60% 60%

44%

79%

67%

0%

20%

40%

60%

80%

100%

120%

Oct-21 Nov-21 Dec-21 Jan-22 Feb-22 Mar-22

Target Y4 (reporting and timeliness rate) Reporting rate Timeliness rate

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60%. The highest rate noted is in February 2022 which was 79%. But still below the target of 90%. Some of the reasons that explain this trend are as follows:

o 11 districts have experienced PC or laptop failures that have resulted in delayed CHANNEL reports.

o 23 providers out of the 78 Pha-G-Dis were new and have not yet completely familiarized themselves with the CHANNEL software, even though they have had on-the-job training

- To address the timeliness issue, the RLA and DPLMT with IMPACT Central team will continue to reinforce the support to Pha-G-Dis providers during the formative supervision and to do on-the-job training for data entry in CHANNEL and send it on time to the central office (DPLMT).

MERL1A1.SA4 Continue to supervise the Pha-G-Dis, Pha-Ge-Com, PARC, PA, Pharmacies, and drug shops on LMIS use In March 2022, two formative supervisions in the Atsinanana and Boeny regions were conducted by the central IMPACT team with the MoPH (DPLMT and DGFS). The purpose of this supervision was to follow up on data collection and ensure the coaching of stakeholders on the use of the stock management tool and database management (online backup) at the Pha-G-Dis level. Table 32: Main issues and action plan

Entity site visited Main Challenge Recommendation/ Action Plan

Pha-G-Dis

SDSP Toamasina I New provider not trained in CHANNEL software

- Training in CHANNEL software by the RLA and remote monitoring of the provider by the Helpdesk/PSI

SDSP Brickaville No provider

- Ensure data entry in CHANNEL by the Health Product Management and the RLA IMPACT - Follow up on recruitment documents completed in March 2022: contract signature in progress by the DPLMT

SDSP Mahajanga I

Data entry in CHANNEL not updated: new provider not trained on CHANNEL software

- Supervise the provider on the use of the CHANNEL by the RLA and the GIS manager - Improve the completion of stock sheet and RMA forms, especially in the PALU program - Ensure the completion of the missing reports in CHANNEL - Archive the signed physical copies of RMAs

SDSP Ambatoboeny

Stock sheets partially completed/updated

- Enhance the archiving/updating of management tools: RMA, stock sheet - Implement recommendations from previous supervisions by the RLA and GIS Manager

MERL1A2: Support technically and financially the DEPSI and DPLMT to ensure that routine data quality assessment (RDQA) is conducted every Quarter at all levels for the three sectors and the data validation process is set up (with a protocol approved by the MoPH). MERL1A2.SA1 Conduct routine data quality assessments every quarter by comparing the improvement between two quarters among a sample of Pha-G-Dis, Pha-Ge-Com, PARC, and PA Monitoring of the action plan developed from the recommendation of DQA USAID

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58% of the activities in this action plan have been completed (50% in Q1) and 39% are ongoing. After analysis and testing with DPLMT and DEPSI, it is impossible to insert a new functionality for CHANNEL software, that has become fixed: with a unique database for each district and mono- post. In consequence, the activity to improve the functionality of CHANNEL to enable the visualization of the data entered and the correction was cancelled. Ongoing activities will be completed in Quarter 3. Further explanations are provided in the Excel file presenting the detailed action plan with update. Graph 4: USAID DQA Action Plan Status

RDQA IMPACT In Quarter 2, IMPACT Central team with MoPH (DPLMT and DGFS) conducted RDQA in Atsinanana regions within the four districts of Toamasina I, Toamasina II, Brickaville, Mahanoro. Since Quarter 3 of Year 3, RDQA exercises have focused on comparing the results of current RDQA data qualities with those of RDQA previously conducted. Graph 5: Evolution of the summary data quality at Pha-G-Dis level (n=4)

- Average on overall data verification score for the seven quality dimensions (availability, completeness, timeliness, integrity, confidentiality, precision, accuracy) had a slight regression.

- Qualitative system assessment of the strengths and weaknesses of the data management and reporting system functional areas.

- The Average score on data quality: “Overall Data Verification Score” + “System Assessment Score” have decreased (about 5%), due to the lack of experience of the new providers who did not have a good knowledge of the system and the LMIS software.

MERL1A2.SA2 Conduct quality assessment of the LMIS data using coherence testing of the data received on a monthly basis by the system For the non-profit sector (social marketing), the helpdesk continued the review data quality submitted by the SPD in DHIS2 that were compared to the physical sources (stock monitoring sheets) received from PARC and PA and are uploaded by the SPD in OneDrive (for data quality checking by the helpdesk).

90% 94% 92%88% 89% 86%

10%20%30%40%50%60%70%80%90%

100%

Overall DataVerification Score

System AssessmentScore

Overall Data QualityScore

First RDQA Second RDQA

58%39%

3%

DQA Action Plan Status

Completed

Ongoing

Cancelled

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In Quarter 2, data quality assessment of the PARC was conducted. A sample of 76% of PA and 40% of PARC were selected for the DHIS2 and physical sources comparison. 77% of the data were accurate and 23% of the data in DHIS2 presented some mismatches/anomalies that were corrected. The mismatches were due to the transcription, calculation errors, and period confusing during the data entry in DHIS2. To address these issues, formative supervisions to strengthen the capacities of the SRDs and SPDs will be conducted in Quarter 3.

Research

MERL1A3.SA1. Evaluation of communication fieldwork team (Equipe de Communication sur Terrain) During Q2, IMPACT implemented the Evaluation study of Communication fieldwork team in the nine IMPACT intervention regions in which activity for malaria or FP or MNCH as well as the vaccination and prevention of COVID-19 were reported during the last 6 months. This study has the objective to assess the added value of the ECT activity. The findings will help adjust the action plan and the strategic message for each health area. Quantitative and qualitative approaches were used during the survey respectively among households targeted by ECT’s activities and key informant in the intervention area (local authority, Responsible of PEV, Chief of CSB, CHV, NGO partners). The study design was finalized, and data collector training conducted. Data collection was implemented from the 13th to the 27th of March. MERL1A3.SA2. Evaluation of SMS broadcast The research brief was finalized during Q2. The study will be designed to collect recommendations from those who have received the SMS broadcast to increase demand and use for health inputs and reinforce the message on their

availability. The results of this study will help to decide if it is efficient to pursuit the activity. The study protocol design, data collection implementation and data analysis will be done in Q3. Knowledge management

MERL3A1: Support technically the MoPH and IMPACT project team in developing and collecting success stories and documenting innovations in the field To document IMPACT’s achievements, innovations and lessons learned in the field, IMPACT continued to support central and field staff in developing success stories. During Quarter 2, six stories were collected. Details are presented in Annex D. MERL3A2: Develop and disseminate IMPACT's learnings and results through different KM products (learning sheets, PowerPoint presentations, reports, abstracts, ect.) and participate in national and international conferences

- IMPACT supported the NMCP in conducting a qualitative survey to identify successes and lessons learned from the mass distribution campaign. Data collection, analysis, and presentation at internal level of the results were completed in Q2. The main findings from this qualitative survey will be presented and discussed during a workshop with all stakeholders involved in the campaign in early Q3 to inform future campaigns.

- IMPACT developed four abstracts to be proposed for the ASTMH annual meeting. The abstracts focused on: o Factors associated with IPTp uptake among pregnant women in Madagascar, o Challenges faced while implementing distribution shortly after household authentication as part

of the 2021 Long-Lasting Insecticide-treated Nets (LLIN) Mass Campaign Distribution, o How to increase the availability and use of injectable quinine to treat severe malaria, o Supervision, Performance Assessment, and Recognition Strategy (SPARS) Approach Leads to

Improved Performance in Malagasy District Pharmacies.

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- IMPACT developed and disseminated to all project’s staff the second internal Newsletter, based on the Quarter 1 achievements.

III.7. COVID-19 ACTIVITIES IR2.1. 14a.A1: Support technically and financially the MoPH to reduce morbidity and mortality from COVID-19, mitigate transmission, and strengthen health systems, including to prevent, detect, and respond to pandemic threats IR2.1. 14a.A1-SA1 P6. Infection prevention and control, IR2.1. 14a.A1-SA2: Supply of products and protective equipment for the staff, CHVs, PA, PARC, Drug Shops… (PPE, disinfectants…) - IMPACT provided supplies to staff for COVID-19 prevention:

o 50 bottles of hydroalcoholic gel 500ml, 5 bottles of bleach 1L, 10 bottles of liquid soap, 10 kg of soap powder, 500 surgical masks to 15 SAVA office and warehouse staff members

o 60 pieces of chamois, 1,500 protective medical masks, 500 surgical masks, and 80 disinfectant wipes to 35 staff members in Atsimo Andrefana

- IMPACT provided 172 bottles of 500ml hydroalcoholic gel, 344 bottles of 1L bleach, 860 pieces of soap

and 8,600 surgical masks to 167 PA/PARC and 5 Pha-G-Dis in the Diana and SAVA regions.

IR2.1. 14a.A1-SA3: Conduct regular disinfection of offices, warehouses, vehicles - IMPACT conducted cleaning and disinfection of ten offices, ten warehouses and twenty-one vehicles

located in Haute Matsiatra, Vatovavy Fito Vinany, Vakinankaratra, Sava, Diana, Melaky, Boeny, Atsimo Andrefana, Menabe, Atsinanana, by external service providers (Aleo Misoroka, BHL, Rindra Consulting, Alitia, Sud Environnement, Vulca Menabe Speed, SARLU Multiple, and Stop Insectes ). Details are presented in Annex H/Table 1

IR2.1. 14a.A1-SA4: Train hygienists and health workers on waste management and IPC (Infection prevention and Control) The next training is planned in May (dry season) for SAVA, Boeny and Sofia due to accessibility issues from communes to districts IR2.1. 14a.A1-SA5: Support technically and financially the MOPH to develop, disseminate and implement SOPs on healthcare such as waste management, disinfection and service delivery No activities during Q2 IR2.1. 14a.A1-SA7: Provide supplies, consumables and equipment related to case management (pulse oximeter, glucometer, equipment for ambulance, laboratory reagents and consumables…) for emergency treatment centers - In February, IMPACT launched the requisition order for the purchase of 99,750 COVID-19 antigenic rapid

tests, the procurement of which were approved by General Secretary of Ministry of Public Health, in collaboration with the Procurement and Supply Management (PSM) and facilitated by MSH-IMPACT.

- During Quarter 2, IMPACT donated supplies (hydroalcoholic gel, bleach, hand towel paper, etc.) Personal Protection Equipment (disposable cap, coveralls, overshoes, etc.) and medical equipment (oximeters, thermoflashes, glucometers, etc.) to health facilities treating COVID-19 cases to 26 hospitals and 07 health facilities. Details are presented in Annex H/Table 2.

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- IMPACT procured and donated Kit MAPI (Four bottles of alcohol, four 1ml syringes, four bags of cotton, etc.) to DRSP Atsinanana for mobile strategy in February.

IR2.1. 14a.A1-SA8: P8. Operational support and logistics Transport of samples for testing - In February, IMPACT supported the Regional Directorate of Public Health on the transportation of

nasopharyngeal specimens for Polymerase Chain Reaction from Boeny (06) to be tested to the Health Watch, Epidemiological Surveillance and Response in Antananarivo, from Analanjirofo (6) to the regional laboratory Atsinanana in Toamasina.

IR2.2.5aA1: Support technically and financially the MoPH to accelerate widespread and equitable access to and delivery of safe and effective COVID-19 vaccinations IR2.2.5aA1-SA1: Policy, planning, and coordination: Support MOPH for micro-planification for Covid-19 vaccination campaign by attending the national and regional technical and logistics steering committee meetings - During Quarter 2, IMPACT continued to support technically the Regional Directorate of Public Health and

Technical and Financial Partners during bimonthly regional meetings for coordination and improvement of vaccination activities, especially on follow up of action plans for vaccines near expiry date (for Johnson&Johnson expired on 14th of February and 6th of March, and for AstraZeneca expired on 28th of February). As a result, the redeployment to other districts of vaccine that were close to expiring was done and mobile strategy was reinforced. Different strategies relating micro-planning around vaccines were launched in 13 USAID-supported regions, namely advocacy and sensitization to administrative, religious, and traditional authorities. Various advanced strategies were also implemented in different regions as per their situations with universities, military camp, market, transporters, customs and port employees, and sensitization with road show staff. Of the people vaccinated, 663 were vaccinated in universities, 544 were vaccinated in prison, 167 were vaccinated with churches, 157 were vaccinated in marketplaces, 80 were vaccinated for customs and port employees, and 35 were vaccinated in police stations.

- From 20th February to 21st March, IMPACT financially and technically supported the vaccination campaign launched by the Urban Commune of Antananarivo in partnership with the Directorate of the Expanded Immunization Program and technical and financial partners (WHO, UNICEF, IMPACT, USAID-funded project Accessible Continuum of Care and Essential Services Sustained - ACCESS, etc.) for 30 days. IMPACT contributed to donation of supplies, Personal Protection Equipment, 47 boxes of connection (24,266,000Ar ~ $USD6,559), broadcasting of TV and radio spots, sensitization with Tam Tam mobile, boosted posts on Facebook and press insertion in the newspaper. More than 11,000 people were vaccinated during the campaign with Urban Commune of Antananarivo.

- IMPACT participated in a coordination meeting for the preparation of the medical caravan, to be launched on the 2nd of March and run to the 8th of March, along with the celebration of International Women’s Day. Sensitization on COVID-19 vaccinations with IMPACT communication teams will be done along the caravan route from Antananarivo to Manakara. IMPACT contributed to the per diem and fuel costs of this event

- On 25th March, IMPACT supported technically the Directorate of the Expanded Immunization Program,

with other technical and financial partners to finalize the vaccination micro planning template to be used

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by health facilities, during a workshop. Micro planning template and filling guide were completed and will be disseminated to health facilities.

IR2.2.5aA1-SA2: Duplicate and disseminate of management tools All management tools are available. No requests received IR2.2.5aA1-SA3: Supply chain and logistics - Transportation of vaccines or vaccinators (including the use of 2 drones) - IMPACT financially supported the transportation of 1,015 doses of Johnson&Johnson and 390 doses of

AstraZeneca by drone in 3 districts (Maroantsetra, Befandriana Nord, and Toamasina II). 15 flights were effective, and 17 health facilities were served . 1,792 people were vaccinated (Source: DHIS2 COVAX). Details are presented in Annex H/Table 3-a.

- During Quarter 2, IMPACT financially supported the transportation of 153,219 doses of Johnson & Johnson

vaccine, 9,763 doses of Pfizer and 11,110 doses of AstraZeneca from central/regions to regions/districts. Details are presented in Annex H/Table 3-b.

- Purchase of generators to increase national vaccine storage - Based on needs expressed by the Ministry of Public Health and after validation of the Directorate of

Expanded Immunization Program, IMPACT launched the procedures of the acquisition of cold chain equipment (generators, solar fridge, cold room) for the districts, Regional Directorate of Public Health, and at the central warehouse of the Directorate of Expanded Immunization Program. Acquisition of cold chain equipment is expected in Quarter 3.

IR2.2.5aA1-SA4 : Provide computer equipment In February, IMPACT provided computer equipment to SURECA to allow COVID-19 data processing (logistics, stock commodities, and vaccines stock status and distribution planning)

IR2.2.5aA1-SA5: Communications and advocacy: Provide internet connection for vaccination activities In February and March,2022, IMPACT donated 3,970,000 Ar ($USD 1,073) of call credits corresponding to 307 hours of calls and 134 Go to the Responsible of the Expanded Immunization Program in districts of Diana, SAVA, Atsinanana, Analanjirofo, Atsimo Andrefana, Vakinankaratra, Sofia and Menabe regions to submit information on vaccine stock and to ensure data reporting to the central level. IR2.2.5aA2- SA1: Country-level coordination, planning, and monitoring Technical support in various committees and meetings IMPACT participated in approximately 78 coordination, logistics and communication meetings led by DRSP teams in all 13 supported USAID-regions and in central with others Technical and Financial Partners (ACCESS, UNICEF, WHO, ect.). Regular meetings focused on coordination and improvement of vaccination activities (mobile strategy, advanced strategy) and action plans for vaccines near expiry date to meet zero expired doses of vaccines. IMPACT participated as coordination, transport and logistic, monitoring and evaluation data, and communication support.

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IR2.2.5aA2- SA2: Provide internet connection and airtime In January, IMPACT donated credit card for 29 hours of communication to the Regional Directorate of Public Health of Boeny to investigate all the tracing contact of positive cases IR2.2.5aA2- SA3: Set a routine data system to monitor the progress of each activity (purchase, distribution, communication, training, etc.) - IMPACT continued to hold weekly meetings to monitor activities progress and achievements using a

dashboard with all COVID-19 committee group, integrating all teams (Distribution, Communication, Regionals Operation and Monitoring & Evaluation)

IR2.2.5aA2- SA4: Recruit temporary workers for Covid-19 support in 6 regional offices IMPACT recruited five logistic temporary workers in five regional offices (Diana, Boeny, Atsinanana, Haute Matsiatra and Atsimo Andrefana) to support the management of COVID-19 response and vaccination activities namely vaccines stock follow up, administrative treatment on procurement and supply chain of donations, monitoring spending plans and budget and all other logistics-related support in accordance with Regional Directorate of Public Health needs. IR2.2.5aA2- SA5: Conduct Supervision of the availability of the use of PPE and social distancing at PA / PARC and the respect of SOP and waste management in collaboration with EMAR/EMAD - In Quarter 2, IMPACT continued to reinforce sensitizations of Supply Points and Community Relay Supply

Points on the importance of vaccination and respect of preventive measures including social distancing in the 13 USAID-supported regions. For Community Relay Supply Points, 56.76% (42/74) and for Supply Points, 42.8%) % (443/1035) are vaccinated.

- On March, IMPACT allocated Personal Protective Equipment (111 units of disinfectant Gel, 555 units of soap, 222 bottles of liquid bleach 1L, 111 boxes of surgical mask) to:

o 43 Supply Points in DIANA o 68 Supply Points in SAVA

IR5.4a. A1-SA1: Community engagement and demand generation: Attendance at meetings During Quarter 2, IMPACT participated in several meetings about coordination of communication activities on COVID-19, as summarized below:

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Table 33 : Summary of coordination meetings on COVID-19 communication activities

Date Organizers Purpose of the

meeting/workshop

Output of the meeting IMPACT role and contribution

9th and 16th of February

Directorate of Expanded Immunization Program and the Ministry of Labor

The recognition of companies which vaccinate more than 80% of their employees

The determination of the name “certificate of recognition” and organization of informational meetings to explain to companies about how to obtain the certificate of recognition.

IMPACT supported the production of the “certificate of recognition”

28th of March

Directorate of Expanded Immunization Program and Directorate of Communication of Ministry of Public health

The coordination of the communication activities for vaccination against COVID-19, with the participation of other partners such as UNICEF, CRS, ASSOS, and USAID/ACCESS

The main subjects were (i) the validation circuit of the communication tools, (ii) the update of the Communication Plan, and (iii) the orientation of the strategy targeting rural area.

IMPACT follows the validation circuit of the communication tools. IMPACT adapted its communication activities on the Communication Plan and on the strategy targeting rural area.(Ex : broadcasting of TV and radio spot, advanced vaccination strategy, etc.).

Awareness through communication teams in the field using mobile sound systems In Quarter 2, during the 662 educational events using mobile sound systems conducted by the six IMPACT CFT, messages on COVID-19 prevention and information on the vaccine were transmitted. More than 163,370 people (70,400 men and 92,970 women) were reached in 46 districts (Toamasina I, Mahanoro, Vatomandry, Benenitra, Betioky Sud, Toliara II, Ampanihy, Toliara I, Maintirano, Antsiranana I, Antsiranana II, Ambilobe, Antsirabe I, Betafo, Faratsiho, Fianarantsoa II, Manakara, Morafeno Be, Antsalova, Toamasina II, Brickaville, Mampikony, Antsohihy, Befandriana, Mandritsara, Mahajanga I, Morondava, Mahabo, Belo Tsiribihina, Miandrivazo, Ambanja, Fianarantsoa I, Ambohimahasoa, Manandrina, Ambositra, Ambatofinandrahana, Fandriana, Lalangina, Ambatoboeny, Marovoay, Analalava, Port Berger, Vohipeno, Mananjary, Morombe, Sakaraha) in 11 USAID-regions (Diana, Vakinakaratra, Melaky, Amoron'i Mania, Haute Matsiatra, Atsinanana, Boeny, Atsimo Andrefana, Vatovavy Fitovinany, Sofia, Menabe), in 11 USAID-regions and Antananarivo during the vaccination campaign. Among the educational events mentioned above, IMPACT communication field teams ensured demand creation for the advanced vaccination strategy carried out by the District Service of Public Health.

Vaccination in the market during advanced Sensitization made by the IMPACT Communication vaccination strategy in Melaky Region Team in a market in Atsimo Andrefana Region

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Production of communication tools

- IMPACT produced tools as: o 5,300 hats with inscription “Za vita vaksiny” and 5,000 masks translated

to “I am vaccinated,” to be distributed to people doing testimonies during the vaccine awareness sessions.

o 2,000 posters for the Episcopal Commission district branch to support their sensitization in the Catholic church in 14 district offices in 12 USAID-supported regions and Antananarivo.

o 30,000 flyers on the four (4) kinds of available COVID-19 vaccines. Awareness through social media

- IMPACT published three kinds of Facebook posts on the Facebook page of PSI/Madagascar:

- Three videos to show how the vaccination at health facilities is done and to sensitize vulnerable people such as pregnant women, elderly people, and people with co-morbidities (blood pressure, diabetes, etc.,), to be vaccinated.

- Five testimonies from mothers, students, a blind person, and the mayor of Mizilo Gara in Fitovinany region. The posts aimed to encourage vaccination, and the importance of being vaccinated.

- Information on the different kind of vaccines. - The different vaccination campaigns were held: - in Antsiranana “''Fagnoesa hagnano vaksiny'' during the week

of February 7th, - in Toamasina during the week of February 7th, and - in Antananarivo, during the month of March. - These campaigns were supported by publications on

Facebook with sponsored posts targeting the population of the region concerned. - With post boosted, 195,232 people were exposed which was the maximum number of people

reached to avoid double counting.

IR5.4a. A1-SA2 Product and broadcast of radio and TV spots

- During Quarter 2,954 TV spots and 7,582 radio spots to sensitize about vaccination against COVID-19 were broadcasted in the 13 USAID-regions.

- The radio spots were translated in dialect from Region of Diana, Atsinanana, Atsimo Andrefana, Boeny, Haute Matsiatra

- From February 7th to 25th, IMPACT aired 5 different videos for a total of 15 broadcasts on the national TV for national coverage. The videos encouraged individuals to get vaccinated, make sure they get the second dose, and showed how the vaccination at health facilities (in rural and urban) is administered.

Organize local public event IMPACT organized local public event summarizes in the table below:

Flyers with information on vaccine available

Post of the testimony of the mayor of Mizilo Gara in Vinany Region

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Table 34: Public events organized by IMPACT

Date Region - District

Event IMPACT

communication contribution

Number of people

vaccinated

Targets % of achievements

February 7th to 12th

Diana – Antsiranana I

“Fagnoesa hagnano vaksiny” (Translated by let’s get vaccination)

- Awareness raising by the communication teams in the field using mobile sound systems supported by a local artist (for Antsiranana I)

- Production and broadcasted of vaccination radio spots in the local dialect

- Post boosted on Facebook to target local population

1,108 1,500 98%

February 28th to March 05th

426

February 7th to 14 th

Diana – Antsiranana II

872 2,190 135%


747


Diana – Ambanja

2,488 1,100

44%

February 7th to 14 th

Diana- Ambilobe

1,238 1,000 124%

February 7th to 11th

Diana- Nosy Be

338 800 42%

February 10th

Atsinanana- Toamasina

Launch of vaccination at City hall

- Awareness raising by the communication teams in the field using mobile sound systems

139 300 46,3%

- 7,356 6,890 106%

IR5.4b. A1: Support technically and financially the MoPH to reduce morbidity and mortality from COVID-19, mitigate transmission, and strengthen health systems, including to prevent, detect, and respond to pandemic threats IR5.4b. A1-SA1: P2. Risk communication and community engagement: Product communication tools IMPACT produced:

- a radio spot, named “Top Horaire”, broadcasted every hour with different messages according to the time of day and linked to barriers against COVID-19. For example, at noon: “You will have lunch? Wash your hands! Don’t forget the other barrier gesture to prevent COVID-19” with a common pack shot “I protect myself; I protect others, I’m also vaccinated”. The “Top Horaire” will be translated in seven (7) dialects.

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- 50 banners on the everyday life with COVID-19. The main message is “Your everyday life protected from COVID-19, continue to respect barrier gesture and be vaccinated”. It will be disseminated to the SDSP.

Banner to be displayed in the SDSP

- Existing TV spot produced during the first wave of COVID-19 was updated (including vaccination) to

reinforce barrier gesture. It was broadcasted on Facebook. IR5.4b. A1-SA2: Awareness through communication teams on field using mobile sound system IMPACT continued to reinforce prevention messages in all field communication activities, especially the respect of preventive measures. During the 699 mobile sound system education events conducted by the five communication field teams of IMPACT, messages on COVID-19 prevention were also integrated. Awareness through social media IMPACT published two videos on the Facebook page of PSI/Madagascar:

- March 9th to reinforce barrier gesture. 1,466 people reached, 244 views. - March 18th to sensitize vulnerable people such as pregnant women, elderly people and people with

comorbidities (blood pressure, diabetes, etc.) on COVID-19 with measure prevention to be taken care, as barrier gesture and vaccination. It was sponsored and reached 90,955 people

IR5.4b. A1-SA3: Support the MOPH for mission in region to train local team from DRSP A supervision mission was carried out jointly with the health promotion directorate and the communication directorate from the central level of the MOPH in Atsinanana region. A meeting was held with the regional managers to discuss the situation of vaccinations in the Atsinanana region. The main outcome was the organization of a workshop to strengthen vaccination and sensitization will be organized with the district manager of the region to analyze the situation and adjust the strategy.

IV- KEY CHALLENGES AND SOLUTIONS Key challenges Solutions

The LMIS software tender process is incomplete due to the lengthy validation procedure at the UCP/GF level.

The LMIS committee will hold a meeting to develop an action plan and explore other possibilities to organize the tender.

Last mile distribution is still a challenge: despite stock of malaria, FP/RH and MNCH commodities are available at the Pha-G-Dis, CSB and CHVs are experiencing stock outs of those commodities.

Increase involvement of the GAS and UTGL committees to analyze consumption of data and review/adjust quantities to distribute to CSB and CHVs and monitor the implementation of the two separate Reports/orders (for CSB and CHVs).

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Key challenges Solutions

Monitor product expiration dates to avoid waste. Hold monthly meetings with the UTGL to analyze inventory reports submitted by Pha-G-Dis and track the expiration dates of the products to organize redeployment when needed. The same analysis will be done at district level to analyze CSB reports and identify quantities of commodities to redeploy and avoid waste.

Limited implementation of the audit's recommendations from the Pha-G-Dis.

Follow up on audit recommendations during each supervision visit to the districts.

The country experienced 5 cyclones that increased the risk of increased malaria cases.

Monitor the increase of malaria cases in 26 affected districts and ship commodities in emergency, in collaboration of other stakeholders

I- MAJOR ACTIVITIES PLANNED FOR NEXT Quarter (YEAR 4, APRIL– JUNE 2022) IR 1: Enhanced coordination among the public, nonprofit, and commercial sectors for reliable supply and distribution of quality health products

- Continue activities to support TMA Champions and GOM’s TMA stewardship, coordination, and facilitation capacity to sustain TMA activities

- Continue the implementation of the TMA roadmap with the three subcommittees, as well as the malaria roadmap with the six specific objectives.

- Prepare the drafting of FP and MNCH roadmap with the Department of Family Health of MOPH. - Meet with the members of the UTGL for clarification of the position of the GTT AMT in the UTGL

IR 2: Strengthened capacity of the GOM to sustainably provide quality health products to the Malagasy people

- Organize a retreat with UTGL members to develop an investment plan taking into consideration the PMI stock out reduction initiative.

- Organize quantification workshops for malaria, MNCH and FP/RH commodities. - Conduct supervision visits of 50 Pha-G-Dis, 100 Pha-Ge-Com, and 39 hospitals. - Train Pha-G-Dis on correctly estimating quantities for resupply. - Provide technical support to organize the 13 UTGLs and 78 District GAS committee meetings. - Discuss with DPLMT on the institutionalization of SPARS and approve the recognition system of the

Pha-G-Dis with high-performing SPARS scores. - Disseminate the recently updated GIS procedure manual. - Conduct data collection and analysis of the EUV survey - Design an interactive online dashboard to visualize SPARS performance indicators of the 78 USAID-

supported Pha-G-Dis. - Develop a pilot implementation plan of the LMIS web-based software. - Prepare for data collection for the NSCA scheduled in July 2022. - Organize a dissemination workshop to use of the findings of the TCA to develop a roadmap.

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LLIN Activities 2021 LLIN mass campaign distribution Campaign

- Present qualitative study findings and RDQA assessment results to NCC - With NMCP, recruitment of a consultant to ensure the final report of the 2021 LLIN mass campaign - Support to the NCC in the organization of the workshop to capitalize on good practices, lessons learned

and recommendations from the 2021 LLIN mass campaign - Final drafting of the 2021 LLIN mass campaign report.

2022 LLIN community-based continuous distribution - Support NMCP in the organization of advocacy missions in the 14 target districts - Collect information about Pha-G-Dis and PhaGeCom in the target districts - Organize orientation sessions for logistics actors: PARC, Pha-G-Dis, PA and PhaGeCom - Prepare warehouses for LLIN storage and organize the transportation - Reception of 1,100,000 LLINS, from April 16

2022 LLIN mass distribution at the 10-elimination district

- Review and adjustment of LLIN distribution campaign strategies based on lessons learned and recommendations from 2021 LLIN mass campaign (May 2022)

- Revision and production of management tools and SBC supports (May 2022) - Training of actors (July 2022) - Conduct of household census in the 10 target districts (July 2022) - Delivery of LLINs from the central warehouse to the districts and then to the distribution sites (August

2022) - Distribution of LLINs to households (September 2022)

COVID-19 activities

- Reinforce vaccination activities with advanced strategies especially in rural zones - Continue the transportation and redeployment of vaccines from regions to districts and to communes - Continue to sensitize the community on COVID-19 prevention and vaccination using mobile sound

systems in all 13 USAID supported regions - Work in progress to plan increased consumption of Pfizer and finalize routing plan of vaccines with

DPEV - Continue approach to the private sector (companies, transporters, etc.), multi-sectorial (various

ministries, etc.), and collaborations with churches and mosques - Follow up on cold chain procurement

IR 3: Expanded engagement of the commercial health sector to serve new health product markets according to health needs and consumer demand

Private sector Engagement

- Partnership expansion to other regions, such as transportation in Menabe. - Formative supervision in the Diana region for drug shops owners. - Finalization of the TOR for the license transfer of Sur’Eau 150 ml product.

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Access to Finance - Evaluate the business financing needs of commercial health commodities enterprises to develop a new

financial risk mitigation mechanism. - Provide group business coaching as refresher training for drug shops which received video training in

SAVA. - Provide initial business-strengthening training to drug shops in either Haute Matsiatra or Melaky. - Support Formasanté in providing training to drug shops or pharmacies.

Support to AMM and ADDO Program

- Collect data in sampled depots in the two selected regions and analyze data for the ADDO baseline. - Develop training curriculum and modules. - Develop ADDO supervision system and guide. - Recruit depot outlets for the pilot phase in the two regions (Atsinanana and Analanjirofo). - Support the DAMM to finalize the selection of an electronic information systems for registration. - Organize training for DAMM personnel on the common technical document (CTD) to improve the

registration process in harmonization with other SADC countries. IR4: Improved sustainability of social marketing to deliver affordable, accessible health products to the Malagasy people

- Scale up of the drone delivery activity in Atsinanana and Sofia for the distance up to 50 km. - Monitor the integration of PARC and PA to the Pha-G-Dis and Pha-Ge-Com in Toamasina 2 - Training of trainers of EMAR from the 14 regions of IMPACT on the integration of PARC and PA to the

national supply chain of health commodities - Continue the integration of PARC and PA to the public sector for the selected districts by the

committee of integration IR5: Increased demand for and use of health products among the Malagasy people

- Contribute to supporting the celebration of World Day as health and malaria - Reschedule the youth event with a youth leader from Andranoboka in the region of Boeny who has

been trained during Year 3 to be a model among their peers. The youth leader should demonstrate good health behavior and increase demand and use of health products. It will be held in collaboration with other partners, (MOH, MYS, Blue Venture, and ACCESS).

- Finalize to develop the label for “ADDO” (name, branding) and the package (signage and display panel) to ensure visibility.

- Strengthen online broadcasts program with famous celebrities on social media to encourage youth to take care of their health and use proper medicines according to rational prescription.

- Continue communication activities on vaccination against COVID-19.

Cross-Cutting

Gender Equality and Social Inclusion - Finalize revisions and distribute all GESI-related factsheets (Access to Finance, TMA, Private Sector,

Public Sector) (carry-over from Year 3) - Finalize GESI slides to support coaching of regionally based staff - Organize quarterly IMPACT GESI partners meeting and sign Year 4 partnership agreement - Support public sector workshops with GESI content as needed

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- Begin outlining GESI mainstreaming manual - Attend key meetings for gender- and health-related working groups as relevant

Monitoring, Evaluation, Research and Learning

Monitoring and Evaluation

- Finalize the selection of new LMIS software - Create data entry template in DHIS2 to collect PA data integrated in Pha-Ge-Com, and the PARC

products integrated in the Pha-G-Dis to the CHANNEL software - Review the helpdesk transfer processes to the DPLMT. - Develop and implement a rapid data collection tool (for example SMS using Android system) to collect

commodity status every week. - Finalize the recruitment of a consultant to create a unique database and automate the calculation of

PMP indicators. - Continue to supervise the Pha-G-Dis, Pha-Ge-Com, PARC, PA, pharmacies, and drug shops on LMIS use. - Continue routine data quality assessments every quarter by comparing the improvement between

two quarters among a sample of Pha-G-Dis, Pha-Ge-Com, PARC, and PA. Research

- Evaluation of communication fieldwork team: data analysis and report finalizing - Evaluation of SMS broadcast: study protocol finalized, data collection implemented, and data analysis

started Knowledge Management

- Conduct field visits to collect the project’s success stories, innovations, and continue to support staff in finding topics for success stories

- Assist the NMCP in finalizing and disseminating the LLIN Mass Campaign final report - In collaboration with IR5, prepare the dissemination of the project’s results and lessons learned per

technical area through the organization of the TMA fair.

V- FINANCIAL SUMMARY Table 35: Financial summary

Description Total Estimated

Amount Obligated Amount

Estimated Expenditures Jan. – Mar. 22

Estimated Expenditures as of Mar. 22,

Estimated remaining Funds as of

Mar. 22

Malaria

$48 585 102

$12 361 000 $751 197 $10 068 376 $2 292 624

MCH $7 045 795 $578 579 $8 128 295 $(1 082 500)

FP/RH $7 079 520 $582 914 $8 056 821 $(977 301)

COVID-19 $3 500 000 $238 149 $1 080 065 $2 419 935

COVID-19 (MOD15) $6 560 000 - - $6 560 000

TOTAL $48 585 102 $36 546 315 $2 150 839 $27 333 557 $9 212 758

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Table 36: Financial reporting: COVID-19 related Expenditures, January - February - March. 22

Total funding

Approved Total spent for

period

Cumulative expenditure (COVID only)

Total Commitments

Supplemental Funds #1 (May.20 – Oct.20)

$700 000 - $700 025 -

ARP #2 (Sep.21 – Sep.22)

$1 500 000 $238 149 $380 041 $54 231 related to transportation of vaccine and samples for testing

$1 100 266 - - $132 was spent on a newspaper ad

TOTAL $3 300 266 $238 149 $1 080 066 $54 363

Budgets have been updated as per Mod #13 and Mod #14 respectively with $200,000.00 and $1,100,000.00 of American Rescue Plan COVID-19 Rapid Response Funds, approved during the reporting period.

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ANNEXES

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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/

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PMP Q2 FISCAL YEAR 2022

USAID IRs and Sub-IRs

Reporting to

Indicator Measure of Unit

Y4 % of achievement.

Observations/Deviation explanations Achievement Quarter 1

Achievement Quarter 2 Target

Intermediate Outcomes/Outputs Short-term Outcomes

SO2 (IR 2.9)

PPR USAID

Couple Year Protection (CYP) in USG supported programs

Number

Public sector N/A N/A N/A No target defined for Year 4

Private for nonprofit sector 143,980 150,355 705,690

42%, target is not met, the achievement is below to the quarterly goal (50% of the annual target). Sales of oral contraceptive, Condom Protector Plus, and Sayana Press at community level did not meet the quarterly target.

Commercial sector 0 0 135,612

Pharmaceutical wholesalers did not share systematically the LMIS data. IMPACT/DEPSI requested LMIS data for every quarter, but they have stated that is too frequent for them. In Quarter 3, IMPACT scheduled a meeting with pharmaceutical wholesalers to present data use of the latest data shared in FY 2021.

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

IR1.1.9 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 1 1 4 50%, target met the quarterly goal (this is the expected achievement for the Quarter 2)

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

IR2.1.1 (IR2.4.1 IR3.1.3)

PMP USAID

Average stockout rate at service delivery points (SDP) of tracer essential drugs (MCH, malaria) Percent

Public sector Pha-G-Dis Malaria ACT Newborn

Percent 13 3 5 Target met

ACT Infant 13 7 5 Target nearly met. The country has enough stocks to distribute at all levels. The RLA will collaborate with

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Reporting to Indicator

Measure of Unit



Achievement Quarter 2

Target

ACCESS to ensure that commodities reach the CSB and CHV on time and in sufficient quantities

ACT Adolescents 9 15 5

Target not met. The country experienced low stock levels in this quarter and shipped quantities under the minimum stock levels to districts as a way of rationing. Consumption increased than predicted. The country is expecting to receive PMI and Global Fund deliveries in Q3. In addition, PMI agreed to procure 180,000 doses to increase stock levels of this formulation

ACT Adult 8 7 5

Target nearly met. The country experienced low stock levels in this quarter and shipped quantities under the minimum stock levels to districts. Consumption increased than predicted. The country is expecting to receive PMI and Global Fund deliveries in Q3. In Q2, PMI agreed to procure additional 84,000 treatment to increase stock levels of this formulation

Rapid Diagnostic Test (RDT)

3 6 5

Target nearly met. The product was available in the country and enough stock to distribute at all levels. Efforts will be made to meet the target in the next quarter.

Sulfadoxine-Pyrimethamine (SP)

14 22 5

Target not met. The product is available at the central level. the Pha-G-Dis distributed quantities to CSB including security stock while waiting for restock

Injectable Artesunate 6 9 5

The result is close to the target The Pha-G-Dis distributed the product to CSB and used also their security stocks. The product is available at central level and will be shipped to districts. The RLA will collaborate with ACCESS to monitor and sensitize CSB to order the product.

MCH

Oxytocin (10 IU Injection)

59 58 10

Target not met. The product is distributed currently by SALAMA through the FANOME circuit. Logistics information are not systematically reported yet for MCNH commodities as they are procured directly by SALAMA

Magnesium Sulfate (500mg Inj) 55 62 10 Target not met. The product is procured by UNFPA

and distributed by DSFa. The new Technical Advisor of

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Measure of Unit




Target

IMPACT supported the DSFa to collect districts orders and planned distribution of MgSO4 in this quarter

Gentamicin (20mg inj)

97 95 10

Target not met. The product is distributed currently by SALAMA through the FANOME circuit. Logistics information have not been systematically reported yet for MCNH commodities as they are directly procured from SALAMA


89 92 10

Target not met. The product is distributed currently by SALAMA through the FANOME circuit. Logistics information have not been systematically reported yet for MCNH commodities as they are directly procured from SALAMA

Pha-Ge-Com

Malaria

ACT Newborn 11 5 5 Target met. The stock availability increased since Q1

ACT Infant 12 2 5 Target met. The stock availability increased since Q1

ACT Adolescents 12 4 5 Target met. The stock availability increased since Q1

ACT Adult 13 4 5 Target met. The stock availability increased since Q1

Rapid Diagnostic Test (RDT)

12 3 5 Target met. The stock availability increased since Q1

Sulfadoxine-pyrimethamine (SP)

18 5 5 Target met. The stock availability increased since Q1

Injectable Artesunate

16 6 5 Target nearly met. The stock availability increased since Q1

MCH

Oxytocin (10 IU Injection)

86 14 10 Target not met. The stock availability increased since Q1 through distribution by SALAMA via FANOME

Magnesium Sulfate (500mg Inj)

83 6 10 Target met. Stock procured by UNFPA was distributed in this Q2 and improved the availability at the CSB level

Gentamycin (20mg inj) 99 63 10

Target not met. The stock availability increased since Q1 through distribution by SALAMA via FANOME


96 31 10 Target not met. The stock availability increased since Q1 through distribution by SALAMA via FANOME

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Measure of Unit




Target

Private for nonprofit sector

PARC MCH


Percent

11 19 5 Target not met due to insufficient stock of ORS. IMPACT received the donated ORS from UNICEF in mid-February which was distributed to PARC in March.

Sur Eau Pilina (67mg tablet) (Community)

0 0 5 The target was met

Arofoitra (CHX 7,1%) (Community) 1 2 5 The target was met


65 99 5 IMPACT is in stockout of Pneumox. The new arrival will be in June 2022

Pregnancy Test (Community)


PA MCH


8 12 5 Target not met due to insufficient stock of ORS. IMPACT received the donated ORS from UNICEF in mid-February which was distributed to PARC in March.

Sur Eau Pilina (67mg tablet) (Community)

0,5 1 5 The target was met

Arofoitra (CHX 7,1%) (Community)

0,4 4 5 The target was met


53 97 5 IMPACT is in stockout of Pneumox. The new arrival will be in June 2022

Pregnancy Test (Community)

0,2 0.1 5 The target was met

IR2.1.2 (HL7.1.3)

PPR USAID

Average stockout rate of contraceptive commodities at Service Delivery Points by family planning methods

Percent

Public sector Pha-G-Dis

Implantable Hormonal Contraceptives

Percent

21 33 10 Target not met. The country experienced shortages of contraceptives. It is anticipated that UNPFA deliveries will be received in Q3

Injectable Hormonal Contraceptives (Depo provera)


95



Measure of Unit




Target

Injectable Hormonal Contraceptives (Sayana Press)


Intrauterine Devices 17 20 10 Target not met despite that the stock availability. The RLA will collaborate with ACCESS to improve quantification of the product

Oral Hormonal Contraceptive. Microgynon

7 15 10 Target not met. The country experienced shortages of contraceptives. It is anticipated that UNPFA deliveries will be received in Q3.

Oral Hormonal Contraceptive. Microlut

8 15 10 Target not met. The country experienced shortages of contraceptives. It is anticipated that UNPFA deliveries will be received in Q3.

Pha-Ge-Com

Implantable Hormonal Contraceptives

11 5 10 Target met. The Pha-G-Dis were able to distribute their security stocks to respond to CSB orders.

Injectable Hormonal Contraceptives (Depo provera) 10 4 10

Target met. The Pha-G-Dis were able to distribute their security stocks to respond to CSB orders.

Injectable Hormonal Contraceptives (Sayanna Press) 12 6 10


Intrauterine Devices 11 6 10 Target met. The Pha-G-Dis were able to distribute their security stocks to respond to CSB orders.

Oral Hormonal Contraceptive. Microgynon

8 4 5 Target met. The Pha-G-Dis were able to distribute their security stocks to respond to CSB orders.

Oral Hormonal Contraceptive. Microlut 5 3 5


Private for nonprofit sector PARC

Oral Contraceptive (Community)

Percent


Injectable (Community) 1,4 0 5 The target was met

FP Condom Protector Plus (Community) 0 0 5 The target was met

Sayana Press 2 0 5 The target was met

ROJO 0 0 5 The target was met

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Measure of Unit




Target

PA

Oral Contraceptive (Community)


Injectable (Community) 1,5 0.5 5 The target was met

FP Condom Protector Plus (Community)


Sayana Press 2 0.8 5 The target was met

Rojo 3 0.6 5 The target was met

IR2.1.16 PMP

IMPACT Number/Percentage of required supply plans submitted to GHSC-PSM during the quarter.

Number

2 2 8

Malaria 1 1 4 Target met as one supply plan is submitted every quarter. the target is an annual target

FP/RH 1 1 4 Target met as one supply plan is submitted every quarter. the target is an annual target

MCH N/A N/A N/A No target defined for Year 4

IR2.2. The public-sector supply chain achieves financial sustainability

IR2.2.1 PMP

IMPACT Percent of product that is unusable due to expiry or damage

Percent

SALAMA Expiry

Percent 0 0 1 Target met Damaged

PhaGDis Expiry

Percent 1 1.2 5 Target met

Damaged

PhaGeCom Expiry

Percent 0,6 1

5

Target met Damaged

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

IR3.1.2 PMP

IMPACT Number of loans (in general) disbursed to businesses (excluding service providers)

Number 15 5 60

33% achieved. Significant decrease in health loans disbursed due to staff turnover at partner banks and to the fact that pharmacies and drug shops are still reluctant to contract loans for the relaunch of activities

97



Measure of Unit




Target

IR3.1.3 PMP

IMPACT Value of loans (in general) disbursed to businesses (excluding service providers) USD $87,703 $19,435 $100,000

107% achieved. One large loan ($40K) in Q1 skewed results.

IR3.1.4 PMP

IMPACT Number of people trained in business and financial management Number 44 15 86 69% achieved, target met to the quarterly estimate.

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

IR4.1.2 PMP IMPACT

Number of socially marketed products distributed

Number

FP

OC Community 324,436 504,957 1,901,680

44% of the annual target. This is slightly lower than the result expected in quarter 2. However, an increase of 55% compared to Q1 due to return to normal supply at all levels after the high COVID-19 rate.

Injectable (Depo-Provera/TRICLOFEM) Community 374,515 422,464 1,624,373 49% of the achievement, is close to the target for the quarterly estimate

FP Condom Protector Plus (Community) 447,025 200,400 1,733,292 37% of the annual target due to the COVID-19 sanitary situation in early Quarter 2 leading the wholesalers and retailers to achieve less sale.

FP Youth Condom Yes (Commercial) N/A N/A N/A No target defined for Year 4

Sayana Press 99,985 37,619 522,976

26% of the annual target due to a decrease of the number of Regular Users (39%) of Injectable in Q2 (Source ACCESS), passed on Sayana Press and not on Triclofem.

Calendar-based method (ROJO) 1,902 420 3,150 74% of the annual target. There were no any distribution of starter batches for CHV in Quarter 2

MCH

ORS/Zinc DTK (Community) 5,799 9 ,254 53,440

28% of the annual target due to the stockout of ORS till the arrival of the donated ORS from UNICEF on February 16th and the resumption of the distribution in Districts (PARC) in March.

Sur Eau 150 ml Commercial N/A N/A N/A No target defined for Year 4

Sur Eau Pilina (67mg tablet) (Community) 312,800 398,000 2,778,000 26% of the annual target due to the existence of some associations and NGOs who built modern infrastructures and pumps for access to drinking

98



Measure of Unit




Target

water, thus less use of Sûr’Eau Pilina by the population.

Arofoitra (CHX 7,1%) (Community) 1,438 1,128 32,228 8% of the annual target due to the free distribution of Chlorhexidine 20 gr of UNICEF to the CHV, thus, the lower usage of the Chlorhexidine 3 gr of IMPACT.,

Pneumox (amoxycilline) (Community) N/A N/A N/A

The product is in stockout at central level due to the elapsed time between the decision by USAID to stop the funding of the MNCH products and the decision to allow IMPACT to procure the MNCH with the Program Income. Thus, the buying cadence witnessed a disruption.

Pregnancy Test (Community) 46,476 36,819 106,090

79% of the annual target due to the positioning of the products at PARC and PA in the 7 regions where ACCESS proceeded the training of the CHW on this product

IR5: Increased demand for and use of health products among the Malagasy people/Output/Activity

IR.5.4 PMP

IMPACT Number of mass media spots aired

Number

Health area

MALARIA 696 1,392 20,000

10%, the achievement is lower than the quarterly estimate (50% of the annual target) due to the very high target. the targets will be updated in AMELP in FY 22

FP 849 1,777 15,000

18% the achievement is lower than the quarterly estimate (50% of the annual target) due to the very high target. Also, the targets will be updated in AMELP in FY 22

MCH 800 1,200 20,000

10% the achievement is lower than the quarterly estimate (50% of the annual target) due to the very high target. Also, the targets will be updated in AMELP in FY 22

99

ANNEX B – Year 4 Workplan Update

100

Activity Code Sub-Activity Code Description of the Activity

Timeline FY22 Status Comments

Quarter 2 Jan 22 Feb 22 Mar 22

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 IR1.1.3A1 Support the development and implementation of the FP and MNCH action plans and conduct the program review of the Malaria TMA roadmap

IR1.1.3A1 IR1.1.9A1- SA1 Finalize and disseminate the FP and MNCH market assessment reports

Ongoing Report validation is pending

IR1.1.3A1 IR1.1.3A1- SA2 Support the development and the implementation of the FP and MNCH TMA actions plans to ensure the availability of quality FP and MNCH products at all levels

X X X Ongoing Depends on the dissemination of the results of the FP and MNCH market assessment

IR1.1.3A1 IR1.1.3A1- SA3 Monitor and conduct the mid-term evaluation of the malaria TMA roadmap with the NMCP and the RBM members and the private sector

X X X Completed The Mid-term review meeting allowed to evaluate the activities progress of the malaria TMA roadmap

IR1.1.3A1 IR1.1.3A1- SA4

Continue to engage the private sector to collaborate with relevant actors and stakeholders in the FP and MNCH logistical committees at the DSFa, and the RBM group at the NMCP

X X X Ongoing Private sectors were involved in the meetings of malaria actors and FP

IR1.1.3A2 Continue to support the GOM to disseminate all IMPACT results and TMI decisions in collaboration with MERL team.

IR1.1.3A2 IR1.1.3A2- SA1 Support GOM in submission of abstracts for and attendance of FP, MNCH, and malaria virtual conferences

Ongoing An abstract on malaria was drafted

IR1.1.8A1 Continue to leverage and strengthen the TMA Champions and GOM’s Total Market Initiative (TMI) stewardship, coordination, and facilitation capacity to sustain TMA activities

IR1.1.8A1 IR1.1.8A1- SA1 Conduct sessions of the virtual study tour with the TMA Champions

Ongoing The next virtual study tour will be on 13th April 2022

IR1.1.8A1 IR1.1.8A1- SA2 Conduct a stewardship capacity strengthening and identify and implement areas for capacity building of TMA Champions and GOM

X Ongoing Stewardship capacity assessment were conducted with two TMA champions

IR1.1.8A1 IR1.1.8A1- SA3 Continue to involve the TMA Champions in planning and implementing TMA activities for their peers (GOM and private sector)

X Ongoing TMA champions presented implementing TMA activities in the TWG meetings in Fianarantsoa.

IR1.1.9A1 Review, update, and continue the implementation of the overarching TMA roadmap for all health products

IR1.1.9A1 IR1.1.9A1- SA1 Support the TMA Champions to sustain the TMA TWG group and meetings as part of the Unite Technique et de

X X X Ongoing Terms of reference for a meeting of TMA TWG members with UTGL members have

101

Activity Code

Sub-Activity Code Description of the Activity Timeline FY22

Status Comments Quarter 2

Jan 22 Feb 22 Mar 22 Gestion Logistique (technical and logistics management unit) to improve partnership and access to commodities

been developed and sent to DPLMT and awaiting feedback.

IR1.1.9A1 IR1.1.9A1- SA2 Continue working with TMA TWG group on texts and regulations amendment and development

X X X Ongoing The next meeting of the texts and regulations sub-committee should include this theme

IR1.1.9A1 IR1.1.9A1- SA3

Continue working on engaging the private sector in the TMA process and encouraging their commitment to TMA activities to strengthen partnership and access to commodities

X X X Continuous Activity Continuous Activity

IR1.1.9A1 IR1.1.9A1- SA4 Review, update and continue tracking the implementation of activities and achievements of the overarching TMA roadmap.

X Ongoing Ongoing

1.2 GOM leads TMI stakeholders to coordinate health product quantification and forecasting, procurement, and distribution according to market assessments and segmentation

IR1.2.1A1 This sub-IR1.2 consists of the quantification and procurement plan for health inputs (Malaria, FP, HCM). The activities in IR1.1.3 A1 and IR2.1.16A1

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

IR2.1.3A1 Increase the capacity of the MOPH to provide oversight to public SCM

IR2.1.3A1 IR2.1.3A1- SA1

Support the GOM and stakeholders to apply the global PMI stock out reduction initiative introduced in 2021. Mobilize Technical assistance from GHSC-PSM to facilitate in country discussions to setting stock out rate baselines and targets, understanding the root causes of stock out reduction and developing solutions to address them, and finally designing interventions that target root causes to maximize stock availability at all levels of the public supply chain

X X Ongoing

In Q2, IMPACT introduced the PMI stock reduction initiate to the PNLP and its stakeholders. A 3-days' workshop was organized with 19 participants who looked at historical data on stock out of malaria commodities at facility level for the last 3 years (2019,2020 &2021) to set targets for the coming 3 years (2022-2023 &2024). Participants were able to define roots causes of stock outs and identified strategies to reduce the stock out by 10% each year. As a next step, IMPACT will support the PNLP and stakeholders to develop an investment case based on the strategies identified.

102

Activity Code



Jan 22 Feb 22 Mar 22

IR2.1.3A1 IR2.1.3A1- SA2

Technically support the central level GAS Committees to collect and analyze consumption and service data in order to develop quarterly distribution plans for malaria and FP/RH products based on reports/orders submitted by Pha-G-Dis. Commodities will be transported to districts through the service contract signed between IMPACT and SALAMA (both routine distribution and emergency distribution)

X X X Ongoing

100% of districts (114/114) have jointly validated their consumptions reports and orders for Q2. Malaria commodities have been transported by SALAMA in 111 districts by end of March 2022

IR2.1.3A1 IR2.1.3A1- SA3

Strengthen the capacity of the GAS committees through monthly mentoring from the RLAs, so that they are clear on their key functions and that they are capable to conduct them.

Ongoing

During the Quarter, new 8 RGIS at regional level, 34 RGIS at district level and 22 service providers of the Pha-G-Dis were newly appointed. The RLA conducted an onboard orientation and are planning a proper training on the revised manual GIS in the coming quarter.

IR2.1.3A1 IR2.1.3A1- SA4

Continue to support in collaboration with ACCESS, IMPACT will also support the DPLMT to develop a quarterly newsletter to share best practices and highlight successes of the Pha-G-Dis and the GAS committees.

Ongoing A photo essay has been produced and still under validation process by USAID to be disseminated through social media.

IR2.1.3A1 IR2.1.3A1- SA5

Provide technical assistance to support 13 regional UTGL and 78 district level GAS Committees to strengthen their leadership to analyze consumption reports from the CSB and plan resupply of malaria, MNCH, and FP/RH products

X X X Ongoing

71/78 (91%) of District GAS committees and 13 /13(100%) UTGL regions held coordination meetings during the Q2. Through the meetings, stocks analysis were conducted, and actions taken to order/resupply or organize redeployment to avoid expiry.

IR2.1.3A1 IR2.1.3A1- SA6

Collaborate and leverage technical and financial assistance with other stakeholders (UCP/GF, UNCEF, UNFPA) to support 13 regional UTGL and 78 district level GAS Committees to train/ coach newly recruited EMAR, EMAD and Pha-G-Dis staff on stock management.

X X Ongoing

In this Q2, 529 individuals (200 males and 329) received on-the-job training and coaching by the RLA in collaboration with EMAR and EMAR

IR2.1.3A1 IR2.1.3A1- SA7 Initiate an e-Learning training program on stock management and collaborate with DPLMT and Service de

X X X Ongoing IMPACT explored the possibility of setting up an e- learning platform for Pha-G-Dis.

103

Activity Code



Jan 22 Feb 22 Mar 22 Formation Professionnelle (SFP) of the MOPH to integrate the training as a requisite for Pha-G-Dis contract process. While the e learning module is being established, IMPACT will conduct a refresher training of the Pha-G-Dis staff in each of the 13 regions.

A meeting was held with the ACCESS team to learn on how they set up a similar online training material platform for CSB and CHV. In the next quarter, IMPACT will engage an external training company to develop the platform

IR2.1.3A1 IR2.1.3A1- SA8

Strengthen the capacity of 13 Regional (EMAR) and 78 District (EMAD) teams to conduct on-the-job supervision visits using the continuous quality improvement approach with SPARS (Supervision, Performance Assessment, and Recognition Strategy) and start to institutionalize it.

X X X Ongoing

The RLAs continued to provide technical and financial support to the 13 EMAR for supervising the Pha-G-Dis, hospitals, and CSBs/Pha-Ge-Com. In total, 54 Pha-G-Dis, 116 CBS/Pha-Ge-Com and 40 hospitals were supervised. In addition, four (4) Pha-G-Dis (Manakara, Benenitra, Ambatomainty and Mampikony) were audited as part of the contract’s ‘renewal process

IR2.1.3A1 IR2.1.3A1- SA9

In coordination with DRSP and SDSP, conduct call-to-action meetings to mobilize resources necessary to upgrade the storage standards and conditions of the Pha-G-Dis to the best practice standards in order to maintain good quality of stored commodities (renovation, cold chain, pallets, shelves, thermometers, management tools, etc.) and transportation of health commodities to the CSB

X X X Ongoing

IMPACT purchased and distributed 36 thermometers to monitor room temperature. In addition, IMPACT replaced nonfunctional laptops of Pha-G-Dis of Manakara (Fitovinany Region) and Nosy Be (Diana Region) to improve the CHANNEL reporting rate.

IR2.1.3A1 IR2.1.3A1- SA10

Organize coordination meetings with key partners (ACCESS, UCP, UNICEF, PIVOT, INTERAIDE, IPM) at central, intermediate, and peripheral levels to plan interventions to support the supply chain of the priority health areas (malaria, FP, and MNCH) at all levels

X Ongoing

IMPACT organized 29 regional coordination meetings and 37 district-level meetings with various stakeholders to coordinate actions aimed at improving the availability of stocks of antimalarial, FP, and MNCH products

IR2.1.3A1 IR2.1.3A1- SA11 Integrate civil society membership into the board of the Pha- G-Dis to increase accountability to the population

Ongoing

IMPACT has conducted a mapping of civil society organizations (CSOs) operating in the 78 supported districts of the 13 regions to determine how to engage those CSOs in the management of the Pha-G-Dis. Currently, 12 (out of 13)

104

Activity Code



Jan 22 Feb 22 Mar 22 supported regions have CSO operating and contributed to the LLIN mass distribution campaign. 1 Pha-G-Dis of the Antanambao Manampontsy district is already managed by a CSO. IMPACT will approach the DPLMT and share the idea of interesting engaging the CSOs to manage 23 Pha-G-Dis currently managed by the MOPH staff and/or associations led by the MOPH staff as the practice is not complying with existing standards.

IR2.1.14a.A1 Support technically and financially the MoPH to reduce morbidity and mortality from COVID-19, mitigate transmission, and strengthen health systems, including to prevent, detect, and respond to pandemic threats for the following aspects

IR2.1.14a.A1 IR2.1.14a.A1- SA1 P6. Infection prevention and control: Provide supplies and expandable equipment for hospitals and DRSPs (PPE, disinfectants…)

X Ongoing 26 hospitals and 07 health facilities were recipient of donation

IR2.1.14a.A1 IR2.1.14a.A1- SA2 Supply of products and protective equipment for the staff, CHVs, PA, PARC, Drug Shops… (PPE, disinfectants…)

X Ongoing Provided supplies to 167 PA/PARC, 5 Pha-G-Dis, 50 staffs

IR2.1.14a.A1 IR2.1.14a.A1- SA3 Conduct regular disinfection of offices, warehouses, vehicles

X X X Ongoing Continuous activity

IR2.1.14a.A1 IR2.1.14a.A1- SA4 Train hygienists and health workers on waste management and IPC (Infection prevention and Control)

Ongoing

The next training is planned in May for SAVA, Boeny and Sofia due to accessibility issues from communes to districts

IR2.1.14a.A1 IR2.1.14a.A1- SA5 Support technically and financially the MOPH to develop, disseminate and implement SOPs on healthcare such as waste management, disinfection and service delivery

X Ongoing Supervision of health facilities on waste management and cleaning equipment were launched

IR2.1.14a.A1 IR2.1.14a.A1- SA6 P7. Case management: Provide essential drugs

X Ongoing Donation of 4,800 vials of Enoxaparin 600mg to MOPH and Kit MAPI for DRS Atsinanana

IR2.1.14a.A1 IR2.1.14a.A1- SA7

Provide supplies, consumables and equipment related to case management (pulse oximeter, glucometer, equipment for ambulance, laboratory reagents and consumables…) for emergency treatment centers

X Ongoing 26 hospitals and 07 health facilities were recipient of donation

105

Activity Code




IR2.1.14a.A1 IR2.1.14a.A1- SA8 P8. Operational support and logistics: Ensure transport of health commodities and equipment X Ongoing

Support the transport of oxygen tank and all donation of consumables and equipment for emergency treatment centers

IR2.1.15A1 Support efforts to strengthen the LMIS and SCM M&E systems

IR2.1.15A1 IR2.1.15A1- SA1

Provide technical and financial support to DPLMT and DEPSI in the deployment process of the new LMIS tools in the public sector. This activity is part of the implementation of the LMIS roadmap validated in March 2021. IMPACT will leverage funding with other donors such as UCP-Global Fund, UNFPA and UNICEF.

X X X Ongoing

During Quarter 2, the quarter, IMPACT supported the LMIS committee and DPLMT to finalize the list of products, and product codes (both FANOME and all vertical programs commodities) and facility codes (Pha-G-Dis, Pha-Ge-Com, PA, PARC, pharmacy unit) that will be uploaded into the new software and ensure interoperability with the existing systems (DHSI2, SAGE SAARI, etc.).

IR2.1.15A1 IR2.1.15A1- SA2

Provide technical and financial support to the DPLMT to review/update the manual for stock management of health commodities as part of introduction of the new LMIS tool

X X X Ongoing

IMPACT supported the MOPH to finalize the revision of the manual for stock management and the manual of logistics indicators. The two manuals were signed in March have been signed by the Minister of Health in March and will be disseminated to all levels in the next quarter. The revised manual for stock management integrates terms of reference for supply chain actors at all levels, the LMIS flow and reporting formats, formulas to estimate quantities to order, the rationing system, and the supervision system based on SPARS.

IR2.1.15A1 IR2.1.15A1- SA3

Conduct two End User Verification surveys in randomly selected facilities in the 13 USAID-supported regions and support the MOPH (UTGL or DPLMT, the NMCP, and DSFa) to implement corrective measures addressing previous weaknesses.

X Ongoing

IMPACT prepared logistics of the fourth EUV survey that will be completed in April 2022. Eight regions have been sampled among the 78 USAID supported districts, with a randomly selection of 66 CSBs, 3 CHRDs, 18 Pha-G-Dis, 1 central

106

Activity Code



Jan 22 Feb 22 Mar 22 warehouse/SALAMA, and 15 CHVs. A total of 36 products, including 12 malaria, 9 FP/RH, and 15 MNCH, will be surveyed. Data collection will start in April 2022 and the reports will be ready for dissemination in June 2022

IR2.1.15A1 IR2.1.15A1- SA4 Collaborate closely with GHSC-PSM, UNFPA, UNICEF, SALAMA to support MOPH to plan and conduct a NSCA X X X Ongoing

IMPACT collaborated with GHSC-PSM to prepare for the NSCA . The Following activities were concluded completed: ● Finaliza on of the RACI matrix to define roles and responsibilities of the key interveners : IMPACT, GHSC-PSM, Ministry of Health, and USAID. ● Developed a formal NSCA SOW to mobilize the technical assistance of the GHSC-PSM and define together timeline of the evaluation. ● Presented the NSCA methodology to engage the new DPLMT Director and key stakeholders (UNFPA, UNICEF, WHO, SALAMA, European Union, UCP) and harmonize the timeline with other supply chain assessments planned in 2022. A maturity model assessment will be conducted in June by UNICEF, followed by the NSCA in July and the SRAT of UNFPA in October2022. With all data collected through those different evaluations, IMPACT will support the DPLMT and all stakeholders to develop a mid-term (6 to 12 months) and a long term five-year strategic plan. ● Developed an es mated budget of the NSCA to mobilize financial resources from other stakeholders. The budget of

107

Activity Code



Jan 22 Feb 22 Mar 22 the NSCA is estimated to be $125,000 USD. Currently, IMPACT has an available budget of $50,000 USD and UNFPA has mobilized $30,000 USD. Resources mobilization will continue in the next quarter to cover the gap of $45,000 USD

IR2.1.13A1 Continue to support NMCP in 2021 LLIN mass campaign distribution strategy, its implementation, and the distribution of 620,350 LLIN procured with USAID/PMI’s fund at the 6 remaining districts

IR2.1.13A1 IR2.1.13A1- SA1 Continue to support NMCP for the LLIN mass campaign coordination at national (NCC), district and community level

X X X Ongoing

Distribution completed for the 101 districts Finalization of data upload

IR2.1.13A1 IR2.1.13A1- SA2

Ensure in collaboration with the Civil Society Organizations (CSO) the distribution of LLIN mass campaign in the 6 remaining districts, the waste management, and the restitution of LLIN remaining stock to the CSB

Ongoing Monitoring of post-Campaign activities ongoing

IR2.1.13A1 IR2.1.13A1- SA3

Continue the support of SDSP and CSB in the implementation and the monitoring of the pre and post LLIN campaign activities through the 26 Controllers and the support staff in central and district levels

X X X Ongoing Contract of Consultants will end by end of March

IR2.1.13A1 IR2.1.13A1- SA4 Support the SBC sub-committee of the NCC for the radio and TV broadcast of per and post campaign focused on the use and maintenance of LLINs

X X X Ongoing

Diffusion of post-Campaign spots in the 26 districts

IR2.1.13A1 IR2.1.13A1- SA5

Support the M&E sub-committee of the NCC on the monitoring, reporting (data collection etc.), and the documentation of the results of the 2021 LLIN mass campaign

X X X Ongoing

Support to the NMCP for the documentation of the results of the Campaign: conducted RDQA, qualitative assessment and recruitment of a consultant for the finalization of the Campaign final report

IR2.1.13A2 Support technically NMCP to organize the 2022 LLIN mass distribution at the 10-elimination district

108

Activity Code




IR2.1.13A2 IR2.1.13A2- SA1 Support technically the NMCP in the organization of the LLIN mass campaign for the elimination districts in 2022

X X X Ongoing Identification of districts completed Acquisition of additional LLIN ongoing Strategy review ongoing

IR2.1.13A3 Support the NMCP in the implementation of Community-based Continuous Distribution (cCD) of LLIN in targeted districts for an effective distribution in early FY23 (October 2022)

IR2.1.13A3 IR2.1.13A3- SA1 Support the NMCP in strategy workshop and advocacy for the preparation of continuous distribution of LLINs in targeted districts

X X X Ongoing

Completed the workshop for strategy review and advocacy at the Ministry of Education Advocacy at regional level planned in May 2022

IR2.1.13A3 IR2.1.13A3- SA2 Organize logistics activities to transport and store 1,100,000 LLINs in the targeted districts to approximately 500,000 households

X X X Ongoing

Acquisition of 1 100 000 LLIN ongoing (ETA April 2022) Identification of warehouse 1 200m² ongoing

IR2.1.13A4 Support NMCP to organize the 2022 LLIN routine distribution at the targeted district

IR2.1.13A4 IR2.1.13A4- SA1 Ensure the procurement of 200,000 LLINs for routine distribution with the financial support of USAID/PMI X X X Ongoing Acquisition of 200 000 LLIN ongoing (ETA

April 2022)

IR2.1.13A4 IR2.1.13A4- SA2 In collaboration with NMCP and DEPSI, ensure the data collection and reporting of the routine distribution in DHIS2

Ongoing Identification of warehouse ongoing

IR2.1.16A1 Implement an integrated forecast and supply planning process for the public sector with related tools for commodity needs assessments

IR2.1.16A1 IR2.1.16A1- SA1

Continue to provide extended technical assistance to build lasting capacity of GOM programs staff (NMCP, DSFa), and SALAMA on quantification and use of Pipeline software and other global supply planning tools (e.g. PPMRm)

X X X Ongoing

IMPACT collaborated with the GHSC-PSM to prepare and submit the PPMRm and Supply plan analytics tools within the deadline. In the next quarter, IMPACT will provide refresher trainings to DPLMT, PNLP, and DSFa staff on the use of Pipeline software in preparation of the quantification workshops of malaria, FP/RH and MNCH quantification workshops

109

Activity Code




IR2.1.16A1 IR2.1.16A1- SA2

Provide technical and financial support to the UTGL members to conduct annual quantification exercises and quarterly reviews to ensure adequate resources are mobilized to procure malaria, FP/RH, and MNCH commodities to cover the public sector needs

X X X Ongoing

IMPACT supported the NMCP and GAS malaria committee to: ● Analyze the updated malaria commodity supply plan, present the supply gaps at the RBM meeting, and organize a resource mobilization meeting with PMI and GF. Following these meetings, IMPACT placed two additional orders for ASAQ 6-13 years (180,000 doses) and ASAQ 14 years and older (362,000 doses). Madagascar has also obtained PMI’s agreement to move forward with ordering the 1,500,000 doses of ACT expected according to in line with the approved MOP FY2023. These orders are expected to arrive in the country by the end of September 2022. ● Es mate quan es of malaria commodities to respond to the post-cyclones period and d——and mobilize resources for procurement. The Global Fund committed the necessary fund, and the approval process has started.

IR2.1.16A1 IR2.1.16A1- SA3

Coordinate with GHSC-PSM on generation of orders and tracking of shipments/deliveries of malaria and FP/RH commodities procured with USG and other donors (Global Fund, UNICEF, UNFPA) funding and according to agreed upon supply plans. Organize delivery/receipt and storage once the commodities are delivered in country.

X X X Ongoing

IMPACT continued to track procurement orders in the pipeline from PMI and the Global Fund procurement offer malaria commodities. Monthly updates are shared with the PNLP, GAS Committee, USAID, and UCP to inform order status updates and any actions that may be required on delayed orders

IR 2.2 The public-sector supply chain achieves financial sustainability

IR2.2.3A1 Based on total cost analysis (TCA) of the public supply chain, prepare evidence to analyze different supply chain alternatives on the total cost to determine progressive integration of commodities managed by vertical programs into SALAMA circuit and reduce dependence to donor funding for different cost categories of the supply chain

110

Activity Code




IR2.2.3A1 IR2.2.3A1- SA1

Support the MOPH to implement some of the changes proposed in the roadmap developed as a result of the total cost analysis to increase efficiency in the supply system and to mobilize other sources of support for the options proposed in the roadmap.

X X X Ongoing

IMPACT finalized the first draft of the TCA report to be disseminated. In this Quarter 2, IMPACT conducted the initial briefing sessions with SALAMA, the hospitals and the TCA steering committee. The steering committee, led by the Secretary General Technical Assistant and comprised of various Directions of the Ministry of Health, SALAMA and TFP (UNICEF, WHO, IMPACT), will meet to plan the wider stakeholder dissemination in June and during which a roadmap for corrective actions will be developed

IR2.2.3A1 IR2.2.3A1- SA2 Support MOPH to develop a new strategic plan for integration of all essential medicines and commodities (PAIS) through the single circuit of SALAMA

X X X Postponed

This activity is depending on the National Supply chain assessment giving that will give enough information to develop the PAIS. Data collection of the NSCA is scheduled in July 2022 and the report to be disseminated and used for strategic planning earlier in January 2023

IR2.2.3A1 IR2.2.3A1- SA3 Support the MOPH to mobilize technical and financial support to implement the new PAIS strategic plan

Postponed Same reason as above

IR2.2.3A1 IR2.2.3A1- SA4

Support the MOPH to study the resources used for procurement, possible efficiency gains in the procurement process and consider a gradual transition of procurement process

X X X Not yet started The activity is planned to start in Q4 as a next step of the Total cost analysis dissemination workshop

IR2.2.3A2 Reinforce the capacity of the MOPH to oversight and monitor the management of FANOME

IR2.2.3A2 IR2.2.3A2- SA1

Support the Interministerial committee of fighting illicit market to compile audit reports of Pha-G-Dis covering the period of 2018 to 2021 and organize a dissemination meeting of findings with DRSP.

Not yet started The activity is planned to start in Q4

IR2.2.3A2 IR2.2.3A2- SA2 Strengthen the district-level supervision and control of the FANOME system through regular audits of the Pha-G-Dis and systematized renewals


111

Activity Code




IR2.2.3A2 IR2.2.3A2- SA3 Develop selection criteria and procedures for contracting Pha-G-Dis


IR2.2.5aA1 Support technically and financially the MoPH to accelerate widespread and equitable access to and delivery of safe and effective COVID-19 vaccinations for the following aspects

IR2.2.5aA1 IR2.2.5aA1- SA1

1. Policy, planning, and coordination: - Support MOPH for micro-planification for Covid-19 vaccination campaign by attending the national and regional technical and logistics steering committee meetings

X X X Ongoing

Attended bimonthly coordination meeting in USAID-13 supported regions for vaccination activities improvement. Micro planning template and filling guide were completed and will be disseminated to health facilities

IR2.2.5aA1 IR2.2.5aA1- SA2 - Duplicate and disseminate of management tools X X X Ongoing All management tools are available. No requests received

IR2.2.5aA1 IR2.2.5aA1- SA3 3. Supply chain and logistics - Transportation of vaccines or vaccinators (including the use of 2 drones)

X X X Ongoing Transported 154,234 doses of J&J, 11,500 doses of AZ and 9,763 doses of Pfizer

IR2.2.5aA1 IR2.2.5aA1- SA4 - Provide computer Equipment X X X Completed Donated 1 laptop to SURECA in February to ensure vaccines logistic follow up

IR2.2.5aA1 IR2.2.5aA1- SA5 6. Communications and advocacy: - Provide internet connection for vaccination activities

X X X Ongoing

Provided 3,970,000 Ar ($USD 1,073) of call credits corresponding to 307 hours of calls and 134 Go to the Responsible of the Expanded Immunization Program in districts

IR2.2.5aA2 Support technically and financially the MoPH to reduce morbidity and mortality from COVID-19, mitigate transmission, and strengthen health systems, including to prevent, detect, and respond to pandemic threats for the following aspects

IR2.2.5aA2 IR2.2.5aA2- SA1 P1. Country-level coordination, planning, and monitoring - Technical support in various committees and meetings

X X X Ongoing

Attended bimonthly coordination meetings in USAID-13 supported regions as logistic and communication committees

IR2.2.5aA2 IR2.2.5aA2- SA2 - Provide internet connection and airtime X X X Ongoing Provided 3,970,000 Ar ($USD 1,073) of call credits corresponding to 307 hours of calls and 134 Go to the Responsible of the

112

Activity Code



Jan 22 Feb 22 Mar 22 Expanded Immunization Program in districts

IR2.2.5aA2 IR2.2.5aA2- SA3 - Set a routine data system to monitor the progress of each activity (purchase, distribution, communication, training, etc.)

X X X Ongoing

- Monitoring of COVID-19 vaccine data reporting with DPEV - Training of data administrators at regional and district level - Regularization of data at district level

IR2.2.5aA2 IR2.2.5aA2- SA4 -Recruit temporary workers for Covid-19 support in 6 regional offices

X X X Completed Recruited 5 temporary workers for regional offices

IR2.2.5aA2 IR2.2.5aA2- SA5

- Conduct Supervision of the availability of the use of PPE and social distancing at PA / PARC and the respect of SOP and waste management in collaboration with EMAR/EMAD

X X X Ongoing

Availability of PPE and their use were supervised during monthly supervision. PA/PARC are progressively vaccinated with 485/1109 fully vaccinated result. Expiring dates were checked systematically during supervision with and early action plan of redeployment if needed.

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 market

IR3.1.1 Continue to promote public and private sector partnerships to engage the private sector in making available health commodities among commercial sector

IR3.1.1 IR3.1.1- SA1 Ensure sustainability of the transportation of health commodities in LMD as part of engagement of the private sector

X X X Ongoing

IMPACT continued to develop and implement private sector partnerships related to the availability of health commodities with Aqualma

IR3.1.1 IR3.1.1- SA2 Ensure sustainability of the partnerships on communication with the private sector as part of their engagement.

X X X Ongoing In Q2, collaboration with Telma on SMS Broadcast

IR3.1.1 IR3.1.1- SA3 Develop partnerships on capacity building and training with private sector that contribute to health commodities availability


IR3.1.6A1 Expand private sector engagement to ensure availability of malaria, FP, and MNCH health commodities

113

Activity Code




IR3.1.6A1 IR3.1.6A1- SA1 Following market assessment results presentation, elaborate action plan to increase private sector contribution in health commodities availability

X X X Not yet started Waiting for the validation of the FP and MNCH market assessments

IR3.1.6A1 IR3.1.6A1- SA2 Ensure private sector data integration in quantification exercises

X X Not yet started Waiting on the availability of the MOPH for a preparatory meeting

IR3.1.6A1 IR3.1.6A1- SA3 Support IR4 to implement license transfer mechanism on Sur’Eau with private sector

X X X Ongoing TOR validation is in progress

IR3.1.2-3A1 Increase access to finance for commercial health commodities enterprises/Expand supply-side financing.

IR3.1.2-3A1 IR3.1.2-3A1- SA1 Provide refresher training to partner banks in credit analysis and loan structuring for commercial health commodities enterprises and utilization of DFC guarantee.

X Ongoing 31/25 staff trained (124%). Activity realized in parallel with training sessions for drug shops in the regions.

IR3.1.2-3A1 IR3.1.2-3A1- SA2 Increase utilization of financial products and tools developed with partner banks in previous years (e.g., pharma loans, motorbike loans).


IR3.1.2-3A1 IR3.1.2-3A1- SA3 Evaluate the business financing needs of commercial health commodities enterprises to develop a new financial risk mitigation mechanism.

X X Postponed Launch postponed to Quarter 3

IR3.1.4A1 Support professional associations to oversee the functionality of commercial health commodities enterprises

IR3.1.4A1 IR3.1.4A1- SA1 Formalize new drug shop associations and revitalize the existing regional drug shop associations.

X X X Ongoing 3/3 (100%) drug shops association officially registered.

IR3.1.4A1 IR3.1.4A1- SA2 Support the development of business management capacity-building within associations by training potential peer trainers

Completed Additional activity: 1 peer trainer supervised in a training during Quarter 2

IR3.1.4A1 IR3.1.4A1- SA3 Facilitate involvement of drug shop associations in MoPH activities (TMA, Association des pharmacies, DPLMT meetings, ect.)


IR3.1.4A1 IR3.1.4A1- SA4 Support existing drug shop associations in planning their first annual meetings and providing thematic training on business management

X Ongoing 2/2 drug shops associations supported during their 1st General Assembly

IR3.1.4A2 Provide business strengthening capacity building to commercial health commodities enterprises

IR3.1.4A2 IR3.1.4A2- SA1 Provide group business coaching as refresher training for drug shops in region(s) which received video training X Ongoing

27/36 (75%).

114

Activity Code



Jan 22 Feb 22 Mar 22 IR3.1.4A2 IR3.1.4A2- SA2 Support Formasanté in developing training curricula Ongoing Will continue in Quarter 3

IR3.1.4A2 IR3.1.4A2- SA3 Support Formasanté in providing training to drug shops or pharmacies

X Ongoing Will continue in Quarter 3

IR3.1.4A2 IR3.1.4A2- SA4 Provide initial business-strengthening training to drug shops

Ongoing 15/30 (50%)

IR3.1.4A2 IR3.1.4A2- SA5 Conduct follow-up survey on improvements in business practices in trained drug shops

Not yet started Planned in Quarter 3

IR 3.2 GOM facilitates the work of the commercial sector

IR3.2.1A1 Facilitate high-level advocacy by the commercial sector to expand favorable FP policies and regulations (this activity will be covered under IR1 through TWG/AMT subcommittee in charge of Regulations)

IR3.2.1A2 Foster sustainable capacity development in regulatory reforms within the GOM

IR3.2.1A2 IR3.2.1A2- SA1

Provide technical assistance to ensure medical products prequalified by SALAMA and technical/financial partners (TFP) are registered in line with the MOU between DAMM and SALAMA, and the DAMM and TFPs

X X X Ongoing

IMPACT continued to support the implementation of the MOU signed between SALAMA and DAMM in regard of the harmonization process of prequalification of suppliers and registration applied respectively by SALAMA and DAMM to assure quality of medicines imported in the country. A joint technical committee composed of staff of DAMM and SALAMA staff has been created in October 2021 to develop a common evaluation grid of dossiers submitted by vendors to SALAMA as part of the international tendering process. 126 dossiers have been assessed with the common grid.

IR3.2.1A2 IR3.2.1A2- SA2 Continue to provide technical assistance to the DAMM to improve its registration process and set up an electronic registration database

X X X Ongoing

IMPACT continued to plan a demonstration of the PHARMADEX electronic management information system to the DAMM team.

IR3.2.1A2 IR3.2.1A2- SA3 Support the DAMM to conduct of an organizational and functional evaluation study of the Madagascar Medicines Agency as well as the analysis of its financial viability with

X X X Not yet started The activity is scheduled in Q4

115

Activity Code



Jan 22 Feb 22 Mar 22 a view to reviewing its legal status, identifying its real needs in terms of resources and update the nature and amount of its service fees

IR3.2.1A2 IR3.2.1A2- SA4

Collaborate with the Syndicat des Pharmaciens to provide technical and financial assistance to DAMM, DPLMT and the Inter-ministerial committee in their efforts to conduct targeted actions to fight illicit market. Regional workshops will be organized to sensitize local authorities in fighting illicit market and counterfeits medicines

X X X Ongoing

A subgroup is being formed internally within IMPACT to develop a draft action plan to fight against the illicit drug market with the objective of focusing on activities to disseminate current pharmaceutical regulations and to inform and educate the public about the risks associated with drugs of unknown source or unassured quality.

IR3.2.2A1 Develop and pilot an accreditation program for retail drug shops.

IR3.2.2A1 IR3.2.2A1- SA1

Finalize the preparation phase of the introduction of the ADDO (Accredited Drug Depot outlets) in selected two regions. The two regions will be selected by the steering committee in place since June 2021

Ongoing

Draft accreditation standards for ADDOs, a revised list of medicines approved for depots, and training topics for owners and dispensers seeking accreditation have been developed and submitted for internal review to expedite the finalization of the ADDO pilot preparatory phase. In addition, the TOR for the recruitment of a consulting firm to develop the ADDO training curricula in coordination with the MOPH technical team is being finalized

IR3.2.2A1 IR3.2.2A1- SA2

Organize meetings in the two selected regions to inform and mobilize health authorities, pharmacists, and drug depot owners via regional associations of drug shops on the purpose and interest of ADDO project. Sensitize the population on how to recognize an accredited drug deport to ensure demand creation

X X X Ongoing

IMPACT started to develop appropriate communication tools to inform the population on how to recognize an accredited drug depot. The tools will be used during the pilot phase of the ADDO once approved by the ADDO steering committee

116

Activity Code




IR3.2.2A1 IR3.2.2A1- SA3 Support the DPLMT and the ADDO steering committee to introduce the ADDO in the two selected regions during a period of 6 months as a demonstration phase

X X X Not yet started The pilot phase is planned to start in Q4

IR3.2.2A1 IR3.2.2A1- SA4 Carry out a baseline of sales practices and availability of products in the drug shops prior to introduction of the demonstration phase

Ongoing

The draft baseline study protocol and the client/depot questionnaires developed in February 2022 are being finalized for translation into Malagasy and will be configured in Survey CTO. The pre-testing of the collection tools and recruitment and training of the teams of interviewers and supervisors are scheduled for May 2022 (Quarter 3). Data collection and analysis will take place in May 2022 and the results will be available in June or /July 2022

IR3.2.3A1 Reinforce private sector active participation to implement TWG-TMA roadmap

IR3.2.3A1 IR3.2.3A1- SA1 Continue to mobilize private sector for TWG-TMA participation through PSHP lead X Not yet started

Delays due to the unavailability and turnover of MOPH staff

IR3.2.3A1 IR3.2.3A1- SA2

Integrate the implementation of TMA TWG of PPN PDPN, Text and regulations, Demand Creation sub-committees activities in PSHP workplan, with the lead of health commission

X Completed

IR3.2.5A1 Continue to support MOPH for effective private sector LMIS data collection IR3.2.5A1 IR3.2.5A1- SA1 Train drug shops on software developed for their LMIS X Completed IR3.2.5A1 IR3.2.5A1- SA2 Develop a tool to collect LMIS data among pharmacies X X X Ongoing Ongoing activity

IR3.2.5A1 IR3.2.5A1- SA3 Adjust the Excel tool to collect LMIS data among pharmaceutical wholesalers X X X Completed

IR3.2.5A1 IR3.2.5A1- SA4 Conduct formative supervision to assist the drug shop, pharmacies during on-the-job training on LMIS data submission and data use.

X X Completed

IR3.2.5A1 IR3.2.5A1- SA5 Collaborate with MERL and DEPSI to develop LMIS dashboard for private commercial sector

Ongoing Ongoing activity

Intermediate Result 4 Improved sustainability of social marketing to deliver affordable, accessible health products to the Malagasy people

117

Activity Code



Jan 22 Feb 22 Mar 22 IR 4.1 Socially marketed products are continuously available at convenient and accessible locations

IR4.1.1A1 In collaboration with IR2, DSFa, DPLMT, and DSSB, develop, finalize, and validate the scored criteria, standard, and process to transition from PARC and PA to Pha-G-Dis and Pha-Ge-Com

IR4.1.1A1 IR4.1.1A1- SA1

Assess the Pha-G-Dis and Pha-Ge-Com using a grid based on SPARS scoring. This evaluation will determine the status of each Pha-G-Dis and Pha-Ge-Com and guide the transition from PAs and PARCs.

X X X Ongoing

15 districts selected for the integration of PARC and PA to the Pha-G-Dis and Pha-Ge-Com Toamasina 2, Majunga 2, Antsirabe 1, Faratsiho, Antanifotsy, Ambohimahasoa, Ambilobe, Fénerive Est, Ankazoabo, Maintirano, Soalala, Morafenobe, Belo sur Tsiribihina, Nosy Be, Diego 2

IR4.1.1A1 IR4.1.1A1- SA2 Continue the transition from PAs and PARCs to Pha-G-Dis and Pha-Ge-Com following the assessment findings through groups: immediate transfer, deferred transfer.

X X X Ongoing

IR4.1.1A1 IR4.1.1A1- SA3

Transfer of the first group of PARC and PA to Pha-G-Dis and Pha-Ge-Com respectively, with integration of the quantity to be ordered into the SALAMA system and the LMIS data to Pha-G-Dis and Pha-Ge-Com.

Completed Kick off of the integration of PARC and PA in Toamasina 2. All PARC and PA in this district are transferred

IR4.1.1A1 IR4.1.1A1- SA4

In collaboration with DSFa, DPLMT, DSSB, and DRSP, continue to organize joint supervision of the groups of Pha-G-Dis and Pha-Ge-Com in order to enhance and upgrade their skills and competencies to be eligible to receive PARC and PA and evaluation of the first transfer to PA and PARC to PhaGeCom and Pha-G-Dis and development of a mitigation plan

X X X Ongoing Joint supervision with the integration committee in Toamasina2

IR4.1.1A1 IR4.1.1A1- SA5

Progressively integrate the quantity and LMIS data of health commodities of the PAs and PARCs who have been newly transferred to the Pha-G-Dis and Pha-Ge-Com into the national supply chain system

X X X Ongoing

Quantity of FP and MNCH integrated to the communes of Toamasina 2; 2 months Starter Batches allocated to the 35 communes of Toamasina 2

IR4.1.2A1 Distribution of socially marketed products across ten (10) regions for MNCH and FP/RH products and distribution of only FP/RH products in three (3) PARN Regions through PARCs and PAs.

IR4.1.2A1 IR4.1.2A1- SA1 Schedule quarterly coordination meetings at central level and districts and monthly meetings in regions for

X X X Ongoing 14 meetings held at regional level and 48 meetings held at district level for community-based distribution activities

118

Activity Code



Jan 22 Feb 22 Mar 22 community-based distribution activities (social marketing stock status and regular users' updates)

IR4.1.2A1 IR4.1.2A1- SA2

Plan and implement supervision to ensure good management, storage, Distribution & Disposal of Public Health Commodities for PA and PARC on a monthly basis by SRD,SPD,CL for PARC and PAs.

X X X Ongoing Ongoing activity

IR4.1.2A2 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 stock out

IR4.1.2A2 IR4.1.2A2- SA1

Conduct training for PAs and PARCs which are not yet transferred to PhaGeCom and Pha-G-Dis on an annual basis with an updated curriculum, including financial management as part of the revenue generating activity.

Not yet started Ongoing activity

IR4.1.2A2 IR4.1.2A2- SA2 Organize the Personal Performance Review (PPR) of PAs and PARCs on a quarterly basis and execute the incentive system for PA and PARCs following the PPR results

X X X Ongoing Incentive attributed to the PA and PARC resulting from the completed Q1 PPR. PPR for Q2 will be in April 2022

IR4.1.2A2 IR4.1.2A2- SA3

Support the PA and PARC, which will be transferred to Pha-Ge-Com and Pha-G-Dis and which have served the community voluntarily for more than 10 years, on: Income-generating activities trainings and certificates of recognition

X X X Ongoing Completed: certificate recognition for 1 PARC and 19 PA in Toamasina 2.

IR4.1.2A3 Start scale up of drone activity and emergency distribution to deliver health products.

IR4.1.2A3 IR4.1.2A3- SA1 Organize the official IMPACT launch for using drones to deliver health commodities

Completed

IR4.1.2A3 IR4.1.2A3- SA2 Continue to deliver malaria products to CSB and FP/RH and MCH products to PA and Scale up the use of drones in other regions

X X X Ongoing Scale up in Toamasina 2 and Sofia (Befandriana Nord)

IR4.1.2A3 IR4.1.2A3- SA3 Conduct monthly supervision visits for drone distribution by the drone supervisors and coordinator


IR4.1.2A4 Define and implement a product monitoring tracking X X Ongoing Ongoing activity IR4.1.2A5 Ensure preventive measure against COVID-19

IR4.1.2A5 IR4.1.2A5- SA1

Provide PPE (personal preventive equipment), expendable commodities, and equipment to distribution team, PA, and PARC to protect against Covid-19 according to allocated funding

X X X Ongoing Disinfecting gel 150 units ; Soap in pieces 750 units ; Liquid bleach 1L 300 bottles ; Surgical mask 150 boxes of 50 masks are

119

Activity Code



Jan 22 Feb 22 Mar 22 distributed for 10 PARC and 140 PA in DIANA and SAVA

IR 4.2 Socially marketed products achieve cost recovery at an affordable price for consumers

IR4.2.1A1 Leverage the findings from IR 1 to optimize the current portfolio of socially marketed products, explore potential additions to the portfolio to enhance sustainability, and adjust marketing strategies accordingly

IR4.2.1A1 IR4.2.1A1- SA1

Explore brand extension of Yes With You condoms with a product at cost recovery in order to have a more financially sustainable portfolio and will continue to adjust the current marketing mix and set up a social business unit


IR4.2.1A1 IR4.2.1A1- SA2

Distribute each product in its respective channel and social business unit (commercial, pharmaceutical, or community-based distribution) according to the segment of population targeted


IR4.2.1A1 IR4.2.1A1- SA3

Engage the private sector to introduce new pharmaceutical products of FP or/and MNCH following the results of market assessment and apply HCD techniques for new products


IR4.2.1A2 Strengthen the medical detailing program

IR4.2.1A2 IR4.2.1A2.SA1 Support the introduction of transferred or new products to the private sector for the availability of the products, and production of posters

Not yet started

Intermediate Result 5 Increased demand for and use of health products among the Malagasy people

IR5.1: The market demonstrates sufficient and sustained demand for health products IR5.1.A1 Provide technical and financial support to MOPH communication activities that are linked to the IMPACT mission

IR5.1.A1 IR5.1.A1- SA1 Technically and financially support the activities related to IMPACT mandate and requested by the GOM (ex: celebration of world health days, etc.)

X X X Ongoing

IMPACT supported the celebration of the international women's day, by sending 1,680,001 SMS broadcasted, publishing factsheets, a press release and producing a video with interview of CNFM and EFOI.

IR5.1.A1 IR5.1.A1- SA2

In coordination with IR2 and IR4, provide technical and financial support to the MOPH on the communication activities related to the transition of the supply chain system from PA and PARC to Pha-Ge-Com and Pha-G-Dis;

X X X Ongoing

IMPACT designed posters to be put up at PA and PARC level. Organization of the official presentation of this project and the signature of the MOU on March 24th

120

Activity Code



Jan 22 Feb 22 Mar 22 through developing and printing communication tools and SMS broadcasting

in Antetezambaro, district of Toamasina 2, Atsinanana region.

IR5.1.A1 IR5.1.A1- SA3

Support implementation of "ADDO", with labelling package, composed of signage sign and display panel will be provided to ensure the visibility. And local radio spot will be broadcasted to create demand and boost the sales of the ADDO.

X Ongoing

IMPACT /IR5 participated in the internal meeting to implement the ADDO model and lead the “Branding and creation of demand subcommittee”. The labelling (name and branding) of this project is ongoing

IR5.1.A2 Develop and implement Youth activities, in collaboration with partners (MYS, MOPH, ACCESS, Blue Ventures, etc.)

IR5.1.A2 IR5.1.A2- SA1

In collaboration with other partners, following peer education strategy, youth leaders will be trained to be a model among their peers, to have good health behavior, and to increase demand and use of health products.

X X X Postponed

The training of young leaders from Andranoboka in the Boeny region was rescheduled due to the inaccessibility of the locality during the rainy season

IR5.1.A2 IR5.1.A2- SA2

Develop and broadcast online program with bloggers, influencers, famous celebrity on social media to encourage youth to take care of their health and use proper medicines according to rational prescription.

X X X Ongoing

Shooting with renowned artist : Mr Saida, on the thematic of family planning and the risk of early marriage and early pregnancy was done. Broadcasted will be held in Quarter 3.

IR5.1.A3 Leverage new technology to drive demand among population and improve prescription of medicines for malaria, FP/RH, and MNCH health commodities

IR5.1.A3 IR5.1.A3- SA1 Integration of the health commodities promoted by IMPACT in the digital platform E-zaho developed by PSI/M

X X X Ongoing On March 15th the digital platform E-zaho was officially launched to the public

IR5.1.A3 IR5.1.A3- SA2

Develop and broadcast online program targeting health care provider. Interventions of renowned physicians on prescription of health commodities will be recorded and posted on medical order's Facebook page. Virtual meeting or webinars will also be organized for the doctors of medial order, on several topics involving drugs

X X X Ongoing

IR5.1.A4 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 (including social media) incorporating gender messaging to promote and use health commodities for population and providers

IR5.1.A4 IR5.1.A4- SA1

Conduct communication activities (broadcast radio and TV spots, produce printed media, organize events, etc.) to different target populations (general population and health service providers, including CHVs) to promote the

X X X Ongoing

4,369 TV and radio spots broadcasted ( 1,200 radio spots on CHX, 425 TV spots and 1,352 radio spots on Family Planning and 1,392 radio spots on Malaria)

121

Activity Code



Jan 22 Feb 22 Mar 22 use of health products for the three prioritized health areas (Malaria, FP, and MNCH), in collaboration with DPS, NMCP, and DSFa

IR5.1.A4 IR5.1.A4- SA2

Increase demand creation of health products by using mobile sound systems organized and conducted by the IMPACT field communication team in the 13 USAID-supported regions. Strengthening of the connections between the actors of the distribution (AC, PARC, PA, wholesaler, drug store...), and pharmacists and drug shops, to stimulate the sales. This approach is effective because it offers a direct communication with interactivity with target population. Then, messages can be easily adapted to the context and the requirement for information. It is also more adapted to rural areas where channels of communication and advertisement are limited.

X X X Ongoing

The social mobilization by the six FCT conducted sensitization activities reached 116,690 people about Malaria; 14,730 people about FP and 152,740 people about MNCH

IR5.4a.A1 Support technically and financially the MoPH to accelerate widespread and equitable access to and delivery of safe and effective COVID-19 vaccinations for the following aspect

IR5.4a.A1 IR5.4a.A1- SA1 Community engagement and demand generation: - Awareness through social media

X X X Ongoing

IMPACT published three kinds of Facebook posts :Videos (3) ;Testimonies (5) and Information (1) on the different kind of vaccines

IR5.4a.A1 IR5.4a.A1- SA2 Community engagement and demand generation: - Product and broadcast of radio and TV spots - Organize local public events

X X X Ongoing

During Quarter 2, 9,54TV spots and 7,582 radio spots to sensitize about vaccination against COVID-19 were broadcasted in the 13 USAID-regions Local public event were organized such as “Fagnoesa hagnano vaksiny” in Diana

IR5.4b.A1 Support technically and financially the MoPH to reduce morbidity and mortality from COVID-19, mitigate transmission, and strengthen health systems, including to prevent, detect, and respond to pandemic threats for the following aspect

IR5.4b.A1 IR5.4b.A1- SA1 P2. Risk communication and community engagement: - Product Billboard

X X X Ongoing The internal process to implement the billboard was on going. Communication tools as

122

Activity Code




IR5.4b.A1 IR5.4b.A1- SA2 - Awareness through communication teams on field using mobile sound system

X X X Ongoing

In Quarter 2, during the 662 educational events using mobile sound systems conducted by the six IMPACT communication field teams, messages on COVID-19 prevention and information on the vaccine were transmitted. More than 163,370 people (70,400 men and 92,970 women) were reached

IR5.4b.A1 IR5.4b.A1- SA3 - Support the MOPH for mission in region to train local team from DRSP

X X X Ongoing

IR5.1.A5 In collaboration with the TMA TWG demand creation subcommittee led by the MOPH (DPS), continue to implement activities to increase the demand for health products and ensure safe use of the products through the National Communication Plan

IR5.1.A5 IR5.1.A5- SA1

Engage private sector members of the TMA TWG demand creation subcommittee to implement the activities included in the National Communication Plan on the safe and rational use of health commodities.

X X Postponed

Meeting of the TMA TWG demand creation subcommittee will be held in Quarter 3 because of unavailability of DPS.

IR5.1.A5 IR5.1.A5- SA2

Technically and financially support the DPS to implement demand creation activities for the safe and rational use of health products according to the National Communication Plan.

X X X Ongoing

During the Press Tour in Toamasina from March 21st to 23rd , the DPS in collaboration with DPLMT and the DirCom of MOPH present the National Communication Plan on the safe and rational use of health products to the 21 journalists

IR5.1.A5 IR5.1.A5- SA3

Train and build capacity of the members of the TMA TWG demand creation subcommittee to support them on the implementation of the National Communication Plan on the safe and rational use of health commodities

X X X Ongoing

The 21 journalists present during the Press Tour in Toamasina received refresh training on journalistic report provided by the training company Kentia

Cross Cutting Gender GESI A1 Reinforce GESI Partnership and Visibility

GESI A1 GESI A1- SA1 Engage IMPACT’s GESI partners (CNFM and EFOI) through quarterly meetings and IMPACT opportunities X Ongoing

CNFM and EFOI engaged as IMPACT key partners in advocacy during IWD 2022; Drafted partnership agreement

123

Activity Code




GESI A1 GESI A1- SA2 Participate in at least two gender- and health-related advocacy events (16 Days; IWD)

X Completed Participated in IWD 2022 celebrations in Manakara (March 2nd to 6th) and Antsirabe (March 7th to 8th)

GESI A1 GESI A1- SA3 Represent IMPACT in gender- and health-related working groups (as relevant)

X X X Ongoing Attended SIGL sub-committee meeting

GESI A2 Strengthen Capacity of IMPACT Partners

GESI A2 GESI A2- SA1

Conduct GESI workshop(s) for supply chain distribution channels from the public sector (e.g., SALAMA, Pha-G-Dis, Pha-Ge-Com, MOPH staff) and possibly the commercial sector (wholesalers, pharmacies, drug shops)

Not yet started

Not applicable for Quarter 2

GESI A3 Provide Technical Leadership to IMPACT Staff and Partners

GESI A3 GESI A3- SA1 Continue to support IMPACT IR teams in the on-going integration of GESI issues in all program activities X X On-going

Drafted GESI coaching slides for regional staff

GESI A3 GESI A3- SA2 Draft a GESI mainstreaming training manual for health commodities supply chain management

X Postponed Postponed start until Quarter 3

Cross Cutting MERL

MERL1A1 Support financially and technically the MOPH to strengthening the LMIS with the use of DHIS2 as data analysis and dissemination tool for the three sectors: public, social marketing, and commercial (pharmaceutical wholesalers, pharmacy, and drug shops) through the implementation of LMIS roadmap

MERL1A1 MERL1A1- SA1

Finalize the selection of new LMIS software with the partners and working closely with the company to adapt the country need (respond to the minimum requirements approved by the MOPH)

X Postponed Under discussion with MOPH and partners to accelerate the process

MERL1A1 MERL1A1- SA2 Select and adapt new LMIS software to fit with the country need (respond to the minimum requirements approved by the MoPH)

X X Postponed Under discussion with MOPH and partners to accelerate the process

MERL1A1 MERL1A1- SA3 Continue the transfer of helpdesk to the DPLMT X X X Postponed

MERL1A1 MERL1A1- SA4 Continue to supervise the Pha-G-Dis, Pha-Ge-Com, PARC, PA, Pharmacies, and drug shops on LMIS use

X Completed Formative supervision in Six Districts

MERL1A1 MERL1A1- SA5 Develop and implement a rapid data collection tool (for example SMS using Android system) to collect commodity status every week

X Not yet started This activity will start in Q3

MERL1A2 Support technically and financially the DEPSI and DPLMT to ensure that routine data quality assessment (RDQA) is conducted every Quarter at all levels for the three sectors and the data validation process is set up (with a protocol approved by the MoPH).

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Activity Code




MERL1A2 MERL1A2- SA1 Conduct routine data quality assessments every quarter by comparing the improvement between two quarters among a sample of Pha-G-Dis, Pha-Ge-Com, PARC, and PA

X X Completed RDQA conducted in six Pha-G-Dis, 3 PARC and 3 PA

MERL1A2 MERL1A2- SA2 Conduct quality assessment of the LMIS data using coherence testing of the data received on a monthly basis by the system

X X X Completed This activity was based on a Desk review by the Helpdesk teams

MERL2A1 Implementing study to evaluate efficacy of communications activities

MERL2A1 MERL2A1- SA1 Conduct qualitative study to assess the efficiency of the field communication team activity Ongoing Ongoing activity

MERL2A1 MERL2A1- SA2 Conduct qualitative study to evaluate efficacy of the SMS broadcast

Ongoing Ongoing activity

MERL3A1 Support technically the MoPH and IMPACT project team in developing and collecting success stories and documenting innovations in the field


Assist technically the MoPH (Central, regional (EMAR), and district (EMAD) team) and the IMPACT field teams (RLA, SRD, SPD, Axian Foundation Representative, PSI Regional Coordinators, etc.) to collect success stories and innovations using provided template

X X X Completed for Q2 Continuous Activity

MERL3A1 MERL3A1- SA2 Post success stories through IMPACT’s, MoPH and USAID Madagascar platforms (Website, social media, periodical newsletters)

X X X Completed for Q2 Continuous Activity

MERL3A2 Develop and disseminate IMPACT's learnings and results through different KM products (learning sheets, PowerPoint presentations, reports, abstracts, ect.) and participate in national and international conferences

MERL3A2 MERL3A2- SA1 Develop and disseminate IMPACT's results on implementation of TMA (Results vs Outcomes, Challenges and lessons learned)

X X X Ongoing Ongoing

MERL3A2 MERL3A2- SA2 Develop and disseminate IMPACT's results on private sector engagement in health sector, specifically on transportation of commodities

X Ongoing Ongoing

MERL3A2 MERL3A2- SA3 Develop and disseminate successes, challenges and lessons learned from of the LLIN Mass Distribution Campaign

X X X Completed

Successes, challenges and lessons learned from of the LLIN Mass Distribution Campaign collected and will be integrated in the final report and disseminated

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Activity Code




MERL3A2 MERL3A2- SA4 Develop and disseminate successes and lessons learned from the implementation of a new electronic tool (SMS Android) during LLIN Mass Campaign

X X X Completed Integrated in the qualitative assessment during LLIN Mass Campaign

MERL3A2 MERL3A2- SA5 Develop and disseminate the results and learnings on the introduction/use of the new LMIS software within two selected regions for technical test

Not yet started This activity will start once the introduction/use of the new LMIS software completed

MERL3A2 MERL3A2- SA6 Disseminate IMPACT's results in participating to national and international conferences through Abstracts X X X Completed

One abstract submitted to ICFP and 4 abstract for ASTMH

MERL4A1 Support technically and financially the MOPH to accelerate widespread and equitable access to and delivery of safe and effective COVID-19 vaccinations for the following aspect


Monitoring, evaluation, learning and health Information systems: Set a routine data system to monitor the progress of each activity (purchase, distribution, communication, training, etc.)

X X X Completed

Refresher training for Expanded Program Managers (region and district) and registerers in Antsirabe, Mandoto, Ambohimahasoa and Fianarantsoa

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ANNEX C - Environmental Mitigation and Monitoring Report

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Summary number of the outlets visited

Type of Outlet Number of

Outlets Visited Total Number of

Outlet % of Outlets Visited Number of Field

Team Supervisors

Public Sector

SALAMA/central warehousing 0 6 0%

13 RLA Pha-G-Dis 54 78 69%

CSB/Pha-Ge-Com 156 1,734 8% Nonprofit Sector (social marketing)

Warehouse 0 15 0%

30 DPS PARC 74 74 100%

Supply Point 1035 1035 100%

EMMP for Public Sector

In Quarter 2, the 13 RLA supported the EMAR and EMAD in the 13 supported regions to supervise 156 health facilities (116 Pha-Ge-Com and 40 hospitals) and 54 Pha-G-Dis. During the supervisions visits:

● 324 service providers of CSB/Pha-Ge-Com and hospitals/pharmacies were oriented and trained on stock inventory management, including waste management. ● 116 CSB/Pha-Ge-Com (116/116, 100%) and 38 hospitals (38/40, 95%) comply with best storage practices while two hospitals (5%) are categorized as having average storage

conditions. ● 155 CSB and hospitals (99%) disposed expired and damaged commodities in a separate quarantined space. ● 50 Pha-G-Dis (93%) and 148 CSB/Pha-Ge-Com/hospitals (95%) have guidelines and communication tools.

The RLA will continue to technically and financially support the EMAR and EMAD to supervise Pha-G-Dis and CSB/Pha-Ge-Com and hospitals to reinforce capacities in stock inventory management including proper management of waste and expired products.

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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 support may include communication materials and packaging (Job Aids)

Number of CSB and hospitals providers trained:

Male Female Total 87 237 324

100% [156/156] Pha-Ge-Com and hospitals visited were trained. In some facilities, more than two people were trained. 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

Number of CSB complying with proper storage conditions: Proper storage 154 Average storage 2 Poor Storage 0

Issues: The CHRD2 Ambilobe and CHRD2 Manja are categorized as facilities with average storage conditions. Resolutions: Supervisor’s teams composed of Regional GIS Manager, District GIS Manager, and the RLA shared the storage best practices according to the existing GIS manual to sensitize awareness of the service providers. ⮚ Proper Disposal of Commodities:

Outstanding Issues: None Recommendations: Collaborate with EMAR and EMAD to share and disseminate best storage practices to the CSB and hospitals during supervision visits

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RESOLUTION - expired or damaged stored in a separate location Proper Disposal 155

Mid disposal N/A Poor Disposal 1

Issues: 155 (99%) disposed of expired and damaged commodities in a separate quarantined space. The CSB of Fénerive-Est need to improve the proper disposal of commodities.

Resolutions: The Chief CSB of Fénerive-Est agreed to improve the storage conditions and transfer immediately the expired and damaged commodities into a separate space.

1.1.2. Provide supervision of CSB providers by using a Rapid Monitoring Tool to assess infrastructure and equipment for handwashing, infection prevention (decontamination and containers for infectious waste), waste cans, safety boxes, etc.

Below are the infrastructure and non-medical equipment for infection prevention:

− handwashing device − soap for washing hands − tissue for cleaning − chlorinated water

- 156 (100%) CSBs and hospitals supervised had non-medical equipment to prevent infection and contamination. The facilities were congratulated by the supervisors’ teams. Issues: None Resolution: None

Outstanding Issues: None Recommendations: The CSB and CHRD were advised to monitor stock of the non-medical equipment and resupply whenever needed to avoid stock outs.

1.1.3. Provide CSB providers with garbage cans & gloves for ordinary waste; sharps

Medical equipment for infection prevention is: − Safety boxes − Sharps containers

Outstanding Issues: None

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RESOLUTION containers and gloves; handwashing device with a bucket to catch handwashing water

− Gloves − Garbage disposal

-154 (99%) of CSB and hospitals were equipped with medical equipment for infection prevention. Issues: The CSB Soanierana Ivongo (District Soanierana Ivongo) and CSB2 Morafeno (Befandrina North district) were in stock out of gloves and garbage disposal.

Resolution: The supervisor teams composed of the Regional GIS Manager, District GIS Manager, and the RLA IMPACT recommended that the Chief CSB purchase gloves and a garbage disposal.

Recommendations: The CSB and hospitals will be reminded to purchase medical equipment with other medical products.

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

1a1) Review of the adequacy of existing SOPs: Results: Document entitled “National Politic for waste medical management and injection security in Madagascar” as SOP was found from the Health Promotion Department. Issues: Lack of SOP check during IMPACT field visit Resolution: Integrated supervision for respect of SOP on health facilities during IMPACT field visit and monitoring tool was set up

Outstanding Issues: Gaps of SOP implementation evaluation in all healthcare facilities. There is not information or supervision in the SOP. Recommendations: Reinforce assessment supervision on SOP application and planning of capacity building to refresh training on existing SOP

1a2a) Verification of the development and implementation of SOP: Result: Document entitled “National Politic for waste medical management and injection security in Madagascar” as SOP was found from the Health Promotion Department. Issues: Lack of SOP check during IMPACT field visit

Outstanding Issues: Gaps of SOP implementation evaluation in all healthcare facilities. There is not information neither supervision on SOP Recommendations: Reinforce assessment supervision on SOP application and planification of capacity

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RESOLUTION 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.

Resolution: Integrated supervision for respect of SOP on health facilities during IMPACT teams’ field visit and monitoring tool was set up

building to refresh training on existing SOP

1a2b) Accordance of the operation with the SOP Result: Some waste management equipment (trash bins, safety boxes, etc.) and disinfection (hand washing device, hydroalcoholic gel, etc.) are present in healthcare facilities Issues: Only 153 health facilities were supervised Resolution: Increased supervision field visit and set up planification of capacity building to refresh SOP application

Outstanding Issues: Gaps of SOP implementation evaluation in all healthcare facilities. There is not information or supervision on SOP Recommendations: Reinforce assessment supervision on SOP application and planification of capacity building to refresh training on existing SOP

1a3) Verification of the development and revision of WMP Result and issues: Document entitled “National Politic for waste medical management and injection security in Madagascar” as SOP and WMP was found from the Health Promotion Department. Application of this document in 100% health facilities is not ensured Resolution: Planification of capacity building to refresh SOP and WMP application for all health facilities (CSB in 13 USAID-supported regions) according to the planning of health and environment department under health promotion department (DPS)

Outstanding Issues: Gaps of WMP implementation evaluation in all healthcare facilities. There is not information or supervision on WMP Recommendations: Reinforce assessment supervision on actual WMP application and revision analysis if needed

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,

1) Training/curricula/ supervision that creates waste as part of the training will address appropriate best management practices concerning the proper management of healthcare

1b1) Respect of the best appropriate management practices during training and supervision Result: The next training is planned in May for SAVA, Boeny, and Sofia due to accessibility issues from communes to districts Issues: Accessibility issues during rainy season (January to April)

Outstanding Issues: None Recommendations: Training of trainers will conduct a training for healthcare workers in each healthcare facility.

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RESOLUTION community health care workers, and volunteers in areas of PPE use, waste management, procurement, storage, and disposal of commodities, and disinfection

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.

Resolution: Training planned in May 1b2) PPE provided and used by trainers: Result: Trainers will be equipped with PPE during the May session Issues: None Resolution: None

Outstanding Issues: None Recommendations: None

1b3a) Interview with participants to verify training was conducted: Result: IMPACT team will conduct interviews with those who attended the training session Issues: None Resolution: None


1b3b) Use of the supervision checklist developed from the training curricula to ensure compliance by health care workers. Result: Supervision checklist is used by the trainers Issues: Gap of supervision budget from MOPH Resolution: Integrated supervision checklist on health facilities during IMPACT teams field visit and verifying budget availability with USAID IMPACT for MOPH supervision

Outstanding Issues: Insufficient supervision budget to ensure compliance by healthcare workers Recommendations: Planification of supportive supervision to ensure the compliance by all healthcare workers with support from IMPACT

2. Social Marketing, Education, & Social Behavior Change Communication (SBCC). 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.

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

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: 2,213 SMS were sent to 959 PA, 67 PARC, 1,108 CHVs and 79 Pha-G-Dis. The message was: “Salama, Atokany toerana ny fanafody simba


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RESOLUTION Improper disposal of these items by end-users (the targets of the marketing messages)

tested with a diverse audience (differences in sex, age, literacy level, and socio-economic status). Details of the activities will be included in the communication plan.

na lany daty ary atero eny @ CSB na hopitaly hikarakarana azy. Mampididoza ny fanafody simba na lany daty!” This reminder message was translated to : “Hi, exclude damaged or expired medicines and take them to the CSBs and hospitals so that they can be taken care of. Damaged or expired medicines are dangerous. ”.This message is taken from National Communication Plan on the rational use of medicines Issues: None Resolution: None

2a (Activity type 1: Communication, outreach, planning - [1.1]). Social behavior change: communications, outreach, planning

1) Stay informed about ways to prevent COVID-19 transmission over the course of the activities, including where 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 Ge ng 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

2a1) Updates made to activities and training procedures to include COVID-19 best practices as appropriate Result: Teams on the field are regularly sensitized on the methods to prevent COVID-19 and on the systematic use of PPE and SHA gel during the activities and respect of social distancing − Commodities (SHA gel) have been made available. −Regular disinfection of offices and vehicles was realized. During the official launch of the delivery of commodities by drones, COVID-19 kit prevention with mask and SHA gel were distributed to the official guests (100 persons) Issues: None Resolution: None


2a2) Use of remote training and meetings. Result: IMPACT continued to apply staff rotation and teleworking, even if the rate of COVID-19 decreased. A lot of meetings were conducted through virtual conferences or in a hybrid. Issues: None


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RESOLUTION 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.

Resolution: None 2a3) Local regulations on the size of gatherings and travel advisories integrated into activities Result: With the decrease in the number of COVID-19 cases, the restrictions on the on the size of gatherings were cancelled. Issues: None Resolution: None


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, PA and public sector (SALAMA/central warehousing, Pha-G-Dis, Pha-Ge-Com 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, and PA trained on expired, obsolete, and surplus commodities:

Type Male Female Total Warehouse N/A N/A N/A PA 438 597 1035 PARC 24 50 74

− No warehouses visited during Quarter 2 for Year 4. Nonetheless, a

training was performed during Quarter 1 which included the management of expired, surplus, and obsolete commodities.

− 100% of PARC and PA visited were trained

Issues: None Resolution: None

Outstanding Issues: None Recommendations: Reminders and support on building capacity to properly manage expired, obsolete, and surplus products are provided during supervision.

Public sector Number of public sector persons trained: Outstanding Issues: None

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RESOLUTION

Type Male Female Total SALAMA N/A N/A N/A Pha-G-Dis 27 58 85 CSB/Pha-Ge-Com 90 230 320

- 100% (156/156) Pha-Ge-Com and 100% (54/54) Pha-G-Dis service providers were trained.

- Among 156 facilities, 260 CSB/Pha-Ge-Com and 60 service provides of hospitals were trained

- More than two people in Pha-G-Dis, Pha-Ge-Com and hospitals were trained in some Pha-G-Dis and Pha-Ge-Com visited

Issues: None Resolution:None

Recommendations: Supervision visits will continue in the next quarter. In addition, IMPACT and ACCESS will technically and financially support trainings/refresher trainings on the new manual of stock management recently signed by the Minister in March 2022

3.1.2. Regularly check expiry date of commodities during monthly visit of PSI central warehouse, PARC, PA and public sector (SALAMA/central warehousing, Pha-G-Dis, Pha-Ge-Com 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 Expired Surplus Obsolete

Warehouse 840 0 0 PA 0 0 0 PARC 0 0 0

Result: No expired, surplus, and obsolete commodities were identified for the PARC and PA visited Issues: None. Resolution: None

Outstanding Issues: None Recommendations: Reminders for continuous expiration date checks, as well as monitoring of stock levels of health products are carried out for each supervision.

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RESOLUTION Public sector

Number of expired, obsolete, and surplus products at public sector:

Product Expiry Surplus Obsolet

e SALAMA N/A N/A N/A Pha-G-Dis 0 0 0 Pha-Ge-Com 50 0 0

50 kits of malaria RDT expired in the CSB 1 Andrahalana in Ambatofinandrahana Issues: In this quarter, the RLAs assessed availability of incinerators in 42 Pha-G-Dis and 152 CSBs: - 54% (23/42) of Pha-G-Dis have incinerators - 69% (29/42) reported the destruction of commodities (paper reports

available) - 58% (89/152) CSB have an incinerator - 18% (27/152) CSB destroyed commodities in Q2 FY4

Facilities and Pha-G-Dis store expired commodities and need to install incinerators Resolution: During the supervision: - Expired mRDT kits were removed from the shelf and then stored in the

quarantine area (in a well-sealed box). - Supervisors reminded the Chief CSB to correctly estimate quantities for

resupply and avoid overstock of commodities - Supervisors provided on-the-job training to all Pha-G-Dis and health

facilities personnel to reinforce their capacities on estimating average monthly consumption (AMC), analyzing stock level, and defining Months

Outstanding Issues: None Recommendations: IMPACT RLA will continue to provide technical and financial assistance to EMAR and EMAD to conduct supervisions and reinforce the capacity of Pha-G-Dis and Pha-Ge-Com as well as hospitals pharmacy staff on stock inventory management (including management of wastes and expired medicines). For Pha-G-Dis and CSBs that do not have an incinerator, explore collaboration with local administrative authorities to build an incinerator.

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RESOLUTION of Stock available (MoS) , to detect overstock and understock situations taking into consideration stock parameters defined at their levels, and order the right quantity in case of understock or organize redeployment in case of overstock to avoid expiration.

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, PA and public sector (SALAMA/central warehousing, Pha-G-Dis , Pha-Ge-Com and CSB)

Nonprofit Sector Number of PSI central warehouse, PARC, and PA that have guidelines and communication tools:

Warehouse N/A PARC 74 PA 1034

− PARC and PA supervised have guidelines and appropriate communication

tools on storage conditions for each product except one PA. − No warehouse visited during Quarter 2 for Year 4


Outstanding Issues: None Recommendations: Efforts to ensure the availability of guidelines and communication tools are undertaken during supervisions. Guidelines and communication tools which are included in the training manual both as a guide for these PARC PAs but also in poster form.

Public Sector Number of public sectors that have guidelines and communication tools:

SALAMA N/A Pha-G-Dis 50 CSB/Pha-Ge-Com 148

- 50 Pha-G-Dis (93%) and 148 CSB/PhaGeCom/hospitals (95%) have

guidelines and communication tools - Guidelines and communication tools are composed of Terms of

Reference (ToR) describing roles and responsibilities of the service

Outstanding Issues: None Recommendations: The RLA, EMAD, and EMAR will continue to sensitize the CSB, CHRD, and Pha-G-Dis to reproduce communication tools. During the next supervision visits, the supervisors ‘teams will print and distribute copies of the guidelines and communication tools

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RESOLUTION provider, guidelines on the management of expired medicines, guidelines for good storage practices, and job aids on the inventory stock management

Issues: - 4 Pha-G-Dis didn’t have the guidelines and communication tools:

Fenerive Est, Diego II, Belo sur Tsiribihina, and Manja. - 8 Pha-Ge-Com didn’t have the guidelines and communication tools:

CSBU Brickaville (District Brickaville), CSB2 Ambohimilanja, CSB1 Maroarina, CSB2 Ambodivoangy and CSB2 Ambodinonoka Vato (Marolambo District), CSB2 Malandrira, CSB2 Manja, CSB2 Vondrove (District Manja)

Resolution: During the supervision, the supervisors all immediately posted the missing communication tools and job aids to the facilities mentioned above.

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

3a1a) Review of product specifications to ensure they meet host country and international regulatory, shipping, and packaging requirements. Result: All products specifications in the procurement requisition form are reviewed by the pharmacist for local and international procurement. Issues: None Resolution: None


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.


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RESOLUTION 2) Develop and implement an inspection and quality assurance process for assessing and monitoring product quality. Considerations include, but are not limited to: ●Selec ng reliable and vetted suppliers: ●Using exis ng 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.

Result: Copies of the Certificate of Analysis for Pneumox® will be included as part of the reception documents for record Issues: None Resolution: None 3a2) Verification of the development and implementation of the quality assurance process Result: Pre-shipment inspection onsite and testing of samples were performed for Pneumox® and all the samples passed the testing 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: to be implemented during Q3 Issues: None Resolution: None


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: Integrated field supervision began in March and site visits of 153 health facilities were conducted Issues: Not enough supervision on SOP implementation on field visit

Outstanding Issues: Report information not set up yet Recommendations: Planning of capacity building and training with

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RESOLUTION Resolution: Finalize the integrated supervision grid template

MOPH, including site visits for SOP implementation

4. Storage and distribution of LLIN 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 N/A

Issues: No warehouse visited during Quarter 2 for Year 4. All warehouses are equipped with wooden pallets and PSI has a security service provider in place to secure areas. Resolution: Supervisions will be planned for Quarter 3 of Year 4


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 N/A N/A

Issues: No warehouses were visited during Quarter 2, but all warehouses were equipped with a post guard or barred windows. Resolution: Supervisions will be planned for Quarter 3 of Year 4


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 N/A

Issues: No warehouse visited during Quarter 2 for Year 4

Outstanding Issues: None Recommendations: None .

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RESOLUTION Resolution: Supervisions will be planned for Quarter 3 of Year 4

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 high

temperature/heat - 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 met 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 warehouses meeting the criteria of storage and transportation of products:

Storage Warehouse PARC PA SS1 N/A N/A N/A SS2 N/A N/A N/A

Outstanding Issues: None Recommendations: Constantly remind PA and PARC supervised to respect the rules for storing and transporting health products

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RESOLUTION SS3 N/A N/A N/A SS4 N/A N/A N/A SS5 N/A N/A N/A SS6 N/A N/A N/A SS7 N/A N/A N/A

Transportation ST5 N/A 74 1035 ST6 N/A 74 1035 ST7 N/A 74 1035

− Standard transportation conditions were respected in all PARCs and PAs

− No warehouse visited during Quarter 2 for Year 4


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 48 153 SS2 54 154 SS3 54 152 SS4 41 134 SS5 N/A 152 SS6 N/A 154 SS7 N/A 154

Transportation

Outstanding Issues: None Recommendations: EMAR, EMAD, and TFPs will mobilize resources to procure thermometers and will sensitize CSB, hospitals, and Pha-G-Dis to procure it themselves

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RESOLUTION ST5 N/A 152 ST6 N/A 154 ST7 N/A 154

Issues: - The country experienced 5 cyclones in Quarter 2 that led to the

destruction of the rooves of Pha-G-Dis Tamatave I, Tamatave II, and the CHRD2 Mananjary,

- 13/54 (24%) of Pha-G-Dis are still not systematically completing the temperature monitoring sheet

Resolution: During the supervision, the supervisors printed and shared the temperature monitoring sheet to 13 the Pha-G-Dis and carried out the on-the-job training on who to correctly complete the sheets. The form should be completed twice a day. In addition, supervisors sensitized the CSB Chief to buy thermometers in order to meet good storage conditions and systematically fill in the temperature monitoring sheet.

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, PA and public sector (SALAMA/central warehousing, Pha-G-Dis, Pha-Ge-Com and CSB), and those

Nonprofit Number persons from PSI central warehouse, PARC, PA trained:

Type Male Female Total Warehouse N/A N/A N/A PA 438 597 1035 PARC 24 50 74

− All the PARC and PA visited were trained − No warehouses were visited during Quarter 2 for Year 4

Issues: None

Outstanding Issues: None Recommendations: Capacity building for the proper management and distribution of health products is done individually during supervision visits pending technical workshops that will be planned in the next quarters (Quarter 3 and 4).

144


RESOLUTION responsible for sending commodities and LLINs.

Resolution: None Public sector

Number of persons from the public sector trained:

Type Male Female Total SALAMA N/A N/A N/A Pha-G-Dis 35 65 100 CSB/Pha-Ge-Com 88 237 325

− 100% of staff of the Pha-Ge-Com (156/156) and Pha-G-Dis (54/54) visited were trained

− At least two people were trained in Pha-G-Dis and Pha-Ge-Com


Outstanding Issues: None Recommendations: IMPACT RLA will continue to provide technical and financial support to EMAR and EMAD to reinforce capacity of supply chain actors at peripheral level.

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

Percentage of communication activities scheduled planned for COVID-19 conducted during the dry season Result: Because the activities of the Communication Team in the Field are the same even if on the rainy or dry season. Issues: None Resolution: None


145


RESOLUTION 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.

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. 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.

COVID-19 support has been reviewed and organized in accordance with the evolution of the number of cases in the regions: Result: possibly caused by the summer season, vaccination activities were prioritized Issues: Less severe cases and few deaths in all regions Resolution: USAID partner PSI/IMPACT donated supplies, consumables, and equipment related to case management (pulse oximeter, glucometer, etc.) for emergency treatment centers in the regions. IMPACT also technically and financially supported the MoPH for sensibilization and prevention to pandemic threats with communication teams and all communication support (TV spot, radio, etc.)

Outstanding Issues: Due to decreased cases of COVID-19, the population was not interested in vaccination, barrier gestures, wearing masks, etc. Recommendations: Sensibilization were on continuous activity

146


RESOLUTION 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: A regular check on the availability of safety stocks is carried out in anticipation of disruption to the supply chain due to climate change and weather events Issues: None Resolution: None


147

ANNEX D - SUCCESS STORIES

148

Resumption of CHANNEL reporting at Antsalova Pha-G-Dis

Since April 2021, the Pharmacie de Gros de District (Pha-G-Dis) in Antsalova District, Melaky Region, had not had a staff member serving as the focal point for the logistics management information system (LMIS) software CHANNEL. CHANNEL is used to manage the stock of commodities and report on logistics data needed for decision-making. The Directorate of Pharmacy, Laboratories, and Traditional Medicine (DPLMT) uses CHANNEL data to inform the quantities of commodities needed by each Pha-G-Dis. Pha-G-Dis that do not report their data in CHANNEL risk facing stock outs or overstocks of commodities when the DPLMT cannot accurately quantify their needs. The lack of a CHANNEL focal point at the Antsalova Pha-G-Dis resulted in a 0% CHANNEL reporting rate for Antsalova from April to November 2021. This also impacted the Pha-G-Dis performance in evaluations of its stock management. From April to December 2021, the Antsalova Pha-G-Dis received scores ranging from 58% to 67%, below the threshold of 80% to be considered “well-performing.”

Nassuiry Jean Ahmed has been an employee at the Pha-G-Dis since September 2020, now serving as the CHANNEL focal point which was added to his responsibilities in December 2021. To help the Antsalova Pha-G-Dis improve its CHANNEL reporting rate and overall stock management, the IMPACT Regional Logistics Advisor (RLA) and the Ministry of Public Health regional management team (EMAR) provided on-the-job training on using the CHANNEL software for Nassuiry.

Following Nassuiry’s training, the Antsalova Pha-G-Dis has seen a complete turnaround in its CHANNEL reporting rate from 0% in April to November 2021 to 100% in December 2021 and January 2022. Nassuiry submitted CHANNEL reports for malaria, family planning, and maternal, newborn, and child health commodities using the skills he learned from the IMPACT RLA and EMAR. Nassuiry’s hard work in improving Antsalova’s CHANNEL reporting rate has also helped the Pha-G-Dis performance in stock management. Prior to Nassuiry’s training, the highest score the Pha-G-Dis had received in evaluations of its stock management was 67%. After Nassuiry’s training, the Pha-G-Dis received an overall score of 80% (officially attaining the “well-performing” designation), with the improvement largely driven by an increase from 44% to 75% in the reporting score, which includes CHANNEL reporting.

Nassuiry is dedicated to working closely with the Antsalova Pha-G-Dis to improve its CHANNEL reporting rate and performance in stock management and said, “Thanks to their interventions, we can continue CHANNEL entries again. We are grateful for the support of the EMAR and IMPACT RLA.”

On-the-job training session on CHANNEL software led by Edson Joachim (IMPACT RLA; seated at computer in gray t-shirt) for Nassuiry

Jean Ahmed (hidden from view behind Edson) with RAKOTO Justin (CHRD1 Head; far left), RAMIARINARIVO Jeanne Adrienne (Pha-G-

Dis Manager; seated behind Edson in white shirt), and FANJALALAINA Harinjaka (Pha-G-Dis employee; red-and-white

striped t-shirt), December 2021

149

EUV results: IMPACT’s technical assistance in quantifying, procuring, and distributing health commodities has improved availability and accessibility for end-users

IMPACT works across all levels of the public-sector health system to ensure health commodities and pharmaceuticals are continuously available and accessible for the Malagasy population. IMPACT’s support for quantification, procurement, and distribution of commodities begins at the national, regional, or district levels, but the ultimate goal is for those commodities to reach the communities and individuals (or end users) who need them. One way IMPACT evaluates the availability and accessibility of health commodities is through regular end-use verification (EUV) surveys and assessments. Since January 2020, IMPACT has conducted three EUV surveys (in January 2020, October 2020, October 2021). The results of the most recent EUV survey showed a marked improvement in availability of many key health commodities.

Through the EUV surveys, IMPACT assesses availability and accessibility of antimalarial, family planning, and maternal, newborn, and child health commodities at community sites and health centers, hospitals, and district pharmacies, as well as Madagascar’s central medical warehouse (SALAMA). After completion of each end-use verification (EUV) survey, IMPACT publishes EUV reports detailing results and observations in stock availability, storage conditions, and case management of malaria and outlining recommendations and next steps for health facilities and workers; district, regional, and national-level public-sector health system individuals and entities; and IMPACT itself. IMPACT tracks implementation of these recommendations and next steps by reporting on their status in the next EUV report.

In October 2021, IMPACT sampled SALAMA, 77 health facilities (including 74 health centers and three hospitals), 15 community sites, and 20 district pharmacies in ten USAID-supported regions of Madagascar to collect data for the latest EUV survey and report (published in March 2022). Compared to previous EUV surveys conducted in 2020 by IMPACT, in October 2021, IMPACT found that great strides have been made for many tracer health commodities and storage conditions at the health facility level:

● 96% of health facilities had antimalarial treatment to treat children under 5 years in-stock, compared to 64% in January 2020 and 86% in October 2020.

● 0% of health facilities had a stock out of three or more days of any antimalarial product, a strong improvement from October 2020, when 45% of facilities experienced stock out of three or more days.

● 75% of district pharmacies had a thermometer—crucial for monitoring temperature and maintaining proper storage conditions for vaccines and other commodities such as oxytocin (used to save mothers with postpartum hemorrhage)—compared to only 59% in October 2020 and 0% in January 2020.

● 93% of health facilities had female condoms in-stock, compared to 0% in October 2020. ● 84% of health facilities had male condoms in-stock, compared to 60% in January 2020 and 68% in

October 2020.

EUV data collection in CSB Ambatotsipihina, Mandoto District, Vakinakaratra Region (Mamy Abéline [seated], two community

volunteers [white caps], surveyor [yellow t-shirt]).

150

● Stock out rates were reduced for several family planning products: 1) long-acting contraceptive Implanon (from 43% stock out rate in October 2020 to 37% in October 2021), 2) injectable contraceptives Sayana Press (from 38% to 20%) and Depo-Provera (from 25% to 8%), 3) copper intrauterine devices (from 22% to 17%), and 4) oral contraceptives Microlut (from 33% to 23%) and Microgynon (from 22% to 4%).

● Stock out rates were much lower for maternal, newborn, and child health commodities including Misoprostol (79% stock out rate in October 2020 compared to 36% in October 2021) which is used for preventing and treating postpartum hemorrhage in facilities without cold chain; Chlorhexidine for preventing umbilical cord infections in newborns (89% compared to 23%); Oxytocin used to prevent and treat postpartum hemorrhage and induce labor during childbirth in facilities with a cold chain (35% compared to 24%); and Gentamicin (15% compared to 8%) used to treat sepsis of newborns.

These encouraging results demonstrate that IMPACT’s central, regional, and district-level technical assistance in quantifying, procuring, and distributing health commodities has indeed led to improved availability and accessibility for end-users. Further improvements can still be made and, as a result of the recent EUV, district and regional authorities have met to plan corrective actions including closer monitoring of availability of products and oversight of stock management practices at the facility level. At the central level, IMPACT is supporting the Ministry of Public Health with a technical advisor to support the Directorate of Family Health (DSFa) in coordinating the procurements and interventions of the various partners to improve the availability of maternal, newborn, and child health commodities at all levels.

Mrs HANTAVOLOLONA Mamy Abéline, a midwife working at the DSFa in Antananarivo, expressed her satisfaction with the EUV survey and her pride in health facility’s achievements: “During this EUV, we had no stock outs of essential commodities for3 or more consecutive days at the health facilities which represents a huge success. It also gave me an opportunity to help health workers better manage health commodities.”

IMPACT will continue to strive to maintain and improve the availability of health commodities and pharmaceuticals and to conduct regular EUV surveys to assess stock availability and orient appropriate corrective measures.

9,612 doses of long-acting contraceptive Sayana Press saved from expiry in Menabe Region, Madagascar

In 2021, the IMPACT distribution team identified 70,000 doses of the long-acting injectable contraceptive Sayana Press—initially procured for distribution through the social marketing circuit—that had expiration dates in early 2022. Of these 70,000 doses, 9,612 were stored in a warehouse in Morondava, the capital of the Menabe Region. The Menabe Regional Logistics Advisor (RLA) explored opportunities to redistribute these products to the public sector to reduce the risk of expiration and waste of the contraceptive.

In September 2021, IMPACT RLA contacted the family planning managers in the five health districts of Menabe to gather information about their needs for injectable contraceptives for the next three months. It was found that the districts pharmacies had been experiencing

151

stockouts of Sayana Press due to late deliveries from the public health sector distributor (SALAMA) during several months. IMPACT quickly assisted the districts to prepare orders for Sayana Press. The orders were approved and the Sayana Press deliveries were organized via regular supervision visits by IMPACT and Ministry of Public Health medical inspectors.

All 9,612 soon-to-expire doses (6,412 with January 2022 expiration dates and 3,200 with February 2022 expiration dates) of Sayana Press were successfully redistributed from the Morondova warehouse to district pharmacies where they could be used before the expiry date, simultaneously preventing waste and ensuring continuous availability of the product for beneficiaries. According to Ms. Sitraka Ratovonomenjanahary, family planning manager at Menabe Region’s Belo sur Tsiribihina district public health department, “We were in stockout of Sayana Press during the last four months and this redistribution helped us to overcome the [SALAMA] delivery delay.”

Using technology to strengthen and expand training for Drug Shops

Since the beginning of the project, IMPACT has trained drug shop owners in operational and financial management throughout nine regions of Madagascar: Analanjirofo, Atsinanana, Boeny, SAVA, DIANA, Atsimo

Andrefana, Menabe, Vatovavy Fitovinany, and Sofia. A total of 195 drug shop owners have been trained, either through in-person sessions or remotely, using video training kits.

During the second year of the project, the IMPACT team began to identify the training participants who were applying what they had learned in their drug shops and who demonstrated interest in sharing and transmitting their knowledge to their peers. The concept was to try to establish a group of peer trainers who would be able to offer basic business training to fellow drug shop owners at a lower cost, helping to sustain the benefits of IMPACT’s training program. In October 2021, 17 peer trainers from five regions (DIANA, SAVA, Analanjirofo, Boeny, Atsinanana) completed a week-long training of trainers (ToT) on operational and financial management for drug shops.

At the end of the peer ToT, a Facebook group was created to exchange news and share documents, in addition to maintaining the group cohesion and team spirit that was developed during the training.

After the classroom training in October 2021, the peer trainers moved on to the first real-life training sessions with other drug shop owners in their home regions, under the supervision of IMPACT trainers. The first peer training session required intensive preparation in two phases: the first phase done remotely, and the second

IMPACT RLA Hasina Marius Tovonomerina delivering Sayana Press in Manja district

The group page created on Facebook for drug shop peer trainers

152

one done on site shortly before the date of the training session. To date, peer trainers have conducted an initial supervised training session in three regions: Atsinanana, Analanjirofo and DIANA.

While the preparatory coaching sessions which IMPACT provided to the peer trainers in the Atsinanana and Analanjirofo regions were done by phone on an individual basis, the IMPACT team adopted an innovative group approach to help prepare the peer trainers in DIANA. They created a chat room within the peer trainers' Facebook group, where peer trainers can simultaneously interact with the IMPACT team and with each other. This solution saves communication costs, brings together several people at once, and encourages exchanges that are not possible through phone calls.

The following table summarizes the results obtained following the supervision of the 3 regions concerned:

Training Preparation Training Results

Region

Number of Peer Trainers

in Region

Number of Peer

Trainers Attending

Event

Peer Trainer Background on Module

Topic?

Used FB room for training

prep

In-person prep 1 day

before event

Mastery of adult training

techniques

Mastery of technical module content

Other notes

Antsiranana 3 2 No accounting experience

No Yes Medium Low Session not completed within allotted time

Analanjirofo 4 3 No accounting experience

No Yes Medium Low to Medium

Session completed to the end

DIANA 3 1 Accounting experience

Yes Yes Good Good Session completed to the end and within the allotted time

LEGEND: Poor preparation/ results

Moderate preparation/results

Good preparation/ results

Two peer trainers conducting their first training for colleagues in Atsinanana

153

Over the course of the supervision sessions and the initial peer trainings conducted in the three regions, a continuous improvement in the performance of peer trainers was observed. The importance of preparation before the initial peer training was crucial, and based on the experience in DIANA, the chat room function to conduct group preparation sessions was deemed helpful. For future peer trainings, the IMPACT team will try to isolate the effect of this more intensive preparation compared to the advantages of having a peer trainer with previous experience in accounting, as was the case for the most recent peer training in DIANA.

IMPACT is continuing to test training methods and results to create sustainable support for drug shops, helping them to grow and serve the health needs of the people of Madagascar in the future.

Two New Drone Take-Off Points to Deliver Life-Saving Commodities to Remote Communities in the SOFIA and Atsinanana Regions:

Given the isolation of some health facilities and Supply points in the SOFIA and Atsinanana regions, IMPACT has set up two new drone take-off points to service these regions. The objective is to facilitate the rapid delivery of health commodities to these isolated areas and to make them available on a continuous basis.

Delivery by drone began in January 2022 with the active participation of the Regional Directorate and the District Public Health, as well as the local authorities at the region and district levels.

From January to March 2022, the drones were able to deliver to 14 supply points and 19 health facilities with life-saving and vital health products for the fight against malaria, family planning, and vaccines. The

delivered commodities included 650 doses of Johnson & Johnson COVID-19 vaccines,3,245 doses of Triclofem, and 3,700 kits of RDT, amongst others.

The establishment of these additional take-off areas will help reduce stock outs and prevent the population from traveling several kilometers to obtain antimalarials. “We are no longer obliged to travel kilometers over several days to collect health commodities at the district level and we have much more time to devote to patients while being reassured that the commodities will always

be available through the drone delivery”, said a Chief of health facility, Vohitrandiana (Tamatave II), Atsinanana region.

Launch of the first flight at the take-off area of the drone in Befandriana North with the local authorities, from left to right: a representative of the gendarmerie, the Medical Inspector of Befandriana Nord, the deputy, the Drone Project Coordinator, commodity manager of Befandriana

Nord and the ACCESS District Coordinator.

Receipt of commodities in Morafeno, assisted by (from right to left): the Medical Inspector of Befandriana Nord district, the Regional Director of the SOFIA Region, the Chief of health facility, the Supply Point, the Chief Fokontany, the

Mayor and the Distribution Point Supervisor of the IMPACT project

154

Drones Continue to Deliver Health Commodities During the Cyclone Period:

Typically, the cyclone season usually runs between November–March in Madagascar, with 2022 being no different. Since mid-January, the country has been impacted by five tropical cyclones. Despite the cyclone period, drones continued to deliver the health commodity needs of health facilities and supply points (PA) in remote areas in the Analanjirofo and SAVA regions.

- The municipality of Androndrona is the furthest (185 km by road) and the most landlocked in the Maroantsetra district (Analanjirofo region), it also does not have a telephone network. To collect commodities at the district level, the CSB chief must travel 5 hours by motorbike, 1 hour by canoe and 2 days of walking (120 km).

- The commune of Antsahamena is the also very difficult to access, it is located 105 km from the district of Andapa (SAVA region) and the only way to get there is 3 days of walking.

Thanks to drone deliveries, these two municipalities were supplied in less than an hour from the Maroantsetra take-off area. The commodities delivered were COVID-19 vaccines (100 AstraZeneca doses) and routine vaccines for the health facility of Androndrona and family planning (60 doses of Triclofem and 60 syringes) for PA Antsahamena.

155

ANNEX E – STOCK INVENTORY REPORT OF MALARIA COMMODITIES AS OF

MARCH 2022

156

TECHNICAL SPECIFICATIONS Unit Expiry date Quantity in

packs

total Quantity in

unit SULFADOXINE-PYRIMETHAMINE 500-25MG - CP - BTE/150

tablet 01/08/24 4,309

SULFADOXINE-PYRIMETHAMINE 500-25MG - CP - BTE/150 tablet 01/08/24 6,667

SULFADOXINE-PYRIMETHAMINE 500-25MG - CP - BTE/150

tablet 01/08/24 6,666

SULFADOXINE-PYRIMETHAMINE 500-25MG - CP - BTE/150

tablet 01/08/24 3,000 516,050


blister 01/01/23 3,197


blister 01/05/23 2,367


blister 01/08/23 822

Artesunate/Amodiaquine 25/67.5 mg Tablet, 25 x 3 Blister Pack Tablets blister 01/08/23 2,014 210,000


blister 01/03/23 1,204


blister 01/03/23 975

Artesunate/Amodiaquine 50/135 mg Tablet, 25 x 3 Blister Pack Tablets blister 01/03/23 5,239


blister 01/03/23 6,216


blister 01/03/23 809


blister 01/05/23 636


blister 01/05/23 6,308


blister 01/05/23 6,262


blister 01/05/23 4,604


blister 01/09/23 3,771



blister 01/09/23 6,093


blister 01/09/23 926 1,229,250



blister 01/04/23 765


blister 01/08/23 6,184


blister 01/08/23 896


blister 01/08/23 2,657 408,800


blister 01/09/23 2,139

157


packs

total Quantity in

unit Artesunate/Amodiaquine 100/270 mg Tablet, 25 x 6 Blister Pack Tablets blister 01/09/23 2,932


blister 01/09/23 3,053


blister 01/09/23 1,882 250,150

Malaria Rapid Diagnostic Test (RDT) HRP2/pLDH (Pf/PAN) Cassette, 25 Tests test 01/04/23 3,034


test 01/04/23 34,722


test 01/04/23 8,615


test 01/04/23 6,292


test 01/04/23 28,031


test 01/04/23 20,119


test 01/06/23 3,653


test 01/06/23 25,200



test 01/07/23 10,392


test 01/07/23 14,408


test 01/07/23 51


test 01/07/23 17,400


test 01/07/23 5,536


test 01/07/23 3,450



test 01/08/23 16,414


test 01/08/23 15,775


test 01/08/23 8,093


test 01/10/23 18,188


test 01/10/23 21,812

Malaria Rapid Diagnostic Test (RDT) HRP2/pLDH (Pf/PAN) Cassette, 25 Tests test 01/09/23 10,690 8,035,400


vial 01/10/23 12,780


vial 01/01/24 172

158


packs

total Quantity in

unit Artesunate (w/ 1 Amp NaHCO3 5% + 1 Amp NaCl 0.9%) 60 mg Vial, 1 Set vial 01/01/24 7,157


vial 01/01/24 62,457


vial 01/01/24 70,557


vial 01/01/24 69,700


vial 01/01/24 61,700


vial 01/01/24 39,257 323,780


suppository 01/09/23 720


suppository 01/09/23 16,560 34,560

159

ANNEX F – STOCK STATUS BY END OF MARCH 2021

160

STOCK STATUS MALARIA

Product Technical specification Unit Stock on Hand March 31st 2022

Expiry date

Average monthly

consumption (AMC)

Months of stock (SoH)

Quantity ordered in

pipeline

Average monthly

consumption (AMC)

Months of stock

(pipeline)

Estimated Delivery

scheduled Donor


Tablet 215,117 Jan-23

May-23 Aug-23

24,137 8.9 84,000 16,763 5.0 29-Sep-22 PMI

93,125 16,763 5.6 31-Oct-22 GF

Artesunate/Amodiaquine 50/135 mg Tablet, 25 x 3 Blister Pack Tablets Tablet 1,318,091

Sep-22 Mar-23 May-23 Sep-23

145,623 9.1

114,375 145,623 0.8 30-Apr-22 GF

493,250 101,133 4.9 29-Sep-22 PMI

797,500 101,133 7.9 31-Oct-22 GF


Tablet 464,867 Apr-23 Aug-23

101,981

4.6

14,375 101,981 0.1 30-Apr-22 GF

125,500 101,981 1.2 31-May-22 GoM

135,000 101,981 1.3 20-May-22 PMI

180,000 70,824 2.5 8-Aug-22 PMI

518,750 70,824 7.3 29-Sep-22 PMI

396,875 70,824 5.6 31-Oct-22 GF


Tablet 332,541 Sep-23 108,522 3.1

155,000 108,522 1.4 30-Apr-22 GF

149,900 108,522 1.4 31-May-22 GoM

84,000 108,522 0.8 20-May-22 PMI

230,000 75,367 3.1 8-Aug-22 PMI

404,000 75,367 5.4 29-Sep-22 PMI

132,000 75,367 1.8 30-Sep-22 PMI

528,125 75,367 7.0 31-Oct-22 GF

Artesunate (w/ 1 Amp NaHCO3 5% + 1 Amp NaCl 0.9%) 60 mg Vial, 1 Set Vial 397,242

Oct-23 Jan-24 Feb-24

47,359 8.4 442,780 47,359 9.3 31-Mar-22 GF

548,610 32,890 16.7 31-Oct-22 GF 100,000 32,890 3.0 30-Nov-22 PMI

Artesunate 100 mg Suppository, 2 Suppositories

Unit 78,190 Sep-23 4,881 16.0 46,000 3,390 13.6 28-Apr-22 PMI

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

Test 9,693,830 Jul-22 Feb-Oct 23

946,008 10.2

1,000,000 946,008 1.1 14-Jun-22 PMI

1,150,000 946,008 1.2 27-May-22 GF

6,071,250 822,052 7.4 31-Oct-22 GF

161

Product Technical specification Unit Stock on Hand

March 31st 2022 Expiry date

Average monthly

consumption (AMC)


Quantity ordered in

pipeline

Average monthly

consumption (AMC)

Months of stock

(pipeline)

Estimated Delivery

scheduled Donor


Treatment 1,597,950 Mar-24 Aug-24

131,698 12.1

536,667 131,698 4.1 30-Apr-22 GF

1,000,000 131,698 7.6 22-Jul-22 PMI

646,667 131,698 4.9 31-Oct-22 GF Primaquine Tablet 7.5mg , 10 x 10 Blister Pack Tablets Tablet - 2,385 0.0 9,000 2,385 3.8

Not available GF

Legend

Over the maximum stock level of 13 months

Stocked according to plan (between Minimum stock of 7 months and maximum of 13 months)

Under the minimum stock level of 7 months

Stock 0

162

STOCK STATUS OF MNCH COMMODITIES, CENTRAL LEVEL

Product Technical specification

Unit

Stock on Hand

March 31st 2022

Expiry date

Average monthly

consumption (AMC)

Months of stock

(SoH)

Quantity ordered in

pipeline

Average monthly

consumption (AMC)

Months of stock

(pipeline)

Estimated Delivery

scheduled Donor

TRANEXAMIC ACID 500MG -Injection- 50 ampoules Pack

Ampoule 500 May-25 1,439 0.3 26,900 1,439 18.7 Apr-22 UNFPA

AMPICILLIN 1G Injection 50 Vial Pack Vial 2,500 Mar-23 16,698 0.1 6,500 16,698 0.4 Apr-22 UNFPA

CARBETOCIN 100µG/ml Injection 10 ampoules Pack

Ampoule 23,040 Oct-24 35,152 0.7 10,000 35,152 0.3 Apr-22 UNFPA

CHLORHEXIDINE SULFATE 7.1% GEL 20GR tube

Tube 531,151 Oct-22 Nov-22

38,861 13.7

GENTAMICIN 40MG/ML Injection - AMP 2ML - (80MG) 100 ampoules Pack

Ampoule 45,000 Mar-23 May-23 Sep-23

186 241.5 500 186 2.7 Apr-22 UNFPA

MAGNESIUM SULFATE 50% Injection 10ML 10 vial Pack

Vial 74,550 Jan-24 Mar-24 Jul-24

2,646 28.2

METRONIDAZOLE 500 MG/100ML Infusion 100ML Vial

Vial 16,350 Oct-22 Mar-23 Jan-24

8,535 1.9

MISOPROSTOL 200mcg tablet 4 Tablets Pack

Blister 46,880 Feb-23 12,997 3.6

163

STOCK STATUS OF FP/RH COMMODITIES, CENTRAL LEVEL.


Unit

Stock on Hand

March 31st 2022

Expiry date

Average monthly

consumption (AMC)


Quantity ordered in

pipeline

Average monthly

consumption (AMC)

Months of stock

(pipeline)

Estimated Delivery

scheduled Donor

COC-Levonorgestrel/Ethinyl Estradiol 150/30 mcg + Sugar Placebo, 28 Tablets

Cycle 2,044,860

Nov-22 Jan-23

May-23 Dec-23 Jan-24

115,079 17.8

Depot (SC) Medroxyprogesterone Acetate 104 mg/0.65 mL

Vial 0 103,646 0.0 1,000,000 103,646 9.6 Apr-22 UNFPA

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

Vial 0 160,562 0.0 1,150,000 160,562 7.2 Apr-22 UNFPA

Etonogestrel 68 mg/Rod, 1 Rod Implant (IMPLANON) Unit 40,000 Jul-26 14,091 2.8 130,000 14,091 9.2 Apr-22 UNFPA

Female Condom Unit 14,200 Jul-23 Unknown Hormonal IUD -Levonorgestrel 52mg Unit 0 559 1,680 559 3.0 Apr-22 UNFPA

IUD TCu 380A Unit 5,156 Feb-26 559 9.2 Levonorgestrel 75mg/rod, 2 rod Implant (LEVOPLANT) Unit 0 14,091 0.0 75,000 14,091 5.3 Apr-22 UNFPA

Male Condom (Latex) Lubricated

Unit 3,780,144 Apr-25 Jul-25

273,408 13.8

MICROLUT Cycle 310,680 Mar-24 Nov-24

14,754 21.1

Note that IMPACT is planning to transfer some stocks of injectable to DSFa while waiting UNFPA deliveries so that districts orders can be filled.

164

STOCK STATUS BY END OF MARCH 2022 AT THE PSI WAREHOUSE

STOCK STATUS FP COMMODITIES


Unit

Stock on Hand

March 31st 2022

Expiry date

Average monthly

consumption (AMC)


Quantity ordered in

pipeline

Average monthly consumption

(AMC)

Months of stock

(pipeline)

Estimated Delivery scheduled

Donor

Oral Contraceptive BLISTER

118 07/22

168 789 17,6 3 027 071 168 789 17,93 1 625 040 on 06/22 and

1 402 031 on 12/22 USAID 13 998 08/22

6 048 10/22 387 965 11/22

2 569 887 01/24

Injectable DOSE 514 576 Exp 2024

140 445 11,7

1 741 975

140 445 12,40 06/2022 USAID 1 122 500 Exp 2025

FP Condom Protector Plus PIECE 5 411 952 11/2025 127 040 42,6 4 836 968 127 040 38,07 12/2022 USAID

Sayana Press DOSE 35 349 12/22

20 927 12,0 372 800 20 927 17,81 12/2022 UNFPA 75 087 01/23 140 000 12/23

ROJO PIECE 21 346 356 59,9 USAID

STOCK STATUS OF MNCH COMMODITIES


Unit

Stock on Hand

March 31st 2022

Expiry date

Average monthly

consumption (AMC)


Quantity ordered in

pipeline

Average monthly

consumption (AMC)

Months of stock

(pipeline)


Donor

ORS/Zinc DTK KIT 102 563 1-Apr-23 3 354 30,58 (ORS) UNICEF/ (ZINC)USAID

Sur Eau Pilina (67mg tablet)

PIECE 600 840 1-Jun-25 318 291 1,89 7 375 600 318 291 23,17 06/22 & 07/22 PROJECT INCOME (IMPACT)

Arofoitra (CHX 7,1%) TUBE 104 055 1-Sep-23 1 145 90,8 USAID

165


Unit

Stock on Hand

March 31st 2022

Expiry date

Average monthly

consumption (AMC)


Quantity ordered in

pipeline

Average monthly

consumption (AMC)

Months of stock

(pipeline)


Donor

Pneumox (Amoxicilline) BLISTER 190 600 6 143 21 179 06/2022 PROJECT INCOME (IMPACT)

Pregnancy Test PIECE 18 661 04/23:

13 023 26,1 USAID 320 699 07/23

166

ANNEX G: Descriptions of the seven quality dimensions for the RDQA

167

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.

168

ANNEX H: COVID-19 Annexes

169

Table 1: Disinfection of PSI/IMPACT offices, warehouses, and vehicles REGION ITEM DISINFECTED PROVIDER

DIANA 1 Office/ 1 Warehouse

BHL SAVA 1 Office/ 1 Warehouse

VAKINANKARATRA 1 Office/ 1 Warehouse/ 1 Vehicle

HAUTE MATSIATRA 1 Office/ 1 Warehouse/ 4 Vehicles ALEO MISIROKA and STATION SERVICE

VATOVAVY FITO VINANY 1 Office/ 1 Warehouse/ 2 Vehicles

BOENY 1 Office/ 1 Warehouse/ 4 Vehicles ALITIA

ATSINANANA 1 Office / 1 Warehouse / 2 Vehicles STOP INSECTES

MELAKY 1 Office/ 1 Warehouse/2 Vehicles RINDRA CONSULTING

MENABE 1 Office/ 1 Warehouse SARL U MULTIPLE

ATSIMO ANDREFANA 1 Office/ 1 Warehouse SUD ENVIRONNEMENT and BHL

6 Vehicles VULCA MENABE SPEED

Table 2: Support to hospitals and facilities for the treatment emergency by providing supplies and expendable equipment

MONTH REGION RECIPIENT DETAILS

JANUARY

SAVA SDSP Vohémar 25 boxes of surgical masks 50 pieces, 91 bottles of hydroalcoholic gels 500ml, 28 cans of bleach 5L, 8 cans of virucid 5L, 10 rolls of trash bag 30L, 5 hand washing devices

ANALAMANGA

DPLMT - CTC Alarobia

10 taps, 5 teflons, 2 big padlocks, 10 buckets 10L, 10 cups 1L, 10 trash bins 10L, 2 drums 250L

Population of ministry for

cyclones victims

750 bottles of hydroalcoholic gels 500ml, 375 cans of bleach 5L, 375 bottles of liquid soap 1L, 500 hand washing devices, 375 boxes of surgical masks of 50 pieces

DIANA SDSP Diego II 2 bottles of hydroalcoholic gels 500ml, 4 boxes of surgical masks 50 pieces

MENABE CHRR Morondava

30 bottles of hydroalcoholic gels 500ml, 10 bottles of liquid soap 500ml, 5 cans of bleach 5L, 5 bottles of virucid 1L, 10 boxes of overblouses of 10 pieces, 30 boxes of overshoes of 2pairs, 10 boxes of overall of 10 pieces, 10 boxes of disposable caps of 100 pieces, 40 boxes of surgical masks of 50 pieces, 10 boxes of KN95 masks of 10 pieces, 10 boxes of exam gloves of 100 pieces, 10 units of thermoflashes, 6 units of blood pression monitor, 6 units of oxymeters, 6 units of glucometers complete kit

170


ATSIMO ANDREFA

NA CHU Betanimena

50 bottles of hydroalcoholic gels 500ml, 10 bottles of liquid soap 500ml, 5 cans of bleach 5L, 5 bottles of virucid 1L, 10 boxes of overblouses of 10 pieces, 50 boxes of overshoes of 2pairs, 10 boxes of overall of 10 pieces, 10 boxes of disposable caps of 100 pieces, 50 boxes of surgical masks of 50 pieces, 10 boxes of KN95 masks of 10 pieces, 10 boxes of exam gloves of 100 pieces, 10 units of thermoflashes, 6 units of blood pression monitor, 6 units of oxymeters, 6 units of glucometers complete kit

FEBRUARY

DIANA

CHU Diego

50 overblouses, 8 disposable cap (pack of 100), 50 coveralls, 30 overshoes, 25 exam gloves (pack of 100), 60 masks KN95 (pack of 10), 70 surgical masks (pack of 100), 5 thermometers, 5 arm blood pressure monitors, 5 oximeters, 4 glucometers, 70 bottles of hydroalcoholic gel 500ml, 60 bottles of liquid soap 500ml, 30 cans of bleach 5L, 20 rolls of trash bag 30L.

HOMI Diego

50 overblouses, 8 disposable cap (pack of 100), 50 coveralls, 30 overshoes, 25 exam gloves (pack of 100), 60 masks KN95 (pack of 10), 70 surgical masks (pack of 100), 5 thermometers, 5 arm blood pressure monitors, 5 oximeters, 4 glucometers, 70 bottles of hydroalcoholic gel 500ml, 60 bottles of liquid soap 500ml, 30 cans of bleach 5L, 20 rolls of trash bag 30L

CHRD AMBILOBE

33 overblouses, 3 disposable cap (pack of 100), 17 coveralls, 21 overshoes, 8 exam gloves (pack of 100), 43 masks KN95 (pack of 10), 40 surgical masks (pack of 100), 5 thermometers, 5 arm blood pressure monitors, 5 oximeters, 4 glucometers, 61 bottles of hydroalcoholic gel 500ml, 50 bottles of liquid soap 500ml), 19 cans of bleach 5L, 17 rolls of trash bags 30L.

CHRD AMBANJA

33 overblouses, 3 disposable cap (pack of 100), 17 coveralls, 21 overshoes, 8 exam gloves (pack of 100), 43 masks KN95 (pack of 10), 40 surgical masks (pack of 100), 5 thermometers, 5 arm blood pressure monitors, 5 oximeters, 4 glucometers, 61 bottles of hydroalcoholic gel 500ml, 50 bottles of liquid soap 500ml), 19 cans of bleach 5L, 17 rolls of trash bags

CHRD NOSY BE

33 overblouses, 3 disposable cap (pack of 100), 17 coveralls, 21 overshoes, 8 exam gloves (pack of 100), 43 masks KN95 (pack of 10), 40 surgical masks masks (pack of 100), 5 thermometers, 5 Arm blood pressure monitors, 5 oximeters, 4 glucometers, 61 bottles of hydroalcoholic gel 500ml, 50 bottles of liquid soap 500ml, 19 cans of bleach 5L, 17 rolls of trash bags 30L

BOENY CHU BOENY

25 disposable cap (pack of 100), 85 coveralls, 25 exam gloves (pack of 100), 50 rolls of trash bag 30L, 8 glucometers, 100 cans of bleach 5L, 100 bottles of liquid soap 500ml, 100 bottles of multi-use liquid soap 1L, 82 surgical masks (pack of 100), 50 masks KN95, 85 overblouses, 50 overshoes, 15 LED display oximeters, 4 dustbin 120L, 4 sprayers of 16L, 25 buckets with rasta brush, 50 double mop, 100 bottles of hydroalcoholic gel 500ml, 8 arm blood pressure monitors, 8 thermoflashes, 30 virucid 5L

171


FEBRUARY

SOFIA CHU SOFIA

10 disposable cap (pack of 100), 40 coveralls, 10 exam gloves (pack of 100), 10 garbage bag 30L (roll of 25), 5 glucometers, 100 cans of 5L bleach, 30 bottles of liquid soap 500ml, bottles of multi-use liquid soap 1L, 45 surgical masks (pack of 100), 25 masks KN95, 40 overblouses, 20 overshoes , 8 LED Display oximeters, 2 dustbin 120L, 2 sprayers of 16L, 10 bucket with rasta brush, 20 double mop, 50 SHA Gel (500ml), 4 arm blood pressure monitors, 4 thermoflashes, 15 virucid 5L

ATSINANANA

CHU MORAFENO

10 disposable cap (pack of 100), 125 coveralls, 50 exam gloves (pack of 100), 10 glucometers, 150 rolls of hands towel paper, 175 bottles of bleach 5L, 175 bottles of liquid soap 500ml, 100 overblouses, 100 overshoes, 10 oxymeters, 175 surgical masks (pack of 100), 375 bottles of hydroalcoholic gel 500ml, 10 arm blood pressure monitors, 10 thermoflashes, 175 cans of virucid 5L

CHU ANALANKININA- HOPITALY BE

15 disposable cap (pack of 100), 125 coveralls, 50 exam gloves (pack of 100), 15 glucometers, 150 rolls of hands towel paper, 200 bottles of bleach 5L, 200 bottles of liquid soap 500ml, 100 overblouses, 100 overshoes, 15 oxymeters, 157 surgical masks (pack of 100), 375 bottles of hydroalcoholic gel 500ml, 15 arm blood pressure monitors, 15 thermoflashes, 200 cans of virucid 5L

ANALANJIROFO

CHRR FENERIVE EST

2 disposable cap (pack of 100), 50 exam gloves (pack of 100), 50 overblouses, 10 oxymeters, 50 protective glasses, 100 surgical masks (pack of 100), 200 bottles of hydroalcoholic gel 500ml, 5 arm blood pressure monitors, 10 thermoflashes

CHRD2 SAINTE MARIE

1 Inverter for GenExpert

ANALAMANGA

Urban Commune of Antananarivo

180 bottles of hydroalcoholic gel 500ml, 15 rolls of trash bag 50L, 300 surgical masks (pack of 100), 450 protective glasses, 450 overblouses, 450 overshoes, 4 exam gloves (pack of 100)

ANTSIRABE

CHRR VAKINANKARATRA

204 rolls of hands towel paper, 60 overblouses (pack of 10), 6 disposable cap (pack of 100), 85 coveralls, 20 overshoes, 45 exam gloves (pack of 100), 75 masks KN95 (pack of 10), 75 surgical masks (pack of 50), 10 thermoflashes , 10 arm blood pressure monitors, 10 oximeters, 10 glucometers, 300 bottles of hydroalcoholic gel 500ml, 175 bottles of liquid soap 500ml, 175 cans of bleach 5L, 175 virucid 1L

CHRD 1 BETAFO

75 rolls of hands towel paper, 18 overblouses (pack of 10), 6 disposable cap (pack of 100), 23 coveralls, 6 overshoes, 45 exam gloves (pack of 100), 25 masks KN95 (pack of 10), 20 surgical masks (pack of 50), 3 thermoflashes, 3 arm blood pressure monitors, 3 oximeters, 3 glucometers, 90 bottles of hydroalcoholic gel 500ml, 40 bottles of liquid soap 500ml, 40 cans of bleach 5L, 40 virucid 1L

CHRD 2 ANDRANOMANELATRA

75 rolls of hands towel paper, 18 overblouses (pack of 10), 6 disposable cap (pack of 100), 23 coveralls, 6 overshoes, 45 exam gloves (pack of 100), 25 masks KN95 (pack of 10), 20 surgical masks (pack of 50), 3 thermoflashes, 3 arm blood pressure monitors, 3 oximeters, 3 glucometers, 90 bottles of

172


MARCH

hydroalcoholic gel 500ml, 40 bottles of liquid soap 500ml, 40 cans of bleach 5L, 40 virucid 1L

CHRD FARATSIHO


CHRD ANTANIFOTSY

75 rolls of hands towel paper, 18 overblouses (pack of 10), 6 disposable cap (pack of 100), 23 coveralls, 6 overshoes, 45 exam gloves (pack of 100), 25 masks KN95 (pack of 10), 20 surgical masks (pack of 50), 3 thermoflashes, 3 arm blood pressure monitors, 3 oximeters, 3 glucometers, 90 bottles of hydroalcoholic gel 500ml, 40 bottles of liquid soap 500ml, 40 cans of bleach 5L, 40 virucid 1L.

CHRD AMBATOLAMPY


HAUTE MATSIATRA

CHU ANDRAINJATO

125 overblouses (pack of 10), 15 disposable cap (pack of 100), 23 coveralls,125 overshoes, 150 masks KN95 (pack of 10), 15 thermoflashes, 15 arm blood pressure monitors, 15 oximeters, 15 glucometers, 150 bottles of liquid soap 500ml, 150 cans of bleach 5L, 150 virucid 1L, 15 strips (pack of 25)

AMORON’I MANIA

CHRR AMBOSITRA

6 overshoes (pack of 10), 150 masks KN95 (pack of 10), 15 oximeters, 5 glucometers, 100 bottles of liquid soap 500ml, 50 cans of bleach 5L, 200 bottles of hydroalcoholic gel 500ml, 150 virucid 1L, 5 Strips (pack of 25), 40 rolls of hands towel paper, 100 bottles of sprayers 250ml

MELAKY

CSB II BETANATANANA

300 bottles of hydroalcoholic gel 500ml, 120 bottles of bleach 1L, 200 disinfection hydroalcoholic 1L, 50 pieces of soap, 120 virucid 1L

CSB II MAFAIJIJO 75 bottles of hydroalcoholic gel 500ml, 30 bottles of bleach 1L, 50 disinfection hydroalcoholic 1L, 125 pieces of soap, 30 virucid 1L , 50 bottles of liquid soap 500ml

CSB II BELITSAKY 75 bottles of hydroalcoholic gel 500ml, 30 bottles of bleach 1L, 50 disinfection hydroalcoholic 1L, 125 pieces of soap, 30 virucid 1L , 50 bottles of liquid soap 500ml

CSB II ANDRAMY 75 bottles of hydroalcoholic gel 500ml, 30 bottles of bleach 1L, 50 disinfection hydroalcoholic 1L, 125 pieces of soap, 30 virucid 1L , 50 bottles of liquid soap 500ml

173


MARCH

SAVA

CHRR SAVA

5 overblouses (pack of 10), 7 disposable cap (pack of 100), 39 coveralls, 32 overshoes, 21 exam gloves (pack of 100), 6 masks KN95 (pack of 10), 30 surgical masks (pack of 50), 30 bottles of hydroalcoholic gel 500ml, 50 bottles of liquid soap 500ml, 19 cans of bleach 5L, 17 roll of trash bag 30L (roll of 25)

CHRR ANDAPA

50 overblouses (pack of 10), 6 disposable cap (pack of 100), 37 coveralls, 31 overshoes, 62 masks KN95 (pack of 10), 61 surgical masks (pack of 50), 18 exam gloves (pack of 100), 5 thermoflashes, 5 arm blood pressure monitors, 5 oximeters, 5 glucometers, 61 bottles of hydroalcoholic gel 500ml, 50 bottles of liquid soap 500ml, 19 cans of bleach 5L, 5 hand washing devices, 17 roll of trash bag 30L (roll of 25)

CHRR ANTALAHA


CHRR VOHEMAR


INFIRMERIE 711 SAMBAVA

10 bottles of hydroalcoholic gel 500ml, 5 bottles of liquid soap 500ml, 1 cans of bleach 5L, 1 hand washing device, 5 masks KN95 (pack of 10)

ATSINANANA

CSB II AMPASIMBE

5 bottles of hydroalcoholic gel 500ml, 2 cans of bleach 5L, 2 virucid 2L , 2 bottles of liquid soap 500ml, 6 rolls of hands towel

Table 3- a : Details of vaccines transported by drone

District

Number of sites served

(Health facilities)

Johnson&Johnson (dose)

AstraZeneca (dose)

Total Flights

Befandriana nord 3 210 0 1

Maroantsetra 15 435 390 3

Toamasina II 11 370 0 11

TOTAL 17 1,015 390 15

174

Table 3- b: Details of vaccines transported from central to districts or from districts to health facilities

MONTH REGION DISTRICT J&J SUPPORT

JANVIER

Analamanga Antananarivo center

Renting vehicle for punch operation (distribution of drugs against COVID-19 for PCR positive patients) : 151 patients visited

Atsimo Andrefana Betioky Atsimo 30 doses of J&J 60 doses of AZ

USAID partner PSI/IMPACT 's vehicle

Boeny Mahajanga I 264 doses of Pfizer USAID partner PSI/IMPACT 's vehicle

Menabe Morondava 2,000 doses of J&J 210L of fuel

Vakinankaratra Antsirabe I, Antanifotsy, Ambatolampy

7,000 doses of J&J 35L of fuel

Analamanga Antananarivo Atsimondrano 1,400 doses of J&J Renting vehicle

Analamanga Antananarivo Avaradrano

Renting vehicle for punch operation, 90 patients visited

Analanjirofo Fenoarivo Atsinanana

100 doses of J&J Shipment freight

Analanjirofo Fenoarivo Atsinanana

1,600 doses of J&J Fuel

Analanjirofo Nosy Boraha (Sainte Marie)

100 doses of J&J Shipment freight

Boeny Mahajanga I 672 doses of Pfizer USAID partner PSI/IMPACT 's vehicle

Haute Matsiatra Fianarantsoa I

Fuel for transport of vaccinators to Beravina : 10 vaccinated persons

Fuel for transport of vaccinators to IFP Tambohobe : 69 vaccinated persons

Haute Matsiatra Isandra 70 L of fuel : 448 vaccinated persons

SOFIA Antsohihy 1,500 doses of J&J 2,800 doses of AZ

225L of fuel and driver’s Perdiem

SOFIA Bealanana 1,500 doses of AZ

SOFIA Befandriana Avaratra

750 doses of J&J 1,500 doses of AZ

SOFIA Boriziny (Port Berge) 1,250 doses of J&J 1,900 doses of AZ

SOFIA Mampikony 900 doses of J&J 1,300 doses of AZ

SOFIA Mandritsara 1,050 doses of J&J 1,700 doses of AZ

175


Vakinankaratra Antsirabe I, Ambatolampy

1,500 doses of J&J 33L of fuel

Vakinankaratra Faratsiho 1,000 doses of J&J

USAID partner PSI/IMPACT 's vehicle Vakinankaratra Mandoto 1,000 doses of J&J

Haute Matsiatra Isandra 600 doses of J&J 41 L of fuel: 1,452 vaccinated persons

FEVRIER

DPEV central DRSP Atsinanana 498 doses of J&J 900 doses of Pfizer

USAID partner PSI/IMPACT 's vehicle (with 900 pieces of SAB 0.3ml, 498 pieces of SAB 0.5ml, 1,398 vaccination cards, SD= 300 pieces)

DPEV central SDSP Marolambo 300 doses of J&J Air freight cost (with 300 vaccination cards, 300 SAB 0.5ml)

DRSP Toamasina SDSP Antanambao Manampontsy 600 doses of J&J Taxi-brousse fees

SDSP Toliara II (CSB ANKILILOAKY & AMBOHIMAHAVELONA)

CSB ANDRANOHINALY

10 doses of J&J

USAID partner PSI/IMPACT 's motorbike

CSB ANTANIMENA 20 doses of J&J

BSD Benenitra

CSB AMBOHITSY 25 doses of J&J 25 doses of AZ

CSB ANKILIVALO 20 doses of J&J 20 doses of AZ

CSB AMBALAVATO 30 doses of J&J 30 doses of J&J

CSB ANGODOGODO 45 doses of J&J 45 doses of AZ

CSB ANKILIMARY 15 doses of J&J 15 doses of AZ

CSB BONONOKY 15 doses of J&J 15 doses of AZ

CSB LIOLAVA 150 doses of J&J 150 doses of AZ

CSB VATANALIALY 10 doses of J&J 10 doses of AZ

CSB EHARA 25 doses of J&J 25 doses of AZ

CSB IANAPERA 55 doses of J&J 55 doses of AZ

DPEV central DRSP Mahajanga 120 doses of Pfizer 170 L of fuel

360 doses of Pfizer 155.5 L of fuel

176


DRSP Melaky

SDSP Ambatomainty 500 doses of J&J

Renting vehicle with vaccination cards and individual forms related to doses transported

SDSP Besalampy 200 doses of J&J

SDSP Ambatomainty 1,500 doses of J&J

SDSP Antsalova 1,800 doses of J&J

SDSP Besalampy 1,600 doses of J&J Renting motorbike (with 1,600 vaccination cards and 1,600 individual forms)

SDSP Morafenobe 1,000 doses of J&J Renting vehicle (with 1,600 vaccination cards and 1,600 individual forms)

DPEV central DRSP Melaky 9,170 doses of J&J 250 L of fuel

SDSP Antanifotsy SDSP Ambatolampy 500 doses of J&J 35 L of fuel

SDSP Faratsiho SDSP Antsirabe II 600 doses of J&J

SDSP Antsirabe I SDSP Antanifotsy/ SDSP Ambatolampy 1,100 doses of J&J 35 L of fuel

DPEV central DRSP Vakinankaratra 5,000 doses of J&J 1,000 doses of Pfizer

53 L of fuel

SDSP Antsirabe I SDSP Farafangana 200 doses of J&J USAID partner PSI/IMPACT 's vehicle and taxi-brousse fees

DPEV central DRSP Vakinankaratra 30,000 doses of J&J 53 L of fuel

SDSP Sambava Antalaha 1,500 doses of J&J USAID partner PSI/IMPACT 's vehicle

Ambilobe 1,800 doses of J&J Taxi-brousse fees

SDSP Diégo I Ambilobe 300 doses of J&J USAID partner PSI/IMPACT 's vehicle

Diégo II 2,000 doses of J&J 60.14 L of fuel

MARS Antsirabe

Ambatolampy 5 000 doses of J&J 30L of fuel

Antananarivo 30 000 doses of J&J

53L of fuel

Antananarivo 918 doses of J&J 53L of fuel (21,000 syringes)

Antananarivo Mahajanga 600 doses of Pfizer USAID partner PSI/IMPACT 's vehicle

177


Antananarivo Manakara

8,500 doses of J&J 3,500 doses of Pfizer


Ihosy 2,000 doses of J&J USAID partner PSI/IMPACT 's vehicle

Antananarivo CSB Tana Sud 8,853 doses of J&J 807 doses of AZ

Renting vehicle

Ambanja Communes, CSB, fokontany in districts Ambanja

1,500 doses of J&J 100 doses of Pfizer

Renting vehicle

Fianarantsoa Ikalamavony 700 doses of J&J USAID partner PSI/IMPACT 's vehicle

DPEV central DRSP Toliara 9,600 doses of J&J 1,320 doses of Pfizer


DPEV central Sakaraha 600 USAID partner PSI/IMPACT 's vehicle

Toliara I Morombe 2,000 doses of J&J 120 doses of Pfizer


CSB Morombe

Vaccination site Antanimieva

50 doses of J&J


Vaccination site Befandria

20 doses of J&J

Vaccination site Tanandava

50 doses of J&J

Vaccination site Ambahikily

30 doses of J&J

Vaccination site Andavadoaky

50 doses of J&J

Vaccination site Morombe

100 doses of J&J

SDSP Morombe Vaccination site Ambahikily

80 doses of J&J USAID partner PSI/IMPACT 's vehicle

CSB Sakaraha

CSB Amboronabo 100 doses of J&J

USAID partner PSI/IMPACT 's vehicle CSB Vineta 100 doses of J&J

CSB Besakoa Ambinany

100 doses of J&J

178


CSB Mahaboboka 50 doses of J&J

CSB Miary Lahatihy 50 doses of J&J

CSB Ampanihy

CSB Fotadrevo 100 doses of J&J


CSB Maniry 50 doses of J&J

CSB Beroy Sud 50 doses of J&J

CSB Beahitse 100 doses of J&J

CSB Ejeda 100 doses of J&J

Total 153,219 doses of J&J 9,763 doses of Pfizer 11,110 doses of AZ

179

ANNEX I: Publications produced by media

180

Week of publication

Media organization

Topic Number of publications/broadcasts

Communication channel

Newspaper

23/03/2022 Taratra Les nouvelles

Health supply chain, IMPACT

2

25/03/2022 Midi Madagascar L'express de Madagascar Les nouvelles Taratra

Delivery by drone

4

28/03/2022 Taratra Les nouvelles

Health supply chain, IMPACT

2

02/04/2022 Taratra Madagascar Matin (Number of publications/broadcasts)

Delivery by drone

2

Communication channel

TV/Radio Broadcast/Facebook

Link

24/03/2022 Press Officer/DRSP

Delivery by drone

https://www.facebook.com/100505768041668/posts/677039390388300/?sfnsn=mo

actu.mg https://www.facebook.com/108227425140612/posts/118777474085607/?sfnsn=mo

Local media https://www.facebook.com/100007282955148/posts/3028021994117203/?sfnsn=mo

Atsinanana Governorate


Local media https://www.facebook.com/100052248459845/posts/501910341560577/?sfnsn=mo

KOLO Tv https://fb.watch/chSyLSFHL4/ TVM RNM VIVA

25/03/2022 2424 https://web.facebook.com/602569476785492/posts/1638104169898679/?sfnsn=mo&_rdc=1&_rdr

24H Mada https://www.facebook.com/1909690405921155/posts/3287412701482245/?sfnsn=mo

TVPlus https://www.facebook.com/1522651413/posts/10226868280122692/?sfnsn=mo

Sobika Mada https://www.facebook.com/1380149855548524/posts/3389115691318587/?sfnsn=mo

26/03/2022 Dream'in https://web.facebook.com/847373075432604/posts/2086900764813156/?sfnsn=mo&_rdc=1&_rdr

Vaovao malaza eran-tany


Vaovao farany https://www.facebook.com/101025968809565/posts/298978445680982/?sfnsn=mo

181

ANNEX J: Updated supply plan

182

Commodities Quantité Supplier Estimated Delivery date

Comments

Artesunate 100 mg Suppository, unit 46,000 PMI 1-Nov-22 Shipment postponed due to over stock

Artesunate (w/ 1 Amp NaHCO3 5% + 1 Amp NaCl 0.9%) 60 mg Vial, 1 Set 548,610 GF 31-Oct-22


100,000 PMI 1-Nov-22

Artesunate/Amodiaquine 25/67.5 mg Tablet, Treatment

84,000 PMI 30-Sep-22 Order placed to prepare high transmission period

Artesunate/Amodiaquine 25/67.5 mg Tablet, Treatment 93,125 GF 31-Oct-22

2nd shipment of GF order (NMF3-2023)

Artesunate/Amodiaquine 50/135 mg Tablet, Treatment



797,500 GF 31-Oct-22 2nd shipment of GF order (NMF3-2023)

Artesunate/Amodiaquine 100/270 mg Tablet, Treatment 135,000 PMI 20-May-22 Emergency order

Artesunate/Amodiaquine 100/270 mg Tablet, Treatment 203,962 GF 31-Aug-22

1st shipment of GF order (NMF3-2023)


180,000 PMI 9-Sep-22 Emergency order



Artesunate/Amodiaquine 100/270 mg Tablet, Treatment 192,913 GF 31-Oct-22 Order placed to prepare high

transmission period Artesunate/Amodiaquine 100/270 mg Tablet,Treatment

84,000 PMI 20-May-22 Emergency order


217,045 GF 31-Aug-22 1st shipment of GF order (NMF3-2023)

Artesunate/Amodiaquine 100/270 mg Tablet,Treatment

230,000 PMI 9-Sep-22 Emergency order

Artesunate/Amodiaquine 100/270 mg Tablet,Treatment 132,000 PMI 30-Sep-22 Emergency order




311,080 GF 31-Oct-22 2nd shipment of GF order (NMF3-2023)

Sulfadoxine/Pyrimethamine 500/25 mg Tablet, treatment of 3 tablets 1,000,000 PMI 17-Sep-22

Sulfadoxine/Pyrimethamine 500/25 mg Tablet, treatment of 3 tablets 689,760 GF TBD

Shipment to be postponed due to over stock