CHILD SURVIVAL PROJECTS

MADAGASCAR  Project Coordinator – Dr. Josea Ratisrarson

Mcdi@iris.mg

 B.P. 15 Bekioky Sud Tulear 612

Telephone:  261-20-22-358-06

The child survival project in Madagascar is undergoing some difficulty due to civil unrest that resulted after the first round of the presidential elections.  Due to this instability, the project coordinator, with the approval of the HO and USAID mission in Madagascar, decided to withdraw all our staff and halt main project activities for a period of ten days; a small number of local personnel remained in the Betioky area. After nearly three weeks following the evacuation, however, all but three staff members have returned to the project area. The project coordinator, Dr. Josea Rastisaroa, has maintained weekly reports relating to the socio-political situation, which has been particularly helpful in facilitating future decisions.

A lesson to be gleaned for all MCDI field teams and project coordinators from the experience in Madagascar is the need for a contingency plan in the event of a security crisis. USAID currently recommends incorporation of contingency plans in the event of security crises in project proposals; MCDI has followed up on this recommendation accordingly.

Prior to the socio-political instability in Madagascar, the project team was in the process of implementing the recommendations of the MTE, particularly with regard to organizing planning workshops and meetings with regional and local health authorities.  The objective of such meetings and workshops was to develop a joint plan of action between the project team and the health authorities, strengthening partnership ties with the counterparts and thereby contributing to sustainability of the project. Additionally, MCDI has submitted a cost extension proposal involving expansion of the project to another district. 

The Madagascar CSP/BS has developed an innovative community based health insurance scheme.  The scheme served as the basis for a medical thesis by Dr. Riga with mentoring from Dr. Chris Schwabe; MCDI’s role in the development of the thesis was well appreciated by the medical school as well as the Ministry of Health (MOH).  The MOH has requested MCDI to attempt to expand the project to cover other areas in the region of Toliara.  MCDI has currently undertaken an evaluation of the community based insurance scheme for possible expansion, despite a number of setbacks due to the eruption of civil unrest.

            In November of 2001, the project coordinator participated in a seminar on “M & E and Sustainability,” organized by CSTS in Mali.  During the seminar, Dr. Josea presented an overview of the project relating to monitoring and evaluation and sustainability. Notably, participants from the three projects being implemented in French speaking countries – Madagascar, Mali and Benin – were present at the seminar, presenting an opportunity for MCDI field staff to network among themselves and exchange experiences. 

BOLIVIA

Project Coordinator – James Selph

Home address:

Avenuda Padilla es 9 America

Edijicio Chamas Anto I-B

Tarija, Bolivia

Jselph@olivo.tja.entelnet.bo

During the second half of 2001, a new team of health professionals began developing project activities.  The team studied management and organizational characteristics of the EPI program and the Essential Drugs program currently being implemented in Cotagaita. The cost study on the National Health Insurance (SBS) is currently underway with participation from Nur University, and the data collection and input is to be completed shortly.  Since the management of Bolivia’s SBS is decentralized with decision-making at the municipal level, the report is expected to assist the Municipal Mayors in understanding the gap between the costs covered by the SBS plan and real costs.  This, in turn, would allow for more adequate and efficient management of SBS funds and will also help the Municipalities in lobbying for a more equitable distribution of SBS funds and revising costing procedures. 

            The project team was also involved with local partners, the MCDI Home Office (HO), and an international consultant in the preparation and implementation of the MTE.  Due to civil unrest involving strikes and roadblocks in Potosi, the MTE was postponed to take place in January. The final report was recently completed and appropriate recommendations have been incorporated in the project work plan.

SOUTH AFRICA

Project Coordinator – Dr. Farshid Meidany

Mcdi@mweb.co.za

MCDI-South Africa

Maritime House, Suite 140, 143 Victoria Embankment,

Durban, 4000, South Africa.

Phone: 27-31-304-0357

          The Ndwedwe District Child Survival  Project (NDCSP) in KwaZulu Natal, South Africa has just entered Phase II under a cost-extension grant from USAID.  The NDCSP is currently under the guidance of a new project manager, Dr. Farshid Meidany, a community health specialist and an Epidemiologist.  Dr. Meidany has previously worked with the Provincial Department of Health in the Eastern Cape Province of South Africa.  Dr. Meidany holds an MD from Tehran University and an MPH in International Health and Epidemiology from the Johns Hopkins University.  He has approximately twenty years of experience in program management as the National HIV/AIDS Control Program Director (WHO/DOH, Equatorial Guinea), District Health Medical Superintendent (Eastern Cape DOH, South Africa), and Head of the Epidemiology and Research Unit (Eastern Cape DOH, South Africa). Dr. Meidany has extensive experience in managing numerous projects funded by WHO, UNICEF, World Bank, the European Union, and the USAID.

            Under Phase II of the project, the NDCSP will continue to focus on maternal/newborn care, pneumonia case management, and control of diarrheal diseases, while furthering its emphasis on prevention of HIV/AIDS and STIs.  The project has recently completed its “Baseline KPC” survey for the extended project area, which involved (as enumerators) Home Based Care Volunteers who have been working with the project’s HIV/AIDS activities.  Additionally, the final evaluation of the Project’s Phase I was recently completed.  The evaluation proved to be encouraging, revealing that most of the project’s objectives have been met; for those objectives yet to meet their target, significant progress is underway

            A key focus of the project’s HIV/AIDS and STI intervention component is prevention among school-aged children in the district.  Accordingly, the NDCSP is continuing support of its partner, the local NGO DramAidE, in establishing Health Promotion Clubs in eight seed schools in the Ndwedwe District.  The Club’s current project focuses on effective communication, particularly regarding HIV/AIDS prevention, through presentations to the students with key prevention messages incorporated in drama, song, and poetry.  The NDCSP and DramAidE have incorporated basic instruction relating to home care of chronically ill children to the Health Clubs training, based on the assumption that many school children will have younger siblings who are born HIV-positive.

            The project has recently finalized its Detailed Implementation Plan (DIP) for Phase II.  It is also supporting a study, funded by the Margaret Sanger Center International - South Africa, to gain insight into existing barriers between the traditional healers and the biomedical health system; the study is expected to contribute towards development of partnerships for collaboration between the two schools of health practitioners.  The findings from this study will be used to influence future interventions to involve traditional healers in HIV/AIDS prevention activities in South Africa.

OTHER PROJECTS

MOZAMBIQUE

Project Coordinator – Edward Aldrich

Mcdimoz@teledata.mz

The project team in Mozambique is currently implementing project activities as included in the work plan. A key activity of the project is the baseline survey, undertaken during the latter half of 2001. The study was designed by the JSI-HSDS team in Maputo and was based on the KPC survey methodology employed by all MCDI Child Survival projects.  However, as the JSI team wished to identify changes and disparities among various districts and provinces, the sample pool was dramatically increased.  In the Niassa province where MCDI is implementing the project, a total of 2,300 WRA/and mothers of children under two years of age were interviewed in a total of six districts.

In December 2001, the project received supervisory support from an external consultant, Dr. Ana Paula M. Oppenheimer, who had previously worked with the team during the completed Niassa Child Survival project.  Dr. Oppenheimer provided recommendation on revision and evaluation of existing training materials for Community Health Volunteers; the team is currently undertaking follow-up on her recommendations.

            The project has also provided training and refresher courses for community volunteers (activistas) with special attention given to training and support of Traditional Healers (TH) and TBAs.  MCDI’s training of the THs as educators for STIs, including HIV/AIDS, in our project areas, has proven to be effective in bolstering the relationship and confidence between traditional medicine and the modern health system, thereby improving community access to reliable information on STIs.

            Since there is a high incidence of HIV/AIDS cases in Niassa (the province with the second highest AIDS prevalence in Mozambique), the project team reached a partnership agreement with the local NGO “ARO Juvenile” to focus on BCC/IEC activities targeting youth in one of the largest and most populated Districts, Cuamba.  This group has undertaken activities such as dramas and sporting events where youth receive information on HIV/AIDS and other STIs; they are also encouraged to develop healthy sexual behaviors and fight social stigma associated with AIDS.

SWAZILAND

Project Coordinator – Dr. Qhing Qhing Dlamini

usdfhiv@realnet.co.sz

or

qhing44@hotmail.com

Prevention of HIV/AIDS among SUDF Personnel

            In November, MCDI partnered with the Umbutfo Swaziland Defense Force (USDF) to obtain funding from the US Department of Defense for a one-year project to prevent HIV/AIDS among USDF personnel.

            The project, which began in January, included representatives from the USDF, the Swazi royal family, cabinet members, including the Minister of Health and the Minister of Foreign Affairs, foreign dignitaries, and local NGOs working on HIV/AIDS prevention issues throughout the country.  The start-up of the project received considerable media exposure in Swaziland.

The Project Manager is Dr. Doris Brown, a retired Colonel of the U.S. Army who had directed the Army’s medical research and development program and provided oversight to the military’s infectious disease program and laboratories.  She also provided oversight for implementation of a research program for the military that included a key focus on preventing and treating HIV/AIDS among military personnel.

            The project’s in-country coordinator is Dr. Qhing Qhing Dlamini, a public health physician with extensive experience in policy development and managing and implementing HIV/AIDS programs and activities.  She served as the Deputy Director of Health Services at the Ministry of Health in Swaziland for eight years, during which she chaired the National AIDS Task Force.  She also has vast experience in clinical management of STIs and HIV-related conditions, as well as in providing Training of Trainers (TOT) training to health personnel.

            The goal of this project is to decrease the incidence of HIV/AIDS among USDF personnel, their families, and communities.    Specific objective to reach this goal include:  1) assessing risk behavior, knowledge and attitudes of armed services personnel about HIV/AIDS; 2) assisting the USDF in implementing new approaches for effective prevention strategies including public awareness and Behavior Change Communication (BCC) initiatives; 3) strengthening the capacity of the USDF to support armed services personnel and their families affected by HIV/AIDS; and 4) developing the capacity of the USDF to monitor and evaluate the effectiveness of their HIV/AIDS prevention initiatives.  Major activities to be implemented throughout the project include the following: