Alcançar Project Midterm Assessment 2021

The project's objectives included understanding the implementation of innovative approaches, assessing the impact of COVID-19 restrictions, and evaluating key project indicators. The project's methodology involved a process evaluation, focusing on the implementation of six innovation approaches in four districts: Monapo, Nacala Porto, Memba, and Angoche. The evaluation included interviews with MCNCH nurses, observations at 12 health facilities, and focus group discussions with beneficiaries and key stakeholders. The findings of the midterm assessment revealed that the project's innovative approaches had varying levels of success. Supportive Technical Assistance (STA) had low coverage among health providers, with only 15 out of 44 stating they had received the STA. However, the project team was unable to visit health facilities due to COVID-19 restrictions, and had to switch to remote methods, which received mixed feedback. Simulations and Collaboratives showed the highest coverage and had a positive impact on providers' confidence and ability to stay calm during emergencies. However, providers wanted additional training on responding to hemorrhages and eclampsia or pre-eclampsia. The simulations had a positive impact on providers' confidence and ability to stay calm during emergencies, with 59% of providers stating they could incorporate all aspects of the simulations into their work. The project also implemented Messages and Trainings using Mobile Phones, including the Viamo Remote Training Tool and 3-2-1 Service. The remote trainings were short, 5-minute pre-recorded trainings developed for nurses and APEs, and all 35 providers who received a training call completed at least one of the trainings. The providers thought the trainings were practical and helpful refreshers. The project's Gender Transformational Actions aimed to increase male engagement and promote gender equality. The findings showed that men and women had positive views of increasing male engagement, with men taking on more household responsibilities and women reporting that their husbands were nicer to them during pregnancy. The project's Clinical Observations revealed that adherence to protocols varied, but overall was low across all consultations. Prenatal care was below satisfactory, with infrequent discussion of contraception, prevention of STIs, and contraception after birth. Maternity care showed gaps in the physical examination, even without the need for equipment. The project's Impact assessment revealed that the simulations and collaboratives were the innovations at the health facility level that showed the largest overall impact. The collaboratives had an accountability component that helped change the culture within the health facilities. However, the STA had the least impact, as it focused on individual provider behavior, which was not necessarily reinforced by or connected to the larger system. The project's Recommendations included focusing and prioritizing the simulation and collaborative innovations, increasing focus on technical assistance to prenatal care consultations, and improving integration of innovations. The project also recommended engaging with young men and women to discuss gender equality, women's empowerment, and equal decision-making.