Annual Report October 2018–September 2019: Integrated Health Systems Strengthening & Service Delivery Activity

under USAID Cooperative Agreement No. AID-391-A-17-00002. The program was officially approved on September 24, 2017, and is focused on strengthening health systems in the provinces of Khyber Pakhtunkhwa (KP), Sindh, and at the federal level. The program's initial work plan, submitted in September 2017, aimed to work in KP, Sindh, and at the federal level. However, by April 2018, JSI's application for a no-objection certificate (NOC) to work in KP was pending, and the annual work plan was revised to shift the bulk of activities to Sindh Province. The first two quarters of Project Year (PY) 1 focused on transitioning from Health Systems Strengthening (HSS) to IHSS-SD in Sindh and continuing support to the Ministry of National Health Services Regulations and Coordination (MONHSR&C) at the federal level. In September 2018, the annual work plan was revised again to align IHSS-SD activities with the Country Development Cooperation Strategy (CDCS) of USAID/Pakistan, which prioritized geographic areas along the Afghanistan/Pakistan (Af/Pak) border, KP, southern Punjab, and Karachi. Countering violence and extremism (CVE) became a major cross-cutting theme, and IHSS-SD revised its theory of change accordingly. JSI received permission to work in Punjab on January 3, 2019, but the NOC for KP was pending. The Activity's third major shift occurred in January 2019, when USAID announced that CVE and health would no longer be linked, and the IHSS-SD Activity should focus on the Global Health Security Agenda (GHSA). The Activity's annual work plan was revised to focus on GHSA and maternal, newborn, and child health (MNCH) in KP, and on GHSA exclusively at the federal level and in Sindh and Punjab Provinces. USAID also requested that IHSS-SD work in Balochistan, and JSI submitted a formal NOC application, which is still under consideration. Despite the submission of the revised Activity description, annual work plan, costed plan, and budget, activities in KP could not begin until JSI received the NOC from the Ministry of Interior on January 24, 2019. The IHSS-SD work plan was re-aligned with the KP Provincial Health Policy 2018-2023 to complement health department efforts to strengthen its health system. USAID approved the re-aligned work plan in March 2019, and after exhaustive discussions, Charsadda, Lakki Marwat, Swat, and Mohmand (from the newly merged districts of ex-FATA) were selected for Activity implementation. The IHSS-SD Peshawar provincial office was established with requisite staff for overseeing operations, and provincial and district-level activities commenced. However, a letter from Agency Surgeon Mohmand District to all NGOs stated that a separate NOC for working in the tribal district was necessary, and JSI is awaiting a reply. IHSS-SD activities in the other three districts continue as planned with the three consortium partners, Jhpiego, Contech International, and Rural Support Program Network (RSPN). In Sindh, activities encompass health department restructuring, Public Health Act drafting, and regularizing CMW cadre as government employees. GHSA activities in the Larkana and Kambar Shahdadkot Districts are underway in close collaboration with the Director General Health Office. The work plan and GHSA activities were finalized with the Health Department Punjab in September 2019, and the provincial staff for IHSS-SD are being hired. As the Activity moves into Project Year 3, it is well-positioned to support the delivery of basic health services along the AF/PAK border and GHSA at all levels of the health system. Pending approval, IHSS-SD will commence activities in Balochistan.