Quarterly Environmental Mitigation Report April 2015

The project operates in 84 public and non-governmental organization (NGO) health facilities and two rally post community service points throughout the Nord, Nord-Est, Nord-Ouest, and Artibonite departments, covering a population of approximately 1.6 million inhabitants. The project's four main objectives are to increase utilization of the essential package of services at the primary-care and community levels, improve the functionality of the USG-supported health referral networks, facilitate sustainable delivery of quality health services, and strengthen departmental health authorities' capacity to manage and monitor service delivery. The SSQH-Nord project is currently in Phase 3: Sub-Project Implementation, as described in the Environmental Mitigation Plan and Report (EMPR) submitted on November 27, 2013. The project and its partners have begun implementing various activities and increasing supported sites' capacity for medical waste management (MWM). During this reporting period, the SSQH-Nord project led an emergency response to a cholera outbreak in La Tortue, supported several pharmaceutical stock management trainings, and conducted systematic, comprehensive, and integrated supervision visits at 81 out of 84 supported sites to assess their progress to date, including their progress on certain MWM indicators. The project received twenty-nine more MWMPs, for a total of 40 plans received to date. Appendix A features a summary of the status of each site's MWM committee and MWMP submission. The SSQH-Nord project supports six health institutions in La Tortue, including two dispensaries and four clinics, to improve primary health care. The lack of basic water and sanitation infrastructure makes La Tortue particularly vulnerable to waterborne diseases such as cholera. Amid an increasing number of reported cases of cholera on the island, SSQH-Nord quickly took action, distributing hygiene kits that included soap, chlorine bottles, Aquatab tablets, water jugs, and buckets to ensure that local residents could protect themselves through hand washing and purifying and safely storing water. A total of 423 families benefitted from this activity. Since mid-January 2015, DSNO Ministry of Public Health and Population officials have noted a sharp decrease in the number of reported cases and patients hospitalized for cholera in La Tortue. In February, no new cases or hospitalizations were reported on the island. From March 3-6, 2015, nine sites participated in a training conducted by partner organization Supply Chain Management System (SCMS) that focused on effective management of HIV materials and expired medications. The participants consisted of HIV inventory managers from both the labs and pharmacies of these institutions. Additional trainings will be planned and implemented by SCMS, in coordination with SSQH-Nord, to target all of the remaining HIV and TB sites supported by SSQH-Nord in the Nord-Ouest and Artibonite departments. Following this training, James Morisseau, a logistician for the SSQH-Nord Health Systems Strengthening team, identified a need for more extensive training in stock and inventory management for other general and essential medications that are not HIV- or STI-specific. SCMS provides quality assurance and capacity building for HIV-related services, but not other products and materials. There are currently no standards for supplying and managing these general medications and therefore they are frequently out of stock. The Departmental Supply Center (CDAI) theoretically should provide vaccines and other essential medications, which they receive from a central depot in Port-au-Prince, but they are irregularly and insufficiently stocked. Also during the month of March, systematic integrated supervision visits were conducted at 81 out of 84 of the SSQH-Nord supported sites. During these site visits SSQH-Nord staff assessed thirty-two MWM indicators, namely: availability of waste separation containers, availability of latrines, availability of incinerators, availability of different water sources for hand washing, sterilization protocols, availability of sanitation materials such as gloves and masks, inventory and stock management, and whether the site has their updated MWMP posted on a bulletin board. Appendix B features an exhaustive list of the data collected, disaggregated by region. This list will serve as a basis for an evaluation of the needs of all eighty-four sites and help the SSQH-Nord staff determine how to best support the sites in improving their MWM practices.