Strengthening Systems for Better Health Activity, Year Two, Quarter One Report, July 16 – October 15, 2018

The Activity aims to improve health outcomes, particularly for marginalized and disadvantaged groups, by enhancing access to and quality of maternal, child, and reproductive health services, with a specific focus on newborn care. The geographic focus of the Activity covers 105 municipalities in Karnali Province and Province 5, with a total population of approximately 2.5 million people. The Activity is designed to achieve three outcomes: improved access to and utilization of equitable healthcare services, improved quality of health services in facilities and communities, and improved health systems governance, including within the context of federalism. To achieve these outcomes, the Activity has established a field office in Surkhet, Karnali Province, and is implementing various interventions, including training for healthcare providers, infrastructure development, and community engagement. One of the key achievements of the Activity is the improvement in access to and utilization of equitable healthcare services. According to the Year Two, Quarter One Progress Report, the Activity has made significant progress in increasing the availability of effective, quality maternal, newborn, and child health (MNCH) and family planning (FP) services at the health facility and community levels. The Activity has also made progress in increasing the utilization of services by addressing social, cultural, and financial barriers. The Activity has also made significant progress in improving the quality of health services in facilities and communities. The Quality Improvement (QI) approach has been further developed, strengthened, and institutionalized, and quality services are being delivered by facilities and providers in the public and private sectors. The Activity has also made progress in improving health systems governance, including within the context of federalism. The governance and accountability at subnational levels have been improved, and annual planning and budgeting systems have been established and/or strengthened at the provincial and municipal levels. The Activity has also made progress in implementing cross-cutting elements, including private sector engagement, gender equity and social inclusion, data-driven and evidence-based programming, and collaboration and synergy. The Activity has also made progress in monitoring, evaluation, and learning, and has established a robust monitoring and evaluation system to track progress and identify areas for improvement. The Activity has also made significant progress in project management, including the complete establishment of project offices, complete recruitment and hiring of Activity staff, development and submission of all contractual deliverables, including the Year Three Workplan, and staff orientation and training. The Activity has also made progress in budget and expenditure management, and has maintained a strong financial management system to ensure effective use of resources. Overall, the USAID's Strengthening Systems for Better Health Activity has made significant progress in improving health outcomes, particularly for marginalized and disadvantaged groups, and has established a strong foundation for continued progress in the coming years.