Year 4 MCHIP ANNUAL RESULTS REPORT/4th Quarter Report MCHIP- Madagascar Annual Report (Oct. 1, 2012-Sep. 30, 2013)

The organization supported the work of its group of MNH experts, who are leaders in their respective fields of midwifery, gynecology, obstetrics, and pediatrics, to introduce and support the adoption of innovative best practices in MNH. A total of 532 participants representing 205% of the original annual objective attended MCHIP technical advocacy presentations regarding MNH. These presentations included working-group meetings during the 5th SOMAPED congress in Mahajanga, the celebration of World Midwives Day with the FSF association, and the annual meeting of the Association of Catholic Doctors. In addition, MCHIP field coordinators conducted meetings with groups of Health Development Committees (CDS) in the Ambatondrazaka, Tolagnaro, and Fenerive Est to mobilize efforts to implement emergency referral plans. MCHIP conducted operational research on the birth register and the register for postpartum and postnatal consultation. The research contributes to improving the availability of data on maternal and neonatal health, particularly those relating to obstetric and neonatal complications. The two different registers were updated by MCHIP and key stakeholders. MCHIP was approved to pre-test the revised maternity registers in the three demonstration districts and subsequently produced a report to present the results of testing the new updated registers with healthcare providers trained in MNH in the three demonstration districts. MCHIP involved key maternal health stakeholders through technical advisory group meetings at the national level. These groups met periodically through all phases of the introductory PPH prevention program and the CHX introduction program. MCHIP worked with PSI on formative research regarding CHX, including brand name pretest, logo, packaging, instructions on how to use 7.1% Chlorhexidine for the care of the umbilical cord of the newborn, and communication strategy. MCHIP also worked with JSI/Mahefa on curriculum development for training health agents and community health workers in newborn infection prevention using CHX. During Program Year 5, MCHIP launched its collaboration with Faith-Based Organizations and MOUs were developed with four FBOs, including SAF/FJKM, SALFA, ECAR, and Santé Sud. MCHIP trained their health professionals during this project year. A total of 154 health agents were trained in maternal and newborn health, including 54 doctors, 73 midwives, and 27 nurses. MCHIP trainers conducted two supervisions with 27 clinical trainers of 83 health providers, and provided training in maternal and neonatal health in a 2-day training workshop to ensure that providers were correctly using newly acquired skills. MCHIP reinforced the technical capacity of its trainers as well as taught them how to be effective trainers during this project year. MCHIP's technical team of MNCH trainers facilitated a supplementary training workshop to enhance demonstration and coaching skills and assist trainers in planning the schedule and content for post-training follow-up visits to trainees. MCHIP also reinforced the technical capacity of 12 trainers to enhance the technical skills of the current team of trainers/supervisors in MNH during two days in Antananarivo. In collaboration with Malagasy private health associations, MCHIP selected 15 additional trainers to participate in a training of trainers (ToT) to improve targeted MNCH skills. These trainers will in turn conduct cascade MNCH trainings throughout Madagascar for association members. During 5 days, 15 trainers participated in a TOT conducted by MCHIP. MCHIP distributed nearly 1,862 job aids to professional healthcare association members and CAs, and distributed 3 types of posters to all providers working with FBOs and trained in MNH. The posters cover the following topics: PPH management, management of PE/E with magnesium sulfate, and action plans for newborn resuscitation. MCHIP assisted with the recent revisions related to the results of field pre-tests of the maternal and newborn health booklets used by both women and ACs to include guidance on community-level recognition and referral of maternal and newborn complications. MCHIP is currently waiting for documents which were finalized by the MAHEFA project; as soon as they are received, MCHIP will print out and distribute the health booklets.