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Annex A: PROJECT PLAN

|Project Title |Welbodi Women Northern Bombali Project |

|Implementation Period |1st May 2016 - 30th April 2019 (3 years) |

|Budget Currency[1] |GBP £ |Exchange rate |7204.91 |

|Budget Amount |Total: £669,960 (4,867,554,343.68 SLL) |% = 100 |

| |Direct £509,379.64 (3,670,034,441.73 SLL) |% = 75 |

| |Indirect: £166,208.88 (1,197,520,012.72 SLL) |% = 25 (+SLA 2%) |

|Implementing partners |Lead: Health Poverty Action |

| |Others: Forum for African Women Educationalists (FAWE); Health For All Coalition (HFAC) |

|Geographic location/s |Bombali district (Sella Limba, Tambaka, Sanda Loko, Magbaima Ndwahun, Gbanti Kamaranka chiefdoms) |

|Funding Partner/s |Main: Big Lottery Fund |

| |Other: Big Lottery Fund |

|Problem Statement (Describe the problem that the project will solve): |

|Before Ebola, Sierra Leone’s maternal mortality rate (1100/100,000), infant mortality rate (174/1,000) and teenage pregnancy rates were already among the |

|highest in the world, with over 40% of maternal deaths due to teenage pregnancy. |

| |

|HPA has been strengthening the health system for RMNH in Northern Bombali since 2005 and has reduced childbirth fatality from 4.4% to 1.2% and doubled the |

|number of women accessing EOC. |

| |

|However, Ebola struck in May 2014. Bombali district became a hotspot with over 960 confirmed cases by the year end. Several health staff died of Ebola or|

|quit due to burnout or fear. Fear of Ebola and a deepening mistrust of the health system led to a sharp decline in the utilisation of RMNH services, |

|contraception, and blood donations for EOC emergencies. Ex. in N. Bombali ANC3+ reduced from 1,123 in the quarter before Ebola started to 929 after Ebola.|

|The birth waiting homes built by HPA for women who live far from health facilities that were receiving, on average, 105 pregnant women per month before |

|Ebola now receive 85. Ebola has worsened the health of pregnant women and newborns, and left many teenagers pregnant at the time when they mistrust and |

|fear the health system. |

| |

|Ebola has weakened health staff and left them struggling to cope with RMNH at time when these services are most needed. Whilst the outbreak highlighted |

|the need for real time disease surveillance and emergency preparedness, facilities have been left ineffective to prevent resurgences in Ebola or other |

|infections. This has been demonstrated by the two new Ebola cases. |

| |

|N. Bombali had the highest teenage pregnancy rate nationally (39.6%) before Ebola, but this has now increased by almost 10% (UNDP) due to school closures |

|during Ebola. Health workers often harbor judgmental attitudes toward pregnant teenagers who in turn fear and avoid health facilities. |

| |

|Post-Ebola recovery will require health system strengthening (including disease surveillance and infection control) and the restoration of essential RMNH. |

|Project Goal (Impact Statement): |

|To improve reproductive, maternal, and newborn health in Sierra Leone, contributing to: |

|Reduction in global maternal mortality ratio to less than 70 per 100,000 live births |

|Ending of preventable deaths of newborns and children under 5 years of age |

|Reduction in global neonatal mortality to no more than 12 per 1,000 live births and global under-5 mortality to 25 per 1,000 live births. |

|Project Objectives: |

|Improved uptake of quality RMNH services for vulnerable women, teenage girls, and newborns in Northern Bombali, Sierra Leone. |

|Expected Outcomes: |

|Increased technical capacity of Kamakwie Wesleyan Hospital (KWH) and 28 PHUs to deliver quality comprehensive RMNH in Northern Bombali |

| |

|Increased knowledge and behaviour change on RMNH among women and teenage girls in Northern Bombali |

| |

|Communities empowered for community based management of RMNH actions that benefit women/girls and improve uptake and utilisation of services |

| |

|Enhanced community coordination with and monitoring of KWH and PHU RMNH services to enhance accountability and trust post-Ebola in the health system |

| |

|Learning and community views from the project contribute to policies, strategies, and replication of best practices on RMNH that integrate Ebola |

|Key Strategies (Provide a description): |

|Please see Annex A(i) which is a diagram showing the mechanism, or Theory of Change, that the project will use to make this change. It shows the |

|progression of the project in building the knowledge base of all actors on RMNH (Step 1), building networks, groups, structures, and dialogue mechanisms |

|(Step 2), to improve on knowledge, actions, and services (Step 3). The project’s approaches, lessons, and advocacy will in turn lead to influencing for |

|sustainability and replication even after the project’s end, and ultimately lead to the change that the project sets out to achieve: vulnerable women and |

|teenage girls secure the right to improved reproductive and maternal health. |

|Main Activities (List them): |

|Strengthen health services (HPA): |

|EOC and youth friendly services provision training for health workers |

|Midwife Supportive Supervisors providing on-the-job training and supportive supervision on RMNH (incl. infection prevention & control) at 28 PHUs to |

|support PHUs with normal deliveries; ANC; PNC; protocols; HMIS and disease surveillance |

|EOC emergency referral system |

|Maternal and newborn death reviews at KWH (these involve health workers only and are different from the village maternal and perinatal death conferences |

|under outcome 3) followed by quality improvements |

|A safe and quality KWH blood bank / blood collection drives |

| |

|Increase knowledge / behaviour change (FAWE): |

|Behaviour change communications strategy based on a study of barriers to RMNH and myths beliefs about Ebola |

|(with HFAC) 252 former TBAs supported to perform a non-delivery role, visiting women/girls for: education on RMNH and Ebola; breastfeeding counselling; and|

|referrals to ANC, skilled delivery, and PNC |

|Call-in radio show and pictorial information materials |

|Gender Clubs in 20 schools to discuss sexual health, FGC, gender, teenage pregnancy, contraception, and Ebola |

| |

|Support community managed activities (HFAC): |

|Community distribution of FP by former TBAs |

|Community Discussions to reach consensus and take action on RMNH issues (including sensitive topics such as FGC) |

|Promote and manage 28 existing Birth Waiting Homes near PHUs |

|Community participatory scoring of households against Community Health Competition RMNH criteria determined by communities themselves |

| |

|Support community monitoring (HFAC): |

|Ensuring community feedback and client satisfaction (incl. teenage girls) is considered by health facilities and / or DHMT |

|28 VDCs supported to monitor and provide feedback to health workers and / or to DHMT on RMNH services (incl. using community scorecard) |

|Village maternal and perinatal death conferences |

|RMNH client exit interviews |

|RMNH beneficiary feedback mechanisms ex. suggestion boxes, SMS /calls, clinic bulletin boards |

| |

|Contribute to policies / replication (All partners): |

|Research into barriers to RMNH (incl. teenagers) and myths about Ebola |

|Disseminate project findings, tools, manuals and community feedback |

|Project Steering Committee includes stakeholders |

|Project Inputs (List and quantify): |

|Staffing |

|HPA: |

|Lead midwife x 1 (100% for Year 1) |

|Midwives x 3 (100% for Year 1) |

|Programme Manager x 1 (100%) |

|Finance Officer x 1 (100%) |

|HFAC: |

|Finance Officer x 1 (25%) |

|M&E Officer x 1 (100%) |

|Field Officers x 2 (100%) |

|Security guard x 1 (100%) |

|Cleaner x 1 (100%) |

|Driver x 1 (100%) |

|FAWE: |

|Finance Officer x 1 (20%) |

|Field Officer x 1 |

| |

|Equipment and vehicles |

|Motorbikes x 3 |

|Laptop x 1 |

|Netbooks x 3 |

|Camera x 1 |

|Sustainability Plan (Description of what happens when the project comes to an end): |

|The project is designed to be sustainable and to promote community ownership; supporting community-led structures / groups to address the causes of poor |

|RMNH and mobilise communities to demand their health rights and access services. It will, meanwhile strengthen the capacity of the health system service |

|delivery in a transition/post-Ebola environment. Crucially it will build operational links between the two. Therefore, the impacts seen during the lifetime|

|of the project will be positive, but activities that are implemented as part of the project will continue to show benefits for years. |

| |

|Sustainability of project benefits has been embedded in the project approach and design and will be ensured in the following ways: |

| |

|Financial sustainability: Some project activities such as material production, dissemination and related IEC/BCC activities, training of community |

|beneficiaries, structures and volunteers, health care workers and other project stakeholders will not be continued after the end of the project as they are|

|designed as “one-off” activities that will support RMNH service provision and demand creation. However, many other activities will be continued with no |

|financing required after the project ends. These include: support to maternal referrals by MHPs/TBAs and CHVs; community awareness raising sessions carried|

|out at village level by community volunteers; monitoring of health facilities by VDCs using community scorecards, provision of improved RMNH services at |

|the health facilities; maternal death audits and conferences. There is every reason to expect that the communities and service providers will be able to |

|continue these activities after the end of the project, given the high level of commitment from government and donors. |

| |

|Institutional sustainability: The project will build the capacity of staff, structures, systems, tools and management in the health system to work with |

|communities, respond to their needs and feedback, and coordinate activities with them on RMNH. The continued implementation of this strategy by the GoSL |

|and NGOs will support the institutional sustainability of the project. |

| |

|The project will also contribute to building the capacity of the health referral system in the project area. It will link the services provided at KWH with|

|the basic emergency obstetric emergency care and PHUs facilities through ambulances, MHP referrals and demand creation activities. This system is dependent|

|on the use of ambulances, mobile phones, and the willingness of MHPs to participate. The cost of maintaining, fuelling and running the ambulances will be |

|the responsibility of the AMC from the beginning of the project, thus contributing to the sustainability. |

| |

|The project will build the capacity of community actors including CHWs, TBAs and VDCs, in order to educate and change behaviour, perform referrals and |

|advocate on behalf of communities. They will be trained and will have a pivotal role in increasing demand and utilisation of RMNH services. These |

|structures are sustainable as they enhance dialogue, ownership, and positive health seeking behaviour among the community. The project will build this |

|local capacity; establish systems and mechanisms for communication, operations, and technical support to them; and motivate them through dialogue, |

|ownership and incentives. |

| |

|Policy level sustainability: The project aims specifically at influencing national policy through sharing lessons learned and good practice, thus ensuring |

|an important element of sustainability. Through conducting research and sharing results and tools with government, NGOs and donors this action will |

|influence policy towards focusing on RMNH and ensuring that good practice approaches from across the country are recognised and utilised within national |

|policy. At a PHU level, the project will succeed in embedding new codes of conduct for ensuring quality of and access to RMNH care provision. The project |

|has been developed in strict adherence to existing and planned GoSL and MoHS policies governing health and wider development issues especially in line with|

|the health sector recovery plan. Through continued engagement with health actors, this project will ensure continued awareness of policy changes and |

|continued adherence to them within the project. |

|Exit Strategy (Include elements of transfer of skills and propose transition plan): |

|As outlined in the section above, sustainability has been embedded into the project design. The project will focus on building the capacity of structures, |

|staff and volunteers at community and health facility level from the beginning of the project through training, supportive supervision and monitoring. As |

|the project progresses, more focus will be placed on strengthening community and health facility ownership of activities such as community birth waiting |

|homes, monitoring of health facilities by VDCs, maternal death audits/conferences, blood bank replenishment, beneficiary feedback mechanisms, community |

|health competition, gender clubs in schools, etc, which will be slowly transitioned to them, in coordination with the DHMT and local authorities. In |

|addition, the project will work with the DHMT to find ways of incorporating MHPs (ex TBAs) into the more formal CHW programme and work on sustainability of|

|activities such as the AMC through budgeting, etc. |

| |

|Assets procured by the project - 3 motorbikes, 1 laptop and 3 netbooks - will be handed over to the DHMT at the end of the project so that they are able to|

|continue to monitor activities. |

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[1] Budget currency should either be in USD, British Pounds or Euros. When budget is in another currency, please convert to USD and indicate exchange rate

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