1
REPUBLIC OF MOZAMBIQUE
NAMPULA PROVINCE
NACALA VELHA AND MEMBA DISTRICTS 
STRENGTH PROJECT 
CS-16
Cooperative Agreement Number is FAO-A-00-00-00036
MID-TERM EVALUATION
ANA PAULA DE MORAIS OPPENHEIMER 
WITH COLLABORATION OF
ERIC SWEDBERG AND JOSEPH DE GRAFT-JOHNSON
SUBMITTED TO
USAID/DCHA/PVC
OCTOBER 31, 2002
2
ACKNOWLEDGEMENTS
MY GRATITUDE TO THE STRENGTH PROJECT FIELD OFFICE STAFF AND THE 
SAVE THE CHILDREN NUTRITION PROGRAM, THAT THROUGH THEIR SUPPORT 
MADE THE EVALUATION POSSIBLE IN THE ABSENCE OF THE PROJECT 
LEADERSHIP. MY THANKS TO THE TRANSLATORS FOR THEIR HARD WORK AND 
TO ALL FOR BEING PATIENT ENOUGH TO UNDERSTAND THE SHORTFALLS OF THE 
PROJECT.
MY HEARTY THANKS TO COMMUNITY LEADERS AND ITS MEMBERS, TRADITIONAL 
BIRTH ATTENDANTS, TRADITIONAL HEALERS, APIAMWENES, ACTIVISTAS, AND 
ESPECIALLY MOTHERS WHO LOOK INCESSANTLY FOR BETTER WAYS TO 
IMPROVE THEIR FAMILIES’ HEALTH.
MY PRAISE TO ALL FOR BELIEVING THAT EMPOWERED WE CAN CHANGE THE 
FUTURE!
3
LIST OF ACRONYMS
Portuguese 
Acronym
Lowest cadre in the MOH health workers structure APEs
MOH Weekly Epidemiological Bulletins BES
Monthly Health Days (Strategy to provide health services) DMS
Traditional Medicine Study Cabinet GEMT
ANC Ante-natal Care CPN
ARI Acute Respiratory Illness IRA
BCC Behavior Change Communication
BF Breast Feeding AM
CBDA Community-Based Distribution Agent (for contraceptives)
CDD Control of Diarrheal Disease
CBSD Cassava Brown Streak Disease
CHT Community Health Team CLCS
CS Child Survival SI
DHMT District Health Management Team EGP
DHO District Health Office DDS
DIP Detailed Implementation Plan PID
DRF Drug Revolving funds
EPI Expanded Program for Immunization PAV
FP Family Planning PF
GAS Swedish Support Group GAS
HBC Home-Based Care
HC Health Center CS
HFA Health Facilities Assessment
HIS Health Information System SIS
HMIS Health Management Information System
HP Health Post PS
HT Health talks palestras
IMCI Integrated Management of Childhood Illness AIDI
KPC Knowledge, Practice and Coverage (survey)
LQAS Lot Quality Assessment Survey
MB Mobile Brigade
MCH Maternal and Child Health SMI
MOH Ministry of Health MISAU
MTE Midterm Evaluation
NaV Nacala-Velha District
PHO Provincial Health Office DPS
QC Quality Control
SC/US Save the Children Federation/US SC
SP Strength Project PF
TBA Traditional Birth Attendant PT
TH Traditional Healers Curandeiros
TOT Training of Trainers
TT Tetanus Toxoid
VHV Village Health Volunteer Activistas
4
Table of Contents
EXECUTIVE SUMMARY………………………………………………………….……………...5
I. ASSESMENT OF PROGRESS TOWARDS ACHIEVING PROGRAM OBJECTIVES … 8
1. Technical Approach……………………………………………………………………..… 8
1.1 Project Overview………….……………………………………………………… 8
1.2 Maternal and Newborn Health……………………….…………………………. 13
1.3 Child Spacing…………………………………………………………………….. 16
1.4 Child Health (Immunization, Malaria, Diarrhea, Pneumonia)……………….. 18
2. Cross Cutting Approaches………………………………………………………………. 25
2.1 Community Mobilization and Behavior Change Communication.…..…..…… 25
2.2 Capacity Building Approach………………………………..……………………. 27
2.3 Health Management Information System………………………………………. 32
2.4 Sustainability Strategy…………………………………………………………… 34
II. PROGRAM MANAGEMENT………………………………………………………………… 37
1. Planning…………………………………………………………………………………… 37
2. Staff Training and Supervision and Technical Support………………………………. 39
3. Human Resources and Staff Management…………………………………………….. 40
4. Financial Management, Administration and Logistics………………………………… 41
III. RECOMMENDATIONS……………………………………………………………………… 44
IV. RESULTS HIGHLIGHT……………………………………………………………………… 47
V. ACTION PLAN……………………………………………………………………….………. 48
Appendixes
1. DIP Baseline data
1A- Project summary 
1B- Training Plan
1C- Technical Plan
1D- Project Human resources
2. Table of Indicator Results
3. Mobile Brigade Analysis
4. SC Staff Background and Training
5. MTE - Assessment Methodology
6. SP Relationships
7. Qualitative Questionnaire 
8. List of People Contacted and Interviewed 
9. Map of Regulados
10. Memba Practical Example of Analysis and Uses of Statistical Data (original physical 
documents)
11. List of Regulados in Both Districts
12. List of Health Facilities in Both Districts
13. Summary Evaluation Results
14. Preliminary Action Plan
15. LQAS Analysis
16. MTE Team Members
5
Executive Summary
The Strength Project in the impoverished districts of Nacala-Velha and Memba, in 
Nampula province, northern Mozambique, seeks to: (1) sustainably reduce MMR, 
and U5MR; (2) sustainably improve the capability of DHOs and communities to
respond to health needs; and (3) develop innovative approaches to inform policy 
and practices of SC and other partners. The main strategies are: (1) Partnership and 
institutional development for district health system strengthening through a Program 
Management Team (PMT) to enhance SC-DHO partnership for program planning,
monitoring and evaluation, capacity-building and sustainability of program activities, 
and (2) Strengthening community component of maternal and child health through 
support for Community Health Teams (CHTs) that would monitor and support the 
activities of community health workers in the Regulados. 
The districts have an official population of 286,814 including a CS16 beneficiary 
population of 134,229 (47,324 children 0-59 months, 21,511 births, and 65,394
women of reproductive age). The under-five mortality rate of 315/1000 is almost 
50% higher than the national average of 219/1000. DDS are the main implementers 
of the six project interventions that support the MISAU's district-level essential 
health package and include: Immunization (15%), Control of Malaria (15%),
Pneumonia Case Management (15%), Control of Diarrheal Disease (10%), Maternal 
and Newborn Care (30%), and Child Spacing (15%). The role of SC/US is capacity 
building, technical assistance, management support, and fiduciary responsibility. 
Main accomplishments of the program include opening the communication channel 
with districts and with THs, improving the quality and skills of the trainers, and the 
perceived changes in the behavior, knowledge and assertiveness of mothers. CLCS 
are well developed in all Regulados and support outreach services by Mobile
Brigades. Training of community-based providers (APEs and socorristas), Activistas, 
TBAs, and other CLCS members, as well as dialogue with traditional healers has led 
to community mobilization for responsive and appropriate behavior change
communication (BCC) for caregivers, community leaders, and mothers.
Overall progress towards achieving program objectives can be summarized by a 
short analysis of achievement of each of the results and intermediate results set up 
in the DIP:
Improved Capacity of two health districts to implement CS approaches and 
support community structures is the weakest achieved at this point. All the 
intermediary results need focus and emphasis in use and management of 
technical skills such us supervision, data analysis,and decision-making.
Improved capability of communities to identify and respond to their health 
needs is one of the strongest. CLCS and all its members have received training 
and seem very committed working for their community’s improvement. CLCS and 
mothers are assertive and demand more services that will benefit them such as 
6
more TBAs, more HP and more MB visits. DDS-CLCS links are emerging but are 
still weak.
Increased use of key health services and improved CS practices at the 
household level has mixed results. Availability of CS services has not increased, 
due to lack of personnel and conflicting MISAU strategies (MB and DMS). Health 
facilities cannot respond to community demands due to lack of HR, fluctuation of 
supplies, and geographic spread of facilities. Lack of vehicles reduces MB and 
other service delivery opportunities. Quality of services is not being monitored 
due to lack of supervision. However, there seems to be increased caregiver 
knowledge of selected CS issues, which will be more fully assessed in the final 
evaluation. 
Increased capability of SC to achieve large scale, innovative CS programs 
in the Southern Africa setting is on a good track. CLCS work can be 
considered a success especially if the trainings are refined and follow-up is 
implemented. The experience with TH needs to be reported and shared with 
other provinces, NGOs and at the Africa regional level. Capacity building at 
district level has not yet been achieved. Since the communication channels
between SC and DDS staff has finally opened, an intense transfer of 
management skills can be hopefully achieved by the end of the project. 
Inform Nampula Province Health Office on innovative CS strategies is also 
on a good track. DPS members have been steady participants of EGP meetings 
where there are opportunities to share strategies and improve implementation. 
The approaching Conselho Coordenador de Saude de Nampula is another 
chance to share project successes and difficulties. 
Main constraints have been small representation of each district at EGP 
meetings; inadequate nursing staff in the two districts due to absolute lack of 
skilled personnel in Nampula province; facilitation of community Alarm and 
Transport (A&T) and provision of bicycle ambulances as part of A&T due to 
failure of community to take on their part of the agreement and to the slow motion 
of logistics both for the bicycle ambulance and the equipment for the maternities. 
Other constraints are not including the data analysis component in CLCS 
trainings, shifting from MB to DMS; lack of district perdiems for supervision; old 
vehicles that delay field activities; food crisis due to drought and CBSD that 
interfere with health activities; and very low advances in FP education and use. 
The production and promotion of clean birth kits was abandoned as a strategy 
due to the local industries’ impossibility of supplying the components of the kit. 
Efforts will focus on health education of mothers on clean delivery.
Prospects for sustainability depend on the successful transfer of capacity 
building skills. Institution of monthly management meetings at district level to plan 
and budget activities and coordinate use of resources, will reinforce a 
management attitude adequate for sustainability. Devising an exit strategy that 
will leave the districts and CLCS strengthened is crucial, including lobbying the 
DPS at the appropriate level to ensure existence of resources after the life of the 
7
project. Institution of supervision would be one of the most important 
achievements. 
Priority recommendations resulting from this evaluation are: 
1. Improve the general Strengthen Project and EGP management starting by
finalizing the Plan of Action with each of the DDS and actively disseminating 
LQAS and MTE results to DDS, DPS, HC and CLCS. 
2. Implement monthly meetings in each of the districts with the technical team for 
the remainder of the project. 
3. Discuss the exit strategy of the project, so DDS directors and staff gradually
TAKE OVER all the activities and leadership. 
4. Implement supervision visits from DDS to Health Centers and CLCS by
immediately setting up a workshop to rapidly provide staff and DDS trainers and 
others with supervisory skills. A checklist directed to all components and cadres 
to be supervised, and a real supervision plan with places, dates, use of
resources, and responsibilities should be the outputs of such workshop. 
5. Re-plan the Mobile Brigades to achieve five annual visits per community, to
become more regular, to arrive early, and to coordinate with Monthly Health
Days, supervision, and supply activities. Include Logistics (SC and district) in the 
elaboration of the plan.
6. Organize specific refresher training of TBAs in Lurio, refresher trainings of APEs 
in distant areas, and training of DDS and SC staff in basic management, data 
management, resources management and basic epidemiology and statistics. 
7. Improve purchasing procedures for bicycle-ambulances in Memba, and
reactivate the A&T system in NaV. Expedite purchasing procedures for material
and equipment destined to maternities and reference hospitals and for two-way 
radios to districts.
8. Improve vehicle maintenance procedures to allow increase of supervision and 
Mobile Brigade activities.
9. Exchange and review BCC materials and messages with SC Gaza Project and 
other experts in this matter. With DPS and DDS acquire, produce and distribute 
IEC materials for all levels of the community and the health system.
10.Expand FP training to Tecnico de Saude in all health facilities and to all 
members of CLCS.
11.Discuss with DPS the feasibility of a pilot study of CBD FP methods in a remote
community as has recently been piloted in the Bridges project and the feasibility 
of a pilot study of Immunization practices by APEs. 
12.Dialogue with GEMT to improve THs procedures on the referral of sick children 
and women
13.EFFECTIVELY improve the EPI situation by addressing management of the cold 
chain, supply of EPI materials and vaccines, and Mobile Brigades planning at 
every monthly meeting.
8
I. Assessment of Progress Towards Achieving Program 
Objectives
1. Technical Approach
1.1 Project Overview
The Save the Children Federation/USA (SC) STRENGTH PROJECT (SP) is 
located in Nacala-a-Velha (NaV) and Memba Districts, in northern Mozambique. 
These are two of the most poor and inaccessible districts in Mozambique with an 
official population of 286,814 including a CS16 beneficiary population of 134,229 
(including 47,324 children 0-59 months, 21,511 births, and 65,394 women of 
reproductive age). The under-five mortality rate of 315/1000 is almost 50% higher 
than the national average of 219/1000 (See Appendix 1). The Strengthen Project 
has a three-year (September 2000 – September 2003) life and a combined 
budget (USAID and SC/US in a 25% match) of US $933.300, for an annual cost 
per beneficiary of $2.32. The ultimate goals are to (1) Sustainably reduce MMR, 
and U5MR; (2) Sustainably improve the capability of DDS and communities to 
respond to their health needs; and (3) Develop innovative approaches to inform 
policy and practices of SC and other development partners. 
The project responds to the needs and priorities of constituent communities, 
Ministry of Health (MISAU) and USAID/Mozambique; all seek reduced under-five 
and maternal mortality and morbidity through a strengthened health system. 
Between July 2000 and March 2001 baseline studies were conducted in 
preparation for detailed implementation planning. In February, 2001 a five day 
project planning meeting was held with district and provincial health office 
representatives, community leaders, and SC technical staff Project; it led to the 
DIP, the project blueprint whose results framework and indicators are presented 
at the end of this section. In July- August 2002 an LQAS survey was conducted 
and data was compared to the baseline studies. The results were used to 
prepare the qualitative midterm evaluation that took place in September 2002, 
whose report is presented here and whose outcome is a Preliminary Action Plan.
The DHO (DDS) are the main implementers of the six project interventions that 
support the MOH's district-level essential health package and include: 
Immunization (15%), Control of Malaria (15%), Pneumonia Case Management 
(15%), Control of Diarrheal Disease (10%), Maternal and Newborn Care (30%), 
and Child Spacing (15%). The role of SC/US is capacity building, technical 
assistance, management support, and fiduciary responsibility. 
The two major implementation strategies for each of the districts are: 
9
(1) Partnership and Institutional Development for District Health System 
Strengthening through: 
ß Program Management Team (PMT), called EGP, to enhance SC-DDS 
partnership for program planning, monitoring and evaluation, capacity￾building and sustainability of program activities. 
ß Support of additional staff for DDS to address the constraint of inadequate 
nursing staff in the two districts by recruiting three MCH (SMI) nurses for 
NaV and three nurses for Memba. The salaries of these nurses will be 
supported by the Strength Project for the first two years of the program. 
The Nampula Province PHO (DPS) will take over the salary payment in the 
third year. The MCH nurses are essential for increasing the number of 
mobile brigades outreach conducted in a month, especially in terms of 
prenatal care and family planning services.
ß Upgrade emergency obstetric health facilities and services. The two CS￾16 districts do not have a comprehensive emergency obstetric care 
(CEOC) facility. Women needing CEOC services are referred to the 
neighboring districts of Monapo and Nacala Porto. CS-16 works with 
Monapo and Nacala Porto DDS and hospital Directors to streamline the 
referral systems, as well as upgrade the maternity wing of their hospitals.
(2) Strengthening the community component of maternal and child health through: 
ß Support for Community Health Teams (CHT), called CLCS, that monitor 
and support the activities of community health workers in the Regulados. 
ß Support of outreach services by Mobile Brigades. 
ß Facilitation of community Alarm and transport (A&T) 
ß Provision of bicycle ambulances as part of A&T
ß Production and promotion of clean birth kits.
ß Training of community-based providers (APEs and socorristas)
ß Training of Activistas and TBAs
ß Training and dialogue with traditional healers
ß Support of community mobilization for responsive and appropriate 
behavior change communication (BCC) for caregivers, community leaders, 
and male and female decision makers. 
A set of measurable indicators established during the DIP was used to monitor 
progress and is described in following page. In addition EGP also monitors DDS 
generated data that is part of the national HIS (SIS). Strengthen Project also 
uses others sources of information such as KPCs and LQAS surveys. 
As outlined in the DIP, SC works most closely with its current partners, the DDS, 
in close collaboration with the DPS and the communities of NaV and Memba, as 
well as the referral hospitals in Nacala Porto and Monapo. 
10
PROJECT KEY RESULTS
These indicators were adapted from the DIP. 
Indicators related to QC were excluded in the MTE. 
Maternal and Newborn Care (30%)
Child Spacing (15%)
Immunization (15%)
Malaria Control (15%)
Diarrhea Case Management (10%)
Pneumonia Case Management (15%)
· 25% of mothers with children under 24 months old, who do not desire to have a child in the 
next two years, will use a modern family planning method. 
· 50% of women with children under 24 months old, will know at least two modern methods for 
child spacing.
· 85% of women will have at least two antenatal care (ANC) visits with trained health personnel 
during their last pregnancy.
· 80% of women will receive two doses of tetanus toxoid during their last pregnancy.
· 50% of women will be attended by trained personnel during their last delivery.
· 10% of women will have birth plans (3 of 5 components) during their last pregnancy
· 90% of regulados will have formal alarm and transport plans.
· 50% of women 15-49 will know at least three pregnancy-related danger signs.
· 55% of children age 12-23 months will be fully immunized by the age of 12 months.
· 80% of mothers with children < 24 months with fever in previous two weeks will seek care 
within 48 hours.
· 85% of mothers with children < 24 months with cough and difficult/rapid breathing in previous 
two weeks will seek care from a health facility.
· 80% of mothers with children 6 < 24 months with diarrhea in previous two weeks will manage 
the diarrhea with Oral Rehydration Therapy (oral rehydration solution or community-based oral 
rehydration fluids such as watery porridge).
11
Capacity Building
Sustainability
· SC/HQ: At least 2 SC Field Offices and/or other organizations will develop a plan for adopting 
successful CS16 approaches. 
· SC/M: SC/Moz staff will participate in policy forums at the provincial level advocating for 
changes in policy based upon CS16 strategies. 
· DHOs: Presence of annual workplan specifying activities, persons responsible, date and
resources available/monitoring and supervisory tools for each capacity.
· Presentation of HIS reports during quarterly PMT meetings. 
· Communities: (1) 75% of regulados will be able to identify 2 or more priority maternal/child 
health problems to be addressed through an action plan; (2) 70% of regulados will have 
formed CHTs and members will know the roles and responsibilities; (3) 80% of CHT members 
will be able to cite five approaches to increase community participation in health activities; (4) 
75% of CHT members will understand numerical trends of HIS and use for health planning. 
· 2 DHOs will prepare an annual health work plan indicating efficient use of resources. 
· 75% of CHTs at regulado level will attend meetings regularly.
· 2 DHOs will have supervisory and monitoring systems for QOC and peer review. 
· DHOs will regularly share lessons learned at provincial and national MOH levels.
· DHOs commit to sustaining CHT training and formation by inclusion into yearly DHO plans.
12
PROGRAM DESIGN
Results Framework: Goals, Results, and Intermediate Results
Goal: Sustained reduction in 
under-five and maternal mortality 
and morbidity in two health 
districts of Mozambique
R-1: Improved 
Capacity of two 
health districts to 
implement CS 
approaches and 
support community 
structures
R-5: Inform 
Nampula Province 
Health Office on 
innovative CS 
strategies
R-2: Improved 
capability of 
communities to 
identify and respond 
to their health needs
R-3: Increased 
use of key health 
services and 
improved CS 
practices at the 
household level
R-4: Increased 
capability of SC to 
achieve large scale, 
innovative CS 
programs in the 
Southern Africa 
setting
IR1: Improved 
strategic mgmt. 
practices
IR2: Improved organiz. 
learning
IR3: Impr. use and mgmt. 
of tech. skills
IR4: Improved fin. resource 
mgmt.
IR5: Impr.HR mgmt.
IR6: Improved support for 
community
IR5: Increased ability 
of comm. institutions 
to analyze health 
trends and needs 
IR6: Improved 
organization of 
community to address 
health needs
IR7: Increased links 
between community 
and the DHOs
IR8: Increased 
availability of CS 
services
IR9: Improved quality of 
selected CS services
IR10: Increased caregiver 
knowledge of selected CS 
issues
IR11: Improved skills 
of SC staff in a 
capacity building role 
at the district level
IR12: Documenting 
and disseminating the 
feasibility and results 
of implementing the 
CS-16 approaches
13
1.2 Maternal and Newborn Health
The following sections will describe for each intervention area the objectives, 
key activities and technical approaches as described in the DIP, as well as the 
project activities and MTE results with emphasis on project outcomes and 
challenges, followed by recommended next steps. A complete Table of Indicator 
Results from the LQAS is in Appendix 2.
Maternal and Newborn Care (30%)
This intervention was targeted towards mothers and their newborns. It sought to 
increase pregnant women’s utilization of antenatal and delivery services 
provided by professional and trained community-based workers. To facilitate 
use of these services, the project sought to increase mothers’ knowledge on 
pregnancy-related danger signs, improve birth planning by pregnant women, and 
improve community referral systems to the health facilities. The key project 
activities proposed to support this intervention in the two districts were;
ß to improve knowledge and behavior of pregnant women through carefully 
designed key BCC messages, 
ß to train traditional birth attendants (TBAs) in clean and safe deliveries,
ß to increase access to prenatal services by increasing the number of 
Mobile Brigade outreach points and number of SMI nurses,
ß to enhance community capacity for establishing and managing alarm and 
transport systems, and 
ß to strengthen the DDS referral system for pregnant women.
Activities and MTE Results
The project has trained teams of volunteers in each of the 46 regulados to 
educate pregnant women and their families on the need for regular antenatal 
care and to deliver with a trained attendant. In addition, the team of volunteers 
educates the mothers on pregnancy-related danger signs that require immediate 
referral to a health facility. The team consists of, regulos, activistas, apiamwene, 
traditional healers, TBAs, APEs, and Socorristas, that forms the Community 
Health Team (CHT), known as CLCS. Overall the project has trained the 
Objective End Results
· 85% of women will have at least two antenatal care (ANC) visits with trained health personnel 
during their last pregnancy.
· 80% of women will receive two doses of tetanus toxoid during their last pregnancy.
· 50% of women will be attended by trained personnel during their last delivery.
· 10% of women will have birth plans (3 of 5 components) during their last pregnancy
· 90% of regulados will have formal alarm and transport plans.
· 50% of women 15-49 will know at least three pregnancy-related danger signs.
14
members of 46 CLCS, 13 in NaV and 33 in Memba district, according to the 
number of Regulados in each district. All CLCS are active and performing their 
role of educating the community on maternal and newborn issues. The 
education is conducted using palestras (health talks), and songs. BCC materials 
used include posters, flip-charts (albums seriados), and pamphlets. Most CLCS 
have also established Alarm and Transport Systems with and without bicycle 
ambulances in their Regulados. 
One hundred and sixty-four (167) TBAs have been trained by the project. This 
has increased the baseline number of trained TBAs from 75 (NaV 35 and 
Memba 40) to 142. Two more trainings are currently taking place (11 in NaV 
and 15 in Memba). Two SC/US trainers and two DDS trainers jointly carry out 
the TBA training using the national TBA curriculum. All the trained TBAs 
received re-usable delivery kits assembled by the project based on MOH 
recommendations. The TBAs have also been linked to the nearest health 
centers so that they can receive re-supply of perishable items such as cotton 
wool, bandage and gloves. Four MCH (SMI) nurses, 10 elementary midwives 
(PE) and three of SC/US trainers received in-service training on prenatal, 
delivery, postnatal and newborn care, and family planning from the DPS SMI 
trainers. 
The effectiveness of the BCC component of this intervention is manifested in the 
increase of percent of women who knew at least three pregnancy-related danger 
signs from a baseline average of 31% (NaV 18% and Memba 44%) to a MTE 
average of 75% (NaV 95% and Memba 57%). However, indicators for maternal 
practices including the utilization of maternity services did not show similar 
impressive increases, with the exception of prenatal tetanus immunization. 
Percent of pregnant women who received at least two doses of tetanus toxoid 
increased from a baseline average of 46% to 57%. This number fell in Memba 
(62% to 42%) but increased in NaV (30% to 74%). Although antenatal care 
coverage is quite high, and TT vaccination can be achieved with only two 
contacts, overall the percent of women who reported that they had at least two 
antenatal visits decreased from 75% to 64%. The decrease was more 
pronounced in Memba, 74% to 55%, compared to a drop from 77% to 74% in 
NaV (see Graph 1.) 
The percent of women who reported having had three of the five components 
recommended for a birthplan increased only slightly from 0% to 3%. The 
average percent of women who were attended by a trained provider during 
delivery showed no significant increase. It actually dropped from 38% to 28% 
for Memba but increased from 34% to 51% for NaV. 
Challenges and Outcomes 
Two approaches in the DIP under this intervention that have been hindered by 
severe constraints are (a) the planned increased access to prenatal services by 
15
increasing the number of Mobile Brigade outreach points and number of MCH 
nurses in the two districts, and (b) strengthen the DDS maternal referral 
systems. The Mobile Brigade outreach has not been regular. A review of the 
transport log for Mobile Brigade by the MTE review team for the period January 
– June 2002 showed that outreach services have been limited in the number of 
sites visited as well as the frequency of visits to same sites (Appendix 3). The 
few sites that were visited by the Mobile Brigades were visited only once in the 
six-month period. The visits were more limited in Memba than NaV. This 
explains the drop in the percent of women who reported attending ANC (CPN) at 
least twice in their last pregnancy. The project had experienced difficulty 
recruiting SMI nurses through the DPS. This is due to the limited number of SMI 
nurses in the country, and the agreement to pay them MISAU salaries. Other 
constraints identified during the MTE include lack of adequate pregnancy-related 
BCC materials such as non-literate flip-charts, pamphlet and posters, and the 
limited number of individuals trained in the use of drama for educating 
community members. The BCC related constraints are elaborated further in the 
BCC section below. 
Despite assurances from community leaders in NaV at the beginning of the 
project to establish a mechanism to maintain bicycles ambulances given to them 
under CS-12, bicycle ambulances in all the Regulados visited by the MTE team 
were broken and the community had no plans to maintain them. The reason 
given for this state of disrepair was that the community was too poor to 
contribute the required money to have the bicycle ambulances repaired. 
Women with danger signs are carried on make-shift stretchers carried by 
community members to the nearest health center. Memba has received 17 
bicycle-ambulances distributed to the southern part under CS-12 and the project 
is yet to supply the northern regulados. Equipment needed for improving 
maternity services at the health centers in the two project districts, and the two 
referral hospitals at Monapo and Nacala-Porto, have not been purchased. 
An assessment on the availability of materials needed to make clean delivery 
kits for pregnant women found that apart from soap and razor blade none of the 
other items are available in Nampula. The project therefore decided not to 
produce and distribute clean birth kit but to focus on the promotion of clean 
delivery based on the use of new razor blade and soap. Lastly, TBAs reported 
not receiving any financial or material appreciation from their clients even though 
Traditional Healers (curandeiros) do get these “payments” from their clients. 
They attributed this to misunderstanding on the part of the community that TBAs 
are paid by SC/US or MISAU, since they were trained by them. 
Next Steps 
To reach its objectives, the project will have to: 
16
1. Increase access to prenatal services by making the Mobile Brigade 
outreach more regular. Better planning of the movement of available 
district vehicles and those of the project could assist in improving the MB. 
2. Re-train more practicing TBAs, in selected areas of Memba based on 
analysis of the distribution of current trained TBAs, in order to meet its 
objective of improving access to delivery by trained providers. 
3. Priority should, however, be given to regular supervision of the currently 
trained TBAs. 
4. Improve purchasing procedures to shorten the time it takes to purchase 
project items such as the maternity equipment and bicycle ambulances.
5. Initiate dialogue with the CLCS that have bicycle ambulances to develop 
plans for getting the broken down bicycle ambulances repaired. 
1.3 Child Spacing
Child Spacing (15%)
Objective End Results
· 25% of mothers with children under 24 months old, who do not desire to have a child in the 
next two years, will use a modern family planning method. 
· 50% of women with children under 24 months old, will know at least two modern methods for 
child spacing.
A comparison of baseline and mid-term maternal and newborn, and family 
planning indicators for CS 16 project
0
10
20
30
40
50
60
70
80
90
100
Births
attended by
trained
providers
Attend 2 or
more ANC
visits
Receive 2 or
more TT
doses 
Know 3 or
more preg￾related
danger
signs
Had birth
plans
Know 2 or
more
modern FP
methods
Women
using
modern FP
methods
Type of indicator
Percent of women
Total 1
Total 2
NaV 1
NaV 2
Memba 1
Memba 2
17
The project sought to increase the percent of women of reproductive age and 
men using modern contraceptives to space the births of their children. The 
intervention includes:
ß Use of multi-channel BCC strategy to motivate women and men to use 
modern contraceptives
ß Increase access to family planning methods through integration of FP 
services with immunization, prenatal and postnatal services provided 
through the Mobile Brigades, and distribution of pills and condoms by 
APEs and Socorristas
ß Community-based distribution of condoms through TBAs and Activistas
ß Improving the FP counseling skills of health personnel
Activities and MTE Results
There has been limited implementation with this intervention with the exception
of the BCC activities and in-service training for health center MCH staff and 
SC/US trainers. Similarly to the mobilization of pregnant women to use maternity 
services, CLCS members have been trained and are responsible for the 
education and motivation of women and men to use modern contraceptives. As 
mentioned earlier under the maternal and newborn section, FP was also part of 
the in-service training conducted by the DPS for health center MCH staff and 
SC/US trainers. 
No progress has been made towards achieving the objectives set for this 
intervention. The percent of women with children under two years who reported 
knowing at least two modern FP methods decreased from a baseline average of 
30% to 25% in NaV, with Memba experiencing the most drop in coverage, from 
37% to 23%. Modern contraceptive use by women not wishing to have another 
child in the next two years remained almost the same at baseline average of 
16% compared to MTE value of 15%. (See Graph 1) 
Challenges and Outcomes
The main constraints in implementing activities planned for this intervention has
been the low priority given to FP-related BCC activities by CLCS. CLCS 
members did not spontaneously mention FP BCC as one of the activities that 
they implement. Lack of carefully designed strategies for negotiating with women 
and men to use modern FP methods was another constraint identified. The 
CLCS lack BCC materials and samples of modern contraceptives for educating 
the community. FP methods other than condoms are only available at HC where 
there is a SMI nurse or elementary midwife. The number of such facilities is quite 
low and far away from most communities. Non-SMI nurses at health facilities 
reported counseling women on FP but they also lack BCC materials and FP 
18
samples. APEs continue to distribute only condoms and not pills as was 
envisioned in the DIP. Activistas and TBAs are also not distributing condoms. 
Lastly, project staff seems not to be aware of all the activities planned in the DIP, 
especially the distribution of condoms by TBAs and Activistas, and pills by APEs 
and Socorristas. 
Next Steps
To reach the objectives:
1. The project and DDS staff will have to become familiar with the planned 
activities for this intervention, and revise the work plan to accomplish 
these activities. 
2. CLCS will have to give FP BCC activities the same level of priority they 
have been giving to the other interventions. Strategies have to be 
developed in partnership with the CLCS to engage women and men to 
dialogue on FP use. 
3. The project should contact their colleagues in Gaza Province, where 
SC/US piloted a community-based distribution of condoms and pills, to 
learn from their experiences
4. Meet with the Gaza office staff to ascertain whether there are BCC 
materials that could be appropriate for the project to use. 
5. Discussions should be held with the DDS and DPS staff to immediately 
train and initiate supply of contraceptive pills to the APEs and Socorristas, 
and condoms to TBAs and Activistas. 
6. To increase access to FP methods at the health centers, the project 
should discuss with the DPS and DDS a strategy to avoid stock outs and 
the feasibility of providing FP methods through the outpatient department 
by the Tecnicos de Saude. At least Tecnicos de Saude should have FP 
BCC materials and samples to use in counseling potential FP clients. 
 
1.4 Child Health (Immunization, Malaria, Diarrhea, Pneumonia)
Immunization (15%)
The program approach to improvement of district immunization coverage has 
been through the following activities:
(1) multi-channel targeted BCC to motivate mothers to attend vaccination 
sessions; 
Objective End Results
· 55% of children age 12-23 months will be fully immunized by the age of 12 months.
19
(2) collaborative MOH-SC village-based vaccination sessions; 
(3) support of continued facility-based vaccine-preventable disease surveillance 
by MOH 
The project was to provide:
(1) service quality assurance emphasizing coverage by geographic locale 
through mobile brigades;
(2) Cold chain equipment at selected health posts and centers;
(3) Train district staff in logistic management to improve drug supply at the 
health facilities;
(4) Bicycles to selected members of the CLCS to use for mobilization.
Activities and MTE Results
The MOH provides year-round services, vaccines, and supplies as well as 
conducting facility-based surveillance for polio, measles, and neonatal tetanus. 
All 46 CLCS engage to mobilize their communities, prepare sites for DDS Mobile 
Brigades, and assist during the brigades. CLCS use health talks and home 
visits to teach mothers about immunization. Focus group discussions with 
mothers revealed they know vaccine importance and they know that five visits 
are necessary to complete child immunization. 
Percent of children 12-23 months fully immunized by age 12 months has fallen 
more than 50% from the baseline (NaV 32% to 12% and Memba 34% to 13%)1
. 
Results of LQAS survey on immunization indicators are shown in Graph 2.
Challenges
Due to the limited vaccination coverage of the fixed health centers the majority of 
immunization needs to be obtained through the mobile brigade strategy. 
However an analysis of the frequency and distribution of mobile brigades in the 
two districts reveals that the quality of DDS Mobile Brigade service delivery has 
not been improved in CS16. Although SC provides a vehicle and driver for each 
district the frequency of mobile brigades in the targeted regulados is not 
sufficient to completely immunize children by their first birthday. In the period of 
Jan. through June 2002 only a few mobile brigade posts had been visited more 
than once (Appendix 3). In NaV district there was a long period in which no 
brigades were executed due to district personnel problems. In Memba the 
communities are spread out and not accessible during the rainy season. In both 
districts political unrest due to the cholera epidemic prohibited the visits of 
 
1
 The midterm LQAS survey included a complete sampling of Memba district not possible during the baseline 
Memba KPC due to the inaccessibility of a number of areas due to impassable roads during the rainy season. 
Thus the Memba midterm results are not directly comparable to the baseline and include communities which 
do not receive mobile brigade services in the rainy season. 
20
mobile brigades in several areas from February through April 2002. It was 
reported that sometimes mobile brigades arrive so late that community disperses 
to their daily tasks, after a morning wait. Some health centers are also not 
implementing the policy of providing immunization services five days a week. 
Vaccine stock-outs have also continued to be an issue at times for the districts. 
In one health center (Baixo Pinda) the cold chain was established but the district 
had not provided the necessary kerosene supply in spite of an existing budget 
line. The tentative initiative on the part of the MOH to shift from a Mobile Brigade 
strategy to the Monthly Health Days (DMS) seems to have led to the disruption 
of the former, without really having started the latter. 
Next Steps
1. Alternatives for immunization services to cut-off areas during the 8 months of 
the rainy season need to be discussed by the DDS Directors, EPI Officers 
and SC Coordinator.
2. The mobile brigades require better planning to ensure adequate 
frequency (five visits/community per year) and coverage in the districts.
3. DDS and SC need to ensure that the MB team arrives early in the 
communities, to avoid missed opportunities. 
4. Determine how the monthly health day (DMS) strategy will complement 
the mobile brigades. 
5. Ensure the availability of EPI material. 
6. Verify that the fixed posts are established and functioning
7. Supervision of activities.
21
Immunization Coverage (Age < 12 mo.) LQAS 2002
0
10
20
30
40
50
60
70
80
90
BCG POLIO 1 POLIO3 DPT 1 DPT 3 MEASLES COMPLETE
Antigen
Percentage
Both Districts
Nacala-Velha
Memba
Graph 2. Results of LQAS survey regarding Immunization Indicators for Nacala Velha, 
Memba and both districts
Malaria Control (15%)
Diarrhea Case Management (10%)
Objective End Results
· 80% of mothers with children < 24 months with fever in previous two weeks will seek care 
within 48 hours.
Objective End Results
· 80% of mothers with children < 24 months with diarrhea in previous two weeks will manage the 
diarrhea with Oral Rehydration Therapy (oral rehydration solution or community-based oral 
rehydration fluids such as watery porridge).
22
Pneumonia Case Management (15%)
To date the program approach to obtaining these objectives has been:
(1) training clinicians at health posts and centers in the MOH IMCI protocol (10 
were trained); 
(2) All CLCS educating women and other community members on the 
importance of early treatment for fever;
(3) Refresher training for APEs to manage uncomplicated fever at the 
community;
(4) Train socorristas to refer fever patients to nearest health facility;
(5) Training CLCS to educate women and other community members on
importance of increasing children’s fluid intake when they develop diarrhea;
(6) Promote the use of community-based oral rehydration therapy by mothers 
and community service providers for management of children with diarrhea.
(7) Refresher training for APEs and socorristas on the management of 
diarrhea;
(8) Train traditional healers to recognize pneumonia and refer clients with 
suspected ARI to the nearest health facility.
(9) Refresher training for APEs and socorristas to diagnose and refer 
children with pneumonia to the nearest health post or center
(10)Conduct palestras at health facilities and Mobile Brigade outreaches on 
recognition of signs and symptoms of pneumonia and the need to refer 
immediately.
The project has not yet provided the following three inputs: 
(1) Training DDS staff in supportive supervisory skills;
(2) Training DDS staff to improve the logistics of drug supply at the health 
facilities and supply of drug kits to APEs (after assessment of the district 
logistic system);
(3) Dialogue with GEMT and traditional healers to explore the possibility of 
using them to manage uncomplicated fever.
Activities and MTE Results
The percentage of mothers with children < 24 months with fever in previous two 
weeks who sought care within 48 hours has decreased considerably from 
baseline in both NaV and Memba districts; Nacala 57% to 30% and Memba from 
66% to 34%. 
Objective End Results
· 85% of mothers with children < 24 months with cough and difficult/rapid breathing in previous 
two weeks will seek care from a health facility.
23
The percentage of mothers with children < 24 months with diarrhea in previous 
two weeks who managed the diarrhea with ORT (ORS or community-based oral 
rehydration fluids such as watery porridge) has showed little change in both NaV 
and Memba districts; Nacala from 66% to 67% and Memba from 67% to 62%. 
The percentage of mothers with children < 24 months with cough and 
difficult/rapid breathing in previous 2 weeks sought care within 48 hours has 
showed a slight decrease in both NaV and Memba districts; Nacala from 64% to 
54% and Memba from 73% to 67%. 
This project has combined IMCI training for health center providers as a support 
for the community level mobilization for appropriate homecare and timely care￾seeking for malaria, diarrhea, and pneumonia. Ten nurses received the facility￾based IMCI training and the ones we interviewed felt it had particularly improved 
their assessment skills and treatment due to the existence of a protocol that is 
easy to follow. 
Focus group discussions with mothers revealed they receive health education 
through palestras carried out by all 46 CLCS and at HC and have good 
knowledge of: 
· How to prepare household ORS and give plenty of fluids child with diarrhoea
· When to take their children to HF for diarrhoea, pneumonia and fever
· The danger signs of diarrhoea
· How to prevent diarrhoea
· Signs of pneumonia
· How to reduce fever at home and during referral transport
· Malaria symptoms and signs
· How to prevent malaria
The training of traditional healers has improved the safety of their treatment 
practices. They now report using one blade for each person and they sterilize 
their knives and other cutting materials. THs state that they do prefer to refer to 
the nearest health center, cases of diarrhoea, malaria, IRA, meningitis, measles 
and tetanus.
Fourteen APEs and Socorristas also provide services in the communities and 
were trained in simplified IMCI. APEs when they have medicines available are 
able to treat malaria, transfer severe cases to the health centers and educate 
mothers on appropriate referral.
Challenges
The major challenges for appropriate homecare and case management of 
diarrhea, pneumonia, and malaria in CS16 are:
24
· Recognition of danger signs by families and traditional healers: Families are 
delaying referral to the HC because the illness is not considered serious (for 
example if the child can play).
· THs also do not always transfer children in a timely manner, preferring to try 
treatments three times or wait two days.
· Behavior Change Communication Approach: CLCS are not clear on child 
health messages and behaviors. In many CLCS there is emphasis on water 
and sanitation – both in terms of messages and in terms of their 
understanding of their role. The messages are generalised and the key 
messages are not well described. For example mothers consider fever as a 
danger sign but because there is a distinction between “normal” malaria and 
“severe” malaria they might delay care seeking. 
· The CLCS in most of Memba do not have trained activistas from previous CS 
projects, so they have less manpower for health education. 
· Some APEs in NaV could not clearly identify danger signs and failed to refer 
when a child should be transferred. 
· Important barriers to seeking referral care in health facilities: lack of money, 
lack of medicines at HC and with APEs (for example chloroquine stock outs 
discourage mothers from seeking care), belief in effectiveness of TH for 
certain diseases, and the fear of their children dying at the HC. 
Next Steps
1. Training DDS staff in supportive supervisory skills to be able to follow up HC 
staff activities, and APEs performance.
2. Training DDS staff, especially trainers in supportive supervisory skills to be 
able to follow up CLCS educational activities in the community with 
activistas, TH, TBAs and others.
3. Improve key messages in the modules and sessions delivered by the
educators at all levels.
4. Follow-up of community-based palestras and other BCC activities.
5. Distribution of IEC materials.
6. Refresher training for APEs and/or on-the-job training during supervisory
visits. 
7. Working with DDS staff to improve the logistics of drug supply at the 
health facilities and supply of drug kits to APEs2
. 
8. Dialogue with GEMT and traditional healers to improve the promptness of 
referrals.
 
2
 Consult document “Avaliação da Gestão do Sistema de Logística, nas Provincias de Nampula e Zambézia –
Medicamentos, Vacinas, Anticonceptivos” por A.P. de Morais Oppenheimer et al., JSI, HSDS Moçambique, 
Set 2001.
25
2. Cross Cutting Approaches 
2.1 Community Mobilization and Behavior Change Communication
Activities
Community mobilization (CM) and behavior change communication (BCC) are 
the key approaches for creating awareness and demand for maternal and child 
health services in the project. CM is also the vehicle for getting the community 
to setup appropriate referral systems for pregnant women with danger signs or 
complications, and sick children. The CLCS are responsible for conducting the 
activities associated with both of these approaches in their communities. The 
project has facilitated the establishment of, and provided training to the CLCS in 
all the Regulados in the two districts. All CLCS members have been trained in 
health talk and community mobilization techniques. The training was done using 
a manual developed by the project. The BCC approaches used by the CLCS 
include group and one-on-one (including house visits) counseling using flip￾charts, posters and pamphlets. Working with members of the community, CLCS 
members have developed songs based on the project’s six intervention themes. 
Staff at the health facilities also provides group and one-on-one counseling for 
clients attending these facilities and at Mobile Brigade outreach.
There are approximately equal numbers of men and women on the CLCS. The 
Regulos are the chairpersons of the CLCS. They are responsible for calling, 
and leading discussions during the monthly CLCS meetings. Other members 
include Apiamwenes, Activistas, TBAs, Socorristas, APEs and Traditional 
Healers. There is regular attendance of, and active participation by all the CLCS 
members at meetings. Interviews with mothers confirmed that the CLCS 
members are truly conducting the health talks and mobilizing communities to 
respond to the needs of pregnant women and sick children. They, also, assist in 
mobilizing the communities for the Mobile Brigade outreach services. All the 
CLCS visited did not have written work plans but relied on members 
remembering assignments given to them during the meetings. The CLCS 
members have specific data collection assignments that they present at each 
meeting for discussion and decision-making. The section on HIS provides 
further information on the type of data collected and by whom. 
 
Community mobilization and BCC are other major accomplishments by the 
project. CLCS monthly meetings were fairly regular in NaV where the frequency 
of meetings ranges from 8-12 times (monthly) in the past year compared to an 
average of 3 meetings (quarterly) in Memba. Use of community data for 
decision-making is more limited in Memba district. Mothers interviewed 
demonstrated adequate knowledge in pregnancy-related and sick child danger 
signs, components of birth planning, what action to take for pregnant women or 
sick children with danger signs and how to manage a child with diarrhea. The 
26
progress towards achieving the set CM/BCC objectives is discussed under the 
specific technical interventions. 
Challenges 
· Some CLCS in both districts reported not having a good relationship with 
health center staff. Twice they mentioned that patients who delivered 
outside the facility were afraid of going to the center for postnatal services or 
were refused services or not treated with respect by the nurses/midwifes. In 
another health center the Tecnico de Saude did not even know which 
community members he should be working with. 
· There is lack of communication between some DDS staff and CLCS. CLCS 
members are not treated with respect when they accompany community 
members to health facilities and are afraid of reporting the situation to DDS. 
 The DDS staff has never supervised any of the CLCS in the two districts. In 
the DIP, the plan was for the CLCS to be supervised every quarter by a joint 
SC/US and DDS team. 
· Lack of focus on key messages is also a constraint. Health talks provided 
by CLCS members tend to cover broad areas and are not limited to the key 
messages that mothers need to know in order to take action to prevent or 
seek early treatment for a particular disease. There is over-reliance on 
health talks as the panacea to get community members to change their 
practices with regards to use of health services or taking preventive actions. 
 When asked what they will do to get mothers to take their children for
immunization or use FP, almost all the CLCS visited mentioned they would 
conduct more health education talks. CLCS members agreed that more 
community members would participate in BCC activities if interactive drama 
was used as the channel for providing key BCC messages. The project 
trained one person from each of the CLCS in each district in drama for 
health education. The trained persons were expected to train other 
members of the CLCS. At the time of the MTE, none of the trained CLCS 
representatives have conducted the drama training for their colleagues. 
· A major constraint to BCC is the general lack of BCC materials at both 
community and health facility level. 
· Lastly, the CLCS members reported that community members do not fully 
trust them, and think SC/US pays them for the activities they undertake. An 
example was given of this distrust that apparently reached crisis level during 
the cholera epidemic. Community members accused the CLCS members of 
causing the epidemic by deliberately putting cholera vibrios (the chlorine 
pills) in the wells. The lack of financial contribution by community members 
27
towards the maintenance of bicycle ambulances was also attributed to this 
distrust.
 
Next Steps 
1. Improve the supervisory skills of DDS and its trainers towards health 
facilities services and staff, emphasizing the importance of the relationships 
with the community.
2. Improve the supervisory skills of DDS and especially its trainers to conduct 
regular visits to CLCS meetings. They should invite themselves to attend 
the CLCS meetings to be able to guide part of the discussion, address the 
weaknesses (use of data, A&T systems, trust issues, including clarification 
on the roles of TBAs and relationships with both SC and MOH.) These 
issues should also be directly discussed with the mothers.
3. Diversify BCC approaches by continuing the development of local theater 
and drama groups in each of the regulados.
4. Review BCC key messages to be delivered by CLCS members to mothers 
and incorporate them into a revised training curriculum.
5. Plan a massive distribution of appropriate, non-literate BCC materials to the 
communities and health centers.
2.2 Capacity Building Approach 
Capacity Building
The essential aim of the CS-16 Project is to build capacity in the DDS and the 
communities for long-term access, coverage, quality, and sustainability. The 
Project addresses capacity building on three systems levels: the household, 
the community, and District Health levels as well as the field office. The goal 
is to provide organizations (families, communities, DDS) with the tools and skills 
they need to promote their own ongoing development. 
· SC/HQ: At least 2 SC Field Offices and/or other organizations will develop a plan for adopting 
successful CS16 approaches. 
· SC/M: SC/Moz staff will participate in policy forums at the provincial level advocating for 
changes in policy based upon CS16 strategies. 
· DHOs: Presence of annual work plan specifying activities, persons responsible, date and 
resources available/monitoring and supervisory tools for each capacity.
· Presentation of HIS reports during quarterly PMT meetings. 
· Communities: (1) 75% of regulados will be able to identify 2 or more priority maternal/child 
health problems to be addressed through an action plan; (2) 70% of regulados will have 
formed CHTs and members will know the roles and responsibilities; (3) 80% of CHT members 
will be able to cite five approaches to increase community participation in health activities; (4) 
75% of CHT members will understand numerical trends of HIS and use for health planning. 
28
CLCS members were to receive training necessary for: (1) developing care￾seeking and transport plans for pregnant/postpartum women and sick children; 
(2) data-driven decision-making with regard to community health; and (3) 
mobilization to reduce barriers to and increase use of existing health services. 
They were to work at the community level to promote child survival through 
community mobilization and BCC focusing on prevention, caregiver practices, 
and appropriate care-seeking aimed at mothers and caregivers, decision 
makers, and community leaders who influence behaviors at critical points (during 
pregnancy, delivery, postpartum, childhood illnesses.) 
The February capacity assessment identified four capacity areas the DDSs 
wished to improve, which are expressed in the following objectives: (1) 
Improving the distribution and delivery of services and benefits, (2) Improving 
needs assessment and planning, (3) Improving financial management and (4) 
Improving organizational learning. These were to happen through the joint 
Program Management Team (EGP). 
Capacity building of SC headquarters and field staff emphasizes strengthening 
systems to support organizational learning and experience-based advocacy 
through the annual "program learning group” (PLG) meetings in which SC health 
staff from headquarters and the field share lessons learned from field experience 
and participate in technical updates on “state-of-the-art” practices in health. One 
anticipated innovation is the approach to working with traditional healers that SC 
Mozambique will document and share at the PLG as well as in international 
forums such as workshops on HH/C-IMCI approaches. SC/Mozambique staff 
identified the need to increase their capacity in needs assessments and 
planning and that was to be given in a practical fashion such as what has 
occurred during the DIP preparation. SC/Mozambique also is to strengthen staff 
skills to advocate at the provincial level based on experience gained through 
implementation of the project. 
Activities and MTE Results:
This section is complemented by the Program Management (section 3) below, 
where project activities regarding capacity building are described in more detail. 
SC HQ have conducted an Institutional Strengths Assessment in Feb 2002 and 
as a result the Office of Health (OH) has developed capacity building plans for 
four current SC initiatives that include immunization; community case 
management of childhood malaria, pneumonia, and diarrhoea; safe motherhood; 
and adolescent sexual and reproductive health. OH also developed a draft 
advocacy plan for health. Contacts between HQ and SC Nacala, besides the 
DIP, have been the revision of 1st year annual report, preparation for the midterm 
studies and evaluation, and financial and administrative backstopping.
 
29
SC Nacala participated in an international forum in NY April-May 2002 where 
one of the staff shared the life and challenges of Mozambican mothers. 
Unfortunately Dra. Catarina Regina, the Bridges coordinator had to cancel her 
planned trip to participate in the PLG this year and the documentation of the 
work with THs has not been done. However, the work with THs, curandeiros, has 
made important progress. The staff considers being able to communicate and 
exchange with such an icon of traditional health care a huge step. As mentioned 
earlier, THs now report changed practices of using one blade per person and 
sterilizing their cutting instruments by boiling. They also clearly identified the 
illness symptoms which they refer immediately to a health facility. In one 
regulado a TH explained how his prompt transfer of a child with rapid and 
difficult breathing saved her life. Some days after the mother had returned home 
with the cured child she approached him to express her deep gratitude for his 
action. However, most of them confessed to keep the child for some time before 
transferring.
The DDS director in NaV has presented a summary of the project to the local 
government Administrative Council. The quarterly joint management meetings 
with Bridges have been opportunities to share project developments with DPS. 
The SC lead trainer started using a supervisory checklist for the first time this 
May. She attended three TBA trainings and assessed the following: training 
methodology, communication skills, knowledge and presentation style of the 
subject, including ability to answer questions and clarify doubts, use of BCC 
materials and motivation of the audience. With this tool and improved curricula 
the quality of the trainings will certainly improve. 
Challenges
HQ and the Strengthen Project need to have more communication and exchange 
of reports to ensure the quality of the planned activities. This may have helped 
detect the need to work even more closely with DDS directors and might have 
steered EGP activities in the right direction. 
DDS directors did not produce annual work plans and/or monthly action plans. In 
NaV, the secretary keeps the director’s meeting agenda and that is what is 
followed as a plan. The SC program manager explained that in spite of these 
shortfalls a huge gain has been achieved in the collaboration between districts 
and SC, and the staff corroborated this opinion, stating that before it was almost 
impossible to work collaboratively with district directors. This effort has been 
accomplished in the joint management meetings. Objective assessment of 
district management, however, showed that SC project documents were filed 
away and not at their fingertips, Mobile Brigades were not planned properly, EPI 
and FP indicators fell since baseline and there was no supervision either to the 
HC or to CLCS. NaV DDS holds a monthly meeting with all technical staff and 
Memba DDS holds a similar meeting on a quarterly basis. These opportunities to 
work more closely with the districts and build their capacity in terms of planning 
30
and monitoring have not been explored. DDS directors complained that the 
contacts with the program manager have been only through the telephone. 
Management of the HIS seems to have improved only slightly. We saw 
rudiments of data analysis and no use in decision-making. Please refer to the 
section 2.3 Health Management Information System for more details. 
CLCS are active and engaged in their work of mobilizing and educating 
communities to the extent they were trained to. The MTE team noticed that 
CLCS tend to perform activities they were trained to, but not activities that were 
left to their own initiative. For example, the regulo performs as a key element of 
the Alarm System as it was oriented to do, but still today nobody is in charge of 
the bicycle maintenance. This decision was not scripted. TBAs collect 
information related to maternal and newborn care and the activista compiles 
them in the tally forms. TBAs carry this information to the HC or to the trainer in 
the district, but CLCS do not know how to effectively use the data to make 
decisions. Management of information at this level was cut from the training 
curriculum. More assertive regulos demand collaboration with DDS but district
and health center staff have not yet received sufficient training to answer those 
demands. 
There are trust issues between regulos and the community that need to be 
addressed in public meetings. An example is the fact that the community does 
not wish to contribute for a cash fund to maintain the bicycle-ambulances 
because they do not trust their money with the regulo and believe that the regulo
is also receiving money from SC to maintain the bicycles. The bicycles might be 
used for other activities to generate income, but they have not come up with 
mechanisms to manage this. There is clearly a need to improve knowledge and 
skills of CLCS members in specific management areas. 
Regarding delivery of BCC messages, CLCS were not taught the Community 
Action Cycle (CAC) which is an alternative to the traditional “talk” or lecture-style 
approach for delivery of BCC messages, drawing on basic concepts of 
facilitating critical reflection and exploration of experiences, attitudes and 
practices. It allows both the community and the field staff to learn about how 
caregivers perceive problems and how they respond to them. Together 
community and field staff can then plan for, implement and evaluate improved
behaviors in IMCI, MNC, EPI, and especially FP.
As stated earlier in the document mothers became very active, assertive and 
gained knowledge through the educational contacts with CLCS, health workers 
and others. All six groups of mothers we interviewed showed these 
characteristics. Their knowledge on fever management, diarrhea management 
and pneumonia management has increased, as well as immunization, pregnancy 
danger signs and even clean delivery and birth plan. Currently the health 
services have not adapted to meet this increased demand. 
31
Training 
Training has been the strongest capacity building component of the Strengthen 
Project. The project has a core of ten Trainers, four from SC and six in the 
districts. They were prepared by provincial TOT and have carried out trainings 
of CLCS, TH, TBAs, and APEs. HC personnel training in IMCI is carried out by 
provincial trainers. As of June 2002, 688 people have been trained.
Training and refresher for 14 APEs, 7 socorristas, 4 SMI nurses, 10 Elementary 
Midwifes, and 9 nurses or Tecnicos de Saude were all carried out by DPS. SC 
staff participated in some of these trainings to increase their skills as TOT. 
These trainings facilitated the transition to IMCI strategy adopted by the country. 
Interviews during the MTE revealed the trained technician had more educational 
materials on hand, they had protocols and reported making more accurate 
diagnosis and prescribing better treatments versus the non-trained technicians. 
The final evaluation with its facility assessment will objectively measure these
advances. The best example of successful training we found in the field was of a 
male nurse who not only used the IMCI protocol but helped the fellow MCH
nurse with prenatal visits and deliveries, studied her manual to help her 
understand more difficult subjects, offered FP education to his adult patients, 
analyzed his registry for disease trends and contacted the respective CLCS to 
discuss possible solutions to the respective communities.
All information on training was obtained from SC office and none from the 
districts. NaV had a dossier with modules but they are not using statistical 
information to track their work. 
However DDS health technicians have yet to be trained in specific areas such as 
the use of the HIS for planning, monitoring and support-a-vision, logistical and 
resource management especially for EPI and family planning. The current model 
of EGP meetings seem not to be appropriate to help capture the essence of 
planning and follow-up. 
SC staff has not received training on needs assessment and planning. Through 
participation in EGP with Bridges to Health Project meetings, the Lead Trainer 
especially had a chance to receive on-the job training on some managerial skills 
and share lessons learned. The participatory and formative approach of the MTE 
was considered by the staff and by the district representatives as a very helpful 
learning opportunity. Lastly, advocacy efforts are a weak area both at provincial 
and national level.
Next Steps
The project needs to emphasize more follow-up to guarantee a level of 
performance according to the training efforts. Both DDS staff and SC staff need 
to: 
32
1. Acquire management, supervisory, data management and resource 
management skills. These are to be transferred in working sessions with 
each of the districts. The EGP meetings might continue until the end of 
Bridges in April 2003. Additional monthly meetings should take place at 
each of the districts with the district technical staff including the director. 
From statistical information presented, communities and health facilities 
are targeted to specific activities, a work plan is drafted and resources are 
made available to execute the activities. These resources may continue to 
come from SC as it has been, but emphasis should go on to drawing more 
and more district and provincial resources keeping capacity building and 
sustainability strategies in mind and the end of the project at sight. These 
FORMATIVE meetings will create abilities to analyze data, lead to quality 
improvement, manage resources and personnel, manage the budget, and 
address community needs, and strength districts, staff and communities. 
Objectives and strategies of the Strengthen Project should be the starting 
point in all meetings, so participants internalize them.
2. Acquire new skills to advocate for the district needs and plans. Once they 
learn to use data that can be used also to better advocate the needs and 
draw more resources to the district. The vehicles need to remain in the 
districts after Strengthen Project ends.
3. Trainers need to learn new skills to use statistical information to increase 
performance and monitor trainees.
4. Follow-up CLCS meetings. The HC and health workers should be 
encouraged to participate in these meetings and receive community￾based monitoring reports from these meetings. Through this mechanism 
facility-based health workers will improve their relationships with 
community leaders, respond to their health needs and gain more respect 
and status at the community level
5. Increase supervision to Activistas, CLCS, APEs, TBAs, by using a specific 
checklist for each of the cadres. This list will be the output of short-term 
training on supervisory skills directed to staff and districts as it is 
envisioned in the Action Plan.
6. Present results of the LQAS survey and MTE results to all HC and CLCS 
as feedback information and to foster “information for action” attitude.
2.3 Health Management Information System 
The CS16 project results are being monitored and evaluated through the use of 
community data, service statistics, qualitative studies, supervisory checklists, 
LQAS, KPC surveys, and Health Facility Assessments. For evaluation purposes 
household and facility assessment surveys (both 30 cluster surveys and LQAS) 
and project training records have been used at baseline and midterm. Project 
activities are jointly monitored by SC, DDS, and CLCS. 
33
SC Level: Rather than establishing a parallel system SC works with the DDS to 
prepare quarterly reports of district service delivery. The project staff also 
prepares separate quarterly and annual reports to describe the key activities of 
the project including trainings, mobile brigades, supervision visits, meetings 
attended, challenges and proposed solutions. This report is shared with the 
SC/US Mozambique Office in Maputo and the SC/US HQ. This report is used to 
monitor the progress of the Strengthen Project and report on its 
accomplishments to USAID. 
District Level: DDS undertakes routine SIS data collection to monitor district 
service delivery including EPI, family planning, sick child consultations, 
antenatal, delivery and postnatal coverage. MOH Weekly Epidemiological 
Bulletins (BES) keeps track of immunization-preventable diseases. Community 
level information is to be incorporated into these service statistics. The M&E 
skills of local staff and partners are to be strengthened primarily through in￾service training and supervision. The SC M&E Specialist works with the DDS 
and specifically with the District Preventive Medicine Officers to strengthen the 
quality of their reporting. Consistent supervision at all levels is critical to 
reinforcing the monitoring skills of the volunteers and the health workers.
During the quarterly EGP meetings, DDSs make presentations on the coverage 
of their services in the preceding quarter and discuss implementation 
challenges. Thus the DDSs are tracking the progress of MOH indicators, and 
meetings are used as a forum for reviewing reports. However the quantity and 
quality of data included in the quarterly report is quite limited. The evaluation 
found that data analysis for decision making and planning is also limited at the 
district level. Computers were given to the districts in July 2002. However there 
is not a training plan or a clear definition of use and responsibilities. The SC 
M&E Specialist does not have the requisite background and training to conduct 
data analysis and provide sufficient training of the district officers. 
The community-based information system has been partially incorporated into 
the districts’ health information systems. The information collected by CLCS 
from the TBAs at the community level (regulado) is being given to the SMI nurse 
of the health facility nearest to the regulado. The SMI nurses are then including 
this community information in their monthly report to the DDS.
Beyond the routine monitoring system, the project used a lot quality assessment 
sampling technique for a midterm monitoring survey. It took four weeks to 
provide an estimate of whether the project was on track relative to its objectives. 
This survey was reviewed as part of the MTE and its results are in Appendix II. 
Quality of services at the health facilities and community-based service points is 
to be monitored by the DDSs through supportive supervision using standardized 
34
checklists. These supervisory checklists which were to be developed by JSI in 
2001 have not yet been done.
Community Level: CLCS have been trained to monitor their activities during 
their regular meetings. The use of data collection instruments is a component of 
the trainings with the CLCS, APE/socorristas, and the TBAs. During regular 
forums (monthly or quarterly) these community providers share the results of 
their work with other community leaders and the information is summarized in 
monthly tally forms. This forum is intended to provide greater feedback of 
information to the wider community so that “social pressure” will stimulate 
behavior change for improved health. 
The evaluation team found the completeness and quality of the community 
information inconsistent. The majority of CLCS are collecting information on the 
use of trained and untrained TBAs as well as the number of maternal and child 
deaths. However few are collecting other information on the number of cases of 
specific diseases. The training on the use of this information at the community 
level was insufficient. 
Next Steps
1. Provide technical assistance on data analysis and applied epidemiology. 
Local resources can be used, for example Victorino from the Gaza office 
and the statistician in Nacala-Velha.
2. Refresher training of CLCS members in data-driven decision-making 
based on the CLCS monthly return form is required. Use the monthly 
meeting report form developed by the Bridges project in Nampula. 
3. Revise the SC quarterly report to include other process indicators to 
measure project progress. 
4. Increase regular supervision of CLCS and service providers focusing on 
the quality and use of data
2.4 Sustainability Strategy 
Sustainability
Objective End Results
· 2 DHOs will prepare an annual health workplan indicating efficient use of resources. 
· 75% of CHTs at regulado level will attend meetings regularly.
· 2 DHOs will have supervisory and monitoring systems for QOC and peer review. 
· DHOs will regularly share lessons learned at provincial and national MOH levels.
· DHOs commit to sustaining CHT training and formation by inclusion into yearly DHO plans.
35
The weaknesses of the capacity building assessment reflect on the potential 
sustainability of activities beyond the life of the project. Neither DDS had annual 
work plans or even quarterly work plans in addition to the SC training plans. 
Monitoring systems for health workers, quality control of services and for CLCS 
do not exist. It is necessary that districts and province commit time and 
resources to continue monitoring CLCS beyond the life of the project to keep 
them motivated. With the interest fostered by the MTE, we expect that the 
relationship of the DDS and CLCS to improve. District financial and budget 
management issues need to be addressed. The periodic unavailability of the 
MOH vehicles assigned to each district will further strain the ability to carry out 
supervisory activities. Finally a huge challenge is the destiny of the cars 
currently working in the districts. These two vehicles might not be kept in the 
districts after the end of the project and this is a major obstacle to continuation of 
activities.
Next steps
In order to ensure continuation of activities SC and DDS staff have to:
1. Institute the monthly meetings at district level and jointly plan and budget 
activities. This exercise for the remainder of the project will consolidate a 
management attitude adequate for sustainability purposes. An example 
could be: 
a. Always start with a clear presentation of the project objectives and 
strategies to keep them in mind.
b. Data presentation by intervention area. Compare with last report. 
Discuss trends, why or why-nots of data, quality aspects. Ask 
justifications, teach data analysis, and stress formative character of 
meeting. Identify problems and problem-regulados. Discuss 
solutions; identify responsible, make clear guidelines and actions. 
Jot down to follow-up accomplishment in the next meeting. Be 
consistent and comprehensive. 
c. Study DIP work plan and MTE Action Plan for activities that are 
planned for the period. Discuss with persons responsible, how to 
accomplish activities, spell out straight guidelines, and confront 
every lack of accomplishment in a constructive way, so difficulties 
are surpassed. Find solutions.
d. Coordinate use of resources, especially vehicles and personnel, so 
several activities are accomplished in one trip. (1 supervisor to 
community activities, 1 or two MB nurses, 1 supervisor for the HC 
or HP). 
e. EPI management: have or prepare list of all health facilities and 
their cold chain status. Look at vaccine supplies to each, compare 
with immunization numbers and targets, find disparities in all 
logistic management information, ask questions, uncover problems, 
36
find solutions, assign responsibilities, and follow up on next 
meeting. Look at QC of immunization data including MB and CIC 
per facility. Discuss trends. Disparities have to be discussed with 
the EPI person and responsible of the health facility and follow-up 
recommended orientations. Look at number of days the facility 
provided immunization, compare well-children visits + sick children 
visits and immunization numbers, find reasons for the disparities. 
Finally, study the feasibility of opening more vaccination posts. 
Create the conditions if they within reach. Make proposals to DPS 
if not. Follow-up on the requests. Instill urgency.
2. Devise an exit strategy that will leave the districts strengthened. 
3. Elaborate a plan for supervision that covers all the follow-up needs at the 
community level, including health workers, CLCS, theater groups, 
Activistas e APEs, TBAs, etc, emphasizing on-the-job training and sharing 
of resources such as time, vehicles and activities such as mobile brigade 
or DMS. It is only necessary that each member has one or more attributed 
responsibility. 
4. Lobby the DPS at the appropriate level, using statistical information 
analysis, to ensure that the vehicles stay in the districts after the en of the 
project and that a vehicle maintenance budget is executed appropriately. 
5. Use the opportunity of the Conselho Coordenador Provincial to present
the LQAS, MTE results, the Action Plan, and a clear outline of the district 
sustainability needs. 
6. Discuss with CLCS the need to continue the activities in the absence of 
sponsorships.
37
II. Program Management
1. Planning
The basic constitution of the PMT (EGP) for both Districts includes the DDS 
director, or a representative when he cannot attend, the SC Strength Project 
program manager, Bridges Project staff, and representatives of the DPS, 
especially the SMI Coordinator and the NEP Coordinator and JSI Coordinators 
from Nampula and Maputo. Several other people have been invited and 
attended, such as other SC staff, district trainers. Local NGOs (GAS, ADPP and 
MS) are always invited but their attendance is rare.
The Bridges Project, which has similar objectives in terms of capacity building 
works in four other districts of Nampula. The Strength Project manager also 
manages the Bridges Project. That meant that the EGP became a bigger 
meeting with representatives of six districts and about 12 to 20 people. 
Representation at those meetings ranged from 21% to 35% for DPS, 10% to 
18% for SC and from less than 1% to 21% for DDS. EGP meetings are called 
and prepared by SC following the schedule. Different districts hosted the 
meeting if there were conditions to lodge all the participants. Neither Memba nor 
Nacala Velha hosted an EGP meeting due to lack of those conditions. District 
directors and SC present their reports in a plenary session. Then the 
participants divide in two groups, the Strength and Bridges groups, to discuss 
issues in more detail.
EGP was scheduled to meet regularly every trimester, what would be six 
meetings so far. We found minutes of only 4 (2nd to 5th) meetings. The agenda 
includes meeting objectives, report presentations by districts and by SC, reports 
on visits made to health facilities, data presentation, discussion and 
recommendations, and a work plan for the coming trimester. However the 
minutes do not reflect the improvements expected at this point. The description 
of the problems is not quantified, do not clearly indicate to which facilities they 
refer to, and the recommendations are too general. The appendixes of the 
meetings are listed but not annexed to the minutes, making it difficult to analyze 
its content. In meetings 3rd and 4th for example problems such as elaborate a 
DDS/SC joint work plan; identify problems with the cold chain; inventory of 
bicycle-ambulances) were discussed and recommendations were made but the 
accomplishment of these recommendations were not tracked down in the 
following meetings. The recommendations are not specific enough (who, when, 
how) and that makes it difficult to track the accomplishments. The report of last
meeting that took place in Ribawe in July 2002, recommended a reporting format 
that allows tracking accomplishments of meeting recommendations. It also 
showed a novel analysis of the data, comparing data of the first semester of two 
consecutive years and what indicators went down or up. However no decisions
were recorded from this comparison.
38
In preparation for the EGP meetings, the SC M&E officer goes to the district, 
collects data and returns to the office to prepare tables and graphs. SC presents 
a proposal of the work plan, mainly trainings as planned for in the DIP. Districts 
and DPS agree on the calendar of activities according to the availability of the 
trainers and this represents SC quarterly plan. District problems or activities are 
not reflected in that plan. The meeting minutes are prepared by the project 
coordinator aided by a participant. The districts could not show their copies of 
those minutes, nor of the quarterly work plans.
Training activities followed closely the DIP schedule adjusted to availability of 
DPS trainers when needed. Trainings only dependent on SC and district trainers 
took place as scheduled. On the logistics side the procurement of supplies for 
the maternities, bicycle-ambulances, two-way radios and others have been 
delayed by six to 9 months. Computer equipment only arrived in the districts 
about two months ago but has been locked, due to lack of trained district officers 
to use them. Explanations for these delays seem to be “things in Mozambique 
are slow “and that logistical procedures in Nacala and Nampula are slow￾moving. 
The staff does not know all the program objectives and were not too clear on the 
cross cutting approaches. They know the intervention areas, perhaps because 
most are MCH nurses and are very much engaged in the activities. Staff says 
they all have a copy of the DIP but could not produce it easily. Only one copy in 
Nacala was available throughout the evaluation. That copy is translated to 
Portuguese, but not complete, and written in a heavy format that does not 
facilitate reading. We do not know if translation was cross-checked for accuracy 
but some acronyms were not translated at all e.g. MNC. There is not a 
comprehensive monitoring and evaluation plan. The M&E specialist needs 
further training to prepare one on her own.
Regarding the use of health information, there is graph frenzy. Graphs are 
generated with MOH data but their quality needs to be improved. They lack 
proper labeling of place, time frame, and source references. Some tend to 
aggregate such a number of variables and bars that they become difficult to 
understand. In addition there appeared to be little use of this information in 
specific decision making. The team leader assessed the set of graphs from 
Memba for the period of Jan-Jun 2002 and made comments that will help guide 
the M&E person to improve the presentation, analyze the information she 
collects and promote discussion around problems identified by the data during 
the monthly meetings with the districts. A copy of this is in Appendix XI.
The hiring of six local MCH nurses did not happen due to lack of skilled 
personnel in the Province, the low MISAU salaries, and the remoteness of the 
39
Districts. Only five months ago, the DPS hired two general medicine nurses 
under that agreement.
Planning of field activities has improved. Initially the training team packed 
foodstuffs and other items to the field, as trainings were never shorter than one 
day. They hired local cooks to prepare the meals for all participants. 
Participants, however, proposed to receive cash instead of the meals, as that 
could be taken home and cover family needs dependent on their income. That 
decision happened at the management level with no advanced notice to the 
trainers in the field. The logistic staff went to the field with the new rules without
properly communicating these changes. Their lack of training on how to deal 
with the community clashed with the traditional authorities and impacted 
negatively on the community. Finally a solution was worked out over the phone 
with the manager. A discussion of the problem on following Monday meeting 
generated a wave of open animosity of one member of the logistics team 
towards the technical staff. It remains till now. This impacts the processing of 
operational budgets, letters and other dispatches which leads to unnecessary 
delays of activities. 
Technical staff in the field or at least the lead trainer does not handle any 
financial operations at all. Usually training sessions are visited by the logistics 
personnel to pay per-diems. Those extra trips to the field that could mean also 
supervision opportunities but this option was never explored.
2. Staff Training and Supervision and Technical Support
The staff has received training in many areas, especially on TOT, health 
education, curricula preparation, programming, clean birth, and computing. 
Beside most have a health background (see Appendix IV). However, in view of 
the results, more formal training on management skills is needed for both the 
staff and DDS partners. BCC training has relied on the traditional health talks. 
Only recently were theater and drama introduced and the CAC approach was 
not emphasized. Basic epidemiology and statistics skills are necessary to enable 
a better M&E performance and transfer of skills to district personnel.
The Strengthen Project has received technical support from overseas, for 
example a consultant that carried out the LQAS, trainings on CLCS and Clean 
Delivery, and the study on the feasibility of selling clean birth kits. Opportunities 
of using local expertise in epidemiology and statistics, exchange of experience 
with Gaza on CBD of FP methods, review and update of BCC messages and 
A&T systems need to be explored. During the evaluation a nurse trained in IMCI 
40
in the Geba HC, Epuite, Memba was identified who could be an example to other 
health workers. 
Recently, for the first time the Lead trainer supervised training sessions 
conducted by her staff 3 times this year. She has developed a supervisory 
checklist to help her achieve the supervisory objectives. Problems pinpointed 
were discussed with the supervised trainers.
The evaluation team did not discuss the program budget in the absence of the 
Program Manager. During debriefing with the Country Director a budget tracking 
tool was made available but the evaluation team did not have enough time to 
discuss it in more detail. The budget will require some adjustments to respond to 
identified training needs including the need for one more TBA training for the 
Lurio area, training/refreshers to selected APEs and management and 
epidemiology training to staff and district personnel.
It was not possible to evaluate supervision of program staff, in the absence of 
the Program Coordinator and Manager. The MTE team learned that the 
manager held meetings every Monday of about 2-3 hours. These meetings 
included the technical and logistics staff. Discussion of the work schedule and 
report of field activities of the ending and starting weeks were the focus of the 
meetings. The staff expressed that they felt sufficiently guided in their activities.
The program has always been understaffed, as a national coordinator was never 
hired due to the shortage of skilled available national workers. Now there is an 
urgent need not only for a coordinator but a new program manager, according to 
the organizational chart Appendix VIII of the DIP. The external evaluators had a 
chance to interview two strong candidates for the coordinator position. Reports 
of these interviews were left with FOD. The lead trainer is filling for both now and 
she herself recognizes not having the necessary management skills. Project 
logistics and operations are staffed with three people who were not interviewed.
3. Human Resources and Staff Management
Some complaints were made in terms of lack of communication related to the 
management of human resources in the prior CS-12 project. For example some 
people being fired without notice and just plainly disappearing from the office 
with no chance to bid farewell. This makes the staff uneasy and fearful that they 
would be next ones. They understand they are under contract and that their 
terms are finite, but feel unstable during the contract period. 
41
Technical staff turnover has been low in CS-16. No staff has left the program so 
far and another trainer joined the NV team two months ago. The greater 
challenge has been recruitment at appropriate skill level.
Usually when a contract ends the staff is given opportunities to apply for 
positions in a new project if one is to come. Otherwise they will engage in other 
projects or other NGOs given their training, skills and experience. Going back to 
work in MOH was not mentioned as an option.
We were told that all staff has job descriptions, although we did not see them. 
However due to the performance of certain elements, for example the district 
directors, there is a need to make sure the job descriptions are detailed enough 
to ensure their performance. The new director should understand the need to 
travel monthly to and work in each of the districts, in order to accomplish transfer 
of management skills and data analysis and lay the groundwork for 
sustainability.
The technical staff is cohesive, committed and enjoy their work. They are very 
much engaged in the activities and truly believe on what they are doing. All are 
skilled in their dealings with the community and easily establish rapport with 
them. They feel the need for leadership especially since the Program Manager 
left two weeks prior to the evaluation. The relationships with district and CLCS 
members is excellent and that impacts positively the program and on the
organization. They seemed to quickly absorb more new skills and perform better 
when they have direct guidelines. The ability to work independently can be build 
over time if they are given proper responsibilities.
4. Financial Management, Administration and Logistics
It was not possible to discuss this in any detail because the responsible person 
was away in a mission in a SC province. We really did not have leaders at all to 
discuss details of the Strengthen Project. However we were informed especially 
by the district directors of the difficult relationships with the Chief of Operations 
and of the problems with the logistics staff. 
Procurement of local supplies for the birth kit has proven very difficult and non￾viable at this point. That was reported by a consultant who visited the field in 
preparation of the LQAS survey, right before the MTE. That caused a step back 
from the planned supply of birth kits to TBAs. Communication on this change has 
not been clear enough and some TBAs still reported an expectation that cannot 
be fulfilled. CLCS and TBAs should be informed and clarified as soon as 
possible. The impossibility of supplying birth kits gave way to improve education 
of TBAs and mothers in clean births. As proposed and elaborated by the 
consultant, the management was ready to carry out a study protocol on the 
42
impact of health education alone. The objectives and feasibility of such a 
protocol should be discussed with the regional advisor before it is started, given 
the shortage of personnel and considering other more imperative project 
priorities. 
Certain equipment and materials for maternities were to be distributed in Q5 and 
Q6 of the project. In April the lists were presented to the project manager and 
six months later the materials have not been purchased. Bicycle-ambulances for 
Memba should have been distributed this last quarter, but apparently purchasing 
orders haven’t been issued yet.
Vehicles are a concern. The current vehicles, with permission from USAID, will 
be transferred to the DPS at the end of CS16. They were originally purchased 
for CS-16. It is possible that the DPS will allocate the vehicles to other districts 
that currently have more severe vehicle needs. The two vehicles are stationed 
one per district, Tuesday through Thursday and under a careful plan support 
mobile brigades, distribution of supplies, and transportation of emergency cases 
to the closest health facility and reference hospitals. Sustainability of activities, 
once CS-16 is over, is totally dependent on these vehicles. Advocating for this 
and other issues is clearly needed. 
DDS directors also mentioned some unfinished construction promised by the 
Strengthen Project. This includes the kitchen to support the TBA training gazebo 
in Memba, and the completion of the kitchen, W.C. and the training gazebo in 
Nacala-Velha. However they were also quick to recognize the important aid 
provided by SC/US, supplying vehicles for example, and the supporting role in 
the partnership and training of personnel. 
The main logistic challenges of the project are:
1. Purchasing and distribution of bicycle-ambulances to Memba, including all 
the necessary steps to guarantee compliance towards a local maintenance 
system.
2. The reactivation of the bicycle-ambulances in NaV and Southern Memba
regulados might prove challenging since it is necessary to meet often with 
CLCS to reopen the issue of the agreement and the maintenance and, if the 
community assumes its responsibilities, to help with some of the repair costs.
3. The procurement and immediate supply of some or part of the equipment 
and material for the maternities, both in the districts and in the reference 
hospitals according to what was set in the DIP. 
4. Systematically inform all TBAs and CLCS of the shift from the distribution of 
clean delivery kits to the education of mothers on clean delivery as a result of 
the consultants’ appraisal.
5. Programming supervision visits with DDS in a way that enables them to 
continue the activities after the life of the project.
43
6. Keep and increase the number of Mobile Brigades to the field and coordinate 
in addition supervisory visits and meetings with CLCS.
7. Keep the vehicles in the districts and set up a maintenance budget to allow 
them a longer life. For now increasing the number of days vehicles work in 
the districts will allow increase in the number of Mobile Brigades and support 
beginning of supervisory visits. 
8. Finish all construction that was promised in the beginning of the project.
44
III. Recommendations
These recommendations are a summary of the recommendations indicated in each 
area. 
1. Program Management:
– Adjust job descriptions to new tasks, for example project manager 
have to travel to the districts often, DDS directors need to take in 
leadership and not act as the receiving end only.
– Expedite hiring of manager and coordinator
– Revise DIP work plan to make sure that strategies and activities 
are followed as set in the beginning of the project.
– Finish the Plan of Action in a larger workshop with DDS directors 
and their technical teams. Discuss in detail the allocation of 
resources, especially the ones coming from DDS, and 
responsibilities. 
– Implement immediately monthly meetings in each of the districts 
with the technical team. These meetings should be working 
meetings, so protocol is left out. DDS directors should lead the 
meetings and SC staff act as counselor and mentor. In 
preparation to the meeting some ground work might need to be 
done in order to enable directors to lead. Adding on to his 
comments, correct view-points, stimulate problem solving, not 
taking laxity and accommodation are some recommended 
strategies. 
– Shadow directors in final evaluation, so they take a leading role
– Discuss with all stakeholders the exit strategy of the project, so 
SP activities are phased out but not over. DDS directors and staff 
should gradually TAKE OVER all the activities and leadership.
– Stress the implementation of supervision visits from DDS to HCs 
and CLCS. 
2. Staff Supervision:
– Supervision should be the main activity for the remainder of the 
project, to allow follow-up of personnel trained during the first half 
of the project. Supervision should underscore on-the-job training 
and formative characteristics.
– Set up a workshop to rapidly provide staff and DDS trainers and 
others with supervisory skills, according to what is delineated in 
the Plan of Action. The outcomes of such workshop are: 1) a 
checklist directed to all components and cadres to be supervised, 
2) a real supervision plan with places, dates, use of resources, 
45
and responsibilities. Such plan can be periodically self-repeated. 
Include Logistics (SC and district) as part of the plan elaboration.
3. Logistics:
– Help DDS to re-plan the Mobile Brigades to increase total number 
of times, to achieve 5 times to same community, to become more 
regular, to arrive early, and to find coordination with Monthly 
Health Days and supervision and supply activities. Invite other 
holders of resources to join in efforts. Include Logistics (SC and 
district) as part of the plan elaboration.
– Discuss wit regulos closer to HCs taking their community to the 
HC, so Mobile Brigade can cover distant areas with no HCs. 
– Improve purchasing procedures for bicycle-ambulances in 
Memba, and reactivation of A&T system in NaV.
– Expedite purchasing procedures for material and equipment 
destined to maternities and reference hospitals.
– Reactivate allocation of two-way radios to districts.
– Improve vehicle maintenance procedures to allow increase of 
supervisory and Mobile Brigade activities 
– Finish all construction activities undertaken in the beginning of the 
project
4. Training:
– Training of TBAs in Lurio, making sure that they will be supplied 
for a period equivalent to the rainy season and visited as soon as 
roads are transitable again every year.
– Refresher trainings of APEs of more distant areas, such as Lurio, 
Mezope and others.
– Training of DDS and SC staff in basic Management, data 
management, resources management and basic epidemiology 
and statistics, in a practical way based on the data and resources 
of the districts (for example Memba data practical analysis 
example in appendix XI).
– Quick set up and computer training for selected members in each 
district (director, NEP, statisticians, SMI responsible).
5. Capacity Building:
– Dissemination of LQAS and MTE results to DDS, DPS, HC and 
CLCS, as these places are being visited. Adjust the reporting to 
each audience, stressing on the key points. 
– Present LQAS and MTE results and Action Plan to Conselho 
Coordenador de Saude de of Nampula Province.
46
– Exchange and review BCC materials and messages with SC Gaza 
Project and other experts in this matter.
– With DPS and DDS acquire, produce and distribute IEC materials 
to all levels of the community and health system.
– Expand FP education and demonstration to Tecnico de Saude in 
all health facilities and to all members of CLCS.
– Spread the positive experience of the nurse in Geba HC, who 
successfully attempted to link the triangle of HC, community and 
DDS. The community needs to know his every day heroes.
– Share the positive story of how a TH saved a child’s life by 
promptly referring her .
– Share lessons learned and experience with SC in Gaza on CBD 
contra-conceptive pills. 
– Discuss with DPS the feasibility of a pilot study of CBD FP 
methods in a far-way community. 
– Discuss with DPS the feasibility of a pilot study of Imunization 
practices by APEs, drawing on the experience of other African 
countries. Such strategies might greatly improve immunization 
coverage in distant and inaccessible areas.
– Dialogue with GEMT to improve THs procedures on the referral of 
sick children and women
– Strongly advocate for the districts to keep the vehicles in the 
districts. Use statistical data to prove the point (immunization and 
CPN coverage, supervision coverage activities, number of 
contacts with CLCS and problems solved due to those contacts.
47
IV. Results Highlight
The Strength Project in the impoverished districts of Nacala-Velha and Memba, 
in Nampula province, northern Mozambique, has set to contribute to: (1)
sustainably reduce MMR, and U5MR; (2) sustainably improve the capability of 
DHOs and communities to respond to health needs; and (3) develop innovative 
approaches to inform policy and practices of SC and other partners. The main 
strategies are: (1) Partnership and Institutional Development for District Health 
System Strengthening through a Program Management Team (PMT) to
enhance SC-DHO partnership for program planning, monitoring and evaluation, 
capacity-building and sustainability of program activities, and (2) Strengthening 
community component of maternal and child health through support for
Community Health Teams (CHTs) that would monitor and support the activities 
of community health workers in the Regulados. 
The institutional capacity building approach is not novel in Mozambique and
many attempts have been tried at national, provincial and lately district level with 
somewhat uncertain results. However, capacity building at the community
level is unique in Mozambique and Nacala-Velha and Memba are the pilot
districts. In here, 46 regulados, geographic and traditional authority areas, were 
identified, with a beneficiary population of 134,229 reproductive age women and 
children under five. Contacts were made with the regulo and his advisor, the
apiamwene, to create a CHT that includes respectable members of the
community such as traditional healers, traditional birth attendants, religious
leaders, teachers, health activists and mothers. These 46 CHTs, totaling a total 
of 332 people with balanced gender participation, have received training to
provide the communities with the tools and skills they need to promote their own 
ongoing development, including leadership, organizational skills, health
education, behavior and information. CHT have been active since and are well 
on their way to effectively discuss and solve their health problems. As it was 
stated by the staff “they see change happening”. A spillover of this democratic 
approach is empowerment of women. Women now speak in public when before 
they would not dare, limiting themselves to silent listening during palestras or 
health talks. Now they are active, ask more questions and have started
demanding services from the district health authorities especially for more
traditional birth attendants and more FP services. They also attend more
preventative services than before. The understanding of the causes of disease is 
also gaining new levels, moving more and more away from supernatural to
controllable causation. 
Being able to communicate with Traditional Healers or curandeiros, the icons of 
traditional health care has been another highlight of the project. THs are very 
well regarded in the community and sometimes are the first to be contacted in 
case of disease. Their practices apparently improved in terms of sterilization
techniques and referral services, after training as members of CHTs. A
curandeiro approached the evaluation team and told us that a seriously ill patient 
48
he had referred promptly to a health care facility with rapid and difficult breathing 
recovered after modern treatment. Upon return to the regulado the mother went 
up to him and expressed her gratitude for having saved her child. His status was 
kept, a child is alive. He was very proud of it. 
V. Action Plan
The methodology used to elaborate the Action plan is described in the MTE 
Assessment Methodology (Appendix 5).
DDS directors and DPS representatives were invited to participate in the 
activities from the beginning of the evaluation. Both appointed somebody else 
and excused themselves due to being involved in local and provincial 
government activities, followed by preparation of the Provincial Health 
Coordination Counsel. NaV representative, the District Administrator, had 
participated before in EGPs and had a better understanding of the project. 
Memba representative was a curative nurse, Tecnico Medio de Saude, who did 
not know about the project. DPS representative, a member of the Provincial 
SMI, had not participated before either in any of the project joint activities and 
could only stay for one day of the nine working days of the evaluation.
It is worth mentioning that DDS directors took this evaluation as a SC activity. A 
better approach to capacity building might have been allowing them to substitute 
the project absent leadership, and to take active roles instead of letting them 
assume an observer role. They think they are expected to only “join” in. This 
approach can be surely tried in the final evaluation. Application of BCC 
strategies targeting communities and health workers should also be tried with 
DDS directors and other decision-maker levels. 
Given the above, the Action Plan MUST be completed using the same 
methodology of the MTE, with the participation of District Directors and their 
teams, including the administrator, the responsible for statistical information 
(NEP), the responsible for Community Health (either EPI, SMI or both), the 
responsible for the district budget, and other local partners such as MS. This is 
to ensure that the final Action Plan is their own, and not one made for them, and 
the availability of necessary and existing resources is better analyzed and 
planned. The Action Plan must not only express the activities needed to achieve 
the expected results at the end of the project but should be seen as another 
valuable chance to transfer capacity building and ensure sustainability. 
This Action Plan section includes:
- An analysis of the quantitative results of LQAS, seen in Appendex 15, 
49
- The Preliminary Action Plan. The plan was developed by using a 
modification of the Logic Framework where the CHALLENGES were the 
basis to brainstorm appropriate solutions and develop a set of activities 
leading to solve the challenges. (Appendix 14)
The final action plan developed by SC and the MOH will be translated into 
English and submitted to USAID.
Child Survival Grants Program Project Summary
The Strength Project 
DIP Submission: Apr-16, 2001
SC Mozambique
Field Contact Information:
First Name: Jeanne Koepsell
Address: Federacao Save the Children USA 
City: Nacala Porto 
State/Province: Nampula Province 
Zip/Postal Code:
Country Mozambique 
Telephone: 258-6-526-218 
Fax: 258-6-526-369 
E-mail: jkoepsel@teledata.mz 
Project Web Site:
Project Information:
Project 
Description:
The Save the Children Federation/USA (SC)STRENGTH project is in 
Nacala-a-Vehla and Memba Districts, in northern Mozambique. These 
are two of the most poor and inaccessible districts in Mozambique with 
an official population of 286,814 including a CS16 beneficiary 
population of 134,229 (including 47,324 children 0-59 months, 21,511 
births, and 65,394 women of reproductive age). The under five 
mortality rate of 315/1000 is almost 50% higher than the national 
average of 219/1000. The project responds to the needs and priorities of 
constituent communities, Ministry of Health and USAID/Mozambique; 
all seek reduced under five and maternal mortality and morbidity 
through a strengthened health system. Between July 2000 and March 
2001 baseline studies were conducted in preparation for detailed 
implementation planning. In February, 2001 a five day project planning 
meeting was held with district and provincial health office 
representatives, community leaders, and SC technical staff Project. The 
DHOs are the main implementers of the project interventions; the role 
of SC/US is capacity building, technical assistance, management 
support, and fiduciary responsibility. Major interventions support the 
MOH's district-level essential health package and include: 
Immunization (15%), Control of Malaria (15%), Pneumonia Case 
Management (15%), Control of Diarrheal Disease (10%), Maternal and 
Newborn Care (30%), and Child Spacing (15%). All interventions are 
consistent with MOH policy. The ultimate goals are to: (1) sustainably 
reduce MMR, and U5MR; (2) sustainably improve the capability of 
DHOs and communities to respond to their health needs; and (3) 
APPENDIX 1A
develop innovative approaches to inform policy and practices of SC and 
other development partners. The two major implementation strategies 
for each of the districts are: (1) Partnership and Institutional 
Development for District Health System Strengthening through: · 
Program Management Team (PMT) to enhance SC-DHO partnership 
for program planning, monitoring and evaluation, capacity-building and 
sustainability of program activities. · Support of additional staff for 
DHO to address the constraint of inadequate nursing staff in the two 
districts. The Nampula Province and SC will recruit three MCH nurses 
for Nacala-a-Velha and three nurses for Memba. The salaries of these 
nurses will be supported by the Strength Project for the first two years 
of the program. The Nampula Province PHO will take over the salary 
payment in the third year. The MCH nurses are essential for increasing 
the number of mobile brigades outreach conducted in a month, 
especially in terms of prenatal care and family planning services. · 
Upgrade emergency obstetric health facilities and services. The two CS￾16 districts do not have a comprehensive emergency obstetric care 
(CEOC) facility. Women needing CEOC services are referred to the 
neighboring districts of Monapo and Nacala Porto. CS-16 will work 
with Monapo and Nacala Porto DHOs and hospital Directors to 
streamline the referral systems, as well as upgrade the maternity wing 
of their hospitals. (2) Strengthening community component of maternal 
and child health through: · Support for Community Health Teams 
(CHTs) that would monitor and support the activities of community 
health workers in the Regulados. · Support of outreach services by 
Mobile Brigades. · Facilitation of community Alarm and transport 
(A&T) · Provision of bicycle ambulances as part of A&T · Production 
and promotion of clean birth kits. · Training of community-based 
providers (APEs and socorristas) · Training of Activistas and TBAs · 
Training and dialogue with traditional healers · Support of Community 
mobilization for responsive and appropriate behavior change 
communication (BCC) for caregivers, community leaders, and male and 
female decision makers. 
Partners:
SC will collaborate with other NGOs working in the area including the 
People to People Development Association (ADPP), Grupo Africano de 
Suecia (GAS), and AMETRAMO the professional organization of 
traditional healers who will provide expertise in training with traditional 
healers. SC will work most closely with its current partners, the District 
Health Offices, in close collaboration with the Provincial Health Office 
and the communities. 
Project 
Location:
SC will work in all communities of Nacala-a-Velha and Memba 
Districts as well as the referral hospitals in Nacala Porto and Monapo. 
Grant Funding Information:
USAID Funding:(US $) $ 700,000 PVO match:(US $) $ 233,000
General Strategies Planned:
Private Sector Involvement
Advocacy on Health Policy
Strengthen Decentralized Health System
M&E Assessment Strategies:
KPC Survey
Health Facility Assessment
Organizational Capacity Assessment with Local Partners
Organizational Capacity Assessment for your own PVO
Participatory Rapid Appraisal
Lot Quality Assurance Sampling
Community-based Monitoring Techniques
Participatory Evaluation Techniques (for mid-term or final evaluation) 
Behavior Change & Communication (BCC) Strategies:
Interpersonal Communication
Peer Communication
Support Groups 
Capacity Building Targets Planned:
PVO Non-Govt 
Partners
Other Private 
Sector Govt Community
US HQ (CS 
unit)
CS Project 
Team 
(None 
Selected) 
Traditional 
Healers
Dist. Health 
System
Health 
Facility Staff
Other CBOs
CHWs 
Interventions:
Immunization 15 %
** IMCI Integration
** HF Training
*** Classic 6 Vaccines
*** Vitamin A
*** Surveillance
*** Cold Chain Strengthening
*** Injection Safety
Acute Respiratory Infection 15 %
** IMCI Integration
** CHW Training
** HF Training
*** Pneumonia Case Management
*** Case Mngmnt./Counseling
*** Recognition of ARI Danger Signs
Control of Diarrheal Diseases 10 %
** IMCI Integration
** CHW Training
** HF Training
*** Water/Sanitation
*** Hand Washing
*** ORS/Home Fluids
*** Feeding/Breastfeeding
*** Care Seeking
*** Case Mngmnt./Counseling
Malaria 15 %
** IMCI Integration
** CHW Training
** HF Training
*** Training in Malaria CM
*** Adequate Supply of Malarial Drug
*** Access to providers and drugs
*** Antenatal Prevention/Treatment
*** ITN (Bednets)
*** Care Seeking, Recognition, Compliance
Maternal & Newborn Care 30 %
** IMCI Integration
** CHW Training
** HF Training
*** Emergency Obstetrical Care
*** Neonatal Tetanus
*** Recognition of Danger signs
*** Newborn Care
*** Postpartum Care
*** Delay 1st preg./Child Spacing
*** Integration with Iron/Folate
*** Normal Delivery Care
*** Birth Plans
*** STI Treatment w/Antenat. Visit
Child Spacing 15 %
** CHW Training
** HF Training
*** Child Spacing Promotion
*** Pre/Post Natal Services Integration
Target Beneficiaries:
Type Number
infants (0-11 months): 7,170 
12-23 month old children: 10,038
24-59 month old children: 30,116
0-59 month old children: 47,324
Women 15-49: 65,394
Estimated Number of Births: 21,511
Beneficiary Residence:
Urban/Peri-Urban % Rural %
25% 75% 
APPENDIX 1B
Table 1.8 Training Plan
Trainees Number of Trainees; Type(s) of training # days Trainer
Traditional 
Healers
60 -- 20-NaVelha; 40-Memba 
All TH trainings in groups of 20 people, carried 
out by district:
· Diarrhea and ARI management/referral; 
diarrhea prevention; EPI.
3 SC/DHO
· EPI Mobilization and IEC techniques. 1 SC/DHO
· Pregnancy-related danger signs; referral of 
women with obstructed labor to HF; early/ 
exclusive BF promotion.
CHTs 49 -- 14-NaVelha; 35-Memba
Each CHT has approximately 10 members; 3 
members from each CHT attend trainings. 
Seven CHTs (21 people) per training 
· Community HIS; diarrhea prevention; BCC; 
diarrhea/ARI/malaria recognition and case 
management (HAF, care-seeking behavior, 
especially for danger signs); promotion of 
early BF; discouragement of useless 
activities such as “malaria control through 
brush abatement”, use of talks, theater and 
songs. 
5 SC/DHO
· ANC mobilization; appropriate behavior for 
birth/postpartum; promotion of individual 
birth plans and community alarm and 
transport plans. Theater on danger signs.
5 SC/DHO
· Exclusive BF promotion; reinforce HIS. 1 SC/DHO
· Community mobilization; developing care￾seeking and transport plans for pregnant 
women (more detail than first A&T).
1 SC/DHO
· Community mobilization/IEC/counseling for 
child spacing (drama, song).
1 SC/DHO
· Environmental health BCC (drama). 1 SC/DHO
APEs/
Socorristas
28 -- 14-NaVelha; 14-Memba
· IEC. 2 SC/DHO
· Pneumonia and malaria DX/referral. 
Diarrhea case management (ORT/HAF, 
referral), prevention; counseling techniques 
based on GATHER; how to use simplified 
IMCI flowcharts
8 IMCI trainers
Trainees Number of Trainees; Type(s) of training # days Trainer
IMCI flowcharts
TBAs 77 new – 36-NaVelha; 37-Memba 
To receive refresher training as well (see below)
MOH curriculum (21 days) + 
· Recognition of diarrhea, dehydration and 
dysentery; use of ORT/HAF; recognition of 
danger signs; promotion of early/exclusive 
BF; promotion of birth plans and birth kits.
25 TBA trainers 
(SC/DHO)
75 current – 35-NaVelha; 40-Memba
These plus the 88 new to be refresher trained, 
as explained below.
MOH curriculum (10 days) +
· Promotion of birth plans/ birth kits; FP 
counseling techniques.
12 TBA trainers 
(SC/DHO)
· Community mobilization/IEC for EPI/Mobile 
Brigades.
1 TBA trainers 
(SC/DHO)
· Malaria case management (recognition and 
referral).
1 TBA trainers 
(SC/DHO)
· IEC/counseling skills for malaria/diarrhea 
prevention; malaria/diarrhea/pneumonia 
case management.
1 TBA trainers 
(SC/DHO)
SC 
Lead Trainer
Curriculum development (in-service) 15 Gaza 
consultant
SC staff 10, including candidates for SC openings
· TOT-community modules, how to prepare 
dramas, songs.
10 Lead Trainer; 
Gaza 
consultant
PMT PMT composed of 1 PHO representative, 4 
DHO directors, 2 hospital directors (Nacala 
Porto and Monapo), SC program manager and 
SC project coordinator. Meets quarterly for 
several days.
· Use of HIS and data collection for planning.
· Logistics related to how to improve supply of 
drug kits to APEs.
1 Program 
manager 
Project 
coordinator, 
PHO
DHO 
Supervisors
20 -- 10 Nacala-a-Velha, 10 Memba 
· Monitoring and support-a-vision (repeated 
several times).
1 Project 
coordinator, 
Trainees Number of Trainees; Type(s) of training # days Trainer
several times). coordinator, 
PHO
DHO 
Mobile 
brigade
Members
20- Nacala-a-Velha 10; Memba 10
· Strengthen logistical and resource 
management; cold chain; infection control; 
prenatal/postpartum care; IEC training .
3 Lead Trainer, 
PHO
· Environmental health; how to do theater. 3 District 
trainers
DHO 
Maternity 
ward staff
10 MCH nurses or elementary midwives; all four 
districts.
· BCC for TT coverage, supervision of TBAs 
linked to US; pre / post natal counseling and 
care; promotion of early and exclusive BF 
(inc colostrums).
3 Lead Trainer, 
PHO
· FP – enhance knowledge and counseling 
skills.
3 Lead Trainer, 
PHO
· Swift appropriate care-seeking behavior 
especially for MNC danger signs; 
supervision and support of quality obstetric 
care, inc. life saving skills.
3 Lead Trainer, 
PHO
DHO 
Administration
10 facility leaders/administration/pharmacists
· Strengthen logistical and resource 
management; supplies and equipment 
maintenance; emphasis on contraceptives 
and vaccines.
3 Lead Trainer, 
PHO
DHO
TBA Trainers
12 – 3 from each district
TOT 25 Lead Trainer, 
PHO
IMCI Trainers 6 – Nacala-a-Velha 3; Memba 3 22 Assistant
· IMCI basic training; TOT coordinator, 
PHO
DHO staff 40 – Nacala-a-Velha 20; Memba 20
· IMCI protocol 11 IMCI trainers
APPENDIX 1C
Technical Assistance Plan
Table 2.3 Technical Assistance Plan
Type of Technical Assistance Consultant When
KPC 2000 Survey Jorge Bardalez, Sylvi Hill December 2000 -
February 2001
Health Facility Assessment Sylvi Hill February – March 
2001
Rapid Rural Appraisal Sylvi Hill January -
February 2001
Detailed Implementation Plan Eric Swedberg; Joseph de 
Graft-Johnson
February-March 
2001
Development of IMCI training manuals JSI As soon as 
prepared --
November 2001
Development of IMCI supervisory 
checklist
JSI As soon as 
prepared --
November 2001
Development of IMCI BCC materials JSI As soon as 
prepared --
November 2001
Curricula Development Intern, SC/Gaza staff March, June-July 
2001
Production of Clean Birth Kits Joseph de Graft-Johnson October￾November 2001
Marketing of Birth Kits Suzanne Smith, SC December 2001
Lot Quality Assurance Sampling Joseph de Graft-Johnson April 2002
Midterm Evaluation Eric Swedberg April 2002
Final Evaluation Eric Swedberg; Joseph de 
Graft-Johnson
August 2003
APPENDIX 1D
Table 2.1 Human Resources for Project Activities
Worker type Agency P/V Duties Time in 
CS (FTE)
Field Office Director SC P Overall guidance, strategic 
review, USAID and donor 
relations
.15
Deputy Field Office 
Director
SC P Oversight of administrative 
management
.10
Finance Manager SC P Fiscal oversight and financial 
reporting
.05
Program Manager SC P Oversees program 
implementation and 
management, technical content 
of training; supervises project 
coordinator, Lead Trainer and 
data officer; links with other 
sectors; relates with partners on 
the provincial level; and 
prepares documents.
.25
Project Coordinator (to be 
hired)
SC P Oversees day-to-day program 
implementation and 
management, develops and 
assures implementation of HIS, 
supervises Lead Trainer and 
data officer; relates with 
partners.
1.0
Lead Trainer SC P Prepares plan for all trainings; 
uses existing curricula or writes 
new curricula; prepares 
supervision schema for each 
group of trainees; supervises 
training teams with the DHO with 
emphasis on the technical 
quality of training; and liaises 
with DHO to develop supervisory 
capacity regarding training.
1.0
District trainers (2) SC P TOT/ supervision of DHO staff to 
train TBAs/TH/ CHT.
2.00
Monitoring and Evaluation 
specialist
SC P Responsible for HIS data 
collection, data entry, analysis 
and documentation; training 
community members to use data 
collection system
1.0
Driver (2) SC P Drive DHO and SC staff to field 2.0
Worker type Agency P/V Duties Time in 
CS (FTE)
for Mobile Brigades, supervision 
and other field activities
MCH nurses (10) DHO (6 
paid by 
SC)
P Prepares and implements 
TBA/TH/ CHT training using 
prepared curriculum; supervises 
TBAs/TH/ CHTs using prepared 
form. Antenatal/ postpartum 
care in Mobile Brigades.
10.0
DHO supervisors (20) DHO P Provide “support-a-vision to 
staff”; to be trained by project
10.0
DHO Directors (4) DHO P Provide leadership and 
supervision
2.0
Table 1: CS-16 Progress Towards Achieving End-of-Program Objectives
 
#
End-of-Program Objectives/Indicators Baseline Mid-term
1 55% of children 12-23 months will be fully immunized by age 12 months
baseline.
N-32% M-34% N-11% M-13% T-12%
2 80% of mothers with children < 24 months with fever in previous 2 weeks
sought care within 48 hours 
N-57% M-66% N-30% M-34% T-32%
3 85% of mothers with children < 24 months with cough and difficult/rapid
breathing in previous 2 weeks sought care within 48 hours 
N-64% M-73% N-54% M-67% T-61%
4 80% of mothers with children < 24 months with diarrhea in previous two weeks 
who managed the diarrhea with ORT (ORS or community-based oral
rehydration fluids such as watery porridge) 
N-66% M-67% N-67% M-62% T-64%
5 Percent of women with children < 24 months who reported knowing at least
two ways of preventing diarrhea
N/A N-56% M-50% T-53%
6 Percent of women with children < 24 months who reported knowing 2 IMCI
danger signs
N/A N-86% M-73% T-79%
7 50% of births attended by trained personnel N-34% M-38% N-51% M-28% T-39%
8 85% of women have at least two antenatal visits with trained health personnel
during their last pregancy 
N-77% M-74% N-74% M-55% T-64%
9 80% of women with children < 24 months will have received at least 2 doses of 
tetanus toxoid during their last pregnancy
N-30% M-62% N-74% M-42% T-57%
10 80% of women with children < 24 months wiill know at least 3 pregnancy￾related danger signs 
N-18% M-44% N-95% M-57% T-75%
11 10% of women will have had a birthplan (3 of 5 components) during their last 
pregnancy.
N-0% M-0% N-2% M-5% T-3%
12 25% of women with children <24 months who do not wish to have another child 
in the next two years will be using a modern method of contraception 
N-18% M-15% N-18% M-12% T-15%
13 50% of women with children <24 months will know at least two modern
methods for childspacing 
N-24% M-37% N-28% M-23% T-25%
14 Percent of women with children < 24 months who reported giving colostrum to 
their children
N/A N-79% M-70% T-74%
15 Percent of women with children < 24 months who reported initiating
breastfeeding for their last child within 8 hours of birth
N/A N-86% M-75% T-80%
16 Percent of women with children <= 6 months who reported giving their
children only breastmilk 
N/A N-30% M-43% T-37%
 
APPENDIX 2
APPENDIX 3
Nacala Velha
Regulado/community 1st visit 2nd visit
Jangane 20-Mar
Micolene 21-Mar
Motia 25-Mar
Muepane 26-Mar
Mutepane 27-Mar
? 14-May
Mangani 28-May
Muetarzi 29-May
Napala 30-May
Nahipa 4-Jun
GerGer 6-Jun
Nacololo 11-Jun
Mepuhula 12-Jun
Marremano 13-Jun
Nantar 18-Jun
Jamarupe 19-Jun
Merunguze 20-Jun
Rassine 26-Jun
Namalala 27-Jun
Memba
Mazua 13-Mar
Tropene 3-Apr
Ecopo 16-Apr
Simuria 18-Apr
Mazua-Sede 23-Apr
Cava 25-Apr 10-Jun
Muipia 29-Apr 13-Jun
Napila 30-Apr 18-Jun
Metupa 4-Jun
Nhaje 6-Jun
Caleia 11-Jun
Miroge 20-Jun
Baixo Pinda 26-Jun
Mangane 27-Jun
Mobile Brigade Sites of Operation for January-June 2002
APPENDIX 4
SC STAFF TRAINING
Name/post Background training Short-term and on-the-job training
Adelia
Lead trainer
-3 years of SMI training 
-10 years of experience as SMI 
responsible in Xai-Xai
-Advanced course in TOT 1997
-TOT for activistas
-Computing
-Programming
-Curricula elaboration
-Community auscultation of social 
problems
Adelina
Trainer
(recent hire) 
-2 years of training as an Elementary 
nurse
-6 months of First Aid training 
-TOT for CLCS training 
-Clean delivery 
Maria 
M&E specialist
-3 months of Accounting training 
-TOT for activistas
-Computing
-Clean delivery
-Curricula elaboration
-Nutrition and Vit A supply
-Community auscultation of social 
problems
Cristina
Trainer 
-3 years of SMI training -Computing 
-Curricula elaboration
-TOT for CLCS training
-Reproductive Health
Florinda 
Trainer
-3 years of SMI training 
-1 year experience in NGO
-TOT for TBAs
-TOT for activistas
-Community auscultation of social 
problems
-Computing (incomplete)
-Curricula elaboration
-TOT for CLCS training
-Essential Obstetric Care 
-Motorbike drivers ed
-TOT for Theater Training 
Projecto Força Avaliaçao de Meio-Termo 16-30 Setembro 2002
PROJECTO FORÇA
PROJECTO CONJUNTO DO
SAVE THE CHILDREN COM OS DISTRITOS DE 
MEMBA E NACALA VELHA
AVALIAÇAO DE MEIO-TERMO DO PROJECTO
METODOLOGIA DA AVALIACAO
A. Caracteristicas que norteiam o projecto
1. Trabalho de grupo
2. Interactivo e participativo
3. Formativo (reforcar a capacitacao, sustentatibilidade)
B. Composicao da Equipa de Avaliacao
Externos: 
1. Ana Paula MD, MPH; 
2. Eric Swedberg MPH;
3. Joseph de Graft-Johnson MD, DrPH 
Internos: Tecnicos de Saude: 
1. Amilton L Alberto -DDS Memba,
2. Alexandre Agostinho -DDS Nacala Velha ; 
3. Maria Adelia
4. Cristina Cardoso
5. Florinda Francisco
6. Maria Manicuela
7. Adelina Xavier
Apoio: 
1. Ana Paula Cortez –tradutora
2. Izidine Omar -tradutor
3. 2 Motoristas
4. M. Lucia Alexandre- secretaria; 
5. Jolly Muxahua- Logistica; 
6. Fatima e Saraiva -servicos
C. Objectivos da Avaliacao
1. Avaliar a meia-vida do projecto
2. Verificar os indicacoes e metas do projecto e resultados esperados 
nesta altura – LQAS (quantitativo)
3. Avaliar a utilizacao das estrategias definidas e as mudancas 
esperadas no comportamento-questionairo qualitativo
4. Redireccionar o projecto se necessario
5. Elaborar e apresentar plano de accao preliminar - Este devera ser 
completado o mais rapido possivel 
APPENDIX 5
Projecto Força Avaliaçao de Meio-Termo 16-30 Setembro 2002
D. Metodo de trabalho
1. Analise conjunta do LQAS e relatorios dos distritos
2. Elaboracao de questionarios appopriados: CLCSs, Maes, PT, 
Curandeiros, Activistas, Trabalhadores de Saude
3. Seleccao de amostra: 6 regulados em um total de 46, 1 regulado/PA: 
Olaika, Morrola, Mebile, Epuite em Memba e Mezope e Rojola em Nacala 
Velha
4. 2 equipas: 5 elementos para NV e 6 elementos para Memba. 
Lider do grupo – entrevista aos directors e DDS juntando-se mais tarde ao 
trabalho de grupo
5. 1 dia de trabalho na comunidade em cada regulado – Notas escritas de 
todos os questionarios
E. Analise dos dados
1. Trabalho grupo e plenaria - analise dos dados dos inqueritos aos 
regulados, identificando os aspectos positivos e desafios
2. Sessao plenaria para identificacao conjunta das solucoes 
apropriadas aos recursos existentes
3. Sessao plenaria para elaboracao de plano de accao preliminar 
dirigido a ultrapassar os desafios encontrados
4. Apresentacao publica dos resultados
1
APPENDIX 7
Qualitative Questionnaire
QUESTIONÁRIOS PARA O CLCs
1. As CLCs tem tido encontros regulares?
2. Quantas vezes as CLCs se reuniu durante o último ano?
3. O que trataram neste(s) encontro(s)?
4. Qual o Plano de trabalho que vocês tem? Que é que já fizeram?
5. Que problemas encontraram?
6. Como fazem o registo de informação de Saúde Comunidade?
7. Qual o propósito de fazer o registo?
8. Qual é a relação existente entre as DDS e as CLCs?
9. Contar as mulheres do CLCS (perguntar se falta algum membro). Contar 
todas as pessoas presentes do CLCS
10.Qual é o papel / responsabilidade de cada membro?
11.Qual e o conselho que o CLCS dá para as mulheres gravidas?
12.O que que CLCS faz (ou pode fazer) para aumentar os partos assistidos por 
pessoal treinado?
13.O que é que os CLCs recomendam a uma mulher grávida no sentido de 
preparar o seu Plano de parto?
14.Por acaso tem um sistema de ALARME e TRANSPORTE para as gravidas? 
Perguntar se ainda existe as Bicicletas? Como é que se comunicam entre o 
doente e o responsável de transporte? Como é que os CLCs fazem para 
sustentar o seu transporte e continuar a utilizar?
15.O que é que os CLCs fazem para que as mamas conheçam os metódos do 
P.F?
16.Que fazem para aumentar as crianças vacinadas?
17.Quando foi a última vez que tiveram brigada móvel - BM?
2
18.Como tem sido a participação dos membros da CLCS?
 
QUESTIONÁRIO PARA AS MÃES
PARTO E PRE-NATAL
1. Perguntar as mães sobre o que preparam para o seu parto?
2. Porque não chamam a PT para assistir o parto?
3. O que podem fazer para aumentar a utilização das PT?
4. Já ouviu a falar-se dum sistema de alarme e transporte?
5. Tem benefíciado do sistema de alarme e transporte da sua comunidade?
6. Como são atendidas nas consultas Pré-Natais?
7. Já ouviram falar de PF? Que metódos ouviram falar? Porque não usam?
8. Quem e que vos falou dos metódos?
9. O que é que a comunidade pensa acerca do PF?
10.Qual é o intervalo apropriado entre os nascimentos?
11.O que pode ser feito para o aumentar o uso de PF?
DIARREIA:
1.1 .O que você faz em casa quando a sua criança apanha diarreia? Onde 
apanha o SRO?
1.2 . Como e que se pode prevenir a diarreia?
1.3 . Quando é que leva a sua criança imediatamente para P.S. / Centro de 
Saúde? (Quais são os sinais graves da diarreia?)
1.4 . O que não se deve dar quando a criança está com diarreia?
3
IRA/PN
2.1. Como reconhecem os sinais de IRA?
2.2. O que se faz quando a sua criança tem doença respiratórias?
2.3. Quando é que leva imediatamente ao P.S. / Centro de Saúde?
2.4. Como trata as doenças respiratórias em casa? O que não deve dar a 
criança doente de IRA?
2.5. Onde apanha o tratamento?
2.6. Quais são os sinais graves da penumonia (IRA)?
FEBRE:
3.1 O que faz quando a sua criança tem febre?
3.2 Quais os sinais e Sintomas da Malária na criança?
3.3 Como se transmite a Malária?
3.4 Como se pode prevenir a malaria?
3.5 O que fazer quando a criança tem febres altas? ( corpo muito quente )?
VACINAÇÃO:
4.1 Para que serve a vacina?
4.2 Quantas vezes levou a sua criança a Vacinação?
4.3 O que acontece quando a criança não apanha vacina?
MUDANÇA DE COMPORTAMENTO
5.1 Nós ouvimos que há mães que levam as suas crianças doentes com febre 
ao hospital mas outras não. Porque as outras mães não levam ao os filhos 
com febre ao hospital?
5.2 Nós ouvimos que outras mães não levam a sua criança a vacinação, 
Porque?
4
5.3 Muitas mães quando a criança de febre porque não levam logo ao 
hospital? Porque?
5.4 Muitas mães quando a criança tem doença respiratória porque não levam 
imediatamente ao Hospital?
5.5 Ouvimos dizer que quando as crianças tem diarreia, muitas mães não dão 
água, comida, mama etc.? Porque?
5.6 Quando foi ultima vez que mãe ouviu falar sobre Saúde?
5.7 Que assunto se falou?
5.8 Quem e que falou e que forma (método) e que usou
QUESTIONARIO PARA CURANDEIROS
1. Quais as doenças em mulheres e crianças que acha que tem de transferir 
para as unidades sanitárias? Que sinais?
2. Qual o material que utiliza para vacinar os doentes?
3. Por exemplo: uma lâmina que serve para vacinar quantas pessoas? 
4. Como limpa o material de vacinar ? e que mais ?
5. Como faz quando recebe criança com diarreia? 
6. E se for criança com dificuldade de respirar?
QUESTIONARIO PARA PARTEIRAS TRADICIONAIS
1. Quantos partos assistiu no mes passado?
2. Destes quantos partos foram complicados?
3. O que fez nesses casos?
5
4. Que dificuldados encontra no trabalho do dia a dia?
5. Qual e a sua relacao de trabalho com a Parteira Elementar?
6. Como laqueiam o cordao?
7. Onde arranjam material para o corte do cordao?
8. Quando decide levar uma mulher gravida ao hospital?
9. Quando decide levar uma mulher em parto para o hospital?
10.Quando decide levar uma mulher pos-parto para o hospital?
11.Como ajuda a mulher que temproblema de parto a chegar ate ao hospital?
12.Tem ficha para registar: nascimentos, mortes, etc…
13.O que fazem com os dados desse registo.
14. O que acontece na comunidade quando morre uma mulher de gravidez 
ou parto?
QUESTIONARIOS PARA ACTIVISTAS
1. Comprende o conceito de mudanca de comportamento?
2. Diga as menssagens chave da 
a. Malaria (fever); 
b. IRA 
c. Diarrhea
3. Que material utiliza para a educacao dos seus pacientes?
4. Recebeu treino sobre tecnicas de mobilizacao da comunidade?
5. Que maneira faz para aumentar a participacao dos participantes da 
palestras?
6. Qual e o seu calendario de trabalho em cada semana?
7. Em que dias faz as palestra visitas domiciliarias?
6
8. O que voce faz depois de receber treinamento da DDS e/ou SC?
9. Que informacao (dados) e’ que voce regista? Onde regista? O que faz 
com esses dados?
10.Acha que o seu trabalho e’ effectivo?
QUESTIONARIO PARA OS TÉCNICO DE SAÚDE: SMI/CONSULTA DE 
CRIANÇAS
1. Recebeu treino sobre AIDI 
2. Quando recebeu a ultima supervisao sobre AIDI?
3. O treinamento ajudou a melhorar o seu trabalho? Como?
4. No mes passado quantos contactos teve com APE, PT, CLCS?
5. Porque muitas as mulheres que vao a consulta prenatal nao recebem 
VAT?
6. Porque que as vacinacoes estao tao baixas?
7. Porque as mulheres nao usam o PF
8. Que maneiras pode fazer para aumentar a numero de mulheres que 
usam PF?
9. Tem cloroquina? Para quanto tempo? Ultima rotura?
10.Tem antibioticos? Para quanto tempo? Ultima rotura
11. Tem soros IV? Para quanto tempo? Ultima rotura?
12. Quais sao os materiais que usa para a educacao e aconselhamento de 
pacientes para febre, IRA, diarrea, PF,e sinais de perigo da gravidez? Pode 
mostrar?
7
QUESTIONARIOS PARA TRABALHADORES COMUNITÁRIOS DE SAÚDE: 
APE/SOCORRISTAS
1. Sabe sobre o sistema de Alarme e Transporte da comunidade?
2. Como e que envia doentes do PS para o Centro ou Hospital?
3. Como trata um caso de febre?
4. Que aprendeu durante o treinamento?
5. Que conselhos e que voce da a mae da crianca doente? 
6. Que e que faz em caso de crianca com respiracao rapida?
Questionario para EGP, DDS e SC Nacala Office sobre 
Capacitacao Institucional (distrito) e da Comunidade e Sustentabilidade 
do Projecto Forca
EGP
1. Tem plano annual de trabalho com actividades, responsabilidades, recursos, 
calendario e avaliacao?
2. Os recursos sao usados apropriadamente? Observar o plano
3. Tem plano mensal de trabalho?
4. Podemos ver os relatorios das ultimas reunioes do EGD
5. Algum destes relatorios teve um impacto a nivel da provincia ou do distrito? 
Mudar a politica de saude ou certas actividades?
6. Os relatorios mostram o uso do HIS ou decisoes tomadas tomadas com base 
nesses dados?
7. Pedir dados estatisticos referentes aos indicadores do Projecto para comparacao
8. Plano de supervisao aos CLCS: visitas realizadas/visitas programadas
9. Fazem uso dos dados dos CLCS?
10. Apresentacoes por escrito ou oral das actividades a DPS (partilhar as licoes 
aprendidas)
11. O que fazer para manter o trabalho dos CLCS por muito tempo 
8
DDS e PAV
1. Treinamentos executados
- Numero
- Participantes
- Resultados dos testes
- Curricula (topicos, objectivos, sessoes, metodologia, material didatico e 
outro, testes) fonte e ano da ultima revisao.
- Os treinos incluem o SIS?
- Participacao do SC, relatorios de actividades conjuntas
2. Uso do SI comunitario durante as visitas? O que fizeram? Como fizeram
3. Ver o plano annual sobre a parte da supervisao e avaliacao (se foi programada, se 
tem recurso alocados, se foi realizada, problemas encontrados)
4. Ver o plano sobre a parte das brigades moveis (o mesmo)
5. Informacao sobre vacinas e cadeia de frio
6. Mostrar os dados recolhidos na Estatistica e os dados do LQAS e obter feedback 
e explicacoes
7. Medidas tomadas para resolver os problemas
SC Nacala
1. Staff senior tem plano annual e mensal de trabalho. Baseado em que? pode 
mostrar documentos? Compreendem as actividades que tem que desenvolver?
2. Participou de encontros distritais e provinciais para explicar o trabalho realizado, 
as licoes aprendidas e as dificuldades?
3. Estes encontros tiveram algum impacto nas actividades da DDS ou DPS?
4. Podemos ver os relatorios destes encontros?
5. Plano de treinamento (completo – ver acima)
a. Que modulos utilizam? Ultima revisao?
6. Acompanhamento das actividades de treinamento? Porque que nao?
7. Quantas reunioes como ontem fizeram com os distritos?
8. Que formacao receberam para cumprir com as vossas responsabilidades?
9. Qual e a situacao dos computadores? E do material para as maternidades? E das 
bicicletas?
10. Plano de M&E do projecto?
11. Quais sao as actividades de monitorizacao da Capacitacao institucional do DDS ? 
E da comunidade?
12. Porque que tem pouco conhecimento da situacao em Memba?
13. Quais sao as estrategias que deram mais resultado (capacitacao, sustentabilidade, 
mudanca do comportamento e comunicacao)? Como? Porque? 
9
Parceiros 
1. Quais sao as suas necessidades de reforco e capacitacao?
2. Que ajuda recebeu do SC nesse sentido
3. O trablho da su aorganizacao modificou-se devido a capacitacao dada ou contato 
com SC?
Project Manager (over the phone)
1) What would you consider to be the main accomplishments of the 
program so far?
2) Regarding program objectives:
Roughly LQAS results showed that for the 13 indicators of the 6 program 
intervention areas in relation to the baseline data:
- 3 (vacinacao, cuidados a febre em 48 h, 2 VAT na ultima gravidez) 
showed great reduction
- 2 (cuidados a respiracao rapida em 48h, conhecer metodos de PF) 
showed slight reduction
- 1 (2 visitas de ANC) showed slight increase
- 3 (manejamento da diarreia, parto assistido por agent treiando, usar 
metodo de PF) showed no impact
- 2 (2 metodos prevencao da diarreia, 2 sinais de perigo da AIDI) had no 
baseline data and were 53% (reasonable) and 79% (high) respectively
- 2 (sinais de perigo na gravidez e plano de parto) showed a sizable 
increase
What are the reasons for such results? Please elaborate
3) What would you say are the main constraints/problems of the project? 
Please explain how those problems hindered the development of the 
program.
5) Regarding the cross cutting approaches:
- community mobilization
CLCS are organized in most areas selected to the evaluation (we still have 2 
more to visit), and they seem to function in a monthly schedule and keeping a 
varied representation of the community leaders. However, they still cannot use 
10
data to make decisions. They seem to have a good relationship with SC staff, but 
a difficult one with some MOH staff from the health unit of reference. They do not 
have a relationship with the district or vice-versa. What has been your 
experience with CLCS and could you add some insight to the above?
- behavior change communication
Activistas are still very active in offering palestras and education. So have 
become some TBAs and healers. However their answer to why some people 
have been resistant to change their behavior, focused on insisting on palestras 
(this year they said there are more change than last year and last year there was 
more than the year before). When probed further they came up with some 
enforcement from the CLCS. What are the guidelines for the training of CLCS 
members on this issue?
-capacity building (DDS, EGPs, partners, other MOH staff, SC staff)
The staff at SC could not enumerate the objectives of the program and could not 
translate to me and list the “cross cutting approaches”. DDS Memba had some 
project documents (old) archived, a sign that they were not being used. He did 
not understand the core of the project beyond participating in the meetings. 
Nacala Velha director has been hard to reach. What were some of the 
problems in this area?
The work plan is heavy on training and addresses little supervision. Adelia has 
done supervision of 3 trainings this year. Memba director did not know what 
CLCS were, neither that he (with or without SC) should be doing supervision and 
improving their relationship. This does not also exist for NVelha. We know that 
training without follow-up might not yield the desired results. Why its has been 
hard to plan for follow-up?
Adelia is not as knowledgeable about Memba as she is about Nacala Velha. 
Why?
-program sustainability
Activities within the community might go on, in result of the CLCS training and 
work. However activities within DDS seem to be linked still to having a vehicle 
from SC to go on. This is very much needed and appreciated especially because 
it covers a wide range of activities that otherwise they could not cover. Are there 
any alternatives that you have tried to address the sustainability of the actions of 
this project, regarding transport or other. With your knowledge of the field, 
what would be necessary steps to achieve sustainability?
11
Regarding program management:
- I could not find a supervision plan and an M&E plan. The team says they 
have not started supervision yet as that would be the focus of this part of the 
project. Could you elaborate on this please? In the trimester work plan (Aug￾Sep) there are two activities named supervision to PTAs but they really mean 
training. What were/are the challenges of supervision?
- Maria says she has received no training to prepare a monitoring plan and 
the graphs she prepares have many faults; they are filled with bars, are difficult to 
understand, are not well labeled etc and are not identified in terms of period the 
data refers to. What are the reasons for such?
- The minutes of the EGP (PMT) include Bridges and Strength projects, as 
you were managing both. The Strength activities got a bit masked that way. The 
identification of the problems is very general in most, so are the 
recommendations. Data is not used in a fashion that could lead to decision 
making. Could you tell us about the challenges of these meetings?
- The computers to both districts arrived about 2 months ago. As a matter 
of fact Memba computer is still locked up as nobody was trained to use it and the 
plan is to train the typist so he could type the letters of DDS. Could you tell why 
the computers were so late? What was agreed in terms of training DDS 
people (who, when, for what?)
- Equipment (including two-way radios and other) and materials for 
maternities and Reference Hospitals of Nacala-Porto and Monapo should 
have been purchased by Q 5-6 and have not been purchased yet. What are 
the reasons for the delay?
- Bicycle-Ambulances for Memba district have not been purchase yet 
also. Why?
- What are the sources of the different training modules? When were 
they revised last? For the interventions? For CLCS? For BCC 
methodologies?
-What was the field office strategy in terms of budget management 
and involvement of local staff, Adelia for example?
-What is the status of birth kits?
8) Please list your recommendations:
- for the program
-for the new director
APPENDIX 8
List of all individuals contacted and/or interviewed
Mothers
Safina Morola, Gracinda João, Maria Ussene, Juliana Mocassi, Madelena Adriano, Aurora 
Nazário, Celestina Eugénio,Filomena Adriano, Laura Mussa,Laura Jaime, 
Margarida Sical, Cristina Alupai, Fátima Buana, Aquina Massira, Marieta António, Atija Máquina, 
Fátima Martinho, Marília Fernandes Pedro, Rosa Niqueri, Angelina Hamede, Cristina 
Omar,Celestina Manuel, Esménia Pedro, Julieta Victor, Madelena Basílio, Gracinda Amisse, 
Elisa Nimorele, Carlota Mussagi, Aída Victorino.
Regulos e Apiamwenes
Rojola Amade, Régulo Rojola;Helena Amade, Apiamwene Rojola; Nússura Waruma, Régulo 
Epuite; Paulo Tomás, Régulo Olaika; Juliana Tomás, Apiamwene Olaika; Mebile Cebola, 
Régulo Mebile
THs
Augusto Molde, Curandeiro Rojola; António Sancula, Curandeiro Rojola; Agostinho Mariano; 
António Culete; Rosário Ismael; Caetano Maputa; Kanaxerehe Ibraimo.
TBAs 
Madelena Carreiro, Rojola; Fátima Abacar, Rojola; Margarida Rachide, Rojola; Maria Waquice, 
Rojola; Maria Nalelane, Epuite; Joana Tiquireria, Olaika; Menina Artur, Salina ( NaV ); Laurentina 
Ruhela, Filomena Gomes,Filomena Kavetho, Palmira Janela-(PT) Rosa Anánias-(PT),Aurora 
Joaquim-(PT), Julieta Lourenço-(PT), Ermelinda Rachide-(PT),Filomena Nacaia-(PT), Maria 
Amade-(PT), Maria Augusta Amade-(PT), Teresinha -(PT); Albertina Jacinto; Natália Armando; 
Florinda Saquina; Marieta Amade; Maria Lídia Sacança; Valentina Feliciano; Maria Olinda Zaíra; 
Rosa Cebola, Mezope.
Activistas
Domingos Mutaiva, Chefe dos activistas, Epuite; Mariamo Sebastião, Chefe dos Activistas, 
Epuite; Candido Rajabo, Chefe dos activistas, Rojola; Pedro Sitanle; Pedro Baniane, Candido 
Rajabo, Rojola; Constantino Murarivo, Rojola; Vernísio Pinto Saquate, Mezope; Raimundo 
Rachide, Mezope; Augusto Muchanqueque, Mezope; Domingos Mutava, Epuite.
DDS staff
Helena Alexandre, Parteira Elementar, CS Mueria; Saírose, Enf.Elementar, CS Mueria, Sr. 
Araujo, Tec Medio de Saude, CS Geba; Maria Sauia, PE, Formadora de PT, DDS Memba; 
Eusebio Jaimessone, resp PAV, Memba; Manuel Miguel Osorio, Tec Medicina Geral, Director, 
DDS Memba; Agira Faquira, enf SMI, Foramadora de PT de NaV; Sr Justino Ngomane Tec 
Medicina Geral, Director, DDS NaV; Pessoal do CS de Chipene e PS de Mazua em Memba e do 
PS de Covo em NaV.
SC staff
All listed in the MTE team
NGOs
Kathleen Stiebritz, MS, Memba; Jose Ngomane, ADPP, Monapo.
Bridges to Health Project
Dra. Catarina Regina, program coordinator.
Nampula SC Office
Richard Dixon, director of Food Security Program, Nampula; Steve McSween, 
Coordinator of Food Security Program, Nampula; Erica Weltzer, Nutrition Advisor 
Program, Nampula; Sr Cristovao, Logistics, Nampula. 
Maputo SC Office
Peter Nkhonjere, Deputy Director, Maputo; John , FOD Maputo
USAID
Christian Barratt - Health, Population, and Nutrition Officer; Dr. Okey C. Nwanyanwu -
Chief, Office of Health, Population & Nutrition; Ilka Esquivel - Health Sector Support 
Results Leader
APPENDIX 11
List of Regulados in Both Districts
Lista nominal dos regulados de Memba
1.-Metarrumo
2.-Mazeze
3.-Olaika
4.-Tiquereria
5.-Mapruma
6.-Melópia
7.-Mualia
8.-Kitaculo
9.-Morola
10-Mauala
11-Suka
12-Nampuitha
13-Mebile
14-Mazulia
15-Mazua
16-Nivale
17-Caleia
18-Namicolo
19-Kapulo
20-Mavia
21-Matico
22-Mutiquinheni
23-M'phatha
24-Napuco
25-Mepava
26-Motia
27-Tulua
28-Matilene
29-Muxaraua
30-Pazaquele
31-Capilelene
32-Epuite
33-Metupa
Lista de regulados de NaV
1.- Vantitia
2.- Meua
3.- Namanca
4.- Nacala
5.- Rojola
6.- Motia
7.- Mezope
8.- Nantar
9.- Morrimone
10-Mepira
11-Cathava
12-Kanira
13-Murrotho
APPENDIX 12
Health Facilities in Memba and Nacala-Velha
(Information supplied by the Strength Project staff in Oct 2002)
Centros de Saúde de Memba
Centro de Saúde de Memba Sede
-Namahaca
-Chipene
-Geba
-Caleia
-Baixo pinta ( por abrir )
Postos de Saúde Memba
-Napila
-Cavá
-Mazua
-Lúrio
-Nivale
-Simuco 
Centros de Saúde de Nacala-à-Velha
1.-Nacala - Sede
2.-Muéria
3.-Namalala ( por abrir )
Postos de Saúde de Nacala-à-Velha
Barragem
Salinas
Postos de Socorros de Nacala-à-Velha
Micolene
Covó
Ger-Ger
Motia
Muentaze
Napala
Vida Nova
Appendix 13: Results Presented at the Evaluation Debriefing as Positive and Challenging Findings
1
RESULTADOS: CLCS
NACALA VELHA e MEMBA
POSITIVOS DESAFIOS
· CLCS de NV encontra-se regularmente, 8 a 
12x/ano
· Tratam sobre higiene, diarreia, avaliacao das 
actividades anteriores, mobilizacao da 
comunidade e fazer mais uso das PT 
· Apresentam os dados comunitarios (PT, 
apiamwene, activistas)
· Mantem registo de dados (activista aponta os 
dados no grafico)
· Registo de dados para nao esquecer, 
apresentar a visitantes, tomar decisoes. CLCS 
tem bom registo dos nascimentos 
· CLCS manda os dados para o CS e depois para
o distrito
· Tem plano oral de actividades, principalmente 
palestras
· Tomam decisoes sobre os assuntos de saude
· As relacoes entre CLCS e DDS sao mistas
· CLCS de Memba so reuniu 3 vezes
· Alguns CLCS nao entendem bem o PF
· CLCS de Memba nem todos utilizam as 
informacoes da comunidade.
· Os registos de dados sao incompletos
· Falta de comunicacao entre o distrito e as 
CLCS 
· Apenas um CS em Memba tem boas relacoes 
com o CLCS
· Desconfianca entre CLCS e equipa de saude 
na epoca da colera (ultrapassado)
Appendix 13: Results Presented at the Evaluation Debriefing as Positive and Challenging Findings
2
· 6-8 membros em cada CLCS com balanco entre 
no. de mulheres e no. de homens 
· Alguns membros tem papeis bem definidos
· Boa participacao dos elementos nos encontros
· Os membros participam nas BM 
· CLCS recomendam o parto limpo
· Usam o metodo de palestras e visitas 
domiciliares
· CLCS tem sistema de ALARME (mulher em 
risco—chama PT—informa o regulo—regulo 
chama o grupo de apoio)
· A BM visitou recentemente apenas em alguns 
regulados
· Outros membros nao tem papel bem definido 
(se nao foi definido durante a formacao, 
como responsavel do transporte) 
· CLCS de Memba – alguns faltou apiamwene
· Insistencia em palestras como unico meio de 
provocar mudanca no comportamento
· Sistema de transporte nao funciona. 
· Bicicletas nao sao de facil manejo com a 
carga e longas distancias
· Bicicletas avariadas em todos os regulados
· Problemas na manutencao das bicicletas 
(contribuicao so funcionou uma vez, depois 
falhou por entendimento que CLCS recebiam 
$ do SC / roubo da bicicleta
· Falta de visita da BM a certas comunidades 
ha mais de 1 ano
Appendix 13: Results Presented at the Evaluation Debriefing as Positive and Challenging Findings
3
RESULTADOS: MAES
NACALA VELHA E MEMBA
POSITIVOS DESAFIOS
· Conhecem e preparam o plano do parto
· Conhecem sistema de Alarme e Transporte
· Utilizaram o sistema de transporte quando 
estava em funcionamento
· Sabem que devem ter parto assistido por 
pessoa formada
· Usam os servicos da PT que vive perto
· Recebem estas informacoes e tambem sobre 
PF atraves da CLCS
· Existe boa relacao entre as maes e enf SMI 
nas US e nas brigades movies na maior 
parte
· Conhecem metodos de PF e seus beneficios
· Conhecem a recomendacao de espacamento 
da gravidez de pelo menos dois anos
· Algumas praticam abstinencia sexual
· Sabem como preparar soros caseiros e dar 
muitos liquidos a crianca com diarreia
· Utilizacao de palestras como unico meio de 
educar as maes sobre o parto assitido por 
pessoa formada
· Se vivem longe da parteira, nao utilizam os 
servicos dela
· Falta de parteiras na comunidade
· Mau relacionamento entre a mae e parteira 
elementar em algumas US
· Os metodos de PF nao estao disponiveis na 
comunidade, so nas US a grande distancia
· Certos alimentos nao sao dados a crianca 
doente
Appendix 13: Results Presented at the Evaluation Debriefing as Positive and Challenging Findings
4
· Levam os filhos a US quando reconhecem 
que eles estao doentes
· Conhecem os sinais de perigo da diarreia
· Sabem como prevenir a diarreia
· Conhecem os sinais de IRA
· Levam os filhos com sinais de IRA a US 
imediatamente. Nao tratam em casa
· Em caso de febre fazem primeiro 
arrefecimento em casa
· Sabem os sintomas e sinais da malaria e o 
agente causador (o mosquito)
· Sabem como prevenir a malaria e como 
encaminhar ?
· Conhecem a importancia da vacina e que sao 
necessarias 5 visitas para completar a 
vacinacao da crianca
· Recebem a informacao atraves de palestras 
do CLCS e nas US 
· Algumas maes vao ao curandeiro primeiro 
quando o filho esta doente
· Se a crianca brinca nao precisa de levar a US, 
porque nao e grave
· As maes que nao levam os filhos doentes a 
US citam as seguintes razoes:
Falta $, falta de medicamentos nas US, 
confiam mais no curandeiro, medo do chupa￾sangue, medo que os filhos morram na US
· Algumas nao conhecem o causador da 
malaria
· Entao porque que os dados da vacinacao sao 
baixos?
· As maes nao se lembram quando foi a ultima 
palestra
Appendix 13: Results Presented at the Evaluation Debriefing as Positive and Challenging Findings
5
RESULTADOS: CURANDEIROS
NACALA VELHA E MEMBA
POSITIVO DESAFIOS
· USAM UMA LAMINA POR PESSOA
· FERVEM OKA E INSTRUMENTOS 
CORTANTES
· ALGUMAS VEZES CRIANCA COM DIARREIA 
E IMEDIATAMENTE MANDADA A US
· SABEM AS MEDIDAS A TRATAR EM CASO 
DE DIARREIA, MALARIA, IRA, MENINGITE, 
SARRAMPO E TETANO
· NEM SEMPRE ENVIAM A CRIANCA 
IMEDIATAMENTE
· AS VEZES TRATAM POR 2 DIAS COM 
TRATAMENTO TRADICIONAL ANTES DE 
MANDAR
Appendix 13: Results Presented at the Evaluation Debriefing as Positive and Challenging Findings
6
RESULTADOS: PARTEIRAS TRADICIONAIS
NACALA VELHA E MEMBA
POSITIVO DESAFIOS
· CONHECEM OS SINAIS DE PERIGO
· E QUANDO ENCAMINHAR A MULHER
· TEM BOA RELACAO COM A PARTERIA 
ELEMENTAR?
· TEM BOA RELACAO COM AS MAES
· FAZEM RECOLHA DE DADOS DE ACORDO 
COM A FICHA DELAS
· RECEBERAM EQUIPAMENTO DO SAVE
· RECEBEM ABASTECIMENTO DE 
MATERIAL DAS US
· ALGUMAS MAES TRAZEM A LAMINA
· SABEM FAZER O CORTE DO CORDAO DE 
ACORDO COM A NORMA ESTABLECIDA
· GRANDE VOLUME DE TRABALHO, 
POUCAS PARTEIRAS PARA MUITAS MAES
· AS MAES NAO ESTIMULAM AS PARTEIRAS 
PORQUE PENSAM QUE ELAS SAO PAGAS
· SISTEMA DE TRANSPORTE NAO 
EXISTENTE PARA OS CASOS URGENTES
· DISTANCIAS LONGAS PARA OS CS
· A QUALIDADE DO REGISTO PODE 
MELHORAR
· HA FALTA DE SAVLON, ALGODAO E 
NASTRO
Appendix 13: Results Presented at the Evaluation Debriefing as Positive and Challenging Findings
7
RESULTADOS: ACTIVISTAS
NACALA VELHA E MEMBA
POSITIVO DESAFIOS
· SAO ACTIVOS NAS COMUNIDADES
· SAO MEMBROS DO CLCS
· RECOLHEM DADOS DA COMUNIDADE 
PARA APRESENTAR NO CLCS
· FAZEM PALESTRAS
· DESENVOLVEM MOBILIZACAO DAS 
COMUNIDADES 
· CONHECEM AS BASES DA COMUNICACAO 
PARA A MUDANCA DO COMPORTAMENTO
· ALGUNS USAM PANFLETOS E ALBUNS 
SERIADOS E DESENHOS
· EM MEMBA NAO HA MUITOS ACTIVISTAS 
FORMADOS
· AS MENSAGENS SAO MUITO GERAIS E AS 
MENSAGENS CHAVES NAO SAO BEM 
DESCRITAS
· HA POUCO GRUPOS DE TEATRO, SO A 
NIVEL DISTRITAL
· PENSAM QUE A INSISTENCIA E 
OBRIGACAO SAO AS MANEIRAS DE 
EDUCAR A COMUNIDADE
· NAO TEM SUFICIENTE MATERIAL 
EDUCATIVO
· ALGUM MATERIAL NAO E PLASTIFICADO E 
ESTRAGA-SE
Appendix 13: Results Presented at the Evaluation Debriefing as Positive and Challenging Findings
8
· CONHECEM AS VARIAS DOENCAS DA 
CRIANCA
· SAO ORGULHOSOS DA SUA ACTIVIDADE
· A COMUNIDADE PODE NAO RECONHECER 
O ACTIVISTA PORQUE NAO TEM 
DISTINTIVOS APROPRIADOS (CHAPEUS, 
 T-SHIRTS, CRACHA)
Appendix 13: Results Presented at the Evaluation Debriefing as Positive and Challenging Findings
9
RESULTADOS: TRABALHADORES DE SAUDE
NACALA VELHA E MEMBA
POSITIVO DESAFIOS
ENF DE MEDICINA E SMI:
· A MAIOR PARTE DAS US VISITADAS TEM 
ABASTECIMENTO DE MEDICAMENTOS 
NUMA BASE REGULAR
· TEM QUE IR BUSCAR AS VACINAS AO 
DISTRITO MENSALMENTE
· ALGUMAS PARTEIRAS ELEMENTARES 
UTILIZAM CARTAZES, ALBUM SERIADO E 
PANFLETOS
· ALGUMAS PARTEIRAS FAZEM PALESTRAS
· TEM ROTURA DE VAT E OUTRAS VACINAS
· TIVERAM FALTA DE CLOROQUINA POR 
UMA SEMANA – ROTURA DE STOCK
· NAO HA DISTRIBUICAO DOS KIT DE 
MEDICAMENTOS. AS UNIDADES E QUE 
VAO BUSCAR POR MEIOS PROPRIOS
· UM CS DISSE QUE SO VACINA UMA VEZ 
POR SEMANA
· HA FALTA DE MATERIAL DE IEC EM 
ALGUMAS US
· SALAS DE TRIAGEM NAO POSSUEM 
AMOSTRAS DE METODOS DE PF, E 
CARTAZES PARA MOSTRAR AS MAES
· EM ALGUNS CS NAO FAZEM EDUCACAO 
DE PF SE O MARIDO NAO ESTA PRESENTE
· NUNCA FIZERAM CONVOCATORIA DOS 
MARIDOS
· NUNCA PEDIRAM AJUDA DA CLCS PARA 
Appendix 13: Results Presented at the Evaluation Debriefing as Positive and Challenging Findings
10
· MUITOS ENFERMEIROS RECEBERAM 
FORMACAO EM AIDI
· A FORMACAO EM AIDI AJUDOU A 
MELHORAR O DIAGNOSTICO E O 
TRATAMENTO PORQUE HA UM 
PROTOCOLO 
· NAS CONSULTAS OS CARTOES DA 
CRIANCA SAO VERIFICADOS E VACINADOS 
AQUELES QUE ESTAO EM TEMPO
· SITUACAO ESPECIAL DE UM ENFERMEIRO:
· ANALISA OS DADOS DA CONSULTA
· IDENTIFICA COMUNIDADES DE RISCO
· INFORMA CLCS
· USA MATERIAL DO AIDI
· FAZ DIAGNOSTICOS MAIS ACURADOS 
DEPOIS DA FORMACAO AIDI
· TEM CONTACTOS COM ACTIVISTA QUE 
TRAZEM MAES PARA A US
· AJUDA O TRABALHO E A FORMACAO DA 
COLEGA PARTEIRA
CONVOCAR OS MARIDOS
· ALGUNS TRABALHADORES DE SAUDE 
NAO CONHECEM OS ELEMENTOS COM 
QUEM DEVEM TRABALHAR (PT, APE, 
ACTIVISTA, SOCORRISTA)
Appendix 13: Results Presented at the Evaluation Debriefing as Positive and Challenging Findings
11
APEs:
· APEs CONHECEM O SISTEMA DE ALARME 
E TRANSPORTE DO REGULADO
· ADMNISTRAM PRIMEIROS SOCORROS E 
TRATAMENTO COMPLETO PARA MALARIA 
E DIARREIA
· TRANSFEREM OS OUTROS CASOS PARA O 
HOSPITAL, POR EX: IRA
· EDUCAM AS MAES PARA LEVAR AS 
CRIANCAS A US MAIS PROXIMA
· NAO ESPECIFICARAM URGENCIA DE 
TRANSFERIR PARA O HOSPITAL
· NAO CONSEGUIRAM DESCREVER OS 
SINAIS DE PERIGO DAS DOENCAS QE 
REQUEREM TRANSFERENCIA
· ALGUNS NAO TEM MATERIAIS PARA 
EDUCACAO
Appendix 14: Preliminary Action Plan Prepared by Evaluation Team and Presented at the Evaluation Debriefing
1
PLANO DE ACCAO: CAPACITACAO
MEMBA e NACALA VELHA
DESAFIOS SOLUCOES ACTIVIDADES RESPON
SAVEL
PERIODO
CLCS
· CLCS de Memba so 
reuniu 3 vezes
· Alguns CLCS nao 
entendem bem o PF
· Os registos de dados sao 
incompletos
· Falta de comunicacao 
entre o distrito e as CLCS 
· Desconfianca entre CLCS 
e equipa de saude na 
epoca da colera 
(ultrapassado)
· Alguns membros nao tem 
papel bem definido
Fazer o 
acompanhamento 
das CLCS 
formadas atraves 
de supervisao
- Treino rapido de habilidades 
de supervisao para DDS, SC, 
pessoal do CS e PS
- Elaboracao de guiao de 
supervisao apropriado as 
actividades das CLCS e de 
acordo com a sua formacao, 
durante o treino
- Elaboracao de um plano 
conjunto de visitas de 
supervisao as CLCS 
- Aprovacao do plano pelo SC 
e Directores distritais
- Inicio visitas de supervisao
DDS
SC
Grupo 
treinado
Grupo 
treinado
3a. semana
Outubro
4a. semana 
Outubro
Novembro 
ate ao fim 
do projecto
Appendix 14: Preliminary Action Plan Prepared by Evaluation Team and Presented at the Evaluation Debriefing
2
· Sistema de transporte de 
emergencia nao 
funciona. 
· Falta de bicicletas￾ambulancia em Memba
· Bicicletas avariadas em 
todos os regulados -NV
· Problemas na 
manutencao das 
bicicletas (comunidade 
pensa que CLCS 
recebiam $ do SC, roubo
Reactivar o 
sistema de 
transporte de NV 
e iniciar o sistema 
de transporte de 
Memba
REFERIDO NO PLANO DE 
ACCAO DA MULHER DDS, SC
US
DDS
· Falta de visita da BM a 
certas comunidades ha 
mais de 1 ano
· EGP (Equipa de Gestao 
do Projecto – conjunta)
Preparar um BOM 
plano de Brigadas 
Moveis (BM)
Fortalecer as 
reunioes dos EGP 
ao nivel do 
distrito
REFERIDO NO PLANO DE 
ACCAO DA VACINACAO
- Marcar encontros de trabalho 
(analise e planificacao) no 
proprio distrito
- Envolver toda a equipa da 
DDS na planificacao
- Decidir calendario de 
encontros
- Melhorar a analise dos dados 
estatisticos do distrito 
- Tomar decisoes 
correspondentes aos 
SC, DDS MENSAL
Appendix 14: Preliminary Action Plan Prepared by Evaluation Team and Presented at the Evaluation Debriefing
3
· Falta de supervisao 
generalizada
· Plano de Accao da
Avalaicao de Meio-Termo 
nao esta completo
· Nao houve a participacao 
dos directores e do resto 
da equipa distrital
Elaborar um plano 
de supervisao 
sustentavel
Completar o plano 
de accao
problemas encontrados e as 
localidades identificadas na 
analise dos dados
- Aplicar o guiao de supervisao 
do MISAU 
-Envolver os directores e 
equipa distrital
-Continuar discussao dos 
desafios/solucoes da avaliacao 
de meio termo
DPS
DDS
SC
Grupo da 
avalaicao 
+director 
das DDS 
+ director 
do 
projecto
Nov 02
Plano de 
Accao 
pronto 
dentro de 3 
semanas
Appendix 14: Preliminary Action Plan Prepared by Evaluation Team and Presented at the Evaluation Debriefing
4
PLANO DE ACCAO : MUDANCA do COMPORTAMENTO
MEMBA e NACALA VELHA
DESAFIOS SOLUCOES ACTIVIDADES RESPONSAVEL PERIODO
· Insistencia em 
palestras como 
unico meio de 
provocar 
mudanca no 
comportamento
Introduzir as variantes 
do teatro e drama
- Grupo teatro de NV 
deve comecar a formar 
membros na 
comunidade
- Recomendar os grupos 
de NV e Memba para 
fazer plano de 
actividades na 
comunidade
- Assistir alguns teatros 
para avaliar a 
qualidade e a reaccao 
da comunidade
Formado e 
CLCS
Formadoras
DDS, SC
1a 
semana 
Outubro
2a 
semana 
Outubro
· As maes nao se 
lembram 
quando foi a 
ultima palestra
· As maes nao 
aceitam os 
conselhos 
dados nas 
palestras
Descobrir as razoes 
porque as pessoas nao 
aceitam os conselhos 
dados e decidir novas 
estrategias de educacao
Fazer visitas 
domicilares
CLCS, 
Activistas,
Formadoras/
supervisoras
A partir 
de agora
Appendix 14: Preliminary Action Plan Prepared by Evaluation Team and Presented at the Evaluation Debriefing
5
· Os metodos de 
PF nao estao 
disponiveis na 
comunidade, so 
nas US a 
grande 
distancia
Discutir alternativas de 
disponibilizar metodos 
nas comunidades
Reunioes com DPS, com 
DDS, rever o Plano de 
implementacao do 
projecto
DDS, SC, 
Regulo 
· Mensagens￾chave confusas
Revisar e melhorar as 
MENSAGENS CHAVE
dos modulos e das 
palestras
REFERIDO NO PLANO 
DE ACCAO DA SAUDE 
DA CRIANCA
· A comunidade 
nao remunera 
as parterias
Esclarecer as maes 
sobre nao remuneracao 
das PT
Introduzir o assunto nas 
palestras e contactos 
com CLCS
A partir 
de agora
· Activistas nao 
sao 
reconhecidos 
na comunidade
Criar distintivos para os 
membros dos CLCS
- decidir a sigla e o 
desenho 
- procura e aquisicao de 
t-shirts, bones, 
crachas
SC, DDS, 
CLCS Nov-Dez
2002
Appendix 14: Preliminary Action Plan Prepared by Evaluation Team and Presented at the Evaluation Debriefing
6
PLANO DE ACCAO: SUSTENTABILIDADE
MEMBA e NACALA VELHA
DESAFIOS SOLUCOES ACTIVIDADES RESPONSA
VEL
PERIODO
DDS:
· Poucos contacto 
com CLCS
· Poucos encontros 
de planificacao
· Supervisao as US 
raramente
Aumentar e manter os 
contactos com CLCS
Manter os encontros 
de planificacao 
regularmente (todo o 
mes)
Utilizar o guiao e 
calendario de 
supervisao do MISAU
Assegurar os 
recursos necessarios 
para o supervisao 
(transporte, 
combustivel)
O distrito deve estar 
presente e liderar as 
visitas de supervisao
REFERIDO NO PLANO DE 
ACCAO DA 
CAPACITACAO
REFERIDO NO PLANO DE 
ACCAO DA 
CAPACITACAO
REFERIDO NO PLANO DE 
ACCAO DA 
CAPACITACAO
DDS, SC Apartir de 
Nov 02
Appendix 14: Preliminary Action Plan Prepared by Evaluation Team and Presented at the Evaluation Debriefing
7
US:
· Alguns 
trabalhadores de 
saude nao foram 
envolvidos para 
manter contacto 
com CLCS
· Algumas enf. nao 
foram recicladas em 
cuidados 
obstetricos e DMS e 
Saude Reprodutiva
Integrar os enf. nas 
actividades do CLCS e 
PT
Integrar os enf. nas 
supervisoes aos 
CLCS
Assegurar que as 
restantes enf. 
completam as 
reciclagens
REFERIDO NO PLANO DE 
ACCAO DA 
CAPACITACAO
REFERIDO NO PLANO DE 
ACCAO DA 
CAPACITACAO
CLCS:
· Todos os regulados 
nao tem sistema de 
manutencao
· CLCS precisa 
aprender a usar os 
dados para tomar 
decisoes
Esclarecer as CLCS 
no sentido de se 
responsabilizarem 
pela manutencao das 
bicicletas-ambulancia
Manter a supervisao e 
apoio dos CLCS
Encontros com os CLCS
Discutir alternativas
Contar as licoes de NV e 
de XaiXai
Fazer acordos com com 
CLCS
Analisar em conjunto os 
dados dos graficos e 
decisoes com CLCS
DDS, 
Formadoras
DDS, 
Formadoras
Appendix 14: Preliminary Action Plan Prepared by Evaluation Team and Presented at the Evaluation Debriefing
8
VACINAÇAO DA CRIANCA- INDICADORES/OBJECTIVOS
PLANO DE ACCAO: VACINACAO
MEMBA e NACALA VELHA
DESAFIOS SOLUCOES ACTIVIDADES RESPONSAVEL PERIODO
· Os dados da 
vacinacao 
continuam baixos
· Numero limitado de 
postos fixos
· Postos que so 
vacinam uma vez 
por semana
· Planificacao 
inaqueada das BM 
Aumentar o numero 
de Postos Fixos
Analisar a situacao 
do Lurio
Assegurar o 
cumprimento das 
normas do MISAU
- Por a fucionar o Posto 
Fixo de Baixo Pinda e 
outros imediatamente
- Buscar formas de 
abastecer a zona para 
fazer face ao 
isolamento causado 
pelas chuvas
DDS
DDS, EGP, 
regulos
DDS, SC
Indicadores/Objectivos do Fim do Programa Linha de Base
1999/2000
Médio –Termo 2002
55% de Crianças de 12 – 23 meses serão completamente vacinadas 
pela idade dos 12 meses linha de base.
N-32% M-34% N-11% M-13% T-12%
80% de mulheres com crianças < 24 meses terão recebido pelo 2 
doses de vacina ante tétano durante a última gravidez
N-30% M-62% N-74% M-42% T-57%
Appendix 14: Preliminary Action Plan Prepared by Evaluation Team and Presented at the Evaluation Debriefing
9
Preparar um Bom 
plano da BM com
priorizacao das 
localidades a vacinar
- Dar prioridade aos 
lugares com 1 ou 2 
visitas anteriores para 
permitir completar a 
vacinacao das criancas
- Cumprir com o horario 
para apanhar toda a 
gente na concentracao
- Preparar a BM no dia 
anterior para sair bem 
cedo e evitar atrasos
- Manter um bom registo 
das saidas do 
transporte das BM
- Aumentar o no de dias 
de apoio do carro da 
SC para as brigadas 
moveis em Memba
- Articulacao com o MS 
em Memba
1a - 2a 
semana 
Outubro
permanen
te
Appendix 14: Preliminary Action Plan Prepared by Evaluation Team and Presented at the Evaluation Debriefing
10
Appendix 14: Preliminary Action Plan Prepared by Evaluation Team and Presented at the Evaluation Debriefing
11
SAUDE DA CRIANCA- INDICADORES/OBJECTIVOS
Indicadores/Objectivos do Fim do Programa Linha de Base 1999/2000 Meio-Termo 2002
80% de mães com crianças < 24 meses com febre nas 2 anteriores 
semanas procuraram cuidado dentro de 48 horas
N-57% M-66% N-30% M- 34% T-32%
85% de mães com crianças < 24 meses com tosse e respiração 
rápida/dificultada nas 2 anteriores semanas procuraram cuidado 
dentro de 48 horas
N-64% M73% N-54% M-67% T-61%
80% de mães com crianças < 24 meses com diarreia nas 2 anteriores 
semanas que manejaram a diarreia com TRO (SRO ou líquidos 
comunitários de reidratação oral tais como papas aguadas)
N-66% M-67% N-67% M-62% T-64%
Percentagem de mulheres com crianças < 24 meses que reportaram 
conhecer pelo menos duas vias de prevenir diarreia
N/A N-56% M-50% T-53%
Percentagem de mulheres com crianças < 24 meses que reportaram 
conhecer 2 sinais de perigo de AIDI
N/A N-86% M-73% T-79%
Appendix 14: Preliminary Action Plan Prepared by Evaluation Team and Presented at the Evaluation Debriefing
12
PLANO DE ACCAO: SAUDE DA CRIANCA
MEMBA e NACALA VELHA
DESAFIOS SOLUCOES ACTIVIDADES RESPONSA
VEL
PERIODO
· Falta de clareza das 
mensagens chave:
-A mae nao da certos 
alimentos a crianca 
doente
-Algumas maes vao ao 
curandeiro primeiro 
quando o filho esta 
doente
-Se a crianca brinca 
nao precisa de levar a 
US, porque nao e 
grave
- Os curandeiros nem 
sempre enviam a 
crianca ao hospital 
imediatamente; tratam 
por 2 dias com 
tratamento tradicional 
antes de mandar
Revisar e melhorar as 
mensagens chave
-Assistencia tecnica de IEC 
e mudanca do 
comportamento de Xai￾xai
- Revisao de todos os 
modulos de formacao, 
especialmente os 
relacionados com os 
resultados encontrados
- Supervisao continua dos 
CLCS
- Reciclagem dos CLCS e 
dos curandeiros
SC
SC 
Formadoras
Dez 02
Fev-Mar 
2003
Nov 02
Nov 02
Appendix 14: Preliminary Action Plan Prepared by Evaluation Team and Presented at the Evaluation Debriefing
13
· As maes que nao 
levam os filhos 
doentes a US citam 
as seguintes razoes:
-Falta $,
-falta medicamentos 
nas US, 
-confiam mais no 
curandeiro, 
-medo do chupa￾sangue, 
-medo que os filhos 
morram na US
Melhorar o sistema de 
abastecimento de 
medicamentos as US
Esclarecer as maes 
sobre os seus medos
-Discutir durante os 
encontros de EGP 
solucoes para este 
problema
Palestras dirigidas as 
preocupacoes das maes
EGP, DDS
Resp 
Farmacia
DPS
· Os APEs nao 
especificaram a 
urgencia de 
transferir as 
criancas para o 
hospital
· Os APEs nao 
conseguiram 
descrever os sinais 
de perigo das 
doencas que devem 
transferir
Melhorar as 
habilidades dos APEs
Supervisao e formacao em 
trabalho durante as 
visitas aos PS
Sr Amilton 
Formadoras
DDS
Appendix 14: Preliminary Action Plan Prepared by Evaluation Team and Presented at the Evaluation Debriefing
14
SAUDE DA MULHER- INDICADORES/OBJECTIVOS
Indicadores/Objectivos do Fim do Programa Linha de Base 1999/2000 Meio-Termo 2002
50% de parto assistidos por uma pessoa formada N-34% M-38% N-51% M-28% T-39%
85% de mulheres têm pelo menos duas visitas pré-natais com uma 
pessoa de saúde formada durante a última gravidez
N-77% M-74% N-74% M-55% T-64%
80% de mulheres com crianças < 24 meses terão recebido pelo 2 doses 
de vacina ante tétano durante a última gravidez
N-30% M-62% N-74% M-42% T-57%
80% de mulheres com crianças < 24 meses saberão pelo menos 3 sinais 
de perigo relacionados a gravidez
N-18% M-44% N-95% M-57% T-75%
10% de mulheres irão ter tido um plano de parto (3 de 5 componentes) 
durante a sua última gravidez
N-0% M-0% N2% M-5% T-3%
25% de mulheres com crianças < 24 meses que não desejam ter outra 
criança nos próximos dois anos estarão usando um método moderno de 
contracepção
N-18% M-15% N-18% M-12% T-15%
50% de mulheres com criancas < 24 meses conhecem pelo menos 2 
metodos de contracepcao modernos
N-24% M-37% N-28% M-23% T-25%
Appendix 14: Preliminary Action Plan Prepared by Evaluation Team and Presented at the Evaluation Debriefing
15
PLANO DE ACCAO: SAUDE DA MULHER
MEMBA e NACALA VELHA
DESAFIOS SOLUCOES ACTIVIDADES RESPONSA
VEL
PERIODO
· Utilizacao de palestras 
como unico meio de 
educar as maes sobre 
o parto assitido por 
pessoa formada
· Se vivem longe da 
parteira, nao utilizam 
os servicos dela
· Falta de parteiras na 
comunidade
· Mau relacionamento 
entre a mae e parteira 
elementar em algumas 
US
· Os metodos de PF 
nao estao disponiveis 
na comunidade, so 
nas US a grande 
distancia
MAIOR MOBILIZACAO 
ATRAVES DOS 
REGULOS, 
APIAMUENES E 
ACTIVISTAS
LEVANTAR OS 
PROLEMAS NO 
PRIMEIRO 
CONTACTO COM O 
REGULADO
REVISITAR A 
QUESTAO DA 
DISTRIBUICAO DE 
METODOS PELOS PT, 
APEs, SOCORRISTAS 
ETC
REALIZACAO DE 
TEATROS
CANCOES
DANCAS
UTILIZAR OS 
PANFLETOS E ALBUMS 
SERIADOS E 
BROCHURAS NAS 
PALESTRAS
SC,
DDS
CLCS
NOV 02
Appendix 14: Preliminary Action Plan Prepared by Evaluation Team and Presented at the Evaluation Debriefing
16
· As maes nao 
estimulam as 
parteiras porque 
pensam que elas sao 
pagas
· Sistema de transporte 
nao existente para os 
casos urgentes
ESLCARECIMENTO 
SOBRE O ASSUNTO 
DO PAGAMENTO DAS 
PARTEIRAS
Compra e 
distribuicao aos CLCS 
de Memba 
Sensibilizacao aos 
CLCS de Nacala Velha
- Contactar Dra Catarina 
e Sr Teodoro
- Preparar a lista 
- Apresentar a Logistica 
para compra e entrega
- Sensibilizar CLCS para 
a entrega e 
manutencao
- Contar a licao 
aprendida de Nacala 
Velha
- Distribuir
- Encontros com os 
CLCS de NV para 
sensibilizar, recordar o 
acordo de entrega e 
negociar a reparacao e 
manutencao das 
bicicletas avariadas
SC, DDS
SC, DDS
DDS, SC
Assim que 
receber 
Durante 
visitas 
supervisao
APPENDIX 15 Page 1
Both Districts Combined: LQAS Analysis of Key Indicators
Supervisory area LQAS sample (n) q (with condition) p=q/n N (P.A. pop) Wt=Ni/sum(N) Wt*p
Early BF 186407.00
GerGer 19.00 15.00 0.79 29075.00 0.16 0.12
Sede 19.00 17.00 0.89 58056.00 0.31 0.28
Lurio 19.00 14.00 0.74 13414.00 0.07 0.05
Chipene 19.00 15.00 0.79 17500.00 0.09 0.07
Mazua 19.00 14.00 0.74 29776.00 0.16 0.12
Memba 19.00 14.00 0.74 38586.00 0.21 0.15
0.80
Colostrum
Gerger 19.00 15.00 0.79 29075.00 0.16 0.12
Sede 19.00 15.00 0.79 58056.00 0.31 0.25
Lurio 19.00 13.00 0.68 13414.00 0.07 0.05
Chipene 19.00 15.00 0.79 17500.00 0.09 0.07
Mazua 19.00 13.00 0.68 29776.00 0.16 0.11
Memba 19.00 13.00 0.68 38586.00 0.21 0.14
0.74
Exclusive BF
GerGer 19.00 5.00 0.26 29075.00 0.16 0.04
Sede 19.00 6.00 0.32 58056.00 0.31 0.10
Lurio 19 9.00 0.47 13414.00 0.07 0.03
Chipene 19 6.00 0.32 17500.00 0.09 0.03
Mazua 19 9.00 0.47 29776.00 0.16 0.08
Memba 19 8.00 0.42 38586.00 0.21 0.09
0.37
Diarrhea
Treated with ORS
Gerger 19 14 0.74 29075.00 0.16 0.11
Sede 19 12 0.63 58056.00 0.31 0.20
Lurio 19 14.00 0.74 13414.00 0.07 0.05
Chipene 19 10.00 0.53 17500.00 0.09 0.05
Mazua 19 14.00 0.74 29776.00 0.16 0.12
Memba 19 10.00 0.53 38586.00 0.21 0.11
0.64
APPENDIX 15 Page 2
Know 2 prevention methods
Gerger 19.00 14.00 0.74 29075.00 0.16 0.11
Sede 19.00 9.00 0.47 58056.00 0.31 0.15
Lurio 19.00 7.00 0.37 13414.00 0.07 0.03
Chipene 19.00 11.00 0.58 17500.00 0.09 0.05
Mazua 19.00 8.00 0.42 29776.00 0.16 0.07
Memba 19.00 11.00 0.58 38586.00 0.21 0.12
0.53
ARI treated within 48hrs
GerGer 19.00 13.00 0.68 29075.00 0.16 0.11
Sede 19.00 9.00 0.47 58056.00 0.31 0.15
Lurio 19 13.00 0.68 13414.00 0.07 0.05
Chipene 18 11.00 0.61 17500.00 0.09 0.06
Mazua 19 9.00 0.47 29776.00 0.16 0.08
Memba 19 16.00 0.84 38586.00 0.21 0.17
0.61
Fever sought care within 48hrs
Gerger 19 3.00 0.16 29075.00 0.16 0.02
Sede 19 7.00 0.37 58056.00 0.31 0.11
Lurio 19 7.00 0.37 13414.00 0.07 0.03
Chipene 19 7.00 0.37 17500.00 0.09 0.03
Mazua 19 4.00 0.21 29776.00 0.16 0.03
Memba 19 8.00 0.42 38586.00 0.21 0.09
0.32
IMCI (knowledge of 2 danger signs)
Gerger 19.00 17.00 0.89 29075.00 0.16 0.14
Sede 19.00 14.00 0.74 58056.00 0.31 0.23
Lurio 19.00 16.00 0.84 13414.00 0.07 0.06
Chipene 19.00 15.00 0.79 17500.00 0.09 0.07
Mazua 19.00 16.00 0.84 29776.00 0.16 0.13
Memba 19.00 14.00 0.74 38586.00 0.21 0.15
0.79
APPENDIX 15 Page 3
Antenatal care
Trained health professional at ANC
GerGer 19.00 15.00 0.79 29075.00 0.16 0.12
Sede 19.00 17.00 0.89 58056.00 0.31 0.28
Lurio 19 12.00 0.63 13414.00 0.07 0.05
Chipene 19 16.00 0.84 17500.00 0.09 0.08
Mazua 19 12.00 0.63 29776.00 0.16 0.10
Memba 19 15.00 0.79 38586.00 0.21 0.16
0.79
ANC visit >=2 times
Gerger 19 14 0.74 29075.00 0.16 0.11
Sede 19 14 0.74 58056.00 0.31 0.23
Lurio 19 7.00 0.37 13414.00 0.07 0.03
Chipene 19 14.00 0.74 17500.00 0.09 0.07
Mazua 19 9.00 0.47 29776.00 0.16 0.08
Memba 19 11.00 0.58 38586.00 0.21 0.12
0.64
2+ TT immunization
Gerger 19.00 12.00 0.63 29075.00 0.16 0.10
Sede 19.00 15.00 0.79 58056.00 0.31 0.25
Lurio 19.00 3.00 0.16 13414.00 0.07 0.01
Chipene 19.00 12.00 0.63 17500.00 0.09 0.06
Mazua 19.00 8.00 0.42 29776.00 0.16 0.07
Memba 19.00 8.00 0.42 38586.00 0.21 0.09
0.57
3+ Pregnancy-related danger signs
GerGer 19.00 18.00 0.95 29075.00 0.16 0.15
Sede 19.00 18.00 0.95 58056.00 0.31 0.30
Lurio 19 14.00 0.74 13414.00 0.07 0.05
Chipene 18 12.00 0.67 17500.00 0.09 0.06
Mazua 19 11.00 0.58 29776.00 0.16 0.09
Memba 19 9.00 0.47 38586.00 0.21 0.10
0.75
APPENDIX 15 Page 4
Delivery
Trained attendant
Gerger 19 13.00 0.68 29075.00 0.16 0.11
Sede 19 8.00 0.42 58056.00 0.31 0.13
Lurio 19 1.00 0.05 13414.00 0.07 0.00
Chipene 19 5.00 0.26 17500.00 0.09 0.02
Mazua 19 5.00 0.26 29776.00 0.16 0.04
Memba 19 7.00 0.37 38586.00 0.21 0.08
0.38
3+ birth plan items
Gerger 19.00 1.00 0.05 29075.00 0.16 0.01
Sede 19.00 0.00 0.00 58056.00 0.31 0.00
Lurio 19.00 1.00 0.05 13414.00 0.07 0.00
Chipene 19.00 2.00 0.11 17500.00 0.09 0.01
Mazua 19.00 0.00 0.00 29776.00 0.16 0.00
Memba 19.00 1.00 0.05 38586.00 0.21 0.01
0.03
Child spacing
Know 2+ FP methods
GerGer 19.00 4.00 0.21 29075.00 0.16 0.03
Sede 19.00 6.00 0.32 58056.00 0.31 0.10
Lurio 19 3.00 0.16 13414.00 0.07 0.01
Chipene 19 3.00 0.16 17500.00 0.09 0.01
Mazua 19 5.00 0.26 29776.00 0.16 0.04
Memba 19 5.00 0.26 38586.00 0.21 0.05
0.25
Using modern FP
Gerger 19
4 0.21 29075.00 0.16 0.03
Sede 19
3 0.16 58056.00 0.31 0.05
Lurio 19 5.00 0.26 13414.00 0.07 0.02
Chipene 19 1.00 0.05 17500.00 0.09 0.00
Mazua 19 1.00 0.05 29776.00 0.16 0.01
Memba 19 3.00 0.16 38586.00 0.21 0.03
0.15
APPENDIX 15 Page 5
Immunization
Gerger 18.00 0.00 0.00 29075.00 0.16 0.00
Sede 19.00 3.00 0.16 58056.00 0.31 0.05
Lurio 19.00 1.00 0.05 13414.00 0.07 0.00
Chipene 19.00 5.00 0.26 17500.00 0.09 0.02
Mazua 19.00 2.00 0.11 29776.00 0.16 0.02
Memba 19.00 2.00 0.11 38586.00 0.21 0.02
0.12
Appendix 16 MTE Team Members and Titles
External: 
1. Ana Paula deMorais Oppenheimer, MD, MPH – team leader
2. Eric Swedberg MPH – SC Child Survival Specialist
3. Joseph de Graft-Johnson MBchB, MPH, DrPH, SC Africa Regional 
Advisor 
Internal:
1. Amilton L Alberto - Tecnico de Saude, DDS Memba,
2. Alexandre Agostinho - Tecnico de Saude, Administrator DDS NaV 
3. Maria Adelia - SMI nurse, Lead Trainer, SC Nacala
4. Cristina Cardoso – SMI nurse, Memba Trainer, SC Nacala
5. Florinda Francisco – SMI nurse, NaV Trainer, SC Nacala
6. Maria Manicuela – Accountant, M&E officer, SC Nacala
7. Adelina Xavier – Elementary nurse, Trainer, SC Nacala
Support: 
1. Ana Paula Cortez –translator
2. Izidine Omar –translator
3. Filo, Salvado and Ismael - SC drivers
4. M. Lucia Alexandre- secretary 
5. Jolly Muxahua- Logistics officer 
6. Fatima and Saraiva –services