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FY16 – Q4 Performance Report

July 1, 2016 – September 30, 2016

Cooperative Agreement Number- AID-696-A-16-0000I

Gikuriro - Integrated Nutrition and WASH Activity

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Quarterly Performance Report FY16 Quarter 4 Report (July 1, 2016 – September 30, 2016) Gikuriro - Integrated Nutrition and WASH Activity Cooperative Agreement No. AID-696-A-16-0000I Submitted to USAID/Rwanda October 28, 2016

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List of Acronyms

AEE African Evangelistic Enterprise

ASOC Village Health Workers - Social Affairs in the village

BCC Behavior Change Communication

CBEHPP Community Based Environmental Health Promotion Program

CBF&NP Community based food and nutrition program

CHAIN Community Health and Improved Nutrition

CHC Community Health Club

CHW Community Health Worker

COP Chief of Party

CRS Catholic Relief Services

CSO Civil Society Organization

CFSVA Comprehensive Food Security and Vulnerability Assessment

DIP Detailed Implementation Plan

DPEM District Plan to Eliminate Malnutrition

DQA Data Quality Assurance

EHD Environmental Health Desk

EHO Environmental Health Officer

ES Economic Strengthening

FA Field Agent

FFLS Farmer Field and Leaning School

FGD Focus Group Discussion

FXB Francois Xavier Bagnoud

FVA Faith Victory Association

GD Give Directly

GoR Government of Rwanda

INWA Integrated Nutrition & WASH Activity

IPA Innovations for Poverty Action

JADF Joint Action Development Forum

KII Key Informant Interviews

KSPI Knowledge Skills Practice and Incentive

LCSO Local Civil Society Organization

MEAL Monitoring, Evaluation, Accountability and Learning

MIGEPROF Ministry of Gender and Family Promotion

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MIYCN Maternal Infant and Young Child Nutrition

MoH Ministry of Health

NISR National Institute of Statistics Rwanda

PDH Positive Deviance Hearth

PSP Private Service provider

RHCC Rwanda Health Communication Center

SAHO Sanitation and Hygiene Officer

SILC Saving and Internal Lending Communities

SMILER Simple Measurement Indicators Learning Evidence-based Reports

SNV Netherlands Development Organization

SPH School of Public Health

SUN Scaling Up Nutrition

ToT Training of trainers

USAID United States Agency for International Development

VNS Village Nutrition School

WASH Water Sanitation and Hygiene

WATSAN Water and Sanitation

WIF Women Investment Fund

YWCA Young Women Christian Association

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1. Summary of the Project

1.1. Summarized Project description

Name of the Program: Gikuriro – Integrated Nutrition and Water Sanitation and Hygiene (WASH) Activity

Effective dates of the Project: Nov 10, 2015 – Nov 9, 2020 Implementing Partner: Catholic Relief Services (CRS) Cooperation agreement #: AID-696-A-16-0000I Name of AOR: Mary de Boer Sub - contracts’ names or Consortium members:

SNV

Newly Identified Local Implementing Partners

FVA (Kayonza), YWCA (Ngoma), DUHAMIC (Kicukiro), WIF (Nyarugenge), Caritas Rwanda (Nyabihu and Ruhango), FXB (Nyanza) and AEE (Rwamagana)

Geographical coverage 8 Districts: Nyarugenge, Kicukiro, Rwamagana, Kayonza, Ngoma, Nyabihu, Ruhango and Nyanza

Reporting period: July 1 – September 30, 2016

1.2. Project Description/Introduction The primary purpose of Gikuriro program is to improve the nutritional status of women of reproductive age and children under five years of age, with an emphasis on the 1,000-day window of opportunity from pregnancy until a child's second birthday, in support of the Government of Rwanda's (GoR) efforts. The program is a five-year activity funded by USAID and is implemented through a consortium of two international agencies—Catholic Relief Services-United States Conference of Catholic Bishops (CRS-USCCB) as prime and SNV (the Netherlands Development Organization) as a sub-recipient.

Gikuriro directly supports and contributes to the GoR-led efforts to combat malnutrition in Rwanda outlined in the strategic priority documents including the Economic Development and Poverty Reduction Strategy II for 2013-2018, the Ministry of Health's (MoH) Third Health Sector Strategic Plan (2012-2018), the Social Cluster's National Food and Nutrition Policy and National Food and Nutrition Strategic Plan 2013-2018, and the Ministry of Agriculture and Animal Resources' (MINAGRI) Nutrition Action Plan 2013-2018. Gikuriro’s focus is on community-level service delivery and district level capacity strengthening. The Program articulates a strategic set of interventions that leverage USAID/Rwanda's history of health, nutrition, and economic growth work and its unique comparative advantages as a donor and key partner. Gikuriro builds on the theory that if the GoR’s community-based programs are fully implemented at district, sector and community levels by skilled and equipped district staff and volunteers; if civil society contributes to these programs in complementary, coordinated and sustainable ways; if each household member participates fully and equally in promoting positive nutrition and hygiene behaviors; then sustained demand for nutritious, diverse and fortified foods, as well as hygiene and sanitation supplies and materials, will be high enough to attract broad-based community mobilization and private sector investment, and with all of these conditions in place, the nutritional status of women of reproductive age and children under five will sustainably improve.

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The following diagram shows Gikuriro’s Results Framework which captures the Goal, Strategic Objectives, Intermediate Results and key Outcomes: Figure 1: Gikuriro Results Framework

1.3. Quarterly Major Accomplishments In the reporting period, the program conducted the following key activities:

1. Beneficiary selection for community level activities in all 5 districts where Gikuriro is implementing nutrition activities.

2. Orientation of partner staff on VNS, FFLS/BIAT and SILC/PSP approach 3. Preparation and training of health facilities’ nutritionists and in charge of CHW on VNS/PDH

methodology

Goal: Gikuriro aims to improve the nutritional status of women of reproductive age and children under five years of age, with an emphasis on the 1,000-day window of opportunity from pregnancy until a child’s second birthday

Strategic Objective: Nutritional status of women of reproductive age and children under 5 years of age improved

IR 1: Capacity of service providers and districts to achieve improved nutrition outcomes strengthened

IR 2: Household level nutrition and WASH behaviours improved

Sub IR 1.1: Capacity of district governments to implement high quality nutrition and

WASH programming strengthened

Sub IR 1.2: Capacity of local CSOs to implement high

quality nutrition and WASH programming strengthened

Sub IR 2.1: High quality nutrition programming

implemented

Sub IR 2.2: High quality WASH programming

implemented

Outcomes:

1. DPEM Coordination Committees have strengthened capacity to plan, monitor, evaluate, report and analyse data for effective implementation

2. District staff technical capacity to implement protocols of CBF&NP and CBEHPP is strengthened

3. District staff technical capacity to implement protocols of CBF&NP and CBEHPP is strengthened

Outcomes:

1. LCSO staff have nutrition and WASH technical competencies to implement CBF&NP and CBEHPP

2. LCSO staff have competencies to effectively take gender dynamics and opportunities into account when implementing nutrition and hygiene programming

3. LCSOs have the institutional capacity to implement CBF&NP and CBEHPP

Outcomes:

1. Households equitably access a diverse and quality diet

2. Households adopt optimal maternal, infant and young child nutrition practices

3. Children under 5 receive all primary care services under CBF&NP

4. Husbands support women of reproductive age to practice recommended health seeking behaviors

Outcomes:

1. Men, women, boys and girls practice key hygiene, sanitation, and water handling behaviors

2. Households have increased access to improved sanitation facilities

3. Households have improved access to drinking water treatment and storage inputs

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4. Supervision of cascading trainings for CHWs on VNS approach in Kayonza, Ngoma and Kicukiro districts

5. Review and updating of DPEM documents in all Gikuriro districts 6. Training of trainers for district and sector agronomists on FFLS approach and BIATs 7. Identification and training of FFLS facilitators (Farmer Promoters) on FFLS approach and BIATs 8. 9. Preparation and training of District and Sector Staff in charge of Cooperatives on SILC/PSP

methodology 10. Orientation of partner staff on SILC/PSP approach 11. Identification and training of field agents on SILC/PSP approach 12. FY17 work plan development, submission and revision 13. CBEHPP Training of Trainers (ToT) for 6 district staff (Nyabihu, Rwamagana, Ngoma, Kayonza,

Kicukiro and Nyarugenge) and staff from 4 sectors in each of the 6 districts 14. CBEHPP ToT for Gikuriro sub-partners 15. CBEHPP planning and learning workshop organized in 8 districts 16. Gikuriro baseline 17. Roll out of SMILER to establish Gikuriro MEAL system by training District M&E, Health

Directors and key staff. 18. Agreement signing with 6 Gikuriro sub-partners including budget for FY16-17 19. First quarter budget forecast and funds transferred to sub-partners for the first 2 months

1.4. Major Challenges

Challenge Planned response

Next steps / action to be taken

Timeline

Responsible

Districts requesting investment in infrastructures through the model villages

Explain to districts the purpose of Gikuriro and our contribution to reduce malnutrition cases.

Explaining clearly to districts Gikuriro’s scope of work

Q1 FY17 WASH Senior Advisor

Approval process for district staff to participate in activities out of their districts

Requesting in advance for the approvals and having focal points in the ministries to support. In addition, having only essential activities of this kind.

Courtesy calls to MOH focal point for support on this. Reaching out to the focal person at MINALOC to develop stronger relationship for collaboration.

Q1 FY17 DCOP

Lengthy beneficiary selection process with list containing duplicates and beneficiaries that seem not to meet selection criteria

Conduct second validation before forming groups

Gikuriro staff and sub-partners to check the qualifying households on the lists while forming group and also check for eventual malnourished U5 that might have been missed

Q1 FY17 DCOP and Gikuriro district focal persons

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Approval process to get ethical clearance for community level studies

This is already done. A considerable amount of time taken to get all the approvals though.

In future, for any studies that require ethical clearance, the program needs to plan sufficient amount of time for these approvals.

NA MEAL Advisor

Long and complex negotiations with IPA colleagues to agree on Gikuriro’s beneficiary identification process and target numbers in the RCT sites

Agreement on the number of beneficiaries per village and the selection process reached. However, this caused significant delay in the overall all community entry process and service start up

Expedite the service delivery and process to compensate for the lost time and communicate with USAID on potential effect on Gikuriro’s ability to meet expectations at midline and program end line periods

Q1, FY17 CoP

District staff who missed the training of trainers (ToTs) that Gikuriro Program organized in August 8-12, 2016, which should allow them to organize the trainings at community level.

The technical staff who missed the training had to be trained on site by Gikuriro The community training had to be organized by the sub-partner staff who have been trained in this quarter 4 and should involve the sector agronomists who missed their training.

- Gikuriro agronomist to follow up on the training organized by the sub-partner technical staff and provide the guidelines and technical support to ensure the good quality of training.

Joint planning with the districts for FY 2017 activities

QI, FY 17 Gikuriro senior agronomist

Delay in starting the agriculture season 2017A due to the fact that the selection of beneficiaries was not yet completed in the beginning of the agriculture season 2017A (September 2016).

Gikuriro had to speed up the process of group formation in October 2016 so that the implementation of BIATs within the demonstration plots and planting with short production cycle crops could be done before mid-November 2016.

- Speed up the training of group facilitators (Farmer promoters) so that the groups will be formed and start operating at the same time in all the villages from the selected sectors.

QI, FY 17 Gikuriro senior agronomist

2. Quarterly Achievements 2.1 Executive Summary

The last quarter of FY 16 was full of activities for the project due to the amount of time left to accomplish key activities scheduled for the fiscal year. The project’s strong investment in community entry, both at national and district levels, fostered a strong relationship and collaboration with the government stakeholders that continuously helps Gikuriro to bring out the desired change in addressing malnutrition. The period also saw signing of agreements with seven local partners to start community

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level implementation of the project as Gikuriro works through partners. The main activities conducted in the reporting period focused on a number of key trainings for all service areas, Nutrition, Agriculture, Economic strengthening, CBEHPP and MEAL. In addition, beneficiary selection in the five districts where Gikuriro is implementing Nutrition activities was conducted with the involvement of all respective district, sector, cell and village authorities to ensure an all-inclusive participation of stakeholders in the process.

Gikuriro’s beneficiary selection was conducted in a participatory and rigorous manner involving all the stakeholders, especially the local authorities and district technical staff, in order to ensure Gikuriro’s integrated nutrition packages benefit the most vulnerable. A database of beneficiaries is under construction to include the beneficiaries’ list in all the villages and for monitoring purposes. The final lists will be validated during group formation at village level.

Agreements were signed with Gikuriro sub-partners and FY16-17 budgets were prepared. A first fund transfer was provided to sub-partners except AEE, which is expected early October. The partners are three USAID LCSOs (FXB, AEE and Caritas) and four Gikuriro sub partners (DUHAMIC, FVA, YWCA and WIF).

After partner selection, agreement signature and grant award, sub-partner staffs were oriented in all the approaches in order to immediately begin supporting sector and health center staff with the community entry activities. The trainings in the full package of offerings is planned for early October.

Trainings were conducted in key nutrition and WASH approaches at district and sector/health center levels and started at the community level. These approaches are VNS, FFLS/BIAT, SILC/PSP, CBEHPP and MEAL. The community trainings are ongoing and will be completed in October.

Gikuriro conducted the main baseline for key indicators in this quarter. This follows a long process of meeting all government requirements for conducting a research study which included securing NISR certificate/visa in addition to MoH collaboration letter. The team of consultants rolled out the implementation of the study by training data collectors, piloting data collection instruments and scheduling interviews with households, FGD participants and Key Informants. The whole process occurred in July-September with the data collection finishing on Sept 28, 2016. The WASH assessment (Sanitation and Household Water Treatment and safe Storage supply chain and market analysis activity) made significant progress with the consultant on board to carry out the research. The plan of the study was shared with the sanitation and hygiene thematic working group under the MININFRA WATSAN sector working group. Other WASH actors, particularly members of the thematic group, were keen to provide inputs and to use the results of the study when available.

This quarter has seen the organization of CBEHPP learning workshops in 8 districts, where 302 actors at district and sector level were invited to share their past experiences in the implementation of the CBEHPP approach in their respective areas. It was an opportunity to understand the challenges faced, lesson learned, opportunities and best practices. The learning compiled from those workshop was documented and will be used for WASH programming.

Finally, a major achievement in this quarter remains the inclusive planning process that engaged all 8 districts and central level line ministries to participate in developing Gikuriro FY17 work plan. The

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process led to a development of a comprehensive work plan which has been approved by USAID following rounds of comments and discussions.

2.2 Progress in Addressing Identified Challenges in the Previous Quarter Regarding Q3 challenges, MoH availed a focal person from the Environmental Health Desk, who has been facilitating Gikuriro contacts within the Ministry. Besides USAID, MoH and MININFRA reached a consensus on the districts selected for Gikuriro Program; therefore, no changes were made to the target districts.

2.3 Quarterly Achievements per Sub-component

2.3.1 Key Realizations/Achievements by Component

This section will follow DIP format in reporting each section with general and M&E activities presented at the end of the DIP listed activities. Only activities conducted in Q4 of FY16 have been listed and for each activity a narrative of the activity is provided.

IR1: Districts and Service Providers have capacity to achieve improved nutrition and WASH outcomes.

Sub IR I.I: Capacity of district governments to implement high quality nutrition and WASH Programming strengthened

In Q4 FY16, in preparation for activities to increase capacity of different service providers to coordinate and implement behavior change activities, a BCC draft module to facilitate 5-day training to service providers in Q1 FY16 was drafted and being reviewed internally. This training will be provided to LCSOs, District Health facilities’ nutritionists and in Charge of Community Health Workers, District and Sector Agronomist and in charge of Cooperatives to equip them with skills in the implementation of BCC activities. The module describes key negative behaviors identified in different studies on nutrition and WASH services, formative research activities, potential messages to address key behaviors, and potential communication channels. The module will be completed by integrating findings from Gikuriro baseline survey and will be finalized in Q1 of FY17, in consultation with Rwanda Health Communication Center (RHCC). The table below highlights some of the negative behaviors observed in previous studies. Key negative behaviors Causes Message Data Source

1 Poor personal hygiene of mothers, caregivers of children and children under 5

Ignorance on the importance and benefits of personal hygiene No accessibility to clean water

Benefits of good body hygiene on child and maternal health

National Social and Behavior Change Communication Sub-Strategy for

2 Handwashing with soap not practiced by mothers and caregivers of children under 5

Handwashing with soap is not a habit No accessibility to clean water

Benefits of handwashing with clean water and soap The four critical times for handwashing

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3 Poor excreta disposal practices in the homes and in schools

Homes lack hygienic latrines Improper use of latrines: dirty, poor disposal of anal cleaning materials No covering the hole Improper disposal of children feces (belief that children’s feces are not harmful)

Importance of a hygienic latrine Importance of proper disposal of children’s feces

Maternal, Newborn and Child Health, January 2012

4 44 percent of households use an appropriate treatment method prior to drinking, while the other 56 percent do not treat their water prior to drinking

Rwanda, DHS 2014 -2015 5 29 percent of households use an

unimproved facility, with the majority (24 percent) using a pit latrine without a slab or an open pit

Activity 1.1.1.1 Supported by Gikuriro and in collaboration with SUN civil society actors, districts will review and update the DPEM (integrating WASH and gender components). To support the districts to update their DPEMs, Gikuriro organized a 3-day workshop during which participants discussed, reviewed and updated their respective DPEM. Participants from each district identified barriers and challenges on existing DPEM implementation and ways of overcoming them in the reviewed DPEM.

The DPEM review strategy focused on the food and nutrition situation. The process strictly followed strategic directions defined in the National Strategic Plan to Eliminate Malnutrition (2016-2018), which include:

• Food and nutrition advocacy to sustain commitment and generate resources for implementation • Prevention of Chronic Malnutrition • Improving Household Food Security • Prevention of all forms of Malnutrition • Improving food and nutrition in schools • Assuring food and nutrition in emergencies • Supporting programs and services

At the end of the workshop, all districts agreed on the way forward to develop the first draft, which will be validated by the district DPEM committee. The Directors of Health in all districts were designated to follow up and prepare a final draft. The workshop was organized in 2 sessions:

• From 16 to 18 August 2016 - Ngoma, Kayonza, Rwamagana and Ruhango

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• From 18 to 20 2016 - Kicukiro, Nyarugenge, Nyabihu and Nyanza Towards the end of Q4, the first draft for each district was developed and shared with an ad hoc committee at the district level for consolidation. This committee includes the district planning officer, the district M&E among others. The validation and finalization of the documents will be done in Q1 of FY17. Gikuriro will assist each DPEM committee to integrate the DPEM key priorities into their respective district action plans accordingly. Activity 1.1.1.3 Gikuriro will utilize JADF monthly meetings to form a JADF sub-commission on WASH and Nutrition and conduct regular quarterly meetings. The Gikuriro team initiated this activity towards the end of FY16 with actions consisting of drafting the Terms of Reference detailing the composition of the sub-commission and the modalities for meetings and its functions. During preliminary discussions with districts, it was proposed to call the sub-commission a technical working group to avoid confusion with existing sub-commissions and the requirement of going through ministry approvals. Extensive discussions have been initiated with Nyabihu district that will likely be the first district to operationalize the Nutrition and WASH technical working group early in Q1 of FY17. The technical working group will be used to optimize the coordination and cooperation between Nutrition and WASH stakeholders in order to achieve an integrated activity plan and to refine their monitoring strategy. This will prevent the stakeholders from duplicating work and will support the achievement of the district development objectives.

The JADF Nutrition and WASH technical working group will contribute to the district open days to raise awareness about nutrition and WASH issues in the communities. It will ensure the geographic coverage of all villages by nutrition and WASH interventions, avoid duplication, and ensure effective use of resources for improved nutrition outcomes.

In September 2016; the Ministry of Infrastructure gave instructions to all districts to establish WASH boards and recruit District WASH officers. This new entity within the district will be complementary to the JADF WASH and Nutrition TWG. The latter contribute essentially to the nutrition outcome which is stunting reduction while the WASH boards is more focus on WASH infrastructures. Members of the WASH boards are very limited and most of them are district staff with exception to one private operators and JADF representative while the JADF Nutrition and WASH TWG gather all implementing district partners in WASH and Nutrition. However, the JADF nutrition and WASH TWG will be reporting to the WASH boards for all work related to WASH interventions done for more coordination.

Activity 1.1.1.10 Gikuriro to facilitate sharing and learning opportunities of CBF&NP and CBEHPP implementation, challenges, successes and innovations at all service provider levels (e.g., Environmental Health Officers, and Community Health Supervisors, Nutritionist, Health Unit Staff). The first CBEHPP learning workshops were conducted in September 2016 in all 8 districts. Even though Gikuriro did not reach village level with CBEHPP rollout, these learning sessions intended to reflect on past experiences that all districts had with the CBEHPP implementation in order to facilitate exchanges on lessons learned, to be applied in Gikuriro implementation in this area.

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WASH staff, Environmental Health Officers (EHOs) from hospitals and health centers, executive secretaries and in charge of social affairs (ASOCs) from sectors in each district attended a full day workshop to discuss challenges and opportunities of CBEHPP implementation. The workshops were conducted in each respective district. The learning out of this activity will help Gikuriro to adjust its planning for maximum impact. The table below summarizes the data of this activity

District Date of Meeting

Number of participants

Male Females

Rwamagana September 13 41 28 13 Ruhango September 14 34 20 14 Nyanza September 16 41 24 17 Kicukiro September 20 36 17 19 Ngoma September 20 42 31 11 Kayonza September 22 46 30 16 Nyabihu September 23 34 22 12 Nyarugenge September 27 28 20 8

In each district, the following staff were invited:

- Vice mayor/social affairs - Executives secretary / all sectors - District Health Unit Director - In charge of Hygiene and sanitation at District - Environmental Health Officer (EHO) based at the hospital - In charge of social affairs/Hygiene at sector level - Environmental health officer/community health workers’ supervisors at health centers

In Ruhango and Nyanza District, Caritas and FXB were invited as sub-partners working in those districts to share their inputs with participants.

The main challenges experienced by districts with past CBEHPP experience are; - Households lack financial means to complete homework assigned during CBEHPP dialogue

sessions requiring some investments (e.g. latrine construction). - Drop out from the CHCs before completion of curricula - Monitoring by ASOC at sector level has failed to support CHC committees regularly for

guidance and continuous orientation (finance and transport facilitation challenges) - Insufficient knowledge of actors on CBEHPP approach (missing CBEHPP dialogue cards/tools) - Weak involvement and lack of CBEHPP knowledge by local leaders to support the process - Households were not motivated to attend CHC meetings and complete home works - Opportunity cost creating conflicting agenda for households with income generating activities (in

urban context) - Unclear responsibilities of government staff at all levels - In charge of Social Affairs in the villages are overloaded with many responsibilities; however,

changing them during implementation also poses problems

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The main learnings coming out of these workshops are: - CHCs work better with members from no more than 30 households - Refresher trainings are important to retain momentum of actors - Monitoring and evaluation is key for success of the approach - The use of membership card is stimulating for households to perform - Availing CBEHPP dialogue cards and books on time is critical for success

Activity 1.1.1.13 Tailored media messages are disseminated to promote improved nutrition and WASH practices. A policy requirement by GoR is that all tailored messages to promote improved nutrition and WASH practices have to be approved by MoH through Rwanda Health Communication Center (RHCC), In Q4, Gikuriro collaborated with RHCC to identify approved integrated nutrition and WASH messages and communication tools, which Gikuriro can use in upcoming BCC messaging. The tailored messages and segmented audience were identified from MIYCN counselling package, National Social Behavior and Communication Policy and Comprehensive Food Security and Vulnerability analysis (2015 Rwanda CFSVA study). The key messages identified include messages on:

• Nutrition for pregnant and breastfeeding women • Immediate breastfeeding after birth • Exclusive breastfeeding during the first 6 months • Complementary feeding at 6 months • Regular growth monitoring and promotion • Household food security • WASH best practices

The communication tools collected include:

• National Counselling Cards for Community Health Workers • 1000 days’ posters on Maternal nutrition, breastfeeding, complementary feeding and wash

handing. • ECD comic book showing the roles of Family members to addresses nutrition issues.

Activity 1.1.2.2 Gikuriro and district staff adapt CBEHPP trainings to reflect findings from KSPI assessment and the baseline gender analysis. Considering the results of the KSPI assessment, it turned out that an adjustment of the CBEHPP tools was not necessary because the large majority of district and sector staff had not already received trainings on the approach or they did not practice it enough to generate consistent critical knowledge to inform the adaptation of the modules. The CBEHPP ToT will be conducted according to the original tools. Activity 1.1.2.3 Gikuriro to conduct a training for District Health Officers: Sanitation and Hygiene Officer, District Hospital Staff and Environmental Health Officer using adapted CBEHPP agenda. From August 8th-12th, the WASH team organized the first ToT on CBEHPP for 6 districts namely Kayonza, Ngoma, Rwamagana, Kicukiro, Nyarugenge and Nyabihu. The training targeted 3 staff working on CBEHPP per district (i.e. Director of Health Unit, Sanitation and Hygiene Officer (SAHO) and Hospital EHO). Staff from the 4 sectors selected for FY16 in each of the 6 district also joined the training. Nyanza and Ruhango were excluded because these districts were already trained by Local Civil Society Organization (LCSO) FXB and Caritas respectively.

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Seventy-one participants (35 females and 36 males) attended the training. It was led by 4 Master trainers selected by MoH. The participants were divided into 2 groups to allocate a reasonable number of participants per group, encouraging active participation. The pretest and post-test performed by the trainees showed an improvement in terms of knowledge, with average scores of 41.1% and 67.8% before and after training, respectively.

Activity 1.1.2.6 Gikuriro to conduct a KSPI assessment on MIYCN/First 1,000 Days and CBF&NP actors (e.g. CHWs and Community Health Supervisor and District Hospital Nutritionist). The Nutrition KSPI assessment was very important to ascertain the knowledge gaps and adapt a strong capacity building plan for districts on Nutrition. From the findings it was certain that a good number of district staff had not been trained on MIYCN, VNS, CBF&NP, Management of malnutrition, strengthening Supportive and positive enquiry supervision, among others. The Nutrition team, cognizant of the gaps, planned to train district staff beginning with MIYCN training and later management of malnutrition to ensure the district staff have a clear understanding and strong knowledge on the vital Nutrition components in addressing malnutrition. Activity 1.1.3.2 Gikuriro will work with Districts, Sectors and Cell Social Affairs staff responsible for CHCs to identify ways to sustain and motivate CHC. Under this activity, Gikuriro intends to work with the MoH and ISUKU IWACU to explore ways of reporting CHC activities, starting with paper-based reporting while exploring a possibility of a mobile reporting system that could be integrated to Systeme d’information Sanitaire Communautaire (SIS Com) or Rapid SMS platforms. Gikuriro will plan a consultation meeting with Isuku Iwacu project to see how to come up with a joint mobile reporting system.

On Wednesday 31st August, SNV/Gikuriro invited 7 staff from MoH to present the first draft of the mobile reporting concept, and get inputs. Three people attended the meeting, from the Environmental Health Desk (EHD), the IT department and e-health department. They showed interest for the proposed system and made constructive suggestions for improvement. It was proposed that the concept should be presented to the e-health technical working group before further development.

Activity 1.2.1.1 Gikuriro and district staff will conduct a participatory capacity assessment of the three USAID LCSOs implementing CBF&NP to assess their technical, institutional and program management capacities.

A consultant was recruited by Gikuriro to prepare an assessment framework and assess institutional and technical capacity of USAID LCSOs. Following the design of the assessment tools, the team reviewed and provided comments and inputs to finalize the assessment framework and rollout the assessment. The consultant worked with the Gikuriro coordination and capacity building advisor to conduct the assessment, which involved: documentation, production of the Gikuriro Program capacity assessment Tool, an assessment exercise with partner institutions, collation and analysis of the findings, provision of reports and feedback on the respective partner reports, identification of gaps and support of the development and production of 3 USAID LCSOs Capacity Building plans. Accordingly, a draft report was prepared towards end of September 2016, which this will be reviewed and finalized in Q1 FY17 along with the capacity development plans for respective LCSOs.

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Activity 1.2.1.3 DPEM coordination committee and Gikuriro will conduct a small grants competition for sub-partners already present in the district and working on WASH and Nutrition to apply for complementary funds to begin implementing or to scale up implementation of CBF&NP and CBEHPP (depending on the needs of the districts which will be identified through IR1.1.). The partners are now on board after an elaborate process of advertising, screening, pre-award assessment and validation from all stakeholders.

Gikuriro team in Q4 conducted a pre-award assessment for the sub-partners. The assessment was conducted for WIF implementing Gikuriro program in Nyarugenge, FXB in Nyanza, DUHAMIC ADRI in Kicukiro, Caritas Rwanda in Ruhango and Nyabihu, YWCA in Kayonza, AEE in Rwamagana and FVA implementing Gikuriro program in Kayonza.

Agreements were signed with WIF, DUHAMIC, FVA, YWCA, FXB and Caritas. Sub-partners FY16-17 budget was approved and funds were released for the first two months of their first quarter forecast.

Activity 1.2.1.5 District sanitation and hygiene staff and Gikuriro conduct trainings for USAID LCSOs and Gikuriro sub-partners on CBEHPP.

The ToT for sub-partner took place from 26 to 30 September in Kigali. Each sub-partner was invited to send 2 technical staff per target district. 15 participants (5 females, 10 males) attended the training from their respective organizations (AEE, Caritas Rwanda, FXB, FVA, DUHAMIC, YWCA, and WIF). It was facilitated by 2 Master trainers form the Ministry of Health. During the training, the trainees prepared work plans for roll out of CBEHPP trainings for all EHOs at health centers and CHC facilitators with support from district staff. Activity 1.2.1.8 Gikuriro to train district technical staff, USAID LCSOs and sub-partners on Monitoring and Evaluation, Accountability and Learning (MEAL) including qualitative methods for gender analyses and data quality assessments.

In Q4, a training on Monitoring and evaluation was conducted in Muhanga from 12 to 16 September 2016 to:

• Develop and adapt an integrated monitoring and evaluation system for nutrition and WASH interventions thought Gikuriro program following the SMILER outputs developed earlier and integrating inputs from the district staff.,

• Provide more in-depth understanding on the existing tools being used by GoR, • Develop business process maps for all information channel, and • Providing basic skills on Monitoring and evaluation in general.

The training was a TOT to prepare M&E district and hospital staff, in collaboration with LCSO M&E staff, to train health center and sector staff on the established functional M&E system down to community level with support from Gikuriro staff. The training was facilitated by CRS/SNV MEAL team and an external facilitator from MOH/HMIS unit, Mr. Emmanuel Ntawuyihiga - HMIS and data quality audit specialist. The training was based on adult learning principles and techniques, building on existing experiences, using feeling, thinking and actions for learning, and emphasizing dialogue, relevance of information, immediate results, respect, recognition and appreciation. The training utilized discussion, questions and answers, individual and group activities, role plays, etc. Participants were given the opportunity to explore the existing monitoring system in the districts, review all documents developed

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during the SMILER session and align or harmonize them to make them easily usable in the process of monitoring and evaluation of Gikuriro program. This training of trainers aimed at strengthening the capacity of the district actors for multisector planning, implementation, monitoring of the District Plan to Eliminate Malnutrition (including WASH and nutrition activities) who, in turn will roll out the M&E system down to community through cascading trainings. The training outcomes were achieved, including:

• Training participants having a common understanding of the Gikuriro MEAL system • List of data collection tools available and reporting flows developed as well as reporting map • Monitoring and reporting tasks shared among district staff, partners and others stakeholders • A draft of accountability and feedback mechanisms established (to be validated) • A roll out plan developed for cascading trainings to lower level staff

IR 2: Household level nutrition and WASH behaviors improved Activity 2.1.1.1. Gikuriro sub partners and district agronomist from five districts trains (ToT) sector agronomist on FFLS approach, bio-intensive agriculture and diseases and pest control.

The training of trainers (ToTs) at district and sector level was organized in Muhanga district, Centre Saint André on August 8-12, 2016. The training was attended by 8 district agronomists and 15 sector agronomists including 3 females and 20 males. The objective of the training was to build the capacity of trainees to train the community group facilitators (FFLS), coordinate the creation of FFLS groups and oversee and monitor the implementation of agriculture activities in the community including the adoption of BIATs in the beneficiaries’ households.

The participatory methodology was used in the training for the theory and the practices. The following topics were covered in the training: - Introduction on Gikuriro Program and agriculture activities planned in the program. - Farmer Field School » Approach. - Training on Bio-intensive agriculture techniques (BIATs) including the composting techniques and

the tillage techniques allowing the improvement of soil fertility (theory and practices). - Introduction on pest and disease control with organic methods and pesticides. - Mushroom production techniques (using cheaper materials).

On the last day, the trainees participated in the study visit to one experienced FFLS groups operating in Nyamabuye sector and to some beneficiaries who adopted the BIATs at household level. The training of district agronomists should have been combined with the training of the sub-partner and LCSO agronomists to prepare them to organize the training of the sector agronomists within the districts but the training of sub-partner and LCSO agronomists was not possible because they were not yet recruited. The involvement of sector agronomist was aiming at making possible the start up of the activity related to the selection of beneficiaries and creation of FFLS that had to be undertaken in September 2016.

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Trainees learning how to construct

kitchen garden with stairs Trainees in practice on making

“container garden” Trainees learning how to grow

mushrooms in a cage made in wood.

Activity 2.1.1.2. Gikuriro sub partners and district agronomist from five districts trains (ToT) sector agronomist on FFLS approach, bio intensive agriculture and diseases and pest control.

The training of sector agronomists from the selected sectors for FY 2016 was done by Gikuriro agronomists in August 2016 together with the district agronomists because the recruitment of sub partner agronomists was not yet done.

Activity 2.1.1.3. Sector agronomist create FFLS in all villages

The creation of FFLS in the villages from the 21 selected sectors was not possible in FY 2016 because the selection of beneficiaries was still going on at the end of September 2016.

Activity 2.1.1.4. Sector agronomist identify and train FFLS group leaders (CHW and farmer promoters) on gardening techniques, diseases and pest control.

In the initial plan, the farmer promoters (FPs) and the Community Health Workers (CHWs) should be selected to facilitate the training of beneficiaries on BIATs within the FFLS. After being informed by MoH that the CHWs should not be overloaded with many duties, it was decided to replace the CHWs by the “Parents lumières/Model parents”. These ones should be selected through VNS but meantime that they were not yet selected, it was decided to start the training with the Farmer Promoters who are working with RAB in all villages in each district. Therefore, after the training of district and sector agronomists in August 2016, the 15 sector agronomists (out of the 21 selected sectors for the first year of the program) organized the training of farmer promoters (one FP per village) in their respective sectors. The training covered the following topics:

- Introduction on Gikuriro Program. - Farmer Field School » Approach. - Training on Bio-intensive agriculture techniques (BIATs) including the composting techniques and

the tillage techniques (double dug bed, sunken bed, kitchen beds…).

In total 336 farmer promoters including 72 females and 264 males attended the training. The distribution of trainees from their respective sectors is shown in the table below:

District Sectors # villages covered by

Gikuriro

Female Male Total

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District Sectors # villages covered by

Gikuriro

Female Male Total

Kicukiro Gahanga 41 6 24 30 Masaka 46 5 22 27 Gatenga 33 - - - Kanombe 49 - - - S/Total 169 11 46 57 Nyarugenge Nyakabanda 27 19 8 27 Kigali 48 16 34 48 Kanyinya 20 5 18 20 Mageragere 44 2 21 44 S/Total 139 42 81 123 Kayonza Mwili 23 2 20 22 Kabare 45 6 36 42 Nyamirama 33 6 26 32 Rukara - - - - Rwinkwavu - - - - Murundi - - - - S/Total 149 14 82 96 Ngoma Sake 34 3 31 34 Rukumberi 26 2 24 26 Zaza 55 - - - Jarama 39 - - - S/Total 154 5 55 60 Total 611 72 264 336

For the sectors (Gahanga, Masaka, with a high number of trainees, the total number of trainees was less than the total number of villages with the objective of making manageable groups. The remaining FPs will be trained in the second round in October 2016.

In Kayonza and Kicukiro district, there was no training in some sectors (Rwinkwavu, Rukara and Murundi) because the sector agronomists did not attend the ToT while two sectors (Zaza and Jarama) from Ngoma scheduled the training in October 2016.

There was no training in Nyabihu district because the sub-partner agronomist who had to coordinate the training (provision of logistics and financial means) was not yet recruited. The training should be organized in October 2016. The following photos show the trainees participating in the training activities:

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Masaka sector Gahanga sector Sake sectors Farmer Promoters in practices for different BIATs during their training in September 2016.

Activity 2.1.1.5. Partners provide FFLS with seeds and agriculture tools.

Activity 2.1.1.6. Partners provide selected FFLS members with small livestock.

This activity will be done in FY 2016 once beneficiaries will be selected and FFLS formed

Activity 2.1.1.7 Linkage with RAB and private suppliers will provide FFLS with seeds including bio-fortified seeds for multiplication in FFLS demonstration plots and distribution to the households (adoption).

Gikuriro agronomist met RAB staff with whom they discussed how Gikuriro can collaborate with RAB and with the projects partnering with RAB (SUSTAIN) to promote bio-fortified crops (Orange Fleshed Sweet Potato and Quality Protein Maize).

On September 20, 2016, Gikuriro Program Chief of Party with the agronomist held the meeting with the Country Manager of CIP in Rwanda, Dr Sindi Kirimi, the Project Manager, Rachael Cox and the Deputy Program Leader for CIP/Rwanda Program, Dr Robert Ackatia Armah, through which both sides discussed the options for potential collaboration in promotion of high quality planting materials for OFSP. As agreed in the meeting CIP was informed on Gikuriro needs in OFSP seeds for FFLS for FY 2017 and the planned planting period to allow the planning of their supply by CIP beneficiaries.

Activity 2.1.1.8 Gikuriro trains CHWs cooperatives' representatives from the eight districts on value chain development and production techniques for CHW cooperatives' selected crops.

This activity was not done because the priority was given to the selection of beneficiaries and the ToTs. It will be done in FY 2017.

Activity 2.1.1.10 Gikuriro trains sub-partners on SILC/PSP methodology.

The Economic Strengthening advisor conducted a 2-day orientation workshop for the sub-partner staff in charge of Economic strengthening component implementing SILC/PSP activities in their respective districts. The main orientation points include:

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• An overview of Gikuriro program and its integrated approach to be used in nutrition • General concept of SILC /PSP and their advantage in improving GIKURIRO beneficiaries’

nutrition status • Presentation and discussion of SILC approach and PSP model (background, lessons learned,

success stories, and key to success in the implementation) • The role of each stakeholder at partner and CRS levels, • FA selection criteria and their deployment in the villages

At the end of the orientation, all participants understood the concept of SILC/PSP approach and its delivery channel in Gikuriro program, as well as the role of each stakeholder in the project implementation. They also planned for the organization of field agent training and to provide support to the district and sector staff identified to conduct the above training. The full training of sub-partners’ staff on SILC/PSP is planned for October 2016. Activity 2.1.1.12 Gikuriro identifies and trains field agents from its sub-partners on SILC/PSP. In Q4, the Gikuriro team prepared and conducted Training of District and Sector staff in charge of Cooperatives on SILC/PSP methodology. The training was conducted from 12 to 16 August 2016 and attended by 21 out of the targeted 29 participants. The missing participants combined ES and Agricultural responsibilities in their districts and were participating in a training on the FFLS approach, as the two trainings were organized on the same dates.

The objective of this training was to provide the trainees with the skills related to SILC and PSP approach to enable district and partner staff to support field activities, as well as monitoring savings groups activities in the communities. Some of the training outcomes included:

• Participants appreciated the training and learned about SILC/PSP model and completed all training sessions.

• They opted to integrate SILC methodology within some cooperatives that they monitor to increase their income.

• Participants agreed to participate in the following activities: • Support SILC group formation and training at village level • Advise group to register at cell level • Monitor SILC groups • Supervise the FA/PSP at the field and provide them with technical support (jointly with

Gikuriro staff)

After training of district and sector staff and the orientation meeting of partner staff mentioned above, 60 field agents were identified and trained from 20 to 23 September 2016. All field agents identified attended the training in all sites (17 from Kicukiro, 14 from Nyarugenge, 14 from Kayonza and 15 from Ngoma). The training was organized at different sites at the partner level.

As Kicukiro and Nyarugenge districts are close to each other, implementing partners combined the training for cost efficiency, technical support and logistic facilitation.

During training supervision and technical support, the emphasis was put on the following points, which are the key training points for the groups:

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• SILC/PSP approach principles • SILC committee roles and election • Preparation of SILC constitution and sharing a copy with cell management authority • Innovation to be used in SILC component during the implementation (Saving with goals, learning

from cohabitants through rotation of meeting in household of SILC members, Reinforce Men engagement by inviting men to SILC meeting)

• In addition, FAs were advised to form their own SILC groups, as they are not allowed to be part of SILC groups they monitor. Also, FAs were requested to advise groups to open saving accounts in their nearest banks, IMFs and SACCOs

• Trained FAs committed to start forming groups immediately; beneficiary lists were shared for respective districts.

Activity 2.1.2.1 Gikuriro will train its sub-partners on VNS methodology Sub-Activity 1: Sub-partner orientation of VNS/PDH methodology Gikuriro conducted an orientation of partner staff on VNS Methodology. The orientation targeted sub-partner nutritionists who will follow the implementation of nutrition activities. Four staff from FVA, YWCA, WIF, DUHAMIC ADRI, and 2 coordinators from WIF and YWCA participated in the orientation. The orientation took place on 15 to 16 September 2016. The activity included:

• An introduction to Gikuriro program and, specifically, to nutrition activities • Introduction of the general concept of VNS-PDH and their advantage as behavior change and

nutrition rehabilitation strategies • Collaborative planning of urgent activities, the supervision of CHWs training and collaboration

with hospital nutritionists To reinforce the understanding of VNS approach, which is new to partner staff as most of them are newly recruited to the partner organization, Gikuriro invited a field staff who is currently employing the approach to share perspectives from field experience. This was very beneficial and replaced the field visit, which will be done during the training, as this was an orientation session. At the end of the orientation, participants had an understanding on the concept of VNS approach and how it is used to rehabilitate moderate malnutrition. Each staff had a plan for CHW training supervision and other FY16 nutrition activities. The full training of sub-partners’ staff on VNS/PDH is planned for early October 2016.

Sub-Activity 2: Health facility staff training on VNS/PDH methodology On 1 to 5 August 2016, Gikuriro organized a 5-day training on Village Nutrition School approach for 69 Health providers (37 females and 32 males) from hospital and Health center level staff, including Nutritionists and Community Health Workers’ supervisors. The objective of the training was to build knowledge, skills and competencies in VNS-PDH. At the end of the training, participants were expected to roll out the training to CHWs, provide technical assistance and monitor implementation of VNS-PDH. During the training, a field visit was organized to further demonstrate how VNS-PDH works. Sub-Activity 3: Training of Community Health Workers on Village Nutrition School Approach

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The training of Community Health Workers was conducted by Gikuriro sub-partners in Gikuriro supported district under the supervision of Gikuriro nutritionist. The training was conducted by Nutritionist and in charge of Community Health Workers at health center level, under the supervision of Nutritionists and Community Health worker supervisors from hospitals and sub-partner staff. In total, 585 Community Health Workers have been trained on VNS methodology, as indicated in the table below. Table 1: Trained Community Health Workers by district

Nyarugenge 91 Ngoma 72 Kicukiro 204 Kayonza 218 Total 585

The training was organized to help the establishment of VNS at village level, which will be used to rehabilitate malnourished children and prevent related nutrition problems. This training is continuing and the remaining CHWs to be trained in Ngoma and Nyarugenge will be trained in October. CHWs in Nyabihu will be trained in October since Caritas didn’t have staff recruited till late September. Activity 2.1.4.2 Gikuriro sub-partners will participate in youth committee (girls and boys) at sector level to promote recommended health services. In order to sensitize the adolescent and young people on their role in improving nutrition and WASH services, Gikuriro scheduled a meeting on September 21st, 2016 with the Akazi Kanoze Access team to identify the area of collaboration and network with Youth groups established by Akazi Kanoze Access in Gikuriro district. Gikuriro committed to support 4 youth groups per district by training one (1) Youth group facilitator on integrated nutrition and WASH messaging, who will then roll out messages to their respective group members, as well as in the community sensitization meetings.

Activity 2.2.1.1 Gikuriro will assess barriers and facilitators (including gender factors) to adoption of improved hygiene and sanitation practices. A questionnaire for this research was integrated into the baseline study conducted in Q4. The barrier assessment will be part of the baseline results. Activity 2.2.2.1 Gikuriro will facilitate a sanitation supply chain analysis to determine the availability of and demand for sanitation products, services and facilities across the eight districts.

In Q4, the team recruited a team of consultants to conduct the assessment. The consultant group was chosen after screening of 14 applications submitted and inviting the best 3 to do an oral presentation, from which one was selected. The contract with the consultant was signed and data collection tools were designed with close supervision of Gikuriro team and Ministry of Health. Before starting the study terms of reference was shared to Isuku Iwacu for inputs. Before issuing the support and collaboration letter for the assessment, the Ministry of health requested the hygiene and sanitation thematic working group members to validate the data collection tools. The results from the assessment will be shared with Isuku Iwacu Project for planning and dissemination. The final report is expected by end of November 2016.

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Activity 2.2.3.1 Gikuriro will assess household access to drinking water treatment and safe storage options. This study is combined with the study under activity 2.2.2.1 above.

2.4 General Project Management Activities

2.4.1 Beneficiary Selection Beneficiary selection was a very key activity for Gikuriro in Q4, especially considering the complementarity with GD and IPA research activities in Kayonza and Nyabihu that are time-sensitive. This activity has received due diligence, as its process was vital in building relationships with communities, ensuring a strict application of the selection criteria and active participation of all stakeholders.

This activity involved stakeholders at all levels: district, sector and cell staff, Hospitals and Health Center staff, CHWs and Heads of Villages, among others. The team held a District Orientation meeting and conducted a demonstration activity on how to select beneficiaries at the village level. The orientation meeting was held at the district level while the beneficiary selection demonstration took place in one sector in each district. Another orientation took place at the sector level for community based stakeholders and the beneficiary selection demonstration took place in one village per sector. Accordingly, the selection exercise began in all FY16 target sectors of the five districts in September 2016. However, finalization of selection process has been pushed to October 2016 due to the high volume of beneficiary data, lengthy validation processed and time-taking consultation process to harmonized the beneficiary data and selection processes with IPA’s listing in the RCT districts,

2.4.2 FY17 Work plan development and submission

The planning process started at the Gikuriro level in July with the pre-identification of FY17 priorities based on learning from FY16 and a review of relevant policy documents. From July 20 to 22, 2016, a 3-day workshop took place to prepare the draft work plan. In the first day, activities from the FY16 work plan were analyzed to evaluate activities that will continue in FY17, depending on the level of FY16 implementation and also incorporating district priorities. On the second day, the outcomes of the Knowledge Skills Practice and Incentive (KSPI) assessment were discussed and considered in the planning. Delving further and following on identified priorities by the districts that were presented as gaps, the team went through the fishbone diagram to analyze specific problems at the household, community, sector, district and national levels. Recommended responses to the gaps were outlined and broken down into activities. This was done to identify key actions needed to address the identified problem. On August 9, 2016 districts’ key staff were invited to review the draft FY17 work plan activities and to generate additional inputs. This event was attended by 100 participants from 8 districts, national-level, Gikuriro sub-partners and CHAIN implementing partner staff. During this meeting, the work plan was shared and discussions were facilitated in small groups using the world cafe method to collect inputs and integrate them into the work plan.

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After the workshop with districts, the work plan narrative and framework was further developed to integrate inputs and comments. The first version of the work plan was submitted to USAID on 19 August and, following around of comments and revisions, USAID approved the work plan on 29 September 2016.

2.5 Monitoring Research Evaluation Accountability and Learning Gikuriro baseline

As mentioned in the previous report, on 24 June, the University of Rwanda School of Public Health (SPH) was selected to conduct Gikuriro baseline study in six selected districts, namely Nyabihu, Rwamagana, Ngoma, Kayonza, Kicukiro and Nyarugenge. The initial stages of obtaining ethical clearance, NISR certificate/visa and collaboration letters from GoR line ministries took a considerable amount of time; however, the same time was used for developing data collection tools, as the study was massive and vital for the program to collect key indicator data from the target communities.

A 3-day training of enumerators was conducted on 9 to 12 September 2016. Gikuriro MEAL staff monitored the training to ensure alignment with the project objectives and the context on the one hand, but also to support with the translation of tools and logistical coordination on the other hand. On 13 September, after the training of enumerators, the consultant team conducted a pilot in Jali Sector of Gasabo district. The pilot aimed to test the feasibility, time, cost, and readiness of data collection tools and the programming of the questionnaire. The pilot study was conducted in 4 households of each of 12 selected villages, or in 48 total HHs. Each enumerator had a chance to pilot a household survey using a tablet.

Household survey: • Of 2592 planned HHs for survey, 2525 HHs were visited. This represents the response rate of

97.4%. The following table gives a summary of HHs visited per district.

HHs visited per District District Frequency Percent Valid Percent Cumulative Percent

Nyarugenge 422 16.7 16.7 16.7

Kicukiro 414 16.4 16.4 33.1

Nyabihu 423 16.8 16.8 49.9

Rwamagana 416 16.5 16.5 66.3

Kayonza 430 17.0 17.0 83.4

Ngoma 420 16.6 16.6 100.0

Total 2525 100.0 100.0

• Among those 2525HHs, there were 7 HHs that refused to be interviewed and requested appointment for another day.

• From the visited HHs, a population of 11,925 was identified. Within the population, 1238 Children were under five years and 527 children were under two years.

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Qualitative data collection All planned FGDs and KIIs were conducted. Transcription and translation are ongoing and the final consolidated draft report is expected by 31 October 2016.

3. Cross-Cutting Themes

3.1 Gender Integration • Based on the findings from Gikuriro’s Gender assessment, relevant activities for gender

integration in FY17 have been identified and incorporated into the annual plan

3.2 EMMP Info • Most of the community level activities including Bio-Intensive agriculture that were of

Environmental Mitigation and Monitoring Plan (EMMP) concern will take place in the next quarter hence no major environmental mitigation activities were needed in this quarter. However, complete EMMP report will be submitted along with FY16 annual performance report as per the deadline.

4. Collaboration with Key Stakeholders

1. On 1 September, USAID convened a meeting to train Gikuriro M&E staff on the use of AID tracker+ for reporting on the program results. AID Tracker is the platform Gikuriro will be using to report on key indicators. Through a live demonstration, the main components of the system were presented and discussed. Following this practical training, USAID created a profile with usernames and passwords that were shared with the Gikuriro team to access the online AID Tracker+.

2. As Gikuriro baseline is not covering Ruhango district, it was discussed with Caritas to collect WASH indicators through the Caritas baseline study. In August 2016, SNV discussed with Caritas to follow up on the baseline process and shared the WASH questionnaire developed under Gikuriro baseline. Caritas will forward the questionnaire to the consultant for integrating into the study.

3. On 2 August 2016, Gikuriro team (COP, DCOP, WASH Project Manager and Senior Agriculture

Officer) met the MINALOC Permanent Secretary to discuss the level of collaboration and administrative correspondence between Gikuriro and different districts. The meeting was called because there was a delay from MINALOC to approve letters from Gikuriro inviting district staff for different planned trainings. Normally, district staff cannot move from one province to another for work-related activities without prior approval from MINALOC. To clarify, the PS advised the Gikuriro team to work closely with the line ministry, the Ministry of Health. For any correspondence from Gikuriro Program, which may need MINALOC approval, it was suggested that the letter should come directly from MOH to MINALOC. Both parties discussed about the new structure of the National Nutrition and Food Programs and agreed to work together to fight the problem of malnutrition.

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5. Lessons Learned • Involving all relevant stakeholders in the process of selecting target beneficiaries takes careful

planning, efficient coordination and clearly articulated guidance including ways of reinforcing the selection criteria. Gikuriro developed stakeholders’ engagement road map ahead of launching the process and conducted series of orientation meetings at district and sectors level to establish clarity among all relevant stakeholders. The practical guidance through undertaking demonstrative beneficiary screening exercise at sector level enhanced collaboration from stakeholders and reduced errors.

Project Management and Governance

1. Administration and Human Resources

Recruitment and Orientation:

• The interviews for the recruitment of the private sector advisor were conducted on 15 July. The successful candidate, Mr. Gasasira Hudhaifa, started his job on 1 September.

• During the quarter, the team developed the job description for Program Assistant GIKURIRO Program. Approved JDs were advertised in the local newspapers;

2. Procurement - Procured demonstration kits (cash boxes and bicycles) for 65 Field Agents in Economic

Strengthening Component;

- Procured Agriculture tools to 662 FFLS in 21 selected sectors;

- Launched approval process to procure seeds for vegetables and bio-fortified crops to 662 FFLS in 21

selected sectors;

- Procured materials, equipment and services in support of program activities:

• Training facilities

• Meeting facilities

• Training materials

- Operations department supported the process of selecting Local Civil Society Organizations as

Gikuriro implementing partners. Seven partners were selected for 8 districts;

- Operations department contributed to the process of creating a database for Gikuriro beneficiaries.

Accordingly, Data Entry Clerks were hired and data are being entered into the system.

6. Public Events Planned for Quarter 1 of FY17 • Dissemination of Gikuriro Baseline and Gender Analysis findings and reports (Dec 15, 2016 –

To be confirmed)

Annex 1: Financial report

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The financial report will be made available through CRS’ HQ as a separate submission to USAID based on the SF425 format. To this effect, the Q4 financial report will be sent to the AoR and AO by 31 October 2016 at the latest.

Annex 2: Success Story

Taking a Stock on Previous CBEHPP Efforts

The Government of Rwanda, through the Ministry of Health, launched the Community-Based Environmental Health Promotion Program (CBEHPP) in December 2009. CBEHPP was designed by the Ministry of Health (MoH) and implemented through strengthening the capacity of Community Health Workers (CHW), under close mentoring and supervision of the Environmental Health Officers who are based in each health center.

Within the CBEHPP the Community Health Club (CHC) approach is used, facilitated by CHC facilitators, to promote hygiene, health behavior and practices at the village level. The CHC facilitators are trained and mobilized to create CHCs in all villages in order to achieve practical hygiene behavior change at households. With the CBEHPP, communities are accompanied to identify their hygiene and environmental health related problems with the aim of finding locally contextualized solutions.

The Gikuriro program is helping the Government of Rwanda with the implementation of CBEHPP in eight districts. During the first fiscal year of Gikuriro, the latter organized a training of trainers at Muhanga district from the 8th to 12th August 2016. The training targeted both district hospital and health center environmental Health Officers (EHOs), directors of district health units and sector in charge of social affairs (ASOC). This training aimed at increasing capacity of districts’ and sectors’ staff to lead and facilitate the implementation of CBEHPP in their respective districts. However before going far with the project implementation, the project needed to learn and identify challenges, successes and innovations. Accordingly, a one-day learning and sharing events were organized at each district where Vice Mayor in charge of social affairs, district health unit director, In charge of hygiene and sanitation at district level, Environmental Health Officer (EHO) based at the hospital level, Executive secretary at sector level, In charge of social affairs/hygiene at sector level, Environmental health officer/community health workers supervisors at health centers participated.

As a result; it was noted that despite the willingness to achieve hygiene and sanitation goals, CBEHPP had not been a priority in all eight districts. This was mostly due to lack of guidance and monitoring system from ministry of health, absence of financial support and clear understanding of the approach by the local leaders. According to the feedback received from these different meetings, there was no real sense of ownership for the CBEHP activities by any of the stakeholders.

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Furthermore, there was no close follow up from the central level and some local leaders heard about CBEHPP only after Gikuriro became operational. Indeed, some key stakeholders admitted that it was difficult for them to offer support to CHC due to their own limited understanding on the vision and objectives of the program. The clubs, mentioned in the different reports from MOH were mere list of groups and had never been functional. It was mentioned that there were no reporting mechanisms to capture what had been done under CBEHPP except for a few districts supported by partners. This story indicated that partners’ involvement in the CBEHPP implementation is key to success.

These meetings were led by the Vice Mayor who appreciated the work of Gikuriro; encouraged participants to learn from the previous failures, challenges and successes; promised to demonstrate better planning of CBEHPP implementation in their respective districts. Working as a whole and involving everyone was encouraged for the success of CBEHPP implementation. All the eight Districts committed to own CBEHPP and improve hygiene and sanitation in their areas.