The Clinton Health Access Initiative (CHAI), Ethiopia has been implementing the Child Survival Program (CSP) since October 2015. It is a multiyear project that is funded by the Bill Melinda Gates Foundation (BMGF) to support the national child survival strategy with a focus on pneumonia and diarrhea. The program is operational in four big agrarian regions of Ethiopia, namely Amhara, Oromia, SNNPR and Tigray intended to serve 1600 Health facilities in 400 Woredas. But oxygen support extends to all hospitals in all regions across the country. Although the program was initially started in 2015 with a specific focus on diarrhea and pneumonia, the work has focused on approaches that would support the broader supply chain as a whole, including the improvement of Integrated Pharmaceuticals and Logistics Systems (IPLS), Drug and Therapeutic Committee (DTC), Quantification, Distribution and procurement as well as access to oxygen therapy (which is a cross-cutting service). In this round of SS, a total of 1110 health institutions (364 HCs, 330 HPs, 363 WoHOs, 41 ZHDs and 12 PFSA Hubs) were visited from June 2018 to July 2018. Overall performance from the planned institutions to visit was 91% achievement. In addition, in this round we were able to access the data from 911 non-model HCs that were collected by WoHO logistic officers during their supportive supervisions. Apart from on-site technical support provided to facility staff, the following major findings were identified by the SS teams. 82% and 74% of pharmacy heads and health facility heads were trained on Drug and Therapeutic Committee (DTC), respectively. The baseline for the same training of pharmacy heads and health facility heads were 13% and 7% respectively. DTC functionality improved from 17% (baseline) to 75%.  The SS revealed that there is significant improvement in IPLS/LMIS implementation and availability of CHCs compared with the baseline. In terms of commodity availability, 92%, 99% and 91% of HCs had Amox DT 250mg, ORS, and Zinc, respectively, on the day of visit. Although there is progressive improvement in using Amox DT for HC, still there are some (6%) HCs that were not using Amox DT for intra facility consumption. Improved adherence to the new IMNCI guideline in terms of diarrhea and pneumonia treatment is maintained to more than 80% like in pervious (4 th round SS). About 86% of diarrhea cases were treated with ORS and Zinc which was 88% in the previous SS. Similarly, among children seen with pneumonia, 90% were treated with any Amoxicillin, but the prescription rate of Amox DT is still low (36%) even if it shows 7% increment from the previous SS. Yet, 6% were treated with other antibiotics, typically ampicillin and cotrimoxazole followed by Gentamycin and Augmentin.Major Gaps Identified: Limitations in updating bin cards for some CHCs including ORS, which is popular for years ,Adapting and utilization of facility-specific medicine list (FSML) is limited ,Some HCs didn’t develop the current year annual action plan for DTC ,There are some HCs yet they do not use Amox DT for HC patients ,The practice of prescribing of Amox DT for pneumonia cases needs improvement ,Utilization of IFRR and regular reporting is poor; some facilities are using IFRR, but many of them report for items that are needed to be refilled, There is a shortage of preprinted updated LMIS format, specially IFRR and HPMRR ,Although data quality is a genuine problem at all levels, there are limited efforts to improve this at the facility level.  Recommendations: The program will continue to provide focused technical supports on major gaps identified during the fifth  round SS, such as: o DTC functionality based on the criteria; CHAI Ethiopia, Child Survival Program, PFSA and RHBs Collaborative SS Report 41 Bin card updating for child health commodities, Availability and proper distribution of CHCs, particularly Co-Pack and Amox DT, Prescription of Amox DT for under five children with pneumonia cases, and providing co-pack for all diarrhea cases Consistently incorporation of CHCs into RRF& Conduct data verification of non-model sites

• • Availability of Child Health Commodities pneumonia and diarrhea • children under-5 • progress of LMIS and DTC status • IPLS training • Ethiopia

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This meta data shows  data of joint Supportive Supervision Reported in  September 2018 by  Clinton Health Access Initiative -Ethiopia on Child Survival Program in Collaboration with PFSA and Regional Health Bureaus    This report investigate the  progress of  % of HCs with Pharmacy head trained , HCs with HC head trained on DTC,  % of HCs with DTC established/formed , % of HCs with functional DTC, IPLS Implementation Status, Supply Chain Management and Availability of Storeroom and Availability of Child Health Commodities for  pneumonia and diarrhea .the data was   cleaned available by excel.

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