Support to primary health care and outreach in Idleb and Hama governorates phase II The proposed humanitarian action is an extension to the HPF action TUR-15/3559/CP/H/NGO/1153. 
The project provides primary health care services through one fixed base outpatient clinic in Atmeh, one fixed base clinic in As Salamiyeh, Hama governorate and one mobile clinic covering the regions of As Salamiyeh and AsSan in Hama governorate. The women's clinic in Atmeh provides general health care for women and a package of reproductive health care services following the Minimum Initial Service Package- pre and post natal care, family planning, counselling and medical care for victims of gender based violence (GBV). Health education, and counselling and support for Infant and Young Child Feeding (IYCF) are also provided. The pediatric clinic in Atmeh provides care according to IMCI guidelines for the children under 59 months and treatment of common disease for the children more than 5 years old. The clinic provides screening of children under 5 years for acute malnutrition and provide treatment in the clinic or refer the cases to Atme Hospital for the cases with complication depending on the need. Routine immunization is also available provided through MSF France. During Phase I of the project, necessary medical equipment were purchased and systems were put in place. During Phase II, the clinics will require support in the running costs only. 

The fixed PHC in As Salamiyeh provides basic health care for men, women, and children through four clinics (pediatric, women, internal medicine and emergency clinics). Reproductive health care and pediatric care is also available as described above for Atmeh clinic. 

The project provides outreach health care services in Hama governorate through a mobile health clinic. The clinic will provide services in villages of north and north eastern Hama. Services include basic reproductive health, diagnosis and treatment of the most common health problems for adults and children, and health education. A team of 5 staff will travel with the clinic, including a doctor, midwife, two nurses, and pharmacy technician along with the driver. The team will receive refresher training on mobile health services including basic trauma care. 

Teams of Community Health Workers are already in place to provide outreach in As Salamiyeh to screen children under 5 for acute malnutrition according to CMAM protocols, provide IEC, and serve as the linkage between the community and referral PHCs.  Additionally, CHW will provide counselling to pregnant and lactating women about IYCF practices. Counseling to women and girls on reproductive health practices is provided. 

The project has implemented a strong capacity-building component for the clinical staff and also for data managers and those involved in monitoring and evaluation activities. Clinical staff of the women's clinic will receive refresher training in family planning, clinical management of rape (CMR), counselling techniques for IYCF, and psychological first aid for traumatized women and children. Pediatric staff will attend refresher training on IMCI guidelines as needed. The mobile health team will also receive these training plus a course on basic trauma care. 

A formal Health Information System (electronic and manual) is already in place in Atme and Hama clinics. Data are uploaded to a central electronic data base for analysis and the information is shared with partners in the health working group, donors, and other stakeholders