SOUTH EAST CDTI PROJECT, LIBERIA INTERIM TECHNICAL REPORT 2O1O oncho_mo hswli b2000@yahoo.co m COUNTRYiNOTF:LIBERIA ect Name: SOUTH EASTP Atrproval year: 2000 Launching year: 2000 ortin Period: Frtrnr: .IANUAII'!' 2lll0 To: DIICEMBEIT 2010Re .\POC' l)roiccl implcmcnlation vcur r-cltorl ,{l)O('lirntling vc:u': (circlc orrc) I 2 -l + 5 6 7 8 9 l0 ll t2 l-l (circlc orrc) I t0 It ll t.\23156i8e Date submitted: 09t02t2011 ORIGINAI-: Enslish Partners: Ministrl, of Health & Social Welfarc Sight Savcrs Intcrnational African Programme for Onchocerciasis Control (ApOC) Mcctizan Donation Program (MDP) 639 communities ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO HNICAL CONSULTATIVE COMMITTEE (TCC) DEADLTNE FOR SUBMISSION: i ToAPOC Management by 3l January for March TCC meeting ,rrral-.YWBS ii:r lni,x-uruflof ''r,.I)'r,t o APoc Managernent by 3l Jull, for september TCC meeting ". n,: li'-, c, AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) !I--liitI 1.. Rt[il t-E li i-, I I ApoC i DtR WHO/APOC, February 09, 201 I -l ffi ffi {*1i*r ffi Flrttlgij ffi: ri"' ri' :.1, ,':' iJr '_:. E! ri irl' Iir. :;: i{uii:' ii'rI, t !, ::. l' :! l- i. I,', tJ'. hi i +,. i,)( }, $il Ir.;n1 lilr H i h,, F+j !-, $t ii; .-)r :+-!t i-s i* :l .\NNLI,\1. l'lto.ltr( I 'l'l:( ll\l(','\1. ltIl'Olt'l' I't t l| ( II\i(.'\l ( ()N\t'l l.\ll\ l:( t)\l\lll ll I rl( t- t IiND()ITSEN,IIiN-I' I'lclrsr ('()ntir-llt r tttt ltltr (' I.cil(l tltis t'cllort hr siglrirrg irt llr'-' a J)l) t'ol) rill tc s ;lltct'. ()l'l'l( l'l{\ (o \rgr) lltt'te;totI ( (rttl)llr i llll lil \ Nlrtrorlrl ( rrtrrtllt.rlrrl' Nlttttt \11ll11rll\ l'. lle ttcr' \ t lrt,rt ttt i i).rle l)c.rlrr,l(r,,1 \ttll ( ll,rrr I.l( rl)t ) licllrcse rltlrlii t' N,ttrrt' ,\tlrrlcr Srrtttt ., .1,SI'I):llltr( , . ./t I ).rlr' ./ -.', i -l-irts tc1-r,r1-1 lt.tr bcctt Pl'cPlll-e(l [r\ \,rtne N( ) I I ] tl'er t.r sr,-rr.Llui , ' ) .' .. '' .i-i.. i,1 1.,-:,-,; " r ' ,., , i ir-iltl'i.,ii rlsil:ir/[]''r\lr l-r \lr,rre ,r-, . ,' . .i ' 'i"lt-l!l::_ i_il,! I rr \l'(,( l - t,,"'.. ll WHO/APOC, February 09, 201 I Table of contents ACRONYMS v DEFINITIONS ... vI FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY SECTION l: BACKGROUND INFORN{ATION...... l.l. GeNeRaL TNFoRN{ATroN..................... 1 1.1 De,tcription of thc projec't (brie/ly) 112 Partnarsltip. 1.2 PoPrir-,rTroN . ............ SECTION 2: IMI'LFIN{ENTATION OF CDTI. 2.1. 'flltt t-rNt, orr,{ct'tvt't'urs ........... .. ..1 2.2. AD\/ocAc\ ... . l0 2.3. N4oBtt.tz,rtroN. srrNSI'f IZl\'r'roN ANI) I-rt,,\LTI I EDt ,c,\ I'toN otj ..\t- RlsK coHtHtuNIt'tes I i 2.4. Col,ttrttrNlTy IN\/oL\/I,N1ENT........-. .. ... 12 2.5. C,,\p.rcrry Butt,DING... ... . . 13 2.6. 'l'Rc,r'r'Htr--Nt-s............. ... ..... ..... 15 2 6.1. 'l'raolntent .figure.r I 5 2 6 2 trllhat arc tlta causes o.f obsenlaei.snt'? l- 2 6 3 ll'hut ura lhe reasons.for refusal.s'? .. 17 2.6.4 Briefl1'describe all knovn and rcrified serious otlyersa et'enl.s (SAE.s) thut .. l7 2.6 5. frend of lrcatntent achievemenlfrom CDTI projecl inc'eption to the current 1'car l92.7. OnoeRrNc. sroRAGE AND DELTvERy oF TvERNTECTTN ...........20 2.8. CotvlltuNtry sELF-N{oNIToRTNG AND STAKEHoLDERS MEErrNc ..... ERReuR ! SrcNor' NON DEFINI. 2.9. SupgRvrsroN............... ......................21 2.9. 1 Providc u .flou' chart of superyision hierurchy,. . 2 I 2.9 2 ll/hat y'ere the main issues identified cluring strpcrti,rion? 21 2 9 3. |[/a.y a supervisiort checklist used? 21 2.9.4. Lllrut v'ere the outcontes at ectch level o.f CDT'l implementulion supert'rsion'? 2l 2 9.5 lVas /bcdbackgiven to the person or group,e supervised?...... 21 2 9 6 Hov'trets the.feedbackused to improve lhe ot'erall pcrfbrtnance o.f the projet't'/ 22 SITCTION 3: SUPPORT TO CDTI 3.1. IJgurelreN'r 3.2. FtNeNcter. coN'fRutuloNs oF TFIE pARTNERS ,\ND coNlNruNlt-tES 3.3. O'r'rten FoRNrs oFcotvtNruNITy suppoR'r............... 3.4. IlxpENolrrrRE pER ACTI\rtry SECTION .l: SUSTAINABILITY OF CDTI..... 4.1. INrpnNel; TNDEpENDENI pARTICIpAToRy N,toNI'roRINc; Evalu,rrtoN 1.1.1 Hus the projecl ev'er been evaluated/rnonilrtred? (Tic'k on1,o/ thc fultoy,ittg:l',hit'h ctrc altplicabla) . 26 -1.1.2 Llthut y'crc the recontmendations'? .. . . 26 1 I 3 Hov' huvc they bss, implentettetl? 26 4.2. Sust.qtNeetLITv oF eRoJECTS: eLAN AND sET TAncE-rs (NTANDAt-oRy A'r.. ..............27 I 2 -) _1 )J l 6 7 lll WHO/APOC, February 09, 201 I .......22 22 22 26 26 Yn 3) .......27 4. 2. 1 P lanning at all relevant levels . . . 27 4.2.2. Funds........ ......27 1.2.3 Transport (replacement and maintenance) ... . 27 4.2.4. Other resources 27 ,1.2.5. To what extent has the plan been implemented. ... . . . . 27 4.3. INrecRarroN ............... ........27 4.3.1. Ivermectin delivery mechanisnts..... .. ... 2- 4.3.2. Training.... 27 4.3.3. ,Ioint supervision and monitoring v,tth other programs .... . 27 4 3 1 Release o.f .funds for projcct uctivirie.s 27 1 3.5 Is CDT'I includecl in the PI{C budgct'? 27 4 3 6 De.scribe other heulth progrununes thul arc u.sing thc C'DTI .\truL'ture untl hotr lhi.s wtt.s uclticye d. Il''hat hut'e been the uchieternants'l 28 1.3 ; Dc,scribe others i.r'srrc^r c-on.siderctl in lha rnlegrulion o/ CDTI 2,\ -i.4. OpgR.rTroN,.\t. RESE,\RCH . .... 3l 1 J I Strntnrttrizc in not more [httn ortt ltttlf o.f u ltttge thc oparutionul rasatttt'lt trrtderlukctt itt lltc projec'l urau y'ilhirt thc rapor'ltrtu period 3 t 1 I 2 Hcnt' y'era tlta re.Etrlt.t ctpplicd in tlta prolat't') 3l SEC.I.ION 5: S fRENG.I.HS, WEAKNESSES, CHAT,LENGES, ANI) 3l SIICTION 6: UNIQUII FEATUITES OFTHE PRO.IECT/OTI{ER NIATTIilts...........3l IV WHO/APOC, February 09, 201I Acronyms APOC ATo ATrO CBO CDI) CD'fI CSNl t,GA N4OI I NGDO N(io NO't-l: PIIC R IrN,l( ) :i.,\t1 SI INl I'C(' TOt' UNICEIT t]TG WHC) CHT OIC MERLTN CRC CI]AI- COS CHDI) CHO BPHS NECP CBN{ IVIERCI African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Communit),-Based Orgalization Colnmunit)'-Directed Distributor Cornmunity-Directed Treatment rvith [r,ennectin Corrrnrunitl SeI f-Moniroring Local Govcrrunent Area Ministrv of I{ealth Non-Govenlnental Dcveloputcnt Organization Non-Govet'nmental C)rganization National Onchocerciasis -l-ask l-'orce Prinrarl' hcalth care Rapid Iipiderniological N,lapping ol' Onclrocerciasis Scverc advdrse event Stakcholdcrs rnecting -l'cchnical Consultative C'onrrriittce ( AI']OC scicntifrc advisory group ) -frainer ol- trainers United Nations Cliildren's Fund [Jltimate Treatment Goal \['orld I Iealth Orgarrization County Health'fearn Officer -in charge Medical cutergency relief internalional Caval la rubber corporatiou Cluistian Health Association C'ounty Onchocerciasis supen'isor Comrnunity, Health department Director Clountl, Health officer Basic Packages of health serviccs National E1,e Care Program Clrristian hlinding nrissiorr lvledical Emergencv Relief and C'oopcrativc International W[{O/APOC, February 09, 201 I Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Elisible populqtion: calculated as 84oh oI the total population in rneso/hyper- endemic cornmunities in the project area (iii) Annual T nt Obiective (A1-O): the estimated nurnber of persons living in rneso/hyper-ettdentic areas that a CDTI project intends to treat u,ith iverrnectin in a given I'ear. (iv) Ultinrate'freatntent Goal (U]'G): calculated as the ntaxir.r.rur.r.r nurnber olpeople ttr be treated artnuallv irt nreso/hvper endernic areas rvithin the pro-iect area. ultinratch'to be rcached w'ltcn thc project has reached {irll ueographic coverase(trortnall-t thc project should be cxpccted to rcach thc tll-(l at the end of the 3'd vear olthe pro.jcct). (r ) 'l-herapeutic crlverage: nurnbcr ol' people trcatcd in a {riren YCar tn'er the total population (this sltould be exprcssed as a pr.rcc-lttage). 1r'i) (ieoqraptticaI coveraqe. t.turnber o1- courrnunities treated irr a git,eu _\car ov'er the{tttal nutnbcr ol'tneso/ltvpcr-endcnric contn.rr.rnitics as identilled bi, l{llNlO in the project area (this should be expressed as a percentage). (r,ii) Irttegration : del ivering additional ltealth interventions (i.c'. r'itarnin A supplenterrts. albendazole fbr I-F, screening fbr cataracL. etc.) through CDTI (using the sarnc svstetns. training, supervision and personne[) in order to rtraxintise cost- eff-ectiveness and ernpo\\'er cornmunities to solve urore of the ir health problems. f his does not include activitics or interventions carried ou1 bv cornrnunitv distributors outside of CDTI. (viii) Sustainabilitr,: CDTI activities in an area are sustainablc u,hcn thev continue to lunction effectively, tbr the lbresecable future, rvith higlt treatment coverage. integrated into the available healthcare service, rvith strong cornrnunity orvnership. rusing resources mobilised by the cornrnunitl,and the govenlnent. (ix) Comrnunit), self-monitorine (CSM): The process by rvhich the community is emporvered to oversee and monitor the perfonrance of CDTI (or any communitl,- based health intervention prograrnme). rvith a view to ensuring that the programme is being executed in the wa)/ intended. It cncourages the communitl,to take fuI resportsibilitv of ivertncctin distribution and make appropriatc modifications rvhen necessar\'. \rl WHO/APOC, February 09, 201 I FOLLOW UP ON TCG RECOMMENDATIONS Using the table belorv, fill in the recommendations of the last TCC on the project and describe horv they ha,",e been addressed. TCC session 3r Nunficr of Rec'otttnrcrtduliott in thc Reporl TCC RECOMMENDATIONS ACTIONS TAKEN BI' THE PROJECT Partnership is being strengtheued to include rnore NGOs. Nlinistry ol' education, Gender ancl dcvcloprnent under irrtc'grated control of N-l-Ds Frorrt line Ilcalth uorkcrs are bc'ing crnporv'ered to engage conrurLrnities At rrational artd Countl' Level Onchocerciasis has been highlighted as prioriry diseasc in the national health plan 201 1- 2021 . With this budget lirres lvill be provided at all levels FOR TCC/APOC MGT USE ONLY Projected I{clated (i) Sustain the partnership initiatii'c airned at using innovative u'at's to mobilise support for CDTI activitic-s (ri) Sustain health cducation and advocacl'at all lcvels lor furtlier iurprovement in coverage and to increase supporl lbr CDDs (iii) Explore the possibility of implernenting lvermcctin distri bution during the dry season to improve co\/erage Efforts are beirrg rnade to facilitate the Projects to irnlllernent distributiorr irr the dry, season. l-[re prograru is rvorking to reduce the constraints preventing tirnell' re lease of funds to the Project. (i") Increase the nuurber of I-lealth staff involved in CDTI More health staff havc been trained in 2010. Funds are being rnobilized fiorn APOC' and NDGO paftner to train rnore health u,orkers to cover all hcalth facilities (v) Train and implement communitl,self monitoring (CSM) and SHM in all counties to improve community involvement and supervision Plans have been nrade tcr initiate CSM and SIJMs in rnore Counties in 201 I WHO/APOC, February 09, 20l l (vi) Follow up on request to APOC for a mid-term sustainability evaluation of the project Request has been made to APOC to conduct sustainabi I iry evaluation. A follow-up letter to APOC rvill be made by February 20 I I(vrr) Intensify efforts at advocating the use of CDTI strategy for other health interventions CDTI has been adopted as the strategy' for co- implementation in NTDs master plan 20ll - 2015 ('Pleose add ntore rov.s if'trcccs.snr1') Executive Summary Prepurc arr ll-recutit'c sutttt,tarl'of the report in not morc lltutt one pflge, I Buckgrouttd on tt'auttnant tuul ltoltulutiott tlulu -'l'olul t'rtntnttrttilic.\, L'()tntnunilic.t trautctl, tolul ytltrrlu/ion. Lr!'G. ,1'l'() uncl pcr.\'on.\' trculad 2 Buckgt'otutd ort ltolttrlutittn tltorantant.t 3 Trairing dutu - CDDS, heulth v'orkcrs, Tittul populatiott (c'otrtntttnitv) par C'DD truined I Challe ngas untl h<nt' llta|, y,s1"s orercome . l-hc Southeastern CDl-t project had a total of 639 target communities in 2010. The population of rneso/hyper comnrunities rvas 335.428. The Pro.iect achieved 100% geographical coverage. 'flie report indicates the follorving achievements 639 communities treated (100%) geographical coverage - 274,726 treated out o1'total population o1'335.428 (82%) tl.rerapeutic covcrage - 165 healtli center/health post staff trained/retrained - 2489 CDDs trained/retrained - 50% communities rvith female CDDs - 26% of health staf f involved in CDTI - 234 (commurrities rvith <80o/, thcrapeutic coverage APOC provided 23 motorbikes to enhance Mectizan distribution and supen,ision to rcnrote conrtnunities in the Projcct area in 2007.llorvever. most of these motttrbikes arc o1f thc road due to bad road conclitions. Challenges . Late acccss ttr lLrrrds lor CD'l'l activities . Lack of cornputer to process data at county level . Inadequate f uel support for the irnplenrentation process . I-ack of sr-rpporl to CDDs . Inadequate lunds fbr rno(orbike tltalllteualtce . Bad roads conditittn and inaccesible citrrrrnunities 2 WHO/APOC, February 09, 201 I ISEGTION {: Background information 1.1. General information 1.1.1 Dcscription of the project (briefl1') Geographical Iocation, topography, climate Population: activities, cultures, language Communication systems (roads...) Administration structure Health system & health care delivery (provide the numbcr of hcalth posts/centers in the project area if the inforntation is available). Nurnber of health staff in project area arrtl nunrber of health staff involved in CDTI activities. l'lie SoLrth East CDI'I Pro-ject consists ol live counties: (irand Cledch. Nlan'land. I{iver (ice. Sinoc and (]rand KrLr. fhe project \\as appro\cd bv Al'OC' in 2001. l'he southeastent region is boundcd br thc..\tlantic Ocean to thc south. thc Rcpublic of Cotc d'lvoire on the east. l{n'ercess countv on the u'est. and Nimba ctlur-tl1'on thc norlh Tltc Rcgion is srtuatecl ri'itliin thc'l'ropical Rain Forest Vegetation Belt o1'\\'est Aliica. N,lost of the irrea conrpriscd ol'fbrest exccltt a narro\\i sfrip along the coast in Sinoe. Grand Kru and N'lary,laud couttties u'here lurangrove Vegetation alternate rvith coastal sar':tnnah. Therc are t\\,o seasons: the raiuv and tlie drv season. -fhc rainl'scasou runs li'orn April to October. and thc dry scason bcgins in October and ends in April. -fhe ar,'erage annual rainfall near tlre coast arnounts to 4770 mn. towards the interior. the anrount of rainfall dccreases to an annual a\/erage of 2080 mm. Excessive rainfall cornes during the rnonths of Junc'to Scpternbcr. The average number of rainy day,s during the rainl' season is about tu'ent),-tu'tr da1's it-t a uronth. Transportation in the South East is rnostly by land on unpaved roads and rvater. Nlost of the roads in the region are ir.r deplorable condition. with ven, rnuddy and deep holes filled with rvct mud and broken rvooden bridges. 'fliis situation partially disrupts road access to CDTI target communities in most counties of tlie Project especialll,in the rainy seasor-r. Most of tlie people who lived in the region do engage in farming. fishing and hunting. Their rnain farm crops are rice, cassava and plantain. There are a tolal of 639 health staflf in thc Pro.iect area u'ith 163 (26%) involved in CDTL The Project in 2010 treated 274,726 out of a target population ot335,428 representingS2% therapeutic coverage. All 639 communities were treated represcnting a geographicaI coverage ol 100%. A total ol 165 Ilealth clinic /health ccnter stalIand 2489 CDDs \\'cre traincd in 2010 compared to ll6 health rvorkers and 24l l CDDs trained in 2009. l-he total of 604.128 tablets o1-Mectizan rvas distributed during the treatment round -') WHO/APOC, February 09, 201 I Counties Population Grand Gedeh 90,463 River Gee 69,330 Grand Kru 5/,432 Mary Land 56,893 S inoe 6 1,3 10 Total Population 335,428 Population of South East CDTI Project, Liberia from Census update by CDDs Table 1: Number of health stallinvolvcd in CDTI 1l'lcusc atld ntore rows if nccessur.t') Drstrict/[,CA Nurnbcr of hcalth staff rnr olved in CDTI activitics. -l-otal Nunrber of Nurnber of hc:rlth hcalth strrff in the staff inr olvcd in err(ire llrojccl lrr:r CI) I I Pe rcc n tagc Br l], Bi=Bzl Br * 100 Grand (icdelr lt_5 -]6 29"1' Rtr er (lct' Grand Kru l0-s t.t l-i ti8 l6 , 1O 1796 N,lan'land 339" Sinoc I Il4 32 l1'h Total 639 163 2(f/o 1.1.2. Partnership Indicote tlte partners involved in projecl itnplententation at all levels [MoH, NGDOs (nationaUinternotio,tol), cotnmu,tities, local orgutizations, etc.J Describe overoll h,orking relotionsltip flnrcng partners, cleorll, irtdicoting specific areos of project activilies (planning, supervisiott, advocacy, plaruting, mobilizotion, etc) tulrere oll portners ore involved. State plans, tf any, to mobilize tlte state/regiort/district/LGA decision-ntokers, NGDOs, NGOs, CBOs, to assisl in CDTI implementation. National Lcvel In 2010. there \\'as strong collaboration uith international and local nongovernnrental organizations including other department of tlie Ministrl of Health and Social Srelfhrc Some of these partners include. Sightsavers, MITRLIN. CtiAL, CBM. etc Thc Ministry of Ilealth and Social Welfare rvas involved in planning, training. rnonitoring. and adr,'ocacy. \vhile \ /lIO/APOC teclliical adr,'iser and Sightsavers provided technical assistarlce and financial support: Christian Health Association of Liberia (CI-lAt,) supponed the program \vith personnel and vehicle to undertake training and nlonitoring ol' CDTI actrvities in thc Projecl area 4 WHO/APOC, Februan' 09. 201 I a Project /County Level At the project level, the county health teams established strong partnership with both local, international, concession companies and communities in 2010. In Grand Gedeh, the CDTI project was re-launched in the city of Zwedru, and the occasion brought together county authorities, NGOs, LIN family, CBOs and community members. During the treatment round. ferv Organizations in the counties assisted CDDs rvith transport and food items. Some of the Development partners in the project area that supported CDTI included German Agro Action, Medical Emergency Relief and Cooperative International (MERCI) provided transportation for CDDs in River Gee County. The Cavalla Rubber Cooperation (CRC) provided food item for the CDDs "vhile Medical Emergencl' ReliefInternational (lv1ERI-lN) provided transportation tbr CDDs during tlie distribution in Maryland Countl'. hr Sinoc County EQUIP and MERLIN assisted rvith transporlation of CDDs during the distribution w'hile tlie superintendent of thc county provided 10.000 Liberian Dollars rvhich is cquivalent to 142 00 [Jnited States Dollars to supporl health n,orkers training. Communitt' Ler-el At the cilurnrunitv lcvcl thcrc have Lrecu grorr'ing partnerships be tu ce n thc traditional authorities. r'outh. \\'onrerl groLrl)s. religious organizatitlus ancl local nredia stutions in the inrplementaticln olCD l'l activitie s 5 WHO/APOC, February 09, 201 I I oN oaO (s -oo Q o o. o I > r.) .! a)U u 7t tr<..ltr.= o(,,)c tn d a a-' uCi c! IOUo FO 0) OJ (JC aO CJPd(E '= ao- o 0) -q c)0Jz oo o9_o ,>d ^au(J >o u.=7.*5o()- o-E oll L {-) L 79E6 (J= na)(.)L(d o 0) 'a L 0.) qr o o I oL o. (J -o q L() -d c- uE =':- 6 ,- .: cI) !c = oo 0) a 0_) a o .) 0) CJ '13 a; oo(t ! o E E o E(-) () c0 (, .J o (H '5 () o-a d ! o a L 0) o Ia() I @ 6 ()() I t--l t-.](, aZ -ia >\ U a) o\ q) q) :\ U U! tJ a \J -'= f- I\ti! !! =: :< \r, :}\ !> t\ f-iCr i:R!< ^aJ :-\ :e-\=b] r{' \i !:IP !c tuxl CU .Y\ lt ; rr -\ t-c c(q) 6 I c) o o c) 0) v U) L (d o (s cd tn o E E oO c .9 +. G =EL o o. N - \o I a. 0) o -o () -o () -d (.) ,* o c) L a 6) t) o z (H a o c-. o !() o. bo li o o.(-) ! 0-) tri.) L '15 0) -o o 0, e! o. q-) p € a =a (J o a a a t)o cd .. o A(! ,:lJ1> q) oL o CN \ (,3 D O- ;a- E 9qU JL oo o\tr) t-. r- aa C! oo ca .i- c.l@$ o. c-r-$ O ra) o\la rr € al cn(o slO O) @N <fla(n(n rq) .= o-N - ),s !\ cj6otr (/1, *o o i=u ..!L YocJ vN-- + (\ @ @r- oo(.l c..l o .O rf) O)(o \o tr) o. -t F- F- c! cnvl-- rn o,v aa -t ca@ CI -1 rf) O) @(o rn a- $ <j- -f \c) r.1t : o r-{ cO r-l(o -1 r-C\? \D ca(-.l -:f 0|o[n r- c.l 0|oa €v I (\ r-O tr- c.r sO U)o bo '-\ G) trl ol(.)l -t LI o)l _ol z q) o- -. oN o.: 6O F I9O (r: q,E Ei-c >r(, '+tr N o t cJ :''l ioq, 33i 2. +.- ll \o c\ A c.) r- C-r aa tr-\o C{ c-r c\o ca ca (o |--. d <f rn r-{ qJ O4ld 9.- ed = o/.:X *er 9-v9-L fi^-^ cO(os O) o cn cn oi(o Gl cO t-' rn ao O) @d rn O ri an .it(o @ s- tn(n fn .?s ot Ys?- arrsv .H.-A6' na_L 'jcr6 () 'o 0,) r5 'o dI o 0)(J c p a,) &, Li v '13 L 'o L d 2. () o V) J F F ) ISEGTION 2: lmplementation of CDTI 2.1. Timeline of activities Fill intableS, limelineo.f'oclivities.furareastreatedincurrentyear,indtcatingwhenthekey activities rvere implemented by the month they began and the month they ended. CDTI activitics rvere scheduled and implemented the same period in the entire Project area (table 3 ) 1 WIIO/APOC. Fcbruarl, 09. 201 I o(\ oiO (o -oo u (J o o. o a () a (,) e so U L() -oo Oc L() -oo o - tr() -oo oC L o -oo oC t< 0) -oo o o oo_E& u)- () F-) (J F- 0.) 0.) h C) a) bI o! (, oC P(-) C I(J c () c 9o - 5! a- = () D O a q) (-) oe LO LE U () o ()) c3a q) bo a- () () () co a q) h bI c( 3 o! EO O cO z (d z Lr O. >. cd ao (n- >. cd a >. cO z (o !O. Z. () NF z ()e ro Q h ) O z h >. u! E! (r) - (J (n z o! 2 () d z (J cd Z U o O o L o oo(, L o d, & b oo a J F F a) a a c,) E o U I ! 0) >' 0)F o (-) Eo (.) L a(d 0)L(d C, ! .o (,() o cdq< c.) () E F Jr (,,)l -oldt -l
2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcomc. Describe difficulties/constraints being faced and suggestions on horv to improve advocacy. At the Project level, advocacy meetings \\'ere lreld u,ith County liealth officers. superintendants. Development. District comrnissioners. paramount chiels and tow,n chiet.s The issLres addressed during the advocacl' rncetings included - InclLrsion olOnchocerciasis in 2010 countv plan and budget - Relcase of firnds fbr CDTI activitic-s - I'rioritization o1'C)nchocerciasrs as a diseasc o1'public health inrportance in tlie counties ('onrrnunitv suppor-t and ou'nership of CD t-l - De la1's in liquidation ol funds provided bt ;\POC and Sishtsai e rs At the cour.ttl and district levels. advocacy rrie etiugs. u,crc helcl rr rth ninc (9) coLrntr adurinistratrve olljcials zrncl cighteen (18)commuuitt, leaders iu Grand Kru. In Siuoe Countr. six (6) cor,lntv aclnrinistratil'c otflcials and tu'elre (12) conrnrunitv lcaders attcndcd advocacy meetirtgs. In Grand Gedeh. thirtl'-six (36) countv administrative ollicials and thirtr (-36) conllunity Ieadcrs ,'vhile there ucrc eightecr] ( 18) countl' adnrir-ristrativc ott-rcials and eighteen (18) comniunity leaders in River Gee and in Maryland cour-rty'eight(8) cornnrunitl, leaders along u'ith six districts otllcials attended the advocacv r-neetings organiz-ed to create a favorabIe poIic1, environrnent fbr CDTI implementation As a result o1'tl-resc meelings the follou,ing were achieved . the county health team agreed to include CDTI activities in the'county budget and rvork plan in 2010-2011 . Superintendent and otlier couuty autliorities cornntitted thclnsc'lves to provide supporl for the program. . NGOs operating in the county provided logistics and materials support tbr CDDs during distribution . Comnrunity expresses rvillingness to support CDDs Challenges . Communities not fullv involved in decision making mostly in Sinoe and Ivlaryland Clounties. . Lirnited stal'f'at countv and lrontline health facilitl'levels to nronitor and supen'isc CDTI activities adequately'. . Attitudc o1'health rvorkers -tlrey pref-er curative services to intcrl'ention for preverrtirc scn iccs irr thc conrrrrunit\' Suggcstion . Strengthen collaboration r.vith other health and development progranunes as mean ol leveraging resources to improve CDl-l . hnprove communication at all lcvels amorlg CDTI partncrs and stakeholder eg. Communitt' lcaders and health rvorkers. countv Onchoccrciasis supervisor and the health lacilitir's. . Supervise and rnonitor liontline health rvorkers 10 WHO/APOC. 24 Novembre 2003 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: - The use of media and/or other local systents to dissentinate informatiort - Mobilization and health educatiott of communities including women and minorities - Response of target communities/villages - Accomplishnrcnts - Suggesl wa1,s to intprove mobilization anrl sensitizatiotr of the targel communities. ln all tivc counties in the project area. thcrc \\L'rc conulunity rtreeting attended bt'opiniorl lcaders and other influential pel'sons in the cornmunitl,rvhich inclLrded elders. )'outlt lcaders. \\onten leaders. teachcrs and religious leaders. I\4obilization and health educatiott \\'cre carried or.rt in the comnrunities b1, health lacilitl'stall. conintLtrtitl'radio stations. C'l)Ds. and contnrunitv lcaders. CD'fl posters w'ere drstributed to somc conlltunities.'l'[rc locerl raditr stlttions plaled a verv significant role in tlie IIrC can-tpaietr b1'airirtg jinglcs atrcl cltlrvit.tg ottt discussion on thc Ivlectizan distriLrtrtion. I--orcxaurplc. thc lirlloiring radio stations uerc nrairtlv inr,'olved in C'D-l-l during the vcar ttt talk shou's. ainng of jinglcs. phoue itr Prosrarttttrtcs o \/oice ol'Sasstorvu in Craud Kru Coutttr': . Voice ol'Sinoe in Sinoe Countl', . Srnile FN,{ in Grand Gedeh Countl'; . Kanu,eakcn cornmunity Radio in River Gec Countv and . Radio lJarper 94.1 FM in Ivlaryland County' Ilowever interpersonal or face to face conrurunicatiou rvas generally u'eak. Or-rl1 lcu, health u'orkers facilitated torvn hall meetings in their catchments coururuuities. l1 WHO/APOC, February 09, 201 I District/LGA Number of communities/villagcs with community members as supervisors Number of CDDs and the communities involved trtrl" tonT- 1 Femalc CDDs Total B7 B8 Be= 87+88 Total no. communities in the cntire project area B Number with com munitl' menrbcrs as superl isors Bs Percentage Il6= Bs/ Br * lo0 Number of com munities rvith fcmalc ('D I)s B'u Crand (ictl.'h I62 120 l 7 lul' ll-l 90 li7 I l li1",, I 92 61 6L)o,i, l -1,5 ll-5 9l') u 266 .19 306 I ()8 I9.1 7'76 6.t.1 -.i0 Rtvcr (iec (lr.rn.l Krrr NIarr l.rrril Srnoc 2u6 -.t6ti Q] lll t9 2li l16 61 190 l 32 ) I 6I l{.r Total 5 6().1, 639 1230 519 750 321. 50"1, 2,4. Community involvement Table 4: Communities participation in the CDTI (Please adtl ntore rov)s if necessary,) 19u4, 7-.1" u ()(r') ,r 5l",, ConrnrcnI on: - Attendance o{'fbrnalc lnemllers ol'the comrllunitv at l-realth education meetings - In general, horv do )/ou rate the participation of female members of the community lneetings whcn CDTI issues are being discusses (attendance. participation in the discussion etc). - hrcentives provided by comnrunities lbr the CDDs - Attrition of CDDs. Is attrition a problem for the project? If y'es. horv is it addressed'/ - Other issues During health education sessiorls there rvere f-er.ver fer-nale representatives than expccted. This could be attributed to the fact that in some parts of t"he project area worllen are represented by tlieir leaders in such lneetings. This calls fbr health education to be given house to house to reach more women. I{orvever lvomen participation in the rneetings was encouragirlg. Some women parlicipated actively in the discussion on CDTI issues. ,'vhich can bc graded as relatively positive. Sorne communities providcd cash incentives to CDDs during the distribution rvhile in some other communities; they assisted thc CDDs to make their f'arms ntost especially in Sinoc Countl,'l'he percentage of Fernale CDDs was higli in Grancl Kru and River Gcc Attrition is a serious problenl lbr the project because other health programs arc pro\,,iding cash incentivc-s fbr their voluntecrs. t2 WI-lO/APOC. l4 September 2009 Number of comnrunities /villages rvith fenrale CDDs Percentage Ilr '=I} * 100 2.5. Gapacity building - Describe the adequacy of available knorvledgeable manpower at all levels - Where frequent transfers of trained staff occur, state rvhat the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is v'hal nleasures v'erc taken to ensure adequate CDTI implementation v'here nol enottgh knou,ledgeable manpowar y,as at'ailable or il'staJ.f is.freqttently transferred during the course ofthe campaign). The embargo placed on recruitrnent olhealth personnel had verl'negative corlsL'quences. Stalts vn,ere overloaded and distribution of qualitred stalf uas skerved touards IVloruovia uitlt dearth ol'clualilied staff in the rural areas. The healtli lircilitics are poorlt,staffed. DLrring thc pcriod under re'n,icu that al'l'ected C' I)'l'l trausf-er ol'trainccl stall'tiout tlie pro-icct ercu \\'r.ts t.tot lut issrtc t3 WHO/APOC. l4 Septernber 2009 c.CO al Lu _o -o c_ D a t U3 c- <?\ :I o O U t z ,Ert Q .\, + u' rlqv U 'J!-1_ $ O r! ao Ln Ot r- @ @ r! c! r-{ F{ O c\t O)$ r\ @ !--{ o, rt.\o al rc ca r/-l a\I l-- cO @ Ln r{ J co r-. r-l rn Olq ri \o$ a- o, €v al € €r- r- \o r- q) q) () I c\ r/.t = -lv ;J = i- ^iu ;w -v L .JqFF cJ' o9? ..J L z C O O O - C C c C o O O O ^\ o U x o ;i! a6 92 tr:- rd)zz q) Errt, : -- I U U e< F \o CI C.l \o t CI =t al \o <f O ci \o $ =j' .a ta) ,ta c\ o q) o 3\ Err u r9 !J! -!u -.) .l_ F a q tl 9q) .iL ,-q/ z O C O C O O q) {) q) o 5\ O U O o(, 6(, oo O Lo &. L (! o -o (q L z- o o ,5 rl F F -:ta cd 0) E(J F t--..1O a () () () L ,0)F 0) C( bo (d!F .nr -l _ol cglFI b4 = e { o\ : c t u o Q h4 a C + i C\ \j € s t n a .: i\ ,a b, ts a \c) al O Table 6: Type of training undertaken (lick the bores y'here specific training was carried out during the reporting period) Any,other conrmcnts 2.6. Treatments 2.6.1. Treatment figurcs If thc project is not achio'ing 100"h geographical coverage and a minimum of 65'h therapeutic covcrage or the coverage rate is fluctuating, statc the reasons and the plans being made to remedy this. Tlre Projecl in 2010 treated 274.726 out of a target population of 335,428 representing 82% therapeutic coverage. All 639 cornmunities were treated representing a geographical coverage o1'100%. The highcst therapeutic coverage 9l7n rvas achieved in Grand Kru. This is quite unusual to achieve sLrcli Iiigh covcrage, but thc health rvorkers cxplained that in the mining areas there was verv srnall proportion o[ underage children u'hich possibly' explains u,hy' alrnost thc entire population in the gold nrining settlernents are eligible to rcceive N,{ectizan. Tlre countl, rvith the lon,est therapeutic coverage of 72oh u'as Sinoc. In the casc of Sinoe County ccnsus registers werc not adequate in some comnrunitics and I'erv CDDs covering the entire counl.)' accounted for the lorv therapeutic coverage. All Counties achieved l0O% geographical coverage. -l'he Pro.ject in 2010 undertook the listing ol cornmunities by hcalth facility, catchments to asccflain thc exact number ol communitics in vieu, of the fact that the number of the communities havc been fluctuating in the past years. Also the Pro.iect plans to carry out geographical coverage deterrnination and GPS mapping to generate rnore reliable data base. l-rainees 'ti'pe ol training CDDs Other Cornmuniry' rnembers e.g. Conrnrunity sLrpervisors Health Workers (frontline health fac ilities) MOH staff or Other Political Leaders Others(spccifi') Prograur rnanagenrcnt Horv to corrduct lle alth educat ion NlanaqerncrtI ol'S,AI'.s (.SN1 SIINl [)ata collectiort L)ata analvsrs Rcport rvriting Othels (spec il'1,) l5 WIIO/APOC. l4 Septernber 2009 O a! O.O L(d -oq) O o. o f \o ! Oo e\! > a U !! a. =\ 0o tJ bo \ rlv: !J: G\o= d-: U:0ri -'\L:< E Sr Ona i '-s d>!d J\!-! tJ i- .o ls -.\1 o .:: | !\L\:o\ g\+- \:A I>x!yI .s')rE >:Y - Y }.S a'< :\\\ .: :\'= -<(! Fr:,-E S'i t'vq! !\Y_- ! u*, ., q': -. + l*iU =:\5- .Y ?=(+- S\So * \-" LFi'-U$\\6 i Sr = S"n I +\y c S'sS ^\.\v? 3= '\J lJso =:iF - !r '--! ba! ! <_ .(: \'-^^ 'ai\ ^- \;3C ! -! c-s ,q\- a ! s i'ax-a:isii \s\s:e:!c t.:S'- S ':d\ i\: ! !i:\-1Fr ts- ='lrll! o() tLl\ A \!! OO I q,) (-)! 0) o o 0) o ! 0) -o Z -o 0) () Od ri F3 .o o\ () .z ,J CJ3 CJ 6J(J F = ? I -o CJ(i o L o o o c-) o. o OJ _o =Z O L O(.) a 0) -a .= 2-t! -C -o 6J .; = .J ;(g a, .9 .= =E 5 .9 E 0.) -o c 0) I L(J a 0) E o ! OJ -o E q E ot- (.) 6J 0) cf CJ U 7) 'o' L UE .=E .=/ l, .? .= = =E E a(-) .9 E(J E () I L O oa 0) t, C o o E oF O =I 0) 0) L () o 0) i]I L ot =t =ltl ZI a L 0) o.tlF^0s oU CF 0)(! L o oo L OJ oO ;(_) ,- -^\ L bIr O OJc 0.J 0) br) 0) o .J O^ (-) o-(0 L() t- a dJ b.t d! 0) o(J (! .9 a CBL bL o c-) OI -d .9 0)o cg! 0) -! at E] 5l(Jl LI fILUI !t -ltrtLI olEI & CN L a(d q) !(d d a() oU -o a r! CN () (d 0)!F r-f ol a j ^ =h \ vE ui6-eh o -E'I O2 o I ri=c - c l:';o..: o>oo OL o -o E =z a o o O O 9,trEL! =jzua O q d, \u U U cco d 6' -O=\/o-:1 ; E€;6Z 6 3-5 oa- @ v -a =l c- oo \o F- .n (A raN ,! =a!'' - 6r-C -l o -a O -a @ F-r t -t U)N ---1)J ) ') / ., :r r-r O -7 r \o t- -t F-- r- a = avr LAE,) - rl + \Dt- @ c o r-a cla- c\ al 6 s=u =a?d -..-9Z o; t c\ € o<) \D t- a r -1 r-l c.l r o =f o. .-! -t -t c.lr- a? r- c.r =dcAD o 6d a o. o aa ^.'€--u =o =€ O di; u ao st O) O co aO oi(O C! cf) <. r'- rn ro O) oo d rn O r-{ coj (O @ s- t)(r1 m =9o -il i:9o'boi- o ll * AH O O O O O \o ':o U C M! -o=6EF F= u =9>-AA N 9 r N 7! i?D -v 3 bo = OJ 9 EI \On L o=::;r 9,-^= 6 i D> --: E do c9EdYlo| ^- - = a N € r : alo a\ o(J -If-a -O i:o(, (, oo o 0.) a trI (s L o ! c3t(d Do '15 ,l4 t-r F 2.6.2 What are the causes of absenteeism? Inadequate sensitization and agreement on the time of distribution Large number of refugees from Ivory Coast that moved into dwelled with households but were not fully mobilized to participate in the treatrnent especialll, in Grand Gedeh County. 2.6.3 What are thc rcasons for refusals? Sorne peoplc stilI t-ear oi'adverse reactions tiorn lvlectizau dcspitc repeated hcalth education 2.6.1 tlriefll'tlescribc all knon'n and verificd scrious:rdvcrsc n'ents (SAIis) that Occurrcd during thc reporting pcriod and provitle (in table 8) the rcquiretl Irrfornration u'he n availaltle. 'l'here \\'ls no .scrious advcrsc cvcrtt during this trcatnrcnt rountl ln cirse the pro.jcct did not lrarc any'cases olserious arlverse evetrts (S.AE) dLrring this reporting pe riocl. pleasc tick in the box. No SAH case to report t7 WIIO/APOC. I 4 Septembcr 2009 o\ (\ L() -o Eq) o- 0)a =f O o o- o v) 1) \ U o r,J ra qJ l/') .r( -:\ Nq aa 1.)Utl - 9 .- q) U) i, o_ -o c ! 0) a- bo F o a.()p () orl L 'o() LL o a rl.] a a OJ a)() 6L OJ -o d a c L 6.) a o a() a O odr ,l al =tFI otr- ^oui>tr u;o <.= E 0- ;O a: :: -, _ = -= o 6= a -qa') E a vaEL u-u- i:-u u: L-..1 d -c d =cJ -c - o gp! 6 =.v.- Yo ii;-zg r!X6_> *6Lp- -4,:o!-ft a>, oo E o L O -o o L(€ 0) o- o- /-o a z a 0) oo o oJ) 0) I L! o OJ tr oo o oo (€ o =o- E o 2 o br) o L c- o oc0c -bn=.->a 6 o- E a -E -. o- .JF I I l i I I I l I I i l I I l I I I I I l I l I l l I I I I ! I l I i r + I l f CJ boOtr^F 6S '- >:- U s r.- f-- sq t-|.- s(r) O) t\ \o € \o a- o\ rJ =lJl c lt ; e rrf a ^ ojl -o soo sOo s @ s O) o\\o o. \o t- o\ :!' :rl k) o d^ iu" oo =t)F s(r) @ str)(o s N@ o\ 6 C] b ll: -,^) ;! rC =.z{ a r- coO c.) NOO CO co NN O) O co € -t cl -a ^l .c alr- +r al !lc-.-/')- (\ N rr) o.lO co Nl'- rr) C.JO $ O') @ N co .I A : @ al (o OJs ro(o$ O)$- rf,(o s tr)N O) O @ cr) F. -f € c.l =1, o 00(d = 0) E E U ll + tJ u ^ oll F u-1'>-- -'c soo soo sOJF- o\ O \o eol)=S=I?tt *e:"i u o ,T,-iO-i-*- ! r-r soo sOo o\ O)l'- ro o\ O h.l - .= di -d) = !!! z3' r.- O) ro f.-(o tr) @ t- € o. o\ \o I! ; ., 2 =/ttr9 -J t- O)(o t-- tr) o)O O) @ o. \o '.I) - =q :--^.u9) t u- /.'" -4-L1 a- o=?,r,!L-Jt- E -u a t- O)tr) l.- O)(r) O)O ooo. o.\o c LL] r- o.1 € o\o O N aO o.l (.l OO a.l (\ <.O c.l C.l \oO a.l r- O al @ O N o\ O ol Oal = al oa CO -o LLj o o- o :E B o'. -U) - ! =(,, (') 0) 00 -Se N'i:o -,J\! .-pl, .=? :- s le 9-s,s.: a. ,- e.:O d!H\ O\ r ,\i'\.= :--,bH vi- gE\tAvlxr- 9d)! o)OLq .ic!Ct C.!cJq')9L o0)=tr'=b! Il- t- a)A.o .gPE -:.E -!c-tr4 t) v !91! r/)U:\ d-trLOoCdr\Loil trEI 9J6.)il tdXl cE6sl E . cgl 0.J(J(Jl =>l 3a) -ol 6(J!oJlz Iiu- a6)Ltr/a :o(H e:(, -U! L =G' LItr(J!gtr0, -Eer'ofa lft q:ts v ^i o,l ;oJl a _,Al L!*-t () LUIL-l Att 2.7. Ordering, storage and delivery of ivermectin Mectizarr@ ordered/applied fbr by - @lease tick the appropriate ansy,er) MOH wHo UNICEF T NGDO D Other (please specify) Mcctizan@ delivered by - @lea.sa tick the appropriate an.sy,er) MOH tr wHo UNICEF tr NGDO f] Other (please spccifi,) Pleasc describe hou'N'lectizan'nr is ordercd and hux'it gets to the comurunities 'I-hc rcquired N,lectizan stock tirr the r,ear is calcLrlated and ordered b1'NO'I'F based on thc target popLrlattons of the respective couutie's. Districts and communitics. .l-he ordcr is sept tcr the N'lectizatt l)onatit'ltt Progranr. \\/lien Mectizan arn\cs in thc couutr\'. thc \\/orld Hcalth Organization (\\/llO) clears the consignurent li-our the port ol-enl.ry ar-rd delivcrs it to the Ministrv of Ilealth. IVIinistrl'o1'health in rclurn transl-ers the drugs to the NationaI Druq Sen ices (NDS) lirr storage pcnding distribution to thc coun-tics Table l0: Mectizan,S) Invcntct - Horv are the rcmaining ivennectin tablets collected and where are the1, kept? The remaining ivcrmectin tablets rvere collected b1' the officers in charge in each liealth facility and kept in the phannacy of the health lacilities in the counties. The Countl' Onchocerciasis Supervisor collccted remaining mectizan aud sent thern to the county pharrnacr,. List and bricfl1' describe thc activitics under ivermectin dcliven' that arc bcing carried out b1, health care pcrsonnel in the project area. .Alier cotnpletion o1'cottturunitv census, the countv requests the mectizan through thc NO-tF secretariat. Witli approval by the NOTF. the counties are supplied mectizan through the county pharrnacists by NDS. At the county'level. the officer in charge of the hcalth facilities request rnectizan through the onchocerciitsis supcn'isor fiorn the countv phamracist rvhile the CI)Ds make request thrrtuglr the OICs at the conrrnunitv leve l. Number of Mectizant tabtets Countr' In stock frorrrprevinus year Requested Received Uscd Lost Wasterl Erpirc d Renrainin o Grand Cedeh 806i0 152.545 10t,54-s I 40040 5i 0 -500 43582 River Cee 547'7 t 75.000 60.000 l0l6l9 ,127 0 0 I 0725 Grand Kru I i340 80,000 80,000 I 1078.1 8l 0 _s00 1913 Marvland 17013 343.788 60,000 8488 r 44 0 0 22088 S inoe r65.i50 40.000 33500 16.1804 153 0 500 3ll9i TOTAL 381l0.t 691333 337045 604128 960 0 l 500 I l56l 20 WHO/APOC, l4 September 2009 Any other comments 2.9. Supervision 2.9.1. Provide a flolv chart of supervision hierarchy. Central Levcl . NOTF . NOCP r Count)' IJcalth Olllcer (('HO) . Cou.rrlunitl' I{calth I)epartnictrt Dircctor (C'HDD) o Countv Onchocerciitsis Sr-tperr isor tCOS) Olllcer in Charge of llealth Facilities ('ountv Level District Levcl a Cornrr-runit-y Lcvel . Cornnrunitt, leaders /torvn chief . Developtttentcoltttnittees . CDDs 2.9.2. What u'ere the main issues identificd during supen'ision? lt was observed that in all counties training rvas conducted at both health facility and community levels. Ilorver,er. the quality,of training of CDDs by'liontlir-re health u'orkers rvas generally poor. Also health facilit.v staff did not carry out adequate follorv up u'ith CDDs during the implementation of activities in the communities especiallf in Sinoe and Maryland Counties. 2.9.3. Was a supervision checklist uscd? Supen,ision checklist w'as used by NOTIr teant during spot check 2.9.4. What w'ere the outcomes at each lo'el of CDTI intplenrentation supen'ision? At the count)' levcl. niorrthly strpervision u,as canied out bv thc COS. As a result. c()lttrttltttit\' rcgister and reporting lbnns and drug stocks rvere replenished 2.9.5. Was feedback given to thc person or groups supen'ised? Ycs feedback u,as given to the c()unt), health team through sharing ol supervision rc'pot1 2l WHO/APOC. Fcbruary 09. 201 I 2.9.6. How was the feedback used to improve the overall performance of the project? The recommendations provided during the feedback sessions and reports were used to renredv some of the gaps identified during supervision. The result is shorvn in thc increases in geographical and therapeutic coverage compared to last year's results SEGTION 3: Support to GDTI 3.{. Equipment Table l2: StatLrs olccluipntent. (Plau.se udLl rrtrtra t'tnrs if ncCa.\'.\'tu--t') *Condition of the equipmenl (F:Functional, CNFR=currently, non-functional but repairable, WO=Written ofl). Horv does the project intend to maintain and replace existing equipment antl other material? The MOH &SW has included CD'fl activities the National and count), health plan so that equipments maintenance cost r.vill be included inLo the county annual budget fbr 201l. i\lso CDTI will benefit from resources allocated for Integrated Neglected Tropical Diseases (NTDs) master plarr soon to come into operation. 3.2. Financial contributions o1'the paftners and conrmunities - Fitl tables l3a. l3b and l3c - If there are problenrs u'ith releasc olcounterparl Iunds. hou,rvere thev addressed'l NOTF advocated for relezrse olcounterpart funds. only staff salaries, r,ehicle and nrotorcvclc fueling and maintenance were funded Sourcc 'l'1pe of equ iprnent APC)C' NlOII DISTRICT/ LGA NCiDO Othcrs Nrt ( ondrtrolr N,r ('()nJltl()rl Nrr C()ttd tllon No ('rrrtJ r trotr Nrr ( tirtdrtrrrn 1. Vehicle 2 J: 2. .Motor ci'clc(s; z-) t; 3. Computcr(s) -1. Printcr(s) 5. Photocopicr (s) 6. Fax Machine(s) 7. Others a)Bicycles t64 F b) c) 22 WHO/APOC, Irebruarr' 09, 201 I o\ c.l 0_) _o E() o-(.) a v O o o- o f a.l -o 0) oo tn l<(! () C)k U)(s C) ! at< 0) !- (! -o a o -o o(-) o a i.i ct) q,) F ofi; C) :l ol!(L oq c{(o o- F- OOOOOO tr)ONLr)oo r- r_ @_ C!NN o o)o Psol :rot'- c! o r'- t @ o rr) o) @ N oq lo o>(o- F- o colr) f.* tr) N ooog OOooO)- or_ oq @ u-, c, .C, o Oor coLo) c.4o'E() EE,JZ C o, E o o f -o .9E 'o L(.l c E(! CL t UJ IF o o oo(9 z ! o @ o @s! th6>c,o6 u)F 't Og =oo'E ot .9Eo (!_ !l(!ocooL.-fo) n0, ot t o) cl o ql - Lltr ol (!l zl o a ro{ c! @ c1 o o(\ ]J ot o o_ OJ c') 6 -o tr UJ (! ! o(! o o o =o 0) o- ol ol ol >.1 o BF o -o 'tr tr o o Fz u, =zt uJ o o 'tl(, o E o OO oo$_ N c, co $ co c.) $ lr) UJz =F UJ oof m o o (! .Nt t4 0,tt io o(J- o6>;E5 F E q rj't E ; >. E cu s i H:[€ ! P 9 t ;\(u u o) E o i: SE q c> $ dso liS u, @ o)Y o B ,^ .C u6Oo.>OI oo O, O,gsgE oo o0) o) o) oF!=r==\ .-66G fLL! .=t-l-o(!! t Nd .(\N5 =q o G $ ut c o o (r, COo)c a;c9 doo=o,rEfshqt c!cQa c.l c.i c.l f(/, a c 0) o) o o) ! o 0) o!o) tr=o)o:a > ,!io!E oo(Duc\o) oLc>;9 Xoor) x b ds 6Y (\a sv$:o(4 o o ul G o ! (! o a q, ! oq) 0, J ooq9 o!(,:-;U \eO,C a-<ox-oczGRPSgtr:X;o>o H=Y-c. .:<oo-o;():J rrlrr>rrrrof, J F oF oz t(9 N o. (d =L -o U o o- o :E ! c(Jf o I'L +aq.f LF rr) ro ro ro t-N\Nr.-g 5555@3::: oo(O_(o OOqq ooOO(o- o- VN oooPoooY oooo633\ <oo<. [ oo rO .(l cr)(o cf) ood a C.,(o c.r_ lr) ao$ o,d(, o o) o .E fc.o :o) E! oo oEOq3 -z c a, E(1, o Jll ,9E 'o L oc ts C' o. t UJIFo I @ oo(9 z oo $(r) cr- @ O o.), c, oI rf N ai c! !q) o a -oo o\E Io_>(Eor6 o)F 't Oe =oo'tr o.9Eo (!(! EEo.9g,E -- 6,6u- .9! UI c ^6trO (! z oo l.- rf)o$(o @ @(o(o(o(o (oq(, c!t-- o F.- O)ooN 1 Go\ o .i o o a-{1 1' o,t o o- o o, '6 -o t ul L G!, c 0)to c o lt L oo Fz uJ =zE llJ o o E o o) c,E c0 IJJ z J F llJ oof, fo o o G .N tn tr o tn So oOCoo t^ c Qob F q 3 SE F E T EEY = = O -cSt -o 2 9 - ;S0, o 6J D (l) {j SE : : : : ti€ q AF e.9 :G >\ (! O;tU ,i9 dc::r;; eCC.= cco(o(otr 66t' 6(rr o) .: -!E='3F!!-a '=sosEd .:;;oQ_ !!:f .c!c!5q =.n= C oo)c oE9 aoo=;=:< +5EE ! NCta dctctf U' Eol2 EC6eR)i(!*q0) cPEE !6q(!Go) 6s b E '-c = 6):o ) aQ> ='io : o .EB € z >!o) -o E ac\ = 9IE E H,> Eq E E E >q, c!a Ib $ $ ; C)o c 0) OJ c o.Qo(Jq- LA0r= ^L<x-)0rc ,^o0)(t;itr> \'= o-04 >96EI+PSb(/)tuAobs: -: ro tri c? 5 J F oF oz t o -t al tnl< 0) C)l- t/) 0) li ,o a li C) t- a - -o oo O r : ar) q.) F O(\ O. x L -oOlL(i o o- o f c.l rJ 0) oo (J()lr at) o L ,o a -o ! oO (d o tr. (.; ra q) a!F .tc c(Jf ol! -th<1, l F 3? o93; o5o roq Y o)-s3 @ c.) ral t-- tr)- (o @ F.-{ @ ro- t- c\,1 oL 0, o '= co trg o o .ntoq3 'z d, E o o -o .9E 'o L o) E(E o_ t- UJIF o o oo oz OO r-g N- oo(')s (o O() N OJ @- o u'l o, F* N o, ! o o _ott G oF (, o i5 E o o(, o o, .; o E o (E ! 0, th L fll .9E o o E o o (E z o - OOOO F-Otr)oo-tr) $(o oo t- ro o-(o(O G.oo(\ ! 0)t oq o '6 -o t UJ (t, ! 0) oo o o o 't o o o o o c o c o J -o o(,) Fz lU =zt LU >l ol ol E o O O rO IU z) F trJ(, o l(D l! d, c o G .\ .: t4 o t4 io G(JcOo>;b- 5 (uc3 E 0 3 iE i E T EEt E s H t -:\o o (.) D o j: <E n ", $ aso 5i€ U, a 0) Y o B 6l lotl o)O:E oo or o)CE cc(o(! ooJ o, o! o===r.=.= .-66G rL .;FF9 t Nq .Nc{5 = (r't o G a l{ o (t) cOO)cUacg ao<o= ALtoYg .. N c, a(tco6f q a C o 0) o a 0) ! o OJ chey -o v) 9*EC -C) o0)Oor> b 6s Na rcvf (r, o) Eo O) G G ! G 3e 5(l)Q> 'tr 0) .Es!bq>rbOG9o sbo> >C) Ib lt, olt, o a-x.-oc -^ o)(!YaccYX> .o E =-b(/)LUo!:q.:(\aJu,0fr J F oF oz t(9 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions ol communities if any) In sotne comtnunities they assist the CDDs to rnake their farm during f-arrning season Some provided food items. 3.4. Expenditure per activity Indicate in table 13, the antour.rt expended during the repo(ing period tbr each activit\,Iisted Write the atnount c.xpended in US dollars using the current United Nations exchange rate to locaI currencr'. lndicate exchanqe rate used herc 70t-t) I t ISD ,,\nv cortrntents rlr crpIauations') SECTION 4: Sustainability of GDTI 4.1. lnternall independent participatory monitoring; Evaluation J. t.l Has thc project ever becn evaluated/nronitored? (Tick an1' of the folkru'ing u'hich are applicable) Year I Pafticipatori, Indepenclcnt monitorinq X Mid Terni Sustainabilin Evaluation 5 1,ear Sustainabilitl, Irvaluation ) X lnternal Monitoring by NO'l'L- X Other Evaluation b1, other partners . What rvere the recommendations ? . MOHATIOTF should ensure tinrely release of funds fbr CIDTI irnplementation to the Project . The Project/counties should ensure proper and timell' liquidation of funds use . Healtli rvorkers should facilitate the comnrunities to select more CDDs especially for River gee, Sinoe and Maryland counties . Health rvorkers should carrl, out regular supervision of CDDs . NOTF should advocate to APOC for the rcplacernent of unserviceablc nrotorbikes . APOC and NGDO partner should provide tunds lbr update ol ccnsus, determination of geographical coverage and GPS rnapping of CDI'l communities. 4.1.2 4.1.3. Horv have thel,been implemented? Treatment rvas updated in Grand Gedeh and River Ciee based on feedback from internal monitoring Most of the activities proposed lor 20ll rvere based orl reconlr.nendation of the internal monitoring a a 26 WHO/APOC, l4 September 2009 I4.2. sustainability of projects: plan and set targets (mandatory at Yr 3) Was thc project evaluated during the reporting pcriod?_NO Was a sustainabilitl, plan written?_NO \\rhen rvas the sustainability plan submitted'/ Wltat arrangements have been made to sustain CDTI alier APOC' firndins ceases in ternrs o1' 1.2.1. Planning at all re levant levcls At tlie national lei'cl. NOI-F has secured the inclusion ol-control o1'(.)nchocercrasls and other Nl'Ds in the ten )'ear's National Health I,lan l()ll - l0ll. 1.2.2. I.'unds Fundinu lbr thc CD'fl ltrojcct uill be proritlcd br thc so\enmrent tl-rrough integrated Nl'Ds master. plan 1.2.3 Transport(rcplacemcntand ntaintcnancc) Vehicles lbrother progralns u'ill be used to carrv out CD I'l activities under the intcgritecl approach Governtttent rvith support lrorn NGDC) parlners u ilI provide budget lines lbr vchicle and motorcYcle nrai ntenancc 1-2.4. Other resources Resources ri,ill be nrobilized through the pool funds 4.2.5. To rvhat cxtent has the plan been irnplementcd A draft NTDs rnaster plan has been developed and its being incorporated in the nationzrl hcalth ptan 4.3. lntegration Outline the extent of integratiotr of CDTI into the PIIC structure and thc- plans tbr cornplete rntegration 4.3.1. Ivermectin delivery mechanisms Ivertnectiu deliverv uses the satne mechanism as other essential drugs through the National Drug Service and Countl,drug depot. 4.3.2. Training 1'raining u,ill be carried out.jointlv u'ith othcr N'fl)s. 1.3.3. .Ioint supervision and monitoring u'ith other programs Supervision s,ill bc integrated u,ith NTDs and other health programrnes. 4.3.1. Itelease of funds for project activities Funds "vill bc released b1'the Ministry of Finance through Nlinistry,of Health and Social Welthrefor CD'f I activities 4.3.5. Is CI)TI included in the PIIC budget? Ycs CDTI activities u,erc included in the 2010 and 2011 bLrdeet in all countics. 27 WHO/APOCI, Februan'09, 201 | Describe other health programmes that are using the CDTI structure and ho*, this was achieved. What have been the achievements? Currentll,the CDTI concept have not been adopted bi'other progranls but they use CDDs as vaccinators, mobilisers and recorders in polio campaigns Filltables 14 and 15 and provide describe other programmes that are using the CDTI structure and how this was achieved. What have been the achievements? For each intervention listed in table 15, explain what were the roles played by the CDDs (census, mobilization, distribution, data collection, storage, collection of drugs, referral of SAEs, etc ...)? Explain what are the combinations of tnterventtons co-rmplemented? How were the rnterventions rmplemented? (at the same timeT) -1.-1.7. f)cscrilrc othcrs issues considered in the intcgration of CDTI. To bc continucs frorn herc. l'hc I\'linistr)' of I-lcalth and Social Weltare has iipproved the intcgration CDTI into thc llasic Packzigcs fbr Healtl'r Services and has included in the 2010-201I budqcts fbr PIIC scrvices 4.3.6 a a ) a a 28 WHO/APOC. Februarl' 09, 201 I O N Lo -o E d) o- 0) U) I O o o- o J o' al -\J $* k \J -- ,qr - qJ\ Cl ^a q) U - a) O )\U qJ :! 0) 6 C'L L o Lq, E z F N0\F.a q) E E o a bo L L L o Z F .f, I-- r-a t: a 2. ;> r9 a) Z- F € f r,9 a./ o\ I E tn c.l6l qE t) )EZo o o() u0 F oo EO J 'tiz C) a ql N ca ob,L tqF 6l .a -i ^.S9\ -oi q)Q =* jv- 0_)E€C'J :i c s:E :i-C- O At- 0J: () L!o::CcO=C(]a-r=o Y r.i ;f Q - r 'v -!FE c'E =-r-:9(-) cr.= N - - S E::! E'5-i d-o -u ':- ;: .- I .- .- j- ri 'J -rvr^-LLt5 p: i c E ; U Ai!UeUA,.,eEEed 'd .\a(,CdL!-bq)J N:d €53 > E> Fr A) CEo al 0Jo>-o a a CN6 (J 0)(.) _Oa A- UC) o C(U .9oPNf(o !! ua) Oro a CE .eE =ro:o @aoOo- a o0J cE oN;(o 3! aC '- (U o(U ot a o c .F =! '-q --4i5i a c (Ll -m o! ar;"roCrL=C rto a .F (E c <0rCE '=atro ()a )oO a a .9 o o_ Qe -)-: O O ;6E'ao. co HH a E o U) o oAa r Fo oL o(-) L z o o L CO z o p (o z E o C) F a o ti6(! O 0aF EB --\ cn a () (,) I (, r+ q) h L I =O a.] o.O L L _o 0)tL o o- s o f , O a a \tJ :- .! U) p U > ! .> IJ 4 a o ! U U = ra) q) a q) q) (, c) q) L o o <) (!(g bn L () on oz o E L a €c Ur aL= a ;o 'i.u9- U o tr.g OA .L =o OO Qaqa, ba sU) () o q) o L o o F C .Eo OJ: OJo>E a o c(U .9o f(! -o! pA .@ -oo-6 a o_ EOJ .eE =o o(! Oo- a oqJ c6 oN ';(oiElc I 6.1 qQ)i-E a zf J o .9 f _o L .qo a C o.) E OJ bo ro C ro .9 Crc oJro ct o+IO a C .9 (o c <qrCE .E OJ L^oi >d a a a a a a a a a <) () F a q o () o_Oo <)? \J(J .2q .T E .9 cd o- J a (d E o a oa FCN o (n (6 (n z E oo(! (n (n 2 o L (d 2 o odLF a o cC d cdQ (,)(.) o.o a C) o U1\ v r\\ oLC\(-\' \.) q \.) *t U () t< SJ C) t< a () bo (t) a() ! brl o Lr L< C) IJ rii 0) F a4.4. Operational research 4.4.1. Summarize in not more than one half of a page thc operational rescarch undertaken in the project area rvithin the reporting period. There lras been no operational research since the prograrn starled. 1.4.2. How'w'erc the results applicd in thc project? SECTION 5: Strengths, weaknesses, challenges, and opportunities I-ist thc stre nsths autl rveakncsses ol'CI)-fl rnrpIemcnlation 1'ltlccss I-rst thc chalIences ancl indicate hou the v n'erc' adclressecl. 'Slslglbs l)cdication of I-lealth stal-f'to CDI'l Support trv cor.r.rr.uunitv leaders Challe ngcs []ad roads condition especiallv dLrring thc- rainv seasr)r.r Weaknesses - CDDs r-notivation bv cornmunity is lorv in sonrr-' counties - Inadequate funds for CDD trairring - There \\'as no firnds provided lor the repair and rnaintainence of nrotor bikes - Iltadquate losistic supoort for routine suppor-tive supervision and rnonitttirng - Inadequate Health education in the comrnunity by health facility stalf Opportunities - Got'ernttrent contmitment to include CD'fl into the Basic Packages lbr I Iealth Scrvices - CDl'l structure to be use for other Neglected 'fropical Diseases - Integration of Onchocerciasis n'ith NTDs SECTION 6: matters Unique features of the proiect/other I I Ivlost parl of the project area are inaccessible due to bad road condition. ('ornurunities are scattereti in thc high rain atrd tnangrove fbrcst belts. Implementation ol'aclivities durins thc- nrin_r scasrln presents a huge challeni-{e. --! I WHO/APOC. 1.1 Septernber 2009