Report of the fifth workshop on the philosophy of APOC, the concept and harmonization of community-directed treatment with ivermectin (CDTI): Nairobi, (Kenya) 20-25 April 1998

African Programme for Onchocerciasis Control (APOC) Prograrnme africain de lutte corltre l'onchocercose JAF-FAC I )t JOINT ACTION FORUM Office of the Chairman JOINT ACTION FORUM Fourth session Accra. 9-11 December 1998 FORUM D'ACTION COMMUNE Bureau du Pr6sident JAF4/INF/DOC.5 ENGLISH ONLY October 1998 REPORT OF THE FIFTH WORKSHOP ON THE PHILOSOPHY OF APOC, THE CONCE,PT AND HARMONIZATION OF COMMUNITY-DIRECTED TREATMENT WITH IVERMECTIN (CDTI) NAIROBT, (KENYA),20-25 APRIL 1998 I t AFRICAI.{ PROGRAMME FOR t Liberia a o\ts I q MAI 1998 .,: :, ,: ,,(APOC) Workshop on the PhilosoPhY of the African Programme for Onchocerciasis Control (APOC) Concept and Harmonization of Community-Directed Treatment with Ivermectin (CDTI) 20-25,April 1998 Nairobi, Kenya TABLE OF CONTENTS LTST OF ACRONYMS ACKNOWLEDGEMENTS 1. EXECUTIVE SUMMARY OPENING CEREMONY. . TECHNICAL SESSION WORKSHOP SESSIONS 4.1. Philosophy of APOC 4.2. REMO/GIS... 4.3. Administration/Budget /Financial Management 4.4. Communitv Participation and Sustainabilitv of CDTI 4.5. Training and Health Education 4.6. Ordering, Procurement and Delivery of Ivermectin 4.7, Recording/Reporting & Feedback at all levels 4.8. Integration of CDTI into Health Services 4.9. National Plan and Project Proposal 4.10. Other Matters. 4.11. Conclusions and Recommendations 5) APPENDICES Page lv 1 ) ) 4 4 5 6 7 9 10 12 t4 15 16 16 t7 1 3. 4. I APOC LIST OF ACRONIYMS African Programme for Onchocerciasis Control Community - Directed Distributor Community - Directed Treatment with Ivermectin Continuing Professional Development District Health Department Expanded Programme on fmmunization Food and Agriculture Organization Geographical Information System Health For All Health Net International Jomo Kenyatta International Airport Mectizan Donation Programme Mozambique Company for Exporting and Importing Drugs Ministry of Health Mombassa Medical Supplies Coordinating Unit National Drug Service Non-Governmental Development Organization National Onchocerciasis Task Force Onchocerciasis Control Programme Operation Life Line Sudan / Southern Sector Rapid Epidemiological Assessment Rapid Epidemiological Mapping for Onchocerciasis CDD CDTI t CPD DHD EPI FAO GIS HFA HNI JKIA IVIDP MEDIMOC MOH MSA MSCU NDS NGDO NOTF OCP OLS/SS REA REMO TB UN RHB RMS SRRA TCC TDR UNDP TiNICEF WHA wHo ZHI) Regional IIeaIth Board Regional Medical Stores Sudan Relief and Rehabilitation Association Tuberculosis Technical Consultative Committee Tropical Diseases Research United Nations United Nations Development Programme United Nations Children's Fund World Health Assembly \1 orld Health Organization Zonal Health Department ill ACKNOWLEDGEMENTS We the participants from Ethiopa, Kenya, Liberia" Mozambique and Southern Sudan wish to express our sincere thanks and appreciation to the Government and people of the Republic of Kenya for the hospitality accorded us during our stay in Nairobi. We also highly appreciate the full participation and contributions made by representatives of the World Banh Mectizan Donation Programme, NGDOs and others. We wholeheartedly commend the APOC management for the patience, guidance and expertise exhibited during this workshop. Last but not least, our sincere thanks goes to the Facilitators and Rapporteurs, who stayed behind and wrote a comprehensive report of the workshop. We will always remember the week of sleepless nights they spent in Nairobi. No degree of gratirude but, the successful control or elimination of Onchocerciasis will be the appropriate reward. lv IwoRKSHoPoNTHEPHILOSOPHYoFTIIEAFRICAN PR0GRAMMEFoRONCHOCERCIASISCONTROL(APOC)' CONCEPT AND HARMONIZATION OF COMMUNITY-DIRECTED TRBATMENT WITH IVERMECTIN (CDTI) APRIL 20-25,1998 Nairobi, KenYa 1. EXECUTIVE SUMMARY Ethiopia, Kenya, Liberia, Mozambique, and Southern Sudan and are among the 19 countries to be covered by the African Programme for onchocerciasis control (APOC)' This workshop was organized to provide a forum through which onchocerciasis control programme issues which face each country could be discussed. The issues addressed were : l.l The concept of partnership within the NOTF and APoc for each participating country in the implementation of CDTI 1.2 The execution and validation of REMo/REA to identify endemic communities requiring treatment 1.3 Programme budgeting and establishment of an efficient flow of funds from all partners for effective use in the treatment of endemic communities and ensuring proper accounting st-stems for funds reieased at all levels' 1.4 Designing training and health education material and activities to properly train health workers and mobilize the communities to participate actively and take ownership of the control of Onchocerciasis 1.5 Approaching the community on the establishment and ownership of CDTI including ways of ens[ring sustainabiiity of the programme after external funding ceases' 1.6 Procurement, delivery and distribution of ivermectin in an integrated and efficient rumner to all eligible persons in endemic communities. Also ways of ensuring proper management,ruf.tyandstorageofivermectinatalllevels' 1.7 How to record, report and monitor treated communities to ensure proper imPlementation of CDTI' l.SHowtointegrateCDTIintoexistinghealthsystemsaswellasin-countryand comm*ity irog.*s that have piou"n successful, without jeopardizing the technical aspects of the various progralnmes' 1.9 What requirements and steps need to be taken to develop National Action Plans and qualitY APOC Project ProPosals' 1 . 10 Possible means of in-country and inter-country communication on APOC related activities which will keep all participating countries abreast of innovative and stimulating info rmat io n' The working sessions were in the form of formal presentations by lead speakers, followed by working groups (country specffic or mixed) and generaldiscussions at plenary. At the end of discussions conclusions and recommendations were made. 2. OPENING CEREMONY Dr. D.K. S*g, Kenya National Onchocerciasis Coordinator, welcomed participants and thanked APOC for choosing Kenya as host for the workshop. He asked participants to feel at home and enjoy the warm hospitality of Kenya. Professor M. Homeida, APOC/TCC, spoke of the need for country teams to appreciate the availability of free ivermectin for as long as is required. He stressed an awakening of all members to strong partnerships in onchocerciasis control with emphasis on the importance of sustainability and integrating CDTI into existing community structures. In his opening remarks, the WHO Representative in Kenya, Dr. Paul Chuke represented by the WHO Advisor on Disease Prevention and Control, Dr. D.M. Mutie stressed the need for community involvement, participation and ownership of health prograrnmes. He emphasised the need for "Continuing Professional Development" (CPD) of health workers to keep abreast of current development in their field. The Keny'a Minister of Healttr- Hon. Jackson Kalweo. represented by Dr. Ivlaina Kahindo (Depury Director, Medical Serv-ices) w'ho officially opened the workshop and pointed out his desire for the participants to avail themselves of the knowledge they could acquire from the workshop (Appendix A). 3. TECHNTCAL SESSION 3.1 Workshop Agenda A provisional workshop agenda which was presented to the facilitators and participants was discussed, amended and adopted for the workshop. (Appendix B) 3.2 Participants and Facilitators Participants for the workshop were drawn from Ministries of Healtll research institutions, universities, LIN Agencies and NGDOs working on onchocerciasis in Ethiopia, Keny4 Liberia, Mozambique, and Southern Sudan. Facilitators for the workshop were from APOC/WHO and NGDOs (Appendix C). 3.3 Workshop Design The workshop was in the form of initial presentations on the various topics in plenary fotlowed by discussions. Country-specific working groups met to discuss issues raised pertaining to their own situations. There were mixed groups to facilitate cross- fertilization of ideas and sharing of experiences. This format was adopted in order to create an atmosphere of open exchange of ideas and experiences with active I 2 involvement of the participants who were mostly field officers. Issues were raised regarding their field experiences and solutions proferred. Dr. Uche AmaTigo, APOC, presented the objectives and eupected outcome as follows: 3.4 Workshop Objectives 3.4.1. To agree on the modalities for establishing CDTI projects and promoting community ownership o f ivermectin distribution fo r sustainability. 3.4.2. To discuss the development of National Plans and CDTI Project Proposals for submission to APOC. 3.4.3. To reach a common understanding on how to establish sustainable CDTI projects integrated into the existing health care systems of each country represented. 3.4.4. To streamline procedures for financial and administrative nunagement of CDTI projects in the spirit of APOC partnership. 3.4.5. To determine ways to avoid duplication of resources and minimize costs at all levels of project implementation by the National Onchocerciasis Task Forces (NOTFs). 3.4.6. To dialogue and harmonise the process of training communiry selected distributors. 3 .4.7 . To re-orient existing and new ivermectin delivery projects to the new strategy of full community participation in and ownership of projects, as a stakeholder. 3.5 Expected Outcomes 3.5.1. Participants would have a clear understanding of the philosophy of APOC and the steps for implementing CDTI. 3.5.2. Country teams would make recommendations on ways to integrate CDTI into existing health systems for sustainability, procure and deliver ivermectin to the communities, and determine how funds will flow from central to district levels. 3.5.3. Partnership spirit among key actors would be strengthened. 3.5.4. National Plans and feasible CDTI Project Proposals would be developed by country representatives fo llo wing the wo rkshop. 3.5.5. Participants would understand the roles and responsibilities of the community, health services, NGDOs, external donors and other partners of APOC . 3 4. woRKSHOP SESSIONS The tbllowing topics were addressed during the workshop sesslons 4.1 Philosophy of APOC/Concept of CDTI Overview of Onchocerciasis (special session) REMO/GIS Ad.ministratio n/ Bud getff inanc ial Management o f APOC Projects Community Participation and Sustainability of CDTI Training and Health Education Ordering/Pro curement and Delivery o f Ivermectin Recording/Reporting and Feedback at all levels Integration of CDTI in the Health Services National Ptans and Project Proposals Other Matters Co nclusions/Reco mmendation o f the Workshop 4.2. 4.3. 4.4. 4.5. 4.6. 4.7. 4.8. 4.9. 4.1 0. 4.1 l. The higtrlights and discussions of these topics are presented in the following secttons: 4.1 Philosophy of APOC/Concept of CDTI Dr. D. Etya'ale, NGDO International Coalition Coordinator, WHO/Geneva and Dr. Uche Amazigo. Scientist. APOC presented papers on the philosophy of APOC in which the following issues were higtrlighted: 4.1.1 . ApOC is a multiple partnership involving participating goverrlments and theil affected communities, NGDos, World Bank, wHo, LINDP and FAo; 4.1.2. In all ApOC assisted countries, the partnership is operationalised through the National Onchocercerciasis Task Force (NOTF) in which governments and their partnersQ..iGDosandotheragencies)areallrepresented; 4.1.3. In keeping with the APOC philosophy of partnership, emphasis should be placed on NOTF rather than on individualplayers. Consequently, the NOTF should be the focal point of all APOC assisted onchocerciasis control activities; 4.1.4. AII partners should ensure that any success achieved will be through and with the NOTF. 4.1.5. CDTI is a new approach for the delivery of ivermectin to eligible persons and empowers ufe"tea communities/villages to design and implement the distribution o f ivermectin (Mectizan@)' 4.1.6. The CDTI approach confers project ownership to the communities and to the health service as equal stakeholders' 4.1.7. To maintain a successful partnership, efforts should be made to improve coordination and dialogue' 4.1 .g. The NOTF should ensure a minimum coverage of 650/o in treated communities to achieve elimination of onchocerciasis as a public health problem. 4 A special session on the overview of onchocerciasis requested by the participants waspresented by Professor C. D. McKenzie of Michigan Srare University,Lsa. in trispresentation the following were highlighted: o Parasite and its biology o Clinical presentation of the disease . Important characteristics of the disease that relate to treatmento The need to provide correct information on the disease and the treatment c It was recommended that this component should be incorporated into future A1OC workshops in counny. 4.2. Rapid Epidemiologicar Mapping of onchocerciasis (REMO) and Geographical Information System (GIS) Dr' H' Edeghere of APOC gave a presentation on the status of REMO/GIS in the planning,design and implementation of REMo. The following issues were discussed: 4'2'l' REMO is e:tremely important to APOC & NOTF for determining endemicity levels and planning control activities in participating countries. triaadition. REMO is a prerequisite for consideration by APOC/TCC of national plans andproject proposals. APOC management anticipates that each country should have its REMO completed by the fonowin.s tentative dates: 4.2.1.1. Ethiopia 4.2.1.2. Kenya 4.2.1.3. Liberia 4.2.1.4. Mozambique 4.2.1.5. Southern Sudan December, 1998 November, 1998 June,1998? July, 1998 Will conduct REA through December 199g 4'2'2' Data from each of the REMO exercises must be cross-validated independently, using internal or external validators. 4'2'3' There is a great need for training of trainers for REMO/GIS and therefore allparticipating countries need to discuss with APOC nrurnagement the most appropriate dates for this to be undertaken in their countries. 4'2'4' APOC numagement will ensure that all activities related to the above are well supported. In particular, adequate support will be provided for the transfer of capacity and resources to assist the countries in generating essential data and maps and ensure that they are readily available to all partners. 4-2.5. REMO activities were officialry handed over by wHo/TDR to Apoc in September 1997.lt is therefore recommended that all requests related to REMo are forwarded to ApOC management. 4'2'6' In dfficult situations (civil unrest and wars) it is recommended that un-validated REMO results could be used for start of treatment. Where REMO is found to be strategically unacceptable, comprehensive REA results could be used as an alternative. 5 4.2.1 In areas of insecurity where people have not stayed for more than 3 years, women may be included in the sampling for REA in the absence of the required number of males if they meet the requirements. 4.2.8 All countries should ensure that high risk groups in inaccessible areas are not dropped because of the inconvenience to the REMO team rather, more efforts should be made to access such areas. 4.2.9. Countries should try to get multiple atlases to update maps for REMO. 4.2.l0.Information on endemic villages to be sampled for REMO, should be done jointly by all three members of the team (Geographer, Epidemiologist, and Entomologist). 4.2.11. REMO/REA is a continuous exercise which should be refined and updated from time to time. A special REMO session was conducted by Dr. H. Edeghere at the request of the participants to clarify the following rssaes.' . Step-by-step REMO/REA methodologt c Training needs . GIS o Internal and external validation of REMO/REA results c Technical expertise from external sources by APOC 4.3. Administration /Budget/Financial Management of APOC Project The two presentations on guidelines for preparation of the budget for APOC funded CDTI projects by Professor M. Homeida, and APOC Financial and Administrative rumagement presented by Mr. Y.M. Aholou, APOC Administrator, highlighted the following: 4.3.1. Prerequisites for good projects that will be in line with the budget guidelines include the following: 4.3.1 . I . well defined activities and requirements for carrying these out effectively 4.3.1.2. population to be treated 4.3.1.3. distances to be covered 4.3.1.4. strategy to be used for administering treatment 4.3.2. Justification of the budget must be detailed for each line item 4.3.3. Costs not covered bY APOC: 4.3.3.1. Basic salaries, office space, transport of drugs from port of entry to health centre. 4.3.4. Costs that may be covered by APOC: 4.3.4.1. Materials for training, meetings/workshops, consultancies, capital equipment. 6 4.3.5. ApOC FinancialGuidelines along with the WHO Imprest Accounting System must be closely followed. 4.3.6. Atl activities in APOC assisted projects should be in consideration of full community ownershiP in 5 Years. 4.3.6.1. It is essential to ensure that the community accepts the programme's financial support and management approaches' 4.3.6.2. Adapt the financial accounting procedures to unique situations (e.g. receiPts not available). 4.3.1. The flow of finances for each of the participating countries goes through the NOTF central account and to the project sites through the most appropriate and efficient means for each country. NGDO and National Onchocerciasis Coordinator representing MOH serve as signatories to the account. 4.3.8. The Southern Sudan finance flow is quite different due to the NOTF being in Khartoum and the need to utilize NGDO systems to get funds to the project sites. 4.3.9 . APOC only funds proposals from NOTF. It is therefore important that NOTFs are formed immediately. 4.3.10. After project approval contracts are signed annually and fi:nds released on an imprest basis. 4.3.1 l. APOC management would ensure minimum delays in the release of project funds. Any reimbursement would be based on timely submission of accounts by NOTF. 4.3.12. All partners in the CDTI projects must be involved in the disbursement, utilization and accounting of funds from APOC. 4.3.l3.There is need for advocacy at high levels by the APOC Management (e.g' Ethiopia) to countries with financial systerns which might not facilitate the APOC trust fund requirements. However, flexibility on this matter should be both on the part of APOC and the host government. 4.3.14. Since most countries in Africa do not budget as much as $2.00 per person for health, it is important to ensure that the cost of treatment in APOC projects is reduced to a minimum that can be sustained by the government and the communities. Country working groups were assigned the task of designing administrotive andfinanciol Jlow charts which is attached in Appendix 4. 4.4. Community Participation and Sustainabilty of CDTI Drs. Etizabeth Elhassan, J.B. Roungou and Josephine Namboze of APOC, presented papers on CDTI implementation with reference to approaching the community and issues of community involvement and ownership of CDTI projects. The APOC CDTI training video, which highlights vital steps in the implementation of CDTI was shown to participants to further enhance their understanding of the concepts of CDTI. Drs. Elhassan and Amazigo also 1 1presented a paper on issues related to sustainability of CDTI. After these presentations and iubsequent discussions, participants were divided into mixed working groups to examine issues of community involvement, ownership and sustainability of CDTI with special reference to re- orientation of on-going ivermectin distribution projects. It was noted that CDTI could initiate and induce communities toward improvement of their health. Conclusions and recommendations were made on the various issues discussed as follows: 4.4.1. The socio-cultural norrns and practices of the people should be taken into consideration prior to approaching the community to introduce the concept of CDTI. The team approaching the community should be as simple as possible, without giving the impression of overt wealth (e.g. moving with a large convoy of vehicles). 4.4.2. Women should be involved in the prograrnme at all levels 4.4.3. 4.4.4. 4.4.5. 4.4.6 To implement the CDTI approach, there is need to re-orient existing and new projecis to the CDTI strategy of full community participation and ownership of the programme. There is need for clearly defined roles for partners in CDTI and ensuring commitment and full participation at all levels. NOTF should clearly define roles and responsibiJities of the communities especiall-r- as pertains to decision making. prograrnme rvlnasement- suneillance and mobilisation roles. Communities should be given a free hand to ptan and implement the CDTI activities. 4.4.7. Health workers should be sensitized to accept CDTI as a partnership between them and the communities. They should facilitate the successfuIimplementation of the prograrnme. 4.4.8. The social and political structures should not be disturbed or antagonised but can be used when approaching the communities for CDTI' 4.4.g. Communities and other partners must accept the responsibilities related to CDTI and assure compliance over a long period; adequate and consistent advocacy and health education should be provided at all levels' 4.4.10. Adequate numbers of CDDs should be nominated by each community' Communities should be allowed to increase the number of CDDs to be trained or change as necessary. 4.4.1L There should be no payments of incentives to CDDs by extemalsources, rather' communities should be allowed to decide on the issue of motivation or incentives for their distributors. 4.4.12.The ownership of the CDTI should be at all levels of implementation -- not just at the communitY level. 8 4.4.13. Health education messages should be clear, standardized and emphasize community involvement and ownership of the progralrlme' 4.4.l4.There is need to identify and target key personalities in the political and social structures for advocac), to raise the levelof awareness and accord priority to the programme. 4.4.15.It is important that programmes are built towards sustenance by both communities and governments after cessation of external support. 4.4.16.partners in the projects should think of ways of promoting community self image and self-confidence and implement this early in order to facilitate community acceptance and ownership of the prograrnme' 4.5. Training and llealth Education Mr. J. Watson, APOC, presented a paper on various aspects of training and health education requirements for implementation of CDTI projects, drawing from field experiences. During the g.orp work, participants identified the target groups to be trained and health educated at all ieu"ts including the approach, topics and materials to be used. Generally, it was agreed that those to be trained oi health educated should be persons who will support, facilitate, and mobilize resources for the successful implementation of the CDTI prograrnme. It was noted that the ke.v- componenrs for successful implemenrarion of CDTI w'ere training. health education and mobiliali6n of the communitv. It was recommended that: 4.5.1. Health Education, being the foundation of successful implementation of CDTI, should be approached systematically and carefully, 4.5.2. Trainers should be more of facilitators in discussions/activities using a participatory approach to learning rather than lecturing to the trainees. 4.5.3. The number of CDDs to be trained per community should be related to the number of persons to be treated. It was suggested that projects train at least 2 CDDs Per 250 Persons to be treated. 4.5.4. Health education and mobilisation of communities is a key component of the CDTI approach. 4.5.5. Target groups for training & health education at the national level should include students, health workers, key policy makers, (including those of other ministries), the media, NOTF members, NGDO personnel and teachers' 4.5.6. Target groups for training and health education at the county, region and district leveis should include health workers, media, staffof related ministries (e.g. Educatioru Agriculture), NGDO personnel and teachers' 4.5.7. Target groups for training and health education at the community level should inctuae nealih workers, local development organization, community members, CDDs, teachers, traditional and religious leaders and healers. 4.5.8. Health education and training topics should include information about the disease, the use of ivermectin for treatment, community mobilization, record 9 keeping, and the need for the community to embrace the programme as their own. 4.5.9. There is a need to establish a subcommittee within NOTF to develop prototype training and health education materials which can be modified/adapted for use in various project areas in the country. 4.5.10. Most materials need to be developed at the national, state, local government and community levels, however, materials such as field manuals, flipcharts, and calendars could be designed and printed at the national level. 4.5.1 l. Posters and village level health education materials (e.g. jingles in local languages) should be developed in the villages with community member participation. 4.5.12. APOC to provide technical support to NOTFs in various aspects of programme implementation and capacity building as the need arises. 4.5.13. APOC should help provide prototype health education and training materials and make them available to member countries. Country working groups were assigned the task of determining the target groups at all levels for training and health education (See Appendlx 4) 4.6. Ordering, Procurement and Delivery of lvermectin Nfu. J. Watson, APOC, presented guidelines using the Nigerian experience on procurement and delivery of ivermectin at all levels. Dr. Mary Allemaq MDP, provided background information on the Mectizan Donation Programme with emphasis on requirements for drug procuement and retirement by NOTFs. Dr. H. Edeghere, APOC gave an overview of areas of integration of ivermectin procurement and delivery into the national system. Drs. H. Edeghere and Josephine Namboze, presented a paper on the management, safety and storage of ivermectin at all levels. Since ivermectin procurement and delivery is one of the important aspects of the CDTI prograrnme, adequate time was allowed for extensive discussion of the topics. At the end of deliberations, the following recommendations and conclusions were made: Procurement 4.6.1. Ivermectin procurement and delivery should be integrated into existing national drug procurement and delivery system(s). 4.6.2. NOTF should ensure that ivermectin is ordered on time (at least 8 months prior to the treatment period) and be responsible for customs clearance, tax exemptions, transport to the project sites and fulIaccountability for the ivermectin. 4.6.3. The community is responsible for picking up the ivermectin from agreed collection points. 4.6.4. Community leveldecision making on procurement of ivermectin should involve the community leaders, members, health workers, village volunteers, and goverrlment, and other sector representatives. t0 t Storage 4.6.5. Adequate arrangements should be made for the storage of ivermectin from port of entry to the delivery in the community to avoid pilferage or damage. 4.6.6. The two months shelf-life of an opened 3 mg tablet bottle (500 tabs), after the removal of the foil seal requires that distribution activities be undertaken within this period to avoid expiration and therefore wastage of ivermectin tablets. 4.6.7. Efforts should be made to avoid situations which lead to exptation of the ivermectin as this could jeopardize the prograrnme. 4.6.8 Delivery NOTF and the communities should agree on the suitable central collection points where the communities can collect ivermectin. 4.6.9. Communities should be informed well in advance about the availability of ivermectin at the central location for collection. 4.6.10. There is need for appropriate timing in the communitl' for ivermectin deliven and distribution. takine into consideration the socio-cultural and economic activities of the people. Safefy 4.6.11. Adequate training should be given to the distributors to ensue: 4.6.11.1. Adequate health education information is passed to community members 4.6.11.2. Adherence to eligibility criteria 4.6.11.3. Correct dosage (especially with the new 3 mg tablet formulation) 4.6.11.4. Adequate recording and reporting 4.6.11.5. Adequate management and referral of cases of adverse reactions 4.6.12. Special efforts must be made to educate the communities prior to treatment on possible adverse reactions. There must be careful monitoring of cases of severe reactions to reassure treated persons. 4.6.13. Where there are severe reactions health education should be intensified to avoid increased number of refusals/absentees during the next round of treatment. Mechanism should be put in place to train health workers to effectively dealwith severe reactions especially at the community level. 4.6.14. Expired ivermectin should be disposed of by burning the tablets in a controlled environment. Professor C.D. McKenzie also presented a paper on numagement of minor and severe adverse reactions to ivermectin treatment. This was by request of the participants. Following the presentation and discussion recommendations are as addressed n 4.6.11, 4.6.12 and 4.6.13. lt 4.7. Recording/Reporting and Feedback at all levels Papers were presented by Dr. Elizabeth Elhassan providing information on data collection, reporting, analysis, and feedback on onchocerciasis control activities at all levels. Drs. J.B. Roungou, and Terese Aparicio presented papers on monitoring of CDTI while Dr. Josephine Namboze, gave an overview of key issues considered in evaluating CDTI projects using the APOC forms. During the country group work, the various components of data collection, analysis, and reporting at all levels of programme implementation were discussed. Also, issues related to project monitoring were addressed. It was noted that the importance of data collection, timely and routine reporting of data and monitoring activities cannot be over emphasized for the success of the CDTI prograrnme. It is therefore recorunended that: 4.7.1. commitments from all participating partners in Ethiopia, Kenya, Liberia, Mozambique and Southern Sudan is necessary for the collection of information required at all levels. There is need to adhere to recording/reporting formats devised/revised by NOTF as necessary. 4.7.2. Information required from the CDDs should be kept to a minimum and be simple and straight-forward and should include the following: 4.7 .2.1. Total population of the community (census) 4.7.2.2. Total eligible population/number of ineligible population 4.7.2.3. Number of people treated 4.7 .2.4. Number of refusals/absentees 4.7.2.5. Number of severe reactions (treated/referred) 4.7 .2.6. Household ffirmation 4.7 .2.6.1. PHC number of household (where applicable) 4.7.2.6.2. Information on Household members (name, age. sex) 4.7.2.6.3. Number of tablets given to each person 4.7.2.6.4. Year of treatment 4.7.3. Methods of data collection: 4.7.3.1. CDDs should use simple exercise or register books which the communities can afford for recording and reporting. 4.7.3.2. The community should be given the responsibility of designing their own ways of recording and reporting of CDTI activities. 4.7.3.3. The NOTF should decide with CDDs in the mobile communities, where the records should be kept if the community is moving to another location. 4.7 .3.4. For the purpose of uniformity of reporting and recording, it is recommended that the NOTF should design a simple and uniform method of data collection for all levels of CDTI (county, regions, zones, districts). t2 4.7.4. Repeated training activities for the community and their CDDs is required for adequate and timely reporting. These training sessions should also extend to the health facilities and county/district level. 4 -7 .5 - A checklist of indicators for recording and reporting should be developed at all levels. 4.1-6. Provision of adequate logistical support by partners (e.g. vehicles, motorcycles, communications) to prograrnmes is required in order to initiate frequent and adequate data collection and monitoring of CDTI activities. 4-1.7. Where feasible, reporting, recording and feedback activities for CDTI could be integrated into other health or development activities as appropriate. 4.7.8. NOTF should ensure adequate and timely reporting of CDTI activities to MDp and APOC as appropriate. 4.7.9. There is need for annual feedback on prograrnme implementation to all partners. Monitoring 4.7.10. Project monitoring is used to improve operational plans for CDTI and to identifi streng.rhs and weaknesses in its implementation. 4.7.11. Standard monitoring indicators, which include input, output and effects have been identified for use in all projects. 4.7.12. There is need to carry out routine monitoring by the NOTF to assure effective implementation of the CDTI projects. Independent monitoring should also be undertaken by APOC to ensure that programme objectives are accomplished. Evaluation 4.1.13. APOC evaluation forms for CDTI projects should be filled annually for each prolect 4.7.14. Evaluation forms consist rnainly of five parts which are all supposed to be filled including: 4.7.14.1. Project profile and management 4.7.14.2. Ivermectin procurement, delivery system and distribution 4.1.14.3. Capacity of the NOTF/Oncho Coordinators/support staffand PHC system 4.7.14.4. Performance indicators 4.7.14.5. Other comments 4.8. Integration of CDTI into Health Services Drs. J.B. Roungou and Elizabeth Elhassan, from APOC, gave a presentation highlighting reasons for, implications and constraints, possible steps/processes and mechanisms of integrating CDTI into the Primary Health Care systenr, and some of the CDTI activities that could be integrated into the primary health system. Considering the importance of integration of CDTI into the health system to ensure sustainability, extensive discussions were allowed. These discussions centred on the various levels of integration, when and where to integrate in relation to the existence of functional PHC system in the country. Country working groups were assigned the task of developing strategies for integration of CDTI into health services and identify constraints of integration and strategies for overcoming them. 4.8.1. Steps towards integration may include: 4.8.1.1. 4.8.1.2. 4.8.1.3. 4.8.t.4. 4.8.1.5. 4.8. 1.6. Ident ification o f health structures/institutions; Identification of level of integration; Sensitizatio n/re-orientation o f health staff; Advocacy to health planners and managers; Integrate training of cDDs into existing training activities for other health prograrnmes; Set up (or re-activate) community health committees for overseeing CDTI and other health activities. 4.8.2 4.8.3 4.8.4 Health w'orkers should not onlv be trained on the health aspects of the disease but also on advocacy and management, which helps them to understand their roles and expectations of the prograrnme. Integration will only be successful if all partners are convinced of the approach and that this will not in any way affect the technical aspects of the various prograrnmes. Some aspects of reporting may not easily be integrated as varioui-prograrnmes have differing requirements and expectations. 4.8.5. CDTI could be used as an entry point upon which PHC could be buiit and strengthened 4.8.6. For compatibility, CDTI integration should be carried out gradually identifying the priority areas to be integrated. 4.8.7. For long term sustainability, it is necessary to integrate CDTI into existing health systems, and development based activities. Areas and programmes with good potential for integration are training, drug distribution, EpI, TB/Leprosy, etc. 4.8.8. Integration should not jeopardise either CDTI or the prograrnme(s) with which it is being integrated. 4.8'9. Inventory of the community mechanisms/structures should be done to identify those that can be used in the implementation of CDTI whether or not PHC structures exist. t4 4.8.10. There is need to establish as soon as possible enabling policies at the highest levelin support of integration of CDTI into the health sysrem. 4.8.1 l. Where cost-sharing is introduced, this should be done in such a way that eligible persons are not excluded. 4.9. National Plan and Project Proposal Professor M. Homeida provided guidelines on preparation of national plans and APOC project proposals while Dr. D. Etya'ale higtrlighted the strengths and weaknesses of CDTI proposals submitted to APOC. Country working groups were assigned to develop country-specific formats for their national plans and APOC project proposals. National plans and APOC project proposals for each of the countries are tentatively scheduled for completion as follows: 4.9.1. Each participating country in the APOC initiative must establish an NOTF with MOH, NGDOs, IJN agencies, and other relevant partners. 4-9.2. The Ministries of Health of the participating countries through the NOTFs are to develop National Action Plans. 4.9.3. National Action Plans are reviewed by the TCC for approval prior to receiving any APOC proposals for a given country. 4.9.4. Proposals must be carefully prepared with the lead taken by the MOH with the partner groups assisting according to ApOC guidetines. 4.9.5. 4.9.6. 4.9.7. 4.9.8. 4.9.9. Proposals should be well written with appropriate maps, charts, histograms, and tables to clearly reflect the plans for the project. In addition, questions in the APOC proposal guidelines must be thoroughly answered. Draft proposals should be developed well in advance of the due date for submission for thorough review and revision by partners. It is recommended by APOC numagement that the proposals be submitted one month in advance of the due date to ensure it arrivei in ouagadougou to be circulated to TCC members for review prior to their scheduled meeting. Southern Sudan acknowledged the proposal for the southern sector and reserves the right to make adjustments and changes during imprementation. Southern Sudan recommended that the NorF should be expanded to include implementors from the field. National Plan APOQ Proposal Ethiopia July, 1998 (first draft) September,l998 Kenya January, 1999 January,1999 Liberia July, 1998 (fust draft) ? SeptembeL 1998 Mozambique November, 1998 November. 1998 Southern Sudan Completed Completed t5 4.9.10 Ethiopia, Kenya, Liberia, and Mozambique have prepared background information for the development of National Plans and APOC project proposals. 4.9.11. APOC Project Proposals for Ethiopia, Kenya, Liberia and Mozambique will be developed as indicated in the preceding table. See Appendix 4 for ffirmation required for National Plans 4.10. Other Matters Other issues discussed with appropriate recommendations were as follows 410.1. Idea of APOC Newsletter as well as in-country newsletters to communicate overall progress and information concerning the prograrnme 4.11. Conclusions/Recommendations of the Workshop Professor C. D. McKenzie led an open discussion on the sunmary report of the workshop. Issues covering specific items were discussed and changes were made upon consensus opinion. The final summary document containing conclusions and recommendations were given to participants. l6 18 22 28 35 44 53 62 7l 80 86 D J) Appendices Appendix A) Opening CeremonY SPeeches.. B) Workshop Agenda C) List of ParticiPants......... D) Ethiopia Country RePort.... E) Kenya Country Report............. F) Liberia Country Report.............' G) MozambiqueCountryReport.......... H) Southern Sudan CountrY RePort. Monitoring Form Evaluation Form t7

APOC/NOTF WORKSHOP ON COMMUNITY DTRECTED TREATMENT WITH TVERMECTIN Welcoming remarks by the National Coordinator The Hon. Minister for Health, Prof. M. Hemeida, Dr. Paul Chuke, Dr Daniel Etya'ale', Dr. Uche Amazigo, distinguished guests, fellow participants, ladies and gentlemen. Welcome to Nairobi for the African Programme for Onchocerciaasis Control and National Onchocerciasis Task Force workshop. We are going to deliberate on important issues on the operations and sustenability of community based programmes, mainly of drug distribution and also vector control in liited foci. As you know the disease is onchocerciasis (oncho). commonly known as river blindness is caused by a nematode Onchocerca volvulus which parasitizes the skin and is transmiffed by blackflies of the genus Simulium. Details of the importance of the disease, its endemicity and morbidity in various countries will be given during this workshop, in sufficient detail to enable us to see the way forward in terms of control. Once again Karibu Kenya!! l8 t' WHO STATENTENT BY DR. PAUL CHUKE, WHO REPRESENTATIVE, KET{YA (READ BY DR D M MUTTE, DISEASE CONTROL OFFICER. WR'S OFFICE, KEI.IYA) Mr. Chairman of this session, Hon. Minister for Health, Director of Medical Services, Dr. Danniel Etya'ale, NGDO Coordinator Dr. Uche Amazigo, APOC WHO Representatives of HQ and AFRO Distinguished Delegates Ladies and Gentlemerq On behalf of the WHO Country office Kenya and on behalf of Prof. Paul Chuke the WHO Representative, I have the honour and pleasure of welcoming you all to Nairobi and to this inter-country APOC Workshop. Cognizant of the role played by infections and parasitic diseases in Africa as major contributors of "Burden of Disease" VIHO, the World Bank and their collaborators have had a strong hand in programmes such as the APOC. [n this connection, Dr. Nakajima the Director General of WHO, has a messa-ee of hope in the 1996 World Health Report. In part he says, and I quote. ull/e stand on the threshold of a neu, era, in which hundreds of millions of people will at least be safe from some of the worlds most tenible diseases. Sooner rather than later, poliomyelitis, leprosy, guinea worm diseose, iver blindness chagas disease and neonatal tetanus will join small pox as diseases of the past" end of quote. Your meeting should be yet another important milestone on the road towards the elimination of onchocerciasis, as a public health problem in APOC countries-of sub- Saharan Africa. Cost effectiveness, affordability, access and use of health care services are fashionable terms within WHO's 9th Programme of Work, which runs from 1996 - 2001. The goals and targets in this particular Programme of Work are an expression of commitment of the international health community, in achieving improvements in health status including the reduction of disabilities such as blindness caused by oncho. Disease. Your meeting comes at another important point in time. Two weeks ago, on the 7th April 1998, WHO celebrated it's 5fth anniversary. In his message to mark this day, the WHO Regional Director for Africa Dr. Samba said and I quote: "Half a century ago, in a spiit of equity and solidaity, the member states of United Nations Organizttions got together and made a solemn pledge to set up a technical body equipped with the necessary resources and erpertise to address various health isszes, diseases and other causes of suffering and death" end ofquote. l9 As you press on with your relentless fight against river blindness, the WHO's commitment remains unaltered. Already on the agenda of the WHA next month is an item of Renewing FIFA Strategy for the 2l st century. Disease control, elimination and, were feasible, eradication are important components of this renewing of FIFA in the new century. Onchocerciasis elimination is on the firing line. The 1997 WHO World Health Report w:uns us that with many governments and international aid agenciesforced to tighten spending in recent years, funding for essential services is in short supply. The challenge now is to find ways of improving health delivery systems at costs people can afford while ensuring the sustainability of programmes and services. In this connection I commend APOC on their innovative strategy to be discussed during this meeting,i.e. Community Directed Treatment with Ivermectin (QDTI). The WHO and UMCEF have, over a considerable period of time, talked about Community involvemenl Later on Community panicipation was preferred - ( I guess that one can be involved in a certain event without necessary participating!). And currpntly the best term seems tobe Community ownerchip of health It is my hope that you will explore ways and means to place CDTI on the community ownership's account . Since 1994, the IITIO Regional Office for A-frica has been promoting the concept of a "ilIipimum Health Package" alternatively called the Essential Clinical and Public Health Pacfage for acceleration of [IFA. It is my hope that within the APOC countries, Onqhocerciasis control will form an ingredient of the "Nfinimam Package". One of the tools for this approach is " Essential Medical Care" and treatment with ivermectin should be considered as an integral part of essential medical care within the "minimum Package". Last but not the least, may I remind you that such gatherings as this week's meetings is an important forum for "Continuing Education,'l for health workers. [n some of the latest issues of the LANCET, one of the renowned medical journals published in the U K ( f think it was the 4th, April, 1998 issue) I read that "continuing education" is now being referred to asuContinuing Professional Development" or CPD. The author of the article says that there is an educative value in professional workers attending a meeting even for those who finally find out that there is no reason to change their practice. [n other words, even if at the end you find that you know almost everything discussed, that realization is a form of learning. There are also many aspects of learning that are not easily measurable. I hope you will learn a great deal during your deliberations. Thank you and good luck! 20 APOCNOTF WORKSHOP ON COMMUNITY DIRECTED TREATMENT WITH IVERMECTIN(cDrr) NAIROBI, KENYA, APRrL 20_25, lggg SPEECH BY TFM DIRECTOR OF MEDICAL SERVICES, DR. JAMES N MWANZIA Prof M. Homeida, Dr. Daniel E. Etya'ale', Dr. Uche Amazigo, Dr. paul Chuke, Members ofSponsoring Agencies, distinguished guests, participants from ApOC countries, ladies andgentlemen. It is with great pleasure for us to host this workshop on community directed treatment of oncho with ivermectin. oncho remains a serious put[" health p.obl.* in much of tropicalAfrica affecting 17.6 million people, of who l5 million (or more than 85%) now live outside the oCP areas of west Africa. Prior to 1987 no safe drug for a community based treatment of oncho was available, until ivermectin was registered for ho-* use. The most serious consequences of the disease is blindness and a very severe skin disease accompanied by an intense itching. APOC has a goalof implementing a community based sustainable control of oncho in up to l6 countries of Africa where the disease is still a public health problern The programme (ApOC) will control the disease by designing and implementin-s a communitv based ir.Jrmectin distribution systenl supplemented by vector eradication in a few isolated foci. This approach ensures ownership of the prograrnme by the community with minimum but effective medical supervision. It forms an important step in eliminating the disease as a public health and socio-economic problem in Africa outside the eleven OCp countries of West Africa. The drug ivermectin (Mectizan) has been provided free of charge for as long as it is needed. APOC will take advantage of this window of opportunity to bring oncho *i.. control. I sincerely thank Merck & co. for this generous donation of Mectizan. Community self treatment with ivermectin will provide an important entry point for other community based health interventions, and thus help to develop a practicaibasis for strengthening primary health care (pHC) in some of the poorest communities. Kenya eliminated onchocerciasis by instituting antivector measures in certain well defined foci in the western part of the country in the 1950s and 1960s. However, residual foci persisted on Mt. Elgon on the common boundary with Uganda and in the surrounding hills where the disease was recently detected. The disease has also been detected in refugees and other immigrants living in Kenya, particularly from Sudan. This and the p..r..rJ. of the vector in Kenya makes re-establishment of the disease as a public health protl"rn a real possibility. An epidemiological assessment is necessary to establish the level of the disease in the country. Thank you. 21 Appendix B TVORKSHOP ON THE PHILOSOPHY OF THE AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC), CONCEPT AND HARIVIONIZATION OF COMMUNITY -DIRECTED TREATMENT WITE TYERIVIECTTN (CDTI). NAIROBI, KENYA (20 - 25 APRrL 1998). ANNOTATED AGENDA (Revision l) Sunday 19/04/98 Informal meeting with participants/ election of Rapporteurs/ introduction of Facilitators 19H30 - 20H30 Monday 20/04/98 SESSION 1: Opening / General Announcements ll Chairman: Rapporteurs: Facilitators: Election of officers Chairman Vice-Charman 08H00 - 08H10 1.2 Adoption of Workshop Agenda 08H10 - 08H20 I.3 Objectives, Expected outcome of Worksho,p (Amazigo) 08H20 - 08H35 1.4 Pre-test ( Roungou and Namboze) 08H35 - 08H50 1.5 APOC/ CDTI Training video fiLn 08H50- 09H30 1.6 09H30 -10H30 COFFEE BREAK r0H30 - 10H45 SESSION 2: Philosophy of APOC/ Concept of CDTI Chairman: Rapporteurs: Facilitator: 2.1 Philosophy of APOC @tya ale) 10H45 - I lH00 Ccrncept of Community Directed Treatment with ivermectin (Amazigo) I IH00 - I lHl0 2.2 Partrrership in APOC @tya ale/ Goepp) I lHl0 - 11H30 Opening Ceremony Video from Sudan (7-8 mins) Welcome address by Natiural Coord:nator/ Kenya Ad&ess by Dr. P. Chuke (WHO Represortative in Kenya) Prof M. Homeida /Technical Consultative Commiuee, APOC Ope"iog address by Hon. Minister of Heahh, Kerya ')') 2.3 3.5 3.6 LUNCH BREAK 12H30-14H30 SESSION 3. Administration, Budget, Financial Management of APOC projects Chairman: Rapporteurs: Facilitator: Edeghere 3.1 Guidelines for elaboration of budget @rof. Homeida) 14H30 - 14H50 3.2 Administration & Management of APOC Fund (Aholu) 14H50 - 15H30 3.3 Discussion l5FI30 - 16H00 COFFEE break: 16H00 - 16H15 3.4 Working goups (5 countryteams) on Administration, Financial Management - Frnancial Flow (chart) from Central -District Levels l6Hl5 - l8Hl5 - Administration/ Financial Reporting Systems Tuesday 2l/04198 Rapid Epidemiological Mapping of Onchocerciasis (REMO) Obj eaive/ methodologyitmportant steps (Edeghere) Status of REMO /GIS for APOC countries @deghere) C o n clu s i o n/ Re co mmen dation s Plarary . Presentation of Financial Flow charts and Administration/ Financial Reporting Systems by country teams C o n clu s io n u n d Reco mmen datio n s I IH30-l2Hl0 l2Hl0-12H30 7H30 - 08H30 08H30 - 09H00 09H00 - 09H15 09H15 - 09H30 09H30 - 09H50 09H50 - l0Hl5 l0Hl5 - 10H30 r0H30 - 12H00 12H00 - 12H30 SESSION 4: Community Participation & Sustainabilty of CDTI Chairman: Rapporteurs: Facilitator: 4.1 Approaching the Community @lhassan)4.2 Filrn (lSmrns) 4.3 Other roles & responsibilities of communities (Roungou/ Namboze) 4.4 Discussion (Questions) COFFEE BREAK 4.5 lYorking groups an: Approaching communrty & responsibililies in ivermectin distribution Plenary on Approaching community & responsibilities Reports from groups: 4.6 LTINCH BREAK 23 t2H30 - 14H30 Reports from groups on Approaching community & responsibilrties Co n cl u sio n an d Reco mmen dat io n s Community involvement and ownership of CDTV Sustainability of CDTI (Amazigo/Elhassan) (With special reference to reorientation of on-going proiects/ Lessons from participating NGDOs) COFFEE BREAK Working groups on Communrty rnvolvement and ownership of CDTU Sustainability of CDTI Participants' assessment ofthe organization of the Workshop - What needs to be improved? / What is going on well? (Etya ale) Wednesd ay 22104198 Plenary: Presentation of workrng groups on: Community involvement and ownership of CDTV Sustarnabrlrry of CDTI C o n cl u sio ns and Reco mmen datio n s SESSION 5: TRAINING AND HEALTH EDUCATION 4.7 4.8 4.9 5.1 14H30 - 15H00 15H00 - 15H30 r5H30 - 16H00 I6H00 - 16H30 16H30 - 17H00 17H00 - 18H30 18H30 - 19H00 08H00 - 08H30 08H30 - 09H00 08H00 - 08H30 08H30 - 08H45 o8Hls - 09H00 09H00 - 90H30 09H30 - l0Hl5 l0Hl5 - 10H30 10H30 - I lH30 l lH30 - 12H00 5.2 5.3 Chairman: Rapporteurs: Facilitator: Training & IEC materials in the context of CDTI (JeffWatsur) Country Experiences: Training & IEC matenals Training video (section on training CDDs) & APOC CDTI Training manual (Amazigo) Harmonizatisp sf Jl3ining /Heahh Education mAhods and materials (JeffWatson) -process -materials -budgeting for lEC/Traurmg materials in CDTI projects Working Groups (mixed): Training/fleahh Education/ tEC for CDTI COFFEE BREAK Group photograph Plenary on Harmonization of Training /Heahh Education/IEC Presentations by working groups 54 5.5 5.6 5.7 ConclusionsondRecommcndations 24 LUNCH BREAK SESSION 6: Ordering, Procurement and delivery of ivermectin Chairman: Rapporteurs: Facilrtators: 6. I Introduction: Procurement and delivery of ivermectin (Watson) -Procedure for Ordenng Mectizan@ (MDP) -lntegration of ivermectin procurement & delivery in the national system @deghere) 6.2 Management, Safety and Storage of ivermectrn at all levels @deghereAlamboze) Discussions COFFEE BREAK 6.3 Working grouPs (by country) on Ordering, ProcuremerU Drug Delivery circuit and integration of ivermectin into the national delivery sYstem 6.4 Plenary on Orderrng, ProcuremenU Drug delivery circurt and integration of ivermectln in the national heahh system 6 5 Conclusions and Reconunendalions 6.6 Management of mmor and severe adverse reactions 12H45 - 14H30 14H30 - 14H45 t4H45 - 15H05 15H05 - 15H20 15H20 - 15H45 15H45 - 16H00 16H00 - l6Hl0 16H10 - 17H10 17H10 - 17H40 17H40 - l8Hl0 l8Hl0 - 18H40 09H45 - I lHl5 lrHl5 - l2Hl5 l2Hl5 - 12H45 Thursday 23104198 SESSION 7: RECORDING, REPORTING AND FEEDBACK AT ALL LEVELS Chairman: Rapporteurs Facilitator: 7 .l Collection of information/ Recordurg/Reportrng/Feedback @lhassan) 08H00 - 08H30 7.2 Monitoring of CDTI Projects @oungou) 08H30 - 08H45 7.3 Participatory monitorurg of Projects (Aparicio) 08H45 - 09H00 7 .4 Forms for Evaluation of CDTI Projects (Namboze) 09H00 - 09H30 COFFEE BREAK 09H30 - 09H45 7.5 7.6 Working groups on Recordrng/ Reporting/Monitoring/ Evaluation ( at all levels) Plenary on Recording/ Reporting/ Monitomg/ Evaluation ( at all levels) Recommendations on Recording, Reporting and Feedback 7.7 LUNCH BREAK 25 12H45 - 14H30 SESSION 8: Integration of CDTI in the Health Care Service 8.1 Chairman: Rapporteurs: Facilitator: lntroduction: Integration rnto Health Care Service (Roungor.r/ Elhassan) 14H30 - 14H50 8. I . I Importance of ntegration of CDTI 8.1.2 Process of integration of CDTI 8.2 Working groups on integration into Heafth Service COFFEE BREAK 14H50 - 16H00 16H00 - l6Hl5 16H15 - I7HI5 l7Hl5 -18H00 08H00 - 08H20 08H20 - 08H40 08H40 - 09H00 09H00 - 10H00 83 8.4 Plenary on Integration of CDTI in the Heahh Care servrce Presentations by working groups 8.5 Conclusionandrecommendations Friday'24104198 SESSION 9: National Plan and Project Proposal Chairman: Rapporteurs: Facilitator: 9.1 Guidelines on National Plan and Project Proposal (Homeida) 9.2 Strengths & Wealaresses of Proposals submiued by NOTFs - and lessons leamed (Etya ale) 9.3 Discussions/Questions 9.4 Working groups ( country teams) on national Plan & Prqect Pro,posals 9.6 9.7 COFFEE BREAK: 9.5 Country Working Groups session on National Plan and ProJect proposal contrnue. Presentation of Country Reports Conclusions and Recommendations LUNCH BREAK SESSION l0: Other matters Chairman: Rapporteurs: Facilitator: Any other matters ( on all issues) 10H00 - r0H15 l0Hl5 - 10H45 10H45 - 11H45 l rH45 - l2Hl5 l2Hl5 - 14H30 26 14H30 - I5H00 SESSION 1l: Conclusions/Recommendations of the Workshop Chairman: Rapporteurs: Facilitators: l0.l Adoption of Plan of the Workshop Report by country delegates and participants 10.2 Adoption of the Conclusions and Recommendations of the Workshop COFFEE BREAK: 10.3 Post Test (Roungou/ Namboze) SESSION 12 Closure of the l{orkshop t5H00 - 15H30 15H30 - 17H00 17H00 - l0Hl5 17H15 - 17H45 r7H45 - l8IU5 27 Appendix C WORKSHOP ON THE PHILOSOPHY OF THE AFRICAN PROGRAfuTME FOR ONCHOCERCUSIS CONTROL (APOC), CONCEPT AND HARMONIZATION OF C O MMU N ITY- D I RE CT E D T REATME NT II/ITH IYE RME CT IN, NA I RO B I, K E NYA, 20 - 25 APRIL 199E Provisional List of Participants Participants Ethiopia l. Dr. Desta Alamerew, Epidemiologist, Malaria & Other Vector Borne Diseases Control Unit, Ministry of Health P.O. Box 1234, Addis-Ababa, Ethiopia - Tel: (251) 1 51 6617 - Fax: (251) I 5193 66 2. Dt. Tekle-Mariam Shiferaw , Head, Health Researches and Public Health Lab., p.O. Box 149, Awassa, Ethiopia - Tel: (25 t) 6 20 t6 45 - Fax: (25 t) 6 ZO t6 76 3. Dr Wondwosen Yimam Getahun, Head of Rigenal. Maleria and Other Vector Borne Diseases Control Department, Benshangul-Gumuz Health Bureau Assosa, P.O. Box 71, Ethiopia - Tel: (25t)7 6t 10 87 4. Mr. Sheleme Chibsa Tujuba , Head, Malaria and Other Vector Borne Diseases Control Department for the Region of Oromia, Oromia Health Bureau, Addis Ababa, Ethiopia - Tel: (251) r sl40 76 (A.A) 5. Mr. Yeshiwondim Asnakew Kebede, Team Leader, Malaria and Other Vector Borne Diseases control, P.o. Box 495, Bahir Dar, Ethiopia, Tel: (z5l) 8 20 09 22 -Fax: (251) g zo t5 17 Ken!a 6. Dr. Maina Kahindo, Head, Division of Communicable of Veector Diseases Control (DCVDC), Ministry of HealttL AFYA House, P.O. Box z}T}l,Nairobi, Kenya - Tel. Qs$2720 533 or (254)2727 809 or (254)2716 515 - For. (2s4)2720 533 or (254)2713 824 7. Dr. David S*9, APOC National Coordinator, Division of Vector Borne Diseases, Ministry of Healt[ P.o Box 20750, Nairobi, Keny4 TeI. (254) z 724 3oz or (254) z 725 833 - Fax. (254)2 72s 624 -Emul: SCHISTO@|KEN.HEALTHNET.ORG 8. Mr. David Koectq Officer in Charge DVBD Rift Valley Province, P.O. Box 5, Kapsabet, Kenya, Tel Q5\ 326 2020 28 9. Mr. Wesiela Francis Chemasweti, Prov. Clinical Lab. Technologist, P.O Box 15, Kakamega, Kenya, Tel. (254) 331 30052 10. Mr. Langat Alfred Kipngeno, Senior Public Health Officer, Ministry of Health, P.O. Box 30016, Nairobi, Kenya, Tel. (254) 2717 077 I 1. Mrs. Obel Millie Chepkemoi, Faculty ofHealth Science, Moi University, P.O. Box 4606 Eldoret, Kenya, Tel. Q5$ 321 32569 12. Mr. John Oluoch, Officer in charge, Division of Vector borne Diseases (DVBD), P.O. Box 92, Kisil, Kenya, Tel: (254) 381 20801 13. Dr. Akhwale Willis Simon, District Medical Officer of Health, Trans NZOIA - P.O. Box 98 Kitale, Kenya, Tel: (254) 0325 70451 - Fax: (254) 0325 31900 14. Dr. Aba Nwachukwu, Zoology Department, University of Nairobi, P.O. Box 30197, Nairobi, Kenya, Tel: (245) 2 72 40 13 15. Dr. Phoebe Josiah, Research Consultant, Health Environment & Population Consultancy, P.O. Box 42679, Nairobi, Kenya, Tel: (254) 2 823 100 or (254) 2 350 002 - Fax (254) 2 542 090 Liberia 16. Dr. Samuel T. Dopoe, National Coordinator, Onchocerciasis Programme c/o Ministry of Health & Social Welfare c/o Wortd Health Organization (WHO) Liberia" P.O. Box 316, Monrovia, Liberia, Tel. (23r) 226 208 - Fax: (231) 226 Zo8 17 . Dr.Dolopei Eugene Ddi, Deputy Director, Liberian Institute for Biomedical Researctq P.O. Box 3 1, Charlesville, Margibi County, Liberia, Tel: (23 l\ 22 62 08 - Fax: (231) 22 62 0$ 18. Mr. David K. Franklin, Data Analyst, Christian Health Association of Liberia (CHAL), P.O. Box 9056, Monrovia Liberia Tel (231) 22 68 23 -Fax (231) 226 187 19. Dr. Fatorma K. Bolay, Disease Prevention and Control Officer (DPCO), World Health Organization (WHO), P.O. Box 316, Monrovia, Liberia,Tel'. (231)226 208 - Fax: (231)226208 Mozambique 20. Dra. Maria Ivone Ferrdo Teimizira, Ministry of Health, P.O. Box 264Maputo, Mozambique, Tel: (258) I 430814(2s8) I 427131 - Fax(2s8) | 426s471(2s8) 1 33320 27. Dra. Lorna Maria Fialho Gujral, National Institute of Health, Ministry of Healtb P.O. Box 264 Maputo, Mozambique, Tel: (258) 1 431103 or (258) 1 430970 - Fax: (258) 1 431103 or (258) I 43097 0 - Email. EVISSER@cdins.uem.mz 29 South Sudan ?2. Mr . Gordon Solomon Alebe, PHCP Senior Supervisor/OV Supervisor, Senior Medical Assistant, PHCP - Maridi County, South Sudan 23. Prof Mackenzie Charles, Adviser, Gl00, Dean's Office, VMC, Michigan State University East Lansing, \ytr,48824, USA Tel: (517) 432 2388 - Fax. (517) 432 1037 - Email: mackenzie@ cvm. msu. edu. 24. Mr. Lawrence Bona. Brock, OV Supervisor, A/?HC/Supervisor, Sanetarian, Mundri County, South Sudan 25. Mr. PeremunaWuraAmaya, SeniorPHC Supervisor, CHD/PHCP, Mundri/I(otobi, SouthSudan 26. Mr. Mangu Wandege Michael, OV County Supervisor, OV County Office, Tambura, South Sudan 27. Dr. Deng Samuel Mayak, Medical Doctor, Volunteer Medical Officer, CCM, Alpha Civil Hospital, Billing, Rumbek County, South Sudan 28 Mr. Gabriel Chol Dhuor, Nurse, Bilin-e Hospital. Rumbek Countv. South Sudan 29. Mr. Bith Maguruk Macol, Laboratory Assistant, Alpha Civil Hospital, Billing Hospital, Rumbek County, South Sudan 30. Mr. Gordon Makuek Marol, Community Health Worker, Kolcum, PHCU, Billing Hospital, Rumbek County, South Sudan 3 l. Mr. Simon Kuot Kuot, Health Coordinator, Medical Assistant, Responsible for Nyamlell PHCC, Aweil West County, South Sudan 32. Dr. AmaMorrisTimothy,M.ScStudent,LondonSchoolofHygiene&TropicalMedicine,John Astor House, 3 Foley Street, Londorg WIP 8AN, United Kingdonq Tel'. +44 0171 380 9l 19 - Fax. + 44 0171 436 5389 - Email: t.morris@shtm.ac.uk 33. IvIr. Camillo Yee Mangieamanga, SRRA Secretary, Tambura County, South Sudan 34. Mr. Philip Caiaphas, PHC Coordinator/OV Supervisor, East Mundri, New Sudan, c/o Mundri ReliefandDevelopment Association(MRDA), P.O. Box60837Nairobi, Kenyq Tel. Q592720995 - Fax: (254)2720977 35. Mr. Emannuel Ezam4 ov Supervisor, PHCP-CHD, Yambio County, South Sudan 30 Facilitatorc 36' Dr' Josephine Namboze, Disease Prevention and Control Medical Officer, p.O. Box 149Kampala, uganda. Tel. (256) 41 344038/34405g - Email: who@mul.com 37' Mr' Jeffrey Watson, Oncho Programme Coordinator, Christoffel Blindenmission (CBM) 34Gomwalk Close, Jos, plateau State, Nigeria Tel: (234) 73 45 65 78, Fax: (234) 73 45 42 30, E-mail <Jeffivatson@maf org> 38 Dr' Henry Edeghere, wHo, zonalNPl Surveillance coordinator, wHo, I Golf Course Road,Kaduna, Nigeria, Tel: (234) 62 237925 or (234) 62 2t3432 or (234) 62 ztt 764 - Celtphone: 09080 50 87 - Fax: (234\ 62 237 924 or (234) 62 238 360 - Email: Edeghere@wHo.org 39' Dr' Elisabeth osim Elhassan, Country Representative, Sight Savers International (SSD, I GolfCourse Road, P.o. Box 503, Kadunq Ngerii, Tet. (234) 62 23g360 - Home: (234) 62 2lo 723 -Fax. (234) 62 238360 40 Profl Mamoun M. A. Homeida, National Coordinator & Chairman of NoTF/Sudan, p.o Box12810, Khartoum, Sudan, Tel: (249) lt 72 47 62 -Fax. (z4g) lt Tz 47 gg 4l Ms Joyce Msuya' Health Speciaiist, the World Bank, Africa Region-onchocerciasis coordination Unit, 18r8 H street, N.w., washington D.c., 2033, usATel (202) 4sB 77 tz - Fax: (2oz) 5zz 3157 -r,mail: JMSITYA@WORLDBANK oRG 42. Ms. Teresa Aparicio-Gabarq Social Anthropologist, LCSES, the world Banh lglg H StreetN.w., washington, D C., 20433,Ter. (zoz) 45& 90r; - Fax (2oD) 676 9373 WHO/APOC Stafr, Geneva 43. Dr. Daniel Etya'ale, wHo/Apoc, Geneva 27, cH 1211, switzerland,Tel @122) 791 26 4Z,Fax. (4122) 7gt477T WHO/APOC Staff, Burkina Faso 44. Dr. Uche Amazigo, wHo/Apoc, p.o. Box 549, ouagadougou, Burkina Faso Tet. (226) 30 23 t2/30 23 t3/30 23 ot,Fax: (226) 30 2r +1tpzi134 26 4843. Dr. Jean-Baptiste Roungou, OTD/AFRO, p.o. Box 549, ouagadougou, Burkina Faso, Tel. (226) 30 23 12/30 23 t3t3o 23 ot,Fax: (226) 30 zt 47/(226) 34 za qg 45' Mr' Yaovi Mokpoko Aholou, WHO/APOC, P.O. Box 549, Ouagadougou, Burkina Faso, Tel: (226) 30 23 rzl30 23 t3/30 23 ot,Fax: (226) 30 zr 47/(226) li zo qa 46. Ms. Patricia Mensah, wHo/Apoc, Box 549, ouagadougou, Burkina Faso, Tet. (226) 30 23 12t30 23 r3t3o 23 ot,Fax. (226) tO it 47/A2q 34 26 48 3l WHO KENYA 47. Dr. Zagana Nevio, Medical Officer, CTD Division, Onchocerciasis Unit, World Health Organization WHOA{airobi, Kenya, Tel: (254) 7 7212 534 - Fax: (254) 2 7214 777 - Email: Zagaian@WHo.CH 48. Dr. Mutie Dominic Makaa, WR a.i., World Health Organization (WHO), P. O. Box Nairobi, Kenya, Tel: (254) 2 72 30 69 - Fax: (254) 2 72 00 50 NGDOs 49. Ms. Irene Goepp, Programme Manager, OlS/Southern Sudan OV Control Programme, HealtlNetlnternational, SuguttaRoadP.O.Box40643,Nairobi,Kenya,TeL.(25$2573704-Fax: (254) 2 574 452,E-mul: hneetno@nbneet.co.ke 50. Mr. Fasil B. Chane, HealthNet International, Sugutta Road P.O. Box 40643, Nairobi, Kenya, Tel. (254) 2 573 704 - Fax: (254) 2 574 452, E-mail: hneetno@nbneet.co.ke 51. Dr. Mary M. Alleman, Associate Director, Mectizan Donation Program, 750 Commerce Drive Suit 400, Decatur, GA 30030, Atlanta, USA Tel. (404) 371 1460 - Fax: (404) 371 1138 - Email: malleman@asldorce org 52.Mr.Ben Male, Programme Support Manager, Sight Savers lnternational - East Central Southern Africa Region, P.O. Box 34690, Nairobi, Kenya, Tel. (254) 2 50 38 35 - Fax: (254) 2 50 55 48 - Email: benmale@ africaonline. co. ke 53. h/k. Cox Ross, Resident Advisor, Global 2000, The Carter Center, P.O. Box 51911, Nairobi , Kenya, Tel'.Q54)2245697 -Fax:(254) 2245690-Email:GLOB2000@AFRICAONUNE CO.KE 54. Dr. Ayodele Benjamin Aderinola, Endemic Diseases Coordinator, Aktion Afrika Hilfe (AAH - Sudan Programme), P.O. Box 76598, Nairobi, Kenya - Tel. (254) 2 571 978 or (254) 2 571 979 ' Fax. (254) 2 574 969 - Email: akafri@form net comm 55 Gathigira Julie Wachera" lnternational Rescue Committee (IRC), P.O. Box 62727, Nairobi, Kenya, Tel. (254)Z 574 488, Fax: (254)2 574 495 56. Ms. Roslind Awando, Health Officer/OV Coordinator, South Sudarq World Vision lnternational (WVD), P. O. Box 56527, Nairobi, Kenya; Tel. (254) 2 Ml 777 - Fax'. (254) 2 441 819 57. Dr Bellario Ahoy Ngong Geng, Chiefl Health Coordinator, Sudan Relief and Rehabilitation Association (SRRA)New Cush New Sudan, P.O. Box 39892, Nairobi, Kenya Tel: (254) 2 44 0l 56 or (254) 2 44 80 75 - Fax: (254) 2 44 80 78 58. Dr. Eyamba Albert, Project Advisor, Carter Center, P. O. Box 4794, Yaounde, Cameroorq Tel/Fax: (237) 20 50 12 32 Other Participants 59. Prof. Braide Ekanem Ikpi, Temporary Advisor to WHO on Impact Assessment, l6 Ibom Layout, P.O. Box 3679, Calabar, Nigeria - TeL. (234) 87 222 87? or (234) 87 220 452 - Fax: (234) | 87 222 872 or (234) 87 220 452 60. Mr. Davies Rowland, Observer, c/o P.O. Box 10018, Nairobi, Kenya PWANC 2J.OJ.I99E )) 34 Ethiopia Appendix D Unselected Areas for REMO Oncho Free Areas CDTI to refine REMO 35 ffi CDTI Areas Afar ETHIOPTA General information Ethiopia is located in the Horn of Africa. [t shares borders with five countries, Eritrea in the norttr, Sudan in the west, Kenya and Somalia in the south and Djibouti in the east. According to a recent census, the population of Ethiopia is about 57 million and 85 % of this is rural. More than 60To of the population lives in the highland plateau where the population density is very high. In the low lands, the land is sparsely populated. Topography, climate and accessibility Ethiopia is a mountainous country with a highland plateau that is divided into several parts by tlre five major river basins (Tekeze, Abbay, Barro, Omo and Genalle). The country is divided in to two parts by the great Rift Valley which crosses from south-west to north- east. The,long rainy season in the country extends from June to September and the short one, occurs between January and February, covering some parts of the country. The dry season starts in October and ends in June. Due to the rugged terrain and the numerous rivers in the country, access to many rural areas is very limited. Up to the zonal level, there are usually all weather roads connecting the zones to the regional capitals. Beyond the district capitals, most of the roads can only be accessed during the dry season. Administration Administratively, the country is divided into ten autonomous regional states which are then sub-divided into 55 zones and more than 500 districts. The health management systenL follows the same set up. At the central level, there is the Federal Ministry of HealttU at the regional level- the regional health office, at the zonal level - the zonal health department and at district level - the district health office. The health care delivery systern, starts from bottom upwards with the primary health care units @HC unit), the district hospital, Regional referral hospital and specialized central hospital. The current health service coverage is about 45%o, that is, the population that has access to health facilities. Onchocerciasis endemicity The existence of Onchocerciasis in Ethiopia was established in 1940 by ttalian investigators, in Keffa region. Subsequent studies have identified the disease to be prevalent in the western and southern parts of Ethiopia. The REMO survey, that was carried out in 1997, showed that the population living in meso- to hyper - endemic areas is about 2.5 million. These areas are isolated foci in south - western and north - western parts of the country. The number of endemic communities is expected to expand after the refinement of REMO, by end of 1998. 36 Objectives General objective: To reduce the prevalence of Onchocerciasis to the extent that it will no longer be a major public health problem. Specific objectives: l. To complete and refine REMO in the remaining parts of the country 2. To attain 80% CDTI coverage in meso and hyper endemic communities by the year 2003. 3. To initiate vector control activities in selected endemic foci. Strategies 1. Advocate support for onchocerciasis control at all levels. 2. Conduct training on implementation of CDTI at all levels. 3. Establish onchocerciasis task forces at different levels. 4. Appoint onchocerciasis coordinators at different levels. 5. Integrate CDTI activities into existing systems. Administration of the programme 1. The NOTF has not been established yet. 2. The proposed composition of NOTF is as follows: Head of Epidemiology and AIDS department - Chair person National onchocerciasis coordinator - Secretary NGDO representative - Vice chairman Other NGDOs - Members Regional onchocerciasis coordinators - Members WHO representative - Member LINICEF representative - Member NGDOs To date, Africare, Global 2000, Sight Savers International and Bahai community have expressed their interests in Onchocerciasis control in the country, informally. 37 Eth'opia F inance Flow Chart APOC/WHO World Bank Trust Fund / I Federal MOIJ.I NOTF Sisnatories: ? Regional Health Bureau / I Zonal Health Department / I District Health Office / I Community ? to be settled between APOC & MOH <- Fund Transfer * Reporting Flow 38 Eth'opia MectizanFlow Chart 6 months # Mectizan Flow * Reporting Flow 2 weeks 2 weeks 2 weeks 1 week 1 week MSD (France) MSI) (usA) I I\ I FMOH Federal MinistrY of Health NOTF Ethiopia NOTF / I RHB Regional Health Board I I ZILD Zonal Health Department / I DHI) District Health DePt. / I Health Facility CDDs (Community Directed ' Distributors) 1 week Ethiopia Reporting Flow Chart ---+ Report Submission Community Health Facility / I District Health Office Zonal Health Department I I Regional Health Bureau / I Federal MOHI NOTF / I APOC/WHO World Bank Trust Fund 40 <- Feedback 41 sq td L E U) 0) .-+i .l .l +i CJ o0tI .-tI .- GL Fr - aI !sI U U2 .-l U2(! .-(.) li()I ot -IaI o(: +) U) .- F] a o Er 0l oEO.r. 96clt-o() -aEE U ach o-) 1a=7e)9 6-)-.C!c='oI-(CO(gC)L c,3Z-2(, 6.) --c!6 (Jtr6o(got- 6?o) =cr=U 0)-E! e='<.>trqoO(q (.) l- aaG) -a-=(J 6)-.crQG'oC(go(gorrE ..1 Fq aao) ic.n= e c-)_.cr9 q '<-rHCCO(!0)L tha() ao=(J 0)-c EG tlH(dO(g0)l- a :j9) =th=e 0)-c!E'oqcgo(q()L :E ,.t ca fr EE $)t =(/)oOEootr ar U .- Viz> A c!a'a u) o !U)C5E (0 <'E i( (d ih u) o 'E(/)E5E (d <.8 iE ag '6 cr: .Y c0 =.i E;T >;dii 0)thP o.Y!o.(,= Er Q< fr. ch ,, GIA =9 .dE >IE d AA F',)C =t (o <,(6A .H€ 6l .l)Lr rrHA et =oog tro.(, :.t 'f>o oF9li ^\ U) oE tdJ>o >EqrF 9l- ^\ l,) oE (B "35fi HE ci5(utroE l.t ":5d I o& t.! Eovv8 Ed50JL6)AOI cnlZ v')otr3# oo!() o> HE agotr oE:1 ,35d t 6l(, o l.] (o -o(! C) (d -o(d -o .9 Cdp Cd -o .2 c0 0.ocg/, a) th (g cd .= OCtrNQ -9o(! 'E .= .e H- o 'J q) al&o Fi oc o.oa €6 Ot j oo a (!E $ I ca c/) Cg $ I c.l a $ I ca ah >.(0! $ I ca rl, ! <f t co aaL cl I cl t= *c,dtr U); 9.2L,r trOrO<() u c0 a tJrF z F o z friFo z Fo& FoN o o 5UP_o()lJr ET ah E 6l I h Gltr IEe>2. .E I-'.eZs: -sda, L/ €ELF Fo z >. 0. o U) o A O p< IJ.]( o z rq& CAh 6)JA,Eo ) -q.r!4ctp< -r r+{ l- (/) .e,A7E EXHE 0')-- F0) i: 8,ec6 ;2(u;Yc)tr dc) ..lE EEbEE oI)Eq^)tr(rF. o(J(g -N dE>Ab-c>.=oB o U)do .9 Q Bq) E(.) o G) tr tr(dl- o0 oh o< c.t rq( o2 rI]& u CO Ev) .= .+rU0 O. -to o=c,&z E;(L)i- lr C) ;\ 0)Eoo €cd .cAA(d):()E rd C) .,8 bEEo06e(H O< oAEH.N to .E€>zb-c>.EA> q) t/)(d c) .2 o 3() L o o o E CIlr bo o c.l (h tr o) JZ Cd F2 X .E bE E o0 = >. iri e,8,&,2 rq( o sl EeF(l) u8,(L)P(dUr6C EHE ndG) -== .g Ea)E= '<0)Uf g oo9be -(HO<vo Ho E =H N F,.A €o>zp. 9tj lc6'E rrlo inOFIE sR=z rq( o\<rz E]& E;q'tr FG) :\ aitso0P(o ,;EcdXC)EL(d 0.) .,E or iIEbo6e<*A or H.S >-o6-9'tz b.c>.=oB 0) U)(c q) .2o< B .9 L.q) o o) E E(dl- ao olrA (f| o nU lI]( o H& b -11b:gi; H;*F TE TJ] -eE Fo) ;\ C)Eoo#(diE(l)E (gQ oECEbEEc06etHA o OH 2n .0€>a!=o3 C)(r) Cd(l) .g Q B .9 e() o C)t E(g bo o o< \o 42 EDUCATION/MOBILIZATTON TARGET GROUPS Ethio la Target Group Level (Nat., State, Local Govt.,Community) Message/ Information Who will communicate the informstion Means of Communication NOTF National Endemicity Commencement of the Program NOTF Workshops Leaflets NOTF Workshops Leaflets Policy Makers National Key Health Education Messages CRDA - Christian Relief & Dev. Assoc. National Advocacy NOTF Workshops Leaflets Religious Leaders University National Advocacy NOTF Workshops Leaflets NGDO, Reg. Policy makers, Reg.Health bureau Regional Advocacy and Basic Information ROTF Workshops Leaflets NlOtvMoE MOAAIGDO Zonal Basic Information Advocacy ZOTF Workshops Leaflets Council/MOH MOA/MOE MOE/Religious Leader District Advocacy and Basic Information DOTF Workshops Leaflets Comm. Leaders Teachers Rel. Leader Local Assoc. Health Workers Community Basic Information Advocacy DOTF Workshops Leaflets 43a 3a \ \ \ \ laz^ \ 9a o\ o\ a ch *ai€\ =e Eo. {a Eo\ ia L6€\ E6, Ea \ !a \ E.o \ lo zo\ \ qG \ 308 \ \ *a;€\ \ \ =B \ \ Eo;a, \ a6 Es\ .ts8 tr c) U) 0) (., .ji an 6tF c) q) q) tr o 2 rdil c) E <n o 040tr .= Gt EC) LF I q)t ah o FZri I ar) an ct o 6t o U I L q) t- o Fa. ri o c) tr B I fiF Z .r) cl qA H al Gll tr o Gz q) trEQa itr q) a ?a oL Q o q) o o q) It a0 GILF F Q rf) ?trLoo BO rtrC)a *.= -t €Elr.qFv z I (J t- ,) oid Gt oN I 3 a aQ I ql cq CJ o q) q) (l clz \o () cq(, c) q) C! o a0o I c) () (J L ah € Gt N I ctI q) c) o U l Fri L aHFiF tsrFU i riz|tj E]t-a -t- ri HF Fz rdF 43b 6t dd ol '.c!q) 6l cll n a3e 0a E { 2 ea Eo ! ;3, E .i= Eo i= \ g^3e \ S= \ E= C 2 L aO <e \ LaoE€ E= E- .= t-(J U2 6) e I .:i an GIH .Ic q2 a)x9 Lq) €:l ()E EO9: =EIe ,i r- AI €.ELtro c)! e/:t5 .EE c)H U) € u0 L o q) o\ C) c)t- (u GTtr u0oL L.Egtr> .9 or cJ .=<tr-O =€GI F( Appendix E Kenya . Eldoret . Nairobi Non-endemic Suspected endemic areas 44 KEI{YA General Information Kenya is situated on the eastern seaboard of Africa, lying astride the Equator between 4o 30'N and S, respectively and between 35" E and 41" E. To the south east is the Indian Ocean, Tanzania in the south, Uganda in the west, Ethiopia in the north and Somalia to the north east. Topography, Climate and Accessibility The territory covers 58?,647 sq km ofwhich 13,096 sq km is water and 488,100 sq km (82%) is arid and semi arid lowlands. The latter occupies the northern and eastern parts of the country. Approximat ely 90Yo ofthe total population (30 million) live in the highlands, the Lake Victoria basin of Nyanza, Western provinces and on the Coast. This comprises 104,000 sq km (18%) of the total area of the country. The landscape is dominated by the south west higtrlands bisected by the Great Rift Valley, which runs from north to south. Most of the rainfall occurs between March to September, with the short rains in December. The dry season is mainly between October and March. A central railway runs from the Port of Mombasa on the Indian Ocean, through Nairobi, Nakuru and Eldoret to Uganda. At Lake Victori4 there is water transport to other East African Ports. Road transport runs alon,e the main railway to Uganda. There are several river systems with their sources in the highlands The largest of these is the Tana which together with the Athi, drain into the Indian Ocean. Rivers Sondu, Nzoia and Yala run westwards and drain into Lake Victoria, while Rivers Turkwel and Kerio run northwards and drain into Lake Turkana.. Administration Kenya is divided into eight provinces: Rift Valley, Nyanza, Coast, Eastern, North Eastern, Central, Western and Nairobi, the capital city. The provinces are divided into sixty eight (68) districts. The Ministry of Health is headed by a Minister, Permanent Secretary and Director of Medical Services. It is divided into several Divisions, including Preventive and Promotive, Primary Health Care, Curative Services and Environmental Health. The control ofvector borne diseases, including Onchocerciasis falls under Preventive and Promotive Health Division which together with PHC deals with prevention and control of infectious diseases. Community Structure The Districts are divided into Locations, which are governed by Chiefs. The Chiefs are assisted by Assistant Chiefs, who govern several villages in each Location. Each village is represenled by an Elder, who together wiitr the Assistant Chieiare elected by the community, while the Chiefs are Civil Servants. In villages are women groups and cooperative societies, which extend to the district and national levels. 45 Onchocerciasis Endemicity Onchocerciasis was first detected in Kenya n l92l among the Kipsigis and Kisii communities living in the vicinity of the well watered Chemosit and Kipsonoi, tributaries of the River Sondu. In an epidemiological study conducted in Kakamega in 1939, a prevalence rate of 50%owasrecorded among 6l patientg detected. The disease occurred in the Kakamega and Kaimosi forests and in the Tiriki and Nandi \ills, and further into the western plains as far as Marach and Buhayo. Onchocerciasis occurs in the highlands, west of the Rift Valley, Nyanza and Western provinces in more or less clearly demarcated foci. This is within an area of high rainfall and drained by the River Sondu and Yala and their tributaries. In the south the areas affected are Bomet, Kisii, Kericho and Rachuonyo while in the central areas Nandi, Kakamega and Vihiga are affected. The northern foci occur on Mount Elgon and the Cherangany Hills. The latter hills occur on the common boundary between Trans Nzoia, West Pokot, Uasin Gshu and Marakwet-districts. Objectives: To determine the prevalence of Onchocerciasis in the original foci and suspected areas. To control Onchocerciasis using CDTI strategy and focal vector control. Strategies REMO/REA will be carried out in all foci and in areas within the range of the vector Simulium naevei. 2. CDTI strategy to be adopted for control of Onchocerciasis 3. Focal vector control on the slopes of Mount Elgon in collaboration with Uganda. NOTF The NOTF will be established in January,l999, after the completion of REMO/REA. 2 46 I I Kenya Finance Flow Chart APOC/WHO World Bank Trust Fund / I NOTF Nat. CoordinatorSignatories: NGDO Rep. / I District Health Unit District Coordinator NGDO Rep. Rgp,. , Sisnatories: I I PHC Facility / I Community #_ Fund rransfer 47 * Reporting Flow Kenya MectizanFlow Chart 1 week L week 2 weeks 1 week 3 days -1 I I I I I I I I I I I I I I I I I I I I I I _l # Mectizan x'low -* Reporting Flow MSD (France) MSD (usA) / I\ I JKIA MSA Sea Port EldoretKNOTF Kenya NOTF / I MSCU Medical SuPPort Coordinating Unit I I RMS Depot Regional Medical Stores / I 6 months District Medical Stores / I Facility Ilealth Centre DisPensarY CDDs (CommunitY Directed Distributors) 48 1 day Kenya Reporting Flow Chart Community / I Health Centre / I District Hospital / I NOTF I I APOC/WHO World Bank Trust Fund * Report Submission <- Feedback 49 50 t, U) EEO.- t€E clL()c) =rc =nfiE U U) o (d o C) :) L.i C^ aii co= a hE ba 3#S.E ll * o;jiF.] XZtu c)(no=cnL.= E t b8rEA.&Z a I a)O. atrodOro. Q)ao-r- Cg oc)U)P c;t<d&E fr EE .9c '1, = =<n<'t Qtr.l (Jrr.l (JF] (Jtr.l .H€tl -rr F at) -E FlFA E fri .i# 'o=Av)<'i (l) l< o(D El I Cd lJ l-.4.9E afr -t f )EE9?,O.EOE d >rOd.i sii frJ{Jq)O0()= aS;E U) l<aotr '5O>' c0 '= cd!v)f; 3,^o.Ao7.i C)6) O.==.&ElE&, v) Laotr s'a str9 o.9 d 3 c)O t/).57&E15J, Ao clI o rl -oo .E z o O Lov q +)ot< (n -ooh cd z >, l< E o() q) ql ,!q) F{ 00 O, o\ otr -' oo 2= -' oo<o\2z U) =O\ C0ho,-oi"9 sr o. 6 C) i,L cl I cl f= Qo Or friFo z J4 U) c0(r !(FE.f I ^A=tiV.Hl-aAZAOri v) (iC) +r -:( cd=(D *-Ef l-r(i (!) ':a -YdX o..r Jfrf ,, E ctE I L GI ti oR:cEiEO >2> lroil .l-(.rcocnEli!/E:O.ZIA;E t! E9 L:!z > Q 6,,p8I H&Fz< u1IQ IErr .?Ziz ET HFr Fr J <n c0F U) (n(0 o a)o o otro cdtr .9clHgZo' tr{ c)o o trr .V U) CdF o()^c-o<66 'E& 'u) -i5 c\ 0 o oOqr o bo tr dl<F ca Ao (AJit-o B o otro CBtr o cd z .t C') c oO l- € F o() \r| cl o V L e U)q) .-{.) .- .l +J(J o0AI .- -I .l GL Ei -oL ! -L Q a .- U2 G .-ILq) c) o - -I -H ot- o +.a .- F] oAl-l ot'l EDUC ATIONTM O BILIZATION T ARGET GROUPS Ke Means of Communication Who will communicate the information Message/ Information Level (Nat., State, Local Gow.,Commun!ryL Target Group LetterNational Coordinator Oncho Plan of ActionNationalMedia Policy makers Face to face visit National Coordinator Oncho Plan of ActionProvinceProvincial Health Management Team MeetingNationaV District Oncho Planner Oncho Plan of ActionDistrictDisrict Health Management Team MeetingDistrict Coordinator District Plan of ActionDistrictDistrict Commissioner District Officer BafizaCDDsCDTILocation or village Chief 5l 25 a Ea la z6 9a Ea o\a u \ Ea \ \ \ \ \ \ €a Eo\ \ \ \ ia L c6Ea \ Ea \ El \ \ 3o \ ioz6 \ \ !- \ G v) E \ =6;6 \ \ aa ;a a z ir o fr I .r2q) h I ! U) GI t-{ ri o !(a rEl& Iq) o DO tr hq) o N -a rr] 6 clt (r) d(i O.iI G-Ccno- clz t cq -cqE otl cq z ra 6l .t) o(t a) (r)q)Fi o r< F{ \o 6lqh Orc Err o r< r- 6 an o o tho a 6 Ea o c!N rr) trq) a o\ F z o DO cttrF orr rr5Cp oo'E EI: GIlrF GI (J tr c!N U' rlq) U) (.) o- tr6eN(ll .d a);!U az fr (.1 L { o0 fr tr r-a l-(a U .(l z frl V L al.l rrl Frtl rrtFU x o f-l zt -]r-'tT i-2. -:- r-'l - F Fz rcF Appendix F Liberia Monrovia Not yet assessed for oncho Counties Capemount Bong Bomi Montserrado Nimba Margibi Grand Bassa Sinoe Grand Kru Mqryland 2 J 4) 8 9 I 1 I Sr,rspected endernic areas 53 LIBERIA General information Liberia is located on the west coast of Africa. It is bordered on the west by Sierra Leone, north by Guinea, east by Ivory Cost and south by Atlantic Ocean. Liberia -hu, un area of 43,000 sq. miles with a population of 2.8 million. 43.1o of this population is below 20 years of age. The population growth rate is about 2.6%. Liberia is recovering from a seven year war Topography, climate and accessibiliqv The country has flat rain forests and mountainous terrain. The major rivers are St. John, St. Paul, Lofa, cavalla, Farmington, cestos, Nuon, Marfa Low4 Mano and Maho. The country has two seasons, the rainy season (May - September) and the dry season (October to April) Most roads are inaccessible during the rainy season. Communication between Monrovia is by telephone, fax and telex. However, from Monrovia to the counties, communication is only by radio. Adlinistration There are thirteen counties made up of several districts. In the districts, are clans made up of towns. At the central level, is the Ministry of Internal Affairs and the Ministry of Health and Social Welfare. The laner is headed by a Minister. There are three deputy- ministers and four assistant ministers with various responsibilities. The Ministrv. supervises, monitors and evaluates health care delivery system in the country. At the county level, is the county health team headed by the county health officer. The county health team is the implementing arm of the Ministry At the local government level, the head of the county is the superintendent. There are alsodistrict commissioners, paramount chiefs, clan and town chiefs. Onchocerciasis endemicity Onchocerciasis poses a serious public health problem in Liberia. The prevalence data has been available since 1950 in Mar_eibi, Grand Bass4 Grand Bong and Lofa, Bomi, Capemount, Grand Gedeh and Monrserrado counties. Data have also been prol.ided bv scientist from the Liberian Institute of Biomedical Research. Eight of the thirteen counries are known to be endemic for onchocerciasis while otherc u." y"i to be assessed At many health posts, clinics, health centres and hospitals throughout the country, onchocerciasis dermatitis is frequently observed as well as palpa-ble nodules. Objectives General objective: To identify and treat endemic communities with ivermectin and eliminate Onchocerciasis as a public health problem 54 Specific objectives: I To determine the prevalence of Onchocerciasis in the country 2. To establish a sustainable CDTI programme Strategies: l. Awareness workshops at National, County and community levels 2. REMO training and assessment of endemic communities 3 Treatment of endemic communities using CDTI NOTF The NOTF is not yet formed but the Ministry has appointed a National Onchocerciasis Coordinator. 55 Liberia Finance Flow Chart APOC/WHO World Bank Trust Fund National County <- Fund Transfer I I NOTF Nat. CoordinatorNGDO Rep. I tories: wHo Rep. I I County Oncho Unit County Health Officer NGDO Rep. 'Control Off. Sienatories: / I Health Facility / I Community 56 * Reporting Flow Liberia Mecti zan f low Chart 2 weeks 6 months RDS (Regional Drug Service) 2 weeks 1 month 1-2 weeks 1 week (CurrentlY not functioning) <-- Mectizan Flow -* Reporting Flow MSD (France) MST) (usA) \ I NDS (National Drug Service)NOTFLiberia NOTF County / I Health Facility CDDs (CommunitY Directed Distributors) 57 t1 Liberia Reporting Flow Chart Community I I Health Facility / I County Oncho Unit / I NOTF / I APOC/WHO World Bank Trust Fund -_>ReportSubmission<- Feedback 58 59 0 HC) ed CqL()0) a20.6 U o o (, co CO o 0.) 9tr lu rJli*C6)()cd.= trH 'i AJ< El \J 0(.)ao= o92 a=q)I&z a I (Jo. AEOc€Oi O. a) .= 6) sg;z I ALi!.= =i €HcSHtrL(-)(-6 LJdiJ X'-= F.] Efi5 3 Qtrl (-) trl () t! a0 ,)tr€ .iOtr-tr 'Ft FE rh O. l- o) o aO. ca a\otra O o Cg C)a 0.) L< ch ;ia l-< Agiv) 00.)7,O.L .= 'r-A_HV9 otr '.= >. Od c0'=U_ii^AH-9cldp6.s Ec4O a li \J a t-A .RatA 00)1a()6) Ado 6l .s ot- o 9 (-) I E q) 6l U() F =a .\ co cdtsorE36"nl-: # \-/ oo A,,,^ t) oq6Po) 99 *p" Bi#o oo o\ o\ L< CS z a =o\ cBk .Et.9 e U)L o G I cq 'cjL.,O- c) A'r I a.U SoQ . rt () f )E 658z> c < F z F Z ali .a 0) '+, -Y c) r- a) 6l () L Cq a _C, l<e9E >T ? g,vtu 'e6ese€8EeE E55$ E?BES H l< 0.)() E >,o)LL9* t<;<P;H_ .Y = (dHOoETL)IE L tl (,)E.V (D -v a Q 41 o .: \J>z etZd t-t -.,0 -'t ,!, frk Et3 a a '5 l- 0.)(-) () oa) O cdh 5tL e -:Zcd rzr '7c6 '- ?-^ o z r! c.l F t-.,1(-) ca bo '= '6 L<F a C) $ C) J L € U)q) ./ +) .- o-+l CJ b0aI .- -L .- GLF - I i fI U u2 .- U) €E .-I -(c)I a - (J tI \J +r +)a .a F] A - F 60 EDUCATIONTM O BILIZATION TARGET GROUPS Liberia Target GrouP Level (Nat., State, Local Govt.,CommunitY) Message/ Information Who will communicate the information Means of Communication National Authorities MOFVAgric. Internal Affairs National APOC Philosophy of CDTI Information about the threat of onchocerciasis NOTF Video Visit Group meeting County Health I Team and CGR (Country Gov. Representative) County Information about oncho Philosophy of APOC NOTF Visit IEC Group discussions Community Community Philosophy of APOC Principles of CDTI County Health Workers IEC materials 6l ,;l laz6 aa a.aa u_ :e Ea aaE6 L €aEa \ 3e a= 3o lez6 \ q6 66a € \ \ \ \ \ \ Ee ;a \ \ €6IE \ \ o.99 CJq q) >. (.) ! aa c!F F z At .t CJ c{ 6Z 6l C!(- C0 G z (r) a€ oE d z .d. O Qal L rr) c, ll L 0 0 a 0 r-. U) z a a O 6 co H U .9Eq')Eac,Eq)6 (\'a CE a h Q U GI ri F] k: a FFT -rF Q r- r-'l -z J F1Fa -F ri F Fz r-'l -lF Mozambique Appendix G Indian Ocean Non-endemic Suspected endemic areas Malawi Tanzanta o la e Zambia Zimbabwe Gaza Inhamb South Africa 62 '-\ i,:'I ''i l'' ,:-',, t.l- r i'-a, l { MOZAMBIQUE General information Mozambique shares borders with Tanzania in the north, Malawi and Zanfria to the north- west, Zimbabwe to the west, Swaziland to the south-west, South Africa to the south and south - east and the Indian Ocean to the east and the north-east. The major rivers in the country are Zambezi and Rovuma, The population is about l7 million made of Bantu and other races. There are various religious groupings made up of Catholics, Anglicans, Moslems and,Ziorletc. Subsistence farming accounts for 7SYo of the major economic activity There is a high level of mobility across Malawi. A peace agreement was signed about five years ago, following a ten years civil war. Topography, climate, accessibility The vegetation is almost all savanna except for the Milange forest areas. The rainy season is frpm November to March and the dry season April to October. There are still a lot of land'mines which makes access difficult. The roads are currently being rehabilitated. -Colmunication between districts and provincial levels is by radio while the telephone and fax gan be used in the provinces. Administration Mozambique has l0 provinces, each being is divided into distrios. Each district is sub- divided into localities and the localities sub-divided into villages. At the central level, therp is the Ministry of Health made up of National Directorates of Health. Under these are fhe Provincial Directorates of Healttr, responsible for hospitals and health centres. I The'District Directorates of health are responsible for rural hospitals and health centres while the localities are responsible for health posts. AII community health activities are carried out by indMduals selected by the community. These are trained for six months by MOH as community health workers. Their main actiYities after training are health education for communities, mobilization and treatment of sonle diseases that are locally endemic. By national law, these people are the only ones allowed to manage and administer drugs. It is therefore likely that these are the same people that will be used in this programme Onchocerciasis endemicity Knowledge of onchocerciasis in the country was reported about 30 years ago but was not docpmented. The possible endemic provinces are Tete, Manica, Zambezia,Nampula, Nia$sa and Cabo Delgado. A survey in Milange district inZanbena showed thai the district is endemic for onchocerciasis. There may be cross-border considerations in areas bordering Malawi and Tanzania. The presence of other filaria infections have been reported in the country. 63 Objective: To control Onchocerciasis in the endemic communities in the country Strategies: I Conduct REMO and review other relevant information that is available 2. Streamline structures pertaining to ivermectin procurement, delivery and distribution 3. Integrate CDTI into the existing system of MOH For long term sustainablity, the programme will use village appointed health workers. The refugee populations have already been integrated into villages thus will require no additional attention. NOTF This is yet to be formed. The NGDO's to work on the prograrnme have not yet been identified. 64 Mozambique Finance Flow Chart APOC/WHO World Bank Trust Fund <- Fund Transfer / I NOTF Nat. CoordinatorNGDO Rep. rgnatories: wR/wHo / I Provincial Health Dir. Prov. Health Officer NGDO Representative / I Districtal Health Dir. District Health Officer NGDO Representative Signatories: / I Community 65 -----> Reporting Flow Sisnatories: Mozambique Mectizan Flow Chart 2 days 1 day 6 months 3 days 2 weeks 1 weeks 2 days <- Mectizan Flow -----> Reporting Flow MST) (usA) MSI) (France) / I Port of Entry (Maputo)MEDIMOC Medical Import/Export Drug Company I I\ \ MEDIMOC Medical Import/Export Drug CompanyNOTF Mozambique NOTF / I Provincial Health Directorate / I Districtal Health Directorate CDDs (Community Directed Distributors) 66 Mozambique Reporting Flow Chart Community I I District Level Provincia Level I / I NOTF I I APOC/WHO World Bank Trust Fund --->ReportSubmission <- Feedback 67 tl 68 q) r'l N e U)o .-{-) .l .- +JI b0aI .-dt .- cqL H - t -+)dI oU U) .El U2 -, .-aI I 0) CJ / - () dtAv tr( +J U) .-I oAt- o t-t 0 HO ec{(LOo) E= U dzebor 'io .= c)cs'o t-. > cd zE lo r- .H C)d-OF> ! C) r<a '=!trH cd cg F.l Q a tr C6 q.,;rO -aO fugi bt |i na tr 0.)tr-o O=()O OO- dCd .5 0) cd; l-F 3_ .= o)gE ezia U)fia cdaA- O .= d!#V J HA|/r,(d<'i !E arl (n cB=A- O .: cd! 1,, ) Lr =u)cd<'i E cr.)t!)(€= .98€ - irJ)l-< =u)cB<'iE 3€Y(h.1 cdE,t - r^r \JBEU .2H6>Eii 0.) a .!lUL)d a(a4Lv().l5tgsE fr< Ar Er aft -Y .= /-cd5 (u ;r a= .E',€AE Fq) _H liJA t) \La! olg -l LJi C).=oE cd6l .r LJ>m ELa!o.)r yL,:U) H9V.r()E CT0):- ! -l>cQ ,F9 ivE C).=o! d0) :* l-rJ>CQ t-Y I E ie$1 FEE€o(,Jc4 a-Y E aq#EdE€o(,Jc( a _94Ytr(J -'1 -o tjl()Oto c> t 6lI oI o)q(d z a ,r, G)gB O':.r _(jl?FHO{o. a C) A.= \J() z,E -OaG)- -c) .i-j!+{ V) <c I #!0())l)Lio=f,EB <QE -oq0);.i <..1 'E02; 8E o tr cl& c) F oo o\ o\ q (.) a oo o\ o -. ooior z2 o\ o\ o\ .o C)trr o\ o\ o\ -o0)tu O\/ )r o. 4a ?,, 6l C.) c(fr 'r- a u)y u=\rtrO.O( t-r ;- a fa F z a F O z 9- a lr<F o z E= EZ E EOTEF E (A Q o 0r U) GI C) fr Gti . .h- LJ.idic;\)QE: 2;, I rr bO +O(!X c6(Hi.0)gZV v) () OO(-.,!A O:1oH. (! .. (H s)a ;-( E.aat r<(- (1 O)o riE_v?,EE:) o oiZOEf 4H !voU t< H!b EEZl-,tu thq) .= \J>z eZ i#9& e,)h cc( F{ o. o a a -y, a;. Q7t-()c) ot o(t Abo\JO L< cd r{ cdtr ,2 (Jol) ()F () o () c cn o o (-.l a C) u(g a z ca oF cd 0.) L) kiJa $ (d 0)F cO C) oQ \at oo a c0 L<F o (c (g c z IJt I l\O 69 EDUCATION/MO BILIZATION TARG ET GROUPS Mozam ue Means of Communicstion Who will communicate the information Message/ Information [,evel (Nat., State, Local Govt.,Community) Target Group Visit Video/TV News Paper Radio National Coordinator Meetings and Documentation Visit Video/TV News Paper Radio Nationat Coordinator Meetings and Documentation National Leaders National ProvinceProvincial Leaders Visits Seminars Posters National Coord Prov. Worker District Meetings and Documentation District Leaders Visits Posters District Dh. of HealthA{OTF Meetings and Documentation Admin. Workers District Visits Posters District Dir. of Health/NOTF Advocacy and Basic Information DistrictPolitial leaders Visits Posters Disrict Dir. of HealthNOTF Basic InformationReligious Leaders Communiw Visits Seminars Posters District Dir. of HealthAlOTF Meetings and Documentation CommunityCommunity Health Workers Visits Posters District Dir. of Health/I.,lOTF Basic InformationCommunityTraditional Healers Visits Posters Community Health Worker Community MeetingsMidwives Visits Posters Commumty Health Worker Community Basic OrientationTeachers Visits Health Education messages Community Health Worker Community Key Health Education Messages Groups at-risk of oncho infection Visits Health Education messages Community Health \\'orker Key Health Education Messages CommunityFamilies t0 Fr2 N fr2 ,- ar-lE F FT -FU -z -J f-lFa -F ri F FzHF il[ il \ iai-6 aa ^6 s )a' ael u^ Ea +6 E^ c6 2 \ \ \ of,e \ \ L <€\ Eq\ \ E- .:;i \ !a \ \ !o \ \ ioz6 \ \ g6 \ \ \ 6 U) \ \ 1aia \ =€ \ \ :€ a€ in ()q q) <J a) C!F (! CJ FT a. f.l a c)!tr >.= Ad <aa ri N cq F z (-) dri 0.i Qqt otr cl z t € -6€tr olr 6z ia 6 U) c.EOqq (J.a(,) t-( \o d U) Ac e) '-rolr o r*. cllo O 0 a € h aqEr- q)0a- t- cqa.9 u0EEq) AZ 6t F o\ tr6 \Jc ao€ trqJ L (] q) c! (,) L aii(€ooc) 2-z (\t !N cE .- :,c)5c) EE fr ?.) o 0) e q) \o € t Appendix IJ Southern Sudan Aweill Twic Gogrral Raga l--l llt f| -!r-f:r U l1 E. Equa Lakes SOUTHERN SUDAN General information South Sudan is bordered in the west by the central African Republic' in the south by Democratic Republic of Congo ura ugunJa' in the east by Kenya and Ethiopia and in the nont, the bo.rrrJary is contentious a::f, :l!-defined Topography, climate, accessibility The water flow is mainly towards the white Nile in the north-eastern direction in the south-western area. The latter is divided into: i) Southern water shed zone (Nile/ congo divide) o-f forest and savanna with good annual rainfall and fertile soil. There i-s a gtadual slope of streams and rivers iD lron stone plateau zone ( intermediate) of savanna with unreliable annual rainfall andshallow,oironironstone.Streamsandriversarefastflowing. iii) Alluvial plains towards Bahr El Arab (10 N) and White Nile (33 0 E)' Grasslands with patchy;;;, unreliable ranrurt-una flat alluvial plains with wide shallow slow flowine rivers' There are two main seasons. The dry season (Iiovember-- March) during which fishing and hunting activities occur and the *.ir.uron (April - October) mainly for farming activities. only one all season road exists ( western Equatoria- Lakes); most roads being seasonal due to destruction of bridges, lack of maintenance or military barricades resulting from the war. Access by OLiAS Indsenio. Snne tturis possible by air only from Kenya' Four wheel drive vehicr.rl*o,otuikes and bicycles are used internally' But by far the commonest means of transport is by foot' Administration Southern Sudan is divided into six regions each consisting of a number of counties' Except for upper Nile, these regions u,..*t,ouy ( Western_Equatoria and Lakes) or largely controlled by the Sudan Peoples I-iberation Mo"*tnt (sPLIvD Each county.consists of a number of Payams each of which in turn is made up of several villages' civil administrative structures have been set;;f1.* the village.level ( Village Councils) to the national level (National Executiu. CounJifi. In additiof tf SPLM has a humanitarian wing, the Sudan n ri"i-a Rehabilitation,{ssociation (SRRA)- Together with ols/ss and other NGOs, this body is responsible for relief and rehabilitation actirities Health services are delivered by oLS/SS and other NGOs in coordination with SRR*A health sector headed by the Chief SRRA coo.ainator. Delivery is through the PHC system which still requires complete structural development in some areas' About fwenty- 72 three NGOs are involved in the delivery of health services in the SRRA accessible areas However, due to the war situation'this number of NGO's fluctuates Community structure Many ethnic groups, subsistence economy is related to zones of permanent residence; i) Sedentary farmers found in the southern water shed zone ii) Mixed sedentary farmers/fishernerL hunters and semi-nomadic pastoralists found in the iron stone Plateau zones. iii) Semi-nomadic pastoralists found in the alluvial plain zone. The leadership structure is principally the same for these groups and consi:l o-f u paramount chief with several exetutive chiefs below him. The executive chief rules over a number of sub-chiefs below him, each of whom has several Gol leaders (headmen) under ni.] n.iig,ous leaders, women associations and traditional healers are among the influential social grouPings. Onchocerciasis endemicitY Onchocerciasis was first reported by Bryant in 1933. He also associated it with endemic blindness in Bahr EI Ghazi and calied ii "Jur blindness" because of it's prevalence then amons the Jur and Balanda tribes near tributaries of the Jur river (Bryant1935) By 1959' more foci had been identified and reported in Bahr El Ghazal, Western Equatori4 Upper Nile and Jonglei. Further investigations in the 1960's, 1970's and 1980's confirmed former findings and revealed additional foci in Lakes and Eastern Equatoria regions' It is therefore clear that the disease is prevalent in all the regions of South Sudan with a total population of about 2.5 million persons at risk. However, the magnitude of the problem remains undefined as epidemiotogical surveys done so far have covered seleot communities onlY. Objective To control onchocerciasis by mass annual ivermectin treatment in endemic communities tkough APOC PaternershiP. Strategies Determination of onchocerciasis endemicity levels Establishment of sustainable CDTI project NOTF To ensure sustainability and full coverage of all SRRA accessible areas' a New Sudan Onchocerciasis task force ( NSOTF), a partnership of SRRA and NGDO's is to replace the SSOCp Field implementors *iilbe included in the NSOTF' Health Net International (HIII), the principat Ncoo shall be the NSOTF coordinator and shall represent it in all NOTF cooidination meetings. The NSOTF shall be located in Nairobi, Kenya' 73 Southern Sudan Finance Flow Chart APOC/WHO World Bank Trust Fund / I NOTF Nat. Coordinator NGDO Rep WR/WHO ignatories: / I Nairobi IlealthNet Int. Sisnatories: HealthNet NGDO Rep. / I NGDO/SRRA HNI Store / I Counties NGDO/SRRA Store / I PHC Facility CDDs (Community Directed Distributors) +_ Fund rransfer -> Reporting Flow 14 Southern Sudan Mectizanflow Chart 3 months I -2 weeks I -3 weeks I week 1 week <- Mectizan Flow MSD (usA) MSD (France) I I \ \ Nairobi Schenker AgentNOTF Health Net I I Loki HNI Store / I Counties NGDO Store / I PHC Facilityl Payam Store CDDs (Community Directed Distributors)------> Reporting Flow t5 Southern Sudan Reportirrg Flow Chart Community / I PHC Facility / I County NGDO/SRRA Unit / I NSOTF/Nairobi HealthNet Int. I I NOTF --> Report Submission # Feedback APOC/WHO World Bank Trust Fund 76 77 0 HO o.- +. atlCl Liq)() =r)iE U a oE CdF fr gE a Oc6O ==0.)Y aE).a.d a oE EA Hh .;: o&ootr EEld r EO,|EE .-Otr .E .FE -L. tsr?A L o:)(d o L(d Ar o aO. u) 9A \J'O o O. o (€ tu o cd O. o- bo fu trr (d o +)o(€ L o G CJ o Fl -oolr cd z ! oJ o *'E al-(Dtrg)! )668 .9adC)trboo(t fi> q) 6l .L q) F{ 0) x U) bo) Ia.C)a oz rr,Lr o 6l q) 6lfr QF"6F-i,oz<2fr .9 N Uq -H MX ,7 ..'o?EA> EobE bo'r=(t)(oez o(-) OY<?> rn tr 6lq (, tr cl F.{ l-r o cd (n .=t E 5 aE .2VFr\rh1_e&UYL'L'V)AA ,hlEyl(') u) -c-ci<i'EEp.E E{ i XE - {-)Ado(+io Eo irr-U!H*;rpHH,^A cd tr 63,-ro (I) o o\-/(J!EQfrZ a.l Oooc cd 0) >+v\) F: a(JEEb L.l o oll >QOrr.l at c) .: l, ..7 c,l Zdl- <<i ed^fFr Fr aJ &a z (d o Cd z cd o oo o) d., c\ Ic) o(-) en 2-r o() $ o I! r', ta) Gl (n t-q) oa L (r) q) o- +r .- .- *lI b0aIt ./tI .- Gl.F - litsI U 0 .l U2 G o-(J li G) C.) arI() at ^q\,(rr +.a .- l] A -to i'{ 78 EDUCATION/MOBILTZATION TARGET GROUPS Southern Sudan SRRA Secretary NGDOs OLS National APOC PhilosophY of CDTI APOC/HM McKenzie Modern Tech. Mesns of Communication Who will communicate the information Message/ Information Level (Nat., State, Local Govt.,Community) Target GrouP Modern Tech.Chief Health Coordinator Health Management APOC PhilosophY Disease RegionalCounty Health Dept Inter-church NGDOs Appropriate Tech. Regional Trainers OV Coordinator Principles of CDTICountyPayam Admin. Chiefs EducationlYouth Appropriate Tech County TraineesBasics of the disease Treatment Side Effects CommunityVHCs (Viilage health Committees) Students 79 z =a z r-l F =O tr € U)ti Ftl -FU rd zj HFaFTF rd F F-z HF 3a ^6 \ \ \ \ \ \ \ ia Z6 \ \ \ \ \ \ \ UA \ \ \ \ \ \ \ o\6o \ \ \ \ \ \ \ 606 \ \ \ \ \ \ \ =a \ \ \ \ \ \ \ \ Ea ;a \ \ \ \ \ \ \ \ daE6 \ \ \ \ \ \ \ \ oEe \ \ \ \ \ \ \ \ LdO\ >o\ \ \ \ \ \ \ \ \ !a \ \ \ \ \ \ \ aa' \ \ \ \ \ \ \ Eo \ \ \ \ \ \ \ \ \ loZ^ \ \ \ \ \ \ \ \ \ \ q6 \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ 9-i6 \ \ \ \ \ \ \ \ \ ;a \ \ \ \ =6 \ \ \ \ a€ 2 \ \ \ 6 a \ \ I aq) q) .jlq)(qF a o a € q,) c,) q) q) E! cl Ia ait q) d U c..l q,) € q) .t Cq N Iq) z s q) q) P o rr} q) cs q) q,) 0) C\to F \o co y3 Eq) () r- .' 0 E c) a oo cq F € a Q E! € F o\ .=q trEC)GEU ic)!t qj q) 2. q q o .:0trtr =.9tra)tr() U IL 6q)q q) U) cl '!n c)cll (\l Appendix I Alrican Prograrttttte titr Ortcitoccrciasis Corttrol (APOC) Proqranrnre africain dc lLltte contre ['onchocercose JOINT ACTION FORUIvI Office of the Chairrnan JAF'-FAC FORUM D'ACTION COMlvl UNE Bureau du Pr6sident JOINT ACTION FORUIVI l'.,ird sess^orr Liveroool. 4-5 December 1997 JAF3/INF/DOC.8 r^'^y\rl, rll\ii. )LL OCTOBER I997 APOC PROJECTS MONITOzuNG FORM 80 JAF3/INF/DOC 8 Pagc I Bockgroutd. This document is a forrnat tbr Monrtoring CDTI projects. The background intbrntation or.r Evaluatton and Monitoring tenns is explanatory, necessary to understand the process used in dcvelopin_u monitortng indicators. You may rvish to skip this section and refer drrectly to the Monitoring Forms if you are fanriliar ',vith the differences as rvell as gray areas betrveen the two terms. Prograntnte evaluation otletttpts lo cletennine the cortgntetlce between petfornnttce (i.e., what occurretl) attd llte rtb,iet'lit,es (i.e. y'ltQt tt,o.s rrrnnnqp,l lo occtrr.l nrrrl ln irnlnto Iho gnlrn/cl nf n "^o-ifir, .ttt-^,',.' /.,11 pt'ogt'Qtttttt(ltic change.s.. outputs, elJeus, ancl intpacts). Programme evaluation focuses pnncipally, although not exclusively, on internal validity of the programme: did this programmc rvork in this setting, and did it produce the observed change? One assumption in programme evaluation is that the model or theoretical basis of the intervention has been confirmed by previous evaluation research (in this case the TDR multi-country study). There are three interrelated levels of the general characteristics of evaluation which are described rn table I belorv: Table I : General characteristics of levels of Evaluation Ler.el l. Process evaluarion: Programme Qualitl, Assurance Revie*' Selected general characteristics Applies non experimental designs Assesses operating procedures Examines structure and process Conducts observational analysis Performs qual itative observations Monitors efforts-activity Reviews-audits data and records Applies quasi-experimental and expcrimental designs Assesses behavioural impact 2. Programme evaluation: Effectit,eness Assessment Uses non-random or random assignment Emphasizes internal validity Uses simple analysis and comparisons Applics tested interventions 3. [:r'aluation resc:trclr Appl ies expcrimental designs Uses randomization and controls Tests hypothesis on bchaviour chanqc Uses multivariate analyses lmprovcs knorvlcdgc base Is groundcd in thcory asizcs intcrnal and cxtcrnal vllidr ty .IAIT3/INF/DOC 8 Page 2 MONITORTNG Definition: "Periotlic collectiott artcl atrolys'is of selected indicators to erruble ntonager:i to determine wltethet key activities are being corriecl out as planned and are lnvhtg the expected effects on tlte target populaliott". Monitoring is herern considered as process evaluation. Objectives of utorritoring CDTI projects. (i) to provide t'eedback to the NOTF and the APOC management on CDTI implementation,(ii) to improve operational plans for CDTI,(iii) to assist the NOTF and APOC Management to identify strengths and weaknesses in CDTI implementation and to apply if necessary corrective measures. Scope of CDTI project fu[onitorirry (i) Target area: CDTI specific project areas'(ii) Faciliries: - Drug delrvery circuit (port to distrrct) - Involvement of the health services - Comn-runiry mobrlization - Collectron of rhe drug by the communir'- (cost covered by'the communlr\') - Trainrng of CBDs - Dtstributton of ivermecttn - Supervrsion - Reporting and leedback to communiry (iii) Pers orr nc l: - NOTF personnel from central level to the communily - Health workers at various levels - Administrative officers at dislrict ievel (financial support to CDTI) - Community leaders - Communiry dtstributors (w) Duration of ntonitorittg Three options on the duration of monitoring are suggested below for as long as project is funded from APOC Trust Fund (5 years). as long as CDTI implemcntation is necessary (longer than 5 years). fbr 3 years and discontinr-re monitoring if the project performance is considered as satisfactory and rn addition the n-rediurn-term evaluation shows a similar lrend. (i) ( ii) (iii) Indicalors For tht'i)Lrrp()sc ol.ntonitoring CDTI pro1ects, the team identrfied and defined three categorres oI indicators namell,: eltect. output and input rndicators. Qr-restions rvere developed covering the three indicators as prese nted in thc Atrncxes below. Definitiorts of rlte rlrrea indicators foltl[ottiroring l. Effect indicators Effects are defined as the knowledge, attitude, and behaviour/practice that result from the outputs 82 JAF3/INF/DOC 8 Pagc 3 t .I . behaviorrt'/coveruge ( comniunity particrpatiort. coverage) 1.2. knowledge (Knorvledge of why taking ivermectin fbr many years is inrportant) t 3 .skills ( appropnate skrlls developed by the actors in CDTI) ., n"+'..'+ i-rlinafrrrc Outputs are immcdiate prodr.rcts and services produced by the programmc 2.1 . utilization o.f'sen,ice (acceptors/users, pro.;ect continuation, drop-outs. cost) 2.2. clualitt, of CDTI service (management of cases, education, contacts. access to CDTIl 3. [nput indicators lnputs are resources needed to carry out CD'fl activities 3.1 . persontrel. (manporver developed at vital levels for CDTI implementation) 3 2. Logistics ( iunds. ivermectrn supply. transportation etc) 3.3.reporting (ararlabrlinoimatenalslorreportrns-notebooks.tbrms.summan'booksetc) 83 iAF3/tNF r)OC.8 Pagc .1 iVI ONITO ITI \ ( ] IiORr\I (C] I{ ECK I, IST IIO II I{O Ti'I' I N E N I ONI'IO RI N G) EFFECT INI)l(-r\TORS Nuu.rt.t.r ot' target communities that decrded on the critena for CBDs selection, or on the pcrttlcl or nretlrt'.I o t' cirug ciistribution/ Annual'lreatment Oblective (A'tO) OUTPUT INI)I('ATOIIS Nunri..'r ot'at-rrsk r r[[ages treated/ ATO Nunri.i'r trt'eligrble persons treated / ATO Cost p.'r [)crson treated Nunrt.t.r ot'target conrmunities rn rvhich CBD rs a part of or is supervrsed by the pnnlary healtl'r carc systeru \TO Numtrr ot' target communities s'hich received ivernrcit irr treatment iATO health education about importance of extended TNPUT INDT(..\TORS NumL'cr' (rt target communities u'tth trained CBDs /ATO NumL's: trf communitres that erperienced late supply or shortage of ivermectin/ATO Numrc: oi target conlmunlties rvhtch collected ivermectin fiom the health centreIATO \urr,l.': ot' irealei commuilllles sirh surnman tonns -l'TO Numci: oi health cenlres u'tth records -\TO 84 JAF3iINF/DOC 8 Page 5 vroNrroRING FORI{ (CHECKLIST FOR INDEPENDENT MONITORS) Independent monitors ',vill be required to use elaborate social science methods to address these indicators in addition to others they may select and submit a comprehensive report to APOC. EFFECT INDTCATORS Nu'tt_..'- rc t::-3,.- :omnrunitres rvl.i.|., decid"d the period s1 msthnd oI trextment Number of target communities that decided on the criteria for CBDs selection OUTPUT INDTCATORS Number of refusals two months after drstribution Number of eligible persons that dropped-out of the fteatment due to cost (Cameroon), side-etfects, feeling of well-being (all countries). (From year 2) Number of at-risk villages lreated Cost per person treated Number of communities where CBDs were changed by the communiry after the first treatment Number of target communities in which the CBD is a part of or is supen'ised by the primary health care system Number oi targel communities rvhich received health education about tmportance oI ertended lverrnectin treStment Number of children 5 vears and above u'ho recetved lvermecttn TNPUT INDICATORS Number of target communities with lrained CBDs Number of communities/ projects that experienced late supply or shortage of ivermectin Number of pro.lects rvhich experienced late supply of funds Number of target communities which collected ivermectin from the heaith centre Number of CBDs rvith measuring device for height Number of treated communities with summary forms Number of health centres without records 85 JOIN'f ACTION FORUM Of tlce ol the Chairman iOINT ACTION FORUIvI Third session Af'rican I)rograntntc titr Onchocerciasis Control (APOC) [)r'ograrr.rnrc alricain rlc lutte cor]tre I'onchocercose JAF-FAC APOC PROJECTS EVALUATION FOfuVI F'ORUNI D'ACTION COMIVIU NE Bureau du Pr6sident JAF3/INF/DOC.7 ORIGINAL:ENGLISH OCTOBER 1997 86 WORLD HEALTH ORGANZATION AFRICAN REGION ORGANISATION MONDIALE DE LA SANTE REGION DE L'AFRIQUE AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) PROGRAMME AFRICAIN DE LUTTE CONTRE L'ONCHOCERCOSE B.P. 549 OUAGADOUGOU, Burkina Faso T6169r': ONCHO OUAGADOUGOU Tel-.. (226)30 23 01 -1[23 12- 30 23 13 Telex: ONCHO 5241 BF Fax (226\3021 47 APOC PROJECTS EVALUATION FORM EVALUATIoNoFcoMMUNITYDIRECTEDTREATMENTWITHIVERMECTIN(cDTl) PROJECTS please complete this form by providing detailed answers to all of the question: b"l9Y: You are required to give the exact figures and where n""Li.rry a Jescriptive explanation. The programme's actjvities will eventually be evalua6d against sustainability and coverage indicators' THE EVALUATION FORM HAS FIVE SECTIONS: please complete allsections' For each approved project a separate evaruation form should be completed. Please return the completed copy(ies) to APOC Headquarters in Ouagadougou' Country State Region Project Phase Project Code Period being evaluated Form completed and endorsed bY DateSignatureNational Onchocerciasis coordinator [Mrs] tMsl [Md [Dr] e-mailFaxPhone DateSignatureNOTF Chairperson/chairman [Mrs] [Ms] tMr] tDrl e-mail:Fax:Phone 87 PART I PROJECT PROFILE AND MANAGEMENT 1. Project Profile 2. Management RePorting SYstem . please, list the principal activities of the project carried out during the period being evaluated: Are activities being carried out according to the plans of NOTF and on schedule? lf not please, state the major constraint(s) experienced o a anization in the project dr€? (name & number)administrative org Number of target communitiesNumber of communities Population of target communitiesPopulation of communities Major constraints 88 Solutions o Were record forms from the prolect area accurate and completed on time? Expected report forms(S'l ) Received record forms(52) Form reporting rate e6) (S3) 53 = (S2:S1)x 100 Report forms co,mPletelY filled Report forms PartiallY filled Report forms received on time Report forms not received on time 3. Administrative and Financial Management of the CDTI project Please attached the twelve month financial report . Which is the month of the last statement received from the bank? o Which is the month of the last bank reconciliation in the accounts of the project? . Have any of the accounts been audited? . lf yes, give the date . Are the NOTF accounts being operated to the satisfaction of the NOTF? . Have there been any complaints or financial irregularities? . Give the exact amount and date the Trust Fund money was last credited into NOTF account. Amount credited (US $). Date: . Did the date of receipt of Trust Fund money meet your expectation? . Did the NOTF experience any administrative problem(s) with the bank? . lf yes, state succinctly the problem(s) What should be done to avoid the problem (if any) in future bank transactions? 89 Are the financial reports from the zones/ProvincesiRegionsiDistricts(s)/LGAs received on time at the NOTF Headquarters? lf not, state succinctly the reason(s ) o a 4. Support from National Authorities (state which level of government provided an assistance) What action has the government (Federal/National. Regional. State District, LGA) taken in support of the project since its inception on . Personnel needs for CDTI operations Transportation needs (in the current phase only)o a Accommodation needs (e.g. buildings provided by government, be specific) a lndicate any other type of support from the government 90 t 5. Effectiveness of communication please indicate (X) beside your response the type of communication frequently used in the current year and which you found most efficient APOC HQ and office of NOTF HQ NOTF HQ & office of chairman NGDO coalition NOTF HA & Zonal or Regional offices Zonal /Regional offices DistricULGA office of the coordiriator DistricULGA office of the coordinator & community leader Type of Communication Effective Not effective Effective Not effective Effective Not effective Eff ective Not effectrve Effective Not ef fectrve Radio Telephone Fax lnternet (E-Mail) Courier Ordinary mail Messenger Any suggestions to improve communication for better management of the project? Please indicate 9l WORLD HEALTH ORGANZATION AFRICAN REGION ORGANISATION MONDIALE DE LA SANTE REGION DE L'AFRIQUE 1 AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) PROGRAMME AFRICAIN DE LUTTE CONTRE L'ONCHOCERCOSE B P. 549 OUAGADOUGOU, Burkina Faso Telegr.: ONCHO OUAGADOUGOU Tel. (226) 30 23 01 - 9 23 12 - 30 23 1 3 Telcx: ONCHO 5241 BF Fax. (226) N 21 47 APOC PROJECTS EVALUATION FORM - Project Code EVALUATTON OF COMMUNTTY DTRECTED TREATMENT WITH IVERMECTTN (CDTI) PROJECTS PART II IVERMECTIN PROCUREMENT, DELIVERY SYSTEM AND DISTRIBUTION Procurement and movement from the Mectizan Donation to the national store house What date was the order to Mectizan Donation Program made by the NOTF? On Which date did the drug arrive at the port? On which date was the clearance from port completed and drug taken to central store house? Who cleared the drug from the port? (Check below) Does the Govemment accord an exemption from taxes and customs duties? Did the MOH or partner /WHO pay any fees/charges for drug procurement from port of entry? a lf yes, how much US $ to whom were the fees/charges paid? Any other problem(s) in connection with the movement of the drug from Mectizan Donation Program to the store house? Please indicate o O O o o a Office of the NGDO partner WHO NOTF Secretariat Ministry of Health (MOH) Others Please specify 92 a2 Delivery and Distribution of ivermectin from national store house to the community 2.1 Movement of IVERMECTIN from national store house to the community What is the average (state minimum and maximum) time it takes for the drug to arrive a Any special problem(s) in connection with the movement of the drug from the national store house to the community? Please indicate Problems Steps taken to deal with the problems Distribution of IVERMECTIN What is the average (state the minimum and maximum) time taken by most communities for drug distribution Time [Hours, days] Average Minimum Maximum a Any special problem(s) in connection with distribution at communi$ level? Please indicate Problems Steps taken to deal with the problems 2.2 a from national store house to Average time Minimum time Maximum time Regional/Province/Zonal store DistricULGA store Central Drug collection point (health racilitv nearest to the communitY) Time [Hours, Days] From arrival of drug at the district until it gets to the communitY 93 I lf several other sfeps more than stated below are involved, please specify 94 WORLD HEALTH ORGANIZATION AFRICAN REGION ORGANISATION MONDIALE DE LA SANTE REGION DE L'AFRIQUE AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) PROGRAMME AFRICAIN DE LUTTE CONTRE L'ONCHOCERCOSE B.P. 549 OUAGADOUGOU, Burkina Faso Telegr.: ONCHO OUAGADOUGOU Tel..: (226) 30 23 01 -{23 12 - 30 23 13 Telex: ONCHO 5241 BF Far (226)3o21 47 APOC PROJECTS EVALUATION FORM- Project Code: EVALUATION OF COMMUNITY DIRECTED TREATMENT WITH IVERMECTIN (CDTI) PROJECTS PART III CAPACITY OF THE NOTF/ONCHO COORDINATORS/SUPPORTS STAFF AND THE PHC SYSTEM Please provide below information on the size of the NOTF (full and part-time staff) by giving the number and category of staff involved in CDTI at: Fulltime Part-time Level Category of staff Number Category of staff Number Central RegionalZonal DistricVLocal G overn m ent Community 95 o How many different categories of personnel lptease srate number in each category) are involved in the training of. Government Staff NGDO Staff Activity Category Number by category Category Number by category Community directed distributors (cDD) DistricVLGA coordinators Health personnel involved in CDTI Health education and information to community I a a Please provide below information - days CDDs were trained in all project communities (averase, minimum, maximum) tr Average number of training days o Minimum... ...... o Maximum - Total number of CDDs trained: o Female o Male - Number of trained CDDs still on job o Female r Male Number and proportion of the health staff at the districULGA levels involved in the project with: Number of health staff Proportion Training the community directed distributors Supervision of ivermectin distribution Management of severe adverse reactions How many of the CDDs are health workers?a 96 I ./ORLD H EALTH ORGANIZATION . AFRICAN REGION ORGANISATION MONDIALE DE LA SANTE REGION DE L'AFRIQUE AFRICAN PROGRAMI\4E FOR ONCHOCERCIASIS CONTROL (APOC) PROGRAMME AFRICAIN DE LUTTE CONTRE L'ONCHOCERCOSE B.P. 549 OUAGADOUGOU, Burkina Faso Til6gr.. ONCHO OUAGADOUGOU Tel..: (226)302301 -3023 12-3023 l3Telex ONCHO5241 BFFax (226)3021 47 APOC PROJECTS EVALUATION FORM - Project Code EVALUATION OF COMMUNITY DIRECTED TREATMENT WITH IVERMECTIN (CDTI) PROJf CTS PART IV PERFORMANCE INDICATORS 1. lndicators of SustainabilitY 1.1. Commitment of the Partners o lndicate in US dollars using current United Nations exchange rate to local currency, amount and percentage share of all costs being provided by: o lndicate in kind contribution of Communities 1.2. Communityinvolvement State the number of target endemic communities under evaluation involved in . procurement and collection of IVERMECTIN from central point:.. o reporting cases of severe adverse reactions:. o referral of cases of severe adverse reactions:. 97 Budgeted Released A,mount($ US) otlo Amount ($ US) otto The Ministry of Health (MOH) The local NGO(s) The NGDO partner(s) APOC Trust Fund Districl/LGA Total 1.3 lntegration into health service State activities under drug procurement and delivery which are being carried out by health personnel in the project area: State the number of target endemic communities in wfrich the CDD is Number of target endemic communities parUstaff of the health delivery system supeMsed by the primary health care personnel State the number of target endemic communities in wl^rich supervision is done by Primary Health Care personnel Number of target endemic communities SupeMsion is done by PHC personnel 1.4. A Round Treatment Estimated Cost lndicate in US dollars using the current United Nations exchange rate to local currency, cost of: a a Estimated cost ($ US) Drug delivery from port of entry to central collection point Training CDDs Supervising CDDs Monitoring CDTI Total (T1) 98 az Ref usal/absentees 2.1. Refusals Please state Number Number of communities in the districUlGA where cases of refusal have been recorded number of people who refused treatment in this phase lrzy Average number of refusals per community State the three frequent reasons for refusals How did the NOTF deal wrth the problem of refusals lrorp€riodbeinsevatuated)? 2.2. Absenteeism What is Number the number of communities in the districts (LGA) where absenteeism is the main reason for not receiving treatment? Total number of people who were absent from their treatment areas during this phase 6rs1 average number of absentees per communi\p Please state, howdid the NOTF deal wth the problem of absenteeism (rorperiodbeinsevaruated) ? 99 Number of targeted CDTI communities treated with IVERMECTIN CDTI communities not treated with IVERMECTIN Population in the CDTI communities (A) Eligible persons not treated (for one of the following reasons) - pregnancy (cl) - breastfeeding 1cz1 - sickness 1cs1 Total Population not treated (B) = (cl + c2 + 63 + fl + T3) Total Population treated (T41 = 4 - t 3. lndicators of coverage of CDTI Please indicate below the number of targeted a 4. a a o Reporting/Management of cases of severe adverse reaction Have you had reporting of severe adverse reactions during the period under evaluation? ..... lf yes, is the NOTF satisfied with the reporting of cases of severe adverse reactions? Please indicate who reported cases of severe adverse reactions (multiplechoice) ? o Communities a Community Distributors a Health staff ls the NOTF satisfied with the management of cases of adverse reactions in the project arca?. D lf yes, what are the major causes of satisfaction? o lf not, what are the major problems and how is the NOTF addressing them? a r00 5a Local Operational Research Are you conducting any operational research in the current reporting period? a lf yes, please give the title of the project and the districulcA vr,trere the operational research study is being conducted. ll DistricULGA a Please state one or two reasons for the choice of the topic of research 6. Local effort to evaluate integration and coverage of the CDTI Project O Are there plans (local efforts) to evaluate the integration of CDTI into health care system? a Are the communities leaders participating in the projet integration or in the improvement of coverage ? lf yes, list activities/decisions;.... a Are there planned activities to promote the involvement of women, school children and non-literates in cDTl activities? lf yes indicate those activities: a a Please describe succinctly the any activities which could contribute to promote or to rmprove coverage r0l PART V Please write freely but succinctly on any aspects of the execution of this project that miglrt not have been adequately covered in the preceding structured questionnaire. a t02