RESERVED FOR PROIECT LOGO/IIEADING OzuGINAL: English COUNTRY/NOTF Proiect Name: NORTHWEST CDTI PROJECT Approval year: 1999 Reporting Period: From: January 2006 To December 2006 Proiectvearofthisreport: (circleone)l 2 3 4 (5) 6 7 8 9 10 Date submitted: July 19, 2007 NGDO oartner: SSI ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC DEADLINE FO SUBMISSION: To APOC Management by 31 Januarv for March TCC me To APOC Management by 31 Julv for September TCC meeting For Tor i ru)fi For Tor , '(.qA cEv BIM a? '++tFsp e fi @,v I L..-----,- AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) I I JUIL. 2007 I WHO/APOC, 30 July 2007 Launching vear: 2000 II I I I I I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEME,NT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: LIBERIA National Coordinator Name: Henry T. Salifu Signature Date Zonal Oncho Coordinator Name Signature: Date NGDO Representative Name: Verda Tarpeh Signature: . Date This report has been prepared by Name: Henry T. Salifu Designation: APOC Signature Date ll WHO/APOC, 30 July 2007 Table of contents ACRONYMS v DEFINITIONS.. VI FOLLOW UP ON TCC RECOMMENDATIONS I SECTION l: BACKGROUND INFORMATION....... ...................... 3 1.1. GeNeRalrNFoRMATroN............. 1.1.1 Desuiption of the project ftriefly)1.1.2. Partnership 1.2. PopuLerroN............... SECTION 2: IMPLEMENTATION OF CDTI 2.1. Truer.rNe oF ACTrvrrrES 2.2. Aovocecy .8 l0 2.3 2.4 2.5 3.1 . 3.2. J.J. MontltzerroN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMuNtups l0 CovuuNrry INVoLVEMENT......... .....12 Capaclrv BUTLDTNG.. ......14 2.6. TRparvpNTS............... 2.6.1. Treatmentfigures ...18 ... 18 2.6.2 l{hat are the causes of absenteeism? .......... ................. 21 2.6.3 What are the reasons for refusals?................ ............... 2l2.6.4 Briefly describe all known and verified serious adverse events (SAEI that ... 2I 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year23 2.7. ORoenmG, sroRAGE AND DELTvERv oF IVERMECTrN............... ..............24 2.8. CovrrauNlry sELF-MoNIToRINGAND STAKEHoLDERS MeprNc 26 2.9. SupeRvrsroN............... ......................27 2.9.1. Provide aJlow chart of supervision hierarchy. ............27 2.9.2. What were the matn issues identi/ied during supervision? .............................. 28 2.9.3. Was a supervision checklist used? ............. 28 2.9.4. What were the outcomes at eoch level of CDTI implementation supervision? 28 2.9.5. Was feedback given to the person or groups supervised?................................ 282.9.6. How was the feedback used to improve the overall performance of the project? 28 SECTION 3: SUPPORT TO CDTI ..............29 EqurrueNr FrNaNcral coNTRIBUTIoNS oF THE pARTNERS AND coMMUNITIES... Oruen FoRMS oF coMMUNrry suppoRT ............. 29 30 30 303.4. ExpBNonuRE PER ACTrvrrY SECTION 4: SUSTAINABILITY OF CDTI........ ..........31 4.1. INrrnNel; TNDEIENDENT pARTrcrpAToRy MoNrroRrNc; Eve1uerroN.................... 31 4.1.1 Was Monitortng/evaluation caruied out during the reporting period? (tick any of thefollowingwhich are appltcable)............ ...........31 4.1.2. What were the recommendations? ............. 32 4.1.3. How have they been implemented? ............. ................. 32 lll WHO/APOC, 30 July 2007 4.2. SUSTRNRnILITY OF PROIECTS: PLAN AND SETTARGETS (UeNoarORY AT............. Yn 3).... 4.2.1. Planning at all relevant levels... 4.2.2. Funds....... 4.2.3 Tronsport (replacement andmaintenance) . ........ . 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented............. 4.3. INrecnauoN,............. 4.3. 1. Ivermectin delivery mechanisms................ 4.3.2. Training.... 4.3.3. Joint supervision and monitoring with other programs 4.3.4. Releose of funds for project qctivities4.3.5. Is CDTI included in the PHC budget? .............. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements?............. . ................ 32 4.3.7. Describe others issues considered tn the integration of CDTI. ..... 32 4.4. OppnarroNAl RESEARCH ..... 33 4.4.1 . Summarize in not more than one half of a poge the operational research undertaken in the project area within the reporting period. . ............. 33 4.4.2. How were the results applied in the project?.... ........... 33 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES.... ...................33 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........33 lv WHO/APOC, 30 July 2007 32 32 32 32 32 32 ............ 32 ............32 ............ 32 ............ 32 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT I.INICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community S elf-Monitoring Local Govemment Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization v WHO/APOC, 30 luly 2007 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84o/o of the total population in meso/hyper- endemic communities in the project area. (iii) I Treatment (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) nt Goal calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached fulI geographic coverage (normally the project should be expectid to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) SustainabiliW: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (.CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of Ivermectin distribution and make appropriate modifications when necessary. vl WHO/APOC, 30 July 2007 FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 24 (Please add more rows if necessary) 1 Number of Recommendution in lhe Reporl TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROTECT FOR TCC/APOC MGT USE ONLY l. That the Northwest CDTI project report be resubmitted to next TCC meeting. The Northwest CDTI Project was carefully Scrutinized and all necessary corrections were made. WHO/APOC, 30 July 2007 Executive Summary Prepare an Executive summary of the report in not more than one page, 1. Background on treatment and population dato - Total communities, communittes' treoted, total population, UTG, ATO and persons treated. 2. Background on population movements. 3. Training data - CDDS, health workers, Total population (community) per CDD trained. 4. Challenges and horry they were overcome. A total number of 1,463 communities exist in the Northwest CDTI project area with a total population of 1,333,116 in the meso/hyper area. A total number of 905,449 persons were treated giving a therapeutic coverage of 68%. The Annual Treatment Goal (UTG) and the Annual Treatment Objective (ATO) are 1,119,817 and866,525 respectively Economic activities of the project area are mainly concentrated in the capital seats of Montserrado, Margibi, Nimba, Bomi, Bong, Lofa and Gbarpolu. Additionally, one of the two major institutions of learning, the University of Liberia is also located in Monrovia, the capital City of Liberia. As a result, large portion of the population move to these counties to seek employment or education opportunities. Moreover, the movements of people intensified during the past 14 year civil war. Some people sought refuge in the neighboring countries or the Diasporas. Nevertheless the Oncho management conducted several advocacy trips to the project areas and was able to achieve a reasonable therapeutic coverage of 68%. Training of health staff and CDDs was carried out in all project areas. A total number of 5,823 CDDs (male-5,495 & female, 328) were trained and 329 health staff was trained under the reporting period. Additionally, 109 health staff are involved CDTI activities As the internal movement of the population became very frequent at the end of the civil crisis, the retention of CDDs in project areas and adequate financial motivation became major challenges. Prompt interventions by county and district elders saved the day when project area, community elders paid the CDDs in kind (food) and affordable cash value services like transportation fees. The challenges faced during the CDTI activities were as follows: o Communities did not show appreciation for the services rendered by CDDs. o Some CDDs did not cooperate in the distribution of the Mectizan. o Some administered the drug but did not record the dosage in their registers. . Some CDDs did not know how to f,rll in the treatment forms (community and county). o Some communities were not treated due lack of transport for the OICs or due to the inaccessibility of motor roads. Notwithstanding, the CDTI activities were carried out with an appreciable level of achievement. 2 WHO/APOC, 30 July 2007 SECTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) G e o gr aphi c al I o c ati on, top o graphy, climate Population: activities, cultures, language Communication systems (roads ...) Adm ini s trat i on s truc ture Health system & heatth care delivery @rovide the number of health posts/centers in the project area if the information is available). Number of heatth staff in project area and number of health staff involved in CDTI activities. The Northwest CDTI project is located in four (4) endemic counties of Lofa, Nimba, Bong and Montserrado, all situated in the North and western part of the country. The terrain is mostly flat, particularly in the coastal plains and rolls up gently through the plateaus and mountain ranges to the highland. The counties are traversed by many rivers and iributaries. Many of these rivers and their tributaries have breeding sites for black flies, the vector of Onchocerciasis. The leadership structure in the project counties varies with the ethnic groups in the communities. In hamlets, villages and towns, there are elected chiefs who are guided by council of elders in decision making. The townships and cities have commissioners appointed by the president and mayors elected by residents. The health system in the project counties is relatively well established. There are eighty eight (88) health facilities in the project area with 329 health staff and 109 health staff involved in CDTI activities. The occupations in the communities vary between urban and rural settings. The latter engage in farming activities from January to December. The Residents of townships and cities are involved in commercial activities, public services and other salaried jobs all year round. aJ WHO/APOC, 30 luly 2007 Table 1: Number of health staff involved in CDTI (Please add more rows if necessary) Number of health staff involved in GDTI activities Total Number of health staff involved in CDTI Number of health B3=B2l81.100% 50o/o 83% 20o/o 38o/o 14o/o 50% 50% 22o/o 30% 18o/o 11o/o 20% 25o/o 20% 18o/o 17o/o 17o/o 50% 7lYo 50% 10o/o 33o/o 43% 33o/o 44o/o 28o/o 57o/o 32 16 50o/o 329 109 33% 1.1,2. Partnership Indicate the partners involved in project implementation at all levels IMOH, NGDOs (national/international), communtties, local organizations, etc. l Describe overall working relattonship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. B1 82 2 5 5 2 2 2 3 2 1 2 3 2 2 2 2 3 7 8 3 4 6 4 4 7 8 6 10 16 12 14 12 I 14 4 6 5 7 4 4 I 10 11 I 10 12 10 13 1 1 11 12 12 30 25 4 Percen e District Belle Gbarma Kongbah Bopolu Bokomu Sanoyea Zota Panta Kpaii Suakoko Salala Jorq uelleh Kokoyah Voinjama Zorzor Salayea Kolahun Foyah Vahn Gbehlay-Geh Tappita Yaruvin-Mehnsonnoh Saclepea Sanniquellie Zoe-Geh Todee(Lower/Upper) Caresburg St. Paul North/South Monrovia Total WHO/APOC,30 July 2007 The Communitv The community leaders select CDDs for training in preparation for Mectizan distribution and sensitize the population on the importance of taking Mectizan. The CDDs, also part of the community, mobilize, sensitize and distribute Mectizan to their respective communities. The communities take ownership of the CDTI activities and pay CDDs incentives in kind or cash to distribute Mectizan. Community members and CDDs report side effects due to Mectizan and members with poor vision are referred to health centers for eventual follow-up by appropriate health authorities. Ministry of Health The Ministry of Health (MOH) and NOTF at all levels do the planning advocacy, mobilization, sensitization, and supervision of CDTI activities. At the end of treatment year, NOTF prepares all technical reports to be sent to APOC. NGDO During this reporting period, our lead NGDO, Sight Savers International (SSI), and Christian Health Association of Liberia (CHAL), all participated actively in the planning, advocacy and supervision of CDTI and Eye care activities in the country. The Mectizan Donation Program supplied the needed quantity of Mectizan requested and on time. 5 WHO/APOC,30 July 2007 F-o N O ca (-) o - o tr o s CL o o- E ogo ^qE O .Es5 -(Eo o, o)lr)s (o o)o (f) (os o) o r @ F- o- r o)N\ - lo O)o (f) @$N (f) r r O)lr) .t soN- o) r O)|l(. f.-- rN lo o) o) o, (oort- s os(fr_ (o r N (o c.) r F* s- (f, o,|,-\ rO ot o- lo otr)oo .8" EL -.- = )E e +gEt R f -E, E roN$- ro o)lr, rO r (r,o(o r o)lo c\l $ (f)(0 o)- (f) v@ @_ (f) Nt-\ 1r, r ro(o nlf, N(o @ e.iN (f)o o)_ lr) N o) O) @_ r s(f) ro Nlo a. o, (o$ O) c") N(f) rs N$(o r(o ooo(o s(o o, ..gEr.Ft E IE;EE !LL^' ooy NQ (o @o co o, .t @ (f)t- co @ @nl O) s(f) @- O) o o! 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Timeline of activities Fill in table 3, timeline of activities for areas treoted in current year, indicating when the key activities were implemented by the month they began and the month they ended. 8 WHO/APOC, 30 July 2007 t-- ON c-t Q 11 Or o\ U) 0.) oO I \o N (,) c! Fr o 3 o *.) rll L *J pn AFt I +. CJq) Lrq) a -\ r\ v 14q\) Uq) q- c1 . p q) o t q) t4 q) E L<(d C) >. 9tro 3<L o o t) tr !o l-J CdoLr+) ad C) L< CB 0) +J k € V) o +J od +r o C) tr o E F c.ir 6)l -ol cdlFI an o)c a o o6EE o(J lr(D -o ooo o k(.)p E(.) oo a L<o .o Eooo a Lros Eooo a ko3 oo() a aocE :tr o Cg a C)k Cd a ok cd a ot< c6 z oL(d a L .r) E ba h a5EE I >t) h >. >' a0EE (n- >. Cd z Cd a (s a >r CB a >, a () 6tEq D qh 0 q)(J o o5EE Q (B >tCB a x(d a >.d a >,(B\3z boEE ch- ot< Cd a oLi(B a ot< =a ot< Cd z oL CB z at 6lLF trts o(J >'t(o a CO d =a CB z CB z b.0EE ?E 6=atr k O. t< O. L<q t<a tiq v4' rO o.E .EH s= &Eootsr c)a o EOEE oQ Ot< cl a ok Cd ok ed oLi(d ol.id b.0Es 1itr cr= a- xL{ cs)i CB >\ (B CB h Cd d >\k CB Cd Li Cd tr(B tr ,.4F r-'r EB dHx&Cr- z Fzp U oa Cdp o o0 o m -(d o F] (d -otr z o13 CB E(.) U) +Jtr o 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current yeor; the ,rotoi(t) fo, undertaking the advocacy and the outcome- Describe dfficulties/constraints beingfaced and suggestions on how to improve advocacy. A total number of four (4) county superintendents and several town chiefs in the project areas were formally acquainted with CDTI activities as the project is only in its first year of implementation. ihese level of decision makers involvement in any developmental project is a must if the project is to succeed. Although it was difficult to meet some of them even at their own scheduled time, NOTF management was however able to get the message across and we are hopeful that with their involvement with the advocacy, our therapeutic coverage will increase in the next round of treatment. 2.3. Mobilization, sensitization and health education ol at risk communities Provide information on - The use of media and/or other local systems to disseminate idormation - Mobilization and health education of communities including women and minortties - Response of target communities/villages - Accomplishments - Suggest ways to improve mobilization and sensitization o-f the target communities. The beneficiary communities were mobilized and sensitized regarding the danger posed by the Onchocerciasis disease, the importance and benefits the communities stand to reap as the result of taking the Mectizan. The brochures, Oncho posters, , land measuring sticks were used to train the OICs and they in turn trained the CDDs. In order to continue to improve the mobilization and sensitization mythologies in these target communities, we move to suggest that more brochures and posters be printed and distributed among all the superintendents including the chiefs in the CDTI project areas so as to involve them in the activities of CDTI. Also, the Management of Onchocerciasis should involve all partners especially the NGDO (SSI) in CDTI project and be very open as to the mobilization, sensitization, health education, monitoring and supervision. l0 WHO/APOC, 30 July 2007
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E6 U) .C o 6)g o -c([ o .Y oY (s E(5 'e '6 cf, -c(56Y c -co 4qq) U v V') r- \)\. t \) riq) a* -F aO (.)fl-cEeo.EEEo.= o .;i Eb .-X +, c.) aI !iE'EfHEEEEo-C': +Iloi fll gt.c"o !q *'- ll * = @$ ,g trQb'dd@ r-oo cl >. co d o o. la rt ca €olr C) ol-r C') C)Q atr c) U) o tr € a a() oI v) 63o rd 63 E o € 0) .54 Ch E(!) o0 bo >'p o d o C)koo Cd Eo B c/) (r) o H oo() tr oa ch O od F oO ol-{) ,d o -( C) o q)s g oil 59odil b.a -cx(Be6tr E9'eSaslr-r6.)=dsF (!.=!E *E !292 U --()x0) €EbE r-O Ei:Bvt(Eb0a' -!e3+ .Z!5^ 6t AH.NE .tr!F20ob9 r\ 6 *\-/ e t)oo'= * *!; sts(.)B=r\a v!z'aE )tnE E898QC)0)!U !4h(*tr9loq{*P.A EE # S -.2 H aEE E ?9x I # *d E o!€ ^.HEy_0).C,c=$ic);{HL '- - irr CdEE N g3o 6 I?c 'A ch =cd>E 6 ^(,o,trx6E : 3UE E 8e.E € n cS Lr f )d.rHE-3 3 e +i€6J!=E d E;a 1 e9E \t BII rr (D -C) EE E EEE E iId)* o)EE T f, qt v B\ a) 4q) V'1 v-, u .k s "sq) rr sq a) q .Fj !:F! aU u =q bO q) \) N.S\ -v>6{-' b U8"s E ts o h LAE V) \+F\. ^LV'E o' *s tsb ., \ ^iY$Y hN !F\$s\<) -qJEs tB$PsE 5E.s . \ sB 8"sSs UrS'S s)+aSE Ss'8.$ hS ^. .Y \X..s *E^s'Rh d.t'E 3Ue! aP-\-s:\ E s 6 -io'=SisEE='i$L!-rdiESsdis s s,t s'<lr^$\)srstN .!l r s'i X\-'F\'* o-o'< E \ \.) ",3 *'I ;\. S s$ssssq) U sN @ c{ o c{ slo N!t F (f, @ r- ss @ sNr s@ r so ssr so s F-r s so c! s@ s c! s(f) r F* N lor o (f)r o @r or N N s N tlo t- N o ro r lo(o (Y)(\oIo tf o,N @ o,N rOoN olf) r F- o) lf,t-N lo @N @ F- ro N lo F- @ o r (f) N $ lr)N c,(\(v)N o - lo r olr) ln) o)rfIo t-oN (o @N o O) oo s@ ooN F-vN @ @ N N lo r N (o$ o so(f) s!t s(o so$ s rr) ro s @(o so ro s$lNso, s(o s r s@$ slr) r @ @ tG'@ (o o o.t sr o $ (o t o) r (o GI'@$@@ o No) (f)@ $o) (f)(f) (oo r (f) O) o (U o ([ E U) .C o) o I (5 -c.o -oo F (E o o. o(J(u a -c.o Lc o v,c -co Ic E(s g of .gctr(E U) -c.o(, I o)oN L o) o-o :) od L o =oJ o c)EoF o)L J -oo oL oo I )(U(L U) 5 3.ea>E9tscooz> E oF L o NoN 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. - Were frequent transfers of trained staff occur, state what the proiect is doing, or intends to do, to remedy the situation. (Ihe most important issue to describe is whot meqsures were taken to ensure adequate CDTI implementation where not enough knowledgeoble manpower was available or if staffs arefrequently transferred during the course of the campaign). In the Northwest CDTI project areas there are altogether 329 health workers and 109 of them were trained to conduct the CDTI activities and the distribution of Ivermectin for the sole purpose of eradicating Onchocerciasis as a public health problem. In order to ensure adequate CplI implementation where there were frequent turnover of knowledgeable manpower who-are involved in the CDTI activities, the attendance of the annual training of trainers was increased from 3 participants per county to 5 participants so as to fill the ,u.urt positions created as a result of quick transferred of health staffs during the campaign. l4 WHO/APOC, 24 November 2003 co N Lop 0) z .f, N (-) - I (J FL ra) looN olo F-o, loi- ol lo(o N ta, o a! \t o;rFY(o o NoN NNN ro O) O)to @o) loNN @ N @o C\t F- O) (o NN (o o,N lo o,N (o o,N o @N @N loo so,N (o o)N ro @.}'oo-to @ @ lr)oN lo @ Nro (o @ oNN to N (t, o) t-@ @N ro r.-N o o, C\t o @N $F- c\t @ ro o,@N @N to o, olf) NN loF- lo lr) o oo rl)N oo c{ o@3r26 $ F- o F- N ro c.) lo o 1o co 1r) rf) (o oN oo N (o oN(.) oc.) o O) ooN o ro(o oo(f) oloN otr) N ro o oo(f) o 1r) (f, E oc r! oooo o o .o =)z O c?, Eo o(f) N olr) N o N oo orr) oo(o lr) N.N o @(r) ooN lO @N rO N(r) N @ rr) CO lo o +(!0 o;rFY N o N $ (o N rO $ $ ro lr) N N N (f)N tr) N (f) (t s N N * (o,!oFd,o cf) (f) o $ N N N!o25 o O O o N o o N o o o o rf, @ (o$ $ rO (o @ F- (o @ t- (o r..) rO (o $ (f) $ (o+€ e= e3s !E OZOE E eo)F(J N $ lf)N $ (9 N lr) s (O N N N (O @ (f, t- F-o3,3ooFI @o N N s N (o (,N $ N N N (f, c., N N spB o o o o N $ t N36 o o o o N N o oNt (o O) rr) (o r{) rr) N (o t $ (o N N o E=E*t e.,ko @ $ N $ N (o l() l() lo lr) o o $ rr) lO N rr) N lo F'oE*,ooFlr rfo c) !t lO N lr) lr) rO lr) r() o o $ N (o (f)EB (o (o lr) N (o it lr) t (o (o N $ No N o N N s c) o o (o CO N3u o o o @t (o tt o @ o @ @ @ o, t- @ F- N @ rr) @ @ $ o(f, *{=oo I s J.! +fis;fi86' o oL rr) E o o N oN c o Ef -c -goY E oo ov o .Y o =a (U c o(L (u oN a E oJo cn (U E o -oo o (, .9,o .g ) : Bh4\) q) .\ \ aL o\ t B \) rtq) U o d (.) tr o o. 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C) =o(L U) I ! B.su)> >9tscooz= E oF t (E =o. o. oF F- o e.l o co U o o N a!a El ! q\B s tl'\ 06 q) 0O \ \/S) -sJB!/ q)L3E d €UB.$i$ r c)t *s: av _-C !! I9-: s;'EH(g !.r (H ir -\Jool !H{t'(.) .E E 'o::S r'EItiP:dIU h\ -c\i $ H': !'HU* .='$s 9a-s *r.s or tl F 'i ol P v 6 -l o.r s Sxle E S vtu!99l o-l = 'i sla. N Srl I : s9l a'E .,{8iE€*(.)l L E !S'a+9 Y \Gt # \ % :I E \ Iol c s E -ot - A '\EIE 5 I5t b s EZlt- .S t boP EN \sil tEQS&'.\ :\s'vL L$$.oES =iE iSE ES € EE cg qJ q)O EE lttll : PFg\\! (') L 9(J(.) -Lo*! c.r 9P Oe()-= 'aA LV ZO) r,trF, = ^/.LA =-o9 U>0)?t- qo()E L .: c)c-o Fhtrd ts6:() ()P a, 'E a)tr al tr!J ol =E *l tsI "l 8r El.gg NI E) Hl o..r+ sl !A @l eol ; ol o olol c,l orl .r Ol -l tr .9l 6 -l o-r!; EI* IIEEt'; ?t< Et I EI = :EI H EIPiil .a Hl - pl v -9t - EtJ gt E01= =tH oI()ol .: El : ol tr8]H 3IE BIEql j ql -! q-l Iol o- ol tr ol-pl O ul 5 rl' -813 -81 " -8lEEIS EIS EIE =lb =lb =lqZl? Zll- Zl< C) (6 C)bo !0aUS></o o oF o (0E C)bo(B L 0) oo (d O.v .dk bo oq) o C) (n L C)bo(d li c) oo O^ '5 ..oLO\dv a.(dtro F ol hrl cdlLI 0)l BI ol EI ol -eloldt Ed ol ol o0rl trldl ol =looldlklol -<t adt !l ot EI ol :l €l .ol JI EI olfrl 2.6.2 ll/hat are the causes of absenteeism? CAUSES OF ABSENTEEISM The high rate of absenteeism was due the movement of people from their actual places of dwelling to refugee camps in the neighboring countries. This is the main reason many did not turn out during the Mectizan campaign. 2.6.3 lAhil are the reasons for refusals? In the Northwest CDTI Project areas a total of 1,042 persons refused the Ivermectin due to miss conception about the Tablet. For instance, some thought that taking the Mectizan would render them childless. Yet some people refused the tablet as a result of mild reactions like headache, temporary swelling of legs and itching of skin experienced by their neighbor during the campaign. But NOTF reached a decision to increase advocacy and sensitization before the next round of treatment. 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that Occurred during the reporting period and provide (in table 8) the required information when available. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report 2t WHO/APOC, 24 November 2004 D $oo c{ Lo .o C) o z <f, N O o L, F! NN v q) L s) .a B\q)q 16 I U\) \- 4I o\ \)\ o t \)q 9 U s *roq b0 tr 1J oq o t< (.) bo lr) E 0)kk oo o tht! a t) tr C) o o V)tr 0) cd an o l<(.) th +r o v)ot)d(-) #r rl -ol(dl FI c) E0e _83 b <.E E L ^6 - bDq) €€E E FEGl 6'5 q< o o.9 CAoE 910 \J O. q(Diex(!Y qD ^ ir.= (l)(.)-c q&3; dG(l;o- o.9 -c o (d4oo O € .lr,E o2=l ar'i i 5 xt o x ,J c! -C q: E.sep.s EEEEg q op. >\ V) tr!;=() -Y hAruo!f0) 6t X*l-.1 o o (E =o .N*EE;A: i (! o 6.)bocG.- ?o x(l)a C) u0 * 4 v) s r @ o E,)O EaF o}Sf B-o rr o.l co Q L., 0. B oosi EgCI IIJ o E"rr (E^E bs oo s$o r oo uI-CD(o ut ul oo UJ oEO5 C'lo tE^ gt'g t oo ..tr oF s @(() E.- HE =.HEzae c, ul o,$q lr)o o) rr) Nlr) @@@ Eo(E (l,.=r trt': EE5 ul (o r c.,(o(.r- c o .Eg CL o o. E E=-EE * (l, UI soo r oo rr I-1l) (\l IIJ IIJ c1' uJ o E')11 (E^tr bs o(, soo oo nI-tFI! UJ c) uJ E .9o -c E'o.!E^gst gE o (f)(os =EvE .,)- E.E Sg E ig E = F'rtsz6(, (9 UJ (f)(o rf Eo 6 o.= = EE iEs (\ IIJ o 6' E,g 5 oo .E E E oo l:. He *t s $;EE H .E ut (f,(os - @ooN o)ooN o oN t. UJ F- o) o,r @ o) o) o, o, o) ooo c{ ooN NooN (f)oo c{ !fooN loooN (ooON l-ooN coN 1 V)\ sll\\E u\I \) s. i'13q)\i \-U .\9 13F(sb\\ AJB *iL\.ils sSI\Ssi\sIUSi tss\,v ^!\a3p\ss ! .B tt vE.[ \Bt',s .s 3)b SJ 'iss.sslis E ETIUlq1N $il .I i xrlHtl esH;Ssl $tB"3E s$ ti^SrSSSH\\)D ! ES$*q.rSEE "i*EXoil :st k sl r 2.7. Ordering, storage and delivery of ivermectin '/ Mectizan@ ordered/applied for by - Qtlease tick the MOH wHo UNICEF Other (please speciff) Mectizan@ delivered by - Qtlease tick the appropriate answer) appropriate answer)tr NGDO wHo UNICEF tr NGDO trMOH tr Other (please speciff) Please describe how Mectizan@ is ordered and how it gets to the communities The required Mectizan stock for the year is calculated and ordered by NOTF using standard methods. The order is sent to the Mectizan Donation Program' When Mectizan arrives in the country, World Health Otganization (WHO) clears it and sends it to the National Drug Services (NDS) through NOTF for storage. Each project county receives according to the initial request and stores it at the health facility for onward delivery to the communities by the OICs and CDDs respectively. 24 WHO/APOC, 24 November 2004 Table l0: Mectizan@ Inventory (Please add more rows if necessary) DistricULGA Number of Mectizan tablets Requested Received Used Lost Wasted Expired Remaining Belle 10,700 1 0700 10680 0 0 20 0 Gbarrna 30,750 30750 30743 7 0 0 0 Konqbah 12,500 12500 12480 10 0 10 0 Bopolu 28,000 28000 27990 10 0 0 0 Bokornu 16,000 1 6000 1 5985 15 0 0 0 Sanoyea 4,150 4150 4135 5 0 10 0 Zota 40,500 40500 40470 30 0 0 0 Panta Kpaii 5,600 5600 5575 25 0 0 0 Suakoko 30,060 30060 30000 60 0 0 0 Salala 12,000 1 2000 11900 16 0 84 0 Jorquelleh 21,100 21100 20980 57 0 63 0 Kokoyah 14,250 14250 14190 45 0 15 0 Foyah 50,000 50,000 50,000 0 0 0 0 Vahn 4,000 4,000 4,000 0 0 0 0 0Voiniama 23,000 23000 22980 20 0 0 Zorzor 8,500 8500 8475 2 0 23 0 Salayea 5,700 5700 5645 0 0 55 0 Kolahun 6,400 6400 6358 4 0 38 0 Todee(Lower/Upper) 68,300 68300 68265 35 0 0 0 Caresburg 132,985 1 32985 1 32985 0 0 0 0 St. Paul 82,400 82400 82309 21 0 70 0 N0rth/South Monrovia 325,325 325,325 325,325 0 0 0 0 Gbehlay-Geh 14,350 14350 14290 0 0 60 0 Saclepea 16,900 16,900 16867 20 0 13 0 Tappita 40,000 40,000 40,000 0 0 0 0 Yarwin-Mehnsonnoh 39,437 39,437 39,437 0 0 0 0 Sanniquellie 8,500 8500 8383 25 0 92 0 Zoe-Geh 52,100 521 00 51 890 45 0 165 0 Total 1,103,507 1 1 03507 1102337 452 0 718 0 Percentage 100% 100% 0.42% 0 o% 0 a a How are the remaining lvermectin tablets collected and where are they kept? The remaining Ivermectin tablets are collected from the communities by CHTs and transferred to MOH and after verification; it is delivered to National Drug Service. List and brie/ly describe the activities under lvermectin delivery that are being carried out by health care personnel in the project area. That a member of CHTs collects the Ivermectin tablets from MOFVONCHO for the counties. That the OICs take delivery of their supplies for their various health clinics. That the OICs deliver the Ivermectin tablets to CDDs at the community levels for distributions. a Any other comments 25 WHO/APOC, 30 July 2007 The OICs have been doing quite well in reaching the lvermectin tablets to the communities. But during the raining season, it is very dfficult to do so on time because of lack of rain gear. Therefore we recommend that APOC/TCC looks seriously at this matter so as to do something about it (e.g. make some provision in the budget for the next round of treatment). 2,8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the proiect area? No. If yes, When? Table I I : Community self-monitoring and Stakeholders Meeting (Add rows if needed) District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) 26 WHO/APOC, 30 July 2007 TOTAL Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle 2.9. Supervision 2.9.1. Provide aJlow chort of supervision hierarchy. Central Level o NOTF o NGDO Countv Level o County Medical Officer (CHO) o County Onchocerciasis Supervisor (COS) o County Health Teams (CHT) District Level a Health Center Medical Officer Clinic Nurse Communitv Level o CDDs o Community Members Supervision undertaken by the NOTF in the Northwest Region 27 WHO/APOC, 30 JulY 2007 a COUNTY SUPERVISION DONE BY DATE DISTRICT OBJECTIVE REMARK Bong Nat'l Coord. & Prog. Manager May 3-4,2006 Salala & Suakoko Census update & Meeting with Comm. Leaders Successful Gbarpolu Nat'l Coord. & Prog. Manager May 14-15,06 Bokomu & Bopolu Census update & Meeting with Comm. Leaders Successful Lofa Nat'l Coord. & Prog. Manager May 5-6,2006 Zorzor & Voinjama Census update & Meeting with Comm. Leaders Successful Montserrado Nat'l Coord. & Prog. Manager May 1-2,2006 Todee & St. Paul Census update & Meeting with Comm. Leaders Successful Nirnba Nat'l Coord. & Prog. Manager May 10-11,06 Sanniquellie & Zoe-Geh Census update & Meeting with Comm. Leaders Successful 2.9.2. What were the main issues identified during supervtsion? The main issues were as follows: o Communities not showing appreciation for CDDs voluntary services. o OICs not supervising very well due to lack of transport. . Some CDDs are not happy with CDTI work because it has no incentives o Some CDDs do not record properly in their registers. o Some CDDs do not know how to fill in the community treatment form. 2.9.3. Was a supervision checklist used? The checklist included the followings: o Census update based on communities registers. o Meeting with communities leaders to acquaint them with CDTI activities o Verification of both communities and counties treatment forms. 2.9,4 What were the outcomes at each level of CDTI implementation supervision? o The communities including the CDDs and OICs all cooperated. . The supervisors from NOTF level thoroughly explained the CDTI activities to the communities by means of meeting with them and what they can do to move the project forward. o The communities expressed willingness to support the CDDs. 2.9.5. Was feedback given to the person or groups supervised? o Yes. Feedback was given each group supervised. 2.9.6. How was thefeedback used to improve the overall performance of the project? The CHTs were given copies of the feedback in order to address the issues and during workshops plans were put in place to improve the overall performance of the project(e.g. Constant supervision, etc.) a 28 WHO/APOC, 30 July 2007 SECTION 3: Support to CDTI 3.1. Equipment Table I 2: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR=Currently non-functional but repairable, WO=Written off). How does the project intend to maintain and replace existing equipment and other materials? Budget allocation has been made for the maintenance and repair of the equipment and other materials and negotiation is going on with the Government of Liberia (GOL) for the replacement of existing equipment and other materials. Source Type of equipment APOC MOH DISTzuCT/ LGA NGDO Others No. Condition No Condition No Condition No Condition No Condition l. Vehicle 2 CNFR 2. Motor cycle(s) 5 F 3. Computer(s) I F 4. Printer(s) 1 F 5. Photocopier (s) 6. Fax Machine(s) 7. Others a) Air conditioner I F b) c) 29 WHO/APOC, 30 July 2007 t3,2. Financial contributions of the partners and communlties Table 13: Financial contributions by all partners for the last three years If there are problems with release of counterpart funds, how were they addressed? Additional comments 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) 3.4. Expenditure per activity lndicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here:-1 US$:50L$ Contributor Year I ('provide the period') 2002 Year 2 ('provide the period') 2005 Year3 ('provide the period') 2006 TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) MOH (Central + Provincial/State) 84,458 86, I 59 109,911 2,098 MOH (District/LGA) Local NGDO(s) ( if any) NGDO partner(s) 58,760 58,187 22,195 9,148 Others a) b) Communities APOC Trust Fund 72,931 72,920 62,087 62,058 65,058 38,979 TOTAL 216,149 72,920 206,433 62,058 197,164 50,225 30 WHO/APOC, 30 July 2007 Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of communr Mobilization and health education of communities Ieurls-efqqAs - Training of health staff at all levels S distribution In_temal monitorir.r*g of CDTI activities A:d1o91c-y visits to health and p_glrtrcel_?ythorities IEC materials , S rqqgly__€epo:!"g) fqtrnl &t treatment V_ehic I e s/ Motorcyc_le s/ b i cyc le s m a_intenance .(fue I ) Ol!,r" Eqqipm-ent (e.g comp_uters, printers qt.c)_ __ Others 300 15,755 100 100 1 ,802 1,1 10 250 22,658 MOH APOC MOH MOH APOCA4OH 4f9"c AP_qc _ APOC,]\{OH,NGDO TOTAL 42,275 Total number of persons treated 905,449 Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? SECTION 4: Sustainability of CDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Partic ipatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF { Other Evaluation by other partners 3l WHO/APOC, 30 July 2007 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? 4,2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No. Was a sustainability plan written? No. When was the sustainability plan submitted? No. What arrangements have been made to sustain CDTI after APOC funding ceases in terms ofi 4.2.1. Planntng at all relevant levels 4.2.2. Funds 4.2.3 Transport (replacementand maintenance) 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. 4.3.2. 4.3.3. 4.3.4. 4.3.5. 4.3.6. 4.3,7. Iv er mect in d e liv ery mech anis ms Training Joint supervision and monitoring with other programs Release of funds for project uctivities Is CDTI included in the PHC budget? Describe other health progrommes that are using the CDTI structure and how this was achieved. What have been the achievements? Describe others issues considered in the integration of CDTI. ! 32 WHO/APOC, 30 July 2007 a 4.4. Operational research 4.4.1. Summurize in not more than one half of o page the operational research undertaken in the project area within the reporting period. 4.4.2. How were the results applied in the project? SECTION 5: Strengths, weaknesses, challenges, and opportunities - List the strengths and weaknesses of CDTI implementation process. STRENGTHS o Sensitization and advocacy were successfully done. o CDTI was introduced to the communities and accepted o The OICs fully cooperated in the training of CDDs WEAKNESSES o Some CDDs did not cooperate in the distribution of the treatment o The communities did not fully support the CDDs. o Not all communities were treated due to insufficient Ivermectin. CHALLENGES . Some CDDs demanded they be given incentives like other programs. o There is no means of transportation for OICs to frequently visit villages in their areas of operation. The NOTF drew out plans to visit these problem areas to explain APOC Philosophy to the communities through under the tree meetings at their levels. In order words, NOTF made the communities to understand that they CDTI project belongs to them and they should put plans in place to help themselves to take their tablets and that the Government through MOH seek ways to address their concerns. SECTION 6: Unique features of the project/other matters The successful distribution of Ivermectin treatment and report writing are the paramount concern of NOTF. Therefore, APOC and TCC should consider the allotment for the training of CDDs, and that OICs to be trained to manage the implementation of CDTI Projects, and regional coordinators be trained to write Technical Reports. JJ WHO/APOC, 30 July 2007