Annual North West CDTI project technical report submitted to Technical Consultative Committee (TCC): January 2012 to December 2012

II t_-._ NORTHWEST CDTI PROJECT, LIBERIA TECHNICAL REPORT 2012 ntds.liberia moh hoo.com I I I _t ORIGINAL : Enelish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNTCAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 3{ Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRTCAN PROGRAMME FOR ONCHOCERCTASIS CONTROL (APOC) North West CDTI ProiectName:ProiCOUNTRY/NOTF: Liberia Launchinq vear: 2000Approval vear: 1999 From: January 2012 To: December 2012Reportinq Period: ( Month/Year)(Month/Year) APOC fundinq vear: (circle one) 1 2 3 4 5 (circle one) 10 11 12 13 4567891011APOC Proiect imple entation vear report 123 12 13 6 7 89 Partners: - Ministry of Health and Social Welfare - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - Sight Savers !nternational - Communities Date submitted: IANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: Liberia NTDs Program Director Name: K. Signature: Date ..8:;2Q13. This Report has been prepared By Name: NOTF Liberia !- Designation: NOTF Signature: Date S ightsav ers C ountry "- ""r:;::"#; ;#:r, -e$Flllt'(d,/*fs I o o ,\, ll Table of contents * 1 . 1 GeruennL rNFoRMATroN.......... 1 Description of the project (brietly)2. Partnership.. .... .....,. PopumrroN ............... SECTION 2: IMPLEMENTATION OF CDTI....... 2.1. Truelrrue oF ACTtvtlES 1.1. 1.1. aJ 3 4 6 7 7 9 9 I 2 4 4 AovocRcy MoatLtzAloN, sENSrlzATroN AND HEALTH EDUcATToN oF AT RrsK coMMUNtIES Counlturutrv TNVoLVEMENT ............. CRpRcrw BUTLDTNG. 2.8. Conauururry sELF-MoNtroRtNG RNo SrnxeHoLDERS Meerrruo 2.9. SupeRvlsroN............. 2.9.1. Provide a flow chart of superuision hierarchy. .............. 2.9.2. What were the main r'ssues identified during superuision? .......... 2.9.3. What were the outcomes af each level of CDTI implementation superuision?............. 2.9.4. Was feedback given to the person or groups superuised?..... 2.2. 2.3. 2.4. 2.5 3.3 Ornen FoRMS oF coMMUNrry suppoRT ............. i I I I 2.6 TReRrueruTS............. 2.6.1. Treatmentfigures...... 2.6.2 What are the causes of absenteeism?....... 2.6.3 What are the reasons for refusals?................ 2.6.4 Biefly describe all known and verified senbus adverse events (SAEs) that Occuned during the reporting peiod and provide (in table 8) the required lnformation when available. ................. 18 x............... ............. t8 2.6.5. Trend of treatment achievement from CDTI project inception to the currentyear......... .............20 2.7. OnoenlNo, sroRAGE AND DELtvERy oF tvERMEclN .,....,.21 t8 r8 2.9.5. How was the feedback used to improve the overall pertormance of the project? 24 3.1. Eourpuerur...................... 23 23 23 23 24 24 .............24 .............30 3.4. ExperuorruRE PER Aclvtw 30 SECTION 4: SUSTAINABILITY OF CDTI....... ...........30 4.1. lrureRrunl; TNDEpENDENT pARTtcrpAToRy MoNtroRtNo; Evn1un1oN................... 304.1.1 Has the project ever been evaluated/monitored? (Tick any of the following which are applicable)......... .....................31 4.1.2. What were the recommendations2............. .....,...... 31 4.1.3. How have they been implemented?......... .............. 3l 4.2. SusrRrNnarLrry oF pRoJEcrs: pr-AN AND sET TARGETS (nanruonroRy nr............. 3l Planning at all relevant levels 31 31 3l 32 4.2.1 4.2.2 4.2.3 Funds...... Transport 4.2.3. Other resources 4.2.4. To what extent has the plan been implemented 4.3. lrureoRRrtoN............. 4.3.1. lvermectin delivery mechanisrns........'... 4.3.2. Training.... 4.3.3. Joint supervision and monitoring with other programs 4.3.4. Re/ease of funds for proiect activities... 4.3.5. ls CDTI included in the PHC budget? ............ 4.3.6. Describe other heatth programmes that are using the CDTI structure and how this was achieved. What have been the achievements?.... 4.3.7. Describe othersissues considered in the integration of CDTI. 4.3.7. Describe othersissues considered in the integration of CDTI. 4.4. OpennloNAl RESEARcH..... 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the proiect area within the reporting peiod. 4.4.2. How were the results applied in the proiect? THE RESULT OF THE KAP WILL FEED INTO THE DEVELOPMENT OF NATIONAL NTD COMMUNICATION AND PLAN AND DEYELOPMENT OF IEC MATERrALS............ ..................... 36 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES... ..................... 36 SECTTON 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........36 32 32 32 32 32 32 32 33 33 33 33 36 36 36 Acronyms APOC ATO ATrO cBo CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG WHO CHT orc MERLIN CRC CHAL CO CHDD CHO BPHS NECP LISGIS African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Comm u n ity-Directed Distributor Community-Directed Treatment with lvermectin Community Self-Monitoring Local Government 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 County Health Team Officer -in charge Med ical emergency relief international Cavalla rubber corporation Christian Health Association County Onchocerciasis supervisor Community Health department Director County Health officer Basic Packages of health services National Eye Care Program Liberia lnstitute of Statistics and Geo lnformation Services Definitions (iv) (v) iii( (i) Total ulation: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census (ii) taking). Eliqible population: calculated as 84% of the total population in meso/hyper-endemic communities in the project area. Annual Treatment Obiective: (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. Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project atea, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'o year of the project). (vi) Therapeutic coveraOe: number of people treated in a given year over the total population (this should be expressed as a percentage). Geooraphical coveraqe: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project arca (this should be expressed as a percentage). lnteqration: 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 maximize cost-effectiveness and empower communities to sotve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (vii) (viii) Sustainabilitv: 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 mobilized by the community and the government. (ix) Communitv self-monitorinq (CSM): The process by which the conrnrr.rnity 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. !t encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. 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 35 Number of Recommendati on in the Report TCC RECOMMENDATI orvs ACT'OA'S TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Report Related 1 Project should update list of Acronyms; The list of acronyms has been updated 2 Complete table 2 by providing UTG figures; The UTG was provided in table 2 3 Provide explanationfor high drug balance. We will improve on drug ordering and supply Project Related 1 Ensure that project achieves and maintains 100% geographical coverage and at least 80% therapeutic coverage; The project is making progress to maintain adequate geographical and therapeutic coverages. 2 Ensure that refugees that joined Nimba County are treated; The refugees in Nimba County were treated during the 2012 mass drug administration 3 lncrease the number of Health staff involved in CDTl; There is a need to train more health staffs with support from government and partners in order to increase the number of health staffs involved. 4 Effort should be made by the project to ensure that treatment coverage for lvermectin remain high despite the use of CDTI platform for other NTD interventions. All effort is been applied to ensure high treatment coverage even with the integrated intervention with other NTDs. Executive Summary Prepare an Executive summary of the repoft in not more than one page. 1. Background on treatment and population data - fotal communities, communities treated, 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 how they were overcome. The North West CDTI Project is located on the North Western part of Liberia. lt is bounded on the north by the Republic of Guinea, on the west by Sierra Leone, Gbarpolu County on the south and on the east by Bong County. The project comprises five Counties: namely Bong, Gbarpolu, Lofa Nimba and Montserrado. partial data from the five counties indicate out of 1,917,141 targeted population of Bong, Lofa, Gbarpolu, Nimba and Montserrado counties of which 1,204077 persons werJ treated with Mectizan representing 58% therapeutic coverage. Treatment data are being expected from Bong, Montserrado and Lofa' Out of 2111 targeted communities, 1532 were treated from data received. A total of 3997 CDDs were trained/retrained compared to 3302 CDDs trained in 2011. 261 health workers were trained/retrained compared to 398 health workers trained/retrained in 2011. 25% communities that reported treatment so far had female cDDs while 110/o of health staffs were involved in cDl in2012 The challenges faced during the implementation of the CDI activities were as follows: . Late deployment of logistics for training, distribution of Mectizan & Albendazole and suPervision . lnadequate HSAM at community level - Frontline health staff not empowered to engage communities . Some communities are not willing to support their CDDs. SECTION 1: Background information 1.1 Genera! information 1.1.1 Description of the project (briefly) Geog raph ical location, topography, cli mate Population: activities, cultures, language Co m m u n i cati o n sysfems ( roads...) Ad mi n istratio n stru ctu re Health sysfem & health care delivery @rovide the number of health posts/centers in the project area if the information is available). Number of health staff in project area and number of health staff involved in CDTI activities. The Northwest CDTI project is situated in the northern western part of the country. The CDTI activities in this project consist of five (5) endemic counties which are Bong, Nimba, Lofa, Gbarpolu and Montserrado counties. The climate is tropical and humid all year round, with significant variation between the dry season (October-April) and the wet season (May-October). Most of the roads in the project areas are unpaved, thus causing difficulty in movement in the counties. In the Northern Counties, palm trees grow wild and the area is fertile for both upland and low land cultivation of rice, the staple food. The vegetation includes the tropical rain forest with many fast running rivers, which covers over 75o/o of the land area. The coastal area is marked by mangroves, dwarf trees, small bushes and various grass types. Most of the population of the communities is normally settled almost homogenous in rural areas and fairly heterogeneous in townships and cities. The structures of the leadership vary according to the types of communities. ln towns and villages, there are chiefs who are elected and guided by council elders who take decision on behalf of the village or town. ln township and cities, there are commissioners who are appointed by the president of the country and city mayors who are elected by the residents of the cities. However, since the 2005 legislatives and presidential election, the election of chiefs and cities mayors has not taken place due to the lack of funding. All city mayors have been appointed by the president. The occupation in the communities varies between urban and rural settings. The rural communities are engaged in farming activities from January to November while the inhabitants of the townships and the cities are engaged in commercial activities and other formal employment Population of Northwest CDTI Project, Liberia from Census update by Counties Population Bong 365605 Gbarpolu 95407 Lofa 219682 Montserrado 534,562 Nimba 701,885 Total 1917141 CDDs Table 1: Number of health staff involved in CDTI Gounties Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI Bz Percentage Bs=Bzl Br *100 Bong 386 57 15o/o Gbarpolu 85 21 25% Lofa 579 67 12% Montserrado 208 37 18o/o Nimba 998 71 7% Total 2256 253 11% 1.1.2. PartnershiP - lndicate the partners involved in project implementation at all levels [MoH, Sightsavers, (national/international), communities, local organizations, etc.l - Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, pianning, mobilization, etc) where all partners are involved. - 'State plans, if any, to mobilize the state/region/districUlGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation' partnership for CDTI was strengthened during the year under review. The program collaborated with Sight savers, WHO Country office, WHO/APOC, and Liverpool School of Tropical Medicine, MedicalAssistant Program (MAP lnternational and Ministry Education for financial and technical support. Additional resources mobilized from the NTD partners increased the implementation rate through integrated training of CDDs and Health workers, HSAM, transport, supervision and monitoring. ln ZO12 the Ministry of Health and Social Welfare had as its theme for the annual health fair "Unitingio Combat NTDs: "Ending the Neglect" with the slogan "reaching the un-reached". -The health fair was held at the Bernes ville Estate Football Field, Montserrado County. The event featured public lectures on NTDs of Public health importance in Liberia, drama sketches on Onchocerciasis, parade by health workers and students and exhibition of health services by NationalAIDS Commission, National Malaria Control Program, NTD Programme, Family Heath, NationalTB/ Leprosy program, National HLath Promotion Program, Nutrition Program and WHO. This is a demonstration of commitment by the government to the fight against NTDs and that has also increased the visibility of the Program of Onchocerciasis and other NTD in Liberia. The NTD Program collaborated with the County Health Services Department, Ministry of Health and SocialWelfare to conduct independent monitoring and supervision which incorporated spot check on Mectizan and Albendazole distribution in the communities. At the county level, the County Health Team collaborated with international and local NGOs, faith based organizations, concession companies, local radio stations and the affected communities for the implementation of the 2012 CDI implementation. CDDs were used to sensitize and mobilize communities for the school-based schistosomiasis Program in the endemic counties of Bong, Nimba and Lofa in the North West Project area. Nimba County Health Team forged strong partnership with the Cocopa Rubber Company in the implementation of integrated MDA round for Onchocerciasis and lymphatic filariasis using the CDI approach. The Robber Company provided fuel for supervision of CDDs in their operational area. dL C) l- .= o! =E .g oo = G. G 0) G C) o 'o. L o. G) -c .c I- o o =o- o o- o) -c f o -oG o o 0) .c o c o (E EL o .E 'q)(o -c,E6 lictsG 'Fo r -c,o -co o o) o o- o) -c EC(u o o 'o cf _g o l- : =.9, .CF oi o)s l- o .=c a E E oo o .C a o f .= ac oo o .C =oE 0)E o o) -(U '= L o =E f E E oo E o) o) .C o) .gof c)L o :f o = 'o o o-o ooL :, oo o .C o c\. o o -o(E 0) -oC' o .CP .E (E (ItEI ol -cl I I o 8q =(/);et,o- -c(5 .9 .o E(tr =2.3ol ^o zto =a o C) c\.Eo L o) o. o)CE o o. oL o .C o) .E J! oco! o 0) 'd l- o- o) -c o a)ac oo (E o(U = G C)q) a' a. ,q) o $o\ b(.) Q) oE o Q) o ol-5 Q) oo o) o !o C) o) a-xq) q) ab 5 o u) oo 0 a. o 5 o o o o)oI oo o a. a O)o o) O) .T b o) oo e(a o C)o e' a. o o =Eo o(u e q) a o 5orL G S d e G oq) 0 a. q) .\ =aa o eo o \ o)E o o a_ Elu)lo)Itr ls5 G5tr oE o) o a q) a o q) o.o o a. o oa 5 ts xG\ o u)$ !o o C) IGlo ltr o 1-5 U, =o eo\ bB o !o L o o. o)c l- o o- E o .C, o)c LfE oc o E G) oo G)L o C) l- o .C o .C =(E o (l, (, o 'd L CL o .E tr o o -c, .g .Ya L (5 c o (E)o oo !C(5 a .9 =C =E E oo e.it ol -ol(El FI tr o s CL o o- o)l- rO- N @(o - lr)o @- l()(o (f) f-o .l: rO o) N @ @- o) N N(o rr)$(o lr) ro @ @- of- (9 Ff otr E 9tEE O .E iEO =o f-o a. rr) c') N @(o- O) N N @ rO- !t (f) lr) l() @ @^ oI- s F- o)- lr)o(o- rr) @ cf) ro +\t I(o = [.g EfE HFoO EI o)\NN s- r() rO O)- cf)NN @ rr)f-- NN @I-\(o rO r() @ @ rr) o) cr) r.() n(o N rO ,.9c ci +g 5$ $s{ t*I,* @ @ cf) of-tf t() l- o rr) (f) .t o)!t o rJ)(o O) C')$ @NN !to O) ro(o tFl ol tr o (U =CL o o- " .e Eo'EI ogt s qootsNO rt I-\f o o) (f)o) @ O)l-N @(f) !O I- N .orltr =tR'- >o XE Eioo . ottrE -o o @N$ O) o)s o) @N olr) Nsl() ..:$ gO E E- cL o'- 4,>EOoI tr tr.FooYNO N os r() O)(o oF (of-f,- (oo(f) .= oo o) s oo .E E E o o tts o L o .cl E z "e E6'E: ,u Ct s qootsNO N @lr)- t(f) ro rr) @ @- of- $ 1'- or- lr)o(o- l()(o (f) I.-o s- lr) O) N @(o- o) N tr o .J -:(u -. -.E E aE.E.S sOO-trtrr=F CL.= O CL< (o o oE G L oo c o = (s -o Ez J F oF o)c o c0 =oo (E -oo oE -Eo -E'9"g'- e9, -.33 g E EE9E SECTION 2: lmplementation of CDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. $E o.= -c(ue0) =8;cD d.g.LE-OoEEc-oooopEs .=P> ai !5 0< EF ca .= L-- YOE ESa g6NH cE;; EbEI e=' ='tr g nE#S;E b€ egE IEE $E(E J ,r'E nr iE E,g !5.o'E o 6c q'6 EE E-HEgE HE $:E ??;nE T igE O frEgEE :EE 8E E g$EP E 8;*;blD=o9o.i E g Etro o{ X E EiEi R 8 EE= .E E={ o o S ;o R = BE E E' iEE*E >2 5 U Bq q o> I -I-! Cb+-FF.= OF N oN (E o c 0) =o o)E .g !o (u o +, o ool- o o -l- o aq) := o(o o oc o) E tr c"it ol -ol(El FI tr .9 ..2 o ct =o ErgEE otro o oo C) oo o oo o oo oq) o trs (E e'o OE (J o o o o o o o C) o tr o = -ct o !t E, o o_ EE cLo EEO-o- o o)o o 0)o C) oo o oo ooo E' -j=c H9 o- oo oo oo oo oo ol (E E c'lf o =otr o C) tr o o= ELoEE o o o o U) o o(/) o- oa o- oa P o. oa ED- 'Eeke+,La- o-oa +t o- 0)a o- 0)a +to C)a o o U) u,tr .E LF o_ EE ELOEEOpo- o) o)f o =o)) o J o)f o J o)f o J ct) = tr-c k orb OE a) o)a a) o)a a =o)a a) o)a a J o)a oo -oo.= (l,3NE €E =(, o_ EE cLoEEOao- :, ) ) ) = E"- .EE ke a- = = f = = =oo o)c o(D J oo (U -oo o o o!(u L oa C o (U -o Ez 2.2. Advocacy Sfafe the number of policyldecision makers mobilized at each relevant level during the current year; the reason(s) for undeftaking the advocacy and the outcome. Describe difficultieslconstraints being faced and suggesfions on how to improve advocacy Advocacy meetings were held with policy makers from county to community levels by the respective County Health Teams in the Project area. ln Gbarpolu County meetings were held with five District Commissioners, five District Youth Leaders, five District women leaders and fourteen town chiefs. ln Bong County advocacy visit was paid to the superintendent, and Development Superintendent. At the District level, eight meetings were planned at every district headquarters involving the district commissioner, paramount chief and other local authorities ln Nimba County, advocacy meetings were held with policy makers on implementation of Schistosomiasis/STHs, Onchocerciasis, Buruli ulcer, and lymphatic filariasis. The policy makers included the following; 17 commissioners of the administrative districts 6 statutory superintendents 12 district education officers ln Lofa the Country Heath Team held meetings with nine policy makers, including the Country superintendant, Development Superintendant and seven political District Commissioners with some strategic community leaders. ln total 14 town chiefs, 18 county officials, 34 district political leaders, 10 youth and women leaders and 12 district education officers were reached in the Project area. The advocacy meetings were held with the aim of explaining the roles of the policy makers in CDI as well as to secure their committment from to support the MDA Program through mobilizing of local resources. However to improve advocacy and increase ownership , more logistical support and funding should be provided to health staff on time to enable them reach more villages chiefs and representatives of community based organizations including schools, churches and mosques Also CDDs complained of inadequate support from their communities 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: - The use of media and/or other local systems to disseminate information - Mobilization and health education of communities including women and minorities 9 - Response of target communities/villages - Accomplishments - Suggest ways to improve mobilization and sensitization of the target communities. During the mass drug administration, various media houses were used to disseminate messages on Onchocerciasis, Lymphatic filariasis and other NTDs at both national, county and district levels. IEC/BCC materials were distributed to various health facilities catchment communities. ln Bong, the County health team conducted mobilization in twenty- nlne communities using lfClACC maierials. General Community health volunteers (gCHVs) and CDDs creaied awareness on NTDs in their respective communities. Promotional messages on Onchocerciasis, Lymphatic filariasis and were aired on Super Bongese FM radio and radio Gbarnga for 7 days in the month of september 2012. ln Lofa, the County Heath Team conducted mobilization and health education by holding community meetings with chiefs, elders, women group and CBOs. Radio talk showJ were held- were held at district's community radio stations stressing the importance of Mectizan and Albendazole treatment. Health staff used IEC materials such as fliers and posters to conduct health education in 100 communities' Women and Youth Leaders played active role in mobilisation and Heath education held in some communities. Town criers were also used to mobilize community members. Most communities' leaders and members accepted the program and the drugs distribution was conducted as planned in targeted communities' ln Montserrado County, Health Education, Sensitization, Advocacy and Mobilization (HSAM) was conducted before and during the MDA. Two community radio stations; ihe voices of rural Montserrado & radio shata were used during the HSAM activities in the community. Posters and hand bills were also used in mobilization and health education sessions. ln Nimba County, gCHVs, CDDs and Teachers were trained to carry out extensive mobilizations in ineir respective communities. Radio talk shows and Onchocerciasis and lymphatic filariasis health promotional messages were conducted on five local fU riOib stations (Karn Voice of Peace, Radio Saclepea, Radio Tappita, Radio Kehgayma and Radio Nimba). Town criers, community meetings, brochures and pori"ri were also used for mobilization and health education during the MDA implementation. All the communities/villages were very receptive to the program. To improve HSAM in the Project area, logistical support is required to enable frontline health staffs reach all communities. Adequate plans should be made with Community Radio Managers to allot special time to discuss the role of the community and other stakeholderJ in the respective counties in the MDA as well as heath education for adherence to treatment by eligible persons in the community. There is need to supply adequate IEC materials to enable frontline health staff to reach communities with appropriate messages during HSAM activities' 2.4. Communityinvolvement Table 4: Communities participation in the CDTI Comment on: - Attendance of female members of the community at health education meetings - ln general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc). - lncentives provided by communities for the CDDs - Attrition of CDDs. ls attrition a problem for the project? lf yes, how is it addressed? - Other issues The attendance of female members in community meeting is generally high in all Counties. There was active female participation in meetings when CDI issues were being discussed. However only 27o/o of CDDs are female and this calls for more deliberate effort to encourage community to select more female CDDs. ln Nimba County and to some extent Bong, communities discharged their responsibility in providing support to CDDs in cash and kind. ln other areas in Gbarpolu, Lofa and Montserrado counties, communities did very little in terms of CDD motivation. CDD attrition is still a problem especially in Montserrado County This made training budget to continue to be high because of training many new CDDs. County Number of comm unities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communi ties in the entire project area Br Number with communit v members as superviso rs Bs Percent age Be= BJ Ba *{ 00 Male CDDs Bz Female CDDs Bs Total Bs= Bz+Ba Number of communit ies with female CDDs Bro Percent age Brr= Bro/Bl*1 00 Bong 471 162 34o/o 581 95 673 83 18% Gbarpolu 190 85 45o/o 315 97 411 66 35o/o Lofa 693 198 29o/o 625 95 720 75 11 % Montserrado 279 0 0 0 0 0 0 0 Nimba 538 194 360/o 883 275 11 54 286 53% Total 2171 639 34o/o 2404 562 2958 510 23o/o To address the issues of inadequate CDD motivation and high attrition, Health staff should improve community mobilization using appropriate channels such as religious leaders, teachers, CBOs and local health committees to improve community ownership. CDDs attrition will be addressed by advocating to the community to support iOOs and also training more CDDs to reduce their work load' 2.5 Capacity building - Describe the adequacy of available knowledgeable manpower at all levels' - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (Ihe mosf important issue to descibe is what measures were taken to ensure adequate CDTI implementation where not enough knowtedgeable manpower was availabte or if staff is frequently transferred during the course of the camPaign). Transfer of trained staff was not an issue. However there is shortage of health staff at peripheral health facility level. The available staff is fully occupied with clinic duties and very few get involved in outreaches. !, og (E *, oo o o rF o olt E z ll+u)(Ot-ddo tr) o rt o E oF .t o 5 =o) = @ o)(o tr)oto (o O) oos f- COl (o(o o rr)Nr t- :_ O)I- 1() ootr) lr) (f)s ro(o o)\t (o o)(o cf) ro$ N o) O) CO $ttr) (f) tr)$r N soo ": tr o E o .9 o ct o oL @O)(o oos olo N oo ro O)!t l- o) o)(f) 9,!P^ .-L o(EFtsoLFO-5ofE o.= LG Ets =rFto z E'L*. =P ooo o o o a\ oq = q) = lr) $ (f) N N N o $ CA (f) (o o N cf) s soo rF c o E o .9 o o)o{o lr) CO N $ (o l- EsflrLt.EooE.eE E8P bEEIt Q+'Etr =o2c) E=&&o o (o o +oq =o = o,$ rr) (f) s (o N r s o) rO CO CO (o N o)N (f) (o N @ s$ @ r() r N N cf) @I- tr o E-oo1- a=s o u) C)!o o)$ (o O)tr) o,N C\(o rON o oJ 9uoo oo o+' os bolt E =z fl "t8o a)o No toq =o = @ @ o Ir) s (o (o o $ \t o (o s N o)N (oN CA soo - +atr o E o .9 o o oL+. @ rr) (o s (o c')N (9 JEo ,t2o o,c o trl ) o o- (5 -o(, (E o oE(E oo c o (U -o .Ez J F oF co c; .\ 5 oo o) a5oE o q eo o e5q o)\G 5 o G o O) E o a_ U) S)too o) oE a a. qt ao (E a o G oE tog =o =* C .9 Gfc o E o o. .E troo rF o -9, C) o c 0)L o) E o .C, (U o) .Ec 'c rbt orl -ol(El FI Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting peiod) Any other comments Treatments 2.6.1. Treatment figures 2.6 - tf the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The Project achieved 80% therapeutic coverage in 2010 and 2011. ln 2012 it achieved above 80% therapeutic coverage in two counties, Gbarpolu and Nimba were full data has been reported, and there is every indication that the Lofa, Bong and Montserrado will record similar coverage when the remaining treatment data have been received and processed. lOOo/o Geographical coverage was not achieved Trainees Type of training CDDs Other Communit y members e.g. Communit v supervisor S Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(speci fv) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (specify) Partnership t4 in previous years, but the geographical coverage survey and GPS mapping conducted in 2012 provided comprehensive list of communities including where treatment had not taken place. The Geographical coverage data was used during the MDA planning and follow-up exercises to endure that all communities were treated in 2012 I EIE!6 El= EI P ilEolE ol ' 8lE bl E bl< -ol EI =lzl oS (g o trD(I, o o C) o al ol olgl ol >t o1 C) (U o =o.(u ooq) o !C o o J (E t- o -c oC)o Eoo o o LL <ioE ooq) o oc o(u oE(5 L o)aPC o *{. * o o) c J oo o)C o co Ec(g (E o Eo o (I, E EE(s(L *I iE*HeEiEf,= o o o o o o - O,r LIJ49o4o 't-a r()$N tr) tr)(o solt o No (o os != =++Hgu g- No N(o rol- o NO) (Orr) E;g$ @No,$ O)I- o@lr)tr) o (f) @ @(o N @ o) @ N g* 5 g I q E- 53-sEE=gs o@N @(o F @ o lt CO C') rr) o tJ)N o & E;-- - () o Fo sat E-Ee (O o EaHes E,* 8E :"flg c (t) fu-f E ?i =6- 6fg I C o (E = s\ @I- sq s@ sq i-f- s C,) c.i @ s @lr) l-(o lr)I- @N (o l-(oo @ (f) f-ltoi- o o) rO(o @ ro lr) F- cf)oN rf)o @- lJ) @ cf) Not- rr) O) N @(o- o) N N(o lr)- s CAlr) rO @ co- oF- $ l-- Or- roo @- !O(o cf, f-o s- rr) O) N @ @- o) N N @lr) s(f) tJ) lr) @ @_ ol- $ 1-- o)- l+ cb o 9>,:- E a g" EEg; pgt " H o rL>3 oo*- o e)o c{o s= EE se 0= $^ H€ EE68 (5t ?( EEE"qg<F o := ao o) '=) E E oo so @ s F- o) sN(o soo sl- O)l- CA lr) @ o(as o o(A r() N(f) rO f-s o O) (a o) CO o,l-N @(f) l() N N f-s o o, CO o)(o O)f-N @(f) lr) f- N c =o() * la o)c o c0 f oo (U -o(, * *(U o E oA*EI Se (u -o Ez J F ot- N oC\ ,C- .Yo L (u o(U C) o (s .E (, o L .aE -o o tU U) !c(o C o E (oI f-t orl -ol ctlFI il E o o\ QTJOE Et Ee dE fi* 'E's a5 o=$o .=(a €*. 's6 E$lE rStl l' EE oots *s s'Eoou!>ciotro .sE EFEB*,otg e=eI [*ptEgr-oQ *$st trtrE.*: s *.q 'lEb" sc$s>ol-E- rr 9E s Es (, o e5\> ot H: XGUE '6r ri ae et E* ?*. :(,H.soo' oq(J :r '=h ES 6SiGoco*,)o :E EHtro .EE EI(U(l, ot I (ol E o -l o Qxl-o i EI9 E El'* E Els i fl;3 bl€ s .t=g) QI dE EIE EztF t\oails S !o a H EH = oriI S5P l'ilf yGs Q.s 2.6.2 What are the causes of absenteeism? Absentees were persons not aware of the treatment dates in the community. 2.6.3 What are the reasons for refusals? Refusals were those still afraid of adverse events 2.6.4 Briefly describe all known and verified serious adverse events (SAE;) that Occurred during the reporting period and provide (in table 8) the required lnformation when available. No SAE case to rePort x l8 ooo -c >-Or'tC € = EE o)9 L .E P- (E83?;JCE-EEEdXUO .=OIJJ O o o)o C) -'65Pg- 6) =ooO ol h-o C bE E e€adsEoqDO(r.9E cE3 - > EEEEE oE'n -c >dr'= = .= Efi =EEc(u € o I or.N $EEEE a E o o- E ct) Pz6 F9 fH$ .NE-a6 = 6iU O aYo> 6.9 o oo)c(5'6) )o x C)a o)(o z U)+ o\ q) o a. q) o o)a 5 o 'tr oq l. N oN .E Eo L o o- o)C E o CL o C)E o)c L JE !o Lfooo (U .C o l.U U) oPC C) o ooL o E(E o J o L oa o a oo Go cit ol -ol(EI FI oHgge -c) s -@ s rF @ s o)N st rO slc) o) C o (g oll -Oo 6rF ,i' ii o)og -t 9 (,5\o o s tO\t sto rF soo st @ sN o) oo *-(o IU ,hr oeDO- nr H€ T,8 _coFo s o)N so(o s(0 @ s ol N(0 s a(o l(, s\ !Fo @ lrJ b r- E HgE69 z- @Nq €N(0 o)t -rt- rOo(n rFtt o-(0 G't lI,Nq No cl, - (9$ rO @$(0 tto @^ Gl)(0q ,\ UJ tsof o.> JE() F E .sl. < E* @o -o olO 14, ot 1.)^(0(0 @ N o) -(o Nt st r() o)g) N(0 G'o\ lO o)a 5 *.e EEgE *E u,rF QLO o E (EBEO N ei) o)@oG'$t (o (r) G' G'. F N(0 @o(.o ot N o)(o -@NJ t\ rO o)(ot o)oo cl,(ot-(o N -t- a o) := a .9 =C J E E oo o ,:hEi uJ o)oE -l- o o>s<B </ o s ciN s oq o CO s € o) S= F oE,8 b o GrL>,S hi = X or$.si llJ *-v^VO oo ul s -!F s(0 r{, soN s$t(,) s rF 64' s € o) (Y) uJg" Ee gE \t o)N c)(o$ rF rOt\@ o)(a rr:) 6) -lO to crr- N UJ cc)EP .EJ L 't =6-.6<g 6 G' o) rON CO CD rON o 00(0 N T\ @ CO (0 @(o r\N co^ = .0.s t ,, EE pssE E' P E= E b * G' CD rON q)(D rON oq,(0 N T\ €(0 rF (o G'(o 1\N cD- rF Lu t oooN ooN NooN (f)ooN $ooN lOoo$t (0ooN NooN c,ooN CDooN o oN -oc o -g)g (u(, o EDg o o(, (9 F3 (! cr-(gLoo +. otEF-Lg RF ft=o roi e 8ft3 NO! Efb TIE. E5g 'sP -oE EEo E-'g' 5acL o9 F PG:)o kNo lBE $S .F 4..E €l Eo cl (EF Ol -e Baf .Bl io o-(l, o)or, (sE E L+.e y:ts QEH IoE, HFL+. ($J .X ao,VPt FIE k+.c FoE EHF ;\.9 "i EE(O -:-'.'-ci El fr €1.!l FITL $ o,(f) co O) N(o N. Nos - .E tr 'Eo, E o E, (f)N rr) o)(f) o)@ o) o,N (o lO (f) N@ @ o =,oL CL x IrJ o oooN ooo(o o Oo o_ l() ooo coN o o o o o o t,o o(l, = (o r() o rr)$ o, (o$ N^$ +, o oJ N(o @N oI-N o (o rO(of- (o @(o f- @@s$o 1r) o @l- a.(o o)@ - N @N. @(a cf) co !, oof l-r @toooN (o(o o_ ro CO 1r) tr)Es eE oo o_ o(o (f) l{) o)- CAoN ooo @ o,(f) @ O)NI- @N !, o .z oo otr oo o- o(o oo rr)_ CA @ oo o- @ o)(f) - oolr) Nl- ooo o @ - oo o_(of-N lJ) oo o- @ o)(f) - oolr) Nl- oo o_ o @ oo o- (f) l-N lr) o+.oo =t,ETotr oo o^ o(o oo rr)_ CO @ o -9 -aG +a otr GN oo =rFo olt E =z o cf) rr)$oN o (o O)f-lr)$ l- @l() o) (o(ooN(o N EGoo ,.t> -- 9Eo ioO.YN6a =o. (E -o Ez J F oF +.c oo C,)C od] =o o-L(U -o(, (U o G oaTcO^>; tr oo oz n E o = I -o !,o C) oE @C(E .N o C) n oo oz tr lr UJ .:{. 9E =3o Co = q o o G o- e a_q q, o o o cn Go a. I -o o E o @C(g .N oo tr o o E o .= rts o F o o!, Etr o o ct)(E L o o o,c o!,L o \C\ !, o oooL .12 (E +a G!, o -g CL E o(, L o rts o !, o .E EL o+.o!, olt '= oE'(E L o o o +atr o E +a GoL N rFoN E =o(E otF * q) Erot! o llJ E9 Q- a_q o oI = o c o) c @C G .N oo C; o -o(E ,^ '6 o o-o oo(U o o- L o -c o -bo5 =o sNo s oq c, s @ rct s oq F CO s c,lO s oq rF @ s@ r() Nr\$_(?Nrt - ro]\- cf)oN lON -\t tN $ l'- o)^ r t(,t\ -$ -citF $ tt- Or_ s CD s FN s -o) s I- oG' - N cf) l.() a)N o) f- N (r) N o) rF I- N rF FoN N FoNl. o c 0) E E oo o) .C o C tsco_o -L.= =.o =-cx-oY'o .b sd=.p oE 6E gIf LE.Yse EgE(/) = Eoo k fLZ: gb.ge; ,EE -tE ?E g€ .E 9 E'Q#(1 lI e FE= -.=L-J!oxooEEoar 3 UEE ilEeE oE E oroX!qc Eqfi fi eEEqr EEAE!:=g EE EEI >.F (U --ot, c) EEfiE E EgE = (u O)rF ' E=ta -C^- (J) U) OU fOu.'t 7H pn* E oEE-a o.e7 > E- E (/)l- iJXoF,20)E)tE oE Ec.,.cerO'=# (,) o) 'E =>A-c ;EE?E oF.9F dO -, ol- c EEE u 9 ar P (D.! O H H;E Sg:7 3 E- ti 'FO)^ .E r (5 E:gAE q5f 8Es 5 P9()IE=Es.B -,r 9acD=F =.EdZ E bo=E 'E:o ': \,, ^'-AHbe BE-o=E8iie€ EooC.C vE.B EOp -:zf ooE.9o.0E aFv .=oF rTH'E .x -C _O arAEEi5ts g = (Do (E -ct5 E g L!Lo- o -c =-V o Ou.9 ! tEE E kE[ E dEE E *EE = e sE g I8E 5 P :E ,g $ UP E 6F '=- ct q) 9E E Ug,E I o .EP 5 R .E-: fr EEE ; 8EE E = #{= _O !2e€ ! k :i ;u E -b J(6 E ,k ' > 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? lf so, When? Commun self-mon and Stakeholders Meeti 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 a flow chart of supervision hierarchy. Central Level Distridt Level Level 2.9.2. What were the main issues identified during supervision? Some communities did not have community's registers. Some CDDs were putting more than two households on one page of the community register. Protocols, Fliers, and IEC materials were not seen at some facilities and communities especially in Foya District. Errors were indentified in recording and dosage for Albendazole a a a No of Communities that conducted stakeholders meeting (sHM) No of Communities that carried out self monitoring (CSM) DistricU LGA Total # of communities/villages in the entire project area Nil Nil Bong Gbarpolu 471 190 Nit Nit NitLofa 693 Nit Nit NilMontserrado 279 Nit Ni!Nimba 538 NiI2171 NitTOTAL a 23 Was a supervision check-list used? Supervisory checklist was used at national, County and district levels 2.9.3. What were the outcomes at each level of CDTI implementation supervision? . Communities where treatment had not started were encouraged to commence treatment. . Communities were supplied with additional community registers . CDDs were coached on census taking using community register. o Meetings were held with some town chiefs district Commissioners to mobilize for mob-up treatment in some communities 2.9.4. Was feedback given to the person or groups supervised? Feedback was given at all levels 2.g.5. How was the feedback used to improve the overall performance of the proiect? The actions required from feedback were implemented in a timely manner SECTION 3: SupPort to CDTI 3.1. Equipment Table 12: Status of equiPment Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condi tion No Condi tion No Condi tion No Condi tion No Condi tion 1. Vehicle 1 WO 2. Motor cycle(s) 5 F 3.Motor cycle(s) Bicycles 168 F Generator Portable METS 3. Compute(s)Laptops- 2 F 4. Printe(s) Cannon 1 F Desk Top Computer GX 280 1 F 5. Photocopier (s) 6. Fax Machine(s) 7. Others a) b) c) *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? This will addressed by providing it in the budget 3.2. Financial contributions of the partners and communities Fill tables 13a, 13b and 13c lf there are problems with release of counterpart funds, how were they addressed? The issue of non release of counter fund was addressed through advocacy and the policy makers now fully support Onchocerciasis and other NTDs. o oo C;o o_ f- oq O) cf) o- o) \o N C) o 0)a o C olaoe E9cclSorza ..i 9$E (g c o = -o L .9.E C o 0) E o) -+ I tt, t oi >io' o ao ! a Eo o t4 t|r o so oo G (u E G o 5a o E oo o s E o =c c oo I o o -c, o(U c) .C +t o o ocE o .1,c .o) -o C oo E C)C(U .E LL (E 00 o 3(EF oq o ro ryN oq(oo o- O) o i o q(0 rO6l iei ,lo i Roi l-lI-l ooqq o,loo lro(o-l- l(),(o oq oo @^ oo C;o @- N oq lr)N\N aln ^i' Ees i IoL os +a o I I I EE 5.E():, I I EB,Jz oq (f)o ryN oq({)oot $l oq(0 N c\t (.o o:ooio(ool-,O F-_iro- $l- oq oo(o oq oo(o i +.tr o E ooL lr ..2t oll-t ol c1E ag o,1t IIJ F o Go{J .C .9o E o oL =llo-sE 6 I I I I I I I I I +,t) +r6 o +iC5 oo G o € {J(Eo E9 E'o =;E.=rrig-9tro3rF o E E a.a oF tr o +, .Ez !to+,o C,!, o F E' '6 sl tr trJ L GE' g TEo o+, o .9 - otr o oL tr o +a .Ct L+.tr oo Fz tu =ztr ut o o I_ .9 .o e oo =U) c.i c o (u)E tu c"i c.j G o Ia v, oiCt l-lOI C' o = ..i (f) $ .T o o o totbOEQ.GSSoE S,i .C =(o o I o o) .g .g(u ol- o) .g .g(uts9 'o) ni { l"i I i I I I I I I i I I I I I I B} sl sl{' .g .E(u c.i ,i OrOi o, o:g) .=c G' o:rEr I'{lrtrl .ol c o Go =Eo l- =(u o) J- a oi $oI dE8s9E ES iO osEOGSNG =Na.EOQ =E{o G o aa q I I I I c o (I, .N E o = - -i Or(U o o E "t c o (u N ,6 C oa ^i IJJz J F UJ(9 ol dt I i I I I I I I I I I o cf) ry(o CJoo o ooN$ ooo o o c')c 'E' '6; o;L o!cl .-tcl '-l(5I LIF! .l rl .!Nl{ ees o o? o6ot (f) oi o- I I i q (o ryN 6t E l,E=oO=oo E'- !9* \ O) -lOor_ C\t ro\ lOo @(o o q rOo o- (f) ftr o E ooL =tt .t2t oL otrt(U CL u IJJIF o oE o 6o +a E" o oq @(o oL =tto-SE U tr, .= rEEE ErF *,oo 5L+.,a, +rojo Eilg EI:o o --.=* C,,C &r9EL Ld.e -flEG osfN o N(Y) @ ii hoN E o -, oe oL E'tr olt tr IJJ L IU!,c -g(E o o -o =o oL CL E rU o F oc o c o .J3 .Ct L+,tr oo Fz IJJ =zu IJJ o o 6 C'IE EE (o(o cf) o rr) UJz J F IJJ oofE c o (5 o)Eo -c =o c)I t r o G(, 5 a.B8s9E ES coosSOGS SN ooEE{o c o (! .N .=oC oa ..i C o (U .N -oo i (o r G o Ia q oq o o- r\ oq CD a) o^ o) c c oo I ooL .C a -g o .C o o o oC .9) -o L C oo Eoc(U C iJ- ii(Y) rF -9lt GF G or.. 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E € Egg E € EE €e E E bs E o =E E2 E E ie E € g Ei b B E is a i iq .gs - o o E€ E E =o q,E E ! o- -co (E = EE hBF- E EAg E 5 Eg EE E = E E; - Ys Eg e\r 'F = a tg b Eqj pr yE E : E Hg ;. :E E, .cg E : S .8E a EE Ee -3L E 1_ EE 72 =a EE o .B-s + f;E# s pE fd *: i s E .frg e EB Pr-s EEa E EiEE Eg i;A ;$ a E ? 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EG 'E E',g = tr o (E tr o E -9 CL -E IE =.9o> 9-EoOEE= g. E,EiJ Oooo gt E u -?>u --b.-8 0 8E =o t.E6E.E cD ttG EOd o!, o E ! o o o. oo +a +,o G C ,- .99Et9 :h l-t-O .= .= .eo= P.d LL aa>= a E,ho .EN ;E Ego6 a rFo_ -AoeEO s6 .='F(,,(E Eb. a io -O =N.Y(g 55ts-o -oaOE o lF o c o f2a A-i o= a o C o E -. 8,.e9(E=FCTU;(E(E -tE a c o (5 c<9 .= c)Eo.(s0. >d o a a a a a a a o 6 tr oo o o EL F .oa(E 'o oo .PE() P- 68 .9 o.Q -c, oo.(E LLio ,9,o .g Eooo .9. -coa I U) EL c oo (U L(E (U o C oo o L o o = c o .E =s(5 (E E oEo(U a o(U (U #(s() F C) o) o-o oL o -c o o G a- Qa a-Gq G to oL =o = a o o o) .sa) oo E E(E L o)oL o. L oE o rb g lt GF 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the proiect area within the reporting period. Knowledge Attitude and practice (l(AP) survey was conducted in Nimba County as part of Nationaliormative research to commence integrated NTD Program in the country. 4.4.2. How were the results applied in the project? The result of the KAp will feed into the development of national NTD communication and plan and development of IEC materials SECTION 5: Strengths, weaknesses, challenges, and opportunities Strengths Experienced NTD focal persons at county level Weakness lnadequate logistics for frontline health staff lnadequate of health staff in engaging communities Challenges CDDs demand for incentives Opportunities Availability of CBOs and private sector organizations Viable community structures in some counties e.g. Nimba lntegration with other health programs sECTION 6: Unique features of the projecuother matters parts of the project area are within Monrovia and other big urban areas in Liberia as well as tne gold mining areas where the population is in constant movement. This project i"qrir"i innovativl strategies to address community participation, CDD selection and retention and population updates' To implement CDI in the highly populated urban areas, deliberate effort must be needed to engage religious orjani=ati6ni,'..hools and other community based organizations to elicit their participation in the program 36