H EAST CDTI PROTECT, LIBERIA INTERIM TECHNICAL REPORT 2OO9 oncho mohswlib2000@ya OzuGINAL: Enelish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Jutv for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) For 'Ia I Cl-i i 40, AftI for hftinoilon To,\\h, q-qoe,'J BIM TK oAb 4oP --irrr-- UNTRY/NOTF:LIBERIACO ect Name: SOUTH EAST Launchins year: 2000 From: JAIIUARY 2009 To: DECEMBER 2009Reportins Period APOCfuntlinsyear: (circleone) I 2 3 4 5 6 7 g 9 10 11 lZ tJ.. tnl tn 1234 5(r7B 910n Lz 13rt: (circle one) Date submitted: Partners: - Ministry of Health & Social Welfare - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - Sight Savers International - 900 communities RECU r.E 0 I FEV. 2s19 - /, il(Ai-', WHO/APOC, l4 September 2009 Approval year: 2000 AI\ rr* [ iAL I'RO.IECT TECI{N IC,tr L Rl]POR't 1'C) I H('HNI(lAi. CONSUL'IATI\,E COMIvilTTEE, (TCC) ENt}ORSE.MEIYT Plcasc ct-rn{irm \rou have read this report hy signing in the appropriate space" ()FFICERS 1o sign the reprrrt: ('our.ttrr'; i .ihcria National('oc,rrdinittor Nlrlr*: Antho t] SitDatur'c I)atc: 3 I Janrrarl 201() ZorraI (.)ncho Coordinator Narnu Signaturc: l)arc N(;DO Representativc Nanrc: l\,lrs. Adolcv Sanii Sigr:aturr [)atc: Sl.lanuan ]010 T'lris reporl lrus lrcen preparcd by Namr Hclcna tr_-- ,r'/ -{ Dcsignation Si*enaturu; i. I) rt-r iriletucr r-jl'...(, lr a; ll, l)atc \\ I i( ),,\ l)( t( . I'l ttptrnrt r..r lli0t) I I ! I I ,t ,l I I ,l ! I I I I ! i I I 'i ,i ,i I I ,l ,i ,l ,l i I i i i I i I I I i i '! ,I Ir 'i I I i I i i I I ! ,i ,i 'i 'i I I I ,i ,i ,i .: ,i ri I i I I I ! i i I Table of contents ACROI\IYMS VI DEFINITIONS ....... ...........vII FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY SECTION I : BACKGROUND INFORMATION............ l.l. GsNERnl-INFoRMATIoN................ 1 . I . 1 Description of the proiect (brieJly) ...... 1.1.2. Partnership 1.2. PopuLaloN SECTION 2: IMPLEMENTATION OF CDTI.. 2.1. TtrrlellNpoFAcrlvlrlEs.............. .....................8 2.2. Aovocncv .........'........10 2.3, MOSILIZATION, SENSITIZATION AND HEALTH EDUCATION OF AT RISK COMMUNITICS IO 2.4. Covuuqlrv INVoLVEMENT.............. ...............12 2.5. Cepactrv BUILDING .......'.............. 13 2.6. TRrarnaeuts................ ................. 15 2.6.1. Treatmentfigures........... ....15 2.6.2 What are the causes of absenteeism?.............. ...'...........,18 2.6.i What are the reasonsfor refusals? ................ .18 2.6.4 Brie/ty describe all known and verified serious adverse events (SAEs) that ....... lB 2.6.5. Trend of treatment achievement from CDTI project inception to the curuent year20 2.7. ORDERING, STORAGE AND DELIVERY OF IVERMECTIN......... .,,................21 2.8. CovtlrumrY sELF-MoNIToRINGAND STAKEHoLDERS MppuNc ...........22 2.9. SuppRvtsloN............... ..................22 2.9.1. Provide aflow chart of supervisionhierarchy. '.........22 2.9.2. What were the main issues identified during supervision? ....23 2.9.3. Was a supervision checklist used? ......... ......'........-.-.-23 2.9.4. What were the outcomes at each level of CDTI implementation supervision? 2 j 2.9.5. Was feedback given to the person or groups supervised? 23 2.9.6. How was the feedback used to improve the overall performance of the project? 23 SECTION 3: SUPPORT TO CDTI 23 I 3 4 4 I 5 7 8 3.1. 3.2. J.J. 3.4. EeutptrdsNr FTNRNCIaI- CONTRIBUTIONS OF THE PARTNERS AND COMMLINITIES Orugn FORMS OF COMMTNITY ST]PPORT Expnr.toltuRE PER AcTIVITY ..,...,.23 ,.,.,...24 ........28 ........28 SECTION 4: SUSTAINABILITY OF CDTI.... 28 4.1. INrpRNel-; INDEPENDENT PARTICIPAT6RY MoNIT9RING; EvaLuettoN...................'28 4.1.1 Has the project ever been evaluated/monitored? (fick ony of the following which are applicable) ........... ........28 4.1.2. lV'hat were the recommendations? ........'.28 4.1.3. How have they been implemented?.............. .'...........'28 4.2. SuStRNestLITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT ...............28 lv WHO/APOC, l4 September 2009 Yn 3)......... ..........28 4.2.1. Planning at all relevant levels ................29 4.2.2. Funds........ .........29 4.2.3 Transport (replacement and maintenance) ....................29 4.2.4. Other resources... .................29 4.2.5. To what extent has the plan been implemented ......... ...................294.3. INrpcRerroN ............... .................294.3.1. Ivermectin delivery mechanisms ..............29 4.3.2. Training .............29 4.3.3. Joint supervision and monitoringwith other programs..... ...........294.3.4. Release offunds for project activities ...........294.3.5. Is CDTI included in the PHC budget? .....294.3.6. Describe other health programmes that are using the CDTI structure ond how this was achieved. What have been the achievements? ............. ..................29 4.3.7. Describe otlrcrs issttes considered in the integration of CDT\............... ........29 4.4. OpsnarroNAl RESEARCH.. ..................32 4.4.1 . Summarize in not ntore than one half of a page the operational research undertaken in the project area within the reporting period........ .................. 321.1.2. How y,ere the results applied in the project? ............... ................32 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES.... 32 SECTION 6: UNIQUE FEATURES oF THE pRoJECT/orHER MATTERS...........32 v WHO/APOC, l4 September 2009 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF 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 Self-Monitoring I-ocal 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 vl WHO/APOC, l4 September 2009 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 84%o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (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. (iu) Ultimate Treatment Goal (UTG): 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 full geographic coverage(normally the project should be expected 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) Intesration: deliveri albendazole for LF ng additional health interventions (i.e. vitamin A supplements, , screening for cataract, etc.) through CDTI (using the same I 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) Sustainability: 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 govemment. (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. VII WHO/APOC, l4 September 2009 FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 27 t I Number of Recommerulation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Report Related (i) Information should be provided on all outstanding issues raised by TCC 26 which was not addressed in the report (ii) Report on the outcome of advocacy visit carried out during the reporting period NOTF was reactivated Staff were recruited to fill the vacant positions at NOTF secretariat (iii) Provide information on the financial contribution in year 1 and 2 Information on the financial contribution in 2006 and 2007 is included in this report (iv) Provide information on the reason for poor utilization of approved budget Frequent changes in management of NOTF secretariat Slow pace of approval of request Non retirement of expenses from APOC trust fund Projected Related (i) Provide explanation on why total population is used as Ultimate treatment goal The Project has reached full geographical coverage and its expected that the UTG calculated would approach total population (iD Reduce CDD: Community member ratio Training of CDDs is being planned to reduce CDD:Community member ratio but the project is not able to WHO/APOC, l4 September 2009 mobilize the required funding to execute the plan (iiD Increase the number of health staff involved in CDTI One of the advocacy issue being addressed at County level is integration of CDTI into PHC and entrenching CDTI activities in the routine tasks of frontline health workers. (iv) Shorten the wide spread period in the implementation of timeline activities It usually intention of the NOTF and partners to facilitate the Project /Counties in shorlening the implementation time frame, but funds and other logistics are available when required. The Project is advocating for timely release of funds (v) Increase geographical coverage at both district and county level The project with technical assistance from NOTF is increasing media campaign to increase demand for Mectizan and compliance Reduce CDDs : population ratio (v) Request for APOC evaluation of sustainability of the project Mather has been discussed at NOTF meeting and a request letter will forwarded to APOC management (Please add more rows if necessary) 2 WHO/APOC, l4 September 2009 Executive Summary Prepare an Executive summary of the report in not more thon one page. 1. Background on treatment and population data - Total 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 southeastern CDTI project had a total of 900 target communities during this reporting period. The population in meso/hyper communities was 355,366. However, treatment data was received so far from 529 communities with one county yet to send in treatment data for 2009. During the period under review, training was conducted at national, county, district, health facility and community levels. At the Project, training targeted health personnel at county, district and health facility. The progress report indicate the following achievements - 521 out of 529 communities treate d (98%) geographical coverage - 208,406 treated out of totalpopulation of 265,611(78%) therapeutic coverage - 168 TOT/CDTIfacilitators trained/retrained - 108 health centerftrealth post staff trained/retrained - 2343 CDDs trained/retrained - 65% communities with female CDDs - 32% of health staff involved in CDTI - Number of communities with <80yo therapeutic coverage 234(44%) APOC provided 23 motorbikes to enhance Mectizan distribution and supervision to remote communities in the Project area. However, most of these motorbikes are not functioning properly and need to be repaired/replaced. Challenges . Bad road condition o Motivation of CDDs o Unwillingness of some communities support their CDDs o Logistical Support from Central level delay for supervision . The funding for the whole training process was inadequate . Lack of funds to procure motor bike spare parts and maintaince o Inadquate financial supoort for routine supportive supervision and monitoimg o Failure to provide incentive for OICs for 2008 CDTI activities o Most communities in the South East Project are inaccessible in the rainy season for most part of the year. o Inadequate Health education in the community by health facility staff is of great concern J WHO/APOC, l4 September 2009 SEGTION {: Background information 1.1. General information l.l.l Description of the project (briefly) Geographical location, topography, climate Population: activities, cultures, language Communication systems (roads...) Administration structure Health system & health care delivery (provide 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 South East CDTI Project consists of five counties: Grand Gedeh, Maryland, River Gee, Sinoe and Grand Kru and was approved for funding by APOC in2002. The project is located in the South-eastern Region of Liberia. The Region is bordered by the Atlantic Ocean to the south, the Republic of Cote d' Ivoire on the east, River Cess on the west, and Nimba county on the north. The Region is situated within the Tropical Rain Forest Vegetation Belt of West Africa. Most of the area comprises of forest except a narrow strip along the coast in Sinoe, Grand Kru and Maryland counties where mangrove Vegetation alternate with coastal savannah. There are two seasons: the rainy and the dry season. The raining season runs from May to October, and the dry season begins in November and ends in April. The average annual rainfall near the coast amounts to 4770 mm, towards the interior, the amount o1rainfall decreases to an annual average of 2080 mm. Excessive rainfall comes during the months of June to September. The average number of rainy days during the rainy season is about twenty- two days in a month. Transportation in the South East is mostly by land through unpaved roads and water. Most of the roads in the region are in very poor condition, with very muddy and deep holes filled with wet mud and broken wooden bridges. This situation partially disrupts road access to CDTI target communities in most counties of the Project especially in the rainy season. Mostof the people who lived in the region do engage in farming, fishing and hunting. Their main farm crops are rice, cassava and plantain. There are 107 functional Health facilities in this Region and 525 health workers with 168 (32%) involved in GDTI. In2009, the total population of 380,975 in 900 meso/hyper communities were targeted, out of which 265611 (78o/o therapeutic coverage) were treated in 529 communitie s (99% geographical coverage) with the exception of Maryland county for which treatment data for 2009 is being expected. 2343 CDDs were trained, and the totalof 502,524 tablets of Mectizan was used in treatment round in 4 out of 5 Counties. Therapeutic and geographical coverages were set at 85% and l00o/o respectively based on JAF directive. Community census update was completed in most communities in the project area 4 WHO/APOC, l4 September 2009 The national Eye care Secretariat and SSI with support from APOC Technical Advisor undertook supervision visits to project counties to appraise logistics, trainings, community mobilization and where necessary provided technicalassistance to avoid some of the pitfalls of 2008. Meeting were held with the county health officer, members of the county health team and OICs to discuss the 2009 treatment round and agreed on strategies for improving the therapeutic and geographical coverage to the recommended treatment threshold of 85% and 100%by APOC Population of South East CDTI Project, Liberia from Census update by CDDs Counties Population Grand Gedeh 82060 River Gee 65246 Grand Kru 54568 Mary Land No Data Sinoe 63737 TotalPopulation 265,61.1 There are at total of 107 functional Health facilities in the Project area and 525 health workers with 168 (32%) involved in CDTI (Table l). Tabte I : Number of health staff involved in CDTI (Please add more rows if necessary) DistrictiLGA Number of health staff involvcd in CDTI activities. Total Numbcr of health staff in thc entire project area Br Number of health staff involved in CDTI B2 Percentage Br=Bzl Br *100 Grand Gedeh 90 26 29 River Gee 85 29 34 Grand Kru 75 30 40 Maryland ll0 45 4l Srnoe 165 38 23 Total s25 168 32% 1.1.2. Partnership - Indicate the partners involved in project implementation at all levels [MoH, NGDOs (national/international), communities, local organizations, etc.J - Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all portners are involved. - State plans, ,f ony, to mobilize the state/region/district/LcA decision'makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. 5 WHO/APOC, 14 September 2009 NationalLevel Partnership at national level include Ministry of Health and Social Welfare and Sight Savers internationalwith technical assistance from the world Heath organization. The Ministry of Health and Social Welfare have been involved in planning, training, monitoring, and advocacy, while Sight Savers International provided technical assistance including release of funds. APOC/WHO provided funds and technical assistance to MOH & SW and implementing partners. The working relationship between the NGDO partner Sight Savers and the ministry of health had improved greatly during the year. Project /County Level During the 2009 treatment round few Organizations in the counties assisted CDDs with transport and food items during the distribution. Some of the Development partners in the project area include German Agro Action and Medical Emergency Relief and Cooperative International (MERCI) provided transportation for CDDs in River Gee County. The Cavalla Rubber Cooperation (CRC) provided food item for the CDDs while Medical Emergency Relief International (MERLIN) provided transportation for CDDs during the distribution in Maryland. In Sinoe County EQUIP and MERLN assisted with transportation of CDDs during the distribution. ln June 2009 the Grand Gedeh County health team with technical assistance from APOC/WHO and WHO sub-office Zwedru WHO Zwedru Sub Office held a partnership meeting on improving collaboration with its health partners, govemment and community based organizations in the implementation of Community Directed Treatment with Ivermectin (CDTI) t in the county. At the end of presentations, the acting County Health Officer and community health department CHDD discussed with the partners on ways of forging an effective partnership in the implementation of CDTI The following organizations were represented at the meeting; l. Tiyatein Health 2. Right to Play 3. GLOF 4. CAzuTAS 5. LNRCS 6. MIA 7. Development Superintendant 8. MERLIN 9. County health team 10. WHO sub-office In Grand Gedeh the Liberia National Red Cross Sociefy assisted in health education and mobilization of CDTI communities Communify Level At the communities level there have been growing partnership between the traditional authorify and Youth and women groups, religiuos organizations and local media stations in the implementation of CDTI. 6 WHO/APOC, l4 September 2009 o\ N () ! Eo o.q)a O o tu o 0.)Lo 0)E o oa (H (! o!(! o() 'a !o 0.) o a o a. 0) o -o a 0) 0) (H o o L C) o >. 0)L C) an d c) li(! C) C) 'd o. C) (H () oLq o (! It)Lo o- C) a , o) oo CN H o E oo o 0 C) o oo (€ o o C)bo(o Lo >. E E o o o c) ho al) o(! o (H L(g C) .6 o a) a 0)oL =o en L 0) o C) o -OAcox ()H 0) (!(!E(U-t2 =c)vO c)-od qDE PZ .^ 0) .= c) L Ea o z ii lt z a(.) .E (,) o. o0 '5 !<oo C)L c) bo .E o E C) c) 'a L a. o .o an U) c)o (B od \ s t'-- o \ a, $ q) :\ u G\ U -o o I .i :: b\ :\ .Y \- a.Gs9 -s .\ Sp %o' B$ .!ss\ ^Es$<\\ Su \-r%U NP \n -Ee s9 s :.\ E-6tlx\= d-; ^s$\ LI:!t,\ -a: '-\5! u .s .Y ri il x! :h^ S$ :\9.-'' ll ; tl\s q :v S)r. t E k 0) o- oo F o.() L 0) bo L o o 0.) (g() L C)L(n 0) L() C) cllo c)q) Lq oL q) C) JZ cr) L (n o o. o ! (c 6 C) o Q a.ll o)l -ol(dl FI E o fl o Je otr N a - - €E- EE3 + ll -oo .= qN !\Eoo!? 3E . qt E 46.=Eii >,! o s * -eqE N^ o Ysc) 3ST E I ,i <o oN o.: cEo F + I q -9 4lE'F{):! *-tro:\9E Ei-(!otr >)otsE N rr) c) o0 c, o)q) tr o CJ o Lq) z a 'EcS ?oEo E'=3SE 2 oo\o $ ra) c- cor- c.t\o \o tn\o(\l 6)Et- o9Gt -.EEEI i3 F FAEA. \o(\ @ co rn\o o oU *<o o c) L 0) & Liv € (d L E (! t,(B z C) a rl F t< !q)CJ .9= qr 9rY-f;. rH F95 6'.A SEGTION 2: lmplementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of octivities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. 8 WHO/APOC, I4 September 2009 o. N o -o Eq) a 0)a + () o (J o c) a *oEE(, oo o o c) t-.,1 o C) t-.1 C) 0) l-1 o 0) o oo- ?tr IO. C)a :) O.oa A"() a O.() a q() a U) OI *oEE (J o. 0)a O.q) a +J a. a.)a A. c.)a q a.)a b.0aE ftr a(.) a O.() a 9q C)a P.() a O. C)a q) (l ah ah oQ EE U A. 0)(n O.()a A.(.) a I O. C)a q(.) a oo-E+ liE bo bo bo oo bo ul C!L Fr EE o() oo oo bo bo bo B0-tr+ ftr 6: bo bo oo oo J b0 <0) EE6l=NI oo =9a o o.EEE U bI) oo oo b0) o0 hna€ ?E c: oo bo bI) bo) oo F] (J L tt) 0) () d O () 0)(J 6) ! v ! dE ! (d x(! oo a F] F oF o\ (r) C) oU I -:-\A 4q a)Uq) 4 o AJ "E S q)6Fi 5 k(d 0) 0)Lt- o 0) E C) (c C)L (h doH q) k aq) o(B (H o 0) o F ..ir o)l -ol(6l FI 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/constraints being faced and suggestions on how to improve advocacy. At the Project level, advocacy meetings were held with County health officers, superintendants, Development superindenants, District commissioners, paramount chiefs and town chiefs. The issues addressed during the advocacy meetings included - Inclusion of Onchocerciasis in2010 county plan budget - Release of funds for CDTI activities - Prioritization of Onchocerciasis as a disease of public health importance in the Project - Political will from policy makers at county, district and community levels - Community support and ownership of CDTI There were also meetings at the district level, with health staff, District Commissioners Town Chiefs, Community leaders, women group and youth leaders. 2.3. Mobilization, sensitization and health education of at risk communities Provide informotio n on: - The use of media ond/or other locol systems to disseminate information - Mobilization and health education of communities including women and minorities - Response of target communities/villages - Accomplishments - Suggest ways to improve mobilization and sensitization of the target communities. In all five counties in the project area, there were community meeting attended by opinion and other influential leaders in the community which include elders, youth leaders, women leaders, teachers and religious leaders. Mobilization and health education were carried out in the communities by health facility staff, CDDs, and community leaders and through he use of town crier. CDTI posters were distributed to some communities. The local radio stations played very significant role in the IEC campaign by airing jingles and discussion programs during the period of Mectizan distribution. All the effort was rewarded by community positive response to Mectizan treatment during the treatment round. There is need for health faciliry staff to be empowered to engage the community in sustained health education and mobilization and the partnership with local radio stations needs to be strengthened. l0 WHO/APOC, 24 November 2003
2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows if necessary) Comment on Attendance of female members of the community at health education meetings In 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). Incentives provided by communities for the CDDs Attrition of CDDs. Is attrition a problem for the project? If yes, how is it addressed? Other issues DistrictiLGA Num ber of comm unities/villagcs with community mcmbers as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communitics in the entire project area B. Number with community members as supervisors B< Percentage Be= BJ B, *1OO Male CDDs B7 Fcmale CDDs Br Total Be= B7+Bs Number of communitics with female CDDs B,o Pcrcentage Brr= Bro/Br* 100 Grand Gedeh 135 120 890h 350 50 400 48 360/0 Rrver Cee l 13 90 80% 290 110 400 82 73% Grand Kru r33 tt2 84% 282 273 655 I t5 86% Man'land Srnoe t18 t25 84% 333 159 488 100 68% Total 529 147 84% 1255 592 1943 345 65. t2 WHO/APOC, 14 September 2009 2.5. Gapacity 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. (The most important issue to describe is what meosures v)ere taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staff arefiequently transferred during the course of the campaign). 13 WHO/APOC, 14 September 2009 oCg O L) o q) z - .1 o.: +L\J: \rqv U = .+ + o1 m \o F- + I a.t a l 1r) oo c{ l/') oo oo : o\6t € o\ (Ot ?a) cl t \o o\?ot- s o\\o () () o \o\o o.l r\ r- \o r.- tta I U U 6ll Fql F q q) cE f.r (J' oq) ,6) Lc!q,L z o o o o\ () crtl- o)o:3 =El2il otot I I Ei't+F-u' &,Q \)E € o{ \o @ cai : @ s o\ a .: t \ol s : €) o o sILF € 00 ao a.t tf, 6 6l O O (, Fl 3p96J o z E,''r + d 1 a< = \oN t- c'l al c-.t t-- c{ la)l r- c.l @ oo : al ----i 6\o o\ F. r-- s Gl U] o q) C)F \t o\ 6t FI ??) ()J ()Eo(, ! d 0)o () a a v <dL o d C) o a l] F F o\ a.l () -.o E o 0.)a <f, (., o q o f !f, a ea o\ a * o B o :\ >1 %\J U AJ c1: \)L "N a,) x U 5 (! o C) o. F L.l O(H o CN o C) oL -c)qi ! C) bo LF ,irr ,l -l -otdlFI o q. o t\ Q I Table 6: Type of training undertaken Sick the boxes where specific taining was carried out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65o/" therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. Data from one county is being expected Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifu) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (speciff) t5 WHO/APOC, 14 September 2009 N 0) -o E() o. a)a s Q o \o (c(I)^L r,1dvE5() 'aca(s=9()(€HE6 ePq)o'=o.=9(g o +q ^:vl Zoi;;uE P, =i =-o;.sI u-.S} C sELE0,l:ds ::b.e!E=-':l-dEc(dElEnEr3 .g [I .U.E1SE o, E F t0) ol = > t! -I H ; EF xI P H Tb El.g c .{o. 6ttr o'5 gI b E \ = :IE E N3r sr st 8t e fl II F Elfl IiE Eli t:l ;l= =l E ;l; ;l E_ .i8I EE EIE EE BE S *l 8lE 8l E BlE 8l u SEI El e BE tl.s rl€ t H1 Elg sl! slE sl = s" E] EIg EIS EIE ;IE s(Ul ol oo .;l E =r :a-8l rrrrr i(dt a-LIS ol !,EI ,\AE E F .EI E;3El g, s SHl E0s!:bl 9 6 E 9 Eol ouC)o:rl Oao0'=.S .Ol oA )\a !tra t ; : Ee{_ =ie qS E I;l g_- s- fr- I sEl E;o;=lLro)oYr)sol .E()t-dt tr o k s \ fz <n L (! v)(t C)L d J o li o E >. -o 0t! (t 0) cd C)kF F-l ot -ol(sl FI eEE9( os E ,6-ehoiiE= o > o I UF!l = tr-c J !)d odg o- a a .a E z -oc oE o u.] =u{Zaut o{ c- r- 6lF- @a.l $ :.U s.g ., sE?e$ 5 Ee H Bzi7*,> .+ t-. F- c-'l \o *N EUOY] 4 in a \o6l $ F- sf aa+ o\ t'- c-lN ^Z- 5;E d trE},-'9E =6- d9z oE <. -f, CI N co al \o o <r- at ll *xx JooO O^oL-o d Qo: ooEoF o :! €q 5 9Eo?c2 u9 EH=U-Co-=<i 6 GA ^,.d- :dl = o :!c ' a 8Js o oo o\ o\ oo € o\ oo oo a- \o r\ .+ (\ -+ a.l oo € F-+ C{ a-\o a{ \o .+ aa N c! € \o+ o.l \o @\o + c- t-. \o \o \oN c.l € \o .+ 6l a\o .+ r- F- \o \o \o6l Il {do H H \oq: U€;3;EE*I - 1a,E YXd - O> FH E E-&'TE o>-u tsq.- o c su!5d= SEtbZE I :o d a.a =F-E69r493' FU 69o -d :eo&> cno E E oU o\ o\ O 6\ o\\o \o o\ c.) ca $ c.l c.) oo<f o\N (! Sror.E >.E oo v N oQ :'bEE L() a'l r >l 0)oo Lo 'a V d!(, -o L cd 2. o a rl 3 F c..l Lo -o 0) o a t (-) o (-- 0O\q) \ bo o bo $\ a. u \ .o € s F 'bi a..9so'{\ ES .E \-ao' !bUY BI Eq)ss!s Ytrbs\: s'{ G*g -r! t\ tsU.Ss: <\ SS utli.$8! -\Bb$ ssa\ s:!I6E{ !Sr !.f Ua.EE oi l\='Is LO\R 2.6.2 What are the causes of absenteeism? Lack of people were absence due to migration to other area. 2.6.3 What are the reasons for refusals? More people refuse to take the mectizan due to the adverse event they experience during the last distribution in 2008 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. o Parasitologisttrained'7 o Existence of microscope? 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 l8 WHO/APOC, l4 September 2009 1 (\ 0i E(.) o-o a$ O o o o\ a. \) o'\q) u\q)q .t( C\ 4q q) U a,) q i \ q) L -E a,)4 \) 5 0)o bo P o (.) () bo L () LL lo C) o (o a r! a ah c) C) o U)ko d .t) o c) .t)(rr o t')q)(h(o O ddr o,l -ol(dt FI o -E!Ea* _89 bi E= ;P8 .EEq(€oi, 9rdx 6.:gloo o.9 EAo-!2 oo L., O- o- qD ^ 5tl (n o-E tr&34 q:;o-O.?E C o C C- (ioog A =.L.O o OeasP (d €-Egp.s?, o.! oflEETg o o. >.a .r; L o= c) lJood =oN'= 93so> x o 6)ooc = bI) 5Lao x C)a C) oo * 1a 0.) bo tr bk - >:_.ro U sN N sq NN sq o, Fr o\ oo r-. o (! q o E< EI r{ l d o ^boU 6^ r 0a\4'>r -o o soo soo s oq $ o, \o @ l-t ll r E] E] 1.1 o\ I =bood 6- s) oo -EoF slf) @ s ro(o sN@ o\ 00 r-. Ll ,o oo o!9_aFC =oZL o- f.-o o- cr)o c9 f.-O o-(.) O CO NN o) o (r) $ € N E] Eo doa aEu\=u 4lDs -io Nt- ro NO c.) NN ro c.iO (f) v o) @N c.) c.l G ^..d-lo -: oA :5A1'o€ .o.i€= Et! ' a 8e o (o o)$_ ro(o v (o O)t_ rr)(o$ lr) N o, o @(9 6l C)bo q) (J ll r r, rrJ l! o ^oo9S:; - ao\ soo soo sO)N 6\a o\ to=3_S^,; Bs !E'!; (lolrl soo soo sO)N 6\ oo o\ ti oE3* c = Hg JtsJ.E '70a N o)lo N(o r, @ N (\ ti =odO= EE9Ti.Qs' Fq, N O) ro F.-(o 1r, o,o o, o\ c.l bo6 =aJ_rd!:., b e) " !; x d=It a= >:: s E => E-T E 3 Eg EA oo N O) ro N o) rr) o,o O) o\N & rrl t-- o\ €o\ o\ o\o\ c{ 6l c.l a.l m 6l $ c.l o.l \o a.t F- c.l co c\t o\ c.t a.l o\ c-'l o -o tr 0) o- o a + o c.t -U) I U5s ! G(J q) EO L 0) v() 7t\JF J =d tE'\ *o -t\EL.-'sE *U .:v\ (,, :qJEUSe '-.-t?-'la 6=c!Fq.q, LlU-63to oslE\ =&.2A- r:eEEAvL< O!l oc.)l c)ol IEI '-ts1Ec. I .oq)l t-tEEIo.El -q)l,ol atlUHI EqYlHLIOcdl&E..I !lCEtrEl IEEI ;0-el Ea(qt 6) c)()I i-IAE>t i2rrlo.J9re !u9bLtr>o!a)l-r(q59' \JLU :(!;J; E.gE0-)!gtro L-Iri!G -o)9qEE\oE e.i o\l ';0.)l u) €l u Fl O. 2.7. Ordering, storage and delivery of ivermectin Mectizan@ lied for by - Qtlease tick the appropriate answer) MOH wHo TIIIICEF! Other (please speciff) Mectizan@ delivered by - Qtlease tick the 'iote answer wHo I.INICEF NGDOtr NGDOtrMOH tr Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities Table l0: Mectizan@ lnventory (Please add more rov'.s if necessctry) - How are the remaining ivermectin tablets col lected and where are they kept? The remaining ivermectin are collected by the officer in charge of the health facilities and kept in the pharmacy of the health facility. The County Onchocerciasis Supervisor collect all the remaining mectizan and send it to the county pharmacy. - List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The required Mectizan stock for the year is calculated and ordered by NOTF based on the target populations of the respective counties, Districts and communities. The order is sent to the-Mectizan Donation Program. When Mectizan arrives in the country, World Health Organization (WHO) clears it and sends it to the National Drug Services QIIDS) through NOTF for storage. Each project county order the the drug through the county pharmacist base on the target population to be treated. The county Pharmacist send the request order NOTF secretariat for approval and the request order is send from NOTF secretariat to the National Drug Services (NDS). NDS detiver the drug to the county pharmacist. The dru gis taken to the "ounty and kept in the county central phamacy room for onward distribution to health facility and the health facility deliver it to the communities by the OICs and CDDs respectively. County N,r.nUe. of Mectizano tablets In stock from previous vear Requested Received Used Lost Wasted Expire d Remainin o Grand Gedeh 37,648 152,545 103,545 l4 1.193 552 0 0 0 fuver Gee 33,366 75,000 60,000 92.954 412 0 0 0 Grand Kru 24,349 80,000 80,000 t03.777 572 0 0 0 Maryland 30,s89 343,788 60,000 Awaiting data Sinoe 165,397 0 0 164,600 797 0 0 0 TOTAL 260,760 32,3545 2,333 0 0 Any other comments 2r WHO/APOC, 14 September 2009 0 2.A. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) 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. An orientation meeting was facilitated by APOC technical advisor in Grand Gedeh Counfy with the County Health Team in April 2009.on Community Self-monitoring and stakeholder meeting. Rollout of CSM and SHM is being planned for early 2010 in pilot counties. 2,9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. Central Level o NOTF o NOCP o County Health Officer (CHO) o County Health Teams (CHT) o County Onchocerciasis Supervisor (COS) District Level a Officer in Charge of Health Facilities Communit-v Level o Community leader /town chief o CDDs Countv Level County 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 (SHfvD Grand Gedeh 135 5 0 TOTAL 22 WHO/APOC, l4 September 2009 2.9.2. 2.9.3. 2.9.4. What were the main issues identified during supervision? Was a supervision checklist used? What were the outcomes at each level of CDTI implementation supervision? 2.9.5. Was feedback given to the person or groups supervised? 2.9.6. How was the feedback used to improve the overall performance of the project? SEGTION 3: Support to GDTI 3.1. Equipment Table l2: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:Cunently non-functional but repairable, WO:Written off). Note: The vehicles are functional but need repair. The use of these vehicles can are limited only in Monrovia, it cannot be used for field activities. How does the project intend to maintain and replace existing equipment and other material? The NOTF secretatariat is advocating to MOH &SW to include CDTI activities into the National and county health plan so that the equipments maintenance cost will be included into the county annual budget for 2010 and20ll. Also CDTI will be part of the integrated NTDs plan. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condruon No Condrtion No Condrhon No Condrtron No Condrtron l. Vehicle 2 F 2. Motor cycle(s) 23 F 3. Computer(s) 4. Printer(s) 5. Photocopier (s) 6. Fax Machine(s) 7. Others a) b) c) 23 WHO/APOC, l4 September 2009 3.2. Financial contributions of the partners and communities - Fill tables l3a, l3b and l3c - If there are problems with release of counterpart funds, how were they addressed? - Additionalcomments 24 WHO/APOC, l4 September 2009 o\ 6l Lo -o () o.q) a t (-) o a.] t, trc,= olr TE LF o o o 'e e, al,>oEe oo tnEOq8 'z tr)oF-Tr)lr)lr)O;NNt-lo i.,166oP sf, rt $ ra) Ei; E" co E oo fo 9,!t 'b ocE(E a d ulEFo ooo(9 z is E oo ! .9 !, o6 ss tDoCF 't o =Oa) .E96;o G !,o(!6C =o .O ElooEt o Er! xo z o 3tt tr o(t Fz u.t E2il, IIJ oo !o o trl!t @ o)oo(\r t Go\ o ,ts oo a.{!. !to o CLoL EI' .solt n ITJ (B!, g(! o. o oz t o G o ieIta c o o f E TU a? (f) q(o ic' o, '6i Ei o!q fi ,.i :i(oi I o, c, o >l o o: a, oi E.oi ol o, o U) ol c o, E'3;>(ul \ 6i s>i -o c.li Q +t s 'i(/, Co fo .9.E c o o E o2; + otr o o) G s$ ! G teEtrloa> 'tro Ee!b tr!EEOG9o sbo>>o Ii c o, Ei > _-#s 1l q c.,li Q "il d ul o 0t o a-x o) EE .e6 .ra 6Eq <. .:Ji - IrJz J UJ oof6 o tr .e G tt so t4 s(J Go o :.€ .sE s€ =oo€o=E8{€ G o aI ao c o (u E -oo r: c o oo E o) E =(\l oI a i >.iot(Ei oloi >iEI <l .l(ol 'l -i c; .9i o, .N, an,cr orl a.i c!i rI c o Gt G ur dc o E o E io lt, .E oaS a4 ,i ol ,oi :o'roi io; C')ic, : .EilC,i ,oi ,\ito)rEiOilr! .:t 'a:tri .-r .Ei FI Fi .:i .i C\ri o" o)lz o' 3 -c i6l o) -i o, o, .E' .ci .g(U F q N G o aS aa v) (B ()() L (r, () L .o (! ct) o -o L oo o t cE ro c) 6lF o\ o.l o -o E() o.oa st O o o \o N o c?(o @ o(! ro @s\t 1r)o o)o @(o @f.-NN !t c,C)3 olr IE oo rr) o o o .E e,o EE oo oEOq8 o rq @ @(\a o) tro Eo P ! .?t, Eotr L G CLt tIIrFo o oo oz f.-sN olr)$ l-() E6 Eoo .cI o :eE oo ll:,(o o E -aE cDotrF 't o OaJ o,P =o(,EIo(!oc5.etl ctc!oEt toE =6:oTHz ooo oo(, rO aoG e! t,ot o CL o ED .s olt t UJ C,E -9(! o o o o o o. Go otro c o tl G o(, Fz UJ E20t IIJ o o Eo o ot o c o GI .! UJ dc o s o E io o .E oaIq o' o,! o; fl Oro' -' o o)c, c 6, 0) \i o,ci - =i \ Ei St-i o Ni Q air 5 "i (a B} tri (!:i: I ooo o o '6 F; c\i olccO o,o EI E =: riJ oi c(Ot (O l! o IaIq(f)i "I'Clo o, oa o E('i o, E9r =, o,d, @t Et oi o-, lbl L-i od) o oi>F'Or\ E:EiE2 >l €Fr N'Q +rw;fr s o o o| G s G ! s G EsECloa> 'tro Eg :T 'Et OGPoSbo>>o Ib t r,oto, E,Ol Iax,'sio,ctia H:- *; E 3i E: , 'rri g(rrN,Qyi ,o ,o: s F oF oz x, o luz J t- UJ(, of d) ,c 'o ,.-oro,, >., E(5.-95-ii E E(rr,9 c.jl s, d rO o s .9 G N to tr otn so Go o !-c-6 5tr'E E .e3 NE€ Eso, o A.^s zo=EE: c .9 o .N =U'c oa q o C)L ahd 0) L ,\) H 63 Ch o ..o L oo (n o d lJ. ta q) (! F c.l o -o 6) o-oa .f, O o o c-(\ E() oo C) 0,)L a(d 0,) l< € (! ch L oo 63 o (n f& I(?) c) c!tr o)(Y)(otNH EE<Flt o oo c co =.95=o EB,Jz o(, ot tro E oa Il .9!, o otr 1: G CLt llJEl-o ooo oz E o o lt o ;sE o,6 or tO Io E'g E"OCF 't o =OaJe.E oe s -.4!o(l Eo(!oc =olrgl&oEE o E6EE z lo d(n FooN !,ot oco ctt '6 lt t llJ art!tc -9(E o o ao o oL o. 6 ooh N o3F c o a3 'i o(, z IU E2 fr, UJ ,o o 1'o oo!, c0 J F oF oz tr o o GI G ul dt o s o E io th .E o aI an a, orol or oi oi ci .E1 oi oi\io,cl 'Ei '6i Fi .:i o.li I s (!iti I G] oi iri atri o o,v o =.c =ooI o N c\l G o a an c o o: G uJ ri(o la; ri N(r) oi ci o. >l o, oo, o) E, o 9, O)l >iolai oi cioi Ei8;>(ui -6i g =i fNi Qer S -i.r, c .9 f -o .9.E E o o E o2 ; s tro o tr) G tr G E E G EeEC5(l,Q> 'tro Ee!bs:E!OG9o Ebo>>o It i o9ig H> * +E ,, li f r,NiQdl -i ,i G E o E!q S utz J F UJ oof @ ici 'ol i (urioi ,fi HJ BiHiSl-;i 3i EIi-it(f)lsiQ -i -i ,i o tr o G '6 ota *(J oo o E-lbci: €E s€ =oEc6=E8 -:€ c o o + -oo =I c o (U .Nzoc oa et 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) 3.4. Expenditure per activity Indicate in table 13, 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. Indictate exchange rate used here Any comments or explanations? SECTION 4: Sustainability of GDTI 4.1. lnternall independent participatory monitoring; Evaluation 4.1.1 Has the project cver been evaluated/nronitored? (Tick any of the follorving rvlrich are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 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?_ Was a sustainability plan wrinen? _ When was the sustainability plan submitted? What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 28 WHO/APOC, l4 September 2009 4.2.1. 4.2.2. 4.2.3 4.2.4. 4.2.5. Planning at all relevant levels Funds Transport (replacement and maintenance) Other resources 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. Ivermectin delivery mechanisms 4.3.2. Training 4.3.3. Joint supervision and monitoring with other programs 4.3.4. Release of funds for project activities 4.3.5. Is CDTI included in the PHC budgefl 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? o Fill tables 14 and 15 and provide describe other programmes that are using the CDTI structure and how this was achieved. What have been the achievements? o For each intervention listed in table 15, explain what were the roles played by the CDDs (census, mobilization, distribution, data collection, storage, collection of drugs, referral of SAEs, etc ...)? . Explain what are the combinations of interventions co-implemented? o How were the interventions implemented? (at the same time?) 4.3.7. Describe others issues considered in the integration of CDTI. 29 WHO/APOC, l4 September 2009 o\ 6l Lo (J o- C)a + Q \J - O C.) q q) a xq) : q p q) q) q) q a q) q) FAR +) c{ q) I c) a I o(,) $ t.l q) ! cg3 o (tl z C! oF o G q) E. q) 2 o o ooL o o z Ilr o 2 .o z F Qa z q3 o.r Etr Zo o I o o a0 tr o.=!l. c.2 =Zz (( oil o o oo CE o?. ;a .: \J\ >r: -os o.S oi oiltrE E9 >rLti q) _c .=oUE9; OJo>E a o coOoENl(o -o! .: qJ .9 -oOE a o_ co) .eEt(E €6 -t'ELa(E oo- a oo) c6 c)N 'E(g €bts-ooO,i5E a o c o f .o Ez.i5i a c o c(! - ffoo96(!FccA6- IEO a .=(o c<oCE 'Eo >;o a a a a a a a a a != or!Qs ->oFq) (r) (h (.) o9-:9 53 (-) 'aA &rno.(! tiL =dE1 (* C)(! o U) o ct') oAa FJ<Fa oL o (d k6(! z oL o(! L(!(! z o L (! a (! o C)(o Ll- t, o(! l<(B (d C) -'h EE I o\O c.r q) -o Eo o- 0)a <f (., ao 4 SJ Rq) t 4 q)\ "aU q) \ .{ b d o q)i q) q) s a) (\ N 4 -\cU C)Lr (_) lr C,) U b0 C,) a() F Lr b0 ot<O. Li() o rii F( q) c! Fr ctl 0) I o o) o,) o g(, o 19 o oL GG EO o& u0 oz2U) 2 6t o o oo LO oo 6 tr-sLE ?uZqE o E.9 Oo =o 'Eaq qE oo '=> eta q) g a Q) € q) P o o F -C .LO6Eei LL C)o:t a o C 0.,o6 PN =(! €E .= C, .9 -oot a o_ c o.) .eEg(!9+ -t'ili^(, .-Loo a oo)C6ON '- (! aQ =oJts-ooOi5E a z =J o C .9P = -o P .9o a P L OJ E o bo(o co.E E6 0r -6EEo* -b a .9 (! C <(UCE '= 0) !!65; a a a a a a a a a o o F q a(g ok o)o_QO -c tro= 58 o (d d ti o (d o. E >. -.1 d O o oa !rFa oL oo(! H (d o! oo (E d (U o H d z (n o odEF 0 o(d d d O e" o C)a0 ok C) o 4.4. Operational research Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. How were the results applied in the project? 4.4.1. 4.4.2. SEGTION 6: matters SEGTION 5: Strengths, weaknesses, challeng€sr and opportunities List the strengths and weaknesses of CDTI implementation process. List the challenges and indicate how they were addressed. Unique features of the proiect/other I 32 WHO/APOC, l4 September 2009