Northwest CDTI annual project technical report submitted to Technical Consultative Committee (TCC): January 2007 to December 2007

S- II uJ VED FOR PROJECT LOGO/IIEADING ,- NOR ST CDTI PROJECTat V ._.._.._.._.._i ORIGINAL: English CC) To APOC Management by 31 January for March TCC To APOC Management by 31 Julv for September TCC AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) NN,f t COUNTRYAIOTF: LIBERIA Proiect Name: NORTHWEST CDTI PROJECT nchinsvear:2004LauApproval yearz 2004 : From: January 2007 To: December 2007e PeriodRe Proiectyearofthisreport: (circleone) I (2) 3 4 5 6 7 8 9 10 Date submitted: January 2007 NGDO partner: SSI For To: For lniorfnoflon ro,5[3 ) c- I ltLF o F fFU 20n0 I WHO/APOC, 30 July 2007 .,i) .lJ \ ANNUAL PROJECT TECHNICAL REPORT TEC SUBMITTED TO CONSULTATIVE CO (r vd J:$v{ DEADLINE FOR SUBMISSION: F(IatI YT II ANNUAL PROJECT TECHNICAL ITEI'OIIT TO TECI-INICAL CONSULTATIVE COMMITTEtr (TCC) E.I\DORSE,ME,NT ' Pleasc connrm vor' ffi:#:,i,-J[;:::" bv signing in the OFFICEI{S to sign the report': Country : LIBERIA National Coordinator Name: Mr. I-len 'f. Salilu Signature: Date: '/ ./k), (fi, . . . . . r. t. .,. t:1: Zonal Oncho Coordinator Naune: NONE Signaturc I)ate NGDO Representative Namc: Mrs Signature: Vcrdg'l-arpeh ,ilr*/^ ,{:,/:.- a Datc (, e,g I-his report has bccn prcpared by Namc : [-[enry'l'. Salilir l)csignation : A a/- \ Signat-ure */, 1-. 08Datc WI IO/nl'}UCl. 30 .luly 20t)7il Table of contents FOLLOW UP ON TCC RECOMMENDATIONS SECTION 1: BACKGROUND INFORMATION l.l. GpNeRer- rNFoRMATroN............. 1.1.1 Description of the project (briefly).... 1.1.2. Partnership 1.2. Popu1erroN............... SECTION 2: IMPLEMENTATION OF CDTI....... 2.1 Turaelwp oF AcTIVITIES ...... 2.2. Aovocecy 2.3. MosllzartoN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMuNrrtes l0 I 3 J J 5 6 9 2.4. 2.5. 3.l. 3.2. CotvtarrNtry INvoLVEMENT......... Cepecrry BUTLDTNG.. ...9 .10 ... 11 ...13 ...17 ... l7 2.6. TReerN4pNTS................. 2.6.1. Treatmentfigures . 2.6.2 Wat are the causes of absenteeism?.......... ..... ........... 20 2.6.3 What are the reasons for refusals?................ ............... 202.6.4 BrieJly describe all btown and verified serious adverse events (SAE) thqt ... 20 2.6.5. Trend of treatment ochievementfrom CDTI project inception to the curuent yeor22 2.7. ORoERnrG, sroRAGE AND DELIVERy oF IVERMECTIN ...........23 2.8. CouuuNrry sELF-MoNrroRING RNo SrereHoLDERS MserrNc .......25 .......272.9. SupEnvrsloN............ 2.9.1. Provide aflow chart of supervision hierarchy. ............27 2.9.2. What were the main issues identified during supervision? .............................. 27 2.9.3. Was a supervision checklist used? ............. 27 2.9.4. What were the outcomes at each level of CDTI implementation supervision? 27 2.9.5. Was feedback given to the person or groups supervised?................................ 282.9.6. How was thefeedbackused to improve the overall performance of the project? 28 SECTION 3: SUPPORT TO CDTI ..............27a EqureueNr FnreNcrat- coNTRIBUTIoNS oF THE pARTNERS AND coMMUNITIES..... 28 29 29 29 3.3. OrHeR FoRMS oF coMMUNrry suppoRT................ 3.4. ExpENorruRE pER AcTrvrry SECTION 4: SUSTAINABILITY OF CDTI....... ..........30 4.1. INreRNer-; INDEIENDENT pARTrcrpAToRy MoNrroRINc; EvelunrroN.................... 30 4.1.1 Was Monitortng/evaluation carried out during the reporting period? (tick anv of rhefollowingwhich are applicable)............ ...........30 4.1.2. Wat were the recommendations? ............. 31 4.1.3. How have they been implemented? ............. ................. 31 WHO/APOC,30 July 2007 4.2. SusrerNesrI.rry oF IRoJECTS: eLAN AND sET TARGETs (unNonroRy AT................31 Yn 3) 4.2. L 4.2.2 4.2.3 4.2.4 4.2.5 31 31 3t 3I 31 31 32 Planning at all relevont levels... Funds....... Transport (replacement and maintenance) Other resources To what extent has the plan been implemented 4.3. INrecnanoN.... 4.3.1. Ivermectin delivery mechanisms................ .................. 32 4.3.2. Training.... . . .......... 32 4.3.3. Joint supervision and monitoring with other progroms........... ...... 32 4.3.4. Release offunds for project activities ........ 324.3.5. Is CDTI included in the PHC budget? .............. . ......... 32 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 in the integration of CDTI. ..... 32 4.4. OppnarroNAl RESEARCH . 32 4.4.1. Summarize in not more than one half of a poge the operational research undertaken in the project areo within the reporting period. ........ 32 4.4.2. How were the results applied in the project?............. .................... 32 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES.... ...................33 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........33 lv WHO/APOC, 30 July 2007 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 Self-Monitoring Local Government Area Ministry of Health Non-Govemmental Development Organization Non-Govemmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technicai Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization v WHO/APOC, 30 July 2007 Definitions (i) Total population: the total population living in mesoftryper-endemic communities within the project area (based on REMO and census taking). (i i) Eligible population: calculated as 84Yo 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. (iv) 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 of the 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) 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 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 1 Number of Recommendation in lhe Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROTECT FOR TCC/APOC MGT USE ONLY 207 Give an explanation for low number of tablets per person treated Miscalculation of fi gures copy corrected I Review the geographic data is it really 100% when some communities were not treated) and therapeutic coverage data where it is over 87% Same as above t Give treatment data for year I to 4 Correct treatment data for year I to 4 Provide information on community involvement Correction noted in succeeding treatment cycle Give details of the monitoring carried out Same as above 208 Increase advocacy in next cycle and carry out CDTI activities in a shorter time frame Same as above 5'year project, therefore should be addressing integration and sustainability issue. CSM and SHM to be introduced CSM and SHM will be introduced in the next treatment year Need to increase advocacy for more funds from the MOH NOTF met with the Honorable members of the House of Representatives Standing Committee on Health and meeting was successful Need to address integration Train more district and health staffand more CDDs CSM and SHM to be introduced Mentioned needs are noted for the next treatment cycle (Please add more rows if necessary) 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 data - Total communities, communities' treated, total population, UTG, ATO and persons treated. 2. Background on population movements. 3. Training data - CDDS, health workers, Total populatton (community) per CDD troined. 4. Challenges and how they were overcome. A total of 2,680 communities exist in the Northwest CDTI project are with a total population of 2,260,867 in the meso/hyper area. A total number of 1,486,041 persons were treated giving the therapeutic coverage of 660/o. The Ultimate Treatment Goal (UTG) and the Annual Treatment Objective (ATO) are 1,899,128 and 1,478,692 respectively. All communities were treated giving a geographic coverage of 70o/o. Population movement in treatment areas was very minimal in the reporting period. With relative peace now in the country after the civil crisis, internally displaced persons returned home and were engaged in farming activities. Most people were found home during treatment hours in the evenings. Same was true in the case of communities that chose to be treated in the moming hours. Training of OICs and CDDs was carried out in all project areas. A total number of 8,530 CDDs (7,959 males and 571 females) were trained. A total number of 533 health workers exist in the project area while 159 health workers are involved with CDTI activities. A major challenge in the CDTI implementation reporting period was that some misinformed individuals carried a wild rumor that the County Health Officers were holding on to monies sent by APOC and intended for the CDDs compensation for the distribution Mectizan. Many CDDs stayed away for a few weeks until NOTF rectified the alleged rumor. NOTF committee of 3 promptly visited the affected communities and carried out intensive sensitization and mobilization with emphasis on APOC Philosophy and community role and ownership of CDTI programs. The County Superintendents were very instrumental in talking the CDDs into returning to duty for the benefit of their own people. At the end, treatment went well with a therapeutic coverage of 660/o. 2 WHO/APOC,30 July 2007 SECTION 1: Background information 1,1. General information - Geographical location, topography, climate - Population: activities, cultures, language - Communication systems (roads...) - Administrationstructure - 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 Northwest CDTI project is located in the northern western and western part of the country. CDTI activities are situated in five (5) endemic counties of Bong, Nimb4 Lofa, Gbarpolu and Montserrado counties. The total population of these counties is 2,260,867 . 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 tress'grow wild and the area is fertile for both upland and low land cultivation of rice, the staple food. Other 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. The population of the communities is normally settled almost homogenous in rural areas and fairly heterogeneous in townships and cities. The leadership structures in the communities various with the types of communities. In 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 of the country and city mayors are elected by the residents of the cities. The occupation in the communities varies between urban and rural settings. The rural communities are engaged in farming activities from January to September. The inhabitants of the townships and the cities are engaged in commercial activities and other salaried jobs. Communication for dissemination of important information is through the leadership structure. Upon proper authorization in rural communities, town criers, drummers, and health workers who are also members of the community may be used to disseminate information using loud speakers in the community or market places. House to House methods including local radio stations are also used. There are 533 health staff in the project areas and 159 involved in CDTI activities. 1.1.1 Description of the project (briefly) J WHO/APOC, 30 July 2007 Total Number of health Number of health Percentage staff in the entire project area staff involved in CDTI B1District B3=B2IB1*100% GBARPOLU COUNTY Belle b 4 67o/o Gbarma 24 4 17o/o Kongbah b 4 67o/o Bopolu 48 5 10o/o Bokomu 6 4 67o/o Guo 6 2 33o/o Subtotal 96 23 BONG COUNTY Sanovea 10 4 40% Zola 11 b Panta Kpaii 12 3 Suakoko 15 3 Salala 't2 5 42o/o Jorquelleh 12 5 42% Kokoyah 12 5 42o/o Fuamah 10 5 5Oo/o Subtotal 94 36 38% LOFA COUNW Voiniama 20 5 25o/o Zotzor 15 6 4OYo Salavea 15 6 40% Kolahun 20 5 25% Foyah 30 8 27Yo Vahun 16 6 38o/o Subtotal 116 36 NIMBA COUNTY Gbehlay-Geh 20 7 35o/o Tappita 15 I 53o/o Yaruvin-Mehnsonnoh 35 6 17o/o Saclepea 30 6 2oo/o Sanniquellie 25 8 32o/o Zoe-Geh 15 6 40o/o Subtotal 140 41 197% MONTSERRADO COUNTY Todee(Lower/Uooer) 40o/o10 4 Caresburg 10 5 5Oo/o St. Paul 10 4 40% Monrovia South 25 5 20% Monrovia North 32 5 16% Subtotal 87 23 166% Grand total 533 159 30Yo Number of health staff involved in CDTI 'lease add more rows Number of health staff involved in CDTI activities 194% 82 4 55% 25% 20% WHO/APOC, 30 July 2007 L.1.2. Partnership Indicate the partners involved in project implementation at all levels IMOH, NG D Os (national/inte rnational), communitie s, local or ganizations, etc. l Describe overall working relationship omong partners, clearly indicating specific qreqs of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, ,f any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The ty 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, NGDO partner, Sight Savers International (SSI), 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 t-ooN co O. so 'l o = oc E PtE.bo5 iuofg @(o N. oN o @N. 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As the project enters its fifth year of implementation, advocacy is our primary concern to ensure sustained treatment coverage. This time around, advocacy was carried out to the Honorable House of Representatives Standing Committee on Health. NOTF Secretariat lobbied and met with the Honorable members in an informal manner. The main purpose of the meeting was to sensitize and enlighten the Honorable members on Onchocerciasis control and efforts being made by APOC and other partners to control the disease in the country. NOTF also ceased the opportunity to advocate for increased budgetary allocation to the Oncho control program. In their response, the Honorable members promised to take our request to the rest of the House and to ensure increased funding from central government to the Oncho project. They most importantly promised to keep the established channel of communication between NOTF and the House of Representatives opened. 2.3. Mobtllzatlon, aensrtlzatlon and health educatlon of at rlsk communltles 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 Re s p ons e of tar get c ommunit i e s/v i ll age s Accomplishments Suggest ways to improve mobilization and sensitization of the target communities. In communities, mobilization, sensitization and health education are done through the leadership structure. Upon proper authorization, town criers and message drummers are used when necessary to disseminate important information. A house to house method may be used in cases of personal messages like family planning methods and the likes. In urban cities, a modified town crier approach of using loud speakers in market places is very common. The response by the target commtrnities to these positive as reflected in the increase of our treatment coverage over the previous year. Considering the treatment data, as indicated in this report, we believe that mobilization achieved its desired results as there is improvement in both the therapeutic and geographic coverage over the previous year. In the 2008 Mectizan distribution year, we intend to carry out an intensive ,mobilization in all communities that have not achieved treatment coverage of 65%. These communities have to be reoriented on the importance of taking Mectizan. l0 WHO/APOC, 30 July 2007 s O) so at s o, s r.- s O) si.- s o, sNto s I slf) slo sro sO) sF. s o) r.l c)@ (t) N t o F3.t .o (o f.- (., (o lo (a (, F-F. !t 1.l$o)NN (f)(o N (?) roN (o (f, N @ (f)(') (i' N ro o O) F-f.- @I.- r.r)N (D F. tO) \t@ tt F)(o N NN o N o) (?, () ro (o |f) |r) (7) |f) oN!t (o (\l NN (oN (o N(\t O) (?) 6t F't N@ Nt, (f,t- NF. \ft- O)@ @ NF. stt sN s|r) s$ sN s N st s@ s<t s@ sN s(o s(o s(?) s N crt c\l @st sf c! t N sl N |f) $(D |f,t @ slr) (?)lr, o)NFI (o$ (o(o @sf o@ t(o Nt.- (o (f)(f) f,)oIt a o o.o @ f Eo .Yodt o3 o E ott :t U' Ezf oo oz oo (E o oE(u U) (! oN :=6oY (E c o(L ov,o .v.(E =@ ss(E U) -c -9 o5o o - -c(u o v, oY g o Eof IL E o ltI(r, o E(E .o o (E -o E')c oY |r) co ON H 0) -o (.) o z <f, N (J { ,J. 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The major cause for absenteeism in this reporting period was mainly due to farming activities. With relative peace in the country, farmers retumed to their original dwelling after the war and engaged in rice cultivation to feed their family. Those that receive treatment did so in the evening hours only. 2.6.3 llthat are the reasons for refusals? The major cause of refusal is due to experienced result of mild reactions of headache, temporary swelling of legs and itching of the skin as noticed from neighbors who took the Mectizan tablets. 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. 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Ordering, storage and delivery of ivermectin '/ Mectizan@ ordered/applied for by - @lease tick the appropriate answer) MOH wHo UNICEF tr NGDO Other (please specify) Mectizan@ delivered by - (please tick the appropriate answer) MOH tr wHo UNICEF tr NGDO f] Other (please specify) 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 Orgarization (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. Table l0: Mectizan@ Inventory (Please add more rows if necessary) ./ DistricULGA Number of Mectizan tablets Requested Received Used Lost Wasted Expired Remaining GBARPOLU COUNTY 35,500 35,500 35,250 45 56 0 149 36,000 36,000 35,774 35 10 0 1 8 1 Kongba 31,1 00 31,1 00 30,906 23 71 100 Bopolu 45,000 45,000 44,910 30 30 0 30 Bokomu 18,000 18,000 17,814 18 68 0 100 Guo 20,000 20,000 19,356 450 100 0 94 Subtotal 185,600 185,600 184,010 601 335 0 654 BONG COUNTY Sanoyea 62,000 62,000 61,042 0 609 0 349 Zola 60,000 60,000 59,881 80 39 0 0 -elle Gbarma 23 WHO/APOC, 24 November 2004 0 Panta K 77 000 77 000 76 237 0 324 0 439 928 216 692 Suakoko 80,000 80,000 79,303 0 352 0 345 Salala 70,000 70,000 69,145 0 200 0 655 Jorquelleh 222,000 222,000 221,558 0 126 0 316 Kokoyah 120,000 120,000 119,875 25 89 0 't1 Fuamah 73,000 73,000 72,256 400 230 0 114 Subtotal 764,000 0764,000 759,297 505 1969 2229 LOFA COUNTY Voiniama 98,500 98,500 97,572 0 0 0 Zozor 40,000 40,000 39,744 0 40 0 Salayea 14,100 14100 13,560 0 170 0 370 Foyah 120,000 120000 119,748 0 132 0 120 Kolahun 122,000 122000 121,752 0 125 0 123 Vahun 34,000 34,000 33,960 0 18 0 22 Subtotal 428,600 428,600 426,336 0 485 0 1,779 MONTSERRADO COUNTY Todee(Lower/Upper) 66,600 66,600 65,946 0 0 0 564 Caresburq 106,000 1 06000 105,308 0 0 0 St. Paul 90,000 90000 89,308 543 0 0 149 Monrovia South 378,000 378,000 377.536 0 0 0 464 Monrovia North 497,624 497,624 497,572 85 115 0 228 Subtotal 1,138,224 1,138,224 1,135,670 628 115 0 2,097 NIMBA COUNTY 0Gbehlay-Geh 88,000 88000 87,966 0 0 0 Saciepea I JU,UUU IJU,UUU tzv,ct o U u U lZZ Tappita 114,050 114,050 113,128 0 0 0 922 24 WHO/APOC,30 July 2007 Yarwin-Mehnsonnoh 000 000 31 126 0 0 874 How are the remaining Ivermectin tablets collected ond where are they kept? List and brie/ly describe the activities under ivermectin delivery that are being caruied out by heolth care personnel in the project area. The remaining Ivermectin tablets are collected from the communities by OICs and transferred to the Health Ministry expiration date verification. If the expiration date is confirmed, the tablets are taking back to National Drug Service (NDS) for the next treatment cycle. If they ate found to expire before the next treatment cycle, they are burned or discarded Personnel Activities The County Health Teams (CHTs) collect the lvermectin tablets from Ministry of Health (MOHAfOTF) to the county health facilities. The OICs take delivery of their supplies from the health facilities for their various communities for distribution. a The CDDs distribute the Ivermectin tablets to their various communities. 2.8. Communtty self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If yes, When? Table 1l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) a a 0 0 0 316Sanniquellie 109,000 109,000 108,684 119.748 0 0 0 2,534Zoe-Geh 120,000 120,000 0 0 2,534Subtotal 593,050 593050 590,230 0 3,109,474 3,095,543 1,734 2,904 0Grand total 3,109,474 0% OYoPercentage 100To 100% 0.42o/o 0 DisficU LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSIO No of Communities that conducted stakeholders meeting (SHIvf) 25 WHO/APOC,30 July 2007 0 TOTAL 26 WHO/APOC, 30 July 2007 Describe how the results of the community self- monitoring and stakeholders meetings have fficted project implementation or how they would be utilized during the next treatment cycle. 2.9. Supewision 2.9.1. Provide aJlow chart of supervision hierarchy. Central Level o NOTF o NGDO County Level o County Medical Officer (CHO) o County Onchocerciasis Supervisor (COS) o County Health Teams (CHT) District Level o Health Center Medical Officer . Clinic Nurse Community Level o CDDs . Community Members 2.9.2. What were the main issues identified during supervision? The main issues were as follows: l. Communities not showing appreciation for CDDs voluntary services. 2. Some CDDs are not huppy with CDTI work because it has no incentives 3. Some CDDs do not record properly in their registers. 2.9,3, Was a supervision checklist used? l. Yes. The checklist included the followings: 2. Census update based on cofilmunities registers. 3. Meeting with communities leaders to acquaint them with CDTI activities. 4. Verification of both communities and counties treatment forms. 2.9,4 What were the outcomes at each level of CDTI implementation supervision? 1. The communities including the CDDs and OICs all cooperated. 27 WHO/APOC,30 July 2007 2. 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. 3. The communities expressed willingness to support the CDDs. 2.9.5. Was feedback given to the person or groups supervised? l. Yes. Feedback was given each group supervised. 2.9.6. How was the feedback used to improve the overall performance of the project? l. 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.) SECTION 3: Support to CDTI 3.7. Equipment Table l2: Status of equipment (Please add more rows if necessary) tCondition 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? Yearly budgetary allocation is made for the maintenance and repair of equipment and other materials. With integration and co-implementation of health interventions, the Govemment of Liberia (GOL) through the Health Ministry intends to co-share mega resources for the maximum benefit of all health programs. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No. Condition No. Condition No Condition No. Condition 1. Vehicle 2 CNFR 2. Motor cycle(s) 8 F 3. Computer(s) 1 F 4. Printer(s) 1 F 5. Photocopier (s) 6. Fax Machine(s) 7. Others a) Air conditioner 1 F b) Generator c) Bicycles 28 WHO/APOC, 30 July 2007 Contributor Year 4 ('provide the period') 2005 Year 5 ('provide the period') 2006 Year 6 ('provide the period') 2007 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) 86,159 -0- 109,911 2,098 80,446 6,000 MOH (District/LGA) Local NGDO(s) ( if any) NGDO partner(s) 58,187 -0- 22,195 9,148 12,100 2,266.25 Others a) b) Communities APOC Trust Fund 62,087 62,058 65,058 38,979 27,441 27,441 TOTAL !.2. Financial contrlbutions of the partners and communities 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. Expendlture per activity - Indicate 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:- I US$: 50LD 29 WHO/APOC, 30 July 2007 Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of cogmu!!Iy Mobilization and health education of communities r1114lts_gf clDl IrairysllselQs!€at all levels F pp.*_iqiqg _q_DD s and di stributi on Internal monitoring of CDTI activities .$!vpgq!ys'rq IEC materials to health and authorities -S-lggpry _(!gp_o_{in g) {o_r11r r for treatment Vehicles/ Motorcycles/ bicycles maintenance (fuel) Office e etc Others 500 MOH 4,433 APOC, MOH & SSI ll,52l APOC 5,033 APOC, SSI ') ,<< 1,500 AP9C, MOH APOC, MOH 300 400 MOH APOC 270 1,858 MOH APOC 315 4,428.50 APOC APOC, MOH TOTAL 32,813.50 Total number of persons treated Table l4: 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 1 Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 30 WHO/APOC, 30 July 2007 a4.1.2. What were the recommendations? 4.1.3. How have they been implemented? 4.2. Sustainability of proiects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? YES Was a sustainability plan written? N0 When was the sustainability plan submitted? NO What anangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels 4.2.2. Funds 4.2.i Transport (replacement andmaintenance) 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented The OICs and the support staff at all levels are being trained to carry out CDTI planning and implementation using the same Primary Health Care (PHC) concept that operates through out the health delivery system. To ensure sustainability, CDTI uses bottom to top approach beginning with the community, district, county, and central levels. The OICs are responsible tot develop annual action plans for CDTI activities indicating the villages to be treated and time of treatment. These plans are integrated into the county health plans. The OICs are responsible for supervising the activities and together with CHOs and COS monitor, supervise and evaluate at county level. Although more advocacies were carried out for increased budgetary allocation for CDTI activities, Government continues for the fifth year, to support the Northwest project now in its 5ft year. Additionally, the Ministry of Health is encouraging all parallel health programs at county level to integrate and make available to each other resources in terms of transportation (motorbikes and vehicles), etc for maximum health outcome and CDTI continuity. 31 WHO/APOC, 30 July 2007 4.3. lnlegration 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 budget? 4.3.6. Describe other health progrflmmes that are using the CDTI structure and how this was achieved lYhat have been the achievements? 4.3.7. Describe others issues considered in the integration of CDTL The Ministry of Health is fully aware with plans in the making that one way to ensure the sustainability of the CDTI is to integrate with other community directed primary health care (PHC) systems. The concept of PHC is over a decade old in Liberia. Eighty (80%) percent of the Country have some form of PHC system functional. EPI, MCH, TB and Leprosy Control Programs have ceased from being vertical programs and are integrated into the PHC activities of the Health Ministry. CDTI is gradually being integrated with the National Eye Care Program services. The Onchocerciasis Program and the National Eye Care Program operate simultaneously in the endemic areas using CDTI structure, same staff, and shared resources. Training of health staff is done in like manner. Selected OICs that receive the annual training of trainers (TOT) are usually the same ones involved in the PHC activities of their various counties and districts. At the training sections, the health staff is often reminded and encouraged to share each other's available resources in carrying out their interventions. The Government of Liberia, through the Health Ministry releases all funds directly to the CDTI Bank accounts in the form of checks. Although the present funding is not adequate to cover all activities, it is surely an appreciable start for sustainability. 4.4. Operational research 4,4.1, Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. 4.4.2. How were the results applied in the project? a 32 WHO/APOC,30 July 2007 aSECTION 5: Strengths, weaknesses, challenges, and opportunities - List the strengths and weaknesses of CDTI implementation process. STRENGTHS . Many more people are taking Mectizan o Govemment is up to date with funding to CDTI activities o Integration and sustainability are about to take root WEAKNESSES o Community support to the CDDs is low in some communities o Attrition of CDDs CHALLENGES o CDDs demand to be given incentives like other vertical programs, eg. Malaria and HIV/AIDs Control Programs. 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. t 33 WHO/APOC, 30 July 2007