H EAST CDTI PROTECT, LIBEKA INTERIM TECHNICAL REPORT 2OO9 oncho_mohswlib2000@yahoo. OzuGINAL: Enslish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FO SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICANPROGRAMME FOR oNCHOCERCTASTS CONTROL (APOC) ! I i I i I ! i I(o! b TLL: For Ad AK fo,? Tor \i BtM q CO UNTRYIrIOTF : LIB E RIA t Name: SOUTH EASTProiec Approval year: 2000 Launching year: 2000 From: JANUARY 2009 To: DECEMBER 2009Reporting Period: (circleone) | 2 3 4 5 6 7 8 9 l0 tl tz LJ, tiP r APOC fundins vear: 1234 567891011 t2 13rt: (circle one) Date submitted: Ministry of Health & Social Welfare African Programme for Onchocerciasis Control (APOC) Mectizan Donation Program (MDP) Sight Savers International 900 communities Partners: t I) I i I i RECU TE 0 I FtV. 2s1s l-',-- r I t iA l( i' i * rj"wkOrirot, 14 september 2oo9 rr li- r iti, ; IAI\ NT]AI, I'ROJECT TECI{NICAI, REPOR'T TO I ECHNTT:Ai. CONSULTATTVE COMtulrTTEE (TCC) ENI}ORSE,MENT Plcase conJirnr you have read this report hy signing in the appropriate space. 0FFICERS to -|-ii{g the report: C'ounlr-r': _l,iheria National C'oorclinator Ntrllr-; ;\nihn llct:fu Signaturc l)atc:31 January 201() Zr:ual (Jncho Cclordinat<lr Nanrc Sigriat.urc: [)arc: " N(}DO Rcpresentative Nanre: Mr.s. Adolo, Sonii Signaturu: Datc: 3l .lanuan' f(Jl U Tliis reporl hns lrcen prepar.cd by N*me : Hclcna K .>- ( Dcsignation J'ro Si*anaturr; 0l ailrrgcr tl Date : \\"1 i()ir\[r(]('. I'l Srptcntlrcr lrrtl,.t f t_-_ Table of contents ACROI\TYMS DEFINITIONS ....... F'OLLOW T]P ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY .............3 SECTION I: BACKGROUND INFORMATION 4 l.l. GeNpReltNFoRMATIoN.................... 1.1.1 Description of the proiect (briefly) 1.1.2. Partnership 1.2. PopuLartoN SECTION 2: IMPLEMENTATION OF CDTI................. 2.1. Ttuslnqe oF ACTIVITIES .............. 2.2. Aovocacv 2.3. MOgI]-IZATION, SENSITIZATION AND HEALTH EDUCATION OF AT RISK COMMUNITIPS IO 2.4. Couuuwrrv INVoLVEMENT.............. ...............12 2.5. Capectrv BUILDING ......................13 2.6. TR8erusNrs................ ................. 15 2.6.1. Treatmentfigures........... """' 15 2.6.2 What are the causes of absenteeism?.............. . ' 18 2.6.3 What are the reasons for refusals? ................ ...... """"' /8 2.6.4 BrieJly describe all known andverified serious adverse events (SAEs) that ......18 2.6.5. Trend of treatment achievement from CDTI project inception to the curuent year20 2.7. ORDCRING, STORAGE AND DELIVERY OF IVERMECTIN......... .............,.....21 2.8. COuUTTNNY SELF-MONITORINGAND STAKEHOLDERS MPPUNC ......,....22 2.9. SuppRvtstoN ............... ..'...............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. Il'hot were the outcomes at each level of CDTI implementation supervision? 2 j 2.9.5. lf/asfeedbackgiventothepersonorgroupssupervised? . .""""2i 2.9.6. How was the feedback used to improve the overall performance of the proiect? 23 SECTION 3: SUPPORT TO CDTI .VI VII I .4 .4 .5 .7 .8 .8 l0 .............23 3.1. 3.2. 3.3. 3.4. EeurpNasNr FmaNCInT- CONTzuBUTIONS OF THE PARTNERS AND COMMTINITIES OTHpn FORMS OF COMMUNITY SUPPORT ExppNorruRE PER ACTIVITY 23 24 28 28 28SECTION 4: SUSTAINABILITY OF CDTI.. 4.1. Ir{teRNat-; INDEPENDENT PARTICIPATORY MSNITORING; Ev41uartON....................28 4.1.1 Has the project ever been evaluated/monitored? (Tick any of the following which are applicable) ........... """'28 4.1.2. What were the recommendations? ...........28 4.1.3. How have they been implemented?........-..... ......." ""28 4.2. SuSteNastLITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT ...............28 IV WHO/APOC, l4 September 2009 t Yn 3)......... 4.2.1. Planning at all relevant levels 4.2.2. Funds........ 4.2.3 Transport (replacement and maintenance) 4.2.4. Otherresources... 4.2.5. To what extent has the plan been implemented............4.3. INrscRerroN ............... 4.3.1. Ivermectin delivery mechanisms 4.3.2. Training.... 4. 3. 3. Joint supervision ond monitoring with other programs 4.3.4. Release offunds for project activities4.3.5. Is CDTI included in the PHC budget? 28 29 29 29 29 29 29 29 29 29 29 294.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? ............. ..................2g4.3.7. Describe others issues considered in the integratton of GDTI. .....29 4.4. OpenauoNAl RESEARCH ....................324.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period........ ..................324.4.2. How were the results opplied in the project? ............... ................32 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, ATID 0PPORTUNITIES ............... .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 I-'NICEF 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-Mon itoring 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 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). (i i) Eligible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. 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. (iii) (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 j'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: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) tfuough 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 govemment. community self-monitorine (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 tate futt responsibility of ivermectin distribution and make appropriate modifications when necessary. (ix) vll WHO/APOC, 14 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 Number of Recommendation 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 \,vas 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 (iiD Provide information on the fi nancial contribution in year 1 and 2 Information on the financial contribution in 2006 and 2007 is included in this repon (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 (ii) 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 2009I mobilize the required funding to execute the plan (iii) Increase the number of health staff involved in CDTI One ofthe 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 shortening 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 than one page. l. Background on treatment and population data - Total communities, communities treated, total population, UTG, ATO and persons treated. 2. Background on population moventents. 3. Troining data - CDDS, healthworkers, Total population (community) per CDD trained. 4. Challenges and hov.' lhey were overcome The southeastern CDTI project had a total of 900 target communities during this reporting period. The population in meso/tryper 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 treated (98%) geographical coverage - 208,406 treated out of total population of 265,611(78%) therapeutic coverage - 168 TOT/CDTIfacilitators trained/retrained - 108 health center/health post stafftrained/retrained - 2343 CDDs trained/retrained - 65% communities with female CDDs - 32% of health staff involved in CDTI - Number of communities with <80%o 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 o 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, 14 September 2009 SEGTION {: Background information 1 1 General information 1.1.1 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 availabte). Number of health staff in project area and number of heatth 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 in 2002. The project is located in the South-eastem Region of Liberia. The Region is bordered by the Atlaniic bcean 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 alonglhe 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 amou nts 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 r.uron 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 functionaiHealth 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 (78% therapeutic coverage) were treated in 529 communirie 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 100% respectively based on JAF directive. Community census update was completed in most communities in the project area 4 WHO/APOC, l4 September 2009 The nationalEye 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 technical assistance 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 54s58 Mary Land No Data Sinoe 63737 Total Population 265,67L There are at total of 107 functional Health facilities in the Project area and 525 health workers with 168 (32%) involved in CDTI (Table 1). Table l: Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project erea B Number of health staff involved in CDTI B2 Percentage B.=Brl Br *100 Grand Gedeh 90 26 29 River Gee 85 29 34 Grand Kru 75 30 40 Maryland ll0 45 41 Srnoe 165 38 23 Total 525 168 32% 1.1.2. Partnership - Indicate the portners involved in project implementation at all levels [MoH, NGDOs (national/international), communities, local organizations, etc.J - Describe overall working relationship among partners, clearly indicating spectfic areds of project activities (planning, superuision, advocacy, planning, mobilization, etc) where all partners are involved. - State plans, ,f ory, to mobilize the state/region/district/LcA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. 5 WHO/APOC, l4 September 2009 National Level Partnership at national level include Ministry of Health and Social Welfare and Sight Savers international with 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 lnternational 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 transporlation of CDDs during the distribution. In 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, government 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; 1. Tiyatein Health 2. Right to Play 3. GLOF 4. CARITAS 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 Society assisted in health education and mobilization of CDTI communities Community Level At the communities level there have been growing paftnership between the traditional authority and Youth and women groups, religiuos organizations and local media stations in the implementation of CDTI. 6 WHO/APOC, 14 September 2009 c.l 0.) ,.o Eo o U) + o () L C) or5 o o ca)(H CO or(B o C) 'd L C) (! o.o o. o o (! a C)L C) qi o o L Lo (!() L C) th oo E o. c) (t o o oL o- o (t aLo a. C) ct) c- CJbo(o L o E Eoo() a 0) 6 oo (d o 0) C)bo(! L o >, o L C) C) oo a ol<(d -ro(*L iGt ri () o'L a, o a) \q) Us$ r- .h oo a C)(_) o ch L(.) o o aU () o -o(€ C) -o C) CN (B 1, o qi o C) C) t< o cr') 0,) (h (€ B o z CH o z (, o .9 Lo o. oo E C) o bo .E 0) o € o C) 'a L o. C) r € c/) (A o c) (g (r)(o \ -a o a ql s! $- t\ 9t 'a- b L,\Gs9 *t >\ .:.nSE :_! bo' ss .te SE ^sB s< $u \*rhu HS lt'ts^tss s9 s :.\ g-6 c\ rE -d> o:- t\ Lt_ :\\ l:=' *i =\ -: HSJ r3 's .Y ci+ (Js \bo {:i ild hB q o q) L ts q) Fi q) o L C) bo ii oq 0)L c) bo L o ko () 6 o)L O)L h C) L(l) o) q) L cq a) c) L q)L o) 0) P (t) L o d o.oq ! a, C) oO o.ir ol -ol(dl FI E o +, G Jc otr N a F I I I I cr7 t) o)o E .9 (d1.. c)Ir =3a/ Fp sE- :E.! = 3e + il .oiE -q)o .= oN EE EF 3€ . ..8 E tE.=s; >r! o o -E E E'FNa A E:e) o= b Yq/c, oF: o *o ciN 3.2 -o (!() oF + il .e3 E.F €E_E o :''lq,E E l-c1.E >r€)FE N a o) a0 cd .t) c) oq) L{) z H.E E:eG 9oE 3SX 2 \oo c.l oo ca rr)\o oo\olr)$tr) r- co r-. co\o \0 rf)\o cl .= 6t 6)Er- o9(\t 9.- _l "i E.EI *or 9-v9-!F AE A oo a F] tr F !:l O cJ -9 -e ql ReEc5' rH E'A (.)Eot) E dL o C) tr(.) & r< M (g rro CI h(B SEGTION 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. 8 WHO/APOC, l4 September 2009 o\ 6l o -o Eo o.() a $ O o ? th o) tr (-) (\ q4 Qq) 4 > oL q) L a "E q) 4 !qJ 5 L C) (.) LLi o() q (.) (B o V)(0 oL(! o t< € ah() o(n (H c) 0) E F ."ir 6)l -ol(Bl FI U) c) a EE Q o 0.) t-.1 C)o o o C) o o c) l-.l o(,) oo-tr+ fE c:atr 0)(n q oa Pg() U) r)O. C)a :) O.oa o o al o9 EE Q 5r a.()a q oa t)O.() a 9 O.() a q oa bneE CE: A. a)a :)q C)a g() a q C)a q oa o(l D ah th q)(J EEo(, :)q C)a A.(.) a O. 0)a O. C)a q 0)a ht)EE YE Gl: a- bo oo) oo oo bo) OI 6l Fr EEoU bo o0 bo b0 oo) B0-E+ liE bo oo bo bo oo) aC) .5H 6=Ni -atrooI- CJa o POEEo Q bo oo bo) o0 9p) oo-ET 1|Jtr oo bo oo bo oo I F] .9 Lr .2 o () o ! d ri c)o o & v d -o co 2 0) a F] F Fr 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 in 2010 county plan budget - Release of funds for CDTI activities - Prioritization of Onchocerciasis as a disease of public health importance in the Project - Politicalwill 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 P rov ide i nfo rmatio n o n : - The use of media and/or other local systems to disseminate iffirmotion - 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 are4 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 facility 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 District/LGA Number of communities/villages with community mcmbers as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communities in the entire project area B. Number with community members as supervisors B( Percentage Be= BJ B. *100 Male CDDs B7 Female CDDs Br Total Bq= Bz*Br Numbcr of communities with female CDDs B, Percentage Brr= Bro/8.* 100 Grand Gedeh 135 t20 89"h 350 50 400 48 360h River Gee I 13 90 80% 290 I l0 400 82 73% Grand Kru 133 tt2 84% 282 273 655 I 15 86% Marvland Srnoe 148 t25 84% JJJ 159 488 100 68% Total 529 447 84% t25s 592 t943 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 were taken to ensure adequate CDTI implementationwhere not enough lcnowledgeable manpower was available or if staff are frequently transferred during the course of the campaign). l3 WHO/APOC, 14 September 2009 o\ a.t o ,o E o C)a + a o B v o a € o ! G o bo o *\ o \ a a. ea B ts o o al O U o q)E z ! o -: +Fe_: t': tv "l to I c.l -: \o r-. $ co : N $ la) @l v-) € € : o\ c.t oo o\ F---- ?ot ?o .I ! \o o\(r) r- s o\\o o E ru () s (.)LF \o\o o.l \o t-. la) c- \o r- tf(.) o 0) .1 o' ct< 6)' o q') ,c) Lcl oL z Gll I L\, = .U trqv ---i o o o o -o o\(,LF Q) =c6L Etsts .tHtr:- zu q)(Jl lEit+f- -.\ F------- (.) Q o< t € 6l \o oo :_ aaI h oo $ :.. o\ i 6 v 6\o s .: tr() () (1) sILF oo co co c..l \t a CB q o Fl3eo0) {)E z - -! Ei'l+F-d \) qJ o( \o c..l a-- o\ : a.t6l t-. c.l la) $ c- c.l oo l_ t: r, :__" N 6\o o\ c-F- s6l ra () A o o s F sf $ o\\o a.l N?e IJ ()!c) ! cd L oor'i () E, V 'o d -o d z o o a F1 F F a 4 % AJ Qq) q: \ \)I\ "N 6 Fi q) E o (! o C) a F t-l Q(H <h 0) C) C)L .0):* ! o bo !F V.)l ot -ol FI Table 6: Type of training undertaken (fick the boxes where specific training 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'/0 geographical coverage and a minimum of 65oh 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(specifr) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (speci&) l5 WHO/APOC, l4 September 2009 o\ O6l o o o.o a t O - - \o 3k r'1 :j5 'd<a .g:9(-) d:()rv-coEi.Eo.=9( 'd-6.S LV-.i -; t €$E P, = i, E='t:'; ,u F'ra=9I .9E.6i .:O.91tr'oE'L =ta6=EcsEIeniE8 :g [I(.) '= o. -oE o' E F i € =t E t sF il 3 E it El.g E .e6- El i s'5 gl b 'd \s Et€ € E* Bt 3 flE a ag 5 fl tl,F Eif, tl$ EIE til tlE El€ =i s tls s *I EIE 8I E 8IE BI U SEI Ha HE rl.s rl€ $ g ;ls ;ls ;l; lls S ol Eo5t .s =l :gl rr r r r !(dt \Lts ol q)El .,t "ds F :'cl u .=l L d) .aHl o,l50 I =lbnNsElEUsE:bl 9 6 E 9 $ol oQ6)o):r-l o;oo'=.S .91 t.l,:. ti^ Ea ii H El EE EE 3E J SEl SFo;tr1Lt6)o!r'--)Sol s_9i\or- .Y cr) L (d cr)(! q)L (B J o !r o x -o(h r! a E (d () Cd()kF F-l o)l -loldtFI AEEggss* O'E= Oi: HgE9d oig o-o o! E z sL AE b u.,la u4 zo6 c..l\oo F-. o\t-- c.l F-. ooN o\ + :.6 s.g ", tEi $gzi'i.<'> + F.- t.- o\ C.l s c.l Eo6!?2nail o\ \oN + F- * oo$ o\o\ F- c.t c{ : e- LC--a)3 9:E EEhrp6j6. Sg $t (..lo\6t € c.l \o 6 =fc.l ll { ^-x !o3boO d^ oL-od oo- oo F tro!rd 2 L! =9 ZEe=UoCo-=<F 6 Lo *3 - A *dEioh- I-.=-OE' a 3go tr: o o\ € o\ € oo o\ oo o\ oo c- O r-+ c{ d al oo @r-+ c.l t-- a.t \o .+ oo o.l \o c.l € sf, c\ \o oa s t-. t'. co\o \o c.l \o 6l oo \o+c! \o oo\o + t-. c.) c-. \o c.l ll r ^'A H >9,p = o= b !);:E*a -3qE.9^-E E S} H- v?o 9o ii 9o\ do E.9 -L = f,i !3 E SHtr tr= ii =E-q AO o 7aE6a c6:1;9.o', FU (t) (h o oU o\ \e 6\ o\\o o\ o\ o\ o\ $ o.l oo$ o\c.l 6 m c.) GI9E r.E >^E €$ c.l >' oQ P5 LO o 0) l, o .z& v dL O ! d (€ z o o U) Fl 3 F ) o\ N C) -o o oO sf Q - o r- al bo !! o: q F a. Oo 60 a \ tr{ 9 \ .E I s\ .a a $U U 'Fd \.Y$s'{\ -is .: L-ao' q: u: EUts iE?tbs\: s'{ B-€E\) s\ \UtsaJs5H tJ q) .Q\ SS a\ET 8=V .4. iir :i ai taa\ SS .G ES SEI! da.sl a:Srh=' il! t\S\s 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. . Parasitologisttrained'/ 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 1 l8 WHO/APOC, l4 September 2009 o\ a.l !o Eo o.()a + (-) o o\ $ S\ q) Lq) \Uq It - ! a1 c) q)() q) q: L \ tN a !q) U -o o L 0) o. oo ii o a. C)L o bo L C)LL o C) o (6 a rr.l a a C) () C)6L C) (o a o Lott)qr o v) C) .A(B O ddr orl -ol(dt FI 0) _E:ao9 E?' o= Lo;o -i c2 ;go3 c.= c edJ(€oi,a= e 9rd x=L llloo os .2 E- o-o60 (J o- o- =a a9^ o.ct&=d qio-O.!EC C€40O !!qq ;6^ .,.- € = €-9ep.E? 2.o.= ogEETS o o. >.a e-^o -; Eo=o Qa66 =o .!'69!?-(dll (dn> 3 o ooOa 6.- =h0>6 xoa q) bo + a i o bo YL^F ON Q s F-N sq Ni.- s(, oiF. o\ € F- o (! o o o ll r rJ tr li o ^d)(_) 6^ r Oa\ -o o soo soo s@ .t O) 5\ oor- ll r E]H Ll o\ ,oood 6'q oo F slo(o s 1r)(o sN@ 6\ 00r- trt ! ,o od .oOED_qtsq ,o a F-o o- (f) o(o Noo coo(o Nt- o, o (f) =f € a.l t =uEEZ 4.oS' -t:o NN ro NO CO Nf.- ro c\io(o $ O) @N CO \o o.l b is ( i o )- .o ss< =H ' I qa o c: o (o o,$- ro(o .t (o O) s- lo(o$ ro f.- Or- o@ c9 \o \o c..l () o0(o o E O ll { kl lrl ri o ^bo f o6\ -o soo soo sO)f.- 6\ € o\ 3_S^,; Bs It,it Ootrl soo soo so,N @o\ tl oEabEbE tr tr= ai , tr< E '70qHO N O)lo N @lo @ N N El :o .do=)-Eo .'35 FL' N o,to F-(o ro O)o o, o\ cl ood =q:I g E-EIt oE >. 1: -PrA=r_ri:c-oE € E 3 q€ Eq oo N o)lo N o,lr) o)o o, o\ c..l & rl] r-. o\ o\ oo o\ o\o\ o\ N N c..l N a.l $ N N c! F- c.l € a] o\ c.l O a.l o\ c.l 6) E() o. C)a t O oA N -.t) 9 q) cl o o AD r!L 0) v() r|rvF J 4B- .iEhH EA !ir CnStr 'sE s:U\oL\,EES e e= :.ia6=cqF q. q.)L -U63to oslE {j\.= AI ! q! c) =qJqj9Li O-la)ol()ol ILI .:EI EEI .gsrl i'Ela,El ra)ll-o-)l otlf l L Ivt EqYlHLI odl&E..r !lcgtrEl 9EEI ;0sl E q)ot E.tsl E :bO: !9!9bL !-k !! - rh:rvLU =(giJe9c)E) ':()!gtrc) LNI-r id (E -a)c) G:;6i o'l ';()l .h tl eFl 0. 2.7. Ordering, storage and delivery of ivermectin ied for by - Mectizan@ MOH Other (please speciff) Mectizan@ delivered by - MOH tr Other (please speci tick the appropriate answer) UI\ICEFtrwHo QtleaseE NGDOtr NGDOtr Please describe how Table l0: Mectizan@ lnv the Mectizan Donation tick the wHo is ordered and how it gets to the communities (Please add more rows if necessary) - How are the remaini ivermectin tablets collected and where are they kept? The remaining ivermectin collected by the officer in charge of the health facilities and kept in the pharmacy of health facility. The County Onchocerciasis Supervisor collect all send it to the county pharmacy.the remaining mectizan List and briefly descn the activities under ivermectin delivery that are being carried out by health care I in the project area The required Mectizan for the year is calculated and ordered by NOTF based on the target populations of the ve counties, Districts and communities. The order is sent to When Mectizan arrives in the country, World Health Organization (WHO) it and sends it to the National Drug Services (NDS) through NOTF for storage. Each on the target population county order the the drug through the county pharmacist base be treated. The county Pharmacist send the request order NOTF secretariat for approval the request order is send from NOTF secretariat to the National deliver the drug to the county pharmacist. The dru gis taken to theDrug Services (NDS). county and kept in the and the health facility central phamacy room for onward distribution to health facility iver it to the communities by the OICs and CDDs respectively Number of I /lectuan@ tablets Lost Wasted Expire d Remainin o I Requested Received Used County In stock fror previous yea 0103,545 141.t93 552 0 037,648 152,545Grand Gedeh 0 060,000 92,954 412 033 366 75,000fuver Gee 0 080,000 103,777 572 024,349 80,000Grand Kru 343,788 60,000 Awaiting data 30,589Maryland 0 0 00 0 t64,600 797Sinoe t6s,397 2,333 0 0 032,3545TOTAL 260,760 Any other comments 2t WHO/APOC, l4 September 2009 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 communify 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 County with the County Health Team in April 2009.on Community Self-monitoring and stakeholder meeting. Roll out 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. CentralLevel . NOTF o NOCP Countv Level o Counry Health Officer (CHO) o County Health Teams (CHT) o County Onchocerciasis Supervisor (COS) District Level Officer in Charge of Health Facilitiesa Communitv Level o Community leader /town chief o CDDs 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 meetins (SHIVD Grand Gedeh 135 5 0 TOTAL 22 WHO/APOC, l4 September 2009 2.9.2. 2.9.3. 2.9.4. What were main issues identified during supervision? Was a su checklist used? What were supervision outcomes at each level of CDTI implementation 2.9.5. Was feed k given to the person or groups supervised? 2.9.6. How was project? feedback used to improve the overall performance of the SEGTION 3: S port to GDTI 3.1. Equipment Table l2: Status of eq (Please add more rows if necessary) *Condition of the WO:Written off) (F:Functional, CNFR:Currently non-functional but repairable, Note: The vehicles are but need repair. The use of these vehicles can are limited only in Monrovia, it be used for field activities How does the project to maintain and replace existing equipment and other material? The NOTF secretatariat is advocating to MOH &SW to include CDTI activities into the Nationaland county plan so that the equipments maintenance cost will be included into the county annual plan. for 2010 and 201 I . Also CDTI will be part of the integrated NTDs DISTRICT/ LGA NGDO OthersAPO C MOH Condrtron No CondltlonCondrtron No Condrhon No Condltlon No Source Type of equipment No Fl. Vehicle 2 F2. Motor cycle(s) 23 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 paftners 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\ N o -o o o.o a + (J o o c.l !,trc,: olLIE o oE o oo .E E E o(, U'EOq8 lr)Nlr)lr) (f)\\ N(.)(f)$c{Nss olr)0 NI" R3-+ro EE 3 Eot oo aIE tt o t G o.t ul Fo ooo oz s E o U' L ll .9!, LoEE E"OCF '5 o =oa, 'i o? =6I!Eo.!i,,c, =otEt{roEu oEr xotf z qloo(\a soo\ o ,b o o Et v, !loE o CLoL ct .= o3 tr uJ IE!tc -g a!(, Cp &t E o C' FzIJ =2il.u oo !,o o trl!, o o GI G ur d .T o o o u, .E oaS an i o" oili o, B, =l(Ei o,Ii o o, .E' .cl o o C',ct - 'Fi \ (Ei G r-i o c\ri Q "ii E oooo o otci ci oi 0rr \loIci '=i Or Fi ':iNl I I I pi Gi tl iC'oiorc '6i .Er .9 '>i bEiili .Ei :oi:io ai 5i 'iilqrd(f)l rri (f,lr G oiI a4 l l o cl or >ioj oi6l Ol >lEi(81 o!gI Or)roia: oi cr c .9 :, -o .o! c o o E o:; -t o o o) G c G E E E G EsECloa> 'tro .EsE5 E:EIOG9o sbo>>o Ib G o dIt4 qt E 0)C,bt> #.s r.rJi o .i itl ,; v, o U, o a-xo fR .96 .!4, t Er I{r .1Ji - J oF oz E o lrJz J F IIJ oo =6 o E .9 G N q o u, *(, G r.) o E-lbCE .sE s€so{lG6=EE{€ c .9 (I, .N bo =I c .9 (E .N --oc o)a c.i c o Foo 15 o)j 5i - Ei EIr O =i i 'ivt oot v)(! o E € ah o -o L oo (n o (n t G ra o 6lF o\O N 0) -o E(J () a $ O o o. O \o c.] (.) o C) C)l- thd o L € (! ch o ! L oo (g C) d tJ. ra o cl3 @ a?(o(o GO$t @(o df.- c\l c\l ! c,O= oL tE oolO $E o o o .E 5c,oEOE'E oo ahEO c, rrq6 oto$ f.- lr)3a o rq @ aoNq) troE @ ?, tt .9E '6 !, IB4t IIJt o o oo(, z f--$N E oo ll o ;3E oo()() oo ro ao o o ssE'oCF 't -9 oaJ o€s .9,Eo(l, to(gotr5.ellc,ooEtr, 6 =6Xo z ooo aoo(\l T'o L o CL6 E" .s olt d UJ (! Etro Eo o o3 o o ct (! o, o o c o a tr o(, zlu =2t ul o(, rc o 0, C,t,5 @ I ,i o' 9id).Eir 'E, Oi ag, '=: ho oriJ ,, qt tFi Nr .Q rri'ri' I , iv, to' o Vr, o,axi o: Gtr o E! J FoF oz t o ulz J F u.l oof @ o s os G ta o t4 so G o o E- ;€ SE s€ =oEco=EE cI (I, oaoq) -c. =(\t o)I a G o aIt4 (r) si 5 Ei .g 'i.i 9 si s ..i "! -i- o Gi G ur 6 o o E o ot oaI(4 o, ofz, ,o =: a', E,Qftiut o' ,OrI' 'orol ,olo) ; Er .-Ei ,Ei .E '(El 6 ! oi o, ,\i\i lolo! u' Ei .Ei =Fr .:i .-Ei \ .=i 6i 6i G 'Ei Fi tri Eti -i c.ii i si *i "i, A ircIOr O) c 'ai .c .o .Fi bE;i: .= =d!6 6i >', .7 :i q' a?(fri or (, G o aI .a i o,, c; o, o, q) o o !,(,l o'LI Or >roi @] oi ciol Ei o)oi>(Ei -Ei E>l g NrQ .;rs 'r(a co 3 .9o c oo E o,2 ; + o o BI G G ! G Eestrlo{l> 'tro EgEb E> '€! OG9o sborl>o Ib o\ c..l o! 0.) o-()a s O o o rr c..l ol(t(o\tNHEE<Fl! 5eoo tr E.85=o EB "Jz o c,o tro Eo6 all .c!, [, L ocE(lo n IJJ I o ooooz t, oo lt o :SE q) @(n- to Io!E cDoCF .; o =OaJe.E o! Icr(U !,o(!otrH.e -ooloo8tr, 6 E6E5iH z ll) ro(D o 3 tr o(., l-zluEz G, IIJ o{, Eo o E,|!, o trooN ttot o CL otL E'I .E olt E UJ a!ttcg IEo o I .9 o CL u, a!ott t\l o 3F l c o,(E= fi \ ru: E ull g ., .(rr r {ld,S "i ut C .9 .9, e o o. fa -ri c!(r) o c o o oo c, Eo c) o) o)o o c c o, l € .9,E: ci o o E o, -lsl o o o) G G ! G EeEClo{r> 'tro Eg :U O(E9o sbo>>o It G o IaIt4 ct st i ci oiC'h>#slrji o Ni Q -i ; o o o oa -d G s o EE J oF oz t(9 utzJ lrJ oo =o o o G lt, o u, *o Go o E-tbc's .sE s€so4r€6=E8{€ c .9 (t, .N 5o =I c .9 (5 .N =oc o)a et o GI G ur d o o o o .E o aI ao -iot LlQi iBi(Jl oioi Il o: ol oi oi ci cl cr c, oi oi oi oi \i \io, otCi Ci ci ci '6i 6i Fi Fit.i ri cliNi c.litl tr; tri Giti .i o c) .Y o 3 Gi oi dl qi () oL ch(d o H € (B (r) o -o L oo (! o (! t C,(?) c) c!F 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 cunency. Indictate exchange rate used here_ Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.1. lnterna!; independent participatory monitoring; Evaluation 4.1.1 Has the project ever been evaluated/monitored? (Tick any of the follorving rvhich 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 p lan written? 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 a 4.2.1. Planning at a 4.2.2. 4.2.3 4.2.4. 4.2.5. Funds Transport ( Other 4.3. lntegration Outline the extent of i integration: 4.3.1. Ivermectin de 4.3.2. Training 4.3.3. Joint superv 4.3.4. Release of 4.3.5. Is CDTI 4.3.6. Describe this was ach o Filltables o For each i a 4.3.7. Describe relevant levels t and maintenance) To what exten has the plan been implemented of CDTI into the PHC structure and the plans for complete ry mechanisms and monitoring with other programs for project activities ed in the PHC budgetr health programmes that are using the CDTI structure and how What have been the achievements? and 15 and provide describe other programmes that are using the CDTI structure a d how this was achieved. What have been the achievements? rvention listed in table 15, explain what were the roles played by the CDDs ilization, distribution, data collection, storage, collection of drugs, referral of SAEs, et ... )? Explain wh How were are the combinations of interventions co-implemented? interventions implemented? (at the same time?) issues considered in the integration of CDTI. (census, 29 WHOiAPOC, l4 September 2009 O o.l () -o Eo o.() a .+ (J A CO ?1 qJ \L kqJ > { L \) .a s q) .{ v1 q)i qJ q) co R I +) Cg +) o o a I o Q s r-l q) cu3 c) G' o o o o z G oF ru otr o z q) o u0 o 4) z oF o of! 2 (,r r ,o -otr z G oF otr o CE a q3 -a5tsrr Zo o (! q) & o EO G 6.e -o r-E.2 =,trz o cq il o o u0 F o6 ^.=\J\ >,h .as oS As olfCt qJ H9 Lr o) _c .LO6E9; (1)o >= a o COJoE .EN f(EfE .: 0J .9 -oOE a o_co .eEE(o €6 ,: .FLa(g oo. a o o,)CE oN '{= S =oJ .= -oqO)i5E a o C .9 = -o '=otz o= a Pc oC(! - sh9(o(! ,-C.CIo- -tro a ,tr (o c<oCE '=(I, >6o a a a a a a a a a oo &: -hoFQ,l ah rh o lio9-UA -cIo= \ro o la E .t) o. c0 ,iL =d (h CO o c/) o ct) oa at) P7{ FO h o d L(n z oL oo (o l<(d d z tr! a (d o o(nkF v) o Cdtr(! U -,hh'5xc) o\ e.t Lo -o Eo o. c)a st U o. (J c.) q q) kq) i \P, q \ U ! q) .{ q q) eo 61 cEE o q o Cr q) oo{) o0 q o& u0 o2 2 tio eE oo F E.9 E- 9 -E o E.9 Oo o G o o =o =o5tsoooea q li, o o €)a u0 .=E .aa p< o (! U) 0) o() o (l) o) o z JJ o C .9) -o L P ,9o a Pc o, E OJ oo G, E.sCLE19 O,' EEEos -o a C .9 (! c <o cE '= oJ h* >; a a a a a a a a a o tro o o o F .E U(u E L o a lc o Pf -o P .9E $o c(uoE gN =(E €EEa, .9 -oo6 a o_ c0J .eEE(o €6 -b'ilir(E .-Loo- a oocEONFS €bts-o6Ai5E a Fa ok oo d cl(! A oH o(,) (d d(! o k (! z (! o odrF a o G,L(\l rd O o(l) o.0 ok(l) o o o o o F h (B() H C)(,) o (-) o o q6 L(d rE (J d q .l a o(n ooo 0 oa q) a- a- \Ls' va v -\c U () +Jo Lr u) nO b0q U) a() lr )r ct3 oo oLO. t< C) o rii Fl 0) E c! Fr 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 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. sEcTtoN 6: matters Unique features of the proiect/other 32 WHO/APOC, l4 September 2009