,l - I I I I I I t_ ISOUTHWEST CDTI PROJECT,LIBERIA I ORIGINAL : English COTJNTRYAIOTF: Proiect Name: CDTI SOUTHWEST PROJECT Approval Year:2004 Launching year:2004 Reportins Period: From: January 2008 To: December 2008 Proiectyearofthisreport: (circleone) I 2 (3) 4 5 6 7 8 9 10 Date submitted: July 2009 NGDO partner: SSI (9v ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 July for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCIASIS CONTROL (APoc) ! rci /to.i f'i+ei/ /cEv EPt-'-Bfn cs-bcoe cfp 't Ll (I rn €^ f'cr inicrlrction Tc; $rf\ $'8oko..p. WHO/APOC, 03 February 2009 '\ I I I I ANNUAL PROIECT TECHNICAT REPORT r0 TECH NrCAL CONSU LTATTVE C0MM|TTEE {TAC} ENDORSEMENT Please confirm you haue read this report by signing in the appropriate space. 0FFICERS to sign the report: Country; LIBERIA-NOTt National Coordinator [iIGD0 Representative 'This report has been prepar*d by Name:N0TF t-iberia Designation: Dr, Bernice I. Dahn, Chief Medical Officer Republic of Liberia WH0IAP0C, 0J lebruary t009 009 r"i. SECTION 2: IMPLEMENTATION OF CDTI 2.I. Tttr,rsr.rNe oF ACTTvITIES ............ ......... 8 2.2. Aovocecy ..................... l0 2.3. MogIlzeuoN, SENSITIZATIoN AND HEALTH EDUCATToN oF AT RrsK coMMtxlrrcs l0 2.4. COtvltVtUNIrY INVOLVEMENT........ ......12 2.5. Cepecrry BUTLDTNG.. ......14 2.6. TReel\4eNTS.............. ..... 18 2.6.1. Treatmentfigures.......... ........... 18 2.6.2 What are the causes of absenteeism?.......... .................21 2.6.3 What are the reasonsfor refusals?................ ...............21 2.6.4 Briefly describe all lcnown andverified serious adverse events (SAEI that...2I 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year23 2.7. ORorRrxc, sroRAGE AND DELTvERy oF IVERMECTTN ...........24 2.8. Couutxtry sELF-MoNrroRrNG AND STAKEHoLDERS MBprrNc.....Ennrun ! SrcNrr NON DEFINI. 2.9. SuppRvrsroN ...................27 2.9.1. Provide aflow chart of supervision hierarchy . . ..... ................. 27 2.9.2. What were the main issues identified during supervision?................ .............. 28 2.9.3. Was a supervision checklist used? ............. 28 2.9.4. What were the outcomes at each level of CDTI implementation supervision? 28 2.9.5. Was feedback given to the person or groups supervised?................................ 282.9.6. How was the feedback used to improve the overall performance of the project? 28 SECTION 3: SUPPORT TO CDTI ..............29 3.1. EqururNr .....................29 3.2. FnteNcIaL coNTRIBUTIoNS oF THE pARTNERS AND coMMUNITIES............. ..............29 3.3. Orspn FoRMS oF coMMUNrry suppoRT............... ................ 30 3.4. ExpBNprruRE pER Acrrvrry ............. 30 SECTION 4: SUSTAINABILITY OF CDTI....... .......... 31 4.1. INrnRNRr,; TNDEIENDENT pARTrcrpAToRy MoNrroRrNc; EvaluerroN.................... 3l ll1 WHO/APOC, 03 February 2009 4.1.1 llas Monitoring/evaluation carried out during the reporting period? (tick any of thefollowingwhichare applicable)............ ...........31 4.1.2. Wat were the recommendations? ............. 3l 4.1.3. How have they been implemented? ............. .................32 4.2. SusrRn{RsrI.rry oF eRoJECTS: nLAN AND sET TARGETS (MANDAToRY AT...... ..........32 Yn 3) .......32 4.2.1. Planning at all relevant levels... .................32 4.2.2. Funds....... ...............32 4.2.3 Transport (replacement and maintenance)... . . . . .... 32 4.2.4. Other resotffces.. .... 32 4.2.5. To what extent has the plan been implemented............... ............... 32 4.3. INrncRerroN............ ......32 4.3.1. Ivermectin delivery mechanisms ............... ................... 32 4.3.2. Training.... .............. 33 4.3. j. Joint supervision and monitoringwith other programs........... ...... 33 4.3.4. Release offunds for project activities ........ 33 4.3.5. Is CDTI included in the PHC budget? .............. ........... 33 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. Wat have been the achievements?............. .................... -33 4.3.7. Describe others issues considered in the integration of CDTI. ..... 33 4.4. OpenaTToNALRESEARCH .....33 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. ........ 33 4.4.2. How were the results applied in the proiect? ............. .,...............'.. 33 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES.... ...................34 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........34 1V WHO/APOC, 03 February 2009 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community-Based Organization CDD Community-Directed Distributor CDTI Community-Directed Treatment with Ivermectin CSM Community Self-Monitoring MOH Ministry of Health NGDO Non-Governmental Development Organization NGO Non-Govemmental Organization NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization WHO/APOC, 03 February 2009v Definitions (iv) (v) (vi) (i) (ii) (iii) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). Eligible population: calculated as 84Yo 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. 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 coverag-e (normally the project should be expected to reach the UTG at the end of the 3'o year ofthe project). Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). Geographical coverage: number of communities treated in a given year over the totainumber of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). 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- e-ffectiveness 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. Sustainabilitv: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. Community self-monitoring (CSM): The process by which the community is ernpowered to oversee and monitor the performance of CDTI (or any community- basid health intervention programme), *ith a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full r"rporribility of ivermectin distribution and make appropriate modifications when necessary. (vii) (viii) (ix) vl WHO/APOC, 03 February 2009 FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fiIl in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session J5- Namber of Recommendution in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY (r) Enhance integration and co-implementation activities (i) Orientation conducted for County Health teams on co- implementation using CDTI approach (lI) Advocacy carried out at National and County levels for policy review (D Develop a sustainabilitY plan No action taken by Project (m) Encourage communities leaders to motivate CDDs Spot Messages have been produced and aired on local radio stations on the need to motivate CDDs (r\r) Seek additional partners to cover the financial gaps Activity 2009 planned for (v) Advocate for government counterPart funding Consultative meetings with Health policy makers held, government agreed on plan to increase support to project in 2009 fiscal year. WHO/APOC, 03 February 2009 Executive Summary Prepare an Executive sammary of the report in not more than one page. l. Background ontredtment andpopulation data Total communities, communities' treated, total population, UTG, ATO and persons treated. 2. Background on population movements. 3. Training data - CDDS, healthworkers, Total population (community) per CDD trained. 4. Challenges and how they were overcome. The Southwest CDTI project consists of five (5) counties: Grand Bassa, Grand Cape Mount, Bomi, Rivercess and Margibi. This reporting period shows that the total target communities increased by 20% (from 2,560 in2007 to 3,195) in 2008. The total number of persons treated during this period was 663,789 out of the target Mesoftryper populations of 936,295 which constitute 7l%o therapeutic coverage. The therapeutic treatment coverage was higher for this period due to easy access to most of the communities. 2,020 communities were reached in 2008 out of the target communities of 3195, which represents 63Yo geographical coverage. The Ultimate Treatment Goal (UTG) was 786,485, whilst the Annual Treatment Objective (ATO) was 853,964. The population movement during this reporting period was stable. With relative peace in the country, the communities were engaged in farming, mining, and other activities for their livelihood. The training of health staff and CDDs was carried out at County, District and Community levels. About 1,659 Community Directed Distributors comprising of 1449 male CDDs and 210 female CDDs took part in 2008 distribution. There are 136 health facilities in this project area with 1,184 health staff. 269 professional health staff were trained and involved in the implementation of CDTI activities. To enhance the smooth distribution of Mectizan in remote communities, APOC provided motorcycles to facilitate easy access to project areas not accessible by vehicles. During this reporting period, the program was faced with the following challenges: Challenges o The frequent change of leadership at the NOCP- Secretariat was a serious challenge which led to the delay of this report. o Untimely release of project funds by MOH o Logistics (Project vehicle not functional to carry out regular supervision of the drug distribution in the communities. o The exclusion of the program from the Basic Package for Health Services o Inadequate number of CDDs per coverage population o Low motivation of CDDs WHO/APOC, 03 February 2009 SECTION 1: Background information 1.1, General information 1.1.1 Description of the project (briefly) - Geographicql location, topography, climate - Population: activities, cultures, language - Communication systems (roads...) - Administrationstructure - Health system & health care delivery (provide the number ofhealth posts/centers in the proiect area if the information is ovailable). - Number of health staff in project areq qnd number of health staff involved in CDTI activities. The Southwest CDTI Project area is located within the South Western region of Liberia. The Region is bordered on the south by the Atlantic Ocean, on the west by the Republic of Sierra Leone, on the east by Cestos River; and on the north by Bong County. The Region is situated in a rain forest with mangrove vegetation. This terrain is mostly flat, particularly in the coastal plains and rolls up gently through the plateau and mountain ranges. Prominent in the region are major rivers, including the Cestos, St. Paul, St. John, Lofa and Farmington rivers, which tributaries are good breeding sites for the black flies, and the vectors of Onchocerciasis. The climate is tropical and humid all year round with variations between the dry season (which begins in Oitober and ends in April) and the rainy season (begins in May and ends in October). the population is most comprised of low income eiuners who depend on subsistent farming of cassava, rice, sugar cane, palm oil, rubber, cocoa and coffee. The farming season begins in February with harvest time in October. The roads in this terrain are unpaved and very difficulty for free movement especially during the rainy season. Four wheel drives are the best suitable vehicle for traveling to some of these countiei that are hard to reach. In some project areas, motorcycles are the only source of transport. The ethnic groupings in the region are homogeneous. These groupings are predominantly from the fpiUe ethnic group.. Other ethnic groups in the areas are Bassa, from Grand Bassa and Rivercess Counties, Kpelle from Margibi, Vai from Cape Mount, and Gola from Bomi County. The traditional leadership structure in the communities is hierarchical in nature. Large areas known as chiefdoms ire under the authority of the paramount chiefs; and the paramount chiefs are the head of clan chiefs with authority over the clans that make up the chiefdoms. The towns/communities make up the clans. [n every village or town, there are councils of WHO/APOC, 03 February 2009 elders who make decision and advise the leadership on matters concerning the development of their communities Table 1: Number of health staff involved in CDTI Number of health staff involved in activities Number of health staff Total number of health staff in the entire involved Percentage COUNTY/DISTRICT oroiect area in CDTI involved in CDTI B1 82 83=82/B1.100% GRAND BASSA COUNTY Buchanan 159 15 9o/o Number I 28 8 29o/o Number 2 L4 4 29o/o Number 3,A. 2L 6 29% Number 3B 7 2 29% Number 3C 2L 6 29% Number 4 24 8 33% Owensgrove L4 4 29o/o Subtotal 288 53 27% BOMI COUNTY Tubmanburg 163 25 15% KIay 42 7 17o/o Dwoin 30 5 17o/o Sueh Mecca 24 4 17o/o Subtotal 259 4t 19To CAPE MOUNT COUNTY COMMON WEALTH LLz 4 4% GARWULA 67 8 12o/o TEWOR 74 TL 15% PORKPA 32 5 160/o GOLA-KONNEH 25 8 32% Subtotal 310 36 14% MARGIBI COIJNTY Kakata 90 69 77Yo Firestone 50 15 30% Mamba Kaba 28 24 86% Gibi 7 7 100% Subtotal 175 115 44% RIVERCESS CENTRA ''C'' 18 3 17o/o DOEDAIN 18 3 17% WHO/APOC, 03 February 2009 JO-RIVER 18 4 22% JOWEIN L2 2 17% TIMBO 80 9 11o/o YARNEE 5 2 330h Subtotal L52 23 20% Grand total 1184 268 23% 1.1.2. PartnershiP - Indicate the partners involved in project implementation at all levels [MOH, NGDOs (national/iniernational), communities, local organizations, etc'J - Describe overall ,oriing relationship among partners, clearly indicating specific areas of proiect activities (planning, sujervision, odro"o"y, planning, mobilization, etc) where all partners are involved. - State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs' NGOs, CBOs' to assist in CDTI imPlementation. Partnership in the implementation of GDTI is at the below levels: National Level The partnership at the national level in the CDTI implementation includes, Ministry of Health and Slocial Welfare, WHO and Sight savers International' The Ministry of Health and Social Welfare (MOHSW) has been involved in planning, training, advtcacy, mobilization, sensitization, monitoring and supervision of CDTI activities' The World Health Organization and Sight Savers Intemational provided technical assistance and funds for prograir implementation. The relationship between NDGO partner - Sight Savers Internatibni andthe tvtinistry of Health greatly improved approaching the end of the year. At the end of the treatment year, NOCP Secretariat prepares all technical reports and submits same to APOC. Project/ County Level partnership at the county level with CBOs and other agencies needs to be strengthened. Effott. Weekly meetings with County authorities, Government agencies and NGO in the health sector have blen initiated to strengthen partnership within the region. Community Level partnership at the community level involves health facility staff, district and town chiefs, women group leaders, faith based leaders and youth leaders. The traditional leaders, CBOs and other community leaders are responsible for the selection of CDDs and the provision of support to them whether in kind or cash during distribution of Mectizan. The CDDs in collaboration with community leaders sensitize the population on the importance of taking Mectizan. However, the capacities of partnership at this level need to be strengthened in order to facilitate community participation and ownership' WHO/APOC, 03 FebruarY 2009 1.2. Population Table2:Communities and population at risk in the entire project area whether they are treated or not during the reporting period' (Please add more rows if necessary) N u m ber of com m un itleg{Y!!Lai99-1n Population of COUNTY/DISTRICT Meso endemic zone in enlire oroiect area Hyper endemic zone in the entire project area Total meso/hyper endemic zone Meso endemic zone in the oroiect area Hyper endemic zone in the proiect area Total meso/hyper endemic zone Ultimate treatment Goal GRAND BASSA COUNTY A1 A2 A3=Al+A2 A4 A5 A6=A4+A5 UTG Buchanan 33 55 88 43486 68016 111502 93662 12577 21415 33992 28553Number I 38 71 109 Number 2 35 70 105 11230 17565 28795 24188 Number 3,{ 25 59 84 10365 17648 28013 23531 Number 38 35 74 109 10431 17019 27450 23058 Number 3C 29 59 88 10485 16400 26885 22583 8529 17315 25844 21709Number 4 46 73 119 Campwood 28 69 97 7013 1 0970 17983 15106 Owensgrove 16 32 48 1 1555 20542 32097 26961 125671 206890 332561 279351Subtotal 285 562 847 BOMI COUNTY Tubmanburs/Seniah 19 75 94 14955 27774 42729 35892 Klay 223 520 743 9607 18648 28255 23734 Dwoin 58 109 167 1 1051 17286 28337 23803 Sueh Mecca L46 178 324 8715 14840 23555 19786 Subtotal 46 882 ,1128 4/.328 78548 122876 103215 GRAND CAPE MOUNT COUNTY Commonwealth 2 I 11 999 3994 4993 4194 Garwula 46 76 122 1 5939 32360 48299 40571 Tewor 51 86 137 11183 20769 319s2 26840 13003 20339 33342 28007Porkpa 49 84 133 6 WHO/APOC, 03 February 2009 Gola-Konneh 77 113 7291 11403 18694 1 Subtotal 184 332 516 48415 88865 137280 115315 MARGIBICOUNTY Kakata 19 43 62 33333 28963 8s458 71793 Firestone 14 31 45 27683 43299 70982 59625 Mamba Kaba 11 26 37 21311 36285 57596 48381 cibi 10 13 23 12619 19737 323s6 27179 Subtotal 35 113 167 94946 128284 246402 206978 RIVERCESS COUNTY Centra "C" 13 29 42 3743 5855 9598 8062 Doedain 14 28 42 6308 11716 18024 15140 Jo-River 32 53 85 1 0340 16172 26512 22270 Jowein 11 27 38 5689 9283 14972 12576 Timbo 25 45 70 6387 12967 19354 16257 Yarnee 18 42 60 3051 5665 8716 7321 Subtotal 113 224 337 35518 61658 97176 81626 Grand total 1063 2113 3195 348878 564245 936295 786485 fu ceogaphic cowrage lnornatly the yoiii snola be spected to reai the L\IG A the ad of the 3d yeo olthe Proied). Was a census for the project done during the reporting period? Yes-{ No If No, what is the source of the data in the table above? * Source: National census 2005 CDD update Other source, speciry: Year: WHOiAPOC, 03 February 2009 IJlou arc uting the krr,, con ntaniq ot tillage, dqine vhat constitures the corn rrar.it! or vilhga Thit wit heb unde$rar.d the proftle olthe pniec, A community or village is made up ofpersons ofthe same ethnic group, heterogeneous origin living together in the same geogaphic area, who share the same social, politicat and economic interest. Is there any other information of interest about the population in the project area? If so, include it here. The population movemelt in the project area was stable. People ftom ploject region are engaged in cross border trade with neighboring Colmty, Sierra Leone along Grand Cape Mount County area. A large number ofrcfugees ftom Siera Leone bas rehrmed and been reintegrated into local communities. SECTION 2: Implementation of CDTI 2.'1. Timeline of activities Fitt h rbbte j, tinteline of aclivities fot areos treared i4 canent yea\ hdicatirrg when the key activilies were inElemen zd by the ,no0lh thq began and the month the! ended. The timelhes ofCDT activities varied from one count to aDothq In Bong and Nimba counties. Ivermectin distdbution was caried out during the rainy s€ason due to the late supply of iveunectin ftom the National level. It u/as untimely because many communities could not be accessed and CDDS were not motivated because foodiupply as scared during the period. However, Lofa, Gbarpolu and Montsqrado counties diskibution was timely. WHO/APOC, 03 February 2009 Table 3: Timeline of activities for the areas treated in the current year (Ivermectin Distribution Time Table 2008) PROJECT SOUTHWEST Mobilization of communities Training Census/Update Drus distribution Supervision COUNTY Startingmonth Completionmonth Startingmonth Completion month Starting month Completion month Starting month Completion month Startin Cb month Completion month Grand Bassa June July July August July August September December July December Bomi May June July July July July August November July December Grand Cape Mount June July August September September October October December June December Margibi July November July August August August September December July December Rivercess June July July August July August September October July November - Comments Late delivery of Mectiz;ar.as well as funds to the project resulted in delay of CDTI activities during the year. WHO/APOC, 03 February 2009 2.2. Advocacy State the number of poticy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe dfficulties/constraints beingfaced and suggestions on how to improve advocacy. Advocacy is one of the activities carried out in all the project areas. Before the distribution of Mectizan, the County Health Teams held meetings with the County authorities and community leaders to advocate for support to CDTI implementation. Motivation of CDDs was key to advocacy plan each year. Most communities have started conceptualizing the importance of CDTI ownership, and have seen the reasons for providing support to CDDs. However, there are still serious challenges for advocacy at the national level. CDTI as a program has not been included in the Country's Basic Package for Health Services, thus causing problem for budgetary allotment in the National budget' 2.3. Mobilization, sensitization and health education of at risk communities Provide information on : - The use of media and/or other local systems to disseminate information - Mobilizaiion and health education of communities includingwomen and minorities - Response of target communities/villages - Accomplishments - Suggeit ways to improve mobilization and sensitization of the target communities. The County Health Teams in the Southwest project areas collaborated with local radio station to air CDTI messages targeting CBOs and community leaders on their roles in CDTI activities. Mobilizatio, ard sensitization activities targeting high risk communities' were carried out using appropriate messages in local dialects. These messages were played on local radio stations in county including UNMIL radio, Varitas, Truth FM and the State own radio station - Liberia Broadcasting Service. Worship places like Churches and Mosque, as well as social gathering, market *"ur, out patient department (OPD) of health facilities. Also targeted for sensitization were rural communities, town criers and CDDs who used megaphones to sensitize and mobilized the population. The impact was significant as is evident in the increase in therapeutic coverage of 7l% in 2008 compared to 690/oin2007. However, there is still a need to increase the number of CDDs involved in CDTI activities to adequately cover all the communities in future treatment round. 10 WHO/APOC, 03 February 2009
2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rowsjf4gge' couNryDrsTRlgr Number of comt with communi supel nunities/villages ity members as 'visors Percentage B5= Number of CDDs and communities involved Male Female CDDs CDDs Total 87 I sa lss=az+ea Number of comunities/villages Number of Percentage with female 811= CDDs B1O I e,oleq*rcow Tota! no. communities in the entire project Area B4 Number with community members as supervisors B5 85/84*1oo GRAND BASSA COUNTY Buchanan 88 16 L8% 15 3 18 3 3% Number 1 109 6 6% 10 L 11 1 Lo/o Number 2 105 8 8o/o 7 3 10 3 3% Number 3,A. 84 8 10% 9 2 LL 2 2% Number 38 109 8 7o/o 16 0 L6 0 o% Number 3C 88 8 9% 9 2 TL 2 2o/o Number 4 1L9 8 7% t7 4 2t 4 3o/o Campwood 97 0 o% 0 0 0 0 o% Owensgrove 48 7 L5% 13 2 L5 2 4% Subtotal 847 69 8% 96 L7 113 L7 2% BOMI COUNTY Tubmanbure/Seni 94 85 9L% 36 6 42 6 7o/o Dwoin t67 52 37% 74 L7 91 t7 3Oo/o Klay 743 119 L6% 4L L 42 1 L% Sueh Mecca 324 58 t7% 33 3 36 3 s% t2 WHO/APOC, 24 November 2003 Subtotal 1328 315 39% L84 27 2tL 27 8o/o CAPE MOUNT COUNTY COMMON WEALTH LL 7 64% 70 8 78 8 73o/o GARWULA 122 58 48% 100 2L LzL 2L L7o/o TEWOR r37 61 4s% LO2 77 119 77 L2% PORKPA L33 7L 53o/o LO7 18 L25 18 L4% GOLA-KONNEH 113 63 s6% tL2 L3 L25 13 t2% Subtotal 515 260 50% 49L 77 568 77 t5% MARGIBI COUNTY Kakata 62 40 650/o 66 8 74 8 t3o/o Firestone 45 L4 3L% 27 L2 39 t2 27o/o Mamba Kaba 37 32 86% 20 5 25 5 L4o/o cibi 23 t7 74o/o 53 16 69 16 70% Subtotal L67 103 620/o 166 4t 207 4L 25o/o RIVERCESS CENTRA ''C'' 42 32 760/o 54 2 56 2 3o/o DOEDA!N 42 27 s3% 98 7L 109 10 20% JO-RIVER 85 47 64% 136 10 L46 L0 t4o/o JOWE!N 38 32 63% 83 9 92 8 L6% TlMBO 70 47 67% 95 L2 LO7 10 L4% YARNEE 50 2L st% 46 4 50 4 Llo/o Subtotal 347 206 59% 5L2 48 560 44 t3% Grand total 3,195 953 43% t,449 zLO 1,659 206 L2% 13 WHO/APOC, 03 February 2009 Comment on: - Atlendance offemale members of the community at health education meetings - In general, how do you rate the participation offemale members ofthe community meetings when CDTI issues arc being discuss€s (attetrdanc€, participation in the discussion etc). - Incentives provided by commuities for the CDDs - Attrition of CDDs. Is attrition a ploblem for the project? If yes, how is it addressed? - Other issues Attendance of female members at Health Education meeting is gradually increasing especially wher€ adequate facilitatiotr is made by health workers. Many femate have shown increased interest and participated in discussion of issues regarding the prevention of Onchocerciasis which also got sociat and economic implication. Community health workers still need to implore much effort aim at ensudng greater represe ation offemale at level during Health Education meetings. Communities' contibution for CDDS support is still quite low. Community thernselves are still tryiug to recover Aom the national economic down trcnd in post war Liberia. However, ihere arc some cornmunities that are making efforts to motirde CDDs tlrough the provision of giffs.. In general, much auareness needs to be done in the areas of community conceptualization and ownership ofthe Fogram. t4 WHO/APOC, 03 February 2009 2.5. Capacity bullding - Desoibe the adeqaacy ofatailable knowledgeablz rnsnpovet at all leveb. - Wherc fteqaent transJers of fiaiwd srst occur, stare whol the project i$ doin$, ot intends to do, to rerrgd! the sitaaliorr. (The ,nosl impo ant issue to describe is vhal meosures yterc taken to ensure o.lequate CDTI impleaunwion wh*e aol enough kaowledgeablc mlrtlnwet ntalt available or dstafs arelreque l! transJefie.l dwing the course ofthe canEaiga\. so quite inadequate. Therc is a gre3lneed to clos€ the gaps ofinadequate taircd p€rsonnel on CDTI by t{geting all heElth statr for traioing in th€ next treatm€nt round. l5 WHO/APOC, 03 February 2009 Table 5: Training at the different levels of CDTI implementation (Please add more rows if necessary) District/LGA Number of Districts/tGAs staff trained Number of Health center/post staff trained Number of other trainers of trainees Number of CDDs trained AtrO New Refr Total ATrO New Refr Total ATrO New Refr Total ATrO New Refr Total c1 c2 c3 C4=C2+C3 c5 c6 c7 C8=C5+C7 c9 c10 c11 C12=C10+C11 c13 c14 c15 C16=C14+C15 GRAND BASSA COUNTY Buchanan 11 3 8 tt 6 1 5 6 5 L 4 5 48 8 40 48 Number I 3 1 2 3 4 L 3 4 3 1 2 3 38 10 28 38 Number 2 2 0 2 2 2 0 2 2 2 0 2 2 5 0 0 0 Number 3,4' 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Number 38 2 t L 2 2 L 1 2 1 0 L 1 10 0 0 0 Number 3C 3 0 3 3 3 0 3 3 3 0 3 3 2L 0 0 0 Number 4 3 0 3 3 3 0 3 3 2 0 2 2 0 0 0 0 Owensgrove 2 0 2 2 2 0 2 2 2 0 2 2 L4 0 0 0 Subtotal 26 5 2L 26 22 3 19 22 18 2 16 13 137 18 58 86 BOMI COUNTY Tubmanburg 199 5 55 61 163 6 19 25 84 42 42 84 72 36 36 72 Klay 133 4 94 98 42 4 3 7 165 74 91 165 L7 74 91 165 Dwoin 72 15 32 47 30 3 2 5 72 30 42 72 t2 30 42 72 Sueh Mecca 60 7 40 4L 24 1 3 4 72 36 36 72 72 35 35 72 Subtotal 464 26 22L 247 259 t4 27 16 393 L82 2L1 309 173 176 205 309 CAPE MOUNT COUNTY COMMON WEALTH 82 27 6L 82 4 2 2 4 78 19 59 78 67 21 46 67 GARWULA t29 30 99 L29 8 3 5 8 L2L 27 94 L27 79 L7 62 79 TEWOR 130 25 105 130 11 4 7 11 t79 2L 98 Lt9 87 16 7L 87 t6 WHO/APOC, 24 November 2003 PORKPA 130 4t 89 130 5 2 3 5 t25 39 85 L25 98 19 79 98 GOt-A- KONNEH r29 48 81 129 25 1 3 4 t25 47 78 125 89 13 76 89 Subtotal 600 165 435 518 53 t2 20 28 s68 153 4L5 490 420 86 334 353 MARGIBI COUNTY Kakata 90 19 50 59 90 19 s0 69 15 0 15 15 150 75 75 150 Firestone 50 0 15 15 50 0 15 15 6 0 6 5 78 39 39 78 Mamba Kaba 28 15 9 24 28 15 9 24 10 0 10 10 138 69 59 138 Gibi 9 4 4 8 9 4 4 8 2 0 2 2 50 25 25 50 Subtotal L77 38 78 115 177 38 78 47 33 0 33 33 416 208 208 266 RIVERCESS CENTRA ucu 74 50 9 59 18 2 t 3 3 2 L 3 64 48 8 55 DOEDAIN 127 98 L4 772 18 2 1 3 3 2 L 3 115 96 13 109 JO-RIVER L64 115 34 749 18 2 2 4 4 2 2 4 158 LL4 32 L46 JOWEIN to4 88 6 94 t2 2 0 2 2 2 0 2 97 88 4 92 TIMBO L87 75 4L L16 80 1 3 4 9 L 8 9 7L2 69 38 707 YARNEE 56 4L 10 51 6 0 2 2 2 0 2 2 54 42 8 50 Subtotal 712 457 tt4 581 152 9 9 18 23 9 L4 23 600 457 103 560 Grand total 1979 701 869 1488 663 76 153 229 1035 346 689 868 1746 945 918 1574 Achievement Percentase Achievement 75o/o Achievement 35% Achievement 84% Achievement 90% t7 WHO/APOC, 03 February 2009 Table 6: Type of training undertaken where trai was catied out duri, the 2.6. Treatments 2.6.1. Treatment figures - If the project is not achieving 100% geographical coverage and a minimum of 65% therapeutic coverage or the coverage rate isJluctuating, state the reasons and the plans being made to remedy this. The project did not achieve 100% geographical coverage during this reporting period due to factors identified below: o Poor motivation of CDDs by some community members. o Number of CDDs was too few to cover the target population. o Inadequate monitoring and supervision by central Ministry and CHTs . The poor timing of CDTI activities especially when treatment was carried out during the rainy season. The 630/o of geographic and 7lo/o therapeutic coverages respectively were achieved during this reporting period. However, there are measures put in place to increase coverage to 100% geography coverage and 80% therapeutic coverage according to JAF recommendation in 2009. l8 WHO/APOC, 24 November 2003 Table 7: Treatment and SAEs by district/LGA in all areas atrisk (Please add more rows if necessary) Number of persons who refused treatment Total Population of the meso/hyper endemic areas LtL502 Number of Adverse to the GRAND BASSA NTY Buchanan Number I Number 2 Number 3,{ Number 38 Number 3C Number 4 Wood BOMI COUNTY Dwoin Sueh Mecca Subtotal CAPE MOUNT COUNTY COMMON WEALTH GARWULA TEWOR t9 PORKPA WHO/APOC, 03 February 2009 GOLA-KONNEH 113 113 113 100% 18694 L5L42 13876 74o/o 193 2004 0 0 516 516 515 100o/o 137280 120413 99995 73Yo 922 2763 0 0 MARGIBI COUNTY Kakata 62 62 30 48% 85468 78654 605s7 71% 647 734 0 0 Firestone 45 45 L4 31o/o 70982 58798 50587 7 1o/o 1109 1118 0 0 Mamba Kaba 40 40 37 93o/o 57596 49765 40654 71% 4724 7656 0 0 cibi 23 23 L7 74o/o 32356 31235 24564 76% 1643 2355 0 0 Subtotal t67 167 101 61% 246402 22Us2 176562 72o/o 8123 11863 0 0 RTVERCESS CENTRA "C' 42 42 32 760/o 9598 8s59 7115 74o/o 40 723 0 0 DOEDAIN 42 42 27 640/o 18024 15545 12786 71o/o 203 1218 0 0 JO-RIVER 85 85 47 55% 26512 24567 19876 75o/o 488 1 963 0 0 JOWEIN 38 38 32 84o/o 14972 13845 10654 7 1o/o 96 1259 0 0 TIMBO 70 70 47 67% 19354 15483 13456 70% 102 1 308 0 0 YARNEE 60 60 2t 35Yo 8716 7655 6756 78% 71 604 0 0 Subtotal 337 337 206 64% 97176 86554 70il3 73% 1000 7075 0 0 Grand total 3195 3195 2020 63Yo 936295 853964 663798 71% 10425 22432 0 0 Puttinq therapeutic and qeosaphical coveraee Therapeutic coveragE mle = Number ofpeoole rreated x 100(71%) Total population living in meso/lyper-endemic communities within the project area Geogrephicat ooverage rate : Nurber of oommmities/villaqes treatrd x 100(610/0) Total number ofmeso/hyper+ndemic communities as identitied by REMO in the project area ATO coverage rate = Number ofpeople k€ated x 100(78o/o) Amual Treatne Objective 84% IITG achieved = Number ofoeoole heated x 100 Total number ofpeople to b€ teated iD meso,/hyper<ndemio areas within the project area (UfC) ,1TO = Ih..sti,,ated,n tficr olppb AvW i ,a5dbp.,-.,tund. a.N thd a CDTI Wi.c. i,t.nd:.o,r.tt vtrh lv.nt..dn ln d gh'at r.at anc=Ih.ndrwmu bq 6p42 to b.tftrkl ln,r6drrwa.atd.rnlc arcas eithi,,h. ptq.ct dt d, ulrit ardy to b. t och.t |9L.n ti. pru:i.d hat,eachdfA S.ogrqN@l @e.tg. Oonaq 6. pni.a thotu b. .xptdql at wh rL. UIG d A. .nd of ti. t'r.ar of .h. Wi.d)- 20 WHO/APOC, 03 February 2009 2.6.2 What are the causes of absenteeism? . Community did not receive their Mectizan supply on time. r Bureauqacy in getting supplies to the counties caused the delayed in getting supplies from central. 2.6.3 What are the reasons for refusals? . Lack of adequate health information at the community level . Mild Drug Reactions 2.6.4 BrieJly describe all known and verifted serious adverse events (SAEs) that Occurred during the reporting period and provide (in table 8) the required Info rmation w h en availa b le. r There were no reports of serious adverse event during the treatment round. ' In case the project did not have any cases ofserious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report 2t WHO/APOC, 24 November 2004 Table 8: Cases of serious adverse events (SAEs) that occurred during the reporting period (Please add more rows if necessary) SAI* Age Sex Village of origin Date Mectizan was taken Date lt' symptom S appeared Symptoms Health status before taking Mectizan Date of admission in health facility Date of dismissal from health facility Results of tests (thick blood smear) Outcome of prognosis Extenuating or complicating circumstances Alcohol involveme nt or not * Serial number of the patient 22 WHO/APOC, 24 November 2004 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year Table 9: Treatments and coverage b)t calendar )tearfor the entire project area. (PleaseJill in the required data) Please indicate the UTG for the 'use this fieure as the denominator in all UTG co calculations. Geographical coverage V"l E4= ATO coverate %t E5= Total Population of the meso/hyper- endemic areas E5 Annual Treatment Objective Number of persons treated Therapeutic coveraSe lY.l E9= E8lE5{'1oo ATO coverage l%l E10= E8lE7*tOO UTG Coverage (Y,l Total # of comm./villages in the meso/hyper- endemic areas Annual Treatment Objective Number of communities/ villages treated E3 23 WHO/APOC, 03 February 2009 Mectizan@ ordered/appliedfor by - (please tick the appropriate answer) MoH E wHh uNrcEFtr 2.7. Ordering, storage and delivery of lvermectin NGDO tr Meclizan@ delivercd by - (please ticll!fu appropriate answer) MOH tr lvso I .t I uNrcEr tr NGDo fl Other (ptease speciry): Ll Please describe how Mectizan@ io odered qnd how it gets to the commrmities The required Mectizan stock for the year was calculated and order€d by NOTF based on the census rcsult Aom CDDS ofthe r€spective county, dishicts and corDmunities. The order is sent to the Mectizan Donation Program. When Mectizan arrives in country, World Heatth Organization clea$ it and serds it to the National Drugs Service (NDS) tbrcugh NOTF for storage. Each project county sends a requisition to the NOTF s€cretariat. The Seqetariat revie*s the request and authorizes NDS to supply the county. The county takes the drugs to the coulty drug depot for on ward dishibution to health facilities wher€ the CDDS take delivery ofthe drug for distribution in the communities. Table l0: Mectizan@ lDvefiory (Pleqse qdd more rows ifnecessary) District/LGA Requested Received Used Lost Wasted Expired Remaining GRAND BASSA COUNTY Buchanan 210000 205000 204700 235 115 0 65 Number I 22000 20000 19800 100 0 0 100 Number 2 15630 L562L 15302 19 0 0 300 Number 3,{ 77870 37936 37700 109 0 0 L27 Number 38 7000 7000 6754 76 0 0 L70 24 WHO/APOC, 03 February 2009 Number 3C LL77O LL77O 11600 33 0 0 L37 Number 4 L6260 L6260 15955 4L 0 0 264 Owensgrove 33000 33000 32700 207 0 0 93 Subtotal 393530 346587 3445LL 820 115 0 L256 BOMI COUNTY Tubmanbure/Senieh 56s00 66500 55600 680 0 0 220 Klay 44500 44500 43650 598 0 0 L52 Dwoin 37500 37500 35790 423 0 0 287 Sueh Mecca 51500 51500 51L1_5 29L 0 0 94 Subtotal 200000 200000 197155 2092 0 0 753 CAPE MOUNT COUNTY COMMON WEALTH L2722 L2722 t2450 87 103 0 82 GARWULA 54278 54278 53900 113 158 0 to7 TEWOR 516s0 51650 5L240 166 L73 0 7L PORKPA 75622 75622 TsLto L27 L32 0 253 GOLA-KONNEH 44223 44223 436s0 193 204 0 L76 Subtotal 23849s 238495 2363s0 686 770 0 689 MARGIBI COUNTY Kakata L7696L L7696L L76069 892 0 0 0 Firestone 84744 105840 105110 672 0 0 58 Mamba Kaba 84744 84744 83406 1338 0 0 0 Gibi 53738 53738 53478 260 0 0 0 Subtotal 400L87 42L283 418063 3!62 0 0 58 RIVERCESS CENTRA ''C'' 15600 15600 15400 L L 0 198 DOEDAIN 31200 31200 30900 49 0 0 257 JO-RIVER 40560 40560 40380 0 5 0 L75 JOWEIN 24960 24960 24700 5 10 0 245 25 WHO/APOC, 03 February 2009 TIMBO 29640 29640 29440 2 59 0 139 YARNEE L4040 14040 13600 0 43 0 397 Subtotal 156000 156000 t54420 57 118 0 1405 Grand total 1388212 1362365 1350499 6817 1003 0 4161 IIot are the remaining Ivetmzctin tablets collecteal aad wherc are lhey kept? The remaining Ivermectio tablets are collected ftom the communities by the CIITs and transfered to MOH health facility stock as balance brought Fonardfor the ext disttibution dnd send report to the NOTF. List and briefly describe the activitiel aruler lvermcctin .lclivery thst are being cafiied out by heohh carc peBonnel it the project area. o The County Health Teams ale responsible for the collecting of Ivenuectin supplies ftom the National Drugs Service storc with approval ofrcquest ftom NOTF seclet riat r The Officer in- charge for each oftie health districts take delivery ofthe Ivemectin tablets for health facility L rder its catchment.I The responsible health worker in rhat facility then distributes the tablets altocatEd !o the communities under its supervision. The CDDs dishibute the &ugs to the beneficiaries and retrun teatnent data and iemaining drugs to the clinic at the end ofthe teatment routrd. 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project qreo? Not yet but would be introduced in the project by 2009. 26 WHO/APOC, 03 February 2009 District Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSIO No of Communities that conducted stakeholders meetine (SHIO TOTAL Table I l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring ond stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. 2.9. Superuision 2.9.1, Provide aJlow chart of supervision hierarchy. Central Level o NOTF o NOTF - Secretariat o NGDO County Level o County Health Officer (CHO) 27 WHO/APOC, 24 November?O04 o Community Health Department Director (CHDD) o County Onchocerciasis Supervisor (COS) o CounW Health Teams (CHT) District Level o Health Center Medical Officer . Officer in Charge (OIC) o Clinic Staffs Community Level o Community Members/ leaders or town chief o Community Development Committee o CDDs 2.9.2. What were the main issues identiJied during supervision? Inadequate motivation of CDDs and less number of health staff involvement in CDTI activities. :i:ffi :3#j;H:il"#'J::;[,Hfi1H;1:T1""",T:tt,l',ffi 3i0"., that led to the death ofone staff. 2.9,3. Was a supervision checklist used? Yes. Checklist was used by NOTF during supervision, but the Project did not use checklist 2.9.4. What were the outcomes at each level of CDTI implementation sapervision? Community leaders were sensitized on their role and CDDs received corrective measures on issues identified on the spot while others were reserved for appropriate meetings. 2.9.5. Was feedback given to the person or groups supervised? Based on the degree of the issues, feedback was given verbally on the spot, presentation of Monitoring reports during meetings and offrcial memo to respective County Health Teams 2.9.6. How was the feedback used to improve the overall performance of the project? The NOTF provided technical assistance to the Project during the Programme review meeting on how to use data collected from supervision and monitoring in terms of gaps identified to improve the performance of the prograrnme 28 WHO/APOC, 03 February 2009 SECTION 3: Support to CDTI 3.7. Equipment Table I2: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:currently non-functional but repairable, WO=Wriffen off). How does the project intend to maintain and replace existing equipment and other materials? The project intensified advocacy to the policy makers to include CDTI in the County health plan and provide budget lines to support logistics such as servicing of equipment for transportation. 3.2. Financial contributions of the partners and communities Table l3: Financial contributions by all partnersfor the last three years Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condition No. Condition No. Condition No Condition No. Condition 1. Vehicle 1 CNFR 2. Motor cycle(s) 9 CNFR 3. Computer(s) I wo 4. Printer(s) 5. Photocopier (s) I F 6. Fax Machine(s) 7. Others a)Generator 1 F b)Bicycles J wo c) Contributor Year I ('provide the period') 2006 Year 2 ('provide the period') Year 3 ('provide the oeriod') TOTAL Cash Budgeted rus$) TOTAL Cash Released rus$) TOTAL Cash Budgeted rus$) TOTAL Cash Released rus$) TOTAL Cash Budgeted rus$) TOTAL Cash Released (US$) MOH (Central + Provincial/State) I1,460 6,930.00 MOH (District/LGA) Local NGDO(s) ( if any) NGDO partner(s) 9,200 7,901 Others a) b) Communities 29 WHO/APOC, 03 February 2009 APOC Trust Fund 40,423 19,783 TOTAL 55,623 34,614 - If there are problems with release of counterpartfunds, how were they addressed? - Additional comments 3.3. Other forms of community support - Describe (indicateforms of in-kind contributions of communities tf any) Community contribution for CDDs motivation was mainly in- kind from some communities during Mectizan distribution . 3.4. Expenditure per activity - Indicate in table 14, the amount expended during the reporting periodfor each activity listed. Write the amount expended in US dollars using the curuent United Nations exchange rate to local currency. Indicate exchange rate used here:-, Table l4: Indicate how much the project spentfor each activity listed below during the reporting period Activitv Expenditure ($ US) Source(s) of fundine Drug delivery from NOTF HQ area to central collection point of gelqmunity and Mgt of SAE 3,930 MOH Mobilization and health education of communities 250.00 APOC }c1!1j{,_g €!Lu_s 5,600.00 APOC rre4!_g_91!9e!th staff at a! lev-els 7,600 APOC ! "U.-, sbglPUlgl{ di stributio n lqt94qel monilo:ug €9Prl egliU!,"1 1,850.00 MOH Advocacy visits to healltr 94{ po!it]c4 authorities IEC materials 2,577 APOC lrqqrqry (reporting) forms for treatment 550.00 MOH ,Vjb!9l9ql4_olg9y9l9slb,rgygle_qlqar4le4ance 1,576 APOC qI!.g Eqglp*""t(e.g "o*p"t"r. g!q) 600.00 MOH Others 2,180.00 APOC TOTAL 26,713 Total number of persons treated 663,789 persons - Any comments or explanations? 30 WHO/APOC, 03 February 2009 SECTION 4: Sustainability of CDTI 4.7. lnternafi independent participatoty monitoring; Evaluation 4.1.1 lAas Monitoring/evalaation 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 Intemal Monitoring by NOTF Other Evaluation by other partners 4,1.2. What were the recommendations? The NOTF recommendations include the following: 1. County level: o NOTF and the county Health Teams should mobilize funds to ensure that all health workers are trained in CDTI o The County authorities should facilitate the integration of CDTI of activities with other health intervention using CDTI approach. o CHT and partners in the county should ensure 100% geographical coverage and more than 80Yo therapeutic coverage o Counties to empower communities to select more CDDs based on the required number of 100 persons to one CDDs 2. MOH&SW: o Review the policy and on the Basic Package of Health Services (BPHS) to include Onchocerciasis Control and Primary Eye Care. o Facilitate timely release of funds for the implementation of project activities to enhance effective CDTI coordination o Request support for replacement of logistic, technology and Special Country Initiative from APOC 31 WHOiAPOC, 03 February 2009 { 4.1.3. How have they been implemented? The implementation of the recommendation has been very slow, especially those having to do with policy review; it requires more time to engage with policy makers influence policy change . 4.2. Sustainability of projects; plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability planwritten? No Whenwas the sustainability plan submitted? NIL What orrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at ull relevant levels Advocacy is on-going with policy makers at the National and County levels for the national and county health plan to include CDTI 4.2.2. Funds The MOH & SW has provided budget line for Onchocerciasis. The sum of USD20, 000 was budgeted and released during the reporting period, and however the major challenge is at the County level where funds released for Onchocerbiasis/CDTl was grossly inadequate. 4.2.3 Transport (replacement and maintenance) There is integrated use and servicing of Programme logistics especially at the County level. CDTI implementation makes use of transportation and equipment facilities provided for other health Programmes. 4.2.4. Other resources Other consumables such as stationeries were provided by MOH & SW at National level and the respective County health Teams in the Project areas 4,2,5. To what extent has the plan been implemented There is still a longway to go infully implementing CDTI in the County Health plan 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plansfor complete integration: 4.3.1. Ivermectin delivery mechanisms Ivermectin delivery mechanism is also 90Yo integrated into the Health Care system right from storage at the National Dug service and the County Drug depots 32 WHO/APOC, 03 February 2009 4.3.2. Troining CDTI was not fully mainstreamed into health workers training during the reporting period. There are plans for integrated training of health workers covering major health care interventions. 4.3.3. Joint supervision and monitoring with other programs There is joint supervision and monitoring by the Community Health Services involving focal persons for Surveillance, MCH, EPI, clinical services Onchocerciasis and M& E. However the development of monitoring indicators for integrated supervision and monitoring was not finalized during the period under review 4.3.4. Release offunds for project activities Release of funds for CDTI was inadequate at all levels of the health care implementation 4.3.5. Is CDTI included in the PHC badget? Onchocerciasis and primary eye care are not spelled out in the National Health Plan. Therefore no specific budget allocation was made as in the case of other diseases like malaria, HIV/AIDS, Polio/measles that are given priority in the Basic Packages of Health Services (BPHS ) 4.3,6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? The polio Campaign used CDDs as local guides during the NIDs, their effectiveness have not been assessed. 4.3.7. Describe others issues considered in the integration of CDTI. Most health interventions rely on limited community involvement and provide cash incentives 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. There has not been any operational research done in the entire area since the inception of the project. 4.4.2. How were the results applied in the project? Not applicable JJ WHO/APOC, 03 February 2009 (- a SECTION 5: Strengths, weaknesses, challenges, and opportunities - List the strengths and weaknesses of CDTI implementation process. - List the challenges and indicate how they were addressed. Strengths - Effective use of local radio stations and town criers to disseminate health education messages and other CDTI information in the community - Dedication of health personnel implementing CDTI at all Levels Weaknesses - Lack of ownership of CDTI planning and implementation at the County and Health District levels - Low community participation and ownership - Poor commutation skills of health workers Challenges - Numerous changes in leadership at the NOTF - Secretariat during the reporting period. - The death of one of the County Oncho focal person on duty - Unserviceable Project vehicles - Delays in the release of funds - Poor recording and reportingllate submission of treatment data from the project areas - Inaccessible roads in the rainy season Opportunities - Increase synergies with CBOs for other health and development prograrnmes to enhance HSAM - Partnership with existing health and development focus organizations SECTION 6: Unique features of the project/other matters 34 WHO/APOC, 03 February 2009