South East CDTI project annual technical report submitted to Technical Consultative Committee (TCC): January 2008 to December 2008

SOUTHEAST CDTI PROJECT, LIBERIA COUNTRY/1.{OTF: Liberia NOTF PROJECT NAME: -South East CDTI Project Annroval April2002 Launchine vear: April 2002 Renortins od: From: January 2008 [December,2008 Proiect vear of this report: (circle one) I 2 s678910 Date submitte d; F eb.27, 2009 NGDO Partner: SSI ORIGINAL: English ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) LINE FOR SUBMIS I For fo: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 July for September TCC meeting Brn C5D c. oPC.lo 'i0 Co T 8fcfoAFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) RECU LE For lnformotlon To, k( \1. B",lcor6] 0 { n0lii Zurs FtN Anha h I (@i APoc/DlR WHO/APOC, 03 February 2009 t ANNUAT PROJECT TECHN]CAI. REPORT TO TECHNTCAL C0NSULTATTVE CoMMtnEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country :Ll -NOIF National Coordinator Name:Anthony (. Bettee NGD0Representative Name:Mrs. ey Sonii Signature: Date: This report has been prepared by Name;N0TF Liberia /r t-, I Designation: Dr. Bernice T. Dahn, Chief Medical Officer Republic of Liberia iii WH0/APOC, 03 Febnory 2009 009 Table of contents ACRONYMS v Ll. GeNpRelrNFoRMATroN............. 1.1.1 Desutption of the project (briefly). 1.1.2. Partnership 1.2. Popur.nrroN............... SECTION 2: IMPLEMENTATION OF CDTI....... 2.1 TtvplrNe oF ACTIVITIES ..9 l0 10 12 l5 18 18 22 22 22 24 25 27 2.2 Aovocacy 2.3. MostLlzerloN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMUNrrrES2.4. CouvruNrryrNVoLVEMENT 2.5. CepaclryBUILDrNG..... 2.6. TRenruENrs. 2.9. SupnRvrsroN............... ...................... 2g2.9.1. Provide aflow chart of supervisionhierarchy... . .. . . .................2g2.9.2. Wat were the moin issues identified during supervision? .............................. 2g2.9.3. Was a supervision checklist used? ............. 292.9.4. Wot were the outcomes at each level of CDTI implementation supervision? 292.9.5. Was feedback given to the person or groups supervised?................................ 29 2.9.6. How was the feedback used to improve the overall performance of the project? 29 SECTION 3: SUPPORT TO CDTI ..............30 3.1. EqurrveNr J 3 J 6 9 2.6.1, 2.6.2 2.6.3 2.6.4 Treatment figures .......... What are the causes of absenteeism?.......... Wat are the reasons for refusals?................ Brte/ly describe all htown and verified serious adverse events (sAEs) that current year2.6.5. Trend of treatment achtevementfrom GDTI project inception to the2.7. ORoERntG, sroRAGE AND DELIVERv oF IVERMECTIN 2.8. CovuurNrry sELF-MoNTToRINGAND STAKEHoLDERS MeerrNc 3.2 J.J 3.4 FntRNclRL CoNTRIBUTIoNS oF THE pARTNERS AND coMMUNITTES Orupn FoRMS oF coMMUNrry suppoRT ............... ExpeNolruRE PER ACTIVITy .................... 30 .................... 30 .................... 31 .................... 3l SECTION 4: SUSTAINABILITY OF CDTI....... ..........33 4.1. INTeRNaI; TNDEeENDENT pARTrcIpAToRy MoNrroRINc; Eve1uarroN.................... 33 4.1. I llas Monitoring/evaluation carried out during the reporting period? (tick any of thefollowingwhichare appltcable)............ ...........334.1.2. Wat were the recommendations? ............. 33 iii WHO/APOC, 03 February 2009 4.1.3. How have they been implemented? ............. .................34 4.2. SusreNesILITy oF IRoJECTS: eLAN AND sET TARGETS (MANDAToRv AT...... ..........34 Yn 3).... 4.2 4.2 4.2 4.2 4.2 4.3. 4.3 4.3 4.3 4.3 4.3 4.3 1. Planning at all relevant 1eve1s......... ........... 34 2. Funds....... ............... i4 3 Transport (replacement and maintenance) .................. 34 4. Other resources ...... 34 5. To what extent has the plan been implemented............... ............... 34 INrecRnrroN .............. ...................... 34 l. Ivermectin delivery mechanism,s................ .................. 34 2. Training.... ..............35 3. Joint superviston and monitoring with other programs........... ...... 35 4. Release offunds for project activities ........ 3J5. Is CDTI included in the PHC budget? ............ ............. 35 6. Describe other health programmes that are using the CDTI structure and how 34 35 35 35 this was achieved. What hove been the achievements?............. 4.3.7. Describe others issues considered in the integration of CDTI. . 4.4. OpenarroNAL 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. ........ 35 4.4.2. How were the results applied in the project?............. .................... 35 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNTTIES.... ................... 35 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS ...........36 lv WHO/APOC, 03 February 2009 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG WHO African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Obj ective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with lvermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization v WHO/APOC, 03 February 2009 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in mesolhyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in mesoftryper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the govemment. (ix) Community seltmonitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of Ivermectin distribution and make appropriate modifications when necessary. vi WHO/APOC, 03 February 2009 FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 26 Number of Recommendali on in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROTECT FOR TCC/APOC MGT ASE ONLY (D Intensify sensitization of the communities to improve on the therapeutic coverage; NOTF developed spot messages which were aired on local radio stations (r) Intensify advocacy at thegoverlment level to increase funds allocated for CDTI; NOTF secretatariat policy makers at County and NationalLevels have requested increase allocation of funds for CDTI within the health budget (IID Encourage the selection of more CDDs to improve the CDD/population ratio; NOTF effort for selection of more CDDs was frustrated by existing policy limiting number of volunteers per target population (Iv) Only l3Yo of the communities have supervisors, they need to increase the numbers. (v) Two communities have low therapeutic coverage and coverage needs to be increased in these communities; (vr) Continue efforts to involve women in CDTI activities; NOTF is exploring partnership with other development programmes for gender mainstreaming in CDTI ryrr) Adjust the treatment period with the communities to the dry season Frequent administrative changes in NOTF secretariat hindered timely deployment of distribution logistics (vuD Take steps to secure ivermectin tablets (Please add more rows if necessary) WHO/APOC, 03 February 2009I Executive Summary Prepare an Executive summary of the reporl in not more than one page. 1. Background on treatment and population data - Total communities, communilies' lreated, total population, UTG, ATO and persons treated 2. Background on population movements, 3. Training data - CDDS, health workers, Total population (community) per CDD trained 4. Challenges and how lltey were overcome. The Southeast CDTI project in the reporting period had a total number of communities of 900 which increased from 700 communities in 2007. The total population in meso/hyper communities was 380,975 out of which 310,972 were treated in 718 communities. The therapeutic coverage was 82%o and geographical coverage was 79Yo. In 2008, the target population of 380,975 which was based on community census was lower than that of 2007. The Ultimate Treatment Goal (UTG) and the Annual Treatment Objective (ATO) were 391017 and328194 respectively. There was an improvement in the therapeutic in 2008 to 82o/o, but decline in geographic coverages at 79 due to more target communitiues reported. A total of 778,636 tablets of Mectizan were used in the treatment round. A total number of 3927 CDDs were trained in the year, out of which 1009 were women representingZl%o of the total number trained. APOC provided 23 motorbikes that were used to enhance Mectizan distribution to remote communities which were not accessed by vehicles. Challenges Support for CDTI activties were not provided in a timely manner by NOTF during the treatment round. The Project failed to take advange of the window of dry season to implement activities. Also during the early part of the year, the conflict in the partnership between the supporting NGDO and the ministry did not allow for optimum support and the smooth implementation of CDTI activities. The UTG targeted for 2008 for all three CDTI projects are the figures that were used before resumption of the projects in 2006. The Project will require assistance in updating the ATO UTG for 2009 The Southeast has the highest number of hard to reach communities. In the rainy season which runs for more that 4 months, treatment areas become inaccessible and many times hinders the CDDs Mectizan distribution plans as well as supervision by health workers. Inadequate Health education in the community by health facility staff is of great concem 2 WHO/APOC, 03 February 2009 SECTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate P opulation: activities, cultures, language Communication systems (roads ... ) A dminis tr ation s tructur e Health system & health care delivery (provtde the number of health posts/centers in the project orea if the information is available). Number of health staff in project ared and number of health staff involved in CDTI activities. The South East Project area is located on the South East region of Liberia. It is bordered to the south by the Atlantic Ocean, on the east by Cote d' Ivoire, on the west by River Cess and on the north by Nimba County The Project area is located within the Tropical Rain Forest Vegetation Belt of West Africa. Most of the area comprises of forest except a narrow strip along the coast in Sinoe, Grand Kru and Mary Land counties where mangrove Vegetation alternate with coastal savanna 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 location of the country, about l0 degrees above the equator and southwest of the monsoon, brings massive rainfalls during the raining season. The average annual rainfall near the coast amounts to 4770 mm. towards the interior, the amount of rainfall decreases to an annualaverage of 2080 mm. The excessive rainfall comes during the months of June to September. The average number of rainy days during the rainy season is about twenty-two days in a month. Transportation in the South East is mostly by land through unpaved roads and water. The roads from Zwedru towards the border with the Cote d' Ivoire, and sections of the road to Mary Land, Sinoe and Grand Kru are in poor condition in certain sections, with very muddy and deep holes filled with wet mud and broken wooden bridges . In the South east torrential rainfall is causing road conditions to deteriorate further in remote areas. This situation partially disrupts road access to CDTI target communities in most counties of the Project. The South East CDTI project consists of five Counties Grand Gedeh, Grand Kru, Mary Land River Gee and Sinoe that are further subdivided into Districts, chiefdoms and clans. Population of South East CDTI Project, Liberia projected from national census Counties Population Grand Gedeh 128,795 River Gee 68,732 Grand Kru 58,307 Mary Land 139,268 Sinoe 107,136 502,238 The projected population of the South East Project is 502,238 based on national census. Most of the people are engaged in farming, fishing and hunting. The main farm crops are rice, cassava and plantain 3 WHO/APOC, 03 February 2009 County/District Number of health staff involved in CDTI activities Total Number of health staff in the entire project area Number of health staff involved in CDTI 83=8.2181"100% B1 82 MARYLAND Harper 16 7 44% Pleebo /Sodoken 9 2 22% Karluway #l l1 5 4s% Karluway #2 l1 5 45% Barrobo /Whoiah ll 5 45% Banobo/Fariah l1 5 45% Sub Total 69 29 420 SINOE Tarsu 2 I 50% Butaw t4 I 7% Kpanyan t9 I 5% Jaedae 15 1 7% Taryuwuon 20 2 t0% Jedepo t2 2 t7% Dugde l4 1 7% Gblonee 8 1 t3% Greenville 9 1 rt% Pyne 4 2 50% Sub Total tt7 13 llo/" GRAND GEDEH Tchien 49 t6 33% Cavalla 28 20 7t% B'hai 7 6 86% Konobo 7 6 86% Putu 2l 20 95% Gboa 2l t9 90% Sub Total 133 87 65"/. RIVER GEE Sarbo 10 7 70% Potupo 10 8 80% Tienpo 4 J 75% Chedepo 4 J 75% Gbeapo 10 8 80% Webbo 5 2 40% Sub Total 43 31 72o/o GRAND KRU Buah 8 6 75% Dordor 8 6 75% Trehn 35 5 14% Jroah 20 2 r0% Barclawille 93 7 8% Sub Total L64 26 160/" TOTAL s26 r86 35'h There are at total of 72 Health facilities in the Project area and 526 health workers with 186 (35%) involved in CDTI (Table l). Table I : Number of health staff involved in CDTI 4 WHO/APOC, 03 February 2009 1.1.2, Partnership Indicate the partners involved in project implementation at all levels IMOH, NGDOs (nationaUinternational), communities, local organizations, etc.l Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. Stote plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The partnership at the different levels of CDTI implementation is highlighted as follows; National Level The partners at the National Level are the Ministry of Health and Social Welfare and Sight Savers lntemational. Other NGOs and government agencies did not play any role in CDTI implementation during the reporting period. The Ministry of Health and Social welfare have been involved in planning, training, monitoring, and advocacy, while Sight Savers Intemational provided technical assistance including release of funds. The working relationship between the NGDO partner Sight Savers and the ministry of health had improved towards the end of the year. Project /County Level Partnership with other government and Non governmental entities is very weak. During the reporting period not much was achieved in terms of partnership in the CDTI Project at the level of County some support was received from NGO partners operating in the Project area such as Merlin in the area of transportation to supervise CDTI. There are plans to use the weekly meetings of the County authorities with govemment agencies and NGOs in the health sector to initiate partnerships for CDTI implementation. The County Health teams were in partnership with the local radio stations in broadcasting CDTI spot messages as well as airing CDTI discussion sessions in the local languages Community Level Partnership at the community level involves Health facility staff, District and Village head chiefs, women leaders, faith based leaders and youth leaders. The community leaders with other CBOs and community members are responsible for selection of CDDs as well as providing them support during distribution, ffid creating awareness among community members and ensuring their involvement in The CDTI activities . The Health facility staffs are responsible for training of CDDs, Health education and mobilization, Mectizan supply to the community and supervision. According from reports from Grand Gedeh and River Gee counties, the Health staff met with opinion and community leaders at the onset of the treatment round to plan for the CDTI activities to be carried out in the community . There are plans in 2009 to hold partnership meeting at the level of county and stakeholders meeting at health District levels to improve on the level partnership in the CDTI Project. 5 WHO/APOC, 03 February 2009 o\oo e.l E.(d L .oq) frr c.)o d o Or E > o o (u CL o(L -gE A9 EEOEE OF = 8"3 o\N$ ca .f, o\t+ c.t \o\o c.l\o $ ooo N\o+ol r- c-r-\o ra inin ca c.lN oo oo c.l \o rn(n\o oo =f \o cA\o\o \o o\F- cA o\ o\ @ (\i € N -8., IL -.- J. = =E s+gE€=[ o\ c.l + cO $ o\s cO \o\o cO\o + oo N\osN tr-r-r-\o ra raia coN C..l ooo oo c-l \o h\a\o oo$ \o ca\o\o \o o\ r-. cA o\ o\ oo N oo N sf 5EE.st ooc.I\o C.I (.} ca r-+ NNO oo la) ca oo oo oo$ ca o\NN6 tt-.\o \o o{ r- o\ .+ \o ca\n\f, car- o\ =f, r-$ ooN o\+ \o tr- cO\o ,.9c tl gEgs tsx o\+ oor- o\ oo+ ra(n\o oo @N N $ r- o\ oo (\l(\lN(.)(\I c\rn rn NO c- o\ co\o N \at oo 16\o o\+ o\ trr N ra)$lrr .= o o E')g oo .E E tr o o o L o .ct E z E= e E;gul \o tr- $tr} Nc.I $N $rr) @c.l 6\oN .f, @ .t c.l a.l \o o\ c.l oo (U ,rOO r'=.s.E E gfl tenq* CL $ o\o.l N O $c.l ia ra ca $ s .f, r- (n ca lar ,iE ,.YEo EE E EHt = 5 He'- (n ca \r) c.l $ ca @ (n rn v \o n \o cO o :E O O O - €g:E 3sF o..! o I .,OE CL o\ c.l $ co .t o\$ cA \o\o co\o .f, oo N\o .f N r--I'r r--\o ia iaia caC\N @O ooN \o rn ral\o oo sf, \o c.t\o\o \o o\r- cn o\ o\ oo N oo ol FAt- fiH EB =uoo.o F C) d.F .o o Fzf oo az Fl & ll2 ko& cl tr o) J1o!oa o!()(l) A + >r(E B clv c.lIt >.(B B Lr clv GI 'a op oL.L. 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CB f.iliAir< rr) Ir1 O-&>PrO a F z oO O 'o C)(, !tr c6L(, q) o() t< C) .8, i(s x Cd ) r< M 'o dko o otr a Ei(d 4 d oo C) 'o o)4 I A P o E C) d I >.s U() Id (.) 4F C) o. H () Lo -u)6 G) -i l_, Po(l) cd >.Eoc!tF -c q) (D .F( EF - oo Lr --o .i ./E:(.) ) E .- ifl:,,.sY'-q;AAE\6Es\) l'1 ' F' -=€ItieE;9 TEF \.=q) B(u-PHHSO . l-r -u!7\B.nL] p Gi(-)tg qr\(tr? o a gEiiq-o.Y.Ehg =.='a =rirl-(DLg\)aixE.: Ftub..Eg!s?3 o- o s! =so(HH o t€ o -sE(l) .= :\o c6i E i0' EZ E o,€ .Elr Ea -;= F E= colF .-a ri\ . .H E olII E =; *ra N ii€ Fl o\ 2.2. Advocacy State the number of poliqt/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe dfficulties/constraints being faced and suggestions on how to improve advocacy. Advocacy has been one of the activities carried out during the period under review in all counties. Prior to the Mectizan distribution, the county health teams met with County superintendants and other members of the County authorities to advocate for their support for CDTI implementation. Also at the beginning of the treatment year in 2008, Front line health staff held meetings with District commissioners, corlmunity leaders, chiefs, women and youth leaders to sensitize them on their role in the distribution of the Mectizan tablets to eligible members of the community. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: - The use of media and/or other local systems to disseminate information - Mobilization and health education of communities including women and minorities - Response of target communities/villages - Accomplishments - Suggest ways to improve mobilization and sensitization of the target communities. Mobilization, sensitization and health education of at risk communities' was carried out in the communities within the months of April to May 2008. The County Health teams collaborated with local radio stations to air CDTI messages targeting community leaders and CBOs on their roles in the CDTL Further more NOCP with funding from Sight Savers International produced spot messages in four languages including Krahn, Sapo, Kru and Grebo and arrangement was made for their airing for a three months duration in four national radio stations (Liberia Broadcasting Service, Varitas, Truth FM and UNMIL radio) to reach the different target audiences in the five counties of the Southeast Project. Also Community leaders reported that they used town criers to inform their subjects that Mectizan tablets were available and requested those that are eligible to take the treatment. Generally the target community responded favorably to some aspects of the mobilization and health education messages as can be seen from the increased coverage's in the community across the five counties. However Sinoe County reported a number of refusals among young women who refused to take Mectizan because, it's alleged that it would make them pregnant. l0 WHO/APOC, 24 November 2003 The following strategies are recommended for the improvement of mobilization and sensitization of the target communities. . Health workers would plan with communities and agree on the most convenient time to held health education sessions that would include all segments of the community including women and children o Health education sessions should be with posters and other IEC materials . The Southeast Project should be facilitated by the NOTF to produce IEC materials that are based on the results of a KAP study in the area, especially to address the perception in Sinoe County that Mectizan makes people pregnant. o Communities need to be empowered with full information on their roles in CDTI, because at the moment they seem not to appreciate their role in deciding period of treatment and reviewing the outcome of distribution. o There is need to introduce CSM and SHMs in the Project in the next treatment round 1l WHO/APOC, 03 February 2009 ca a.l o -o o o z tf, c.l d o o< o c.l E,,,E* gE$ o.E g (l,E,{ oeE sE(J - .; o o E" G(r> gE E E oo dz tz dz tz tz tz tz rf)c\l o o oc\l @(o (o (f) & z & z & z & z & z & z & z N N @ dtEiotrlFtl o) dt 8,,2 Eo eo EO m .Ef" ooo 3E cl E o o .E E E o o E' IE oo oo o olr E z 1.} ca ra) ca ca ca N $\nN C{$ \a ra o\ N Nc.l sN ooN \oN t--N t{r)N t1 co (n co N oo N GTN O cA N \o cO oN (.l o\ o\ \o coN .+ ?.) € c.l NN .+ ct racil +N \oo.l $N ooEDOSrrFE@tomOeboO o- otP =O>oDq .9tsfl0,trEi> EE o=oE bEoh 5Etl -tr =!z oo t o\ t,-) oi \O ia \a) Ota) *tr) 9\o\o \orn q €\o \o N c.) co \o cO ro(\l c.l $ ca O oo o\ c.l \o r-. +tr) NcO $C.l $la, @c.l €\oN + @ $N o'l \o o\c.l Fot 9,o z =oo az Fl & li(l) o. G' tq)}1o €o rA op oo 0{ +t C, B l. clv olIt Cd B dv G' 'a op o (tt o d .F dfr. op o cl Ea cl oF E 0 rc oz -tt) U'L{ clF B crl pa cl trd o.V o) cl €o G, tr o3 B L(tlF oo(l) €o o! o0 o FoO C) o Cda() lidg U)o g oQ -+t o.r I -oldtFI {J tr o E oI o .E =tr J E E o o 1N o\ o o'l hd c -o0) f& too O o o. o E o ca oo N cnON trl t- ca C) C) oso N o q o)N oN @ o@ N @d (o @(filr) (o (o(o o ro t- c.i Ir 0q c,to (r) l.r) q(o to o o) lr,@ oo, @ (n@ ol c, (0 $ O (nca N oo @ ca ia6 \f, oo oo r-- r- t\o oo N oo c.l oo $ r- r,-r- ?a + co rn o{ (\lin(\l tr) c- @ \o co(n trl o\N6 ol oo Oo\ oo N \o ra) o\O co $$ ooN+ olv t.-N o\(a \o t rr}rt \o rat \o oo\o \o €\ ra €N c..l o.lN \o ca t+ca ia \o +$ .+ c.t ootal r-. r- ra$ o\ coN (.l N €(.)(.1 o.l Ora) ra)\o oO ra)@ o\ ra No\ O\o @oo ttr- (a \o€ iat o\ t--\o (r) oo \o oo t--(n o{ ia6\o 6 o\(\l \o r-\o ,.r? tr} \o t-- q N t- rr) C.l \o r=N caN tr) ia O € (\I o\ \o to\ r= .f, ca r- ca aa co ca + r- o 6 at o\ O $ rn+ (.}N !f, r-.o\ s +co raiaN \oN rn \o co Nca (.) O C.I $ ca C\l c.l \o+ cata ia\o o troo(, q) H A 6l o Er E a rd riI az &(J tro -qoF Cd Cg (ll O cl ca op otro 14 t A C, op(, cl oH E (a ri riI & f-l & o -oL Clla oa oA o o. o F oa() .o o CJ o o. G,q) !(, o -o!o > ot'i E (n &V z dI c, o L<oEko a tr o F (d o (u x GI oL. GIo cl otr E a -1 H otr Comment on: - Attendance offemale members of the community at health education meetings - In general, how do you rate the participation offemale 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 problemfor the project? If yes, how k it addressed? - Other issues In general the female members of the community attendance at health education meetings is high were there is adequate facilitation by the health Workers. There are no local norms in the Project area which prevent females from attending meetings. Females are not shy to make contributions when issues are being discussed. Only those front line health workers did not make adequate plans to have all segments of the community in health education sessions. On CDD incentives, communities have scored quite low on that. Many communities did not provide incentives either in cash or kind. Some communities complained that distribution took place during what they called hunger period, therefore could not offer much to CDDs during such periods. Others who provided incentives said they gave CDDs cash of 5LD per household, one cup of rice per household, clearing their farms, exemption from community labour. CDD attrition is a problem in the Project. High numbers of CDDs abandons their communities either due to relocation to the urban areas or due to dissatisfaction from lack of support from community during the treatment round. Where communities have not appointed new CDDs, Health workers requested the help of some other CDDs to fill the gap by distributing to those communities without CDDs until the affected communities would appoint new CDDs. This approach has also led to over loading of CDDs. CDD attrition is highest in Sinoe County where young people are involved in mining business and Mectizan distribution is considered to them as a distraction. To address CDD attrition in a sustainable way, efforts are being made to implement effective HSAM to empower communities in the selection and encouragement of community members with a means of livelihood to serve as CDDs. Also women are being encouraged to play more prominent role in the distribution of Mectizan in their communities. t4 WHO/APOC, 24 November 2003 co ON Lo -o o o z$ci Or o > o (n U' o (I,t EH @ o o ro O)o(o ${ @6ts Nrl C\l NN \tN @N (oc! t-c\l loN \lN @ $N oN F ,ts(,o-ta) lot* lolo @to !tr- (oN Nt lo @ ]roFzo lot* @ro (r)ro oN NN o (o s o N N |.- @ i-aE ; "gE O c.r ko o|r) o,o(r) v$ @N$ N\t N NN $N @N (oN t-N lON o o ot GO o;.FY N o o o o o (oN oi'N o o o o .!- &6 o o o o $ rl o o o o o o o =o96 o o o o o, o) o o o o o o bbe I .o-c o O?- -;iEtE 9,F(J o o o o (r)N e)N o o o o o o o F-o EEooFI @o o o o o r^.- 1.- Eu o o o o $ o!f o o o o o Es o o o o (f) .i' bE LCL -tsE E EE EHE Ptko o o o o F I.- N (r, o E&ooFI $o o o o o o o o o o o o o o Eu o o o o !t t o o o o o o o iu o o o o @ (o o o o o o o o e.tlE b *'Ell.= r EfiE2,6'o 9-to o o o o o o o o o o o o o o L o i5 tr =oo fEv oz G o E o =tr) L o € oo c ! o F E oo a -9 (It o G' d) E oF tt o ]U oz o e oF = (l, , tr) c o L o o.Y o(UEoo - c of =fe oF oooEq,? o -o c, Jo q > !L t\ o t s q) Fj q) F O(rr o U) o o tr(.) Lr .olli C) d cc)OE(otr 6sp (l).= =dtrJ= s€CLd (tid O-0Qa =dOE o;r\ G)vao bs HO oe >.2a-LTFEOE(J otr :YO b0H 9;BboQ. t; c()dLL6)eEC)L!(o rso"o o.= boE8. =d/ooH o.r o* OQ)q -ao -oOJJ . .E€ aoEe 3P .:tr E.Eoo-6 I-ehEo'a .E o. -c)o=>; oE AE 8j>0) ->!eo(n- od doc) o=EStrt(l) d; o).= cEqrP oE: s.= E "o.9 3u aOLJ o'€ -oE^<a; q){ rEollEs'its u\ 3N'is 8Srs s\$e';E .33 :& EE,sq)$b 'S .!4 EB ltf :\-u :\ l! 3s >q)\'1\)G ss\B sS -\)tt s!)\0a €\- S:- .si \t(s{ -b6vi €u .{: [$T+\itsE.j EE *E -!) $sla :Sf.sSr9FaEa\U(!' !J ": ll\* .s*saSubs S:e sE$E *t !i.ESSSr! sisbFt +ES tr, tr 1' - a- =o +,tt o IEct! o alo aN oN o\ o c.l h e -o(.) tl. c.lo (J 11 A > N @ oN o o o o \o bO o s -o o\ o L t s o B bo\ s \ o t o; aE ! Bt\ tg =+ o o o o o otr -9lt o rt(o loN Nlt,N lo (f) o, o o o o aoa., o) to F- o@ o(, o(o (f)lO o)N c, oN o@ o o O) o@ oN oo(o NtN aY, o, F- No ro(o o, o o o o roar) o, t- F- @o oc., o@ oF- (or() @ t ot- o$ o(o or() o$ ot- oci'ci, tt oao a,, lo @ oI'- o o o o o o @o) (f, oro ot- oo, oo \t orO o!!t olr) o$ o$ olO oFN o)oi- s(f) rr)N Nl(, N lo(r) o, o o o o loat(n rot- o@ olo o(o (oro o)N @ oN o@ o o o) o@ oN oo(o Nt C9 o o o o O o o o o (o o o o o O (Y' (Y) (f) !t CO $ @ ro!t o o o o o o o o o N o o o o o N CO (f) $ N $ i. @(r) o o o o o o o o o o o o o o o o o o O @N o o o o o o o o o (o o o o o o c't (f) c.) \r N s 1.- rtro o @ t (oN o o o o (Y)N o (f) (Y) (f) (r) Ci,N o o $ v o lr) c)\t t o ro o rO (f)(\l o o o o c)N t- (f) (o (f) (f) o(\l F. @ (r) (o @ $ c.,(t roo) o o, o o o o o o (f) o o o o o o (o N N o NN (o c{ i- (f)N o o o o (,,N F- (f) (O (f) @ o o .t $ o rr) ci,t c, o o o l() o o o o ta, N (o (o (f) (,)N (o c.) t- (f, (r) s t- loro o o o to o o o o to o (f) (o (o N (o (f) t- (f) N s @t o o o o o o o o o N o o o o o N o o o o o o, o o o r() o o o o l(, N (f) (f, (o (tN (o (o (f) (f) $ i- roro -9 't c oo o oc IL E oF .of U' oz E = Lq) e o - (u = GY cq) v o!oo ottq, -9 TL E o Il =o I UJo IIJ(, oz E,(9 c .9EoF (I, I to c oNG -oo o3 oc oY J(L E oF I|Jo ITJ IJJ(J u tu t o -oL o U) o CL J o(L o CIcotr o o. o!oEo oo(E 0, -o(9 o .cl!o 3 E oF D o E o t,E!o E o G lJ- o -o Eod) .o G oo Table 6: Type of training undertaken Qick the boxes where specific troining was caruied out during the reporting period) - Any other comments The Project plans to place more emphasis on data collection and recording to improve on the quality of data in the next treatment round Trainees Type of training CDDs Other Community members e.g. Community supervisors Health Workers (frontline health facilities) & OICs MOH staff or Other Political Leaders Others(specifu) Program management How to conduct Health education Management SAEs of CSM SHM Data collection Data analysis Report writing Others (speciff) t7 WHO/APOC, 24 November 2003 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 is fluctuating, state the reasons and the plans being made to remedy this. Some of the factors identified for low treatment coverage's in the Project area include; o Inadequate drug supply to counties: Drug supplies have not been based on actual census o Number of CDDs too few to cover the target population o Enumeration of communities is either not done or is poorly completed in most communities before treatment . Lack of local funds from County to support supervision and monitoring of CDTI activities in the community o Poor timing of CDTI activities, when treatment is carried out during the rainy season , supervision is always difficult Plans have been made in 2009 to undertake the following measures to ensure improved coverage of 100% geographical coverage and 80% therapeutic coverage according to JAF recommendation. o Planning of CDTI implementation in 2009 has taken into account the window period January to March and November to December to implement CDTI in view of the difficult terrain of the Project area. . Communities will be empowered to decide the period of distribution to reduce the high number of absentees due to inadequate planning of distribution schedules. o Integrated supervision and monitoring with checklist by Community health Department will be intensified o Community would be empowered to select more CDDs o Health Education will be intensifies using IEC materials o Community supervisors such as teachers will be indentified and trained in especially in Sinoe County where there is shortage of health staff. o advocacy to policy makers at all levels will be intensified for logistic support for supervision and health education o Partnership with NGOs and Government agencies will be improved upon l8 WHO/APOC, 03 February 2009 o\oo cl h d -o() tL O O o o. \J Jr > !;$gt-'g o o o o o o o o o o o o ErE< =ozE o o o o o o o o o o o o bg bsIttrco =o2fr lo @ @oN (f, N (f,(f) ot* (o N (o @ C!o rr) rO(olo N ;;+-E Eei-g F-N lr) vv (o(f) NN oi-\t $ v@ NO) t- @ os !t c o s Jo o o- oo I lf,o o I @o o 'Eo =cDo(!^ *bsi:>vooEOF s o, @ s @@ sir @ s O) s o, @ s @ @ s F- @ s(O lr) s(ot- s o,t- so @ s(Y) @ oi* E uE" IC (o o, @ @ l() o)t-$ $o rr)(o @(f, r.() @ lo (f, @ @ o(o(9o rO (o(o o, N @$ ooo rr) Nr-t- v t- @Nlo c)$ CE (o o _Ee(Uo.= =5!l €Ea= @o @(o Nl()o l.r) t.i.-(f) l'*o(o(o t- N o, t(,t(,!t tO o,(o o, o) F-(f, N s o) rr) N(f) rr) N @@ rr, O) rr) (f) |r) oEE * $ tet. g, l() lotr @@ rr)lr, t*$$lO oNi.- (f)t-N N tool'- l(, cf)NN @o @N (o rr) rr)- @ @so @ (,(o(o @ O)N CO o oglg o o .E =E E oo to E .9oE E') cL!!^FE:sfle- o soo soo soo soo soo soo soo soo soo soo soo soo G)o tE o s E=g* =E 5 !z6 o oN $ (, NN @$ ar)4., $ @ tN o N (o No ?o(Eo.= =EEEH.q oc\t $ (o NN @tt F'(v) t @ tN o N @ o iE $eBE* $ != EaEH o c.l * ca c-.1 c..l \o$ F'a., \f, @ \f,N N \o It o o E = oo DtY oz d(9 E GJ trl o .cIL oo c -c EF E GI .a -g oE (E ct E o a .ct =U' UJ o =o =oL oF = (E J ct co E o o.Y o G!, o(u - c of =fb c,F o o.ooo -) o\ JZtn 3< (d U)(d(I) L(d (€ o r-l o t< U) E >' .o .t) E] U) Cd (l) tr d(l)lrF r-l olrl -otdtFI o\O Ntd e -ooIL c.)O L,/ o o > r- O)(f) oo(o @ o, o, @ o c., o @ o O) s(f,t- s(o o) NN o)N N o\ c.l o -o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o t o) o) o)(o N O)s G' (ot @ F*lo $Irt- o, t@ (o ro to @ @ t@ a.,N o o,(o ro o @tt tN(oro(o o (o oo @ @lo oot- @ \t @ N ro F. 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Ordering, storage and delivery of lvermectin '/ Mectizan@ ordered/applied for by - Qtlease ttck the appropriate answer) MOH UNICEF tr Other (please specify) Mectizan@ delivered by - (please tick the MOH wHo wHo! 'iate answer) UNICEF N NGDO tr NGDO tr Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities The required Mectizan stock for the year is calculated and ordered by NOTF based on the target populations of the respective counties, Districts and communities. The order is sent to the Mectizan Donation Program. When Mectizan arrives in the country, World Health Organization (WHO) clears it and sends it to the National Drug Services (NDS) through NOTF for storage. Each project county receives according to the initial request and stores it at the health facility for onward delivery to the communities by the OICs and CDDs respectively. 25 WHO/APOC, 24 Novemb er 2004 District/tGA Number of Mectizan tables Requested Received Used Lost Wasted Expired Remaini GRAND KRU Buah 16199 t5122 L4730 99 0 0 303 Dorbor 13576 tto29 10768 106 0 0 155 Trehn 50776 30300 29694 L42 0 0 440 Jroah 50543 42306 t4260 80 0 0 242 Barclayville 20151 14579 4L456 168 0 0 752 Sub-Total t5tz45 113336 110908 59s 0 0 1892 SINOE Tarsu 10,000 6,500 5,258 0 7 0 1235 Butaw 10,000 5,600 3,753 0 78 0 2769 Kpanyan 20,000 15,900 L3,76L 0 tL7 0 1865 Jaedae 10,000 5,500 2,9L6 0 16 0 2427 Taryuwuon 28,000 18,700 14,580 0 116 0 40t2 Jedepo 18,000 10,500 8504 0 8 0 Dugbe 30,000 2t,100 15,990 0 45 0 Gblonee 11,600 6,2O0 4,348 0 22 0 2100 Greenville 42,OOO 30,500 23,599 0 168 0 52L2 Pyne 15,000 9,300 5,126 0 2t 0 1822 Sub Total 194,000 103,355 99,935 0 598 0 28252 MARYTAND Harper 150980 105350 87202 331 0 0 17818 Bambo/Farjah 20626 18000 10140 159 0 0 770L Karluway #1 25932 21360 15435 0 0 0 4925 Karluway #2 40295 38000 31855 60 0 0 5085 Pleebo/Sodoken 130236 111,300 88s03 576 0 0 2222t Barrobo/Whojah 50000 43,000 31139 2t 0 0 11840 Sub Total 418059 337010 265274 tL47 0 0 70589 GRAND GEDEH Tchien 25,000 23,705 15,394 86 0 0 Cavalla 54,400 54,000 48,833 433 0 0 B'Hai 22,o00 2L,200 20,452 7L4 0 0 693 Konobo 40,000 30,670 26,144 100 0 0 4426 Putu Gboa 37,500 37,046 34,150 101 0 0 3364 60,000 57,250 40,702 224 0 0 16,294 Sub Total 238,900 223,87L 185,575 1558 0 0 33,130 RIVER GEE Sarbo L9,097 19097 L7,2L9 78 0 0 1800 Potupo 23,000 23,000 22,661 129 0 0 2L0 Tienpo 12,000 12,000 11,836 64 0 0 100 Chedepo L8,620 18,620 t8,248 72 0 0 300 Gbeapo 26,000 26,000 24,7LO 101 0 0 1159 Webbo 23,000 23,000 22,L70 85 0 0 745 Sub Total t2,-,7L7 L2,-,7t7 t16,844 s29 0 0 43L4 Total 1,123,931 899,299 778,636 3,929 s98 0 L38,t77 Table 10: Mectizan@ Inventory (Please add more rows if necessary) 1839 4977 3,619 4,734 26 WHO/APOC, 24 November 2004 How are the remaining ivermectin tablets collected and where are they kept? The remaining Ivermectin tablets are collected from the communities by CHTs and transferred to MOH and after verification it is delivered to National Drug Service. List and brieJly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. The County Health Teams are responsible for collecting ivermectin supplies from the National Drug store with approval of request from NOTF secretariat. The officer in-charge for each health District take delivery of the ivermectin tablets for health clinics under its catchment The Responsible health worker then this distributes the tablets allocated to the clinic to communities under the supervision of the clinic. The CDDs are in turn expected to make their returns of treatment data and remaining tablets to the health clinic at the end of the treatment round. 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? No Community self monitoring would be introduced in the Project in 2009 Table 11: Community self-monitoring and Stakeholders Meeting (Add rows if needed) a a a District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSNI) No of Communities that conducted stakeholders meeting (SHIO 27 WHO/APOC, 03 February 2009 TOTAL Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle 2.9. Superuision 2.9.1. Provide aJlow chart of supervision hierarchy. Central Level . NOTF o NOCP Countv Level o Counry Health Officer (CHO) o County Health Teams (CHT) o CounU Onchocerciasis Supervisor (COS) 28 WHO/APOC, 03 February 2009 District Level . Health Center Medical Officer o Clinic Nurse Community Level Community leader /town chief CDDs 2.9.2. Main issues identiJied during supervision? CDDs complain of community not providing incentives Some CDDs refused to distribute Mectizan after training. Treatment not being carried out in some communities 2.9.3. Was a supervision checklist used? Checklists were not used by CHTs, only NOTF used checklist during monitoring 2.9.4. What were the outcomes at each level of CDTI implementation supervision? At the community level, community leaders are sensitized to the roles, while CDDs are corrective measures are taken Most identified issues were solved 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 giving verbally or in writing explaining investigation and final results. 2.9.6. How was thefeedback used to improve the overall performance of the project? In the case of the CDDs complain that monies meant for them was withheld by CHOs, they clearly understood after the interventions by central administration that such was not the situation, rather that the community is responsible for their incentive and they accordingly went back to work. a o a 29 WHO/APOC, 03 February 2009 SECTION 3: Support to CDTI 3.7. Equipment Table l2: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:currently non-functional but repairable, WO=Written off). How does the project intend to maintain and replace existing equipment and other materials? The Project is advocating to county administration to include CDTI activities such as equipment maintenance in the annual budget and provide the funds for the activities 3.2. Financial contributions of the partners and communities Table I3: Financial contributions by all partners for the last three years Source Type of equipment APOC MOH DISTzuCT/ LGA NGDO Others No. Condition No. Condition No. Condition No. Conditron No. Condrtion 1. Vehicle 2 F 2. Motor cycle(s) 23 F 3. Computer(s) 4. Printer(s) 5. Photocopier (s) 1 F 6. Fax Machine(s) 7. Others a) writing board 1 F b) c) Contributor Year I ('provide the period') 2006 Year 2 ('provide the oeriod') Year 3 ('provide the period') TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) MOH (Central + Provincial/State) MOH (District/LGA) Local NGDO(s) ( if any) NGDO partner(s) 29,050 9,148 10,040 4,000 ? 8,358 Others a) b) 30 WHO/APOC, 03 February 2009 Communities APOC Trust Fund 122,569 84,994 95,699 74,639 58,490 33,285.78 TOTAL If there are problems with release of counterpart funds, how were they addressed? Additionol comments There are problems with release of counterpart funds during the period under review. No specific funds have been allocated for CDTI, at the County level except some support for motorcycle fueling during supervision. The CHT has been advocating but nothing has changed. 3.3, Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) Community contribution is in form of cash and kind to CDDs during distribution. In some communities they decided on payment of 5 LD per house hold, in others the house holds gave a cup of rice, while other communities cooked for CDDs. But the Project has not quantified the contributions made by communities. 3,4. Expenditure per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here 1 US$: 50LD Table 14: Indicate how much the project spent for each activity listed below during the reporting period Activity Expenditure ($ us) Source(s) of fundins Drug delivery from NOTF HQ area to central collection point of community 5,000 500 4,495 10,905 MOH Mobilization and health education of communities APOC Training of CDDs APOC Training of health staff at all levels APOC Production & Airing of CDTI Messages t247 SSI Project review and Planning meeting 6154 SSI Supervising CDDs and distribution Internal monitoring of CDTI activities 1887.s0 SST Advocacy visits to health and political authorities I ,000 MOH IEC materials 5,r19.40 APOC Summary (reporting) forms for treatment 500 MOH Vehicles/ Motorcycles/ bicycles maintenance/fuel 6,225.38 APOC 31 WHO/APOC, 03 February 2009 Office Equipment (e.g computers, printers etc) 350 APOC Others 5,70 I APOC TOTAL 49074.28 Total number of persons treated 310,972 Any comments or explanations? 32 WHO/APOC, 03 February 2009 aSECTION 4: Sustainability of CDTI 4.7. lnterna$ independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of thefollowing which are applicable) _Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Intemal Monitoring by NOTF Other Evaluation by other partners 4.1.2. lAhil were the recommendations? The NOTF conducted a participatory monitoring of CDTI during the treatment round, and two counties Grand Gedeh and River Gee were selected among other counties in the country Major recommendations of the NOTF monitoring: To counties . County Authorities should provide frrnds for integrated planning, supervision of health prograrnmes at community level . The National Oncho Programme should facilitate training of health staff at District level in Lofa and Nimba . Training on record keeping, reporting and inventory of ivermectin should be carried out for CDTI supervisors in all counties . County authorities should ensure that all health Staff are trained on CDTI . Counties should empower communities to select more CDDs based on a ratio of 2CDDs:100 persons . County teams should ensure 100% geographic coverage and > 80% therapeutic coverage MOH & SW Timely procurement of Mectizan tablets and distibution to collection points by communities Review the policy on Basic health Package to include Onchocerciasis Control and Primary Eye care Request support for Special Country Initiative, replacement of logistic and technology from APOC and take urgent steps to build capacity at all levels in all counties especially Lofa and Nimba on CDTI concept and promote corlmunity ownership and sustainability Facilitate timely release of all funds (MoH&SW, APOC) to enhance effective coordination of implementation of CDTI Support planning and review meetings, agree on work plans for the subsequent year with counties and ensure similar meetings are held at all levels a o a 33 WHO/APOC, 03 February 2009 t To WHO and Partner o Support high powered advocacy to MOH & SW to fund CDTI activities at all levels o Advocate to MOH & SW to review policy on Basic Health Package to include CDTI and primary eye care o Provide support for special country initiative to support capacity building for effective integration of health prograrnmes and supportive supervision o Replace logistics and technology support to NOTF secretariat and counties and NOTF sub-committees identified by it i.e. development of IEC materials based on KAP, operational research 4.1.3. How have they been implemented? The Report was shared with the Counties at the Southeast Project Review meeting. Based on the gaps identified in the Monitoring report County 2009 plan of action addressed some of the issues raised in the report based on their context. 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 plan written? NO Whenwas the sustainability plan submitted? Nil What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels NOTF Facilited the Project for a participatory review and planning meeting involving members of the County Administration, CHT and District health workers at the end of the treatment round . The two day meeting facilitated the Project to review its activities for 2008, and agree based on the projects strengths and weaknesses the direction for 2009. The meeting enabled the counties for the first time to develop plans for implementing CDTI in the next treatment round with budgets and sources of funding. 4.2.2. Funds Advocacy meetings with county authorities to provide funds for CDTI activities 4.2.3 Transport (replacementandmaintenance) Advocacy for integrated use and maintenance of logistics and equipments 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented Not much has been achieved 4,3, lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms Ivermectin delivery is through the health system drug delivery channels 34 WHO/APOC, 03 February 2009 I4.3.2. Training Training of all health Staff on CDTI and co-implementation with other health prograrnmes is being planned for next treatment round in the Project 4.3.3. Joint supervision and monitoring with other programs The Members of the Community Health Department of the County Health Team carry out integrated supervision. In River Gee and Grand Kru for instance there is full integration in supervision from County down to community level. Efforts would be made in 2009 to improve in other counties. 4.3.4. Release offunds for project activities Funding is grossly inadequate at the moment 4.3.5. Is CDTI included in the PHC budgetz In the Basic packages of health policy of the MOHSW, Onchocerciasis- ivermectin drug distribution is not spelt out like malaria, HIV/AIDS, Polio/EPI immunization etc . So when it comes to funding it is not given priority like other diseases components 4.3.6. Describe other health programmes that are using the CDTI structure und how this was achieved. lilhat have been the achievements? In the Project area, Polio campaign and Malaria bed net distribution are benefitting from using CDDs in the community. Also the Community registration is serving as good data base on population less than 5years and pregnant women required by other Programmes 4.3.7. Describe others issues considered in the integration of CDTI. Dffirent policies regarding incentives at the community is not helping integrotion. 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. No research has been carried out in the Project area 4.4.2, How were the results applied in the project? SECTION 5: Strengths, weaknesses, challenges, and opportunities Strengths of South East CDTI Project '/ High level of dedication of Health Personnel '/ Involvement of community leaders in CDTI Challenges ./ Difficult terrain - hard to reach communities '/ Non release of funds from County authorities for supervision and health education{ l} 35 WHO/APOC, 03 February 2009 Weaknesses { Communities not empowered to play their expected role in CDTI ,/ Inadequate enumeration or census update ,/ Low involvement of women as CDDs ,/ Poor recording and reporting skills at all levels ,/ Inadequate planning of distribution/over reliance on NOTF secretariat to initiate activities SECTION 6: Unique features of the project/other matters The South East Project terrain is rugged and covered with forest. The counties are traversed by numerous rivers and tributaries. The roads are unpaved and tavelling in the project area is anl,thing between nine hours to twenty four hours in the dry season. During the rainy season, only four wheel drive and heavy duty trucks can access difficult to reach areas. Other modes of transport are canoes, motorbikes and by foot. There are two well marked seasons, the dry season running from January -May and the rainy season running from June - December. Inaccessible roads and far flung communities, remains a major problem a 36 WHO/APOC, 03 February 2009