Southwest CDTI annual project technical report submitted to Technical Consultative Committee (TCC): from January 2006 to December 2006

RESERVED FOR PROJECT LOGO/IIEADING ORIGINAL : English ANNUAL PROJECT TECHNICAL REPORT i SUBMITTED TO i TECHNICAL CONSULTATIVE COMMITTEE (TCC) i I +o *v, lcc fsArtev " Btu coP *+tF 3?0 t"o R ; ..' l: ,}j I+rDEADLINE FOR SUBMTSSION: To APOC Management by 31 January for March TCC meetinJ To APOC Management by 31 Julv for September TCC meeting BA l A*yr1td t1.@h],i , ? I I I I AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) t I JIIIL 2007 I COUNTRY/NOTF:LIBERIA Proiect Nanqe: SOUTHWEST CDTI PROJECT Approval year: 2004 Launqlrtugyeatz 2004 Reportinq Period: From: Janua ry 2006 To: December 2006 Prqiect_vqar oll this report: (circleone)(1) 2 3 4 5 6 7 8 9 10 Date submitted: July 19,2007 NGDO partner: SSI WHO/APOC, 24 November 2004 ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE, (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country LIBEzuA National Coordinator Name: Henry T. Salifu Signature Date Zonal Oncho Coordinator Name Signature Date NGDO Representative Name: Verda Tarpeh Signature Date This report has been prepared by Name : Henry T. Salifu Designation : APOC Signature Date ll WHO/APOC, 24 November 2004 EXECUTIVE SUMMARY 2 SECTION 1: BACKGROUND INFORMATION....... ......................3 1. GeNpRer-rNFoRMATroN............. 1.1.1 Desuiption of the project (briefly) 1.1.2. Partnership 2. Popu1erroN............... SECTION 2: IMPLEMENTATION OF CDTI....... .......8 J)J 5 6 2.5. Capacrrv BUTLDTNG l4 2.6. TRperupurs.............. .....17 2.6.1. Treatmentfigures.......... ........... 17 2.6.2 What are the causes of absenteeism? .......... ................. 20 2.6.3 What are the reasons for refusals?................ ............... 202.6.4 Briefly describe all known and verified serious adverse events (SAEs) that ... 20 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year22 2.7. OnoeRmc, sroRAGE AND DELTvERv oF IVERMECTIN ...........23 2.8. Covvuqrry sELF-MoNrroRrNG aNo SrerpHoLDERS MperrNIc ............25 2.9. SuppRvrsroN ............... ......................26 2.9.1 . Provide a flow chart of supervision hierarchy. ............ 262.9.2. What were the main issues identified during supervision? .............................. 27 2.9.3. Was a supervision checklist used? .............27 2.9.4. What were the outcomes at each level of CDTI implementotion supervision? 27 2.9.5. Was feedback given to the person or groups supervised?................................ 272.9.6. How was the feedback used to improve the overall performance of the project? 27 SECTION 3: SUPPORT TO CDTI ..............27 2.t. 2.2. 2.3. 2.4. 3.1. ).2. J.J. 3.4. Ttver-me oF ACTTvITIES .8 Aovocacv ..................... 10 MosILIzaTIoN, SENSITIZATIoN AND HEALTH EDUCATION OF AT RISK COMMUNITIES 1O CovvuNrry INVoLVEMENT......... .....12 EqurrveNr... 27 28FngaNcml coNTRIBUTIoNS oF THE pARTNERS AND coMMLTNITIES Oruen FoRMS oF coMMUNrry suppoRT ............. ExpBNorruRE PER ACTrvrrY .28 .28 SECTION 4: SUSTAINABILITY OF CDTI....... ..........29 4.1. INrenual; INDEIENDENT IARTICIpAToRy MoNrroRrNc; EvaluerroN.......... ..........29 4.1.1 Was Monitoring/evaluation catied out during the reporting period? (tick any of thefollowingwhich are applicable)............ ........ ..29 4.1.2. What were the recommendations? ............. 29 4.1.3. How have they been implemented? ............. . . .. . . .. ..29 4.2. SusrarNasrlrry oF rRoJECTS: eLAN AND sET TARGETS (MANDAToRv AT................30 ll1 WHO/APOC, 24 November 2004 Yn 3)... 4.2.1, 4.2.2 4.2.3 4.2.4 4.2.5 4.3. INrEcnartoN............ 4.3.1. Ivermectin delivery mechanisms 4.3.2. Training.... iil,","i,;,; ;ii,: ;';;;;; t;;;i;''' Funds....... Tronsport (replacement and maintenance) . . .. Other resources To what extent has the plan been implemented 30 30 30 30 30 30 30 30 30 4.3.3. Joint supervision ond monitoring with other progroms........... ...... 30 4.3.4. Release offunds for project activities ........ 30 4.3.5. Is CDTI included in the PHC budget? ............ ............. 30 4.3.6. Describe other health programmes that are using the CDTI structure and how this wos achieved. What have been the achievements?............. .................... 30 4.3.7. Describe others issues considered in the integration of CDTI. ..... 30 4.4. Oppna,TroNAL RESEARCH 30 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project areo within the reporting period. ........ 30 4.4.2. How were the results applied in the project?.... ........... 30 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES .....31 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........31 1V WHO/APOC, 24 November 2004 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG WHO African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Govemmental Organ izatton 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, 24 November 2004 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 84Yo of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expectld 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 government. (ix) Communit), self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. vl WHO/APOC, 24 November 2004 a 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 24 (Please add more rows if necessary) 1 Number of Recommendation in lhe Reporl TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY I That the Southwest CDTI Project Technical Report 2006 be resubmitted to next TCC meeting with all necessary corrections The Southwest CDTI project was carefully scrutinized and all necessary corrections made WHO/APOC, 24 November 2004 Executive Summary Prepare an Executive summary of the report in not more than W.poge. Background on treatment and population data - Total communities, communilies' treated, total population, UTG, ATO and persons treated. 2. Background on population movements. 3. Training data - CDDS, health workers, Total population (community) per CDD trqined. 4. Challenges and how they were overcome. Total communities in the Southwest CDTI project area is 1,486 with a total population of 395,505 persons in the mesoftryper areas. A total number of 308,130 persons were treated given 78o/o therapeutic coverage. The ultimate treatment goal (UTG) and the annual treatment objective (ATO) are 332,224 and257,078 respectively. Population movement in this part of the country was very frequent during the reporting period. With relative peace in the country, many people returned home and settled months before treatment was carried out. The four project counties, Grand Bassa, Cape Mount, Bomi, and Margibi are the closest to the capital city, Monrovia, where people sought refuge during the civil war. The training of health staff and CDDs was carried out on County, District and Community levels. A total number of 4,512 CDDs (male 2,219 and female 2,293) were trained. There are 288 health staff in the project area and 123 health staff were trained and involved in CDTI implementation activities. The major challenge of the Southwest project area is the frequent turn over of trained staff and CDDs abandonment of assigned areas. One of the four project counties, Cape Mount is a bordering county that links Liberia with neighboring Sierra Leone through the Mano River Bridge. Numerous economic transactions in terms of goods and services occur daily between the two countries. Our health staff and especially the CDDs with no fixed wages usually leave to seek other jobs for their livelihood. Nonetheless, NOTF management intensified the training of more health staff and doubled the number of trained CDDs to ensure increased coverage as is evidentby 78% therapeutic coverage. 2 WHO/APOC, 24 November 2004 I SECTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) - Geographical location, topography, climate - Population: octivities, cultures, language - Communication systems (roads...) - Administrqtionstructure - Health system & health care delivery (provide the number ofhealth posts/centers in the project area if the information is available). - Number of health staff in project areq and number of health staff involved in CDTI activities. The Southwest CDTI project area is located in the rain forest with mangrove vegetation zones. The terrain is mostly flat, particularly in the coastal plains and rolls up gently through the plateau and mountain ranges. The counties of the project area have some major rivers such as the St. Paul, St. John, Lofa and Farmington rivers. Their tributaries are good breeding sites for the black flies, the vector of Onchocerciasis. The climate is tropical and humid all year round with variations between the dry season which begins in October and ends in April. The rainy season begins in May and ends in September. Farming season begins in March and harvest starts in October. The crops cultivated include cassava, rice, sugar cane,) palm oil and rubber. Most roads in this area are unpaved, thus causing difficulty in movement during the rainy season. Traveling to some of the counties takes almost a day due to difficult terrain. Four wheel drive cars are mostly used to travel from county to county. In some areas motorcycles are used to travel where there are no motor roads. The project area is ethnically heterogonous with the Kpelle ethnic group found in every county. The major ethnic groups in the project areas are, Bassa, in Grand Bassa County, Kpelle in Margibi, Vai in Cape Mount, and Gola in Bomi County. The total population in the Southwest project area is 395,505 people with 288 health staff located in l12 health facilities, while 123 trained health staff is involved in CDTI activities J WHO/APOC, 24 November 2004 COUNTY/DISTR!CT Number of health staff involved in CDTI activities Total Number of health staff in the entire project area B1 GRAND BASSA COUNTY Buchanan 35 Number 1 7 Number 2 7 Number 3A 5 Number 38 0 Number 3C 11 Number 4 3 Campwood 0 Owensgrove 5 Subtotal 73 BOMI COUNTY Tubmanburg 75 Dewoin 6 Klay 16 Suehn/Mecca 12 Subtotal 34 CAPE MOUNT COUNTY Gola-Konneh 6 Porkpa 7 Ganruular 13 Tewor 13 Subtotal 39 MARGIBI COUNTY Kakata 75 Firestone 65 Gibi 2 Subtotal 142 Grand total 288 123 58% Table 1: Number of health staff involved in CDTI (Please add more rows if necessary) Number of health B2 Percentage staff involved in CDTI B3=B2lB1.100% 8 5 6 3 0 10 1 23o/o 71o/o 860/o 60% 0o/o 91o/o 33o/o 0o/o 40% 48% 10 13o/o 2 33o/o 15 94% 10 83o/o 27 79% 5 83o/o 5 71% 12 92% 11 85% 33 85% 18 24o/o I 14% 1 50o/o 28 20% 0 2 35 4 WHO/APOC, 24 November 2004 1.1.2. Partnership Indicate the partners involved in proiect implementation at all levels [MOH, NGDOs (national/international), c ommunities, local organizations, etc.J Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, super-rision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, if any, to mobilize the state/region/district/LcA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The Community The community leaders select CDDs for training in preparation for Mectizan distribution and sensitize the population on the importance of taking Mectizan. The CDDs, also part of the community, mobilize, sensitize and distribute Mectizan to their respective communities. The communities take ownership of the CDTI activities and pay CDDs incentives in kind or cash to distribute Mectizan. Community members and CDDs report side effects due to Mectizan and members with poor vision are referred to health centers for eventual follow-up by appropriate health authorities. Ministry of Health The Ministry of Health (MOH) and NOTF at all levels do the planning advocacy, mobilization, sensitization, and supervision of CDTI activities. At the end of treatment year, NOTF prepares all technical reports to be sent to APOC. NGDO During this reporting period, our lead NGDO, Sight Savers International (SSI), and Christian Health Association of Liberia (CHAL), all participated actively in the planning, advocacy and supervision of CDTI and Eye care activities in the country. The Mectizan Donation Foundation supplied the needed quantity of Mectizan requested and on time. 5 WHO/APOC, 24 November 2004 $ O c.l Lo E a) o z$(\ O o o \o o o -g ct o o. 6 o!)o Afit = altFLEarF 'r=E fEL o o)s Or- @ o)oN s (o @ o- o) o) @N- N sttt\(o N(f)t- lr) Nr s_ cf) N r rot-@ co (\l C') G) -f(0 _ E., EEEE @!o ro NN r o- lr) (f, O)I\ o r o(f)(o- v @No @ \fN @(o N(oo s o)(o CO (o s o lI:) @-(o lo sfi 5$ Hs cf)(o(o $r f- roN co (o Nr F- No @ o, o(o @ ro (o @ ro NN f-_ N o)@ lr)f- ry(r) CD^ ro \f ,.9c !- cE5s Is |.r) o) @ l'* $ rr)\ r ot-(o- (r) @N@ s @(o r N @ (f) @_ o .if (o_ r o ro @(f)(rr- o(o +(\l .E o c) E'g 't o o '= E tr oo o (, ll E z N I(Y:' i t.gE >E 9#! rr L PEE R oo E t- No) @@ t-(o NO) t\ No o@ rCO !+ C"(0 E* tEg* (o$ o(o @|r, |r)$ f-(o sfro @(o NN $ sgH:gs= roN N(f) o(r) NN roN r\r $cf) O)N o) (Y:' NN -o(EbE E EE Eg P -ee.E oPge.= a @ ro r() niN o to (f) O)f-- o o (f)(o_ s @No @ .tr N@(o N(oo s o)(r) (f) (o s 6tf,(o d o e o o zf oo oa o> OFzz<ftrooo c(E c o -c.of(n L c) _o Efz c{ L o) -o E :Jz (r) L o -o E :lz m(f) L o -o Ef,z O(a L o -o Ef,z s L o _o Efz ooo =o_ E(tr o c) oL o) @c o Bo E o .ct a zf oo =oo Ei l-iop. bo ! q olr C) o0 k o L<o ! c) Cd 0)tr C)Lr cd >) C) ! 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Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe dfficulties/constraints beingfaced and suggestions on how to improve advocacy. In the Southwest CDTI project for the reporting period, advocacy was especially intensified in Cape Mount County (541 communities) with a high tumover of CDDs. At county level, a two-day CDTI management meeting with the local chiefs reiterated among other things, the role of local chiefs in the selection of CDDs for training and community provision of incentives to ensure that the project retain the CDDs. The retention of the CDDS has not been easy especially when the community falls short of their expectation in terms of incentives provision in cash or kind. However, as the project is only in its first year, NOTF management intends to do more advocacies at all levels before the next round of treatment. 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 Re s p ons e of tar get c ommuniti e s /vi I lage s Accomplishments Suggest ways to improve mobilization and sensitization of the target communities. Channels of communication in mobilization, sensitization and health education of at risk communities are many and varied. In the Southwest project area, communication is through the traditional authority structure, i.e. From paramount chiefs to clan chiefs, then to town chiefs, quarter chiefs and finally family heads. In the Southwest, there are numerous active community association andlor grouping in almost all communities. Women organizations, youth groups, birth cohorts, poro society and sande society for male and female respectively are also common. These organizations are active in initiating developmental projects and safeguarding traditional norms and practices. Most target communities respond and react positively to sensitization and mobilization although it is sometimes difficult to bring all individuals to a common cause. During the reporting period under review, we achieved a therapeutic coverage of 7\Yo partly due to successfu I mobilization. I0 * ,l'l WHO/APOC, 24 November 2004 cnO ol !o .o o o z$ c.l E o N 9,, E E; Eo.E !=sse E o o cn LG r-)qD{lo E+J Z= E o o sf- ss s(a sO) ss s.t sl.r) sO) s(o sNlo rO s (f) (o s (f) rO l- N o)a) @oE*omFil o) m 9o9O @tso mfo E" E EE E-Z8:6.=g8 o.= rCo5 -cIE l=g 2-S (o o) ro f-oN os roN rr)@ Nf- lo Cf) o,Ns CO @ (\tt\ @ rOf- @CO rr)CO rr)N @ roN o(f) oN lolf) ro(9 rNlr) O) cf, rOo oo r.-(o f-s rr)o O)o r @N N(Y) SP(E= =u i..L(o t ,{m oEB o o .9,t o U' o c, oL E,EEDF(!6 ic.>- trhba z=tr =oEOO-oE .; s rO ss sN sCO sN ss scf) s s(o sNt+ s N N N cf) (f) N oa) N No) @@ l-(o NO) N No o@ CA t o)(o Fo e.Fa 6 Fzf oo oo o> OFzz<ftooo C oC(u -Co J m o -o E =z N o -o Efz (f) o -o E =z m cf) o -o E =z O(f) o -o Efz s q) -o Efz E o o = o- E oo o ot- o) U,c o =o E o .ct o -:. s U;q) u a) q > o\ q)\ o t ! q)q 5 F O C) o A. o !(t P. a C) U rt o.r I -ol(gt FI fl E o E o a: o .E # Ef E E o(J q N $ N Lo -o o o z .f, c\l O o o ca s(Y) @ s o)s so)(o so so scf) ss srot s @ soN s @lr)sN sf- solr) f- O) o @C\t (Y)N lo o ro oN @r @ o(o lf) ro cf) N 1()o!+ =. 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'Evh\a? -'"a = FUFHA -s x cuv: dir sF.SN' Ei U S E E HgI\Sca!9!S: SF'T ^-t" -.: EN:s t v-so '<boFo s > tr^i: E:F?s s cs.1' .o$ ^. ef (lr\ u .r G .q; d s- ^S O'P !6 = E 38AN\HL eu-9-3E h 8.e}E ?.rHHS E s EPS ESt3r g8 =-N*^ :58IU S 4zzSq,S gzir:iS$ EEEEN'J I= =i SS EE;\^,.\L€-cI i\ I cs'-3I: t b.E .osi 5tss .x v \ '- ^ 4N\LVH s!A-*du:d sgH\ss s H;SB*ctr()o.l .ELAA-.-d S^.SJJ c \'!. -c:Y-b3S E-S'E h %+.r .=o-? .gs i gEqS S.q.r - d ).B R> F..s4=\Xr.:A-.5i:s PEE$Et 9gT ,L.= $ 5'" r\ -L\!,\€ ^, V L J L H S I$ ? H gE$L+^0-) fE!v^I 9 ! L I * U, q) q) ! L a): a. \) .a q) bn\-q) l *Y q) .a ! $:.,t q) a) 'al-U4q)\ I do (c o c6 U)(.)(r) c/) o ch o0 C) -o(.) Lr(d a(.) rr') rt) F () C) ti (h bo () od a-.tr.d !() ';r bC()b1 tibo= -oCtr ! .r-d! F o.lxP(.)x U) H() =P-.jj A _C . <) ?) b' = t'l (-) UAG)-= (! -E+iE0) -d^.cBEi-o.,odv0) -(trit E ^*,>, -o) .: er Li a.rEts H€ =-vt..tr ! o.l.OdvakF.r- 9 roit-H o 9r ,d a.l o.l 'i ei =I E ^.9 X! !v .t v *v *9 f r a.'O!1"NYtld9t X E otr q.A H.E;isao"E;i Lr;J OliF-O(tr ^)aa1 -^o 95.o,y.', E 3'eE; .uEtj=oI B c >oE 9': gL) !HA.@o ^o *t= o) .. O+'- (r (J -ECCSEC.)-i,oirihX>!:v: dIF.dfi !iH.\!!Lb U 9"'E b'-r I :€wL.\9*L!JV!U\1r9Xtr-/^ H - - *H \ v o(-)rrrrr trl Et-! I l-f! # II(, t!c G(, alr, IN c.) ON o -o o o z$N {o (r) t,otr (E oooo o L o)Il E z ta, o +(r+!E? @ o (o o)lr) NoN os (o N lr)@ Nt- lo (f) o,N (o @ (\ N(o o ooN !roo-E,O @(e F.o o(o $rc, o(o Ns o(o F-$ @ (n N(D |r)(o o(r) B.c25 (r)N oo o@ F- roc\t o(.) roi.- N@ lf)(o (.,tF- lr)t- o|r) Oo Eo oo@ olr)N Nlr) ro F- ro oo (f) o tr) N o(o N oo(.) No(o(\ o ro olr) (f) o +(u0Ef N o lr, t s N N N F.N (o ,!0r-to N (o N N $ o o o t (f) o !o26 (f) N o (.) a., N €t E' Ef * o (uzoE .: o)o o F r.- ro @ (f) (f) $ N N N tt lo @ N(.)E3ooFI @o (f) N o N (\ ro (.) 1\o(l,d N N o o o @ (.) N (o o Boz o o o o o $ c\t E=E*t ro o o F t- N (f) ro sl CO N $ tI.) lr)(r) o o (., oE&o(JFil to @ N t- $ (o @ N @ (\ato N o) (t ootr @ t N (c) N (O $ Lr) (0(9 (o 6to 3oz (.) N o N N N (t) (l, (t) *{ooo !U s J.! €€S;;E6' o o O) @ (f) o) () F- @ (f) o N(l, (o N oJDo .9o 2fi'<urftr<ooqlo E(o c(otof d] o) -o E =z N o -o E =z (f) o -o E z @ C.) o) -o Efz o(.) c) -o Efz $ q) -o Efz ro oo = o- E(E O o o olo c o3o E o ttJo F -z =foooo o l -oc G E -ofF c 6 =oo qq q) (.) q) \- 4: o\ q) r. ! t q) F; !q) 5 cld C) oq F oUqi o a C) (.) () Lr .0) q-j (.) (B bo (€ liF ..iir o-rl -ol(Bt FI $OO c..l Lo -o Eo o z$N U o tu o \o hO o s .a o\ o p s p B 5 o a b0 -E a * o .\ t p\ qt € + B B o Bt :- z ; o N loo sl N rot st-(o @lo 00t\ @ @ tr) O) @O) oN F ro F- o (9 lo @ ro o$ (') N rfN o) oo 1(,(\lf)N (,st N o (?)o oo (ot oo$ (f) @ Nttl @|f) o@ lr) O) o t c) o N t 00 F.@ @st N o N rooN (\ @ o N (oo(.) t N lr) (7) (\$ c) o tr) CO lr) N oo (f) o C') Not\ @ c o E o .9 o s (o @ () lr) lr) rl) o(\l tI.) ro N N tot- si-v N $ c.) N t (f, @ otN .+ C') (.) N (f) ol N t ro(Y) c.{t N @ (f) N ot @ o) lf) N(9 @lo tr o E G' .g .tr(., ss $ (f) |f) c{ @lo sNt(f) @ |f) st \f lo @ o) (r) (t N t o{ N (f) (o roaa) N N (o F'NN N ol N (l, N $ ol\t o, f.- @ o, (tc) o) (o F- N6t o)G' o Eo .9 -co s N ro(\ F- N f.- F- coc{ O) o ro +N o)N ss{t- $ (0 (o |r) s $ C') @ F. !t O) oC'I (., o, N (., (.) o) c.j ro (nc) @ ro\t N o @ O) o,G' () o co (vtF) o)l\ o Eo .9E(,) ;e (E ooo =ct o) =U) E o Il =(t, Fzf 9r wZLf <ooo E o)c cov -go(, (5ofl o o- (E f E(E(, o; o)F E o lt o E> _FOzE,)<o =o (! (! J(sY oco th o .= LL _b(, E o I!fo t o E' fi, (9 E* EE'>trooEgo0) <o- o N F. o)(, t-lr)$ N tr, () () (o (f, N N |r) N lr) o Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% 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. Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(speci$,) OICs Program management ! { ^/ How to conduct Health education { { { Management of SAEs { ^/ CSM SHM Data collection { ./ { { Data analysis { ^/ { Report writing ^/ { ^/ Others (specifu) 17 WHO/APOC, 24 November 2003 tO c'l Lo .o (.) o zsN O o P oF g ;*gE-= # o o o o o o o o o o o o o 9o{J s 1!lE O<AU'z o o o o o o o o o o o o o oES Eo6)oz-o (! rtt @ O) $t- o t. oN o N(, st(\ $F- (f)N (f) F.CO t.nES* 5 s H,3 :"[EE=E (r) lr) f.- st (f) F.s N(o @ tr)N N(f) t-r-N f.-$ o @ ro(o oo rr I- :-oo t-o No aoo r.l o oEOJE'OG E9oo -coF i* EE!"[g tso(E (l).= = Et r u!-F(J Fg-ai s(fJ @ s(o @ s (f)(o s o) s$ @ s$N so@ sN@ s(o O) s c{ @ s f.- @ ssF. solr) s F- F- soN- @ N @ $ F. tr) f.-. @ o o) c{ (", O) sfN-(o @t- <)_() t- ro N (f, \t @lif st_ <f o)o(o ni(o o) o,o ro F-(, (') (o @(o ro @-(o (.)(o(o- $ F-() N(.) ro o l'- o ro. o) @ N. rO @ (f) s- sf o sl(o_ N o o, @ O) o)_ N @ c{ @- o)t rto N @ 6I F- O) N v O)N lr) f.- F- lo @lf) tr)_ N N o- lr) CO o,N o o(o(o. t @N o_ @ $N @- @ N(o o- s o)(.) (f) @_ rf @lo(0- (ot- N(o- N (f) F. tr)$ (f) tr)tt $@ @ co rto aoo (\ o o G .9 or -c E'o-!!^get 83(, =Ev..= rr- €:$f;5 E'rtszd ?oE 6.2 =EtE H.O'.< q)-oEo $ r, E:e ".58 E; EgE E :P EE 5gE n -cctr v eo o.:o soo soo soo soo soo soo soo soo soo soo soo soo soo soo N N o) @@ N(o No) N No o@ (f) \t cn @ (o t N o) F- N o, @ @ f.-(o No) N c!o o@ (o $ot(o (o $ N o) t- NO) @@ t-(o No) N No o@ (o tC')(o (o !+ N o) oJ o .9o EzD oo oo o oz E, o c oE GEo =co o -o E z N q) -o Efz o q) Efz o(.) c) -o E =z o (f) o .ct E =z sl o -o E5z Eoo 3 o. E(5 o o o o)oc o) 3o i6 o Il U' Fz f, oo =o(D E,) JIl c G E -o F .E o; o)o o Y (o oo o) =cE of U) oo !qq a)U a) k_ 4 > \ q) L. -d s q) 4Bq) 5 .v U) l< d a C)H Fl o r< rn >) -o a rI] U) (d ! C) doL3 r*f orl -oldtFI c) .f, O N !() -o o o z 'f,N o - o F(t s @ lo N o\ oF d oL(! o C) 'd L o. o ct) (.)Ld o E 0) o IL o o. oao E (.) ^, 6) -l oxlf 9l o-r3la!l IC)l a al q=ol (,()l Loloql ! ?I E ol c .ol _ l-l (! =l ozt? (d oL(n Io(.) 'a <tXo!o) 99()-C).= 'AA LV Hz(-) rYl = t/. d -c J-r € I>o)? t- ao= L .=()cE - (!) FA5.qo.: oi ) LVt !0) ol =! *l Htr vl O() '-l c)J. TI .,C) ;l .-o- (dItrh 91 6 * !t aA alc otd ol (J olol 0) oQ.r ol *l tr Sl 6 -l o-,rl ; =l * :l.iHl '- >l -c Xl i)I, OO Xit -> yt c)31.= :El E 315!1.- cl H EIQt- -t F I6.)t =tr ot= -t - HtL -t Lol= =l H o.toQI.: FI; RIEH+s 51 3 .H+ H9lJHl-HlYol o. ol tr ol-rl O ul f rl'ol o- 6)l c 0)l= ,ol .ol - -ol :trl 'cd trl <s trl= =l 'o =l o =l trzl? zl- zl< O o C) - -oo\ o cdL o 9p :v/^6S></ o(.) oF C) (sL C) oodL C) o o/: t<bo o(.) 0.) cdL 0) bo () oo O,^ 'E rolo\d- o. L C) 9J o CIl- o ,t Gt-b (, (6 o P () c l- C.s+ u f @ C'! (o o) \l bo(! v I Cl *i a- sq) 00 \){t u a) .q U a) (a- \=Ss 60i B\ .ss s!Id!.f \ s€\^ st' .EE E's ss s$ €bllt s !\l .-8 $.$g s\ a. Sqr\ '=sl\ =.ro 'i:' a $SE tXS !r: .::ci s:s tR .: yis $st *;s s.sqr >\{ ;E n rys' sI E \u! s< - 9{\-s 3I 'i os E E$\ RSb :'; AJ 6ES Els :r: is \ t\S :V(3 S'\ s k\E d\s sl u qri{SrF\ H\' il ll Es 9tt\ !.:\ ac or, (ot(\ N soo @ o, G o Il o o o o oo o o o o o o o o oo o o o o o @ F @!t o co (.)N (\rf, $(f) (o(f) (f)o oN os N(9 rot- (o(.) lr)N (o(f) to) @$l(o s()t- s o) F- s(o N s(o F. s F-F s F-|'.- s @ F. sN F- sFt- s@ F o) O) o lf) O)t- @ F. @ o)_ (f, N t$ ro co N t\ F'. o) N @ @ o F- $lr) c? O)\t (o F- s_ N o)ot\- N(r) oF' doG' (o (t) -' t ro o)N. (, -t-N €i- o-t\lI) N $$N N tr) N tr) lo (?) o)(.) oN N s- tN tNto. i-F (t)o o_ o(o t-() ro- t- (f) tt(t- C,) (f) (f)_ N o, N @ N. (f)(o NN(.) Fi Nir C,)-(\t N loolod C')F' o) N|f)-(o N r+ @@ oN $ F,- (f)- (o soo soo soo soo soo soo soo soo soo soo (f, (t) $$ Ntr) N t ro o) @t @ 1.)lo (o c,t (f) (f) s$ Nlr) N t ro o, (os @ u,lo (o @t @$ It)lo @ @\t^ (o(9 $$ Nro N tro O) @ Ez f oo Fzf o =ul o- o =o)c c oY o o(, 6 o-v o 0- (E =E(E o o =c)F E o .ct .o Ez oo o 6d = (E 6Y(,Y oco a o) .= IL 5(, E o E' o E o Ecg(, 2.6.2 Whut sre the couses of absenteeism? The cause of absenteeism in the Southwest project area is due to high rate of border crossing of the target population into Sierra Leone for economic transaction. Many of these people never return home on time for the annual treatment. 2.6.3 Whut are the reasons for refusals? In the Southwest CDTI project area, there were 628 refusals. There are multiple causes for these refusals, outstanding among being the gross misunderstanding of the word refusal by the OICs and CDDs. According to records, anyone that resides in the mesolhyper target population that did not show up to receive his/her tablets after mobilization was registered as refused and this is totally wrong. This was observed during our routine monitoring and supervision visits. There were however others who refused because of mild reactions like headaches, itching temporary swelling of legs experienced by others. NOTF intends to intensiff TOT training and advocacy before the next round of treatment 2.6.4 Briefly describe all known and veriJied serious sdverse events (SAEs) that occurued during the reporting period and provide (in table 8) the required information w h en available. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report 20 WHO/APOC, 24 November 2004 wO(\ (.) -o (.) o z d c..l O o o. o N q) ! q) v T\q) t q Iqq q) U$) \_ q + \ r. t q) a) 5 o L< 0) bo li oq ofr (.) bo lr .o !oLrLr oo o E (/) rl] (n C' 0) C)() a H() E a t<(.) ch +r o ao cr)(c U #r()l -ol cdlFI 0) o99 _caEaz h 4 c2 L - oooX'].8 P cEoi, O:Jrxc E] oo o o,l .9 EAo- .9 So(Jo. 0)#exqiX aS ^ 6.= (.)()-c tr _.r dN(Hi;()-O qE Ct o c cJ eLL'rd40oA E.Jr,.g ,.9Et --b A H -H,.S cd € - 9 ep.EG E,9.: !?#sEt: o o. a -EH L():+() !6aG .N*gE; a> = o oboc N.- =oo20 x 0)a C) o0 * U) $o N L C) .o () z$N U Or o q () N CN Ut\ o \.1 \) .s r.) { \) V) \ a.r 13 \,) \){ t\ a.)s a.) \.) a) U) B A)F F-ooN oooN tt ooN COooN (oooN roooN NooN ooN @ooN O) O) O) @ o) o, t\ o, O) tr IJJ s(o o, o E') P 5sD B-o soN oo * LrJ @ IIJ 6' cn .r (E^tr bs oo lto ul s@t- oo *(0 uJ @ uJ oEO =E)o t!^3bsi: >-oo -ga I o) IIJ E* EE E'[g @]U o cr) @o(f) @t- o_ t-- r() N Eo(! (l,,= =E6c cl .l "86 UJ EE=-iE* (0lrJ lr)o rO- tr) o,(.) tr o s o or soo oo t(\ UJ (v) UJ o E"6 (E^tr bs o o il rD IIJ oo I IIJ c, IIJ E .9o -tr E)o-!E^F 6S E,B -6o o il$ IJJ soo (o @tt tE.^ EE sEt;s E = EE!z6 o (9 lrJ Eo; 6.= =EEiEs 6t lIJ (o @s o o E,l s 5 oo .E :, E E o o =$ iE*E 9 SI EE;EE8 E5 IJJ (o @ .if o oN o,ooN t' \ \,) G.qJ \) * \\ UqJL(.\Bs\)U} q, t!{ riP SlFus+ .: Nrrs!.: Iq)\p|\El\. a,6ri \ TY\sl:*lsil stl .g >l *rulU$qloo rBs\qrY dsTS \S USTE\)4S\o .. c.i ql$l "al st sO C.J Ho -o 0) o z tN O cnN g.tsB :X|,]()(J)(JtP6d EALo)E?a .''1 .=(/) E.= PH 02?o ESfA . A 906 ' \1.! oU,IE! qEe5 utAO|a H E TAHPol-{ -o s >ulr L\ .rcd'= o E E e,U E!Ytr*aEC9(J ss !5 iE;eF; g.tsOE Y - -z <J O. o)tF-qE ^'^q d; Bq E!i=()trt s SE(r6;OC) -P\J '!r U) I4PdcEo -r.-P s {i* c cd >F I =.n^ a)FV.io a26N c-cE; s sE d r.H9;3.q€ ahZ.^. e 0() tA h € qQ"Y ,5 E E.E - aA -}l-()C)(-) tr o .cSa s's- zg'g*Stu ooPi*XXi6)EEC€ZHEx EE!= .=.ija -i A cd c)rsz bY'.= c.t ts e 8€r ,Li H (1F2.YE V1 a) oU q) Ua Si) oo : \)r.ql\L o .*i @ N u .q)\ : \) "o\.U4U\ a)q 9q) Q., ,^' qh o 0)q .r) C) V) () o. Ho o tr z n tu rc 9 z D tr =a q): q q) \ a-o'\\ \) *t U \)q q) F\S I >' 'a' q) r.p s)\ @ $N \ ,E" oo C) 0)(h(t oq l.ro o n z tr t=HU z tr ta q) > .s3 lIF{o:oxE'FTs.OPi$OprIo.si\lr S)\bos!* !sJElGi' o\oat! \'\a)Ostr A-o.$$!EX' t \@)oE N rjH c,i x Table 10: Mectizan@ Inventory (Please add more rows if necessary) GRAND BASSA COUNTY Requested Received Used Lost Wasted Expired Remaining Buchanan 58,000 58,000 57,980 20 0 0 0 Number 1 14,000 14,000 13,895 72 0 33 0 Number 2 22,100 22,100 21,980 120 0 0 0 Number 3A 41,000 41,000 40,975 22 0 3 0 Number 3B 24,300 24,300 24,275 25 0 0 0 Number 3C 1 8,1 50 1 8,1 50 18,070 80 0 0 0 Number 4 10,600 10,600 10,585 15 0 0 0 Campwood 1,000 1,000 980 15 0 5 0 Owensqrove 15,209 15,209 15,209 0 0 0 0 Subtotal 204,359 204,359 203,949 369 0 41 0 BOMI COUNTY Tubmanburg 23,000 23,000 22,980 20 0 0 0 Dewoin 10,000 10,000 9,980 20 0 0 0 Klay 1 ,100 1 ,100 1,058 15 0 27 0 Suehn/[t/ecca 14,000 14,000 13,975 25 0 0 0 Subtotal 48,100 48,100 47,993 80 0 27 0 CAPE MOUNT COUNTY Gola-Konneh 67,000 67,000 66,690 32 0 278 0 Porkpa 60,000 60,000 59,890 46 0 64 0 Ganruular 75,800 75,800 75,390 40 0 370 0 Tewor 89,600 89,600 89,575 0 0 25 0 Subtotal 292,400 292,400 291,545 118 0 737 0 MARGIBI COUNTY Kakata 118,1 00 118,100 1 18,005 0 0 95 0 Firestone 58,800 58,800 58,790 10 0 0 0 Gibi 38,500 38,500 38460 40 0 0 0 Subtotal 215,400 215,400 215255 50 0 95 0 Grand total 760,259 760,259 758,742 617 0 900 0 Percentage 100% 100% 0% 0 0% 0 24 WHO/APOC, 24 November 2004 How are the remaining lvermectin tablets collected and where are they kept? List and briefly describe the activities under lvermectin delivery thot are being carried out by health care personnel in the project area. Any other comments 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, Wen? Table I t; Community self-monitoring and Stakeholders Meeting (Add rows if needed) District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) 25 WHO/APOC, 24 November 2004 TOTAL Describe how the results of the community self- monitoring and stakeholders meetings have fficted project implement(ttion or how they would be utilized during the next treatment cycle 2.9, Supervision 2.9.1. Provide a flow chort of supervision hierarchy. Central Level o NOTF o NGDO County Level o County Medical Officer (CHO) o County Onchocerciasis Supervisor (COS) o County Health Teams (CHT) District Level o Health Center Medical Officer o Clinic Nurse Communitv Level o CDDs o Community Members 26 WHO/APOC, 24 November 2004 2.9.2. What were the main issues identified during supervision? Main issues identified during supervision Lack offinancial motivation of CDDs by their communities CDDs registrar not properly recorded Highfigures recording of Mectizan refusals 2.9.3. Was a sapervision checklist used? A supervision checklist was used 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Identified problems were rectified or referred to appropriate authorities 2,9.5. Was feedback given to the person or groups supervised? Feedback was given to the persons supervised verbally on the spot. Issues that needed discussion were reserved to be taken to appraiser meetings. 2.9.6. How was the feedback used to improve the overall performance of the proiect? Communities reacted positively and concerned issues were corrected thereby increasing therapeutic coverage slightly. SECTION 3: Support to CDTI 3.1. 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). Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condition No Condition No. Condrtion No Condrtron No Condrtron 1. Vehicle 1 wo 2. Motor cycle(s) J F 3. Computer(s) 1 F 4. Printer(s) 5. Photocopier (s) I F 6. Fax Machine(s) 7. Others a)Generator I F b)Bicycles J F c) 27 WHO/APOC, 24 November 2004 How does the project intend to maintain and replace existing equipment qnd other materials? Budget allocation has been made for the maintenance and repair of the equipment and other materials, however, negotiation is going on with the Government of Liberia (GOL) through the Chairman of the NOTFfor the replacement of existing equipment and other materials. 3.2. Financial contributions of the partners and communities Table I3: Financial contributions by all partners for the last three years If there are problems with release of counterpart funds, how were they addressed? Additional comments 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) 3.4. Expendilure per activity Indicate in table 14, the amount expended during the reporting period for each activity listed. l|/rite the amount expended in US dollars using the curuent United Nations exchange rate to local currency. Indicate exchange rate used here -1 US$ :50L$ Table l4: Indicate how much the project spentfor each activity listed below during the reporting period Contributor Year I ('provide the period') 2006 Year 2 ('provide the period') Year3 ('provide the penod') 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 * ProvincialiState) 84,934 2,102 MOH (District/LGA) Local NGDO(s) ( if any) NGDO partner(s) 17,295 5,1 40 Others a) b) Communities APOC Trust Fund 56,164 54,994 TOTAL 158,393 62,236 28 WHO/APOC, 24 November 2004 Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of communl Mobilization and health education of communities :I?s!e of CDDs Training of health staff at all levels Supervising CDDs and distribution Inte-rnal mo{to:Lrlg of CDTI activities _$y g c_qcy- y_i s its to he al th. ?l4p_o_l itical authorities IEC materials Summary (fep-q4ing) fory-nt for treatm_ent ___ Y q}.,_iq l_. r/ yo to rcy_c1 e s/ _b ! q_y_. l. t m ai l te n anc e Office Equipment (e.g computers, printers etc) Others 300 10,556 20,206 3,750 3,151 1 4 50 ,675 950 13,073 MOH_ APOC APOC, NGDO APOC APOC,MOH,NGDO MOH APOC,MOH,NGDO APOC APOC, MOH TOTAL 56,811 Total number of persons treated 308,130 Any comments or explanations? SECTION 4: Sustainability of CDTI 4.1. Internal; independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) _Year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? 29 WHO/APOC, 24 November 2004 4,2. $ustainability of projectst plan and set targets (mandalory at Yr 3) Was the project evaluated during the reporting peri'od? N Was a sustainability plan written? _ When was the sustainability plan submitted? Wat arrangements have been made to sustain CDTI after APOC funding ceoses in terms of: 4.2.1. Planning at all relevant levels 4.2.2. Funds 4.2.3 Transport (replacement and maintenance) 4.2.4, Other resources 4.2.5. To what extent has tlte plan been implemented 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. 4.3.2. 4.3.3. 4.3.4. 4.3.5. Ivermectin delivery mechanisms Training Joint supervision ond monitoring with other programs Release offunds for project uctivities Is CDTI included in the PHC budget? 4.3.6. Describe other heslth programmes that are using the CDTI structare and how this was achieved. What have been the achievements? 4.3.7. Describe others issues considered in the integration of CDTI. 4.4. Operational research 4.4.1. Summarize in not more than one holf of a poge the operational reseorch undertaken in the project area within tlte reporting period. 4.4.2. How were the results applied in the project? 30 WHO/APOC, 24 November 2004 SECTIOI{ 5: Strengths, wealcnesses, challenges, and opportunities List the strengths and weaknesses of CDTI implementation process. List the challenges and indicate how they were addressed. Streneths The project recorded improved therapeutic coverage inyear 2 Government is paying it share of the Oncho budget Many people are anxious to take the Mectizan tablets. Weaknesses Community support for CDDs is low Insufficient funding from government Project vehicle needs replacement Challenees Late starting of Mectizan distribution in project areas Data collection and improper recording of figures Misunderstanding between the words (refusal) and being absent SECTION 6: Uniquefeqtures of the project/other matters With the formulation of National Policies and Plans for the control of Neglected Tropical Diseases Q.{TDs), the present co-implementation of the CDTI activities along the National Eye Care Program is a positive giant step towards the integration of activities, thereby encouraging partners to support co-implementation and flexible use of funds and resources to empower communities in the health care delivery. It is our hope that when integration among the various health activities is complete, coverage of interventions will significantly improve. 31 WHO/APOC, 24 November 2004