Southeast CDTI project technical report submitted to Technical Consultative Committee (TCC): January 2012 to December 2012

SOUTHEAST CDTI PROJECT, LIBERIA TECHNICAL REPORT 2012 ntds.liberia moh@yahoo.com ORIGINAL : Enelish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNTCAL CONSULTATTVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRTCAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) I I I I I I Proiect Name: Southeast CDTI ProjectCOUNTRY/NOTF: Liberia Launchinq vear: 2000Approval vear: 1999 From: January 2012 To: December 2012(Month/Year) ( Mo'!th4[e4)Reportins Period APOC fundinq vear: (circle one) 1 2 3 4 5 1045 11 1267(circle one)APOC Proiect impl 13 891011ntation vear report: 12 13 6789123 Date submitted: Partners: - Ministry of Health & Social Welfare - Sight Savers International - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - communities ANNUAL PROJECT TECHNICAL REPORT TO .|ECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: Liberia NTDs Program Director Name: K. Signature: Datel r*,t 8;'.{-At.1 Sightsavers Country Director Name: vtii. iaotLy sonii /,. / Signature : .L.Ld !.(frL**t* B$Ht"#fdHfs o o This Report has been prepared By Name: NOTF Liberia ! Designalion: NOTF Signature Date \r i a ll Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG WHO CHT orc NTERLIN CRC MAP COS CHDD CHO EPHS CNTD gCHV SS PCT CUSD MERCI IVIDA African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Comm unity-Based Organ ization Commun ity-Directed Distributor Community-Directed Treatment with lvermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organ ization Non-Governmental Organ ization 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 County Health Team Officer -in charge Med ical emergency relief international Cavalla rubber corporation Medical Assistance Program Cou nty Onchocerciasis supervisor Community Health department Director County Health officer Essential Packages of health services Center for Neglected Tropical Diseases General Community Health Volunteers SightSavers Preventive Chemotherapy Treatment community union for sustainable Development Medical Emergency Relief Cooperative International Mass Drug Administration Definitions (i) (i i) EIs Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). calculated as 84o/o of the total population in ( iii) meso/hyper-endemic communities in the project area. Annual Treatment Objective: (ATO): the estimated number of persons tiving in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given Year. Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached iull-geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'o year of the project). Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (iv) (v) (vi) Geographical coveraoe: number of communities treated in a given year over tne total number of meso/hyper-endemic communities as identified by REMO in the project arca (this should be expressed as a percentage). (vii) !nteqration: delivering additional health interventions (i.e. vitamin A suppternents, albend azole 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) Sustai bilitv: CDTI activities in an arca ate 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 mobilized by the community and the government. (ix) Commun itv self-monitorin (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 Program me is being executed in the waY intended. lt encourages the comm ivermectin distribution and make necessary. unity to take full responsibility of appropriate modifications when Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG WHO CHT orc MERLIN CRC TVIAP COS CHDD CHO EPHS CNTD gCHV SS PCT CUSD MERCI MDA African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Commun ity-Based Organization Commun ity-Directed Distributor Community-Directed Treatment with lvermectin Comm u n ity Self-ttlon itori ng 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 County Health Team Officer -in charge Med ical emergency relief international Cavalla rubber corporation Med ical Assistance Program County Onchocerciasis supervisor Community Health department Director County Health officer Essential Packages of health services Center for Neglected Tropical Diseases General Community Health Volunteers SightSavers Preventive Chemotherapy Treatment community union for sustainable Development Medical Emergency Relief Cooperative lnternational Mass Drug Administration Definitions (iv) ( ii) ii) (i) Total pooulation: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). Eliqible population: calculated as 84o/o of the total population in meso/hyper-endemic communities in the project area. Annual Treatment Objective: (ATO): the estimated number of persons tirlng in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given Year. Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'o year of the project)' (v) Therapeutic coveraoe: number of people treated in a given Year over the total population (this should be expressed as a percentage ) (vi) Geooraphical coverage: number of communities treated in a given year over tne total number of meso/hyper-endemic communities as identified by REMO in the project afea (this should be expressed as a percentage). (vii) lnteqration: delivering additional health interventions (i.e. vitamin A supptements, 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) Sustai bilitv: 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 seryice, with strong community ownership, using resources mobilized by the community and the government. (ix) Commun itv self-monitorin (CSM): The process by which the community is emPowe red 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. lt encourages the ivermectin distribution and necessary. community to take full responsibility of make appropriate modifications when A total of 1 58 Health clinic /health center staff and 3165 CDDs were trained in 2012 compared to221 health workers and 275 CDDs trained in2011. The challenges faced o Late arrival of IEC materials o tnadequate funding to take the messages to all nooks and crannies of the Project areas especially were radio reception could not reach. o Bad Road condition as MDA was carried out during the rainy season. SECTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate Population: activities, cultures, language Communication systems (roads... ) Ad m inistration structure Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). Number of health staff in project area and number of health staff involved in CDT! activities. The South East CDTI Project consists of five counties: Grand Gedeh, Maryland, River Gee, Sinoe and Grand Kru. The project was approved by APOC in 2002. The southeastern region is bounded by the Atlantic Ocean to the south, the Republic of Cote d' lvoire on the east, River-cess county on the west, and Nimba county on the north. The Region is situated within the Tropical Rain Forest Vegetation Belt of West Africa. Most of the area comprise of forest except a narrow strip along the coast in Sinoe, Grand Kru and Maryland counties where mangrove Vegetation alternate with coastal savannah. There are two seasons: the rainy and the dry season. The rainy season runs from April to October, and the dry season begins in October and ends in April. The average annual rainfall near the coast amounts to 4770 mm, towards the interior, the amount of rainfall decreases to an annual average of 2080 mm. Excessive rainfall comes during the months of June to September. The average number of rainy days during the rainy season is about twenty-two days in a month. Transportation in the South East is mostly by land on unpaved roads and water. Most of the roads in the region are in deplorable condition with very muddy and deep holes filled with wet mud and broken wooden bridges. This situation partially disrupts road access to CDTI target communities in most counties of the Project especially in the rainy season. Most of the people who live in the region engage in farming, fishing and hunting. Their main farm crops are rice, cassava and plantain. Partial treatment data was received from four out of five counties, with Sinoe yet to report as at the time of preparing this report. The reason being that Sinoe conducted training of CDDs and health workers late in the year due to logistic constraints. From partial data received out of 856 reported,627 communities were treated representing 96% geographical coverage. 309483 (63.9%) persons from a population of +ggAZO from the communities reported were treated with the exception of Sinoe where data is being expected. A total of 158 Health clinic /health center staff and 3165 CDDs were trained in 2012 845,414 tablets of Mectizan were distributed in the Project area during the 2012 treatment round excluding Sinoe County which report is still awaiting' There are a total of 1516 health staff in the Project area with) 160 (1 1%) involved in CDT!. Population of South East CDT! Proiect, Liberia from Census update by CDDs Table 1: Number of health staff involved in CDTI Counties Number of health staff involved in CDTI activities. Tota! Number of health staff in the entire project area Br Number of health staff involved in CDTI Bz Percentage Bs=Bzl Br *100 Grand Gedeh 415 28 7 Grand Kru 233 27 12 Maryland 324 32 10 River Gee 218 26 12 Sinoe 326 45 14 Total 1516 160 11o/o lndicate the partners involved in project implementation at all levels IM O H, Sighfsave rs, ( n ati o n a lli nte rn ati o n a l), co m m u n iti es, I o ca I organizations, etc.l Describe overall working retationship among pariners, clearly indicating specific areas of proiect activities (planning, superuision, advocacl, pianning, mobilization, etc) where all paftners are involved. Stafe ptini, if any, to mobilize the state/regionldistricuLcA decision- makeis, NGDO5, NGOs, CBOs, to assist in CDTI implementation. P2.1.1 a r t n e r S h i p Counties Population Grand Gedeh 93983 Grand Kru 62198 Maryland 136424 River Gee 75105 Sinoe 1 16160 Tota! 483870 A total of 158 Health clinic /health center staff and 3165 CDDs were trained in 2012 compared 1o221 health workers and 275 CDDs trained in2011. The challenges faced o Late arrival of IEC materials o lnadequate funding to take the messages to all nooks and crannies of the Project areas especially were radio reception could not reach. o Bad Road condition as MDA was carried out during the rainy season. SECTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate Population: activities, cultures, language Communication systems (roads... ) Administration structu re Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). Number of health staff in project area and number of health staff involved in CDTI activities. The South East CDTI Project consists of five counties: Grand Gedeh, Maryland, River Gee, Sinoe and Grand Kru. The project was approved by APOC in 2002. The southeastern region is bounded by the Atlantic Ocean to the south, the Republic of Cote d' lvoire on the east, River-cess county on the west, and Nimba county on the north. The Region is situated within the Tropical Rain Forest Vegetation Belt of West Africa. Most of the area comprise of forest except a narrow strip along the coast in Sinoe, Grand Kru and Maryland counties where mangrove Vegetation alternate with coastal savannah. There are two seasons: the rainy and the dry season. The rainy season runs from April to October, and the dry season begins in October and ends in April. The average annual rainfall near the coast amounts to 4770 mm, towards the interior, the amount of rainfall decreases to an annual average of 2080 mm. Excessive rainfall comes during the months of June to September. The average number of rainy days during the rainy season is about twenty-two days in a month. Transportation in the South East is mostly by land on unpaved roads and water. Most of the roads in the region are in deplorable condition with very muddy and deep holes filled with wet mud and broken wooden bridges. This situation partially disrupts road access to CDTI target communities in most counties of the Project especially in the rainy season. Most of the people who live in the region engage in farming, fishing and hunting. Their main farm crops are rice, cassava and plantain. Partial treatment data was received from four out of five counties, with Sinoe yet to report as at the time of preparing this report. The reason being that Sinoe conducted training of CDDs and health workers late in the year due to logistic constraints. From partial data received out of 856 reported,627 communities were treated representing 96% geographical coverage. 309483 (63.9%) persons from a population of +ggg7O fiom the communities reported were treated with the exception of Sinoe where data is being expected. A total of 158 Health clinic /health center staff and 3165 CDDs were trained in 2012 B41,414tablets of Mectizan were distributed in the Project area during the 2012 treatment round excluding Sinoe County which report is still awaiting. There are a total of 1516 health staff in the Project area with) 160 (1 1%) involved in CDTI. Population of South East CDTI Project, Liberia from Census update by CDDs Table 1: Number of health staff involved in CDTI Counties Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI Bz Percentage Bs=Bzl Br "100 Grand Gedeh 415 28 7 Grand Kru 233 27 12 Maryland 324 32 10 River Gee 218 26 12 Sinoe 326 45 14 Total 1516 160 11% lndicate the paftners involved in project implementation at all levels IM O H, S i g his ave rs, ( n ati o n al/i ntern ati o n al), co m m u n iti es, I oc a I organizations, etc.l Describe overall working relationship among partners, clgarly indicating specific areas of proiect activities (planning, superuision, advocacl, pianning, mobilizaiion, etc) where all partners are involved. Siate pins, if any, to mobilize the state/regionldistricULGA decision- makeis,IVGDOs, NGOs, CBOs, fo assisf in CDTI implementation. 1.1.2. P a f t n e r s h i p Counties Population Grand Gedeh 93983 Grand Kru 62198 Maryland 136424 River Gee 75105 Sinoe 1 16160 Total 483870 NTD Program at partnered with Monitoring and evaluation unit to carry out KAP studies of Onchocerciasis, Lymphatic filariasis, Schistosomiasis and Soil transmitted helminthes in the project. At County level all the County Health Teams partnered with Education Ministry and County authorities to carry out mobilization and health education. ln Maryland county health team collaborated with Cavalla Rubber Corporation and Maryland oil Palm Plantation to carry out mobilization the company's operational areas. ln River Gee, the County Health Team collaborated with international NGO known as Medical Emergency Relief Cooperative lnternational (MERCI) to transport Mectizan and Albendazole to the respective health facilities serving as collection points and also assisted in supervision during the MDA ln Grand Kru, the County Health Team collaborated with a health partner, Medical Emergency Relief lnternational (MERLIN) to transport Mectizan and Albendazole drugs the respective health facilities serving as collection points. Also a local NGO community union for sustainable Development (CUSD) assisted in the supervision during the MDA round under review. o 0) Io 0) E E Esj66L-3=co) =Eqr69 -l!.- =8.(/)*ft 'o)gE(s6 FS6Abo -!l-9)- -Lt'-CCLA 8E o= l-A#= EH. =o)J-uL .-P a= -)Xoit96 =o;Ecc Eb -CO.O EE -F:b o-C >'; .L0) L- )PI EoI tr>I EkN' cPE =oR 95I q,ll-lv ?Eo(E .s sE - N '6;. <Ldo->o rr -C -P > '6 ooa o,o J oo C) l- o o 0) ooo oo) oa * c\. o) o -o(o o) -o(o P o) = ,= (u (s ! o) .E o oo f oo C) .C ,a (s .C, =oz = oz =l lo o C\.!o L o o- o)CE oo o o) -c C,)C L)! o)C oE o o '6' o- o) l- L o a)aC oo (E a G = Ooo a' a. 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N (o (r) rr) (f) Noro ro(f) o)rO .El ol olgrl(! oo .E =E E o o o L oll E =z "e E6'E: G n d.=E =E g.E ooENO ol-6(a @s @ o, N(o sNs(o(o roo l() N o @ @ cf) @ o)(f) o, tr o E -. -.t E *iE $uF CL.= O EL G ooc6 J F oF .C o)E C)(, Ec(5(, fLY !c(5(, !c(5 b(o o) o o 0) ,=t oE -co -E'e"gl'- o9 -.P{ g E 5E9E SECTION 2: lmplementation of CDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. tr .9 .12 E oo =o EE cLo EEO-o6 oz oz oz oz o oo tr .tr k orb AE oo oo oo oo oz trl .el = .cI .2!, cn Lo Ero.cEE.9 6otro oz oz oz oz oC)o A- 'Ec SEa- oo oo oo C)o oz ol (E !,d f o otr oo Ero.cEE.9 6otro o-0)a o-oa o-0)(/) +t o- oa () o ED- .EE ke o- o oa o- o U) o oa o- o) CD o o E' .= tr (E F Ero.cEE.9 6otro o.C)a oq)a ooa o-oa ()o E' - ECH9 o- o oa o oa o- oa o o U) C) o oo -oo= .!fNtr EEgE Eso.cEE.9 6o=o o)) o)= o)) o)f f o- o CD ED- .EE (E: a- o) = o)) t,)) o)f o-oa fltr oo E o)! 0)(, lC C(U(, =Y EE(g(, Ec o e(u = o o(, o .zt o)oc6 N oN (I, o C EL)o o l- .tr E o (u o o(u o o o .C L o a .o = o(u o 0) .= q) E tr ait orl -ol(El FI 2.2. Advocacy Sfafe the number of policyldecision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficultieslconstraints being faced and suggesffons on how to improve advocacy. Advocacy meetings were held in all the five counties in the Project area ln Grand Kru County, a total of 135 policy/decision makers were reached. These include county superintendent and other functionaries, Religious leaders, partners and influential leaders. The meetings were held at county, district, and communities levels. In Grand Gedeh, the County Health Team conducted advocacy meetings at all levels of the health system (county, district and community levels). Participants in these meetings were town chiefs, district commissioners, youth leaders, head teachers, religious leaders, and health partners in the county. The theme of the meetings was community ownership of CDTI and support to their CDDS. ln Maryland, the county Health Team held meetings with the following decision makers at County level; Acting Superintendent, County Educational Officer, County Development Officer from Ministry of Planning, and Harper City Mayor. At District level, the team met with 6 District Commissioners, Paramount Chiefs, District Superintendent and District Education Officers. At the community level Health facility staff met with town chiefs, women and youth leaders. !n River Gee County six major Advocacy meetings were held in the County. A total of 72 policy makers that include Commissioners, town Chiefs and Elders were reached in 12 districts of the County. ln Sinoe advocacy meeting had a total of 25 policy makers including the Acting Superintendent, commissioners , paramount chiefs, head teachers, community chairpersons, lmam, Pastors, city mayors, county and districts education officers at the county level. The gender distribution is 20 male and 5 female. At the district level meeting, a total of 40 policy makers were in attendance. Those present at the meeting were town chiefs, School principals, traditional leaders, district educational officers, town criers, women leaders and pastors etc. The Topics of the advocacy meetings at district and community levels includes; o [Vlass distribution of Mectizan and the introduction Albendazole. o The Role of Stakeholders in making the distribution campaign successful . Communication strategy to be adopted based on communities specific situation. o Consideration for Motivation for CDDs to be provided by communities. The outcome of the meeting were positive in the sense that policy leaders at County and district levels agreed to take the lead in mobilization and dissemination of information on the diseases through commuity radio, town meetings, churches and mosques. The schools Principals promised to spread the health education messages 9 the various school and encourage students to take the message to the communities' The Pastors agreed to take the message to their congregation for onward dissemination at the community levels. The major challenge in terms of advocacy was not having adequate logistic support to enabll frontline health workers to reach most policy makers at commuity level especially in hard to reach areas. Z.l. Mobilization, sensitization and health education of at risk communities Provide information on : - The use of media and/or other local sysfems to dr.sseminate information - Mobitization and health education of communities including women and minorities - Response of target communitieslvillages - Accomplishments - Sugges t ways to improve mobilization and sens itization of the target communities. ln all the five Counties, CHT employed the use of the community radio for talk shows and announcement. The following local radio stations were used - smile FM in Zwedru, Grand Gedeh september to october 2012 - The Voice of Barrrobo FM station Maryland 2 weeks in September - Jam Radio Plebo, Maryland one month - September 2012 At the commuity level, town criers, schools and community meetings were used as channels for mobilization. Health workers carried out Mobilization and Health education with posters, hand bills and brochures during the Mectizan and Albendazole integrated MDA round. HSAM conducted in the Project area was instrumental to the high therapeutic coverage achieved in the Project area' The challenges faced o Late arrival of IEC materials o lnadequate funding to take the messages to all nooks and crannies of the Project areas especially were radio reception could not reach. o Bad Road condition as MDA was carried out during the rainy season. ln order to improve the quality of HSAM, adequate IEC materials should be provided and there is need to avoid MDA in the rainy season. Funds should be provided to improve the logistics of frontline health staff to reach more communities for HSAM. 2.4. Communityinvolvement Table 4: Communities participation in the CDTI Comment on: - Attendance of female members of the community at health education meetings - ln general, how do you rate the participation of female members of the community meetings when CDTIissues are being discusses (attendance, participation in the discussion etc). - lncentives provided by communities for the CDDs - Attition of CDDs. ls aftrition a problem for the project? lf yes, how is it addressed? - Other l'ssues Female participation in meetings and contribution to discussions has improved compared to previous years. The percentage of female CDDs had decreased from 54% in 2011 to 43o/o in 2012. ln Sinoe and Grand Gedeh more CDDs were supported by their respective communities compared to previous years, and in Sinoe communities agreed to provide feeding for the team of CDDs during lvermectin and Albendazole distribution exercise. However in Grand Kru the result was not so good because almost 75o/o of communities did not implement decisions on CDDs motivation during the last distribution round. County Number of commun ities/villages with community members as supelvisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communi ties in the entire proiect area B+ Number with communit v members as superviso rs Bs Percent age Bs= BJ Br *1 00 Male CDDs Bz Female CDDs B6 Total Bs= 87+Bs Number of communit ies with female CDDs Bro Percent age Brr= Bro/Bl*1 00 Grand Gedeh 163 74 45o/o 246 117 363 82 50o/o Grand Kru 143 95 65o/o 322 236 558 113 79o/o Maryland 220 103 47o/o 502 164 666 0 0 River Gee 122 77 630/o 434 117 551 84 69o/o Sinoe 208 0 0 0 0 0 0 0 Total 856 349 54o/o 1504 634 2138 279 33o/o Attrition of CDDs is high and health workers continuously have to sensitize communities to select new CDDs and find ways to motivate them. 2.5. Capacity building - Describe the adequacy of available knowledgeable manpower at all levels. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (Ihe mosf importantissue to descibe is what measures were taken to ensure adequate CDTI implementation where not enough knowtedgeable manpower was availabte or if staff is frequently transferred during the course of the camPaign). Health staffs are inadequate terms of number and skill in project atea. The use of teachers and personnelof other community based organizations are being used to implement MDA E o =(E L ooo o o olt E z Ett+,,, +l(.!t- P ootr if) o t o +oq iq) = oNs o)o(a o(o : O) cf, o)(o oN @ @oN Nr o rO r() o) o)$ o lr)r : (f) lr) 9 N(o lf)(o CO NO lr) l()(o (o rr) soo rF tr o E o .9E(, G' oio oN$ o(orO oN@ orr)r() rO@ lr)(o cf) E o .=o(EFtso r-FO-5ooo b.E L(EEiEO =z El+ +rNQ- F ooct o =o *d ,h q)t $ cf) |f) (o N eo N (9 N (f) N @ N soo tr o E o .g o(n oIo s tr) (f) cf) (f) Es rgQtoErrE e0lOO P.EbSE4g*tstr =o2c) E. &&o No (o o +oq =oz @ @ o @ : f- sN l- : l- N $ (o C\(f) rO : l- l-o rr)lr) slr) s tr o E o .9 -co oo - ro oio sN l- N(f) No o (9 J 9ooo o$ o: os boIt E =z E sao d (\ o q\ o)q = q) = (o f N rr) cf) N (o (f) co @ lr) o : (o s cf)(o N N soo +atr o E o .g o o oLF (o rO (o (o o (f)(a oJEo ,|2o E oEoo EC GL o ) Y EC(5 o EC Gi G = o) o)(, o t o)oC a J F oF c.) o) oo o a =o! o o Qo G e5 u) o r< G 5 o G o O) E o a-(/) o) oo o) o! o a. qt a G s$ o o q)B tq) E = q) =* c .o (5 c o E o o- E troo rF o -9,o C) E o oItr E oE (U o) .C .E(tr LF tir ol -ol(Ul FI Table 6: Type of training undertaken ircX the boxei where specific training was carried out during the reporting period) Trainees Type of training CDDs Other Communit y members e.g Communit v supervisor S Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(speci fv) Program manageme nt How to conduct Health education Manageme nt of SAEs CSM SHM Data collection Data analysis Report writing Others (specify) Partnership Any other comments 2.6. Treatments 2.6.1 . Treatment fig ures tf 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' The project has been consistent in both therapeutic and geographical coverage over the pasi five years. Therapeutic coverage has been above 80% and Geographical coverage fluituates between 90 and 100o/o. The Project plans to conduct geographical coverage survey in 2013. l4 (, f (U o (U o o .6. L o- oE .cE = =ao oL(o .9 E c)Ec o IL o o- E, oo o E .c E o (U o o -o o o o o o o- o o -o E)c E oF o) ooE o#oCOOrEx#(UEoo t-(U -o(u.=loco<8 o o L o -o E)z oo x 1' o GoL o o ooo o o -o E)z lt ,S' GEbo u)o(5'=9E8seLo5t-ks ooo(E L G) oo E .o .Co o oo o)o EC(E .9 =o o. oL o *,E9o -ctt'Eof{r. Ol ob cLoOoE6 oolz=l rr el trElZ tr-l e 3 usRE PE A- 59fi x6$EEg* o o o o tz o - O,r LJJ2E ?$' o,$r O)rr) oCf)rr) o E.z @(f)f- L C-c =O r.=:e O 6'Et F;E $€ E,e b.Qv I oZ. -'# - 5 O (o CO l- $$ x.z @@ 5E=*.p No(f) l-o(o $l-N f-o(o r E.z to o)l- cf) 5e" flE€treEE o)(f)(o (oNN $rr)N 6(f) tz ootrr C o (E o. o(L oo { tat o ll-dde; ;-t sq(o@ sq$@ sl-d@ s\@ E.z sqCO(o NoE* BEto(a(52ge o cf)lr) @l- rr) (o N r() @ o)(o N l()(a (o tz cf) @$ o,o(o (o o toE fr EEEa** cf) @ O) cf) o) @ o) N(o $Ns(o CA lf)o rOf- o(o (o of-@ cf) @$ tO o E *e s6€E-E e (f) @ o, cf, O) 6 o) N(o $N$(o (f) rr)o rOI- o(o (o ol-o CO @s oo o) -(g :o .q =cf E Eo() oo -ll* ood (.t o =oo- o)(!- (Ea b, Iq b;eo - >-oo(9o s rr) o, s @ o, s(o O) s o) O) tz s s cf)r\ c)o €: =Ecfi z [i c:=ts tO rO os N N tz NN(o No <oE fr EEEa** (o(o (f,v oNN NN @oN (o ro @ E= E+siE{E H" (f)(o CAs oNN NN @oN (o rr) @ E< E9o- P6EEoo fLY Ec(! o Ec(E E o o o) o L o t q) oc6 J F oF E G(t) t4 ooo c4i Q e o b! o oq (U o E. J .oL G a(U oL G G .E o o L .aE -o o LU a EC G c o E G c) r'- t ol -ol(El FI S,ToyI o\ts Qvb st E tH *.E\E ESS 'Es $fl E$[ .$gEE .stt Ets Is H EE E$ES E: E rfl .s tBg tsi sEi il eb tER' \ t-Ql*O OGGta asEtr S*.{- = =[IE S rg.S EPp' .S.. .itb't I$EsE + I SEE 2.6.2 What are the causes of absenteeism? Not aware of time of treatment, some travelled out during MDA period 2.6.3 What are the reasons for refusals? Fear of adverse effects still present despite health education 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that Occurred during the reporting period and provide (in table 8) the required I nformation when available. No SAE case to report No t7 €E$to ta ooq) q =e o o b! o oq o 0) ts Eo L oo o)CE o o- o o -c o)C L)E E o =oo o Po .c o l'U (/) o c o o oo 0) !(U a) o L oo o o 0)a(U o ccit orl -ol(ul FI 6ob -c )- €E E e o)9 .=:==E 8t; L9EdXgO.rA[u o o o)o c) ,-a5P €t IO ol d-o C Iit E -Lgza dsE #E€ (5Eu)L)r,->, -gA\ ? - -.,- EEEEE oE'n -c hlrt'= = .- Efi =EEC(E E#f;gE o Eo o E a .9k f* He gr .NE-a6 = 6 8g EE o o)o)E(U'6; )o xq) a o)(o z U)* o CL o o o .t2 o otr 6 oo (! oolt (E E(! CL .12 N oN .-E (E(! t, tro E (E or oc .9 ! = -9oo o o oo o f (! .E o (E 'E oc oE o o o o .12t o o = (Y) N € c)to irio (E o, o oFf oE o(! .9E .E o o(!g G a GE Eo SUo o Ll=(!hqro >o rGtro ss oni oo !o !E E'sEo.o!, c, .= eO EE9':oe EEo>LIEolo:l ,ts 6l .r= ol E3E -Ot E*s, 3.8 g o=oS EE\E(u E$E S:E : EF .lP F o,lb";elod€l * orFl st-t- sq Nt- s rr) oir- s @ st- o, s o? t@ s ol c)(0 o s o) es:->)o o st- o, s CD t@ sq(9(0 o[ -o uiu i- UJ o Ege o soo soo s@ + o, s(o o) sN@ s o?t € s o) c"i(o =oo )O- Oag.e bs .g B-Fo ,hn I oe @ IIJ slO(o s rr)(o sN@ s r @ t-oo c")o(r) T\oo c")o(a NN o) o (f) @$N(a$N @N t-_ $t-N $(f) o,lO \r (o @ sf o)o(o o a_ e 6p#(/,oEbE20- o IJJ EC)E e.tsiEo EEa* NIu Nt-lr) c.io (f, NNlr, ^io(o s o) co c{ (f) (a (f) l() c{ o)to\ @N (os o) @$ ot- @(o @s ot- @(9 @$ co G =oo TL E E, EE.P =.E. E . P AEE H'!2 (l)(l)o E (o o)$- lr)(o tif (o o)$ lr,(o\r lr,N o) o@ (f) t- sf cf, o(o @N$ lo (f) (f) (o\r o)@$ s o)t\ soo soo s e o)(n s o) o ,lrli uJ o) o,O Qa k gU o soo soo soo soo so)r- soo soo s e o)g) s s (f) r- *go $E gs,j,tnF- T\ o)tr, t-(o 1r) @ rt- @ o) r{) o)(r)(o ttN@ r-N@ . = o-E 5P.U 5=EEg IIJ o) cf) @ (D N € (o rO @ -o)E 9.E :E() EEa= UJ t- o)lr) F-(o 1r) o)o o) @ o) rO o)6t@ (o r.r) @ =EE gH E E gEE' t- o) ro N o)|o cto o) @ o) rO o,(f)(o o o) o) _(o = oo =cf E Eoo (DooN o oN oN N oN I E. IJJ ooo e{ ooN Noo C{ (.,ooN $ooN lt)eoN COoo(\t ooN @ooN 21. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - (please MOH Other wHo cify) tick the appropiate answer) UNICEF N NGDO f] Mectizan@ delivered bY - (P/ease MOH ! WHO Other (please sPecifY): appropriate answer) UNICEF tr tick the NGDO tr Ta Mectizan@ lnvento *Mectizan inventory will be - How are the remaining updated with Sinoe data ivermectin tablets collected and where are they kept? 4429, The remaining lvermectin tablets are collected from the communities by the health staff and kept at County drug depot. List and briefly 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 Nationit Orug store with approval of request from NTD secretariat. The drugs are stored at County pharmacies/depot and then issued to district health officers based on request by facilites/ from communities census data . Officer in-charge of clinic or health center distributes to communities in its catchment area. Number of Mectiza tabletsn Expire d Remai ning Lost WastedTotal Mectizan Tablets in Stock UsedReceive d ln stock from previous year 2011 Request ed Gou 0344 01 88900 14426115200036900 1 52000Grand Gedeh 265580 01 54805 4321 56500 1817951 56500Grand Kru 25295 2000 8569585 0453000 3652204530000 453000Marylan d 40 110 0181128 8611 86000 1 860001 96800River Gee 0 NRNR NRNR NR295000 2950002950000* Sinoe 2000 16055I1722 01 304695 8454141253300 124250062195TOTAL Any other comments 20 2.8. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? lf so, When? No comment here? T Commun self-monitorin and Stakeholders Meeti1 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. Supervision ln the Counties supervisory visits were conducted Health Officers for activities such as: a. Training b. Recruiting of CDDs c. Distribution d. Advocacy and Sensitization meetings, and e. Collection and compilation of data by program focal person, District 2.9.1. Provide a flow chart of supervision hierarchy. County Level District Level DistricU 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) Grand Gedeh Grand Kru Maryland 163 146 220 Nit Nil Nil Nit Nir Nit NitRiver Gee 122 Nit Sinoe 208 Nit Nil Nil NitTOTAL 856 Communitv Level 2.g.2. What were the main issues identified during supervision? o lnadequate number of CDDs found in some communities in Maryland CountY o some communities did not support their CDDs during MDA in Grand Kru o poot'recording by some CDDs in River Gee County o Lack of effective follow-up of absentees in Sinoe county o cDDs recruitment was not gender sensitive - Grand Kru 2.9.3. Was a supervision checklist used? Supervisory checklist was used at the County and district levels 2.g.4. What were the outcomes at each level of CDTI implementation supervision? o Communities not covered were later covered o Recording errors by CDDs were corrected 2.9.5. Was feedback given to the person or groups supervised? o CDDs were encouraged to revisit homes that had absentees and also revisit all homes with newly delivered and pregnant women to administer their drugs o Communities were encouraged to motivate their CDDs 2.9.6. How was the feedback used to improve the overall performance of the project? ln River Gee Feedback given to CDDs and town chiefs helped to improve coverage and record keePing SECTION 3: SuPPort to CDTI 3.1. Equipment f able 12 Status of equiPment Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condi tion No Condi tion No Condi tion No Condi tion No Condi tion 1. Vehicle 1 WO 2. Motor cycle(s) 5 F 3.Motor cycle(s) Generator Portable METS 3. Computer(s) Laptops 4. Printer(s) Cannon Desk Top Computer GX 280 5. Photocopier (s) 6. Fax Machine(s) 7. Bicycles 198 F a) b) c) *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? 3.2. Financial contributions of the partners and communities - Fill tables 13a, 13b and 13c lf there are problems with release of counterpart funds, how were they addressed? Advocacy meetings were held with the National and County policy makers with good outcome. MOH provided USD 22,423 for CDD and health workers training in 2012 oo oo ,r)- F o C;oo o^ l- tN E o = -o L .9.E c C) o E o + oto -\;Eg ltr!oa EEas) 'F>SOto v,tt oootr sob psrH5 IIHA o (6 q) o .C o(U o) .C, o o (o aC o = -o L C oo E C)C(E .g TL id(,) g lt(!F oq ooN. (f) oq oo o)- oq N(o or- lO oq N(oo o'oq- N l5o$_ rJ$ oq f- o)$- FEes oq(o (Y) or 1\ oq oo(o- oq(o O)(o- oo C;$(o- $ I II I I o oE+, o i I I E8 5Eo= I I I I I I I oEOq8 -z q GO -ON$ o c"j -Ool$ q(o 61 € q rof- a. q tt\(o oo o oq oo rO oq oo(o I I I I I C o E o oL. =ll ..2 : t LrJ F o oL o (! th{J ..c .9o oL ll3n-sE 6 I I I I Is='H. $=i +. Iol rl{Jtr =oo r!tr o -,(E z E'tr '= -9 o raa o'tr EOH,E 6eg, 'o lt .t2!, o tr o E E +a oF (\ lra(\ o tr olt t. uJ L(U!tc -9(E o tri o 3 L +atr o(, Fz UI =zt UJ o o 6 EDT' EE I I i I(,,CCI O Li#oi (! 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CL o .E E E o(, o o EL or- o o .i G) oroqq o,oOro o, Io) r,- GltJ o IaT an o o .C,P o s rr) io oc(u C o c r'6Ei> <Dl otrl o olo '=i= o1 (l) r.ui> I N:<f) rii ri I o,o .lo,o,s Nr(f) i(f) o' o L(E (g o Ir l()' o ol oq l4)(9 oq(0t\o(9 o a ro\tol (O(D co J F oF oz t(, .E (U Eotr (J.r .rr E ,=rF9aag o= =o -a.=o a- .oE >oEG) H(,, o=Oo> ,-\ 8?g(DO-crFf c)oN-Csf = tN= gLsIUP(/)Q -*f e /1bE g cO r-f o- oaE oO''T P -CO C#(J O _9L!2c d)Uio a(6E trod .=9E I oE qEH q P6: oEor -oZ-- o-e , €3 I -Y FZ.E Z[r E aE, LGO o ';-i o- c =o- tso= (E90 0-EE b5= E€ -- cL>ro tr 91 -oEg EE €'9 F .; =o- of q ooE- Er r${ -N tr .=rrsE l- =R I I a(E -c o oo '= I- oa .C =Go -c o 0) o)(E .Yo(E o- E c oooo q) -c Ec(E C(5 o. .C =(E oE Ec o (E E aL G o c o 0)E Ce -oEE 1f-3at roYtr o'- 0)>ho-gUE +r -O '- E E9 A Fil 9o b -)- oEz oHbd P€t 'EpE9 -I-9L-tE t'O Id-*rE(o- -'P?c.i. ,r \1,q UEqtoort o-cCO,o= o o EL o .= a oa(U oo o) .EECf O o(L a (E troo C '(5 o)a o ooo E C o o -o o (5 .C o C o E o o)c(U L (U (U .C = G.Eo .E -o =a C(U o- =-o(U ._c G o =o o -c o G =c o .C = c..C o) 'E =c(U o. =-oo .E$ a Ja (U a(U = +rl(Elilol -, I(El!rleltulEIYl thl9loc..PE(U'E+t G) *,ooo) .=Y?l-6g_tro GL -cL g Tgo)(rco'='g€ CLEEOo6 #<g lto clP F() .=o(E'- T,A \JoGO kgo> t ..i s (\.!to+,tr o E o CL .E =o olt oE+, o (!t =o .i F + (\. otr o G!,tr o E E o(, o o oL o! Gs = ..i rF + a ocE o o- L o .CIo -o c o (U =(U tu L o .C o I tL oz -o o)c L o .=C o (U CL o c C o (Ef (E LU := -ooc '(! o =@ L o o) rr) o (Ef G tU = -o(E c '6 o J U) E o p I o(It =ca.9 =Eo-o-coEE -GAE ?, at-sg .=aooEOboo e!.o!:E ="P ;6 '-a g u; = auJH l'6 roE OP o- c =L(U(D^fr EEEEE dl !D O-.=CtrcYE 9ssgE' EE 3 SO- B* E O) O (\-'E -'FP €E'66fi6 E E EE E T e + ! gI H EE:HEIg ="EEF,EE$HE€EE ' -c.= eP (Dl**6ogE s5E:f;eq; -.o B g#9EE=9 =E b.E *ETL(o[LEIJJI(\. o -a o E o .9 C) tE o)E$9iEgE€? € E {ECNoli.>c.qo 'F!='=Eo2 E=8 9, Ao 2 F= ,3 :E*.58;EE fi ES E =-; fi H:.E E eEE €;X * * .+g g:! g fgEE.=rotr 'i-i5E ilji E s i tE Y ;; -6; s - +. P E g * EE g $ EE fl -= g ;E 3 a t, oEc ;:i?fr.E E ".8 NETCEE Ee E ; E Et a e g+' z E E ;$ g .: fiE e p E EE' i €E E5 E I E EE .o r-e ,J E .E 3 =gEE o EE o fi 7 E gI E EE E, H $ ; Ea='rj = EE 3s A g E€EE -- nE * = E ; EEf;EgEBEg E EEEBEEEIEEiETi EEE-, E TEEE iEeeE g EgEg E EE:SEE;BE + E E;iE. E EAEEESE EE I E EE;IE figEfrfiE$$gfrH E * E$EE$ gEE$g€$T$E= $ ,g (EgI oo C o) E E C) o o d o E G o- E e Lu8.Go- v)oao !o.=a=9E -+, F .=o o)EEo),87(tr= LO.=O-tt caoo(I,cE 3 .9oc6EoNoo E -gEP.= 6o cEbt=Oi:o)q o oEEII o-=(D - oll vtdtu,-cg-eQti g2Ph-tqoc9EPLiu^.- ,r OE Y F!its= oE EEE AE H+ 5EEEEEt E LL-t q ?E E ,i! o@-ceEFE.e x s*tE r 3+Seo o.=q Ne& cg o aar] ca o a. oxoi a q 5 o o o aG o) !o o q o ot 0) o az oc og ot,ELO rFsoo .(EgE E =z E oF (a @s o,o(f) @s O)o(o (o ? EoolI.o (f)o(o(o COo(o(o oo (U = sN rr)$(f)$ to$(f)tFN oE o o ol,o.gbt, 1-Lts E =z E oF l- @(f) @so N @ CO @$o E Eoolro lo ro (f) rr) N(f) lo ro cf)tr) N Cf) o -9G = cf,o(o Nf- (f)o(o Nl- E bg rOo> .Cttr =o1d o E oF o(o o(o FO6olJ.(! l-oto f-o rr) Ea $o - (v) (a so oEE r=Fts5szd o o(E &E l-N @ NN(o +.o E')L .E T'FO (o rO @ CO rO @ b, b.E4tsto2i o(E #8 (f)cf) (a(a o E" G!'FO (f)(f) COco i$c !8spg' C o Go)E o .C, =(o o I tr ,- .9oE t9 :hLr-o .= a a a a o a a o a oo otscLc>oFO ,6 (U '6 8aOE .CCoocoOa o (U.QEA o_o LLi(o .q Eooo .9,Eoaa'6 IFa (tr- 'EO(E.:EF >E (s- '=O(U.=gE c o .E =C G (U E o -coo o o(U L(U (U o ,F E8 t^ Ut g o (E tr o E -g CL E I oo t rF o E(EF oP E o)oC .9. o o .C L o o) =o -c tr .o .o o ao .9 z o(/) .C =(E oT 'E f E E8e -OEfG_o )-e 6.(/,bE9ao-c a=FEoEzo or .9io >,c -oo EE op!E(E= ocoooox -oYo-9e(U= :o)o->o.=OCcfoc -EOog <.r >c)F.Noco9Fo= .C(UF-c -:Fo o o c o (E L E' o .= os .= !,o op otr o o oo =o ,9, 9, o o ott o ooo { cr) + a ac-(E(l, .=o !,trtr .Y FA .EEo,r ! 'F.H dE tr t-$o ot 'tr OrE+, -='E E',g = +; o> .a- .bo o'E- E- g= Eg .Y O.E,oo gt E q -->o -LLr-ro o o!,(ro =o ,EtE I: o+,E.E =o (E tr o E -g CL E o!t o E E o o CL o) '== EOd ooo(lt trl a o .E E E oo o +atr o E o -=o tr a a a o aa a o ao o o aa a tr ,- .9oE t9>rLr-O .= o o o) .C, o 6 C oo (U L(5 (U = 6 c oo (u L(s (U I_ o .E =c (E (U E o -cC)(u F o o(5 (u (U o o to.QEO o.(u LL;o .9,o .g E oo oP .9.Eo ct) I ct) .9.o(5 '6 o)oOE -CE OU 6L tr oo o o EL F t4q)g ox o) =.p a4 = o) o o a(E q) !q) ta q o o)t o) Q) a = a q) G o-o a. a-o t4 o r<o .E o)L) o)L o oo o)c,6) o o E E(E o)o o- o) .C o lb -93 oF tt 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. 4.4.2. How were the results applied in the project? SECTION 5: Strengths, weaknesses, challenges, and opportunities Strengths . lntegrated supervision . Good coordination and collaboration with stakeholders Weakness o Late access to fund for CDT! activities. o lnadequate support of motorcycles maintenance o Staff not motivated o Limited funding o lnadequate number of CDDs Opportunity Availability of health partners in the counties. Commuity willingness to take Mectizan and other NTD drugs Wav forward o Funds for all activities should be provided on time. o Adequate funds should be allocated for the maintenance of the motorbike . Support should be increased for HSAM o lncrease logistical support for hard to reach areas o Provide more IEC materials o Start implementation early in the year SEGTION 6: Unique features of the projecUother matters The South East Project is situated in difficult terrain, covered with high rain forest. The roads are unpaved and tavelling is difficult 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. lnaccessible roads and far flung communities, remains a major problem i3