North West CDTI project annual technical report submitted to Technical Consultative Committee (TCC): January 2011 to December 2011

-l NORTHWEST GDTI PROJECT, LIBERIA TECHNICAL REPORT 2011 ntds.l [be_{a_mo_h@yah9_o, com ORIGINAL : Enslish [i it,r I'l{^t^i{ i ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNTCAL CONSULTATTVE COMMTTTEE (TCC) Dorfr: DEADLINE FOR SUBMISSIO N: To APoc Nlanagement by 31 Januarv for March rcc meeting To APoc lVanagement by 31 Julv for September TCC meeting t.l :!Y - - -l -i1[ v@r AFRICAN PROGRAMME FOR oNcHocERctASts coNTRoL (APOC) COUNTRY/NOTF: Liberia Proiect Name: North West CDTI Project Approval year: 1999 Launchinq vear: 2000 From: January 2011Reporting Period: Monthl/ear To: December 2011 Monthf/ear APOCfundinsvear: (circleone) 1 Z 3 4 5 6 APOC Proiect implementation vear report: (circle one) 12 13 78910111213 1 2 3 4 5 6 7 I I 10 11 Date submitted Partners: - Ministry of Health and SocialWelfare - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - Sight Savers lnternational - Christian Health Association of Liberia - 1973 Communities For To: 35 -Irc oo ANNUAL PROJECT TECHNICAL REPORT TO 'I-ITCFINI CAL CON SLILTATIVE C OMMI'|TEE (TC C) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Countv: Libclia NTD/NCD Program Director Narne: K. i ('. Signature: Date 3.1, . .2q'. /.1. SightsaversCountry Director Narne: Mrs. Adoley S /. r' .1t:t1!1 rL Signature: Datb: ..rr. pare'dbyThis report has been pre Naint:N0TFI l.iheria .- -'\l NOTIi Co -/ t """"'r'/'l atrDesignation: Signatule: . ; ll I ll I rl t 4 Table of contents ACRONYMS V DEF!NtTtONS ........... ...vt FOLLOW UP ON TCC RECOMMENDATIONS.. EXECUTIVE SUMMARY SECTION 1 : BACKGROUND lNFORMATION...... 1.1. GrrueRRt TNFoRMATIoN ....... 1.1.1 Description of the project (briefly) 1.1.2. Partnership 1.2. PopurRrroN ...... SECTION 2: IMPLEMENTATION OF CDTI.. 2.1. Trurrrrue oF ACTtvtlES ..... ......6 2.2. AovocncY ......8 2.3. [t/oatttzAltoN, sENStlzATtoN AND HEALTH EDUCATToN oF AT RtsK coMMutttttrs. B 2.4. Counltururry TNVoLVEMENT... ...............9 2.5. CnpRcrry BUTLDTNG .. 10 2.6. TRERrrrrrruTS.... ..........12 2.6.1. Treatment figures. ..........12 2.6.2 What are the causes of absenteeism? ......14 2.6.3 What are the reasons for refusals? ........... ........14 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that 14 2.6.5. Trend of treatment achievement from CDTI project inception to the currentyear.. ....16 2.7 . ORornrruc, sroRAGE AND DELtvERy oF tvERMECTtN ....172.8. Cotr,'ttuurutry sELF-MoNrroRrNG Rruo SrnxeHoLDERS lvlerrrruc ...EnneuR ! Srcrurr NON DEFINI. 2.9. SuprnvrsroN.... . 18 2.9.1. Provide a flow chart of superuision hierarchy..... .. .18 2.9.2. What were the main issues identified during supervision?..... .....19 2.9.3. Was a supervision checklist used? .......19 2.9.4. What were the outcomes at each level of CDTI implementation superuision?.... ....19 2.9.5. Was feedback given to the person or groups supervised? ..................19 2.9.6. How was the feedback used to improve the overall pefformance of the project? 19 SECTION 3: SUPPORT TO CDTI.. 1 2 2 3 3 4 5 6 3.1 . Eourplr,rrrur 3.2. FrrunrucrRr- coNTRtBUTtoNS oF THE pARTNERS AND coMMUNtIES 3.3. OrnrR FoRMS oF coMMUNtry suppoRT..... 3.4. ExprruorruRE pER AcTtvtry SECTION 4: SUSTAINABILITY OF CDTI 4.1 lrurenrunl; tNDEpENDENTpARTtctpAToRyMoNtroRtNo; Evnlunrtoru 19 19 20 25 25 26 26 lll 4.1.1 Has the project ever been evaluated/monitored? (Tick any of the following which are applicable) ......26 4.1.2. What were the recommendations? .................20 4.1.3. How have they been implemented?... ................264.2. SusrRtNnstltry oF nRoJECTS: eLAN AND sET TARGETS (MANDAToRv AT...... .....26 Yn 3) .......26 4.2.1. Planning at all relevant levels .......27 4.2.2. Funds. .......27 4.2.3 Transport (replacement and maintenance)........ ..........27 4.2.4. Other resources ..........27 4.2.5. To what extent has the plan been implemented ...... .........27 4.3. lrurecnRrroN...... ......27 4.3.1. lvermectin delivery mechanisms........ .......27 4.3.2. Training.. ..............27 4.3.3. Joint supervision and monitoring with other programs ....27 4.3.4. Re/ease of funds for project activities ...................27 4.3.5. ls CDTI included in the PHC budget? .... .......274.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? .........28 4.3.7. Describe othersissues considered in the integration of CDTI. ............28 4.4. OprnnroNAl RESEARCH ........31 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... .......31 4.4.2. How were the results applied in the project? ........31 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES 31 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS..........31 lv Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHIVI TCC TOT UNICEF UTG WHO CHT orc MERLIN CRC CHAL CO CHDD CHO BPHS NECP LISGIS African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Commu nity-Based Organization Commu nity-Directed Distributor Comm u n ity-Di rected Treatment with lvermecti n Comm un ity Self-lMonitoring Local Government Area It/inistry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiologica I It/a pping 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 tt/ed ical emergency relief internatlona I Cavalla rubber corporation Christian Health Association County Onchocerciasis supervisor Community Health department Director County Health officer Basic Packages of health services National Eye Care Program Liberia lnstitute of Statistics and Geo lnformation Services Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eliqible population: calculated as 84% of the total population in meso/hyper-endemic communities in the project area (iii) Annual Treatment Obiective: (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 expected to reach the UTG at the end of the 3'd year of the project). (v) Therapeutic coveraqe. number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geoqraphical coveraqe: number of communities treated in a grven year over the total number of meso/hyper-endemic communities as ldentified by REMO in the project area (this should be expressed as a percentage). (vii) lnteqration: deliverin g 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 maximize 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. i) Sustainabilitv: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilized by the community and the government. (ix) Communitv self-monitorlnq (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. lt encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. (v VI FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 32 Number of Recommendatio n in the Report TCC RECOMMENDA T'OAIS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY Report Related (i) The report should be resubmitted when outstanding treatment data is available, The outstanding data were collected and the technical report was resubmitted to APOC. ( ii) Provide information on the process of stopping treatment in Monrovia Project Related (i) Train and re-train more programme managers and CDDs to improve the quality of CDTI implementation; Training conducted in 201 1 included more program managers at county and district levels. All District Health Officers were trained on CDTI concept. CDDs trainings were also improved by moving venues closer to the community to accommodate more CDDs into the training. ( ii) Ensure early retrieval of outstanding treatment data and commencement of year 2011 treatment The remaining data were collected from the field, compiled and submitted to APOC managemenl.2011 implementation started right after the collection of data from the field. 1 Executive Summary Prepare an Executive summary of the report in not more than one page, 1. Background on treatment and population data - Total communities, communities treated, 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 they were overcome. The Northwest project is the oldest CDTI project in Liberia. lt was established in 2000 after the Rapid Epidemiological Mapping of Onchocerciasis (REIVO) in 1999. The project comprises of five Counties: namely Bong, Gbarpolu, Lofa Nimba and [/ontserrado. The report of full treatment data from the five counties indicates 1973 communities out of which 1801 communities were treated representing geographical coverage of 91.2%. A total of 1,423,477 persons were treated out of 1,740,475 total population of the project area. Treatment data from all target communties in the five counties were received compile and validated. ln 2011 Nimba County witnessed an influx of refuges from the internal conflict in lvory Coast, thus population of the county increased with the refugees sheltering in the host communities and some refugees in settled camps. A total of 3302 CDDs were trained/retrained, while 398 of health workers were trained/retrained. During the year under review, 36% communities treated constitute female CDDs while 19oh of health staffs were involved in CDTI in 2011 APOC management provided five motorbikes to all the onchocerciasis supervisors, which really alleviated some of the logistic constraints Challenges . Weak community structures in Montserrado and Gbarpolu counties . Changes in health personnel in Lofa and Bong ln lVlontserrado County health personnel have not been able to engage creditable community structures mostly urban populations, while in Gbarpolu there was major re-location of people from one place to the other in the mining areas. Also the mass lay-off of health workers in many of the facilities in Lofa and transfers in Bong affected the implementation of CDTI especially in HSAtt/, supervision and training of CDDs These challenges were overcome by training of new health workers on CDTI and support provided by NOTF staff in orientating and building the skills of health workers on approaching the community as part of HSAM and supervision. NOTF facilitated HSAM in some communties of Montserrado and Lofa. 2 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 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 CDTI activities. The Northwest CDTI Project is located in the northern western part of the country. This CDTI project consists of five (5) endemic counties namely; Bong, Nimba, Lofa, Gbarpolu and Montserrado. The climate is tropical and humid all year round, with significant variation between the dry season (October-April) and the wet season (May-October). [/ost of the roads in the project areas are unpaved, thus causing difficulty in movement in the counties. ln the Northern parts of the project area, palm trees grow wild and the area is fertile for both upland and low land cultivation of rice, the staple food in the country. The vegetation includes the tropical rain forest with many fast running rivers, which covers over 7Soh of the land area. The coastal area is marked by mangroves, dwarf trees, small bushes and various grass types. [Vlost of the population of the communities is settled and almost homogenous in rural areas and mostly heterogeneous in townships and cities. The structures of the leadership vary according to the types of communities. ln towns and villages, there are chiefs who are elected and guided by council elders who take decision on behalf of the village or town. ln township and cities, there are commissioners who are appointed by the president of the country and city mayors who are elected by the residents of the cities. However, since the 2005 legislatives and presidential election, the election of chiefs and cities mayors has not taken place due to the lack of funding. All city mayors have been appointed by the president. The occupation in the communities varies between urban and rural settings. The rural communities are engaged in farming activities from January to November while the inhabitants of the townships and the cities are engaged in commercial activities and other salaried jobs lation of Northwest CDTI P c Liberia from Gensus u ate CDDs J Counties Population Bong 327,807 Gbarpolu 78,961 Lofa 232,956 Montserrado 534,562 Nimba 566,1 89 Total 1,740,475 . Greater lvlonrovia is excluded from target population There are 276 functional health facilities in the project area. However, only 204 health facilities participated in the treatment round. The health workers in the project area are about 2200and 416 participated which constitute 19%. 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 Bc=Bzl Br "100 Bong 374 86 23% Gbarpolu 73 37 51% Lofa 567 148 26% Montserrado 196 61 31% Nimba 990 84 8% Total 2200 416 't9% 1.1.2. Partnership lndicate the partners involved in project implementation at all levels [MoH, Sightsavers, (national/international), communities, local organizations, etc.] Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. Partnership at all levels in the project area was strengthened. At the national level, the program collaborated with WHO/APOC and Sightsavers for technical assistance and financial support. There was increased collaboration with other departments in the Ministry of Health and Social Welfare to implement the CDTI program. At the project level, the partnership with lnternational Organizations, Local Organizations, faith based Organizations and local radio stations were strengthened. Some of these organizations include: Equip-Liberia, lnternational Rescue Committee, Save the Children UK, Africa Humanitarian Action, Africare, Ganta United Methodist Hospital (PHC) Unit. They carried out integrated supervision at health facilities and communities' level. 4 ro 0) oL o- c) -c !C G aL 0)ECf o-bs '= ;E'=o - -c. =oo)o) roG= :o Loo .-c :l A.E'o =o)LLo(6 oP oXo)POEE_Ho) P _l_ 'FP @- t-O-o6 otu 20 ooco- i=OY U -#ofo)oG-O _:G ,aXo) L -.c frrcOILlccIL txlu(E - :LLR9 BI o.r .El-cLIP(DI rrr(U CE'9 6 (U -?- co oX (tr\LU - (U'61 p =k oc >.o P *-C A _, =o o) o_a C)oL f, oa Lq) -CPo a 0) Io o O afaC 0)() oc o (s z 0)oL f o U) lo)la tc lort.clilclo)lslol(Blq)t\ lq)t-o ..i oo!q) l5 0'o: ES =o\ 33 (!Pl tsa) Ioo I'd's Ili: Il9r I lc o IlEe IEr IS! (1 .a(D ,l(U(n QX(U) .Qo IEc I\!t 9q at EH 9L\l0)n IQi Il.o I\o Id;: Iox Iox 1tEf o '- 0)i'a c..ES Eqo 'EE; g. EE P ti oY F O '\o- o -oa9 0- oJJt O dt n\L-=;S e €EE -gePg !L bE'E rs €0 I 6Sd b Equ ! o) c.Q P -c\ F '\ss s bxoD E 0)H8 0- Ilo) o :fP= S OtF : aR.o 6 o.) 'e6\fEE 3 ise ? ,lio o ):(B(u O = P5 s 25E- 5 = q q) oq) q =0 s) or E! G q)q G ! o '= o o_ (,) c E o o_ o o _c C,)C 'tr l ro oC L o E a) (U oL oL(5 o)s 0) _c 0)c =(g o G o o o o- o o 0) -c .c -Ya .E (tr C o G :l o- o o- !C(! a .0) .= C f E E o C) o.jr orl -ololFI o (E) o. oL "i oFl oc = o- =E(!E.t oE (!O =o o + I a r(DLE .= &R ESEioo) ' otEE,Eo) f-O @_ t-N cf) r(o O) @N (o rr) o- N coN N(o lr)_ $ cf) rr) O) @ r (o(o rr) lo f.-$ osf.- - q) ,.95r:bEiEqgt ,'E'H < -bbo N (o vNN(o N (o ro(r)(o N r F- oN rr) @ co ro O)(r) N|tr) o)N rr)$ (o rf) an(o F. aO ri o o s o. o(L 0)vtroO.o o I9-.o.Y o-o S Ee ktrvtrEo'- (o rr)lo(o oo$ rr) s$N (f) f.-f.-(o @ C9 f.-(o N CA r Or rl rl st(o cO N +_ il I roLC E &R ESEioo ' oEEC,Lo) 1r) o) CO N o, ro(o o) f--N @N rO cf) f.- o, f.- ro N o@ @N 1r) o NN$ N Ot cO ri ,; o U) s 't o o .E ) E E o o o o! E =z o Ee E1r- o o'- o -r(l)d, o=o *x a I (Detroo.9 o I9'.Ul ,Y O-O €Eorh40.cEeC-o'- N @ c.) N co (f) o) @ r (oo (oF- rn ...E Eo= (! E 6* --.9 --Uir(E = -c.=I rs Aoo-iF o..= o. t-o @- NN co (o o_ @ l- @ rr) O)_ N cf)N N(o lo_ $ co rr) o) @ r (o(o ro rO f.-$ o .t f.- - oE -cog.- -.9-J3'- o g, -.3{ g EEEqE()o- o g)com f,6 o_ (I' -oo (! oJ oE o oo o (! -o ,Ez F o SEGTION 2: lmplementation of GDTI 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. The timeline of activities vary from county to county based on each county plan for CDTI. 6 r- .9 .9.t o a. a tr o or= cLo EE o o o) -o E ooq) o L o _o o o o o) -o E o oz L c) _o o() o L o) -o E 0) oz ED- he . of L -o G) LL .(, f,c(tr - -(5l c(U -) L(, fE(, -) L(I, f L _oq) LL o .cl o !, U) o o_ EE cLo EEo-o- G) -oo o o L o -oo o o L G) -oo o o L o) _o o o o L o) -oo C) o ED- PLhq a- a =o)f o =o) = o f o)f af o)f of o) = o (E E o.f o J o o o .9- EEo-o EEo-o- : o_ : L o_ o)c :f - (s -Co L(E 9-c H9 o' EoL o -co L(E : L o- Eo (\, (! f L _o o) LL g, '6 F o_Eio-o EEo-o- oc f -) =-) ->= - L o) _o E o o_ c)a o)- ;q a- o)c = - (E c)cf --) o)cf '1 o =o)f oo c.9o.= G=NE ?earE6o =() o EEo-o EEo-o- f,--) oc =--) o 0)C f - a f o) = o- 9Lke a- - ofc o --) e^(5lLo 0)II e. GfC o -) L GllL _o o LL -olC(E -) o o o) ogl f o o-L o _o(, (o oJ op (E LL o) @ c o (I, -o Ez roN (U o C 0) L lo (.) = .c 1) G) (o 0) L U)(o G) G c.) -c. o a .0) .= o(U o 0) .cb E tr air ol nl(ol FI 2.2. Advocacy Stafe the number of policy/decision makers mobilized ait each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/constraints being faced and suggesfions on how to improve advocacy. At the Project level, advocacy meetings were held with 347 ,iounty and district authorities in the five counties in the project area. The purpc,se of the advocacy was to educate the county and district official on the need to for them to support onchocerciasis control as their own program. Community leilders were requested to mobilize other community members to participate fully in deciding selecting/replacing their CDDs, timing and mode of [Vlectizan distribution and kind of support the community wish to provide for the CDDs. 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 - tr/obilization 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 tr/obilization, sensitization and health education were carried out in the project arca. Various local radio stations were used to disseminate CDTI messages on the role and responsibility of communities, the importance of ther drugs, the cause of the disease and prevention. ln the various counties the local radio stations aired CDTI message twice a week for two months. These radio statirrns included radio Nimba, Senwai, Kerghemahn, Karn voice of peace, radio Tappita, radio Saclepea and radio Bahn all in Nimba county, Radio Kintoma in Voinjama and Radio Zoryea in Zorzor) were used in Lofa, radio Bong, Gbarpolu and Caresburg were also used in Bong, Gbarpolu and [t/ontserrado Counties respectively. Health workers and CDDs also carried out health education in the communities NOTF had a special intervention in Lofa, Nimba and Montserrado Counties the purpose of the exercises was to assist the frontline health staff to improve HSAM in the communities. ln Lofa the NOTF team in company of drstrict health officer and officer in charge of Sarkonedu health centre, had initial meetings with the respective town chiefs to re-introduce Onchocerciasis and CDTI to the community. Appointments were made for another meeting to include more stakeholders in the community. Durrng these meetings health education was provided, including the roles and responsibilities of the community leaders, community members and the health facrlity staffs in the planning and implementation of CDTI. At the end of each meeting, communities agreed to select new CDDs to fill existing gaps and provide other resources to sustain the programme. The communities were requested to liaise with the officer in-charge at the health facility, to follow-up with training and supervision of census update, and drugs supply to 67 women leaders. Technical assistance was provided to district health offlcer and health facility staffs in Saniqwelle mah to conduct HSAM in 11 CDTI communities. The Objective was to improve the skills of health workers on how to approach the community and carry out HSAM. The Team also met with CDDs and their records were reviewed. Most of the communities covered in the two counties are communities located at the Guinea - Liberia border. ln the two Counties, advocacy was held with 92 traditional leaders and 43 youth leaders. Also 850 community members (men, women young adults & children) were reached during health educations sessions held in the area 8 Support was also provided to Montserrado Health Team to facrlitate sensttization & mobtlization of communrties towards the 20'11 annual Mectizan treatment round in Todee and Caresburg Health Drstrrcts 2.4. Community involvement 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 CDTI issues are being discusses (attendance, participation in the discussion etc). - lncentives provided by communities for the CDDs - Attrition of CDDs. ls attrition a problem for the project? lf yes, how is it addressed? - Other issues The attendance of female members in community meeting is high in rural Nimba, Bong, Gbarpolu, Lofa and rural Montserrado especially Todee district. Female members of the community participate fully and made good inputs at meetings. However in the cities female participation is not as high when compared with rural communities. The low participation of female members in urban areas is a result of inadequate community structure to organize them. There is need to for health workers to target the religious organizations and other social groups with HSAM to reach more females. Motivation of CDDs in the urban areas of Montserrado is quite low. ln other counties some communities provided cups of rice, cassava and sometime $5-10 Liberian Dollars as incentives to CDDs. There is high rate of attrition of CDDs and efforts have been made to minimize il, but more still needs to be done. More faith based and social organizations will need to be sensitized to support CDTI especially in the urban areas, where traditional community structure is weak. . 9 County Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Male CDDs Female CDDs Total Bg Be= ll7+filt Bt Number of communities /villages with female CDDs Total no. communities in the entire project area Ba, Number with community members as supervisors Bs Percentag e Be= 85/ 84 -100 Number of communities with female CDDs Bro Percentage Brr= Bro/Be-100 Bong 395 154 39% 563 146 709 117 30% Gbarpolu 112 77 69% 236 g4 330 45 40% Lofa 659 257 39% 931 93 1.024 76 12% [\Iontserrado 279 98 35o/o 401 209 610 169 61% Nrmba 528 189 36% 823 365 1188 273 52% Total 1,973 775 39o/o 2954 907 3861 680 34% 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 most imporlantissue to describe is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or if staff is frequently transferred during the course of the campaign). Training was provided at all levels. However there is a need to train more health workers and CDDs. The transfer of staffs was a major problem during 2010 where almost all the officers in charge of health facilities in Lofa County were replaced by more qualified staff. Also the lack of effective transition between the old and new onchocerciasis supervisors in Lofa and Bong left a gap in CDTI implementation in the area. l0 Ooo (o @(o $ CO cf) c.) cf) $rN O) o) f.-(o @ @Os o)lr) No iq) a o + .E&d Eil Pd N$ ro c! @ (f) o(o o E o .9 o s CD @o LO @ c.) NN oo f.* t- rolr) oo oot- cr) No(,(, l'-(\l ot ot l{) No oo(o otr)$ oo r.- E'o 'a ooo o o o .ct E z oF t* ct $ N o N Tq)( 6ttO Ed*=o \. :d o : F- 6) E o) .g o soo N O o F o o .=oGl- .:O O-E-o 3Eo.= rGriEbl=lz o s(olr)(o C') co oss 6 o)(, o ro N @t 6) E o .9 ! o so O)NN @t- O)(o O) rO @ o O) $@ N cf) N rO o F \ 0)( o iq) a G,, d Fci*.F(J o co N C.) c, ON @ t =(5 6'I o o .cl E Jz !, o (g (E o o o() @ c.) rO Lo N C9 + o E a)( oiq) = El .OO - (o N (o O)N O) c! o, ON o l- @ LO o o 9ooo o(g oP o(E boll E z oo(U 0)a C o (o -o EZ o c o) E 6' .9 o soo r o)C oo =o o- L(o _o o (! o) oJ o L ,o o o) E o o a o 'o o q o 0)s G o lf, lr4 o o o O) ttr oaq O) oo Q) q) 'o o a. o) o o o o =o 0)! \og C o (E c C) E 0) o- E Fo O o a 0) o c o)L 0)Itr E G) .C (! o) .C .E(o LF rbr ol -ol(trl FI N N (o$ @ O) (o o (o (o $ O $ s 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 lf 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 prolect has made significant progress rn achieving good therapeutic and geographical coveragein20l0anditexpecteditwill bemaintainedin20ll. Partial datafromfouroutof five counties indicates good coverage's; however the picture will become clearer when complete data are received from Montserrado and Lofa. NOTF with technical assistance from APOC is planning to support NOTF to conduct geographical coverage survey in 2012. Trainees Type of training CDDs Other Community members e.g. Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specif v) Program managemen t How to conduct Health education lvlanagemen t of SAEs CSTVI SHM Data collection Data analysis Report writing Others (specify) Partnership t2 ca o U)(u\g o o (E .c $ tr!o8l- o) J .:(oE0)\ oslE€:s. H()c \(l)o ti '-) OE; :Q6 g oc 'F _c'{ (#E a. r'i o, .=o ccoES €U|)> S3s EET E ,r!o .Y(! \ -OoEE ;6s i'J-q Gqs .stl-E :: *E s6'6. hth- bE- O:Eh gH - o :'6.EI Sb- oG c:I s s:Yur 'SoSE IE:l ti a) o trc rE TEo_Y o! =b tEv q $or L A AFos st -o d 9E E 3 Esr d E :s _tr S F E:F'S PH\ :Eg 6o * e;6 qr9 *Q BE: &ri 33s 3_!tr EdB i6P s8 .s E'6.E Ei0) \cc o:-l- e>\ ll rrFP PS cc x E 0..) o o c.) o o o o o) -o Elz o c) -o-o C 0) or E ul 6rl o) xl .- ol - ot 6 9t E -l <OI EI ol oJl ol *l 3l oJlol EI =lzl ol ol 016l ol >t 8l -lolfl o-l ot ol 0)l ul -ol El(trl ,.ll =lo)lol(ol d)l sl olcl !llt oJ EI 3l LI ol (6I =lH ol tr- I s I o!to) o>O) A)OF9E O rnoY o5 Lks E ^. c=E +EusSpEe ;3E detgE O o o o o o Os otr otJ.l 2a$ @lr)O) orO t-Nco $N cf)t-N (\ co N r-l oEv = q E E=H E" E'2AB E 8 O)o scO O)cf)c.) (oc.) NN oO)rn O)= €r H rf L-o O) ZG N@NN N @ O)N co(os F- N @ @O) @ oo(.o f\,1 Ln ! e=c- E tr)(o c.)s Ntr)lr) N(o Ir)N c.)oN o,N @ c.) (O rl @ c! Fl C o .F o f o_ o 0- oo o'8 oLE ooD o(E(!o-LE q)ol> -coFO s(n NN Nq st @ x Fl rc; N \oo\ n N oo sq |r) oo >s oq rl @ o o o- ox0) -!_r (, (I,Eb9 z* (o Ns c.)tr) N oN cr)(o(o \tNt- F- o O) cr)os\t oo @@$ f.. F. st cO c!$ r-l o EarE 9.::?tro t (.)-o FU NO @- t-N co r(o o)- @ f- (o lr) o)- N coN N(o r() $ c) rr) O) @ (o @ rJ) rot* s_ ort r.- - o oj c Rcrq€ o, =..E 38:5EE Hb' oo)O-tr NO @_ f.-N co (o O)_ @N (o ro O)- N coN N(o ro- s co LO o) @ r (o @ ro rr) f.-$ o$t- - a o) C,) -(U = a 0) v cl =lEI E o() oo rr I-dd o $o(D :PF-ba;. > :.-x'o ou(r- o\@ o\r'{o) o\rlO) o\@O) o\OO) o\!-'i o '=Eo b 5 P,B ! E:(UEtr5o) =EE= tr) c9 No O)O) Lo .if f.- N rO Ns o @ o E0) f t x =6-6ie I tr)o)co N o)|r)(o o)f.-N @NrO Cf)f.*o) oc ,a ). o * l- ii or5 E o gEEg:=E;H" lr)o) C9 N o) tr)(o o) f.-N @Ntr) cf) f.- o) - c f o O o)E o co f6 o_(! -o(, (g oJ o(! O)a c o (E ! Ez o r roN .E l<a L (o a oq) L(E (U .c oJ o .aE _o a r.u U) -If C(U C 0) E (o oLF l.-t ol -ol(El FI lt 2.6.2 What are the causes of absenteeism? The absenteeism was due to the schedule of the distribution at the time when more communities were engaged in farming. ln this project area the main occupation of the people is farming. Another problem was that the CDDs did not follow up with the community members who were not present at the time of distribution. 2.6.3 What are the reasons for refusals? The reason for refusal was due to the inadequate health education by CDDs and health workers in some communities. 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 !nformation when available. The project did not have any case of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report 14 oE- ob9 _c>-8g b <.= E 3rg EE# c o!sEd)<nLt-t.t6o o.9CAbPqo, rOob E_ Ia 0)!! =ou(/)E^ =rz (o(,oooE trE=-a o *AOa->, ^,= _=-_ EEFEE cOs 't u,=u(r(u> o F (I)=6EE oo 6.8,8 c o € o I orN(s.i O.= o(D (oXlt (I) -6;g> N ..;9<saoo(oo> 3 X o)a z @ a E o_ E U) tl- OJ (It o I o)( o.r G)L o o) o_ o_(o c o c 0)lz(U o oo)co6):-)o I o_CiPaL r l -I l I I r+ ta) q) G a- q) r o\q) a o a)q + r rON .C ! o L c) o_ (,) c E o o_ 0.)L 0)c o)c L fE ! 0)LL foO o (o _c a I.JJ a a c 0) 0) o)aL o E(U U)f o .E o @ o a o)a(0 O <br ol _ol(trl FI -_ - t- I L C,) rDgF g os)6 O s (o s @ s C')t- st rr) s u) o) s o) s oq @ C o (o J o_ o o_ oo rr I- uj LlJ lt, 0) o)6 o^ ? s-o s rOt sto soo st@ s ct) sq 6 oo rr I- Ul llJ UJ '; o):, o)ooH9sb 6- .c()Fo s CD ot s c,(0 s(o(0 s o) ci(0 s a(9 rr) s\ @ s 0q @ ul ! 0) o(E -o0).=D- u)Fc =oz2 o o_ @t- o (o C')t -:t^loo o) tod @t lo N(o t-6 e) (v)t r.c, @rt(0 to ,o crt(o a t ft1 N <l ri UJ c0) E EE c o.=/ C)-O -tro (o oodo rC, !l,$l rod(0 o N ct) @- G' rf t ro o) o) (o @o d ct)a lo $^ o$ J bi . P..->: o =c (,iEg*E E,tFf 6co+ oc) otr N(9 C') @o(9N (o c)(9 (r,:r^ ao @o(o N c.i C"(0 @_ i-to oi o)(ot C')o € (Y)(ot- (v)$tt^ ro h-t- o$ D- a G) o) o: aa o) . =E E oo oo rr I- UJ llJ l,l.J o(,) r-) ([^ F o)o\ o s c;$t s oq o(9 so cn s (D =-gB $e E s*;()O-; ooul s s(o l(, soI.- s ot(v) s (9 s @ o) s CD IJJ \'= o o) f X'q) ! F: dEtr>o))O6-Zoa) t o)(\l c)(ot lo i- @ o)(9 ro o) lo to cc- o @ UJ Eq) <ooZ ?cL) r(5a .Z aD -Eo @ CD r4)N @ o) rc)$t oo(o(\t l.- @ @ (o 6(o r- ol(9^ (, o sa 's JoE;9 e I rg:E3 =s =;E'E*E E gE3E LC8', @ CD ra,(\ @ o,l(,(\t o @(o ol No(o (o @ r.o i-$t(.r- (9 CD t LU o) o) o) - oooN ooN NooN COooN sooN ta,ooN (o oo ot ooN €oo$t CDooN o o6t oN \o E' o oo o ,9 (E (E E' og CL E oo 0, (! E' o .E o oE' 0)It 't o E')(E o o o o E G o o(\t Eo ot * -o e o (E) o (E o og)(! t_ 0) o o oFf (u LL(!EE =r(I,L-Eoo.=TNL =ro(r()trooYoEENo o(o-Co c:oo::(E ooO-OtrO'=Jo9Ct) L. 't? o .2or-o'E= olo)lqrorJ.of v :^ (v,lJXtrl()+@ trE*;oco , El sL(JI Locl (EEol ?e 3l E:it g'Eoo'(Eo)o +J (O -trc:+J ar ttJ LE B€H:Oo!ll-L!-:-t)([) :aoVp !E'KcYoE E EF:YO ..iEE(O :', . U)l arNol 6 '=l (utl sFl (L F- a c o E E oo L 0) _c o C tj c)ooba6oo)sf- aqo! .=5 'o 9.sg_ 5c) $1 (g(uos-c o= .c(tr €o) .E -c o- _ool<f !O L7(s6 u) 'E .qb =oA.:i-o C,,o_(g c9: o)+! n -iEf o c)EP E 9o o6s 5 LsLo- o €b .z;E 3Ee E z(EO6.n q#PL(Jd)Fo: 6 o(o.= L?E €o:i cby f(oE a:6 eL\P o-.4oE', 5E'= G Ors I .>E * EDq O)c- -o .EP 5 .E-i EtE io 5oX o) -:= '- €+= -og'a jo([L'c =P I qO.P A -rl)rb rG ,(, o c o c @C(! .N o 0) r 0) _o(!F '6 o) o_a 0)a o 0) o q) .C, o tr oo oz u lL IU o zf oI = tr I o = ,.\ a)iq $ a) (o o.p o_ o- G a) \o a) u) oq) a_ I -o '13 0)L c) 0)E @c(o .N o 0) oo oz ,i^\ o = q r o q) (o 'F o-p a_ao q) \o a) U) o 0) a. I -o L o E .0) o- o- o io o L oE o @c o .N o c) E o o E L o .z o o .u6E E' (! o U)(! o a o, .E oE o \(\I tr IL lU o z I s =o8!o_E3 Ibo5 =o o, '= .E E o)t @oN l.r)(o t-f.- cO F.- o @ roo O)N Ntr)(o o l.r) N @(o O)(o o @ .n @ Ln(o oo @ Fl E' o) 'a x tu o o o o o O T' o th(E = o o o o o o @ o N@NN @N cO o N(o CO @ rr) N c.) @ f.- cf) O) r"i r\.1 .\t c\l E o, th f @(o rf) Nlf) N cO$ Lr) o) Nt- O) cf) tr) os@ o,N c.) N cr) l.r) N o,\t I.\ rn str\Oo st o e f E5a9 -LY ! or PE Ea o)(o cr)sf.- N cf) o) co(o N NNN@o @ @$(o N@ ro co @N cf) cf)N Ot LnN(o r-{ I.\ Ln E' o) ,z o o ot, ooOo N ro OOO |t.- oO l.r) o o) rO sN@ F..- Lr) tr) oOo rO @ f-- <f,(\ aosN rO$ Eo o o) ET o)d Ooo Nlr) ooo t- s O) o,o cr)(o ooooo(o ooo rO @ f.- $Ot o)(O @ ri sl og -o(o (g N o o =o o -o E z trGoo)L:x t oo o =oO.Y N6a :o O)(o cr)NN l-.- cr) O)N O) N N f.- F.- N iil N @sN CO @ N@ Nlr) lJ1 cn O) r-l OrO ri o o o)C o co =o o_ L(U _o(, o oJ oE oL Lq) a c o o! Ez o 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? Table 11: Commun self-monitorin and Stakeholders Meetin 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. Community Self Monitoring will be conducted in l\Iarch of 2012 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. Central Level . NOTF . NOCP . County Health Officer (CHO) . Community Health Department Director (CHDD) . County Onchocerciasis Supervisor (COS) District Level . District Health Officers . Officer in Charge of Health Facilities Countv Level Community Level a a a Community leaders /town chief Development committees CDDs 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) Bong Gbarpolu Lofa 395 112 659 Nit Nit Nit Nit Nit Nit Montserrado 279 Nit Nit Nimba 528 NitNit TOTAL 1973 Nit Nit 18 2.9.2. What were the main issues identified during supervision? During the supervision, it was noticed that all of the health workers received funding from the county level to conduct CDDs training in their catchment communities. Health workers training was also conducted in the five CDTI Counties. One CDD is still covering a large population more than the required number prescribed by CDTI strategy. lVlectizan were available at all health facilities visited and distributed to communities 2.9.3. Was a supervision checklist used? Supervision checklist was developed and used but not at all level 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Supervision reports from County Onchocerciasis Supervisors were not available at county level. lt was recommended that all COS prepare supervision report and submit copy to national. 2.9.5. Was feedback given to the person or groups supervised? Feedback of national level supervision was provided to the county health team in a meeting 2.9.5. How was the feedback used to improve the overall performance of the project? The recommendation of feedback was not really follow up by county to submit regu lar supervision reports. SECTION 3: Support to CDTI 3.1. Equipment Table 12'. Status of equipment Source Type of equipment APOC IVOH DISTRICT/ LGA NGDO Others No Condrtron No Condrtron No Condrtron No Condrtron No Condrtro n 1. Vehicle 1 WO 2 [Vlotor cycle(s) 5 F 3.Motor cycle(s) Bicycles 168 F Generator Portable METS 3. Computer(s) Laptops 4. Printer(s) Cannon Desk Top Computer GX 280 5. Photocopier (s) r9 6. Fax Machine(s) 7. Others a) b) c) *Condition of the equipment (F=Functional, CNFR=Currently non-functional but repairable, WO=Written ofO. 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? When there is a problem with counterpart funding, the issue is addressed by the policy makers of the tt/inistry of Health and Social Welfare. 20 o9 E+_(o3 c\ OoO s ONo(ooo cor o @o o cf) oo cjsN o, ! 0)l c c oo aL(g o) o)L -C a(o c) _c L oF a L 0)CE(u :l ol -o ac .o f _o L c oo Eoc o .c LL iri co o -o(! 8B EB FV= t z g !ErEfr+ E E 3:3 .E(6dd)r= q..Nga Jrotr)totr) o Iu oforr(L o ct| C; @ot (o co -O,( r N- @^ N- q8R \n<o '- (")- rrl: '61 OO N s- co- LO N Ir- o3Rt- -F- @sos @too$ oL oo fc.o :q) Eeo'=o- EB "JZ c C) E C' oL f .9! 'o L o ts(! o.t ulIF o 0) .E o E .9o o L oPq; E* Ou:ON rrid83 ri<o q 9o 3-E [- rf\F 88 (o <+Nst sp Itrlc.i E o o alt os6 oooQooo><oooY$rr,N.- oooooo o_Egi8 ctc 't Og =oo'tr at .95o G- !, (!ocoofo, -o o)ot E o og Eo (E z EEEE{,rrN: o a! ! 0,E o o. o cn '6 o t UJ L(UEc o (I,() o o o o)L o- oL(! o N o BF o alt L tr o o Fz UJ =zd 1! o o ! o ogj E o ^(OOr-X(o$ocot'co c\J (o oo l'r!+se uHRa OOoooo llJzf F UJ oo l dt o tr o G .N '6 o lt, io GOcoo>'EE. c F 3 d.E fi E TEE* E e I = :\O C) O El O i: sE : : : : s -:S q o G5 G lu 6c o tr o o =.9-saoa.d6 giu)= o 0) I ; oEoii LJ O)OI oo c') o) .E .c cc '6 '6 o 0,) o) o,cc cc 'G6 FF ': ctN c\.1 trl tr G t- i c oolco.E.9 19q= +E E E -o.i c.jdc.j (fj c"j f ,U' Elo lDtrt$Htro)(!!,s:s(Eoo) be b E i$ € E .EB e -ctb c Pqt = k EE E g sI s s>o r(\l Ib s $ G o afq ofIt C)r ol1.(L oq (,o @(O $ lr)tr) co c! t-o)lr)N o) o,N N oroq e.itrlNc.itoN@c.i@Nc.)N rO e? @(,t- (\a (olr) co\ cO O)@o) orr) EA Oo, co:o Eeo'Fo- EB "JZ c o) E o L fo .9!, e otrE(E CLt IrJIF o o) (! o E .9o oL oq o rO F- oq t- ro @ @ oo$ O)tr) !, o) oL l -oo ;eE Io->(Uo6 EDF L 't Oe =oo'= o.95o t!_ !, (l,otrooL.-5 E' -ooot E o X6 tro (! z o oq! !, o L o cL o E') tr olt d lrJ L oT' trg(! o o o3 o oL o- oL(! o (\I oiF c o f l! L tr o o Fz IU Ezt uJ o o o 0) o U' ! o IUz J Ft! oof o E tr o G .D o t4 s,o oOCoo>;E5 F E q EE E S B Es€ E 3 9 t ==o I o ir o i: sE : : : : ris q AF oo :G 5\ _G aouJHg 61U !bE so)o)!cc'E cco(5(oF d)d)i nu, o) .= u'==='3F.:.:a '=rEpsd .:r-;oa$.rf .c!c!trq =q= c oq)ca;cg =LCo(o=6\=l- +EEE 9;NCra c.j c.j c.j i U, oo t- c!N Eo!,tsC ouPdtr0)os,EEbftr(uoo) de b Eltrq'2 -o:e E 2 'f o: bEB E Z!5 c PEi E H,9o E E sl -e s>o .:N Ib 'if s E of,E c oo aL(o o 0)Ls U'(u q) -c L o a L 0)cE :l ol _o ac .o :l ! L c oo (E '6 c(o .E LL iri(9 o I(UF q oooo o(9 oo c;t(\ o) ooo$ GI(o o\t G o a5q o- -c.ax =coDOc ECoc 3o-2.e -o)co) =(u(5.= =U)GC>^ r.u =iE cc :ffEEEEooOOqq tr)tr) ct)d CDto(o o o ci coOg r(9 o cotC! o) oooC' r Gio c,t J F oF oz t o @(o(, ca C..l ]C 0)fc C oo aL(o o 0)L -C a(! o _c L o aL o (o ac .o fo L C oo -goC oC 1r lt(9 g lt(EF ooO C\ cOo)c!EeCoGorEl lvs CD CO CO E of olr tE LF o 1.()(o O ro E$$ro F- oL oc o '= c,o :oEe oo .o8q3 -z c o) E 0) o f -o ,2! 'o o) c ts(E o.t ]U IFo L o) (E o ! .9o o E o) oL f -oo ;eE I o sg ctotrF 't o €.eLOeeO =i56E' o(!oci.e .og)u,0)Et o =.E :o z oooN aoa e: o c o o! E, UI (! ! g r! o o o o c o fo L c o o Fz UJ =zt uJ o(, E' o UJz J F UI oo lo to lso .E G N '6 so lt, *o$Oro5>=3" . E 3 -O o .Y f EE .E s T E Ni E H : E E sE : : : : S .i{ q o G)lz o 3 6Eo= tJ 0)OI oo o) o, .s .EG(E o0) C,) o) o,EF= F=.:'=sss .EFFg I Nd .(\o.il =q o G G ut i o u,to a.f U, sEs*EFfr 1r)t- + c9 @_ @ o o{ o a r()t+ -o,(o osou) o$oco@-co N @(o o alovtJ O)(o o- ocoJpP tro,oa ECOC3soo-9<:o<(o,Yqo)gl E*,? 6E EESB0)CL6S EEieocl:-G ,^o6^3o!iiEofEE :g o-o^ff, 'Ho5Eh'EE.E oo-oicc i;Nc")so() -: ,rj ,rj ,rj lr.j q q G o a5q J F oF oz t o G o a q $ c..l @SINcoSo (o N s_ f.-N roq @NN N ooo oo o- @ ooo co oo o- @ J F oF oz tr o al ICIol>l(I)t ol alLIOI[,(E 0) sb9tr=oE;A o:b e:bo!E:6bH P 3=oric>IgEti3;c.idt+$d o ooo o bq G o sa t, E c o o e o S tt 0) t4 tro a-x-OCE3E\\ '- d ) .9(o'=: .= (E c,' iJE.r')IJJOE: Ju,u,d G o a5q 3.3. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) Community support to CDDs were in the following forms Most of the community support to CDDs is usually in kinds such as cups of rice, cassava, plantain etc. Cash incentives are also provided in some communities. 3.4. Expenditure per activity lndicate in table 13, the amountexpended during the reporting period foreach activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. lndictate exchange rate used here_1 USD = 70LD Any comments or explanations? 25 SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Has the project ever been evaluated/monitored? (Tick any of the fo!lowing which are applicable) X Year 1 Partici patory lndependent monitoring x Mid Term Sustainability Evaluation _yes 5 year Sustainability Evaluation lnternal l/onitoring by NOTF _ye S Other Evaluation by other partners 4.1.2. What were the recommendations? 1. Onchocerciasis control work plans should be integrated into overall county annual work plan 2. Counties should have a clear budget for CDTI activities and release funds for sustainability of the program 3. CDTI should fund part of the minimum/recommended package for FLHF. 4. All FLHF staff should be trained on CDTI with emphasis on including ordering of Mectizan tablets 5. Appropriate transport should be made available to county Onchocerciasis Supervisors to facilitate monitoring and supervision 6. Monitoring and supervision should be integrated and checklists used at all levels 7. Community leadership should be enhanced to create ownership of the program and improve CDD. population ratio to reduce workload B. Community-self monitorrng should be initiated to foster community ownership and sustainability 4.1.3. How have they been implemented? A plan has been developed to follow-up with the implementation of the recommendations of the sustainability evaluation. There will be a review in June 2012 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Wastheprojectevaluatedduringthereportingperiod?-yeS Was a sustainability plan written?-yes When was the sustainability plan submitted?-yes What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 26 4.2.1. Planning at all relevant levels Planning was done at all levels. The county health team developed a county health plan on CDTI and also included CDTI into their county health annual operational plan. 4.2.2. Funds Funding for onchocerciasis has been integrated with other NTD programs that have continued to receive support from government and donors beyond the years of support provided for CDTI by APOC. 4.2.3 Transport Vehicles provided by government and other donors will be used to implement CDTI program. 4.2.3. Other resources Government at national and county levels with support from implementing partners will fund integrated plans and budgets developed for onchocerciasis and other NTDs. 4.2.4. To what extent has the plan been implemented The sustainability plan developed by each county will be used to implement the CDTI and NTD programs through the decentralization process of the I\Iinistry of Health and SocialWelfare 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. lvermectin delivery mechanisms lvermectin delivery is done through the supply chain system of the Ministry of Health and SocialWelfare from the National Drug Service to the County Depot. 4.3.2. Training Training will be integrated with other NTD programs and other departments working with the same cadres of workers and community distributors. 4.3.3. Joint supervision and monitoring with other programs Supervision will be integrated with NTDs and Community Health Services Department based on the implementation strategy of the Essential Package of Health Services 4.3.4. Release of funds for project activities Funding for the program will be released by the government of Liberia through the Pool system and the office of Financial lt/anagement at the Ministry of Health and Social Welfare 4.3.5. ls CDT! included in the PHC budgetz The CDTI and other Neglected Tropical Diseases have been included in the Ten Years National Health Plan and Essential Package for Health Service and have been included the into the national budget. 27 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? . Filltables 14 and 15 and provide describe other programmes that are using the CDTI structure and how this was achieved. What have been the achievements? . For each intervention listed in table 15, explain what were the roles played by the CDDs (census, mobilization, distribution, data collection, storage, collection of drugs, referral of SAEs, etc ...)? . Explain what are the combinations of interventions co-implemented? . How were the interventions implemented? (at the same time?) 4.3.7. Describe others issues considered in the integration of CDTI. The CDTI concept has been adopted by the NTD programs especially for LF and onchocerciasis elimination and community Health Services Division to boast community participation in other health care interventions such as malaria and reproductive health. 28 c\ U) o a- Gx 0) i .e u) s) (o o a G 0) ! a) (r) q r o a) a) a) c0 z o o o ol,o-o oo -(E6e -o- E) z E oF f.-t-$ cf) Ns (o @ o)\ir(o N o)f.- tr) O) rn(o @ Ot cn (o of.-N$ Fo60)IJ. IE slf) cf)@o) f.- o o G = @ O) F.- S co(o o o o OEcLobs 3s E) z t oF lo f.-so$t-r N(oo @(o o)N f.- tr) (o O r..t(o(D co C.) 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(o (E O =o 0) o-a a L o) _c o a a o +,(o +, o E o o. E I o o t -o Il(U F Do (E(E EIcc -= Eo -0,6s ur) EE o. E,, E o CL o)tr '=o=Eaobo = 'E. &.e3O th 5 €c!oOP E o! 9. E g63 .9 IHt E A e.- -LL.-oooo EE =oEEe G)^ otro,= c o G o Eg o- E .; o .E E E o o o o E o2 o o) '7= do o- o o) 't o(! q, E o '= 0) o- E o a a a a .c E(E = a C .o(! c 0) E a a a a a 0) C(tr = No L o c .9 :f -o L .9o a !or -oEN €bE-o .9aoE a o c .9 f2o eLA- o= a o c 0) E9o or H''cC;:G L E_o(!(uItrtr a -CEeo= P,d o(/)>E a o _oXo <Hic :?Eo)A6 Oro a o c o P o .= o o) o- F c) L o) .C o E L c oo (E L(E o o C oo o o o c o .E fc (5 (5 E o _co(tr LF o()(o L(E oO a 'a o 'o o)o €E l) --!nO6 .o(6(,) -c.'6o-(Etr'E ;(E .9a .(o E oa o .9Eoa IFa 6L o(.) o o CL F ca q 0) a- (u x a) =.e u) s) o q) a o q) r !q) q q o r q) q) a) c0 e o $ a- e a- a-(U U)(U \o o!- f oft- a - O o)C ,a f a 0) E E CUt- o) o o- o _c. +, o rrt r o -o(!F a4.4. Operational research 4.4.'a. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. No operational research have been conducted in the project area 4.4.2. How were the results applied in the project? No operational Research has taken place since the program began SEGTION 5: Strengths, weaknesses, challenges, and opportunities Strengths - lnclusion of CDTI into the EPHS - lntegration with other health programs - CDDs willing to continue CDTI implementation Weakness - lnadequate government support to CDTI - lnadequate transport logistics and delay in vehicle maintenance due to lack of funds - Lack of supervision and monitoring reports - lnsufficient CDDs in the communities - lnadequate CDDs motivation by the community Poor record keeping Challenges - Lack of vehicle for monitoring and supervision - Provision of monetary incentive by other programs - Bad roads condition especially during the rainy season Opportunities - Development of 10 years Health Plan and Essential Package for Health Services including CDTI - lntegration CDTI into other health programs - Commitment of MOH to deploy skilled staff at FLHF SECTION 6: Unique features of the proiect/other matters Parts of the Project ateaate withrn Monrovra and other brg urban areas in Lrberra This prolect requtres tnnovative strategies to address communily participation, CDD selection and retentron, population updates t I 3l a$ t,