I I I APOC CDTI SUPERVISOR'S GUIDE A PRACTICAL GUIDE F'OR STJPERVTSION OF CDTI BY LGA/SUBCOT'NTY LEVEL PERSONNEL r"Li*: I i I J ]" +@ f { ',i - - I I I E SEP ?l]t]'z ,.,,,. ir i i I i tl tor lnformo?ion ToriF .- ,", l3 *-.i:v 9tf't t< t-i; For Action Tol I\. ,. ,H \ # : '" B -*' *- $. s ict ..: r.'1li+ .t1\- :::r" ..? ''1 , +' - ""#'dt8 .:.. * Au.o3 2TO SUPPORT SUPERVISORS OF CDDS IN ENSURING QUALITY DELIVERY OF CDTI ACTIVITIES AT THE COMMUNITY. Produced by: DR. Uche Amazigo CSD a.i APOC and Mr. Ukam Oyene State Oncho Coord inator Cross River State CDTI Project, Nigeria. 3'd draft IOtl' August ,2002 JCONTENTS In this Guide for supervisors of Community Directed treatment Distributors (CDDs), you will find the following inforrnation helpful you to get started in your work as a CDD supervisor. The guide has the following sections Section A Background The purpose of this guide How to use this guide Who is a supervisor? Membership of Supervisory teams at all levels of GDTI implementation. Functions of Local Government / Sub-County Onchocerciasis Control Teams (LOCTs) Section B Outline for supervision process - Planning for supervision - Preparation of work plan Section C Steps for effective supervision of CDTI in the Community. - Plan supervision exercise - Materials to take during supervisory visits - Use of supervision checklist - What to know about the community? - What are the key health education messages for the community? - What do you know about record keeping and reporting? - Mission or objective of supervision exercise - What supervisors rnust look out for during supervision - Use of check list for supervision - Integration of Supervision into Primary Health Care (PHC) - How to collaborate with other sector in supervision - What you need to supervise at each period in the treatment round Section D FEED BACK FROM SUPERVISION: 4SECTION A BACKGROUND: The method of community- Directed Treatment with (CDTI) has been adopted by the African Programme for Onchocerciasis Control (APOC) to distribute Mectizan in l9 countries in Sub- Saharan Africa. It is a method of drug delivery designed to ensure active community participation and ownership of Mectizan distribution. The Objective of APOC is to establish within a five year period a process to empower the communities to the responsibility for deciding on selection of CDDs, determining mode and period of treatment, and proving the necessary support both in cash and kind to the implementation of CDTI activities for as long as necessary. The realization of this goal would greatly depend on the quality of implementation of activities in the community. PURPOSE OF THE GUIDE A major purpose of this handbook is to support you to effectively supervise CDDs for quality delivery of CDTI activities ar tlre community. It is hoped that this rvould contribute to the achievement community participation, ownership and sustainability of CDTI In this guide , we shall Iist (describe) the process, functions and task of supervisors of CDDs in CDTI. o a HOW TO USE THE GUIDE o Please find time to read this guide prior to starting supervision During your planning meetings it would be helpful to take turns reading this book out loud and to discuss the ideas together in your tearn. Do not forget to along with you during visit to the community. It would not be bad to refer to relevant portions of it when the need arises. a Master the content of the book for more confldence in the work. WHO IS A SUPERVISOR? o A supervisor is some who as been trained by the CDTI method and has been assigned a State/district, LGA/Sub- county, a cluster of communities to over see the day-to day implernentation of CDTI activities. o o 5a Primarily the responsibilities for supervision rest on the Health service, community and the NGDO. In the spirit of collaboration other partners in health and development have a stake in supervision of CDTI at all levels and should be co-opted as supervisors. B MEMBERSHIP OF SUPERVISORY TEAMS AT ALL LEVELS OF CDTI IMPLEMENTATION A NOTF Membership: o National coordinator o NGDO Coalition group o Other members of the Ministry of Health, NOCP o Ministry of Information and Media organizations o Ministry of Education, an other agencies in Human Development . Indigenous NGOs S TA T E/D I S T RI C T O N C H O C E RC IASIS COI{ T R O L TEAMS Membership o Staff of Ministry of Health Onchocerciasis Control Unit . Other PHC Programme officers/managers o Ministry of Education, information, and women affairs o Government Agencies in Human Development activities o Media organizations . LocalNGOs o CBOs etc LOCA L G OVE RN M E NT/S U B -C O U NTY o NC H O C E RCIA^SI^S CONTROL TEAM (LO Cr) Membership o LGA/Sub-courrtry Primary Health Care Staff o Education and Information department staff o Forestry and Agricultural extension agents Development staff o LocalNGOs o CBOs . Religious leaders etc C 6FUNCTIONS O F LOCAL GOVERNMENT/SUB-COUNTY oNC H O C ERC IA,SIS COTTTROL TEAM (LO CT) Calculation of number of tablets for next treatment Provide assistance in the organization of Community feed back forum. Advocacy visits to community leaders Mobilization of village groups - religious, traditional Annual meeting with all the leaders of the communities in LGA/sub-county Sensitization and health education of communities Trainirig CDDs on census - assisting CDDs with the initial exercise to ensure it is Properly done Supervision of distribution of ivermectin in the villages under his/her supervision Initiation of community self-monitoring and stakeholders meetings a a a a a a a a n z -<,O E, o<oz z z oo oo o-(r)z t oF Ioz 6 o)EfC_Ols-- o o !.I- Eq:08U>s(D.s t- (E .=rEo ,E U;E o - (l)= o!20 .E 5r:>s o\: tr)'CK.s k =.E oo >* =oc{oo b o E *$Dbo6Ao L (, (Jro(I)'< c -oc'=oq &E"EZ'oP.9. aoa LSbc b8E s 6# =LaL6r- €5e '-L€ ri t.s o) .Ea efoo >\g ;.4 6! \'-o (= E 8.82_=E <U)o Eg s8o-FXf, u.r O L o occo:'6 p 6 >*8P i - =9ddE_ :(I,c qO P'rn g? o _^';.9 -ov, i-P R! o';=I- O-'{= (I,JI()>LL(,C,(o c * O-o.ta 6 .=L6 s &[ adtr o aC-e55b00: >'If c 0).YI o-i -Yl(E(J(,)o tBraa: E 8_xdaE lU =tl! 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CaE - g? g,r FE 9O-O)Fch H EsEA o TU =Fo -oaA =Eo=o->d5 S(E =oEdeg. hU) e E:EEO>TU co ir*ggis := EExEE E rr aL_P)!U,^L g 5 Es !Lv,E8Ep, EP:E =:E:Y>D> P ]U oillb C' IU HA@O z U' o\ zI<buo<oz z t oF o o z bB'ioLUrOO'< oE _O (..P'= E 8- E.E2aAe _ng fi8IF v4D r.u O 2ptr0)oE -aF9b(Ip ccooE :98EL(UL (D: .o o-(E*=c:r> :o(,(E IU =u LL TU =F o(I) o I -oo lJ. (D z o tr C) Oc=Erak 0E d.o .I!(IIO)F-r L 6- dr= ? BESHEE(Io- Lo ort; U' TIJ F Fo b o Ee 0:g .= >\Eo .aa aE .o- r= r(/) uJ Fo]U (D o o tr o]U TLa z a il WHAT DO YOU HAVE TO SUPERVISE? Prepare a work plan for supervision of,CDTla a A work plan is a schedule of activities prepared within a time frame to guide CDTI implernentation .lt is prepared to meet the resources and the ATo of the project. Remember you can have a monthly, quarterly and annual work plan . ldentify the key CDTI activities to supervise . Determine the peak CDTI periods/months o lntegrate the plan into on-going PHC and other development plan /activities You can prepare a work plan for supervision to suit you following the guide below o I O LUo X X X x x oz x X Fo o X X (L tU U) of Jl -) z :) - x X x X x t o_ x X X x X tr X x x X x co tulr X x X X X X X X x z -) X X x x x X x C o ta a -aa >r LL _or AAIlror F C) oJ AaItrOI ^ -Faao -u-arorf Fo@ar.)I TLlor Fo@anIl.L 11 or Fo@a 9"=+ Foaa11Ilrllor Fo@a(.)-lrlior avo(5 F a .o .= o afUDCcO 8Eb9 -E .E=(/)0) '>b Eiu!+1]JOU)= Ec(s C .o oAoo l3ots C- :3E>o H* =(,6e o .c .g o oo O o c .9 .9. z o o.f U) c oq) EL o rF o c ^c:6€ >:lb€o-.= =AAE cc.o -P(tr(o o.NT:*-o E9 -LE: .9o>EIq56U) o) o oLf,ooG'Cb9 -:z (o8E _cE()= +COO.lo-*a6 c o o) EL o o *c B.e !-o6 O.=o.QAp ac =E E5oooE6 -E'.=ccoo (u=> .9 orol z.s Eg)o c o+o-EXz =$?U)cr) o-.tr O oo O o .Y Eeo5 -Ooo) o_LQ=oq) .Etr =EJ(EO0) 4€ c)p a o c oEaoco)o(s '{=co(E(tr >E tro o !J. o z o o =tlrJ o.fo t. oll. z tLYt o = o CL E o x lrJ t4 SECTIOIY C STEPS FOR EFFECTIVE SUPERVISION OF CDTI IN THE COMMUNITY STEP 1: PLAN SUPERVISION EXERCISE,. Determine the supervisory area and location of the villages How many villages are in each comrnunity in your catchments area? List them by name How do you locate the name and the house of the village leaders ? How do you locate the name and the house of women leaders, religious leaders? How do you locate the name and the house of every cDD in villages under your supervision? Determine the mode and cost of Transportation Secure appointment with village leaders and CDDs Prepare a schedule for the supervision exercise > MATERIALS TO TAKE DURING SUPERVISORY VISITS . Checklist (make copies and take with you); o Pens, Pencils, notepad o Treatment summary forms o Supervisor's Guide > I|/HAT TO KNOW ABOUT THE VILLAGE/VILLAGES o Example: Socio-economic activities and health needs of the community a a a a a a a l5 > WHAT ARE THE KEY HEALTH EDUCATION MESSAGES FOR THE COMMUNITY? Example a Give adequate messages on what the CDTI method is about, and what a community would gain as the lead partner. The contributions of the external partners by the Ministry of Health and NGDOs o Provide information about how much the external partners (Ministry of Health, Merck and NGDOs) are paying to bring Mectizan to the community. lnform community members and CDDs about it. Use this information to encourage community to take on the responsibility of supporting the CDDs. tr Emphasis the need for registration update and the benefit to all partners o Explain how to conduct Mectizan treatment, eligibility, exclusions criteria, possible reactions, and management of minor reactions and referral of severe reactions. o How to calculate number of Mectizan required for next treatment > WHAT DO YOU KNOWABOUT RECORD KEEPING ANT) REPORTING? Example: tr How to complete a treatment register. o How to complete the treatment summary form. o How to forward reports on treatment to collection point Note: Your ability to position nnd market CDTI in the community depends on your understanding of the concept find power of presentation. Bear it in mind that you need to leave the village better tn med a,bout CDTI st the e,nd o ench visit. l6 > MISSION OR OBJECTIVES OF SUPEVISION. WHAT DO YOU HAVE AS YOUR MISSION OR OBJECTIVE FOR EACH SUPERVISORY VISIT? tr You need to have a mission statement to address the supervisory task to be performed during the period of the distribution round. o You are to provide minimum but effective supervision for CDTI activities at the community level. WHAT SUPERVISORS OF CDD MUST LOOK OUT FOR DURING SUPERVISION? (SUMMARY OF KEY INDICATORS): Availability of standard register, measuring instrument, chalk, pencils and pens. Registration update in the communit1, s66 records of registratiorr Number of drugs supplied to the comrnunity and inventory of supplies. Presence of Health bducation material such as posters in public places and flip charts in use at the community. Determine whether cornmunity took Decisions on mode and period of treatment o Adequacy of dosing and criteria for exclusions o Follow-up of absentees and refusals a a a o o Note: When you are in the community endefivor to intimate the community leadership of your presence and explain the objectives of your mission. At the end of the exercise discuss your findings with them. The communities have been complaining that tltey see you around but do not know your mission and the outcome o, ur visit. 17 a O a a Are pregnant women and sick people later treated? Determine the quality of recording and reporting of treatment Quantify Cornmunity support for CDTI in cash Ascertain the management of minor adverse reactions and ref-erral of severe reactions Availability of treatment records in the community Have the mechanism for planning and implementation of community self- monitoring and stakeholders meeting been put in place. Are there plans by the community to execute CSM and HSM? a a a WHAT DO YOU NEED TO GUIDE YOUR SUPERVISION? YOU NEED A CHECK LIST FOR SUPERVISION! A checklist is a guide to ensure that during supervision CDTI performance indicators are systematically assessed. Without a checklist there would be no uniformity in procedure and to compare performance of the different CDDs and communities would be difficult and you may easily forget to check on some key indicators. a l8 Exarnple : CHECKLI FOR SUPERVISION F CDDs AT COMMT TY LEVEL Name of Community Name of Supervisor. LGAlsub-county Date . Mobilization & health education of comntun ity leaders, entire community and other target groups in the roles -! Lr and res biti in CDTI 2 Registration update undertaken by community J Qqlleqqon of drug from agreed point 4 Number of Mectizan adequate 5 Inventory of Mectizan 6 Selection of CDDs by community 7 Number of CDDs adequate 8 Cornrnunity decision on mode of distribution 9 Community decision on period of d istribution l0 Treatment undertaken by CDDs l2 Skills of CDDs on dosing adequate r3 Follow-up of absentees and refusals l4 Pregnant women later treated one week after delivery l5 Management of minor reactions l6 Referral of adverse reactions 17 Skills of CDDs on record keeping adequate l8 Treatment records avai lable l9 CSM and SHMs planned/ implernented 20 Feedback on appraisal (t zt! 2 o(.) Fz t.l(n e t-Zooozaz ori FzD92Aodao. t.l F >7 z- EJ z=\ U< q ri F F Q oo LL o o d (.) .E oo 'o 6 o h0 Cg o o(_) d E L 9-v! 992 d=o< .- -c QoC0cq.9 8.$(c o5 'otr >tr 0) '5 od o o C) o. ! 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22 WHO DO YOU INVOLVE OTHER SE,CTORS IN SIJPERVISION OF CDTI AT THE COMMLINITY? YOU CAN COLLABORATE WITH OTHER SECTORS IN HUMAN DEVELOPMENT TO PROVIDE MINIMUN BUT EFFECTIVE SUPERVION IN THE COMMUNITYY. WHY: collaboration with others to help keep track of GDTI . Health programmes and other positive events in the community. Others in the comrnunity such as teachers, Agric extension workers. Forestry. and other voluntary groups who work for the well being of the community Exarnple: In cross River State, Nigeria field staff of the National park has been co-opted to supervise cDTI in remote villages of their support zone. In Uganda Teachers and other literate members of the community have been co-optgd to aid supervision, while in Sudan Soldiers have undertaken supervision in unstable areas. wHo WHEN: Collaborate with others all the time in your work as a CDD supervisor HOW To initiate an effective collaboration with other sectors in CDTI = Identify development programmes, CBOs, Schools found in the community. = lnitiate a meeting and explain the benefits to be derived by the partnersh ip. ]lnvils the partners for orientation on CDTI. = Invite your partners for the stakeholders meeting in the conrmunity. = Develop a check list for joint supervision with other sectors 23 WHAT YOU NEED TO SUPERVISE AT EACH PERIOD IN THE TREATMENT ROUND.. BEFORE TREATMENT WHAT TO ST]PERVISE! o Follow up to ascertain community has applied to resolutions from the last appraisal of distribution in the community. Check to ensure thai community registration update have been conducted and inspect the register to check adequacy of format and entries tr Check for availability of measuring instrument and for correct calibration o Determine whether community has taken decision on the number of Mectizan tablets required, from the registration update, arrangement for transportation and the period for distriburtion. DURIIVG TREATMENT WHAT TO SUPERVISE! o Find if the decision on period, and rnode of treatment have the knowledge of a largersegment of the population, it is important to minimize absentees and ensure adequate coverage. D Determine whether CDDs and community leaders have given health education to members of the village. o Determine correctness of dosing and the use of the scale, do spot check on those already dosed. Also check to ascertain that ineligibles are not treated. Check the recording of doses in the register to ascertain correctness. o Find out whether CDDs have Followed-up on absentees and refusals o Determine the number of pregnant women who were later treated after one week of delivery. o Determine the number of sick people treated after they recovered. o Determine if adequate decisions have been taken on the custody of drugs and registers during and afier treatment. Check how CDDs are handling the rnanagement of minor reactions B Check referrals patients with adverse reactions if any by CDDs to the Health centers tr Check if there are records on adverse reactions at the health centers. AFTER TREATMENT, WHAT TO SUPERVISE o Visit the village to determine the community's knowledge of their responsibility on record keeping and reporting and stress its importance to them. Inspect the CDD records and take some time out to update the skills of CDDs and other volunteers such as teachers in recording and reporting. Stress the need for prompt reporting. 24 tr o Assist the implementation of Comrnurrity self-Monitoring and stakeholders meetings for appraisal of CDTI in the community. o Give feedback (strengths and weaknesses, opportuhities for improvement) to the community from the health service. Plan adequately to meet the community with the CDDs. SECTION D FEEDBACK FROM SUPERVISION REMEMBER TO REPORT YOUR SUPERVISION TO ALL STAKEHOLDERS! = Intimate Community leaders and CDDs of your findings and hold brief discussion on how to improve on their performance before leaving the community. = Visit the head of health facility and other staff and debrief them on your findings and highlight aspects that require improvement from their part and also the community. = Prepare a detail report of your mission for your office and if need be the LGA health department and discuss ways of improvement = Endeavor to use the result of your supervision to update your plans for training, Health education and supervision in the Cornmunity. Note: Please take notes of important observation in the communify t