Independent monitoring instrument review workshop: Ouagadougou, 1-11 March 1999

/r'' I f t INDEPEI{DENT MONITORING INSTRUME,NT RE,VIE,W WORKSHOP Ouagadougou, I-l I March, 1999 A.POC w 0 SUGGESTIONS DURATION OF MONITORING About four weeks, including in-country training, data entry and report writing periods. TIMING OF MONITORING Projects to be monitored every lwo years DEPARTURE OF MONITORS Monitors should depart to their respective countries of monitoring from their locations PREPARATORY ACTIVITIES BY APOC MANAGEMENT AND NOTFS l. Team composition Increase team size 1 External Monitor 2 rnternal monitors 1 External NGDO or NC for one week preferably the second week 2. Logistics 2 vehicles per monitoring team to facilitate work in category A and B villages computer for report monitoring, writing materials photo-copying of monitoring instruments Funds for paying local guides National Co-ordinators to remain in their countries durir-rg tl-re first week of the visit of Independent monitors. This is to ensure they will be present for a meeting rvith monitors. SUGGESTIONS-1 Major Differences Between current and Previous Instrument Development Exercises . The team reviewed the indicators to ensure that they are adequately worded and are measurable . The team undertook a one-to-one matching of indicators with the questions in the instrument in order to ensure that relevant information is collected on all indicators . Appropriate instruments for measuring the indicators were determined. Considerable amount of time was spent on determining which instruments should be used to collect information needed to measure each indicators . Reduction in the size of the instruments without loss of information. Based on previous monitoring exercise, it was decided that some questions were redundant. Such questions were eliminated. . Sotne questions were reworded in order to make them more meaningful and easy to understand. The rewording of questions was based on the team's previous experience. ' Tl-re team undertook a pre-coding of some questions for easier and more unifbrm analysis of data across monitoring groups . New instruments were prepared for: r Programme managers r Monitoring of CDTI by communities themselves r Monitoring of CDTI by NOTF REVIEW-ACTIVITY-I t,ti . Pretesting and consequent revision of instruments: A field trip was uldertaken on March 6, 1999 to an oncho endemic area in Burkina Faso to test the adequacy of the instruments. Based on our observations, the instruments were reviewed. . Guidelines were developed for ffaining of field workers, selection of study sites, administration of insffuments and data analysis o A standard format for report writing was prepared by the team. The document includes dummy tables and contents of report. Data Analysis: EPI INFO program will be used to analyze quantitative data. The data entry programs will be ready before the May meeting in Uganda' Textbase Beta for qualitative analysis (content analysis). REVIEW-ACTIVITY-2 I L., i rt REPORTTNG FORMAT BY INDEPENDENT MONTTORING TEAM EXECUTIVE SUMMARY INTRODUCTION - Brief background of the Country and Project including the NGDO involved in the project - Terms of Reference METHODOLOGY - Selection of villages - Sampling - Instruments - Limitations (if any) with data collection RESULTS - Indicators- see analysis of data section - Constraints - Sustainability - Cornrnunity perception - Quality of the implementation of CDTI - [-.,nique features of the project area DISCUSSION AND CONCLUSIONS - According to indicators ( comparing findings with CDTI expectations) RECOMMENDATIONS ANNEX l. List of lndicators 2. List of lnstruments 3. Guidelines 4. Other attachments 5. Debriefing sessions with NOTFs and Country WRs REPORTFORMAT-I i :2. j. " MONITORING INS TRUMENTS INDICATORS FOR INDEPENDENT MOMTORING EFFECT E-1 Proportion and number of target communities which decided on the period or method of treatment E-2 Proportion and number of target communities where the "community" selected their own CDD OUTPT]T 0-1 Proportion and number of refusals two months after distribution 0-2 Proportion and number of absentees that were later treated 0-3 Proportion and number of arrisk villages treated 0-4 Cost per person treated* 0-5 Proportion and number of communities where CDDs were changed by the cornmunity after the first treatment 0-6 Proportion and number of communities in which the CDD is supervised by the health care system 0'7 Proportion and number of target communities which received education about importance of extended ivermectin treatment 0-8 Proportion and number of children 5 years and above who received ivermecrt, l{""t #r,- ,INPUT l-1 Proportion and number of communities with trained CDDs l-2 Proportion and number of communities/projects that experienced late supply or ' shortage of iverntectin l-3 Proportion and number <lf projects which experienced late supply of luncls l-4 Proportion and number of target communities which collected ivermectin from collection point/the health centre * It is suggested that APOC Management considers addressing this indicator separately U l '-, 1-5 Proportion and number of CDDs with measuring device for height 1-6 Proportion and number of communities with treatment registers l-7 Proportion and number of treated communities with summary forms at the district office I -8 Proportion and number of communities whose nearest health facilities have "severe adverse reaction" records t l I a, i.a ,:I Ke), Informant Interview: Village Leaders Village Name: Country: Vitlage Code:_District/LGA : Date of last distribution 1. Please tell us about any prograrnme concerning onchocerciasis treatment in this village? (PLEASE NOTE THAT THE FOLLOWING ISSUES ARE ADDRESSED) . who brought the idea of the onchocerciasis programme to this village? ' when did the person(s) come talk with you about onchocerciasis? ' did the person(s) meet with you and other village leaders first? . what did he tell you? (Probe for community ownership of programme and community responsibility) ' Did he ask for you to arrange a meeting? 2. Horv was the time (month/season) for distribution decided? I at a village meeting - everyone discussed 2. village elders 3. villagechief/leader 4. health worker 5. village committee 6. other (specify) 3. What mode of distribution was decided? 1. house-to-house 2. central place (specify 3. both house-to-house and central place 4 other ( ) 4. How was Lhe mode of distribution decided? I . at a village meeting - everyone discussed 2. village elders 3. villagechiefileader 4. health worker 5. village committee 6. othcr 5. How many persons in this village (CDD) give out the drug for onchocerciasis? VILLAGE A-LEADER -TOOL- I 25. If yes to Q24, where is the register kept? 26. What are your suggestions on how the community could be more involved in treating its members with ivermectin for several years? 27 .ls there anything you will like to tell/ask us? r-, VILLAGE A-LEADER -TOOL-4 ) GROUP DISCUSSION GUIDE AMONG COMMANITY MEMBERS TARGET GROUPS: ADULT MALES; ADULT FEMALES; YOUNG MALES OR FEMALES 1. Please tell us what you know about the onchocerciasis treatment prograrnme (PLEASE ENSURE THAT THE FOLLOWING ISSUES ARE ADDRESSED) ' the person(s) who brought the idea of the onchocerciasis prograrnme to this village ' the time when the person(s) came to talk with you about onchocerciasis ' whether there was a village meeting at that time ' Issues that were discussed at the meeting . ownership of the prograrnme . expectation from the programme . role of the community 2 Please describe how the communiry took decision on the time (month/season) and mode of distribution. PLEASE PROBE FOR: Persons involved in decision-making Time of distribution Why the time was chosen Method of disrribution Why the method of distribution was chosen 3. Please describe how the community took decision on the persons responsible for distributing the drugs to community members. PLEASE PROBE FOR: Persons involved in decision-making Who will be responsible for distribution How the persons were selected Method of drug collection r 4. Has there bcen any change in the person responsible fbr drug drstribution (CDD) since the beginning of the programme? (PLEASE TELL US WHY) I GROUP DISCUSSION-I 5. What were you told about the need for community treatment with ivermectin? (PROBE FOR ANNUAL TREATMENT FOR SEVERAL YEARS, THE BENEFIT, SOURCE OF INFORMATION AND COMMUNITY RESPONSIBILITY) 6. How is the drug normally brought into the community and distributed to community rurembers? PROBE FOR: ' point of collection ' person responsible for bringing it to the community, ' person responsible for distribution within the community and ' mode of distribution 7. Would you please tell us those who should not be treated with ivermectin (exclusion criteria)? 8. How was dosage determined by the CDDs during the last distribution? PROBE FOR MEASURING DEVICE 9. What problems have you had with respect to the distribution of the drug? PROBE FOR ' timeliness of supply to the community ' adequacy of supply ' storage 10. What problems have you had after taking the drugs? I 1. How prepared is the community to take control of ivermectin distribution programme? (How does the community intend to sustain the exercise for several years?) 12. What support has the community given to the CDD? PROBE FOR : . lncentives in cash or in kind . Provision of means of transport . Mobilization of community . Ensuring compliance 13. Could you please tell us how you rvould measure the success o1 thc CDTI progranrmc'? (PROBE FOR THE THREE IMPORTANT MEASURES IF MORE THAN THREE WERE GIVEN) 14. How well has the CDD performed? (PROBE FOR ATTITUDE). GROUP DISCUSSION-2 IN-DEPTII INTERVIEIY OF CDD Name of Village Name of CDD Main Occupation: Village code: _ District/LGA: Sex: 1. Female 2. Male Date of first distribution (CDTI) i L II u J .!t Date of last distribution (CDTI) 1. How was the time (month/season) for distribution decided? l. at a village meeting - everyone discussed 2. village elders 3. village chieflleader 4. health worker 5. village committee 6. other 2. What mode of distribution was decided? l. house-to-house 2. central place (specify 3. Both house-to-house and central place 4. otl-rer ( ) i. Hou, u,as the mode of distribution decided? 1. at a village meeting - everyone discussed 2. village elders 3. village chieflleader 4. health worker 5. village committee 6. other (specify) 4. J-low were the persons (CDDs) selected to do the work? l. at a village ntecting - everyone discusscd 2. village elders 3. village chieflleader 4. health worker 5. village committee 6. other (specify) 5. Has any CDD been changed after the first distribution? 1. Yes 2. No 3. Don'tknow CDD-I 6. If YES to Q5, Why was the CDD changed? 7. Have you ever been suPervised ? 1. Yes 2. No 3. Don't know 8. If yes to Q7, who supervised you ? (IF NAME WAS METIONED; PLEASE ASK FOR IDENTITY/POSITION/STATUS OF THE PERSON) 1. Health staff 2. Village health committee member 3. NGO partner 4. Community member/chief 5. Other (specify) 9. At what occasions were you supen,ised? (TICK ALL THAT APPLY) l. Before distribution 1. Yes 2. No 2. During distribution 1. Yes 2' No 3. Soon after distribution 1. Yes 2' No 10. Have you received education on the importance of taking iverntectit-t tablet annually for several years? 1. Yes 2. No 3. Can'tremember 1 1. Did you provide the community with education on ivermectin treatment? 1. Yes 2. No 12. lfyes to Q1l, when did you provide the education to the community? (TICK ALL THAT APPLY) l. During the first meeting l. Yes 2. No 2. Before the first distribution 1. Yes 2. No 3. During distribution 4. Soon aftcr distribution i. Ycs 2. No 1. Yes 2. No 5. Otlier (spccify) 13. If yes to Ql1, what did you tell the community? (TICK ALL THAT APPLY) 1. Taking ivermectin annually for several years 1. Yes 2' No 2. Benefits of treatment 1. Yes 2. No 3. Communityresponsibility 1. Yes 2' No 4. Side effects I ' Yes 2. No rJ i 6DD -2 J ,,. 15. l6 14. Did you receive any training on how to treat community members? l. Yes 2. No If Yes to Ql4, when did you receive training? Who lrained you'/ l. Hcalth personnel/oncho coordinator 2 NGDO staff (specify) 3 ,.\rrothcr CDD 1. Other (specify) 17. How long drd the training last? 1" training 2"d training_ last trarnrng 18. How many CDDs were trained together (size of the group)? 1'' trainin.q last training.- 19. Was the venue of training convenient for you? (PLEASE EXPLAIN IN TERMS OF DISTANCE TO VILLAGE AND SPACE OF VENUE) 1. Yes 2. No 20. Ilno to Q19. u,hy? 21. What \\'ere you taught during training about onchocerciasis (TICK ALL THAT APPLY) l. Etiology/cause 2. Symptoms 3. Socio-economic importance 4. Community perception of disease 5. Ivermectin as treatment for a long time 6. Other (specify) 1. Yes i. Yes 1. Yes 1. Yes 1. Yes 2. No 2. No 2. No 2. No 2. No 22. What were you taught about the drug? (TICK ALL THAT APPLY) l. Duration of treatment l. Yes 2. Coverageof distribution 1. Yes 3. Dosage determination by measuring height l. Yes 4. Expiration of drug after removing container seal l. Yes 5. Treatment of absentees 1. Yes 6. Side effects (counseling and referral) l. Yes 7 . Exclusion criteria 1. Yes 8. Record keeping 1. Yes 9. Census 1. Yes No No No No. No No No No No - ql 10. Other (specify) CDD-3 2. 2. 2. 2. 2. 2. 2.) 2. 23. What were you taught about reporting? (TICK ALL THAT APPLY) l. Number of persons treated 2. Number of refusals 3. Number of absentees l. Yes 2. No l. Yes 2. No 1. Yes 2. No t- 3r. wr fri!il t J r 4. Numberofexcludedpersons l. Yes 2. No 5. Number with severe side effects 1. Yes 2. No 6. Other (specify) 24. Did any member of the community collect the drug from a collection point? 1. Yes, always 2. Yes, sometimes 3. No 4. Don't know 25. If "yes, sometimes" or no to Q24, why? 26. Where is the collection point? Zl. Did you experience late supply of drugs during the last distribution? L Yes 2. No Please explain 28. Horv do you normally determine the quantity of drugs required by the community? l. Census 2. Previous treatment records 3. By counting the number of households 4. Other 29. Did you experience shortage of drugs during the last distribution? l. Yes 2. No 30. How do you determine the number of tablets to give to an individual? (TICK ALL THAT APPLY) L Take height measurement 1. Yes 2. No 2. Use weight 1. Yes 2. No 3. Visual observation 1. Yes 2. No 4. Age 1. Yes 2. No 5. Other (specify) at do you do about individuals who are absent during normal distribution period?_ CDD -4 32. What do you do about individuals who refuse treatment? 33. Which categories of people would you not give the tablets (PLEASE TICK ALL THAT APPLY) l. Individuals below 5 years of age l. Pregrrant womcn 4. Sick individuals 5. Visitors 6. Other (specifo) 34. How do you ensure that these categories of people receive treatment? 3. Women who delivered less than two weeks before distribution 1. Yes 2. No l. Yes 2. No l. Ycs 2. No l. Yes 2. No l. Yes 2. No 35. How long do you normally keep the tablets in the communiry? 36. Where do you normally keep the tablets? 37. Do you have drugs to take care of minor side effects? I. Yes 2. No lS \\'hat kind of support do you receive from the community? l. Transportation for drug collection 2. Incentives (specify) 3. Other (specify) 39. Do you have problems with record keeping? 1. Yes 2. No 40. If yes to Q39, please explain 41. Please tell us how you feel about the programme (PROBE FOR WAYS OF SUSTAINING THE PROGRAMME; COMMLTNITY RESPONSE; CONSTRAINTS ; SATISFACTION) 42. What do you think should be done to improve the programme? I It- l! U IJ n CDD-5 43. Are you willing to continue as a CDD? l. Yes 2. No Please explain PLEASE ASK FOR REGISTER AND MEASURING DEVISE TO PROVIDE ITO I- I.O\\'ING INFORMATION 44 Is nreasuring device for height present? 1. Yes, seen 2. \'cs, but not seen (Explain 3. No, Explain 45. Is treatment register present? I. Yes, seen 2. Yes, but not seen (Explain 3. No, explain 46.|f Q45 is "Yes, seen" EXAMINE RECORDS AND OBTAIN INFORMATION ON: l. Total population 2. Age composition of people: Below 5 years_ 5 years and above 3. Sex composition of the population: Male Female 4. Number of persons treated 5. Number of persons aged 5 years and above who received treatment 6. Number of refusals 1. Number absent during last treatment 8. Number with severe reactions 9. Number of tablets received 10. Number of tablets used 1 1. Number of tablets left in the drug kit I .j II CDD.6IJ 't Key Informant Interview: Villaqe B Leaders Village Name: Country: Village Code:_District/LGA: Date of last distribution rr ! U J \n I . I Iavc people in this community been treated with ivermectin in the past one year? l. \'es2. No 3. Don't know rF NO TO Ql END TNTERVIEW 2. How was the time (month/season) for distribution decided? 1. at a village meeting - everyone discussed 2. village elders 3. villagechief/leader 4. health worker 5. village committee 6. other (specify) -l \\'har nrotle of distribution was decided? 1. house-to-house 7. central place (specify 3. both house-to-house and central place 4. other ( ) 4. Horv was the mode of distribution decided? 1. at a village meeting - everyone discussed 2. village elders 3. villagechief/leader 4. health worker 5. village committee 6. other 5. I{ow many persons in this village (CDD) give out the drug for onchocerciasis? 6. Ilow were the persons (CDD) selected to do the work? 1. at a village meeting - everyone discussed 2. village elders 3. villagechief/leader 4. health worker 5. village committee 6- other - VILLAGE-LEADER-B-TOOL- I .t id J l' 7. Have the CDDs received any training? 1. Yes 2. No 3. Can't remember 8. Have you changed your CDD? 1. yes 2. No 3. Don't know 9. Did any member of the community collect the drug from a collection point? l. Yes 2. No 3. Don't know 10. Did you experience late supply of drug during the last distribution? 1. Yes 2. No 3. Don'tknow 11. Did you experience shortage of drugs during the last distribution? 1. Yes 2. No 3. Don'tknow 12. Does the community have a treatment register? l. Yes2. No 3. Don'tknow VILLAGE-LEADER-B-TOOL-2 Instructions to Representative Answer in The Village Name response=99 **code: nothing=1, modern medicine:2, traditional M ottl g Questrons Should []c Ansivcrcrl hy to List f'he Names ol'All rhe Mernbers or"t'hc I Iouscrrorcr. Ncx( Appropriate Column (Use Additional Sheets It l{equired). (codc Village code livcry Mcrnbcr of-'l-he I Iorrscholrl I l)osc 'l hc Iiollorvrng Qucsttons to all no response code as 9) I:rrsl Ask IIrr, IIcarl of 'l'he Ilotrscholcl or His/her Lach IloLrsclrLrld Mcnrber And Record 'l'he Date of last treatnrent headache=04, swelI ing:05, nausea./vomiting:O medicine=3, others:4 refusal:4, not informed:5, sick=6, others:7 VILLAGE: IF YES TO QUESTION I IF NO TO QLilrST. I QUESTTON 2 NAMES of household members During the last general treatment, did you receive tablets? Y=1 N=2 How did rt affect you?* If unwell within two days, what did you do?** Why did you not receive the tablets at that time'7* * * Have you. taken these tablets srnce then? \':1 N:2 Did you take the tablets the year before the last distribution? Y=l N:2 ***code: child<S:1, absenF2, pregnanF3, _. rrl IN-DEPTH INTERVIEIY OF CDD (VILLAGE BI \.rnrc tll'Vrllage Name of CDD Villagecode:_ District/LGA: Sex: 1. Female 2. Male Date of last distributionMarrr Occupation: l. Horv were the persons (CDDs) selected to do the work? 1. at a village meeting - everyone discussed 2. village elders 3. village chief/leader 4. health worker 5. village committee 6. other (specify) 2. Has any CDD been changed after the first distribution? 1. Yes 2. No 3. Don'tknow -l li.n c voll e\ er been supen,ised ? l. Yes 2. No 3. Don'tknow 4. If yes to Q3, who supervised you ? (IF NAME WAS METIONED, PLEASE ASK FOR IDENTITY/POSITION/STATUS OF THE PERSON) 1. Health staff 2. Village health committee member 3. NGO partner 4. Community member/chief 5. Other (specify) 5. Have you received education on the importance of taking ivermectin tuUt"t annually for several years? 1. Yes 2. No 3. Can't remember . Did you receive any training on how to treat community members? . 1. Yes 2. No L lri, tJ I J CDD-villageB-1 I 7. Is measuring device for height present? 1. Yes, seen 2.Yes, but not seen (Explain 3. No, Explain 8. Is treatment register present? l. Yes, seen I Yes, but not seen (Explain 3. No, explain I J J I CDD-villageB-2 QU ESTIONNAIRE FOR HEALTH PERSONNEL District: Country. Name of health personnel Position: Qualification: ,l .l IIJ n Responsibilities in Oncho control Programme: 1 Oncho Coordinator 2 other (explain) 1. Drd you receive any general orientation to CDTI? 1. Yes 2. No 2. Did you receive training on how to train CDDs? 1. Yes 2. No 3. Please tell us what you know about the cDTl programme with respect to: 1. Role of the Community responsibility 2. Role of the health system in CDTI 4. Was there an initial meeting with the community where CDTI programme was introduced? 1. Yes 2. No 5 lf yes to Q4, what role did the health staff play in arranging for the first meeting? 1. Facilitated the meeting 2. Met with village leader to anange for the meeting3. Other 6. Who led the facilitating team to the community? 1. health staff 2. government administrative staff 3. NGDO staff 4. other_ 5. Nobody Health Personnel - r 7. Were the communities (where you worked) educated on the importance of treatment with ivermectin tablets? 1. Yes 2. No 3. Don't know B. lf yes to Q7, what were they told? (TICK ALL THAT APPLY) 1. Annual treatment for several years 1. Yes 2. No 2. Benefits of treatment 3. Community responsibilitY 1. Yes 2. No 1. Yes 2. No 4. Others (specify) 9. Were CDDs in the communities (where you worked) trained for the CDTI programme? 1. Yes 2. No 3. Don't know 10 lf yes to Q9, did you participate in the training of CDDs? 1. Yes 2. No 11. Who supervised the CDDs 1. Not supervised 2. Village head 3. Village health committee member 4. health personnel 5. Other 12. lf not supervised, why? 13. At which occasions did you visit the CDD? OICK ALL THAT APPLY) 1 Before distribution 2. During distribution 3. Soon after distribution 4. None 1. Yes 2. No 1. Yes 2. No 1. Yes 2. No 1. Yes 2. No ": tr "J ItJ *t 14. What functions do you perform during your visit to the CDD? (TICK ALL THAT APPLY) 1. Collection of unused drugs after distribution 1. Yes 2. No 2. Review of records 1. Yes 2. No' 3. Management of adverse reactions 1. Yes 2. No 4. Supervision of drug distribution 5. Other (specify). Health Persomel - z 1. Yes 2. No 15. What constraints do you have in supervising the CDD? (TICK ALL THAT Apply) 1. No constraints 2. inadequate/lack of means of transport 3. Too much work 1. Yes 2. No 1. Yes 2. No 1. Yes 2. No 4. lnadequatellack of supervision allowance/remuneration 1. yes 2. No 5. Other (specify) 16. Have there been any delays in both receiving and distribution of drugs? 1. Yes 2. No 17. lf yes to Q16, please explain 18. What constraints have you experienced in getting the drug? (TICK ALL THAT APPLY) 1. Transport problem 1. Yes 2. No 2. lnadequatesupply 1. Yes 2. No 3. Delay in supply 1. Yes 2. No 4. Other 5. None 1. Yes 2. No 1. Yes 2. No l L-J I J il 19 How do you estimate the quantity of drug required by the district? 1. Not responsible 2. Number used during last treatment 3. Based on requests from the communities 4. Total population (with the formula) 5. Other (specify) 20. Did you get the drugs when required by the district? 1. Yes 2. No 21. lf no to Q20, why? 1. Shortage at state, regional level 2. Means of transport 3. Other 22. Do you have facility for storage of ivermectin? 1. Yes 2. No 3. Don't know Health Personnel - : 23. Have you experienced loss of tablet due to pilferage? 1. Yes 2. No 3. Don't know 24. Were cases of severe adverse reactions reported to you? 1. Yes 2. No 25. RECORDS OF ADVERSE REACTION (CHECK AVAILABILIry) : '1. Available 2. Not available 26.Are you willing to continue to participate in the cDTl programme? 1. Yes 2. No whv? 27. Whal other health activities do you combine with oncho control programme activities? rd ti Health Personnel - ag I INTERYIEW GLIIDE FOR POLICY-MAKERS/ WRs/PROGRAMME MANAGERS/ COORDINATORS l. Please describe how the CDTI prograrnme is being implemented in your area PROBE FOR a- The approach used for introducing GDTI to the communities b. Elements of collaboration between Community, Health system and NGDOs(IDENTIFY SPECIFIC ROLES) c. General re-orientation of health personnel towards CDTI programme d. Training of health staff as trainers 2. Please explain process of receiving ivermectin. PROBE FOR : a. Delays in supply r at what level and why? c. Adequacy of the quantity received./shortage d. Storage e. Dishibution to communities f. Constraints (storage, transport, etc) g. Pilferage 3. FUNDING: Please probe for a. Delays in receiving funds o at what level and why? b. Adequacy of funds received c. Fund administration (disbursement and retirement procedures) d. Cost per person treated POLICY-MAKERS-I t: +J J fi 4. Please describe the programme's plans for improving sustainability 5. Which other health activities do the oncho supervisors combine with their oncho control programme activities? 6. Would you please explain the programme's record keeping procedures EXAMINE THE FOLLOWING RECORDS Summary sheets: 1. Available 2' Not available 7. EXTRACT INFORMATION ON: a. Total PoPulation b. Number of villages in the area c. Number of villages with summary forms d. Number of villages treated e. Number of eligible PeoPle f. Number of PeoPle treated g. Number of eligibles treated h. Number with severe adverse reacttons i. Evidence of report update (check annual returns after distribution) 1. UPdated 2. NotuPdated g. MOH POLICY MAKERS ( Permanent Secretary/Director Disease Control) a) Do you have a national Plan for the control of onchocerciasis ( Probe for the importance attached to onchocerciasis control b) How do you perceive the CDTI strategy of APOC ( Probe for personal opinion and official policy on CDTI) c) Is the Oncho Programme integrated into the health system ( Probe for activities which indicate integration and ownership/ Plans for Sustainability. I , P.LICY-MAKERS-2rl I ,i3 6 9 INTERVIEW WITH WHO COUNTRY REPRESENTATIVE What is your perception about the APOC strategy for ivermectin distribution ( Probe for feasibility of the CDTI concept to solving other health problems) what is the relationship between the wHo office and the national onchocerciasis Task Force (NorF) with respect to CDTI implementation.( Probc for issues relating to transfer of funds, support to NOTF and monitonng) a) b) ;Lr lJ € POLICY-MAKERS-3 ( i) I-I MONITORING BY COMMUNITY Indicators 1. Access to the drugs, ivermectin 2. Management of side effects 3. Compliance by community members 4. Performance of CDD 5. Community support for CDD actrvities 6. Storage and quality of record keeping l. Name of community 3. Name of CDD 4. Sex 5, Name of the previous CDD if there has been a change 6 Date of last distribution 7. Number treated 8. Number absent <) Number refused 10. Number to be treated iater 11. Number of tablets available at the of distribution 12. Location of collection point 2. Date. 3. Age .... 13. Did any member of the community collect drug from the collection point during last distribution Yes No 14. CDD used measuring stick to determine dose yes No 15. Update of records Yes No 16. Storage facility available in the community yes No 17. Late supply of drugs yes No18. Drug shortage last distribution yes No19. Unmanaged side effects in the community yes No20. Drug Kits available 21. Tick the type of support given to CDD by the community (D Incentives ( Cash/ in-kind) yes No(ii) Transportation (iii) Others 22 Date of next distribution 23 Date of next supply of ivermectin ... Yes No Yes No rl j {t COMMUNITY-SELF-MONITORING-TOOL- I DOCUMENT FOR NOTF TO MONITOR THEIR OWN PROGRAMMES Aim: NOTFs will use findings for improving performance and monitor adherence to CDTI implementation procedures \\'hat to monitor: Process oICDTI implementation (training, mobilisation, education, supervision, community support and involvement and constraints). User: It is advised that NOTFs include independent experts from research and educational institutions. Target: Respondents are community leaders, CDDs and Health workers. .j J 6 SECTION A: COMMUNITY (Village chieflleader ) Name of Village Village code: _ District/LGA: I. Plcase tell us what you know about onchocerciasis treatment programme ( Probe for the orvnership of the programme, expectation from the programme and role of the cornmunity) 2. Please describe how the community took decisions on: a) time of distribution b) mode of distribution c) persons responsible for distributing the drug 3. What support has the community given to the CDD? 4. How does the community collect drug from the central point? 5. How well has the CDD performed? 6. How does the community intend to sustain the CDTI programme for several years? 7. Please tell us how you will measure the success of the CDTI programme? NOTF-monitoring-l SECTION B: for the Community- directed distributor (CDD) Name of CDD Main Occupation: Date of last distribution (CDTI) l. How were decisions taken on the following: a. time of distribution? b. mode of distribution ? c. selection of the CDD ? 2. Who supervised you ? 1. None 2. Health staff 3 Village health committee member 4. NGDO partner 5. Committee member /chief 6. Other (specify) 3. At rvhat occasions were you supervised? (TICK ALL THAT APPLY) 1. Before distribution 1- Yes 2. No 2. During distribution 1. Yes 2. No 3. Soon after distribution 1. Yes 2. No 4. Have you received any training on how to keat community members? 5. If Yes to Question 4, how many times have you attended training? 6. If Yes to Question 4, when did you receive the last training? 7. How many days did the last training last? 8. \\/hat do you know about a) Onchocerciasis (the disease)? b) Treatment with ivermectin ? c) Reporting? Sex:-. Date of first distribution (CDTI) NOTF-monitoring-2 t.-l t I .a ""r 9. Did any member of the community collect the drug from a collection point? 10. During the last distribution, did you experience: a) Late supply of drugs? b) Shorlagc of drugs? I l. How do you manage: a) Minor side effects? b) Severe side effects? 12. What kind of support do you receive from the community? 13. How has the community been mobilised for CDTI activity? 14. what difficulties do you encounter in performing your functions? SECTION C: HEALTHWORI(ER Nante: l. What is your position in the oncho. control programme? 2. What is your role in the CDTI programme with respect to: a) Training of CDDs? b) Supervision of CDDs? c) Supply of ivermectin drug ? d) Storage of ivermectin drug? e) Management of severe adverse reactions? . 3 Did you receive any training on your role in the GDTI programme? 4' Which other health activities do you combine with Oncho Control programme activities? 5' What difficulties have you experienced in the performance of your functions? \, NOTF-monitoring-3 )J it ,t Data Anall,sis Fornrat Indicator E-l: Proportron and nunrbel ol talget cornrrruuities u,hich decrded on thc pelrod or method of treatnlent: Sources of quantrtatilc infbrnratron. Villagc leader*, Q2, Qa; C'DD*, Q2, Q3 and Q4 Table E-l.l: Pelcentage drstributron of targct conmrunities according to how time oldistribution wasdecided** Decision-Maker Source Source Village leader (Q2) cDD (Ql) No. (%) No. (%) At a village meeting Village elders Village Chief/elders Health worker Village committee Other Total number r * Use both A and B villages to calculate proportions among village leaders and CDD o ** Table above relates to one village. Use sanre to calculate for all villages Sources of qualitatrve information: Village leader, Q1; Group discussron, Q2 ,\N; lli l', r\ I r . <'f . -.l| -.Jodl\1u. Table E-I 2: I)rstlthtltlolt rr{'talgct cotttltrr.rnltlcs accolrlrng to hori,nrode ol-clrstlr6rrrrtl. r'as decided Decrsion-Maker Sotrrce Source Village leader (a4) cpp - (at No.(%) No. (%)At a village meeting Village elders Village Chief/elders Health worker Village committee Other Total number *+ Use both A and B vrllages to calculate proportions among vilrage readers ard cDD Sources of qualitati,e iribrmation: village leader, e1;Group discussio,, e2. xr<**1.{<*r.*,** ,,\N.r' IS-l;, -'A',l' r "-: I - tD Indrcator E-2: Propoltrou and nurrber ol'target courntlllrtres rvhete tltc "colttlltLlltlty" selected their own CDD Source of information: Vrllage leader, Q7; CIDD, Qa u.'i'' Table E-2. Drstribution of communities accordrng to horv CDDs u'ere sclected Decision-Maker Source Source Vrllage leaders (Q4) cDD (Q3) No. (ol,) No. (%) At a village meetirlg Vrllage elders Village Chief/elders Health rvorker Village committee Other Total number (Possible) sources of qualitative infon"nation: Village leader, Q1;Gloup Drscussion, Q2 h.rdicator O-1: Proportron and r.nrrlber of relusals trvo months after drstrtbtrtron Indicator O-2: Proportion and numbel of absentees that were [ate1 tleated Indicated O-8: Proportiou and number 5 years and above wiro received ivertlectiu ,,\r l.'l r\l J,3 t = Table O-l: Tleatr.nent Strruntar-1, rruustrlrulu sutvcy; l(ec - recotos i;J;.,", o-3. Proportron arld number of at-,sk villages treared Indicator O-5: Proportron and number of conmrunities were CDDs were changed by the community after the first treatment Sources of Infomration: Household survey and in-depth interview with CDD in group B; for CDD change, obtain information Table ...Proportron of vrllages treated and in which CDDs were changed after the first tr.eatment LGA,Parish Villages (Both A and B) Treated (Yes,No) CDD change (YesAIo) A I (A) 2 (B) 3 (B) 4 (B) 5 (B) B from village leader Q12; ttunlber of conturunities in which the supervisol is supervisedby the health care system. tluttlber of target cotlrntutltties rvhiclt t'ecerved health education about importance of extended ivermectin treahnent. hrdicator 0-6: Proportion Indicator O-7: Proportron and and G Villase 6 HS - I-lo ehold r e ; I{ oidi r\ N,/ lS 1,, A'l ll Table ...Proportrort ,rl'r'rllages ri,liich rcccrvcd lrcalth cducallon alld ln \\ hrch ('DDs rvcrc supelvisecl by health care systcnr LGA/Parish Vrllages (Both A and B) Receivecl health education (Yes/No) CDD supervised by health system A I (A) B Indicators l-1 to I-8 Table: Indicatols I-l to I - 7 Others I . Sustainabihty: Key Infomrant intervierv (Que stions I , 8, 14, 18,21, 22) Group discussion ( Questions 1, 2, 11, l2) In-depth urterview ( Questions 13, 38, 41) Intervierv guide for Programnre Mattagers ( Questions 4) 2. Indicators of Success ( Conmuniry perceptron): Group discussion ( Questions 10, 12) Key Inforrnant 3. Communify perception of programure Key Informaut ( Questionsl ) Group discussion ( Question 1) LGA/Parish Vrllages Trained CDDs Late Supply Drug Shortage Late Funds Collectron fi'om a point Measuring device for height available Treatment register available Summary form in dishict office Adverse reaction record available YesAio YesA.{o Yes,No YesAJo Yes,t',lo Yes,No YesA.{o YesA.{o YesA.Io A 1(A) 2 (B) 3 (B) 4 (B) s (B) B :,, *T B GUIDELINES I. MEETING WITH WHO REPRESENTATIVE IN THE COUNTRY Brief the WR on the mission Fix date for debriefing session with WR 2. MEETING BETWEEN EXTERNAL AND INTERNAL MONITORS -Train nationals on instruments, data collection and analysis (l day) - Develop Plan for field activities in category A and B villages 3. MEETING WITH NATIONAL COORDINATOR & NGDO PARTNER (Hqs). Discuss objective and modalities for selection of site, local guides and discuss field activities. Plan field activities in category A and B villages Discuss logistic and other needs of the monitoring team 4. MEETING WITH PROJECT TEAM AT STATE/DISTRICT LEVEL Discuss objective, selection of site and discuss field activities. Selection of villages to be visited (categories A & B) Monitors should be allorved 2 days in the district to select and train local guides Selection of local guides who are capable of working in the selected villages Train local guides to understand the instruments (especially concepts like mode and time of distribution, community perception of CDTI, community role in CDTI, the concept and responsibilities of the health system) Plan for sending advance messages to selected villages. It is advisable not to inform communities earlier than two days prior to arrival of the team Discuss logistic and other needs of the monitoring team The monitors should, as soon as training of local guides has. commenced, share out responsibilities among themselves in order to save time in the field METHODOLOGY: SAMPLE SELECTION A minimum of 30 villages consisting of 6 category A (core) and24 category B villages must be selected by stratification based on social structure, accessibility to healttr facility ( far and near) and geographical spread ( first line and secondary villages based on Rapid' Epidemiological Mapping for Onchocerciasis (REMO)). A village is considered ' near' if it r< is less than 8 kilometers from health facility. ir .li.. I GUIDELINES-I J ft I- By category A villages we mean, those villages in which in-depth study will be undertaken. - By category B villages, we me:m those villages in which minimum information is obtained with the purpose of determining whether distribution has taken place. In order to ensure that for each category A village, a minimum of 4 category B villages are covered, select 5 group B villages for each category A village at the initial stage. DATA COLLECTION A) ROLE OF INTERNAL MONITORS There will be two internal monitors. One internal monitor will supervise data collection in B villages while the second internal will work with the external monitor in category A villages- Both internal and external monitors will be involved in data collection' B) ADMINISTRATION OF INSTRUMENTS Eight instruments must be administered. These are: (l) In-depth interview with villaee leader. If a village head is not available, intervierv his assistant or representative. (ii) Group discussions with community members. In each group A village, one Male and one Female adult group discussion must be conducted. In three of the six group A villages, group discussions must be conducted with male youths-and in the remaining three discussions must be held with female youths. For monitoring CDTI projects, youths are defined as individuals between 15 and 24 years- Ideally, each village must be informed that group discussions among male, females and youths will take place before the monitoring team arrives in the village. The cDD must arrange for a comfortable place that offers some privacy and enough places to sit Each group must consist of 6-8 people Depending on culture, the group discussions may need separa'te meeting place for male and female so that people can speak freely One of the monitors should be the moderator while a local guide person takes notes (rccorder) r-, J {N GUIDELINES-2 :L ftltl;U J GI (iii) In-depth interviews with CDDs. At least two CDDs must be interviewed in each village. To be administered only in group A villages. (iv) In-depth interview with villaee B leaders. To administered only in group B villages (v) Household Survey This instrument must be administered in group A villages. A minimum of i5 households should be surveyed in each village. In a village with less than 15 households, survey all households. Otherwise, select the household in such away that all the different parts of the village are adequately represented. In any selected household, accept surrogate response if member is not around. If in the absence of household head, the wife refuses to respond, go to the next household. Similarly, if there is no respondent in a selected household, go to the next household. (ui) In-depth interview with CDD in eroup B villaees Two CDDs per village must be interviewed. (r'ii) In-depth interview with health personnel This instrument should be administered on the district/LGA oncho co-ordinator. A minimum of 3 health personnel who are supervisors of ivermectin distribution programme should be interviewed. (viii) Interview quide for proqramme Manaqers/ co-ordinators This instmment should be administered to state and district co-ordinators. Treatment Register In addition to the instruments, treatment registers must be examined to obtain relevant information on: - Total population - Number of children under 5 years of age - Number of people 5 years and above treated - Number of refusals - Number of absentees - Number of ineligibles Also, the treatment registers should be examined for accuracy of recording. GUIDELINES-3 Cross-checking accuracy of dosage In a minimum of 3 goup A villages, efforts must be made to crosscheck accuracy of dosage. This will be achieved by taking heights of 5 randomly selected individuals and comparing the ideal number of tablets with the actual number of tablets given by the CDD. ! : J {t GUIDELINES-4 Training And Data Collecting Guide Informations for Trainers This guide is to provide some instructions for using the different monitoring instruments. The trainer should begin by discussing the philosophy of the CDTI programme and describing what is expected of programme implementors. The trainer should explain in very clear terms the meaning of certain concepts in the local language : I.CDTI : the process of entering the community, the role of the community in design and implementation, (the difference between CDTI and CBTI should be mentioned ). 2. Time of distribution : the season or the month 3. First distribution : note that distribution may have been on-going in the area using other methods. First distribution refers to the first time the community will use CDTI approach 4. Last distribution : this refers to the most recent distribution of ivermectin within the community. It does not refer to the last time the individual was treated but the last time the entire community had their general distribution 5. Mode of distribution : this refers to the method of getting the drug to every individual within the community e.g. central point, house-to-house or a mix of both central and house-to-house. It is very important that the trainees have a general understanding in the local languageof several other terms that will be used frequently in the field (e.g. oncho programme, m ecti zanlivermectin). At the beginning the trainer should briefly the objectives the exercise and the importance of collecting accurate data. The trainer should ensure that the trainees practice interviewing and note-taking during the training period. Every participant should take part in role-play *O in learning to use the various tools. Trainer should demonstrate how to tick (circle) the appropriate responses, especially the multiple responses. It should be emphasised that the interviewers and facilitators should not be in hurry even if there is some delay at the beginning of the exercise. They should take care to listen to the responses and to probe or repeat the questions when they are not well understood by the respondent. To avoid delay it is recommended that you send advance notice (the day before) to the village chief so that all the persons needed would be around when you arrive in the village. Be on time if you have made an appointment. Do not delay or change the appointment without giving any information to the community. Key Informant Interview : village Leaders ( vilage A and vilage B) This instrument is to be administered on the village chief or a representative of the village chief- The chief can ask another person to assist with the interview and even have a .uy d*irg the interview. Do not refuse. Most of the question are structured so you put in a circle *o.rrrd appropriate codes. But do not prompt the responses but allow the respondent to answer while you circle the appropriate option to the respondent's answer. Listen to the chief and choose t, TRAINING GI.IIDE-I zrmong the items provided. If he tells something different select'Other' but write in the space provided for the actual response. This is applicable to all instruments except the group discussion. In the B villages the person you choose for the interview may not be the chief. It can be any head of household or any adult. So he is chosen randomly. So when you enter the village choose the first head-of-household or the first adult you see for the interview. From him get itrlormation on the name and location of the distributor and interview him/her later. Group Discussion among community members This is an important tool for obtaining the community perception of the programme. The constitution of the group is crucial to the quality of information that will be obtained. Ensure that the group is homogenous with regards to social class, age and sex. Ressource persons from the community can assist you to constitute the group. If you are provided more people than required ( more than 12 persons) choose randomly the required number and explain reasons for not selecting them. Remember it is important that the group is homogenous at least for some caracteristics : age, social stafut, sex). The group discussion must be tape recorded. Obtain the consent of the group members. In the unusual situation that they object to the use of the tape get someone to take notes of the responses. your attitude during this session is very important. Do not react to the answers as if you are already doing the analysis. Do not display emotions of suprised, disgust or become _lLrdgemental. By all means do not let them know your opinion. Be the moderator and manage the discussion in such way that everyone participates in the discussion. Summary the discussion. To avoid that some participants do not live before the end of the group discussion, clo r-rot excced more than an hour. Some discussions sometimes go on among the participants atier the session has formally ended and it is good to listen and make notes of all relevant issues related to the discussion At the end of the session, play back the tape for a few minutes to be sure that the discussion was properly recorded. Label the cassette (Narne of the Village, the group identity, date). ln-Depth Interview of CDD ( Village A and village B) Choose a maximum of 2 CDD per village. The in-depth interview of the CDD is adminstered in the same manner as the interview of key infbrmant. Before beginning the interview ask the distibutor to get his tools ready and get them around : measuring devise, registers, remaining drug if it is the case... When a question requires multiple responses, do not forget to put a circle around each applicable response code. + Household Survey ( Village A only) This instrument is to be administered to 15 household in all the core villages. Choose randomly. The households so selected should be representative of the entire community. Therr questions should be answered by every member of the household. First, get from the head of ; TRAINING GUIDE.2 Jfrl: fa J g Itouseltold or his representative the names of all members of the household. The head of household or any member of the household can answer for members.who are absent and for the children. If there is nobody to answer in a household go the the next household (near the one previously chosen). For each person put the code corresponding to the answer in the required column. Questionnaire for health worker This qucstionnaire is adressed to any health worker in the area of the programme which health centre has some villages of the sample in their catchment area of this health centre. It is also for any health worker involved in the process at different level : national, state, district. So coordinators at different level should be interviewed. So the number of helath personnel to be interviewed depends on the situation on the ground. Before the interview ask the health personnel to bring all the tools he uses in his activities which are related to the implementation of CDTI. Interview guide for CDTI programme managers This interview is administered on Coordinators and representatives of the NGDO involved in the programme. It is like the interview of health personnel. The tools such as registers should be requested before the formal interview so that information can be extracted for the report. TRAINING GUIDE-3 COMMUMTY DIRECTED TREATMENT WITH IVERMECTIN (CDTD MOIYITORING TOOL REYIEW MEETING OUAGADOUGOU, l,-tt MARCH tggg LIST OF PARTICIPANTS DR. OLADELE B. AKOGUN Parasite and Tropical Health, Department of Biological Sciences, Federal University of Technology, Yola, Nigeria PhoneiFax: (234) 75 626467 E-mail: akogun@cyberspace. net.ng or : badakij@unijos.skannet.com DR. BAMIKALE FEYISETAN c/o Policy Research Division, Population Council, One Dag Hammarskjold Pleza, New York, NY 10017, usA Phone: (212) 3394687 - Fax: (212) 755-6052 E-mail : bfeyisetan@popcouncil.org PROF. RICHARD B. BIRITWUM Glrana Medical School, Department of Community Health, P.O. Box 4236, Accra, Ghana Phone: (233) 216677 05 - Fax: (233) 2166 81 61 E-mail : biritwum@africaonline. com. gh DR. (Mme) BISSEK ANNE-CECILE DAV ELIG ESSONO, 8.P.4129, Yaounde, Cameroun Ter: (237) 23 95 12 - Fax: (237) 31 73 78 ... DR TIEMAN DIARRA Institut des Sciences Humaines, B.P. 159, Bamako, Mali Tel: (223) 2l 14 64 - Fax: (223) 22 75 88 E-mail : cemanjae@yahoo. com PROF. OBIOMA NWAORGU Department of Applied Biology, Enugu State Universiry of Science & Technology, P.M.B. 01660, Independence Lay Out, Enugu, Nigeria Phone: (234) 42250836 (office) - (234) 42256128 (Home) - Fax: (234) 42257499 E-mail: onwaorgu@infoweb.abs.net lt :l U J c DR FLEURIE MAMADOU YAYA Directeur R6gion Sanitaire N" 5, B.P. 18, Bangassou, Bangui, R6publique Centrafricaine Tet. Q36) 6t 4528 - lr U J T