Northwest CDTI annual project Technical report submitted to Technical Consultative Committe (TCC): January 2007 to December 2007

RESERVED FOR PROJECT LOG NORTHWEST CDTI PROJECT ? I aI ORIGINAL: English ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC To APOC Management by 31 Julv for September TCC AFRICAN PROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) t a -FF'i z0n0 - CO Y/NOTF: LIBERIA Proiect Name: NORTHWEST CDTI PROJECT Approval vearz 2004 Launching year: 2004 Reportins Period: From: January 2007 To: December 2007 Proiectyearofthisreport: (circleone) I (2\ 3 4 5 6 7 8 9 10 Date submitted: January 2007 NGDO partner: SSI Fon To: cs\ CM Mle 3Fo FO 3 { r.( ) LY for To, I fi 6 WHO/APOC,30 July 2007 IANNUAL I}ROJECT TECHNTCAL ITBPOIi.T TO TECI INICAL CONSULTATIVE COMMITTEE (TCC) EI\DORSE,ME,NT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: I Country : LIBERIA National Coordinator Narlc: Mr. I-len T. Salilir Signature Date: . * L/ r-<'. Q.:..Qr.!.:{1... Zonal Oncho Coordinator Name: NONE Signaturc: .. I)ate: ... NGDO Representative Narnc: Mrs. Vcrd4'l'arpeh s ignarurc, . . . .i'/r*/^ {" -/:- i 'l'his report has bcen prepared by Namc : l-rcnry'r'. salilu Dcsignation : AP Signature: .. ,/r:L_. Date 0{ rl WI IO/nl'}OC. 30 .lu11' 2007 I d Table of contents ACRONYMS v I DEFINITIONS... VI FOLLOW UP ON TCC RECOMMENDATIONS I EXECUTIVE SUMMARY 2 SECTION l: BACKGROUND INFORMATION........ .....................3 L l. GpueRer- rNFoRMATroN............. 1.1.1 Description of the project (briefly) 1. 1.2. Partnership 1.2. Popu1arroN............... 2.1. Trvpr-ne oF ACTTvITTES 9 2.2. 2.3. 2.4. 2.5. Apvoclcy ..................... l0 Moetl-IzertoN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMuNrues l0 Cotrlutntry INVoLVEMENT......... ..... 1l Capacmy BUTLDTNG.. ...... 13 3 J 5 6 2.6. TRpervpNTS................ 2.6.1. Treatmentfigures l7 17 .............28 .............29 .............29 .............29 2 2 2 2 2.7. 2.8. 2.9. 3.1. 3.2. J.J. 3.4. 6.2 What are the causes of absenteetsm?.......... ................. 20 6.3 What are the reasonsfor refusals?................ ...............20 6.4 BrieJly describe all lcnown andverified serious adverse events (SAEr) that... 20 6.5. Trend of treatment achievement from CDTI project inception to the current year 22 ORoeRntG, sroRAGE AND DELIVERv oF IVERMECTIN ...........23 CovurrNrry sELF-MoNrroRrNG AND STAKEHoLDERS MtprrNc ............25 SupnRvrsloN.... 27 2.9.1. Provide aflow chart of supervisionhierarchy . . .................27 2.9.2. What were the main issues identified during supervision? .............................. 27 2.9.3. Was a supervision checklist used? ............. 27 2.9.4. What were the outcomes at each level of CDTI implementation supervision? 27 2.9.5. Was feedback given to the person or groups supervised?................................ 282.9.6. How was the feedback used to improve the overall performance of the project? 28 SECTION 3: SUPPORT TO CDTI ..............27 EqurrueNr.. FrNaNclel coNTRIBUTIoNS oF THE pARTNERS AND coMMUNrrrES.. OrHpR FoRMS oF coMMUNITy suppoRT ............... ExppNotruRE PER ACTIVITy . SECTION 4: SUSTAINABILITY OF CDTI....... ..........30 4.1. INreRNer.; INDEIENDENT pARTrcrpAToRy MoNrroRrNc; Eva1unrloN.................... 30 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick aryt of thelollowingwhich are applicable)............ ........... 30 4.1.2. What were the recommendations? ............. 31 4.1.3. How have they been implemented? ............. ................. 31 lll WHO/APOC, 30 July 2007 I I4.2. SusreNeert.rry oF IRoJECTS: ILAN AND sET TARGETs (uaNoeroRy AT................ 31 Yn 3)......... ................ 31 4.2.1. Planning at all relevant levels... ................. 31 4.2.2. Funds........ .............. 3I 4.2.3 Transport (replacement and maintenance). . . . . . ...................... 31 4.2.4. Other resources ...... 31 4.2.5. To what extent has the plon been implemented................ .............. 31 4.3. INrecRerroN ............... .....................32 4.3.1. Ivermectin delivery mechanism,s................ ..................32 4.3.2. Training.... ..............32 4.3.3. Joint supervision and monitoring with other progroms........... ...... 32 4.3.4. Release offunds for project activities ........ 324.3.5. Is CDTI included in the PHC budget? .............. ........... 32 4.3.6. Describe other health progrqmmes that are using the CDTI structure and how this was achieved. Wat have been the achievements?............. ...... ............. 32 4.3.7. Describe others issues considered in the integration of CDTI. ..... 32 4.4. OpennTroNAL RESEARCH ....32 4. 4. 1 . Summarize tn not more than one half of o page the operational research undertaken in the project areawithin the reporting period. ........ 32 4.4.2. How were the results applied in the project?............. .................... 32 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES.... ...................33 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........33 I lv WHO/APOC, 30 July 2007 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT I-JNICEF UTG WHO African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organ ization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization v WHO/APOC,30 luly 2007 Definitions (v) (i) Total population: the total population living in mesolhyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84Yo of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of Ivermectin distribution and make appropriate modifications when necessary. vl WHO/APOC, 30 July 2007 FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, frll in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session I Number of Recommendalion in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROTECT FOR TCC/APOC MGT ASE ONLY 207 Give an explanation for low number of tablets per person heated Miscalculation of figures copy corrected Review the geographic data is it really 100% when some communities were not heated) and therapeutic coverage data where it is over 87% Same as above Give treatment data for year I to 4 Correct treatment data for year I to 4 Provide information on community involvement Correction noted in succeeding treatment cycle I Give details of the monitoring carried out Same as above 208 Increase advocacy in next cycle and carry out CDTI activities in a shorter time frame Same as above 5h year project, therefore should be addressing integration and sustainability issue. CSM and SHM to be introduced CSM and SHM will be introduced in the next treatment year Need to increase advocacy for more funds from the MOH NOTF met with the Honorable members of the House of Representatives Standing Committee on Health and meeting was successful Need to address integration Train more district and health staffand more CDDs CSIVI and SHM to be inhoduced Mentioned needs are noted for the next treatment cycle (Please add more royys if necessary) WHO/APOC,3O Ju,ly 2007 rl 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, WG, 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. A total of 2,680 communities exist in the Northwest CDTI project are with a total population of 2,260,867 in the meso/hyper area. A total number of 1,486,041 persons were treated giving the therapeutic coverage of 66%. The Ultimate Treatment Goal (UTG) and the Annual Treatment Objective (ATO) are 1,899,128 and 1,478,692 respectively. All communities were treated giving a geographic coverage of 70Yo. Population movement in treatment areas was very minimal in the reporting period. With relative peace now in the country after the civil crisis, intemally displaced persons returned home and were engaged in farming activities. Most people were found home during treatment hours in the evenings. Same was true in the case of communities that chose to be treated in the moming hours. Training of OICs and CDDs was carried out in all project areas. A total number of 8,530 CDDs (7,959 males and 571 females) were trained. A total number of 533 health workers exist in the project area while 159 health workers are involved with CDTI activities. A major challenge in the CDTI implementation reporting period was that some misinformed individuals carried a wild rumor that the County Health Officers were holding on to monies sent by APOC and intended for the CDDs compensation for the distribution Mectizan. Many CDDs stayed away for a few weeks until NOTF rectified the alleged rumor. NOTF committee of 3 promptly visited the affected communities and carried out intensive sensitization and mobilization with emphasis on APOC Philosophy and community role and ownership of CDTI programs. The County Superintendents were very instrumental in talking the CDDs into returning to duty for the benefit of their own people. At the end, treatment went well with a therapeutic coverage of 660/o. 2 WHO/APOC,30 July 2007 SECTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geo graphical location, topography, climate Population: activities, cultures, language Communication systems (roads ... ) Adminis tration s tructur e Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). Number of health staffin project area and number of heolth staffinvolved in CDTI activities. The Northwest CDTI project is located in the northern western and western part of the country. CDTI activities are situated in five (5) endemic counties of Bong, Nimb4 Lofa, Gbarpolu and Montserrado counties. The total population of these counties is2,260,867. The climate is tropical and humid all year round, with significant variation between the dry season (October-April) and the wet season (May-October). Most of the roads in the project zlreas are unpaved, thus causing difficulty in movement in the counties. In the Northem Counties, palm tress grow wild and the area is fertile for both upland and low land cultivation of rice, the staple food. Other vegetation includes the tropical rain forest with many fast running rivers, which covers over 75o/o of the land area. The coastal area is marked by mangroves, dwarf trees, small bushes and various grass types. The population of the communities is normally settled almost homogenous in rural areas and fairly heterogeneous in townships and cities. The leadership structures in the communities various with the types of communities. In villages and towns, there are elected chiefs who are guided by council of elders in decision making. The townships and cities have commissioners appointed by the president of the country and city mayors are elected by the residents of the cities. The occupation in the communities varies between urban and rural settings. The rural communities are engaged in farming activities from January to September. The inhabitants of the townships and the cities are engaged in commercial activities and other salaried jobs. Communication for dissemination of important information is through the leadership strucfure. Upon proper authorization in rural communities, town criers, drummers, and health workers who are also members of the community may be used to disseminate information using loud speakers in the community or market places. House to House methods including local radio stations are also used. There are 533 health staff in the project areas and 159 involved in CDTI activities. J WHO/APOC, 30 July 2007 Total Number of health Number of health staff involved in CDTlstaff in the entire proiect area B1 B3=BZBI'100%District GBARPOLU COUNTY 6 4 67YoBelle 24 4 't7%Gbarma 6 4 67o/oKonqbah 48 5 10o/oBopolu 4 67%Bokomu 6 33o/oGuo 6 2 96 23Subtotal BONG COUNTY 40o/o10 4Sanoyea 11 6Zola 12 3Panta Kpaii 3Suakoko 15 5Salala 12 5 42%Jorquelleh 12 42%Kokovah 12 5 50%Fuamah 10 5 38%Subtotal 94 36 LOFACOUNW 25o/oVoiniama 20 5 6 40%Zorzor 15 40Yo15 6Salayea 20 5 25o/oKolahun 30 8 270hFovah b 38loVahun 16 36Subtotal '116 NIMBA COUNTY 20 7Gbehlay-Geh 8Tappita 15 6 17%Yanivin-Mehnsonnoh 35 20o/oSaclepea 30 6 32o/oSanniouellie 25 8 4Oo/o't5 6Zoe-Geh 197o/o140 41Subtotal MONTSERRADO COUNTY 4 40o/oTodee(Lower/Upper) 10 50o/oCaresburq 10 5 4Oo/o10 4St. Paul 5 20%Monrovia South 25 5 16%Monrovia North 32 23 166%Subtotal 87 30Yo533 159Grand total Number of health staff involved in CDTI lease add more rows Number of health staff involved 82 1 55% 42% 35o/o 53o/o 4 WHO/APOC, 30 July 2007 1.1.2. Partnership Indicate the partners involved in project implementation at all levels IMOH, NG DO s (national/international), communitie s, lo cal or ganizations, et c. l Describe overall working relationship among partners, clearly indicating specific areos of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, ,f any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The Community The community leaders select CDDs for training in preparation for Mectizan distribution and sensitize the population on the importance of taking Mectizan. The CDDs, also part of the community, mobilize, sensitize and distribute Mectizan to their respective communities. The communities take ownership of the CDTI activities and pay CDDs incentives in kind or cash to distribute Mectizan. Community members and CDDs report side effects due to Mectizan and members with poor vision are referred to health centers for eventual follow-up by appropriate health authorities. Ministry of Health The Ministry of Health (MOH) and NOTF at all levels do the planning advocacy, mobilization, sensitization, and supeivision of CDTI activities. At the end of treatment year, NOTF prepares all technical reports to be sent to APOC. NGDO During this reporting period, NGDO partner, Sight Savers International (SSI), participated actively in the planning, advocacy and supervision of CDTI and Eye care activities in the country. The Mectizan Donation Program supplied the needed quantity of Mectizan requested and on time. 5 WHO/APOC, 30 July 2007 F-oo c.l i. o c.} U o. o (o o{ F- o o, Or.(o @ o o, @. @I N(o oI(o @ c) (, Ff oc = 0,- ::EGE-bo 'E qo @(o N. oN o@N. 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Cd >,d z >'. cB a .E cB= l-{g $iA. l-{9. tr9. l.rA" v4, -€) .E.E s= &troor-()a EE o U a''! oL CU otrd ()k CB z o l-< rd -z oLd\=a EO -E >rL< ct3 Lr(d x CN Cd >\ Cd (d >. Cd Cd Li Cd Cd tr .aF r-'r E> C,HfrilF{O z Frz o Q og L{ CB -oo b0 tro FA ,rE o Fl c0p tr z o € COL (l) a {-Jtro 2.2, Advocacy State the number of policy/decision makers mobilized at each relevont level during the current yeor; the reason(s) .fo, undertaking the advocacy and the outcome. Describe dfficulties/constraints beingfaced and suggestions on how to improve advocacy. As the project enters its fifth year of implementation, advocacy is our primary concern to ensure sustained treatment coverage. This time around, advocacy was carried out to the Honorable House of Representatives Standing Committee on Health. NOTF Secretariat lobbied and met with the Honorable members in an informal manner. The main purpose of the meeting was to sensitize and enlighten the Honorable members on Onchocerciasis control and efforts being made by APOC and other partners to control the disease in the country. NOTF also ceased the opportunity to advocate for increased budgetary allocation to the Oncho control program. ln their response, the Honorable members promised to take our request to the rest of the House and to ensure increased funding from central govemment to the Oncho project. They most importantly promised to keep the established channel of communication between NOTF and the House of Representatives opened. 2.3. Moblltzatlonr sensltlzatlon and health education oJ at rlsk communltles Provide information on : The use of media and/or other local systems to disseminate information Mobilization and health education of communities includingwomen and minorities Response of target communities/villages Accomplishments Suggest ways to improve mobilization and sensitization of the target communities. In communities, mobilization, sensitization and health education are done through the leadership structure. Upon proper authorization, town criers and message drummers are used when necessary to disseminate important information. A house to house method may be used in cases of personal messages like family planning methods and the likes. In urban cities, a modified town crier approach of using loud speakers in market places is very common. The response by the target communities to these positive as reflected in the increase of our treatment coverage over the previous year. Considering the treatment data, as indicated in this report, we believe that mobilization achieved its desired results as there is improvement in both the therapeutic and geographic coverage over the previous year. In the 2008 Mectizan distribution year, we intend to carry out an intensive ,mobilization in all communities that have not achieved treatment coverage of 65%. These communities have to be reoriented on the importance of taking Mectizan. l0 WHO/APOC,30 July 2007 sN co N Lo -o o o z$N o.{o 'Jr (o(o(\ t c{(\,tN srt N N ro Ezf oo f o o.tr<g Eg sF. s(r) sl.- s o) sNto s s rf, s ro s|f, so) sr.- s o) s(D so@sO) @ (?, F- !t o N(., ro (') F. 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IL U) E foo(! '5 eco EEoz(! o co = E o lt =U' E o E E(9 fri 2.6.2 What are the causes of absenteeism? The major cause for absenteeism in this reporting period was mainly due to farming activities. With relative peace in the country, farmers returned to their original dwelling after the war and engaged in rice cultivation to feed their family. Those that receive treatment did so in the evening hours only. 2.6.3 What are the reasons for refusals? The major cause of refusal is due to experienced result of mild reactions of headache, temporary swelling of legs and itching of the skin as noticed from neighbors who took the Mectizan tablets. Briefly describe all known and verified serious adverse events (SAEs) that Occurred during the reporting period and provide (in table 8) the required information when available. 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Ordering, storage and delivery of ivermectin / Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH wHo UNICEF tr NGDO Other (please specify) Mectizan@ delivered by - Qilease tick the appropriate answer) MOH N wHo UNICEF tr NGDO f] Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities The required Mectizan stock for the year is calculated and ordered by NOTF using standard methods. The order is sent to the Mectizan Donation Program. When Mectizan arives in the country, World Health Orgarization (WHO) clears it and sends it to the National Drug Services (NrDS) through NOTF for storage. Each project county receives according to the initial request and stores it at the health facility for onward delivery to the communities by the OICs and CDDs respectively. Table l0: Mectizan@ Inventory (Please add more rows if necessary) ^/ { DistricULGA Number of Mectizan tablets Requested Received Used Lost Wasted Expired Remaining GBARPOLU COUNTY 35,500 35,500 35,250 45 56 0 149 36,000 36,000 35,774 35 10 0 1 8 1 31,100 31 ,1 00 30,906 23 71 0 100 Bopolu 45,000 45,000 44,910 30 30 0 30 Bokomu 18,000 18,000 17,814 18 68 0 100 Guo 20,000 20,000 19,356 450 100 0 94 Subtota! 185,600 185,600 ,l84,010 601 335 0 654 BONG COUNTY Sanoyea 62,000 62,000 61,042 0 609 0 349 Zota 60,000 60,000 59,881 80 39 0 0 elle ibarma z3 WHO/APOC, 24 November 2004 80,000 80,000 79,303 0 352 0 345Suakoko 70,000 70,000 69,145 0 200 0 655Salala 222,000 222,000 221,558 0 126 0 316Jorquelleh 120,000 120,000 119,875 25 89 0 11Kokoyah 73,000 73,000 72,256 400 230 0 114Fuamah 505 1969 0 2229Subtota! 764,000 764,000 759,297 LOFA COUNTY 0Voiniama 98,500 98,500 97,572 0 0 040,000 40,000 39,744 0 40Zozor 0Salavea 14,1 00 14100 13,560 0 170 0 120Foyah 120,000 120000 119,748 0 132 125 0 123Kolahun 122,000 122000 121,752 0 0 18 0 22Vahun 34,000 34,000 33,960 485 0 1,779Subtotal 428,600 428,600 426,336 0 MONTSERRADO COUNTY 0Todee(Lower/Upper) 66,600 66,600 65,946 0 0 0 0Caresburq 106,000 1 06000 105,308 0 543 0 0St. Paul 90,000 90000 89,308 0 0 464Monrovia South 378,000 378,000 377,536 0 0 228Monrovia North 497,624 497,624 497,572 85 1 1 5 2,0971,138.224 1,135,670 628 115 0Subtotal 1,138,224 NIMBA COUNTY 0 0 0Gbehlay-Geh 88,000 88000 87,966 0 U U 1ZZSaciepea I JU,UUU IJU,UUU tzv,ctd U 0 922114,050 114,050 113,128 0 0Tappita Panta K 77 000 77 000 237 0 324 0 439 216 149 t 928 370 564 692 24 WHO/APOC, 30 July 2007 Yarwin-Mehnsonnoh 32 32 000 31 126 0 0 0 874 How are the remaining lvermectin tablets collected and where are they kept? List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel tn the project area. The remaining Ivermectin tablets are collected from the communities by OICs and transferred to the Health Ministry expiration date verification. If the expiration date is confirmed, the tablets are taking back to National Drug Service (NDS) for the next treatment cycle. If they are found to expire before the next treatment cycle, they are burned or discarded Personnel Activities The County Health Teams (CHTs) collect the Ivermectin tablets from Ministry of Health (MOHAIOTF) to the county health facilities. The OICs take delivery of their supplies from the health facilities for their various communities for distribution. a The CDDs distribute the Ivermectin tablets to their various communities. 2.8. Gommunity self-moniJoring and Stakeholders Meeting Hos any training (of trainers) for community self-monitoring been done in the project qreo? If yes, When? Table 1l: Community self-monitoring and Stakeholders Meeting (Add rows if needed) o a 0 0 0Sanniquellie 109,000 109,000 108,684 316 119,748 0 0 0 2,534Zoe-Geh 120,000 120,000 Subtotal 593,050 593050 590,230 0 0 0 2,534 1,734 2,904 0Grand total 3,109,474 3,109,474 3,095,543 Percentage 100% 100Yo 0.42% 0 0To o% DistricU LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitorins (CSIO No of Communities that conducted stakeholders meetins (Sffn4) 25 WHO/APOC, 30 July 2007 TOTAL 26 WHO/APOC, 30 July 2007 Describe how the results of the community self- monitortng and stakeholders meetings have fficted project implementation or how they would be utilized during the next treatment cycle. 2.9, Supervision 2.9.1. Provide aJlow chart of supervision hierarchy. Central Level o NOTF o NGDO County Level o County Medical Officer (CHO) o County Onchocerciasis Supervisor (COS) o County Health Teams (CHT) District Level . Health Center Medical Officer o Clinic Nurse Community Level o CDDs o Community Members 2.9.2. What were the main issues identified during supervision? The main issues were as follows: l. Communities not showing appreciation for CDDs voluntary services. 2. Some CDDs are not huppy with CDTI work because it has no incentives. 3. Some CDDs do not record properly in their registers. 2.9.3. Was a supervision checklist used? 1. Yes. The checklist included the followings: 2. Census update based on communities registers. 3. Meeting with communities leaders to acquaint them with CDTI activities. 4. Verification of both communities and counties treatment forms, 2.9.4 What were the outcomes at each level of CDTI implementation supervision? l. The communities including the CDDs and OICs all cooperated. 27 WHO/APOC, 30 July 2007 2. The supervisors from NOTF level thoroughly explained the CDTI activities to the communities by means of meeting with them and what they can do to move the project forward. 3. The communities expressed willingness to support the CDDs. 2.9.5. Was feedback given to the person or groups supervised? l. Yes. Feedback was given each group supervised. 2.9.6. How was the feedback used to improve the overall performance of the project? 1. The CHTs were given copies of the feedback in order to address the issues and during workshops plans were put in place to improve the overall performance of the project(e.g. Constant supervision, etc.) SECTION 3: Support to CDTI 3.1. Equipment Table I2: Stotus of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? Yearly budgetary allocation is made for the maintenance and repair of equipment and other materials. With integration and co-implementation of health interventions, the Govemment of Liberia (GOL) through the Health Ministry intends to co-share mega resources for the maximum benefit of all health programs. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condition No Condition No Condition No Condition No Condrtion 1. Vehicle 2 CNFR 2. Motor cycle(s) 8 F 3. Computer(s) I F 4. Printer(s) I F 5. Photocopier (s) 6. Fax Machine(s) 7. Others a) Air conditioner 1 F b) Generator c) Bicycles 28 WHO/APOC, 30 July 2007 3.2. Financial contrlbutions of the partners and communities Table 13: Financial contributions by all partners for the last three years If there are problems with release of counterpart funds, how were they addressed? Additional comments 3.3. Other forms of community support Describe (indicate forms of in-kind contributions of communities if any) 3.4. Expenditure per activity - Indicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here:- I US$: 50LD Contributor Year 4 ('prowde the period') 2005 Ye* 5 ('provide the period') 2006 Year 6 ('provide the period') 2007 TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (US$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) MOH (Central * Provincial/State) 86,159 -0- 109,911 2,098 80,446 6,000 MOH (District/LGA) LocalNGDO(s) ( if any) NGDO partner(s) 58,187 -0- 22,195 9,148 12,100 2,266.25 Others a) b) Communities APOC Trust Fund 62,087 62,058 65,058 38,979 27,441 27,441 TOTAL 29 WHO/APOC, 30 July 2007 Ac!!yity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community 500 MOH Mobilization and health education of communities I&uusercP!'- Ie,liqs o t!ee.l4 i1q{L4"elllgvq!'_ -_ S qpgrvlging*9PDr and.distribu_tion Intemal monitoring of CDTI activities 4,433 APOC, MOH & SSI lt \) I APOC 5,033 APOC, SSI 2,255- 1,500 APo*qzM_Q,E_ APOC, MOH A!y_q.ggy:r'I!!_o_bgallh_1n{pq_li IEC materials tical authorities 300 400 MOH APOC SUttpg_ry G.p_qrti"e) forms for treatment Vehicles/ Motorcycles/ bicycles maintenance (fuel) 270 1,858 MOH APOC _o![gg_E_qqtppg!q@_e-c!g.rpI19$._pn49!l stc) .___ Others 315 APOC 4,428.50 APOC, MOH TOTAL 32,813.50 Total number of persons treated Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? SECTION 4: Sustainability of CDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4,1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Year I Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners t 30 WHO/APOC, 30 July 2007 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? 4.2. Sustalnability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? $ Was a sustainability plan written? NO When was the sustainability plan submitted? NO What anangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planntng at all relevant levels 4.2.2. Funds 4.2.3 Transport(replacementandmaintenance) 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented The OICs and the support staff at all levels are being trained to carry out CDTI planning and implementation using the same Primary Health Care (PHC) concept that operates through out the health delivery system. To ensure sustainability, CDTI uses bottom to top approach beginning with the community, district, county, and central levels. The OICs are responsible tot develop annual action plans for CDTI activities indicating the villages to be treated and time of treatment. These plans are integrated into the county health plans. The OICs are responsible for supervising the activities and together with CHOs and COS monitor, supervise and evaluate at county level. Although more advocacies were carried out for increased budgetary allocation for CDTI activities, Government continues for the fifth year, to support the Northwest project now in its 5tr year. Additionally, the Ministry of Health is encouraging all parallel health programs at county level to integrate and make available to each other resources in terms of transportation (motorbikes and vehicles), etc for maximum health outcome and CDTI continuity. 31 WHO/APOC, 30 July 2007 I 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3,1. Ivermectin delivery mechanisms 4.3.2. Training 4.3.3. Joint supervision and monitoring with other programs 4.3.4. Release offunds for project activities 4.3.5. Is CDTI included in the PHC budget? 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. lVhat have been the achievements? 4.3.7. Describe others issues considered in the integration of CDTI. The Ministry of Health is fully aware with plans in the making that one way to ensure the sustainability of the CDTI is to integrate with other community directed primary health care (PHC) systems. The concept of PHC is over a decade old in Liberia. Eighty (80%) percent of the Country have some form of PHC system functional. EPI, MCH, TB and Leprosy Control Programs have ceased from being vertical programs and are integrated into the PHC activities of the Health Ministry. CDTI is gradually being integrated with the National Eye Care Program services. The Onchocerciasis Program and the National Eye Care Program operate simultaneously in the endemic areas using CDTI structure, same staff, and shared resources. Training of health staff is done in like manner. Selected OICs that receive the annual training of trainers (TOT) are usually the same ones involved in the PHC activities of their various counties and districts. At the training sections, the health staff is often reminded and encouraged to share each other's available resources in carrying out their interventions. The Government of Liberia, through the Health Ministry releases all funds directly to the CDTI Bank accounts in the form of checks. Although the present funding is not adequate to cover all activities, it is surely an appreciable start for sustainability. 4,4. Operalional research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. 4.4.2. How were the results applied in the project? I 32 WHO/APOC,30 July 2007 aSECTION 5: Strengths, weaknesses, challenges, and opportunities - List the strengths and weaknesses of CDTI implementation process. STRENGTHS o Many more people are taking Mectizan o Government is up to date with funding to CDTI activities o Integration and sustainability are about to take root WEAKNESSES o Community support to the CDDs is low in some communities o Attrition of CDDs CHALLENGES o CDDs demand to be given incentives like other vertical programs, eg. Malaria and HIV/AIDs Control Programs. SECTION 6: Unique features of the project/other matters The successful distribution of Ivermectin treatment and report writing are the paramount concern of NOTF. Therefore, APOC and TCC should consider the allotment for the training of CDDs, and that OICs to be trained to manage the implementation of CDTI Projects, and regional coordinators be trained to write Technical Reports. I t JJ WHO/APOC,30 July 2007