Ghana Oncho Control Programme annual project technical report submitted to Technical Consultative Committee (TCC): January 2011 to December 2011

"':#r.Jr,roIii \7 1 COUNTRY/NOTF: Ghana Proiect Name: Ghana Oncho Control Programme Approval yearl 2007 Launching year: Reporting Peuqd: From: January 20ll (Month/Year) To: December 20ll ( Month/Year) Prqieqtfear of this repoft (circleone) I 2 3 4 5 6 7 8 9 10 Date submitted: January 2012 NGDO partner: SSI, USAID ANNUAL PROJECT TECHNICAL REPORT SUBMITTBD TO TECHNICAL CONSULTATIVB COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting i To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME CIASIS CONTROL (APoc) s +'f v:-.;I'i/ ***,."39..,. F,yr .{c.ii";r,r T*r -fcc rt. PRo &E?JEffi- fcr h#ere'$:,,x: L:o .btR 31 4.c"5D FOR RECU tE ONCH APOC / DIR Ghana OCP, 25 January 2012 I l iI t dI I I I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) tl{D0RStMtl{T i Please confirm you have read this report by signing in the appropriate space, OFFICERS to sign the report: Countrv: GHANA National Coordinator Name: Dr. Naqa-Kwadwo Birim'u Signature: r'1. ^)d\ // .,, ..I,t V,v,V,!1,;lll l{l '' ll00ut{ lt I tx till IIlJfi 0t II Date: 25-01-2012 il0 coilr 0lll'lt llt Prq0f,l#Ir il{ stIytct NGD0Representative Name: Signature This reporl has been prepared by': Dr. I,J ana- Ku,adlo B iritu um . Programme Man,{er Mr. Odame Asiedu. I'echnicaiOthcm -- '' : 'J 1J\) I Date: Signature t Table of contents ACRONYMS v DEFINITIONS VI FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY SECTION 1: BACKGROUND INFORMATION....... 1.1. GpNenel rNFoRMATroN............. 1.1 .l Desuiption of the project (brieJly) 1.1.2. Partnership.... 1.2. PopulauoN........... SECTION 2: IMPLEMENTATION OF CDTI....... 2.1. Trupr-mr oF AcrrvrrrEs ............ 2.2 Apvocacv.. 2.3. MogtLIzarIoN, sENSrrrzATroN AND HEALTH EDUCATIoN oF AT RISK coMMUNITres . 8 2.4. CoNaNaLD.rrry rNvoLVEMENT........ 2.5. CepacnyBUrLDrNG.. 2.6. TRrarueNTS.............. 2.6.1. Treatmentfigures.......... 2.6.2 What are the causes of absenteeism?. 2.6.3 What are the reasonsfor refusals?..... 2.6.4 BrieJly desuibe all lcnown and verified serious adverse events (SAEs) that ... 24 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year26 2.7. ORppRlNc,sroRAGEANDDELIVERyoFIVERMECTIN.............. ...............29 2.8. CouuuNrry sELF-MoNrroRrNG AND STAKEHoLDERS Meermc 30 2.9 SuppRvlsloN................ ...30 I t I 2 2 2 3 5 6 2.9.1. 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.6. 3.2. FnreNcIaL coNTRIBUTToNS oF THE pARTNERS AND coMMUNITIES Ornen FoRMS oF coMMLNITy suppoRT.......... ExpeNprruRE PER ACTIVITY 6 8 ............ 1 1 ............ l4 ............ 14 ............24 ............24 3l 32 32 32 Provtde a/low chart of supervision hierorchy . .. . ................. 30 What were the main issues identified during superttision?............... ............... 30 Was a supervision checklist used? ............. 3I What were the outcomes at each level of CDTI implementation supervision? 3l Was feedback given to the person or groups supervised?................................ 3l How was the feedback used to improve the overall performance of the project? 3t SECTION 3: SUPPORT TO CDTI ..................31 3.1 EqurrureNT .............. J.J. 3.4. SECTION 4: SUSTAINABILITY OF CDTI....... ...........33 4.1. INrERNer.; INDEIENDENT pARTrcrpAToRy MoNrroRrNc; EvelunrroN.................... 33 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of thefollowingwhich are applicable)........... ............33 4.1.2. What were the recommendations? ............. 33 4.1.3. How have they been implemented? ............. .................34 4.2. SusraNasILITy oF IRoJECTS: ILAN AND sET TARGETs (uaNoeroRy ar................34 Yn 3) .......34 lll Ghana OCP, 25 January 2012 4.2.1. Planning at all relevant levels.. 4.2.2. Funds....... 4.2.3 Transport (replacement and maintenance)............. 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented............... 4.3. INrecRnrroN............ 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 activities4.3.5. Is CDTI included in the PHC budget? .............. 4.3.6. Describe other health programmes that are using the CDTI structure this was achieved. What have been the achievements?........... 4.3.7. Describe others issues considered in the integration of CDTI. 4.4. OppnarroNAl RESEARCH 4.4.1. Summarize in not more than one half of a page the operational undertaken in the project areo within the reporting period. 4.4.2. How were the results applied in the project?............. SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, OPPORTUNITIES... SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS lv Ghana OCP, 25 201 2 .. 34 ..34 .. 34 .. 34 .. 34 ..34 ..35 ..35 ..35 ..35 .. 35 how .. 35 ..35 .. 35 35 35 AND ......35 ...36 I Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF 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 Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization v Ghana OCP, 25 January 2012 Definitions (i) Total population: the total population living in meso/hyper-endemic within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84o/o of the total population in endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons meso/hyper-endemic areas that a CDTI project intends to treat with i given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of be treated annually in meso/hyper endemic areas within the proj ultimately to be reached when the project has reached full geographic (normally the project should be expected to reach the UTG at the end year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year total number of meso/hyper-endemic communities as identified by project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A albendazole for LF, screening for cataract, etc.) through CDTI (using systems, training, supervision and personnel) in order to effectiveness and empower communities to solve more of their health This does not include activities or interventions carried out by distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they function effectively for the foreseeable future, with high treatment integrated into the available healthcare service, with strong community using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the co empowered to oversee and monitor the performance of CDTI (or any , based health intervention programme), with a view to ensuring that the is being executed in the way intended. It encourages the community to responsibility of ivermectin distribution and make appropriate modificati necessary. vl Ghanq OCP, 25 201 2 unities ln lna atea, the 3 rd total same cost- to unity is gramme full when to ln the the FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, filI in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 32 (Please add more rows if necessary) Executive Summary Prepare an Executive sammary of the report in not more than one page. l. Background on treatment and population data - Total communities, communities treated, total population, UTG, ATO and persons treated. 2. Background on population movements 3. Training data - CDDS, health workers, Total population (community) per CDD trained. 4. Challenges and how they were overcome. I Number of Recommendation in the Reporl TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROTECT FOR TCC/APOC MGT USE ONLY Develop a CDTI sustainability plan for the project in Ghana A draft plan awaiting finalization from various stakeholders has been developed for the country CSM implementation Health workers training for CSM has been done, implementation expected in some districts though prograrnme is yet to monitor for CSM Ghana OCP, 25 January 2012 SBCTION 1: Background information 1.1, General information 1.1.1 Description of the project (briefly) Gcographical location. topographl'. climate Ghana lies on the West Coast of Africa between Latitudes 5o and ll" North of the Equator and between longitudes lo East and 3o West of the zero meridian. It is bordered by the Gulf of Guinea in the South, Togo in the East, Cote d'Ivoire in the West and Burkina Faso in the North. The country covers a total area of 238,537 sq km. The combination of low altitude and proximity to the equator gives Ghana a typical tropical climate. The rainfall figures are highest in the forested southwest and lowest in the north. The Harmattan winds blow from the northeast during the dry season bringing dust from the Sahara. Onchocerciasis control activities started in Ghana in 1974 and focused on aerial larviciding. Ivermectin distribution in Ghana started with the use of mobile teams in 1987 and CDTI was introduced in 1998. The Special InterventionZone was created in 2002 to serve as the focus of CDTI implementation after the devolution. However CDTI also continued in non-SIZ areas till the phasing out of the SIZ in 2007. The Onchocerciasis control programme in Ghana using the CDTI strategy is implemented in the Oncho-only areas located in the following regions; Ashanti, Brong Ahafo and Volta. The northern, westem, Central, Upper West, Upper East and Eastern regions are co-endemic for Onchocerciasis and Lymphatic Filariasis, and so, employ mass drug administration strategy. It uses the same CDTI approach of training, supervision, selecting CDDs except that CDDs are paid for their services. The total at risk population is 3,060,479 spread in about 3,204 communities in 91 districts (there has been a recent re-demarcation of districts in Ghana which has increased the number of endemic districts). Population: activitics. cuhurcs. language Ghana's population is estimated to be about 24,252,438 in 2009 extrapolated from the population census in 2000. About 70Yo of the population live in rural areas and are mainly engaged in agriculture and fishing. There are many ethnic groups with diverse cultures and perceptions and also groups with religious beliefs and practices that may influence their attitudes and practices towards Onchocerciasis. Communication sy'stcrns (roads. . . ) All regions and districts have fairly good road networks that support programme implementation as well as commercial activities. Majority of villages are linked by feeder roads except in very remote villages (2o/o) where access is a problem. Apart from that there is mobile phone connectivity in all districts, which facilitates communication from one area to the other, even to some remote areas. Admi nistration structure Ghana is divided into 10 administrative regions and 170 districts. All districts have been subdivided into an average of 6 sub-districts with each sub-district covering a 2 Ghana OCP, 25 January 2012 defined geographic area with a population of between 20,000-30,000 people. Beyond the sub-districts are the Community Health Planning and Services (CHPS) facilities that are manned by Community Health Ofhcers and located at the door steps of communities. They serve a few communities. l-lealth syslcm & hcalth calc dclivery (provide the nunrbcr of health posts/ccnters in the project area if the inlbrnration is ar.,ailable). The health system in Ghana is managed by the Ghana Health Service, the main implementing body of the Ministry of Health with several levels. These are the regional, district, sub-district and community levels. The clinical health services are provided by central government, local institutions, Christian missions (private non- profit agencies), and a relatively small number of private for profit practitioners whereas public health, which is headed by a Director works through regional and district directors of health services. Nur-nber ol'l-rcalth stall'in pro.icct area and number of liealth stalf involvcd in CDfl aclivities. At each region a Deputy Director in charge of public health and coordinator works with a team of district directors, Nurses, Disease Control Officers, Data Managers and Pharmacists as well as front line health staff to execute CDTI activities. Table I : Number of health staff involved in CDTI (Please add more rows if necessary) DistricULGA Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Bl Number of health staff involved in CDTI Bt Percentage BrBtl B, *100 Ashanti 94s 482 51.3 Eastem I,198 371 30.9 Volta 497 241 48.5 Western 172 89 51.7 Brong Ahafo 824 623 75.6 Northern 291 218 74.9 Central 127 tt2 88. l Upper West 36 27 75.0 Upper East 42 33 78.6 Total 4,r34 2,196 1.1.2. Partnership Irrdicate the partncrs involved in pro.fect implementation at. all levcls [Mol-I. NGDOs(national/international ). conrntunities. local organizations, etc.l The Ghana Oncho Control Programme continues to work with partners for effective implementation of activities as follows; At the national level Sight-Savers Ghana and World Vision Ghana (the local sub- grantees of the USAIDA.ITDCP grant) are key partners. The regional level works J Ghana OCP, 25 January 2012 closely with Ministry of Local government, other state agencies such as Information Services department, Ghana Education Service etc as well as some NGOs. It must be stated that not all regions have NGDOs that support Oncho control activities. At the district level, activities are planned with the local government, World Vision (in some cases), the Red Cross, local communities, etc. Describe overall working relationship among partners. clearly indicating specific arcas ol'project activities (planning. supervision. aclvocacy. planning. mobilization. etc) rvhere all partners are involved. Support for implementation of activities at the district level has been based on the strengths of each partner. Whereas the Red Cross and World Vision are involved in community mobilization and education, Sight-savers International has played a key role in advocacy and supervision of activities. District officers also facilitate and coordinate meetings of all stakeholders and assign specific roles for effective monitoring of activities. State plans. if any. to mobilize the state/region/district/LGA decision-makers. NCiDOs. NGOs. CBOs, to assist in CD'l'l irnplcrncntation. An advocacy seminar to mobilize support for the prograrnme was organized for media persons and members of parliament as well as personnel from Sightsavers and World Vision as part of efforts at strengthening advocacy support for CDTI activities in Ghana. Subsequently, media persons and members of parliament were mobilized to visit the field to appreciate, at first hand, challenges encountered by field staff. 4 Ghana OCP, 25 January 2012 or oN \ N a" U\) B B r<(U 0) e"() oa(/) 0)ol-{ o v) L<o o c\.o !adx 0)H d () I d (B a2tu)HEv(J()- odLrd 3E(,ts 0):E1 .=8 Lr cdi EO d z(! Fi J( \x U;sA v')o o l-{ 0.)a bI) L oq C)H C) b0q L E q) o € o() 'a L{ O. (l) fr € U)) cr) C)o Cd V) cd \) \ \) L q)\ () b.\ q) p q) uq) a- qj q) -a\ e, }i \) o'\\q) B\ q) bo(l\\) I $L bo o bo q) u s) t q) o'\\ q) \) : s\)\ \) .a qr s F q) ls ts q) o'\ a. q) h \)\ U q)\ q) Lq)\n\ ci qj B \q) q) L !) -s o q)\ q)\ L s) .a d q) s q) I()t\b qi q L q) S* t g a)q uq) o lr G)a b0 li o (l)L 0) bo Lr L< o o (c() t< 0) L< CB >. c) Lr C) () cqq) lr cl Iq) La 0)L q) (.) 9 .54 c/) k CB o d q oq ! ad U) 0,) o(J o.ir 6)l ,oldtFI tr o +,(E Jc or N F lrl F 6)EeO)c!tr .! 6t c! O\o .+ C\ o\\o\r-$ co o\ $ oo o\ cn r- o\ o\ c.) co -f, ol $ rr $ (n o\N \oN oo c.l \osc'I ooN N ta) \o^ @\o 6 t tF- o\ + ll b .rE &x >.9 -\ trg;3 .o9EFEc, (r) r- ra) rrl(..l N r- + co$ $N o^ @ o\$ \o o\q ca c.l$ r-\o @ oi o\ t--\o\ oo\o ca r-.(n \o^ C\tr-C\ N caq tr) co tr) oo lrr @ t-!$ iaia t\ q) EC!ri OfL(rEw Ltr C)I 5 ..31 f'E s Ed C.l o\ ,rI lr) @ t-- \$ tr1 ca r- N o\ oo O f- o\ +(n c.l a$ .+\o 6\oq €t o\ t cl E q) EC!c)9) E.= 6 rg B cr.9artro eFa 6lr) r- ral oo s c.l @ o\$ o\ t--\$ ca co \o ca \o r,- r-. o\ c- c.t \or- oo N N coq rn ca lr) oo(n oo (\l ia(\t \o I () oq()0) N -=(J cg q) + il lr) F- * € oo ra1 caN@ o € N co ra) calat o\(n$ c.loo N .+ la ra ?o $ c.) c.) r-$ c) o) 9'= trt- Eq)EE *i p ilNC! $ cO tr- cn O r- rn ?o (a) 6) a0 aa)q) () o ko E z () oc) E.= c IQ3 qr.9!.itrOESE. $ tr- caN@ o\ c- cA c.lN olN co N oo c.I .f, 6ia N tr9 trE!joo= LYi!E?= .SlE 3g P'F AE A F- o\ N ra) o.lt-rq oo cA c.l o\ oo +tr)$ ct oo \o N caNvI c.lr- c-.1 tr) o\ ca o.l \oO r-\oq c.t c..l(n +o\\o trl c,- r- ca ro!<f o\ o\ N - 4) r:.f0d?) :!E q)v .E.= a l-1 O C)H(.L cNqE E\Ji q) GI tr cg U) €(6 hI)Io l-< co E() t/)(d IJ] CdP o Lo U)(.) F (U l.<I (.) Q !O tro z (t')() L() a.g t) CBr! l-{(l)aa j F oF SECTION 2: Implementation of CDTI 2,1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. 6 Ghana OCP, 25 January 2012 c\ sa\ I s a\ a- U o r\ q)\ > E$$B\s :'i :^ .ss >bo .ss Ss .F'i\ S-s -:r._P\F'E EFr-. tx%Et tlsSN s)uUE X0o s* \j= eY xQ)Rbo$slsi-s .Sg P:i q)\ =B\i CJ$5 s,\br SSes \* ssv QS t- hS riR q)9ss st %'n >q) s.i ::o dB\.s<o 0- ESooO E$ \r/ U 3^l L1q uq) q- cai vL q) T\ t q)q q) U ti Cd C) C)kLr)o o # t C) Cd(.)k rr)(d C) L<(6 o k € ao o(c q< o C) () E3 ..ir o,>l -ol cdlFI r.- ar) P q) a o q) o-E oOQE p c) -o () o. C)a k() -o 0) o.(l) a L() -o E 0)o c:) a L() -o 0.)o 0) H E() -o () q 0)a r C) -o E(.) q(l) U) H 0) -o () o C) n ko .o 0) a. 0)a kq) -o 0) o.()(h u0 LTE cgo rht bo a bo H C) -o oo o) o E C) -o o) o z q oo q oo k 0)p o)o(D t-l bo bO lr U) bo li o 0) ^E ool.'E k() -o E 0) aoa L c) -o C) A() U) kop 0.)o o) o r() .o 0) o z k() -o o o. C)(t) o) -o 0) o. C)a ro -o 0)o C) IJ ko ,o () o.()a H 0.) -o c) a. C)a u0 LE do AE bo q o0 E 0.) -o 0) o z Ho -o o o z bo oO L(,) -o 0.)o 0) o bO bo 0) cB T') t) E c) U o 6) =-cEeooUE q oo o o0 k() -o C) o z H 0) -o a) o z bo b0 kq)p (.) o z o0 o0 bD rrE c!O AE a bo q oO k() -o 0) o z r 0) -o (.) o z q o0 q bo r C) -o o o z q oo bo aa 6lLF o q)7-c oo9ts 0 a0 bo o) -o q) o z Lo ,oo o o q oo) q o0 H(l) -o o o z bo oo UD LE clo at bo a oo L 0) .o C) o z ko -otr c) o.oa q bI) o bo () -o o o z oo oo AE !qtrN- Qioaa, 0)7-c E; ooUE a bo oo q bo) o bI) bo bo oI) bo q oo a AD LE(!0 AE I € IE o0) o bI) I! t1, A bo = I 'd ) I! (, ,l (J L ah n F Q !q *,1 x< c cg €(B oo oH ca (cE q)(J CB o k() (,) > E(.) q d E] E() li o z (d rI] k(.) trp. C) () a.q Fl F o Fr 2.2. Advocacy State thc number of policl/dccision rnakcrs rnobilizcd at cach relcvant lcvcl during the current ycar: thc reason(s) for undcrtaking thc advocacy and thc outcontc. Dcscribc difliculties/constraints being l'aced and suggestions on horv to irnprove advocacl'. Advocacy activities have generally been held by health teams from the national through the regions to the district levels. Activities have involved engaging politicians, community activists, community leaders and social groups to mobilize further support, including resource, for improving Onchocerciasis control. Members of Parliament whose constituencies are endemic for Onchocerciasis have been very supportive of CDTI activities, especially during the 1't round distribution where most MPs took time off their busy schedule to visit the field. Activities have ranged from engaging community leaders to meeting policy makers and politicians. Another initiative taken to lobby the policy planning, monitoring and evaluation division of Ghana Health Service to have an Oncho indicator captured as part of the routine health service indicators by which they will also be assessed. The presence of this indicator will not only commit local managers to CDTI activities but will ensure that budget lines are available for Onchocerciasis control in the regions and districts. The challenge is the misconceptions held by most health persons that Onchocerciasis is not a disease of priority. The programme therefore need to work through politicians and the media so as to influence this policy decision within the Ghana Health Service. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on 'l'hc use of media andlor otl-rer local sy'stems to disseminate information Information dissemination during social mobilization activities has always been done using a multiplicity of channels. While the national and regional levels are involved in media briefings, radio discussions and jingle announcements, the districts make use of mobile vans fitted with public address systems to mobilize and educate the public. Districts with access to radio also run some discussions and respond to phone-in programmes during such sessions. At the community level regular meetings are the order of the day using local traditional means like gong-gong beatings, church/mosque announcements and group meetings to communicate the messages. Mobilization and health cducation olcomrnunities including wornen and minorities Communities involved in CDTI were mobilized through the traditional forms of gong- gong beatings and in some instances church and mosque announcements. All other minorities including groups, are reached by the same me€uls except that such groups are met separately because of the traditional place of women in the community. In the much endowed areas some people pick announcements from radios and follow all other discussions on that medium. The programme within the year under review, produced and disseminated leaflets, posters, cue cards and 'Questions & Answers' booklets on NTDs to the various districts and communities to facilitate information dissemination on onchocerciasis and other neglected tropical diseases. 8 Ghana OCP, 25 January 2012 lLc spon sc o1- target c o I'tt nr un i tics/vi I I agcs People's attitude to such public education has been positive. It has helped to reduce negative perceptions and fears associated with Ivermectin intake especially with regards to side reactions. Suggest ways to improve rnobilization and sensitizatir-rn of tlie target comtnuuitles. Community sensitization on Onchocerciasis and its prevention must be an integral part of the routine health education programme of the health services other than making it an annual or biannual activity done prior to treatment. Enough IEC/BCC materials would need to be produced and made available to endemic communities. The Health Promotion Unit of the Ghana Health Service should be engaged more to ensure that onchocerciasis in incorporated in their plan of work for dissemination as it is done for other programmes like malaria, HIV/AIDS and TB. 9 Ghana OCP, 25 January 2012 2.4. Gommunity involvement Table 4: Communities participation in the CDTI (Please add more rows tf necessary) Comment on: - Attendance of fcrnale members o1'thc conrmunity at health education meetings Generally the presence of women at health education sessions is more encouraging than their male counterparts, except to state that they tend to be silent when males are present. - In general. how ilo you rale the parlicipation of female menrbers ol' the corntnunity -..tingr whcn CI)l'l issucs are being discusses (attendance, participation in the discussion etc). Attendance of female members in these community meetings is generally encouraging, though in some instances their participation is limited especially in the presence of their opinion leaders whom they look up to for direction. - Incentives provided by communities fbr the CDDs This is one critical area that needs some attention as community support to CDDs is virtually absent. Nevertheless few communities manage to exempt CDDs from paying levies, Lspecially when it is towards the development of the village. The great majority view CDDs roles as paid positions which shoutd at all times be honored by govemment (Ghana Health Service) as demonstrated by other health interventions like NIDs, distribution of ITNs and contraceptives (condoms), Guinea worm filters, etc. Indeed it is the greatest challenge and threat to the sustenance of CDTI implementation in Ghana as payirents to CDDs by other interventions put unnecessary pressure and tension on the Oncho control programme to let go of some allowances. - r\rtrition of CI)Ds. ls attrition a problenr fbr the project? If y'es. how is it addresscd? Yes, especially in the farming villages and the urban centres. As captured above, districts are compelled to recruit personnel for orientation to replace persons that have deserted the progralnme. - Other issues DistricULGA Number of communities/villages with community members as suPervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communities in the entire project area B4 Number with community members as su perviso rs B( Percentage Be= Bs/ 81 *100 Male CDDs B7 Female CDDs Br Total go= gr*Br Number of communities with female CDDs Bro Percentage Bn= B'./8.* 100 Ashanti Eastern Volta Western Brong Ahafo Northem Upper East Upper West Total l0 WHO/APOC, 24 November 2003 2.5. Gapacity building - I)escribe the adcquacl' ol'availatrlc knowlcdgeable manporvcr at all ler.'els. Every region has a pool of trainers that ensures the maintenance of trained personnel to support the CDTI project inspite of the frequent transfers that occur, but it often cost a lot more to retrain. - Where fi'equent trzrnsf'ers o1'trained staff occur. state r,vhat the project is doing. or intends to do. to rcmccly thc situation. ('l'ha mo.sl intporlant is,sue to tlescribe i,s v'hut m?u!;ufi'es v'ere tukcn to en.ture udetluule ('D7'l implemenluliort v,here not enough knrnrleclgeuhlc munpov'er ttr,y cn'uiluhlc ot' i,/',stu/l trre ,fi'eqttentlt, transferred during llrc cours'e of'tltc campuign). The national level management ensures that all key players required to play a role in CDTI activities are taken through the basic annual routine of the CDTI philosophy and elements and re-define clearly the roles expected to be played by all partners. This is to ensure that all persons not trained would be well orientated to monitor and supervise activity implementation. The same orientation also takes place for all CDDs who have quit the village or have been replaced. 1l Ghana OCP, 25 January 2012 q) c( ar2 (J q) z Uq {"+- FUO ,L q\) *uI \o co o\o s c.) C\ r-t c'l $ oo vs .{ :. c']ol c.l c.t c.) c.t @ r) or- a.l\oO € \o c- c.t$ c.l ca oo i i r- \c) cn N $ oo c.l $ .: co t- rn .I ? = ? ?o[a ar q) Eq) o (,) s o \oc.) c.t c.l sc\ c.) co or- o- \or- oo o\ \o $ @ C.l t- ra N o\ o ahL o 6t L6)-4u):F Et- \oq, o)Eo) ZE =Ug rL+. I:Y o< \J t I I I 0) (l) c) o \Yo\UF I cl *c) c( -6 ah ahoqr< -oL :a)a. a, UG:ll + F(JU U ': .L o< z o\ oo :. $ : a.t r- t co a.t o\ co : o c.t\o $ oo ral$ @ co F- \o c-l :- oo ? @ a.l l s : cl c.l c.t rA F- € ro tcl (u q) o q) U o o\ oo r- co o\ ci\o \a$ \o c.l $ N rA t- CB ah ah (J Fl u) e) ah e 3E zl Q + Q \) o Eu FQ = co\o c.t\o c.r : c.l$ c.t o c.l : i rat cO : co c.) c.t c.) iA cl al (tI t €) o (l) q) \c Q LF c.)\o c.l+ oca c.l coc.t n c.l co iA cl al o u0 Q)& cd C) E] (o o c li 0.) o(.) ts rdLq C)(.) €(d bo oL ca E() L oz (.) ko o. o. dl! H 0) o- o.) Fl F o - coo c.l r() .o o o z t C.l (J I I E c.l bo oo s o\ o s Q i. o ho ri t ou * o a. qi aE B E (lt\- ,a q :" + ?\ vqq q) Iq) q o q) L t v q) $q) ea o Cd o tro F oO(t< (n o q) doLi .c)H t (.) Cd b0 dLrF .iir 0)l -ol(dl FI I I I I I I I c.l Table 6: Type of training undertaken (Tick the boxes where specific training was carried out during the reporting period) Any other comments Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(speciff) Program management x x How conduct Health education to X x x x x Management of SAEs x x CSM x x x x x SHM Data collection x x x Data analysis x x Report writing x x x x Others (speci&) 13 WHO/APOC, 24 November 2003 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 650/o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. l4 Ghana OCP, 25 January 2012 a\ \I \ c\ L\, U \J B \J (a) q > L q) rr \ B JI v) k (d U) cd() Ld d H oJ o Lr (A E (n H a E (d € O E Cdo l.<F r..r ocEts :;,i ,. t'.'.t: ,. ., ra// -.i 1 ll:i:'. K ,-' i f.-(o N o c) o)to(t- N stt o)- N (o(o @_ rO(o @ cf)Nlf) N o)(o_ N CO t- N(o (oo)N (o aN NlO\ f.- Nlr) c\l F- O)o(o (o @ @@ @- f.-{- sN (o CON it o, lr,s o(o Nv loN N (\\iN 6i @ rO N- (f, o)(f) $ @f.- o- N @ c.i@ o? @ \ @ a o,N 1r,(fi @ q N @ c? O)t- u? N @ q ro @ t-@ a t.-N u? @ @ e(Y) @ @ otlr) 01 @ @ q s@ lr) N o)- C7) (o F- o, co(o oo(f)- o,$ (oo co_ rr) (f)lo(o- (o N O o{ @lO O) o, ot-$- @lr) o F.- N @ cf) @- oN Nlo o ro o- 1()$ 6(\ a N$tY loN o{ o, ro @s o)- @ ro lr, @- I-- @ o CO $ o,@@ @(o O) cfr- rO F.- o, @- slr) t-s 1-N cf) o,$- @lr) o rO @- O) $lo cOlf) @o t- o,N oN lr, v .1 O)(o N (f)$ (') @s- o(f,$ (0 ro $@ (t(o F-_ N F.- @ (')_ @ @ cf)N(o- @ o,(o(o- @t- l.c)t-(0 o(o lo @lr) s(o @ cf, o)- CO N(o!t- (o @ @ @ lr)_ F- a. @(o NF- o. oN @ @- c)N N co rr)o O) o|r, N\t(o ol{) voo o o, $o(o- rO @ cf)o O)-(oo \lr) @ o cio q lr) O) q N @ o? @ co r- cd o, l.c) o O) o?(o o, q oo nf.- o) q oo coo r.i o) o oo o CJo o CJo $l() @cf, lf)@ T\s $@ r()F. o) (oO) (o N(o lI) lr)(r) ro ro(o o,t* oN (o(') o,o (o(o @(o @(o $1r) Nt- (oN. N @o, cf) @cf) ro lr)(f) O)@(o o)t- oN (ocf) o)o (r) @ @(f, @@ $lo Nt- (of.- N @O) CO @(o 1o rr)(f) q) 6 € o)t- oN @C, o,o o ',J = -of -oo ! l o a) ol OJ EI(Ul CI "l EE oz o o. E o C Y EE oz (U Nc(5 o .Yz -c :lo U) oNc o o .Yz =(L E o U) oE GF .E(!F E =o oco U) Ets oz oc o F- '=!o o = (5 = .Y o o C GIL oo o .v. o = o .I E .Y U' o LrJ oro EEtI]< OrO EE(D< Oro EE(D< BE(D< OrO EE co< o)o EE(D< BEd)< oro EE(D< o)o EE(D< 3ErD< o)o EEdl< o)o EE co< G P G o .,roq € G p o o co o G' LU C o) o o LU cL o tt(E tu ELq) o o lU tro IEot oq o o o ut i to E Ec oq N (f) v rO (o N @ o, o N (o $ l() (o t,;o o J o :.8' e\ sN \ N U \J \o $N(r) N(o @ t.- O) NN O) (o N cf) F- @N @ @- @ @N(f)- N ro @N. N $t- - 6Na N o @(f)- (o @ c{ Or- c\l o) @ ro- N o o, o,@(o- (o o,(, (o @- @ @ F.. NoN @o rr) @(o o@ @- o_ N (f)ss F. o)to rft (o o, F- $ @N$ o o,s o @(f) @ F- N. @lo F.-F.- (o F- N o)(o (f) @(f) N oN a O)t- I$@ q o, F- a? o @ c! N @ q lf) F- u? o @ lrl o,N q @(o (o atN oqtN a? NIr c @ o? to f.- q o @ \ N @ \ @ @ o? o f-- c! o,t- c N @ $ ro (o o$-{- lo(o N.(o @o to_ @N ro@$- O) @ oNlo- ro (f) o,lo s- N (o o- !t @ lo_(o O)(o o-(o lr) f.-N o f- @ l'-_(o N(?) F-- @N f.-(o N.$N lo(o s- o,lo @ O) O)- N@ @ o,tf) o, ro $N Or- C\TN N(f, o{$s v Gt a{ ro( (f)o Or_ O) t-oo s F-(o c.r-(o o)(o lf)_ $to @ to_(oo$ N(o (f)- (o (o @ @- o, oo or_ o)N O) @N. f.-t- Ns r*- t-(f, F-to o- NN t- C\t a"(o f..-v o- f.- @N co N @$- s(f) N f.- oi.- N O) o_ @lo NF- co- F- t- o)N- (f) @ o)o to- $N o,$ Or. to N (o O)t-- lo o o) c\l @ N$t lf, olr)(o- $t-- s o o,$- r.- lr) @ ro- @ O) t(o @- co N O) o) $(o (o l(,N eiN\t O)sN. O) (o (f) CO c! F-N d(o (o o,rt- o) No$-$$ O)$ ro os O)l.- i.--(o O) (f,$(')- @(o t-(o O)-(o @ q oo q oo q oo q oo O cio q oo o CJo coo q oo u) o) o) coo oq (Y' o, q oo N$ o, tt- o, c\l o O) q oo q oo q oo o? F- O) lo$ oN lo O) o) s 1r)tt N$O) @@ No vG)(o N$ o@ (o o@ (ot-torr) o,(o @@ @(o lo$ N@t* lr)$ oN rr, o, O) $@(o @o) @@ No f..Cf)(o N$ $(o @ o,(o@ro o,@ @@ ro o, o, rt tr,$ Nh\(t(o N$ s(o (o o,@ @F- lo$ oN(oto o,(o @@ @cf) (oo, @@ No E oo o o .v. o U) o(5 uJ o o J o U) E fo U) o o x oa -cE oz ,6 c oE 6 E oo .9 u, c G E oE o II o E oo o(I) E) o(n an L(E E E f oo o c(E o ! ts oz o vtc o E oz oC o o ! ! f oo oc o o ! (E :,c o o. =G E E (U ul .g -oo 3z (U E E ! :, oa E i6 E c o)o E i5 ooc(I, E o I EE oz E iE E oL5 _o o)(E =Y c o -o(U - =o)z EE oz = -c.o =Y .F c(uEo 'a E(5 an 'ac o .Co 'a C(E Eo .E c(! E,o 'F C oEo c o o tU UJ CL o) o o uJ G ol- Gc o ooq tr o t4 G ut 'i= c(E -co 'a E o o .E c o .c. .n .E E o !o .F C oEo .E c oEo Ec o -co C o o o TU E o o(g r.lJ C o o(U LU c o o o TJJ E c) o G, LU o(o (f) c{(o (f,(?) sCO ro(o @(ooN N NN (t,N $N 1r)N @N F-N @N o,Nt- co O) (o @ @ l{) o- N o@ o@(')- @F- ro(, o_(o co co @ @_ r.- o, q oo c\ aN h G \ a\ U o B \J @(o F.-(, a? F- @ oNN lr) lr, @ o- lo N @ or- lo r- o oo I @F- ot N t*(f) @ ro$$ O)(f) oJ- (o D-lr) 1r) (o @ @_ ro lo- r) N tri F- @ @$$- @ N@ co- N N(o ro- N r.-lo + F.-ON.(o O)(o @- U)N NNa 6tf) (o$(f) c.) (r)\t(9 c'i @ F- O)- N $(o(o @@ o)t- oN(o F-(o lr,@ o)(olo I.r(f,(o \t(o(, r't NF-v o,@ a- (o O)(f) o)o s- NF-(.)- tf NN o- Oo N(o o)$ s(f)O) \(') o) (f) @F- (t6N .t o,F. oq (f) F. .q N @ n$@ o,F- q(o @ q N F- \Nf.- F\ hiN q (f) o) a @@ u? N @ \ o,@ q(o o ol c, q t- @ (o r.j6 \ @t.- N(6t\N C"i @ \ N co otr) @- O) (f) N s lo c\!. s Nv\ N (o O) F-- CO N o- F- @ ro o- O) $o(f)- @ (o o (o6 I.-$ @_ @N NN6l Nt- o Cf)(o- N$ $(f) o{ N@ oN(o- (o @ (o ro_ N CO (o Nlr) t- @ tf) \t or t(, o or(n (Yi(o a o)(v, c't(o N O)- o CO o$ o- N N 1o F-- s (o$(fr- $ c.)o Or- N @ o-$ ro(o @-(o O)o @- o c.) N ot (o o,$- (f)oN N(Y) o-(o N @ @_ @ o, o o) o- o)$ @$ o)_ i-F. (oo c\i @ o,@(o_ to(o @(f) s- O)(o Cf)(o @_ @(o ro N lr,- (o Nlo- @ o,lo c\l$(9 (f)lo F- +N o o) rr)_ rr, cf) tr) @(o t-- rr)N o @- $ @t- o- @ @$- N i,rN$- (Dov oi c)(\ (o N(o_ o(o (o(r). (o CO ro t-- f.-lo o\ o, rr) o)lr). @ O) 6loN o,lr) N o,(o- @ (o ro o) c) a) € @N(e- Nt- 6(, o,iN too(o_ ov la)o(') d!t o oo coo coo coo coo q oo q oo q oo qj o) q oo c.i o, q oo d o) o oo Ioo q oo o) h.' o) c rr) o) a ro o) o oo O)(o N(f) F-. to(o CO @N @ 6h. l-ro *O) @@ t- (o O) @N $N vo(o Nlo Nlf, t-@ N6 o,(') N(9 t- lr)(f) (f) @N (o (f) O)t- t- r{) o @@ (f) N (oO) @t- tt- t- @ o(o o(o F.-@ N@ o,(o N(f, t- [o(f, (f) @N @ (9 o) t-lo o @@ (f) 6t @o, @F- st,- N (o o@ a(o t-@ N6 o .c c,(L E G <l (Dt ol >JJI(r)I cnl E o. o .E f, ,6 (! = -oo tt o =.eoc o E c o3 of - c)o(5 E =E o) -v.o U) (5 f itr' 6 o. :g f o)C o o-lclLI(El >l o -oo =Y(5 o, -c. l ol @l olal cl EI ol .qco oo =.g =Eo U) (E o E o o .Y oo(5 o .c. =C '='66= _5t cotrl o(U t.lJ c o) E (! o ah o = 6o 3 c o) E G u)o(E = o!, o -o(U f - oo B v = (5 co U' o LU (U = .F c(E !o .E c(s ! v, .F C oEo EC GEo F (E ! ah .E c(UEo .E c(! -c.U' .F (U -co lE ol- s G €to c o oo = cL o) o o) B c o o o) = c o U'o = EL o) al, o = E o) .t o B c o oo = G o G tr o BIoq o 10 o = o(U TU o o. o.f G ot- t4 G IIJ oao5 U' o) B o o. o.f E ol- r!- o trlot ol SI LI o,l N(f) @cf, o)(o os $ N$ (o$ s$ |f,$ @s N$ @$ o,$ olo tr) Nlo (olr, C.l s c\ A s o\ U U \l 6t\ ot(\l o)d(9 o, rr) c\l$(r) oo a e;o @$ I N O)- lr)o, loo(fr- N NN o) (o roo eo lo ost o; $lr) or_ (o- o@ co-$ @NN sN o)- (Y) t\ o, u) N lr) @ @- co N(o N. o, (f) @_(, N @. lo oF. o- slo o- lr) sof-d lr,lr) @ @F- O)(fr- N o @ Ns N ! F.-o c\l t-(o @ oo @- $ o c{(o o @ o- (\ 6(.) od @F- c\t N (ooN (o ro o{ @o)$ (f) tf) N (f) @N !t(o t- o(f)(o a? @ @ q o @ oq o, F- Ndf.- a @N co -G' u? @ @ q @t- q (f) @ I @ $@ c,) tG' o? lo(o u? o @ a? @ @ \(o @ f.- otf.- o?$@ @dF- a(o N r.-o O)_(olo (o @(o- (o(o (o @N lot- oN o- o, @Nt-- (f)(o \t to(o (\(\ o@(f)- t- o) o,(f) @- t- O)$ o-(o $@N. o$ f.-N{-- t-(o o)(\oda c,) r{) C\tlf)- lo $N @- ro @ o $-(o oNN. @N $o(o- lo (o cr) O)$ lo NN- (f, sr-N. $ O)o @-$lo ot(f,- @ c) Nlo o @ N]o @- N roo @.(o (f) @lo N- (f, N o,s ro. (r) O) (o o) ry o, t* @$- lo N.Ntt @ @ @- r.-(f, @@(f). @o(o N@o- t-(o N ro e\{ O)(o $ O)(o- @ @N F-- f.- C\l Nlo o- to tr) Nlo Or-$ (o N d cf) !t(o$. @!t @$-$(o @o lr,$ f.- o, ^L$ O) @ot- lr) N lo(o o. (t)$ ro(o N (\t @lr)o o @ o,(o- NN (.)$ @- ro(f) o @ @ o$ otr) ro- !t$ o)a € N ao(?) N o, @- @ F* o,t-t- @ o$ @- o, N @- N(o t-(o\$(o o, lr)- f.- N co_ $ 3 @- slo o oo q oo q oo oq(9 O) coo c') o; o) coo q oo q oo co o, o oo q;o) o oo q oo coo q oo coo q oo coo q oo t*(f) N() ro$ ro!t t-t- €lo!t o(o (o!C NN o(o @to € lr) @@ @t- loN CO @lo (?) to Nf.- o@ N(o Nlo lr)s @s F-F- o,los o(f) (o$ NN ot- @ro lo c!lo @(o (oF. loN (f) @lo (?)ro Nt.- o@ @$ N(r) N1r) rott @$ r\r- o)ll)\t o(Y) (o$ Nc{ ot- oro ll)(\() (o@ (oN lr)N (o @lo (oto Nr-- o@ @tt o) o co E o C(5 z o)l o (g U) 'o Dc(E o.)z EE oz G -o E c(E z (! .E o(, o(U LU lE o G o trt oq so ts o = !E oz .E art o -c =oa .Coo oJIF oo LU o '= Jc oo o o. o.f, oo 3 (I, L .Y C oo L oo o.f .E ol- Gtr o ooq q troo 6o :0c =oI o)oc oI o! c. ooY o ov .(I, c) E .9.E oY c o .\. ah G -) U' o t.U =o(U Y ! =o U) (E E(E = .Yz ! ts oz (u c(U 3 .Yz c oEE oz c o) ts oz E oE.E oz c o) -cE oz CL o !E oz 6 C o)o i6 c o)() EL c o)o t E oo 6 c o O (I, =o (U =o (u =o (o =o o =o (! =o G =o o =o o =o $to lolo (oro t-1r) @1() o,1r) o(o (o N(o (9@ s(o lo@ @@ F-(o @(o o)(o oF- t- NF- I N s\ \ N LL U r\ Cf)(o(o- (o o) o,(f) q t- @ (Y)$(o_ $ O) @- N(f) o\ o)(f) @_ @$ q oo loN s_ NNN tri(n t (n- (o(o (o (o a(o F. colo- @ ro q cr) @ ctdi- o, o, @lr)lo 1o t\ (9 F..\t(9 o o- oltt c{ @(o O)_ lo lo @- o, @(o G' +o(o. (\I ro F- co ot\ c) odl()v (o ro +(0 o- c,) o oo o eio Gt. ,,crijrO)i ro N (\ lo oG't (n G' rl rtr) N N ro |r, N (\ k) 6 a)t o o =o o Y o =o G P G o d oll-l -l ri (f) I.- AJ sQ ,,, . ,r , tN N T \ a\ a- U B B N I EgH #i5 (7)s @- @ h\ h*o ciN o,(Y) ot \tr $$ o- N t-(o F* o) @ (f) !t @_ @ O)(o(o-(o Nlo Or- F-N(o_ $ F- ro Or- N olo @- F- cr) F.-_ N CO @ Ntt o, c o o! o,(t) @ o)t-- o)(9(v) \tro) oN f.-F. co" (f)o ro o N NNN N o, F.- f..- $N oG)('t ro -- O)f.-(9|r)(o @(o lo o,$ ro$N !, o of ot @ @t- q @rt q to oq(o r.- tr? Noqo@ c Nto \ @t- \{t.- qo@ oq@@c@ qN@ c?N@ oq(f)@ q@@s o o) o o oo Nd @ (ov co-$ (o @ s-$ @ N o) o)\i ro C') N o(\i v(t sF- c\l- o(o @o(o- lo f.- o,$(f) olr) @@rt- $(o c?)$ o)- lr)t 1r) o, @.(o|r, o)(t)(f)- !t(o (oo ro- @ @ (o (f)- O) @$ ro lo(.) L9o;o =(E29. o F-$- f.- @ o,N. lo @ No @- N|r) Nt-(o- F- oN(o- (o N$ N O) o- @lr) NF- co- f.- F. o) F--(') @ O)o rO sN (o NF lo @ olO @- O) $l.., co rr) lr)o rfr- o, @(o r- @$_ s(r) N t- o,t- o\r rr)- @(o c.,o rf,- o,|o o@$_ rO rO @N @- $(o Eo _o>(5 E.El-: o c6(l) EE8 vN$- |..- f.-(o O)- (f, @ v$to ct o)!t o)t- F-_ (f) o, (f)s(fr_ @(o f.- @ or- (f)o ro @ ro- @ o) s(Y) @- @N $I- o, o$ roN c.)- t- F- @@ lo_ F- s- @ @ N N \i:(?) v o,I rr)- o$ O) o)$- oN lr)(f)(o- o@ (f,o o- o F- t- c! lf) @ o u0o qJ oU .9 f o o. 6 (u EF C o _!-y(E=r(a = o-'E ,e oJ -(L i! 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IET PEEs \isEtsSU .s '+sE \.ui *[\ sq)r ss|-{ } s'Y =bE IXs :T"k 'trqr!,l S.S5 t* .! Y'rrs gr E E.S} E:b !tB * sP$ s\ ^\'ivE 'tsuI ts .s st OA$qJ =' 'Q\'l os cr .: iiE SEs *$s' iu\ Saf EE: s.s t SbE rsi .s'P * d\I St Cr qJiN Ns il ilEo ()tt\ S.S\ .g 2.6.2 What arc the causes of absenteeism? The high absentees, as recorded in the Ashanti and Brong Ahafo regions, are as a result of migration. There are lots of migrant farmers from the North who go back to prepare their lands for farming activities during such periods of the year. They stay in the north after the heavy rains and only return to the south during the dry period after the main harvesting season. All districts have been charged to identify and list out all migrants for effective targeting. Apart from that a tracking system is being developed that would be used to follow up on all such persons in the communities. 2.6.3 What are the reasons for refusals? Results of a post-CDTI validation survey conducted in the last quarter of year 2009 showed a low risk perception developed by some community members, and thus, influenced their attitude towards the administration of Mectizan. The survey results revealed a non-compliance rate of 10.3% in the general population. Additionally, there were few persons (0.8%) who admitted receiving Mectizan tablets but do not take them for obvious reasons. These perceptions are being worked on through regular community education and on radios. Monitoring and supervision has been stepped up to ensure CDDs complied with supervising Mectizan intake at the point of delivery. 2.6.4 Ilriefly describe all knorvn and verified serious adverse cvents (SAEs) that occurred during the reporting period and provide (in tablc 8) the rcquired information rvhcn available. There was no reported incidence of severe adverse reactions. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report X 24 WHO/APOC, 24 November 2004 sO c.l ko -otr 6) zs c.l Q oA > tr)N q) q) \- Lq) .a \q)h * -:. 4q a)u a) \- q + L. q) r- o t B a)4 a) $- o t-<(l)q b0 t< op. oti o bo L) q)trL{)oo o Cd a) r! a c/)Ptr(.) o) 6)(r) tro €d U)) o H 0) ar) ({-< o rh 0) rn <g(.) #r o-,l -ol cdlFI c) -E:-o9 =>cEE a <.= E L o bo()dd I ! d:iGoo 6:f =x 5.9El oo qr o at .2EAOEq3. 6E- o-d oo -o(H o 9- q .= (t)0)-c tril9d -Edc) .A= bo t t=!HH.<doooOEE.E o 2-b o'=E= ^9vdt-t (d -< (ii d €-999.8? 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Ordering, storage and delivery of lvermectin Mectizan@ ordered./applied for by - (trtlease tick the appropriate answer) NIOH I_--l WHO tr UNICEF N Other (please specify): Mectizan@ delivered by - (please tick the appropriate answer) MOH tr WHO tr UNICEF N other(pleasespecify):fiffi fIfi fffi h$Bffi .D$#.4$mW#gPUffi#m NGDO tr NGDO tr Please describe holv Mectizan(IU is ordered and how' it gets to the communities Mectizan tablets for treatment of Onchocerciasis in Ghana is ordered by the Ghana Health Service to MDP and is received through WHO into the Ghana Health Service's Central Medical store, from where it is distributed and delivered to the regions. A regional Coordinator, on behalf of the Regional Director also by a distribution list distributes the consignments to the districts. A focal person distributes to villages based on the population and consumption patterns but also ensures that a buffer of tablets is reserved at frontline health facilities to support the distribution effort should there be any shortages of tablets during the distribution period. Table 10: Mectizan@ Inventory (Please add more rows if necessary) - How are the remaining Ivermectin tablets collected and where are they kept? Technical teams are dispatched fiorn both national and regional levels to visit each district. sub-districl and fror-rtlinc lacilities including villages that arc suspected to be keeping sonre Mectizan tablets to retrieve all left-over drugs fbr storage at the regional stores. All bottles whose seals arc not broken are kept and rc-distribiled during the next distribution while opened bottles are left at health facilities to treat passivc cases and persons that were absent at the time of thc distribution. State/District/ LGA Number of Mectizant tablets Requested Received Used Lost Wasted Expired Remaining Ashanti 778,500 534,126 244,374 Eastern 1,010,000 889,029 120,971 Volta 593,500 410,915 182,582 Western 415,500 322,088 93,412 Brong Ahafo 934,500 848,8 l0 85,690 Central 912,000 740,542 160,658 Northern 559,500 48 1,875 77,625 Upper West 150,000 I17,308 32,692 Upper East 180,500 180,000 500 TOTAL 4,958,500 3,959,699 998,504 29 WHO/APOC, 24 November 2004 List and briefly describe the activities under lvermectin delivery that are being carried out by health care personnel in the project area. Any other comments 2.A. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? Yes. If so, When? During the trainer of trainers workshop at each of the regions ie. May' & June 201 0 Table 1 1: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. The hierarchy of supen,ision in Ghana fbllow's the health system structures. thusl r-rational. regional. district, sub-district and comnrunity level. [[owever during Mcctizan distribution the national tearns sllpport the regions to supervise districts 2.9.2. What were the main issues identified during supervision? o Most normads f}om llLrrkina Iraso arid Togo do not perceive themselves as risks for Onchocerciasis. and so- shy away from treatment under the pretext that they have already reccivcd trczrttnenl liorn their home country . Some CDDs in the Ashanti region had either travelled or withdrawn from the treatment programme at the 1lth hour thus compelling late replacement o Most villages did not have any arrangements for treating persons who miss out on treatment during the official periods o Some villages adopted the central point treatment strategy to the disadvantage of households that are a bit detached from the main villages. o Most posters and fliers that were distributed and pasted during the sensitization periods had been removed. Only a few were around. o It was also observed CDDs at some villages were only interested in dishing out Mectizan tablets to the people but did not wait to observe its administration. This, in our view, compromises compliance and may lead to false treatment coverage t District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSNI) No of Communities that conducted stakeholders meeting (SHIvf) TOTAL 30 Ghana OCP,25 January 2012 2.9.3. Was a superwision checklist used? Yes 2,9.4. What were the outcomes at each level of CDTI implementation supervision? 2.9.5. Was feedback given to the person or groups supervised? Yes 2.9.6. How was the feedback used to improve the overall performance of the project? All thc issues iclentilled rvas fbd inlo the planning ptocess to reinlbrce inftruration. education and cor.nrnrrnicalion o1-the- CDI philosophy and ensure irnproved treatnlenl outcontes SECTION 3: Support to CDTI 3.{. Equipment Table 12: Status 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? Source Type of equipment APOC MOH DISTzuCT/ LGA NGDO Others No Condition No. Condrtion No. Condition No. Condrtion No Condition 1. Vehicle 2 F 2. Motor cycle(s) 3. Computer(s) 1 F 4 F 4. Printer(s) I F I F 5. Photocopier (s) I F 6. Fax Machine(s) 7. Others a) b) c) 31 Ghana OCP, 25 January 2012 Contributor Year I period') ('provide the Year 2 ('provide the period') Year 3 ('provide the period') 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) 123,382.00 12,648.27 MOH (District/LGA) Local NGDO(s) ( if any) NGDO partner(s) S i ghtsavers 211,567.00 81,7 17 .24 146,666.76 146,666.76 Others a) USAII) b) Communities APOC Trust Fund (CDTI+ Surv) 481,920.13 191,608.01 APOC Trust Fund (CDTI ToT) 72,428.22 63,823.02 I10,667.00 I10,667.00 TOTAL 889,297.35 349,796.54 257,333.76 257,333.76 3.2. Financial contributions 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? The problems associated with release of counterpart funds was as a result of undue delays in the submission of returns by districts and regions, which ultimately affected the release of funds from donor partners. Accounts personnel from the headquarters followed up returns at thefrontline healthfacilities, districts andregions to help prepare and submit returns to APOC. Training has been identified for all institutional Accountants to them trained on APOC funds to facilitate returns submission. 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 $l=(ihcl.5 32 Ghana OCP, 25 January 2012 Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? SECTION 4: Sustainabilify of CDTI 4.1. lnternall independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) Ycs_Year 3 Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? l. Generally, the key activities of CDTI need to be enhanced - The project management at various levels should enhance advocacy and sensitization on communiry participation and ownership, educate the communities on their roles; women leaders should encourage Activity Expenditure ($ US) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training of CDDs Training of health staff at all levels S,upervislng CDDq _a4d distribution Internal monitqring of QDTI activities Advocacy visits to he?ltb an( polili_c4l_4gQgg1lgs IEC materials S ummary (reportin-g) forms for treatment Vehicles/ bicycles maintenance -.1 9{!,"q Equippelt (e.g compute!,s, etc _t Others I t'------- TOTAL Total number of persons treated JJ Ghana OCP, 25 January 2012 women to participate as CDDs; increased advocacy at all levels for resource mobilization and for more partners to support program. 2. Programme management should ensure that the training and supervision of actors at different levels especially training of FLHF staffs who have to guide the communities in the implementation of the CDTI approach are improved upon. CDDs should be retrained especially on record keeping and reporting. APOC and other partners needs to ensure timely release of funds and logistics to the project so that CDTI activities are implemented as planned. 3. There is the need to develop special motivational packages for CDDs e.g. exempt them from paying community levies, provide T-shirts, pay for their National Health Insurance etc. 4.1.3. How have they been implemented? The recommendations of the IPM study would be used to strengthen the next round of mass drug administration, which is scheduled for February 2012. 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period?_Y ES Was a sustainability plan written? No When was the sustainability plan submitted? NA_ What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels Districts and regions are being encouraged to develop composite plans with budget lines for NTD activities. 4.2.2. Funds The NTD advocacy stratery focuses on in-country fund raising using multiple approaches. This innovation is vigorously being pursued 4.2.3 Transport(replacementandmaintenance) The NTD programme, which is part of the Ghana Health Service, works closely with other departments of the service to request for transport from the government pool to run its activities. 4.2,4. Other resources 4.2.5. To what extent has the plan been implemented 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 34 Ghana OCP, 25 January 2012 4.3.1. Ivermectin delivery mechanisms Iverrncctin delivery to endemic districts is done through thc health system. just as any other cornrnodity in the hcalth sen,ice. Regional Coordiuators prepare distribution spreadsheets which guidcs the allocatiol.ts to each district. 4.3.2. Training A pool ol-national level stafl'supporls regions to conduct training and oricntation activilies lbr the cff-ective distribution of Mectizan tablets in the various endemic villages 4.3.3. Joint supervision and monitoring with other programs I'hc N'fD Prograrnrne. in collaboration rvith the Disease Control and prevention Department ol'thc public health division. mobilizes technical stall lrorn the various programmes to monitor and superuise CDTI activities in the regions using the NTD developed checklist. 4.3.4. Release of funds for project activities I:unds nonnall1, go through the health service structures ie. fiom the Director of Public Health to Rcgional and District Directors of Ilcalth Scn,ices. I'hc Programnre Manageronly reqllests Iirr the release of firnds for implementation of CD'I'I activities in the regions. 4.3.5. Is CDTI included in the PHC budget? 'l'here is a budget line fbr Onchocerciasis control rvithin the overall public health budget at the national levcl which ensures that liurds are rcleased cach year to support Oncho surveillancc actir ities in the regions. The NTD progralnlne is through its advocacy activities encouraging regions ancl districts to do same. 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? Currcntly in Ghana the CD't'l structures are used by ahnosl all the community-based prograntrnes; guinea wornt eradication programmc. the Immunization programme (EPI). 'fube-rculosis Programme, the L[r prograrnrne. National Malaria Control Programme, Family Plzurning progran'rme, ctc. all oI which uscs. in rnost cases, the same CDDs to distribute their cornnrodities. Additionally. the Surryeillance Department has trained these volunteers to idcntily and reporl any health event occurring in thcir respcctive villages to thc nearest health lacilities fix' irnmediate response and management. 4.3.7. Describe other issues considered in the integration of CDTI. 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. 4.4.2. How were the results applied in the project? SECTION 5: Strengths, weaknesses, challenges, and opportunities - List the strengths and weaknesses of CDTI implementation process Strengths include o Availability of operational plans and guidelines o Availability of APOC guidelines for implementing CDTI o Commitment of Ghana Health Service shown by the willingness of health workers to implement the programme o Clear de-centralised system for programme management o Established channels of communication 35 Ghana OCP, 25 January 2012 o Availability of tools and reporting formats for programme implementation o Percieved benefits of the drugs by the communities o Readily available donated drugs Weaknesses include o Acute shortage of trained staff o Problems of transportation from district to sub-district/community level o High attrition of trained staff o Competing health activities o Inadequate funds and resources to implement all prograrnme activities List the challenges and indicate how they were addressed Challcngcs o Synchronizing funds from programme partners for implementation o Late reporting by district and regions on CDTI o Poor monitoring and supervision by health workers during the activities o Micromanagement of programme by some partners o Late release of funds by some donors o Competition with other health programmes o Implementation of CDTI in the context of other NTDs which employ the campaign strategy for implementation o Need to train new technicians to help with programme evaluation through epidemiological and entomological surveys as old staff approach retirement Recommendations o Programme to identify all onchocerciasis endemic communities in the country by working with endemic districts and provide a line listing of all these endemic communities for regular treatment by communities o Draw a strategic plan for implementation of onchocerciasis control based on the updated onchocerciasis prevalence data o Identify black fly breeding sites for possible ground larviciding in endemic river basins particularly in the Black Volta Basin o Identify and train technicians to take up the place of aging ones o Identify focal people in all regions to train for epidemiological and entomological surveillance activities in the country SECTION 6: Unique features of the project/other matters 36 Ghana OCP, 25 January 2012