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

-l t_ SOUTHWEST CDTI PROJECT, LIBERIA TECHNICAL REPORT 2OII ntds.liberia moh@yphop._co-m ORIGINAL : Enslish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) DEADLINE FOR SUBMISSION: To To APOC Management by 3l January for March TCC meeting To APOC Management by 3l Julv for September TCC rneeting AFRICAN PROGRAMME, FOR ONCHOCERCTASTS CONTROL (APOC) sa For To: ''-i a Pr r' ,t / i, For In[or,rr tion I I i I I ; y( Proiect Name: South West CDTI Project COUNTRYiNOTF: Liberia Approval year: 1999 Launching year: 2000 From: January 20llReporting Period: Month/Year To: December 20ll (circleone) 1 2 3 J 5 6 7 tl 9 l0 ll l2 13 rre rt: APQC,luldiryxarl 12 3 { 5 7 I 9 r0 ll 12 t3APOC Pro cct im lementation Partners: - Ministry of Health & Social Welfare - Sight Savers International - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - 1828 communities Partners:Date submitted: I I (circle one) t! ANNUAL PROJECT TECHNICAL REPORT TO I'ITCFINICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICBRS to sign the report: County: Liberia NTDA{CD Program Director Name: K. Signature: Date It.,>{-fi t 2} Sightsavers Country Director Narne: Mrs. Adoley S Signature: This report has been t'L '?C,..?q.t?: :;-t ', '' i. . i n --.nr fl.-rqr ; :1.,-r'i 1 .1 Nanf6iNOlE r. Designation: NOTF r'- i -. '. Signature:,......-: .. rr,.(.. --. ./'f ,\ Date ........ .'.'..... ;....:':/ Table of contents ACRONYMS V DEFINITIONS VI FOLLOW UP ON TCC RECOMMENDATIONS....... EXECUTIVE SUMMARY.... SECTION 1: BACKGROUND INFORMATION l.l. GpNpnalrNFoRMATroN..................... 1 . I . I Description of the project (briefly) 1.1.2. Partnership 1.2. Popu1nrroN............... SECTION 2: IMPLEMENTATION OF CDTI........ 2.1. TIvpLtNp oF ACTrvrrrES ............ .........8 2.2. Aovocacy ..................... l0 2.3. MostltznrroN, sENSrrrzATroN AND HEALTH EDUCATToN oF AT RISK coMMuNtles l0 2.4. Covrrr,tuNlry rNVoLVEMENT........... ..................... l1 2.5. Cepecrry BUTLDTNG.. ......12 2.6. TRperueNTS.............. .....14 2.6.1. Treatmentfigures.......... ........... 14 2.6.2 What are the causes of absenteeism? .......... . .. 16 2.6.3 What are the reasons for refusals'?................ .. 16 2.6.4 Briefly describe all knotvn andverified serious adverse events (SAEs) that ....... l6 2.6.5. Trend of treatment achievement from CDTI project inception to the current year l8 2.7, ORDERTNG, SToRAGE AND DELIVERY oF IVERMECTIN 2.8. CotutuuNrry sELF-MoNrroRrNG AND STAKEHoLDERS MpprrNc ............20 2.9. SupeRvrsroN ............... ......................20 2.9.1. Provide aJlov, chart of supervision hierarchy. ............ 21 2.9.2. What y,ere the main issues identified during supervision? . ............................ 2l 2.9.3 l|/as a supervision checklist used? ................21 2.9.4. What v,ere lhe outcontcs al each level o.l'CDTI intplementation supervision? 2l 2.9.5. Was feedbctck given to the person or groups supervised?........... .................... 22 2 9 6 Hov'rt'us the.feedbackused to intprore lhe oyerall performunce of the project? 22 SECTION 3: SUPPORT TO CDTI... )) 3.1. EqurrueNr .....................22 3.2. FmaNclel coNTRTBUTIoNS oF THE pARTNERS AND coN4NIuNrrrES............. .... .........23 3.3. OrHen FoRMS oF coMMUNrry suppoRT..................... ERnsun ! SrcNnr NoN DEFrNr. 3.4. ExppNprruRE pER ACTrvrr\' .............27 SECTION 4: SUSTAINABILITY OF CDTI. 11 4.1. INreRNnr-; TNDEnENDENT pARTrcrpAToRy MoNrroRrNc; EvuunrroN.......... ..........27 1.1 . 1 Has the project ever been evaluated/monitored? (Tick any of the follotuing which ure applicable)... ................27 1 1.2. llhat v,ere the recommendations? ............. 31 1.1.3. Hoty have they been implemented? ............. ................. 32 4.2. SusrRrNRgrLrry oF eRoJECTS: ILAN AND sET TARGETS (MANDAToRv AT...... ..........32 iii 1 3 4 4 4 5 7 8 Yn 3) .......32 4.2.1. Planning at all relevant levels... .................. JJ 4.2.2. Fttnds....... ..............33 1.2.3 Transport (replacement and maintenance) ......... 33 1.2.1 Other resources ......33 1.2.5. To what extent has the plan been implemented................ .............. 33 4.3. INrecRerroN ............ ......33 1.3. I lvermectin delivery mechanism,s ................ ... ... 3 3 1.3.2. Training.... ............... 33 1.3.3. Joint supervision and monitoringwith other programs.... .. .......... JJ 1.3.4. Release offunds for project activities ........ 331.3.5. Is CDTI included in the PHC budget? .............. ........... 33 4.3.6. Describe other health programmes that are using the CDTI structure and hotv this u,as achieved. What have been the achievements?............. .................... JJ 4.3.7. Describe others issues considered in the integration of CDTI. ..... 31 4.4. OpenarroNAL RESEARCH .....38 4.1.1 . Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. . J8 1.4.2. How were the results applied in the project?.... ........... 38 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES... 38 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........38 lv Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG WHO CHT OIC MERLIN CRC CHAL CO CHDD CHO BPHS NECP LISGIS 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-Govemmental 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 County Health Team Officer -in charge Medical emergency relief international Caval la rubber corporation Christian Health Association County Onchocerciasis supervisor Community Health department Director County Health officer Basic Packages of health services National Eye Care Program Liberia Institute of Statistics and Geo Information Services Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (i i) Elieible populatiqru 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) Ultimatc]reatment Goal (UIG] 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). (v) Therapeutic coveraqe: number of people treated in a given year over the total population (this should be expressed as a percentage) (ri) 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 maximize cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainabilit),: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, rvith high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilized by the community and the governtnent. (ix) Communit), self-monitoring (CSM): The process by which the cornmunity is emporvered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), rvith 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 FOLLOW UP ON TGC REGOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session Numher of Recontmendatiort in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT ASE ONLY Report Related (i) Table 2: reconcile the sum of Meso and hyper-endemic population with the total Meso and hyper-endemic population; The table was reviewed and corrected ( ii) Explain the increase in the number of communities from 1267 (previous year) to 1449 in the current year; The increase in the number of communities was due to the splitting of communities that were merged (ii i) Reporl on the outcome of advocacy meetings; The advocacy meeting held with The chief medical Officer of Firestone and 5 medicalstaffs of LAC on the low coverage of therapeutic coverage resulted in the two organ izations partic ipating fully in CDTI. Advocacy meetings with policy makers at MOH & SW resulted in the inclusion of Oncho and other NTDs in National Health plan (iv) Reporl on the irnplementation of the recommendations of internal monitoring by NOTF in the next annual technical report; Report of the implementation of intemal monitoring by NOTF has been summarized in the technical report ( ) Give details of the correct figures for the population numbers and for details of Mectizan Tablets, requested, supplied, The population was cross checked and corrected. Concerning the Mectizan the figure, it was calculation error. The actual Mectizan provided to this project was L5 million and I I 8l I 94 were used instead of 3.25. 1 used, lost and remaining. Cross check because the report states that 5 million tablets were asked for - 1.5 million were provided and 3.25 million were used. Project Related (i) Train more health staff in CDTI and aim for 100% coverage; In 201 1 number of health workers trained increased by 24%. Funding constraints will not allow the Project to train all health rvorkers (ici) Increase the number of communities with community supervisors and improve the Male: Femelle CDD ratio; The number of communities rvith supervisors is still low effort will be made in 2012 to get communities to involve more people as community supervisors. The female ratio is also lorv, The Project rvill request technical assistance for gender mainstreaming in CDTI (iii) Improve on the CDD to population ratio and aim to achieve I CDD to 100 population; The Project rvill mobilize additional resources to train more CDDs to meet the required ratio of I CDD to 100 population (ive) Streamline the ordering of drugs to tally rvith the need of the project; The dnrgs have been ordered based on the population of the project al'ea. (v) Conduct CSM and SHM trainingl CSIvI and SHM rvill be conducted in March 2012 (vi) Repair/replace the project veh icle and motorcycles; The vehicles have major problem that require huge funds to repair. There is need to replace the vehicles for smooth running of this program. (vii) Carry out the fifth year sustainabi I ity evaluation; Sustainabi I ity evaluation rvas conducted in August 201 I in the project area. 2 Executive Summary Prepare an Executive summary of the report in not more than one poge. 1. Background on treatment and population data - Total communities, communities treated, total population, UTG, ATO and persons treated. 2. Background on population movements 3. Training data - CDDS, health workers, Total population (community) per CDD trained. 4. Challenges and how they were overcome. The southwest CDTI Project was approved in 2002. This project consist of five counties which include: Bomi, Grand Bassa, Grand Cape Mount, Margibi and Rivercess There was great improvement during the year under review. The inclusion of onchocerciasis and other NTDs as priority diseases in the ten years National Health Policy and the Essential Package of Health services impacted positively on CDTI implementation at national and Project levels. Also the appointment of District Health Officers (DHOs) helped to bridge the gaps between the frontline health staffs and the health personnel at County level. Achievements o Total of 580,098 persons were treated out of the target population of 705,572 which constitute (82.2%) therapeutic coverage compared to 79o/o coverage in 2010 o Total of 1760 communities were treated out of the target of 1828 communities which constitute 96.2% geographical coverage. . 430 (24%) of communities with less than 80% therapeutic coverage. . l39l health personnel in Project area with 332(24%) involved in CDTI . 2148 CDDs trained/retrained . 312 health workers trained /retrained . Public-Private partnership established with two Rubber companies . 5 years sustainability plan developed by counties in the Project area. . National Program review meeting held in Gbarnga APOC provided 5 motorbikes to ease the logistic constraints faced by the Oncho supervisors The Project faced the following challenges '/ Delay in the release of project funds by MOH to counties: '/ Logistics (the Project vehicles have fully depreciated as a result they are not functional to carry out regular monitoring and effective supervision of the CDTI activities ,/ Inadequate number of CDDs to cover the required population; ,/ Lowmotivation of CDDs '/ Delay in Projects/counties retirement of funds 3 SECTION 1: Background information 1.1. General information l.l.l Description of the project (briefly) Geographical location, topography, climate Population: activities, cultures, language Communication systems (roads. ..) Admini stration structure Health system & health care delivery (provide the number of health posts/centers in the project area if the information is available). Number of health staff in project area and number of health staff involved in CDTI activities. The Southwest CDTI Project area is located within the South Westem region of Liberia. The region is bordered on the south by the Atlantic Ocean, on the west by the Republic of Sierra Leone, on the east by Cestos River; and on the north by Bong County. The Region is situated within the rain forest and mangrove vegetation belts of the country. This terrain is mostly flat, particularly in the coastal plains and rolls up gently through the plateau and mountain ranges. Prominent in the region are major rivers, including the Cestos, St. Paul, St. John, Lofa and Farmington Rivers, which tributaries are good breeding sites for the black flies, the vectors of Onchocerciasis. The climate is tropical and humid all year round with variations between the dry season (which begins in October and ends in April) and the rainy season (begins in April and ends in October). The population is mostly comprised of low-income earners who depend on subsistent farming of cassava, rice, sugar cane, palm oil, rubber, cocoa and coffee. The farming season begins in February with harvest time in October. The roads in this project area are unpaved and very difficult for free movement especially during the rainy season. Four-rvheel drives are the best suitable vehicle for traveling to some of these counties that are hard to reach. In some part of the project areas, motorcycle is the only means of transport. The ethnic groupings in the Project area are predominantly the Kpelle ethnic group. Other ethnic groups in the areas are Bassa, f}om Grand Bassa and Rivercess Counties. Kpelle from Margibi, Vai from Cape Mount, and Gola from Bomi Countr'. The traditional leadership structure in the communities is hierarchical in nature. Large areas known as chiefdoms are underthe authoritl'of the paramount chiefs: and the paramount chiefs are the head of clan chiefs with authority over the clans that make up the chiefdonis. The towns/communities make up the clans. In every village or town, there are councils of elders who are involved in decision making for the administration of the community. 4 Table I : Number of health staff involved in CDTI Cou nties 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 B2 Percentage Br=Bzl Br *100 Bomi 246 50 20% Grand Bassa 2t2 48 23% Grand Cape Mount 359 70 t9% Margibi 29t '78 2t% Rrvercess 283 86 30% Total 1391 332 24Y" 1.1.2. Partnership Indicate the partners involved in project implementation at all levels [MoH, Sightsavers, (nationaUinternational), communities, local organizations, etc.l Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. National Level Partnership with Sightsavers, WHO/APOC, MOH and Christian Health Association of Liberia partnership was strengthened in 201 1. Sightsavers and WHO/APOC provided technical and financial support to the program while CHAL provided technical support in the area of training. Project/County Level There was increase in partnerships in 2011. Public - Private Partnership on CD'II was established between the county health teams of Margibi and Grand Bassa rvith two concession companies - Firestone and Liberia Agriculture Company (LAC). These two companies have taken up the task to carry out CDTI implementation in their catchment areas. These partners supported the CDTI with necessary logistics for HSAM. treatment, monitoring and the construction of measuring stick and reproducing of reporting forms for the CDDs. The reason for the partnership initiative was the need to improve on geographical and therapeutic coverage which was low, but have now increased. In Rivercess County Africa Humanitarian Action (AHA) and a local organization known as Citizen Development Association of Rivercess (CIDAR) assisted the county health team in monitoring and supervision of CDTI activities. The community based organization assigned one staff in each of the health facilities in the county to work along with the general Community Health Volunteers and the community Directed Distributors in the 5 implementation of various health programs. They also assisted in planning, supervision, health education, sensitization, advocacy, mobilization and reporting. In Bomi County, a meeting was held with all districts and decision makers. 6 o 0) '= Li o. 0).. (Jtr rEooc)LL (-)()_c -C rj n (-)Y .c,) 63 q-.j a 0)(d 3a 0) =aYa ao ,*aFa -.' oU6 oI)(€.o =-o'-a= v o.) '= c) o(do oo {i cn .:<(Ji )-q 6cdEor :9 =6J -r'1 0.) :1 N oooboL 0) a6 c 0.) For =o.o(HOO FO-()- 0)oo 6 - a o)) ^o)u.* \t c-l :' o() O.a () ot< oa !o - V) Ui) o'\\ !D i U q)\ q) -o o >. \) s! x.'\d!\\ _qr :\ 6.EL.\B sq) .s >. px Bq) is sr\ qj! Sq) ^\_%o i-\e:9 =*\i-6t\ C={} C> *! ^" LL{:\:!- LY -o: iq) av Q! -rY !c nr :! Bq) -Y= ild Ls q + r* q)\ o ^d q)qR q) d o lr 0) a. oo li o O. oLr() bo li lr o 0) o H ot<(! >' a) H() o cgq) Io () q) () !a H ao E U oir OI _I _ol(dl FI tr o +, G 5 o. oo aN F r- ao/ l-.1 a. L.,l0)r, >v _o(i 0_) -o 0) va 0rl S,q q< 0)oo a=9H ca(BOZ .^ 0) .= t) L '= r^ .: CH ._ o z I -7 I Iao/ c..E t-o co ! 0) Lr o 50 Ii c) 'd o 0) 'a H a. (.) tn U) c)o U) .? o F = Ot = o-Ico 5 gq(, + il r 0,) -oo .= o.N 9\ c r q)E -(, No C9 o) NNNN(o o rooo o) slo o)f.- @ ri'$o$t- r! 1'* rf) lJ)Ol'r . o-tr E !.'= ! 6&5.=;; >,E(')()-E E 5'FNa Nso (f, f.- O) (o(o N osoN ro o) oo CO ro NN o) tr) lJ) N cOor\ Ln G 'EgE jec ?.U o=Li=i '- Q2. o(o N @ $ ro(o (f) o o@ (f) so|r) N C9 o) r @$ f.. sl r\.1 rn an rl I q) ON o.= dq) oF + il lo rN (f) N (f) tr)|r) .ts (f) lr) o) cf) @(\ co F-{ o .9 a, €?E; ()E >r c)FE N f.-(o t-NN r$ O) t,q) b! q) 0) c) ! o) zt ?.U o-L ='-Q2 @s (oo) o$ N@N N(o $oN @ Nr! Fl O Ln rr) 0.) OC'lcB P.i .i -,= q !{6I Cr.3. E *q, 9'vu-h LA-A No(9 o) NNNN(o o rooo O) $lf) O)t-@ rtr$o$f.* r\J l-- rn Lnol-. '!i () c) .3s q) ?iricc .-.r a 0)O q 7t'rcr6 n'I F E o o z. o c-(!(, 'o d 5 bo oo o .:& J F F SEGTION 2: lmplementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, indicating when the key activities were implemented by the month they began and the month they ended. 8 o\ U) c) a o oe EE U L 0) ,o () o z (.) (.) o 0) l-l (.) -o () o C) IJ o -o E C)oo Lo -o E(.) o 0) o b.0iE a- L d L .o C) f! h L d (! L d a cd L U) uc L c)e o5Htr U () -oo o ^ L(-) -o E o o. C)a L 0) -oo o o L() .o o o C) -oo o uoET q) c!3 v) U) 0) U o9 EH o Q a bo L o. L o. o-4 boEE cq: a- a) L c'd L -oC)b =L -o0) tr< bd -o(.) k UI 3 0Je HO EE U q) b.0CA cq= a- 0) = (J = (-) (J = aQ) a-tr ii= !tr f-{ Iz c)! o.5tstr U L 0.) -o E o z iq) -o (.) z 0) b! -E a- h L -o o)q. b cd h (! h -o0) r U E r (€ ! o o- Cd O ! -oa0 oo o .z& 6l Lr Cd o >. oF o() 0) o t< cr) ot<(o (.) H _o a C) o(! (H o 0) (.) F ..ir o)l _ol cdlFI 2.2, Advocacy State the number of policy/decision makers mobilized at eoclt relevant level during the current year; the reoson(s) for undertaking the advocacy and the outcome. Describe dfficulties/constraints being faced oncl suggestions on how to improve odvocacy. Advocacy meetings were held with counties authorities, International organizations, local organizations, concession companies, religious leaders youth leaders, traditional leaders and women groups. The reason for the advocacy was to inform stakeholders about the CDTI activities and to solicit their support in whatever capacity they could help either as individuals or organizations. At the National level advocacy meeting were held with the Deputy Ministers, Assistant Ministers for the inclusion of CDTI and other Neglected Diseases into the ten years National Health Plan and Essential Package of Health Services. Also wide consultative meetings were held with stakeholders and partners using the findings from mapping of the NTDs diseases to garner support for NTDs during the priority setting phase of the National Health Plan development process As a result, Onchocerciasis control was included in the national health plan as one of the priority programs of the ministry of Health and Social Welfare. Projects/Counties followed suit by creating budget lines for NTDs in their annual operational plans. Margibi and Grand Bassa County Health Teams in collaboration with NTDs Program held series of advocacy meetings with the management of the Firestone and Liberia Agricultural Company. The outcome of the meetings was successful based on the commitments from the various partners to make the program a success. The Firestone Plantation Company and Liberia Agriculture Company were among the concession areas where CDTI have been fully mainstreamed in their health and Development programs. In the Project area advocacy meetings were held with a total of 80 policy makers made of Superintendents, Development Superintendents, health partners and district commissioners Some of the policy makers at Project level were also involved in the development of their orvn sustainability plans for CDTI activities beginning 2012-2015. 2.3. Mobilization, sensitization and health education of at risk communities Provide inlbrmation on: - The use of rnedia and/or other local systems to disseminate infbrmation - Mobilization and health education of communities including rvomen and minorities - Response of target communities/villages - Accomplishments - Suggest ways to improve mobilization and sensitizalion of the target communities. There was increased awareness in 2011 during the time of distribution. The County Health Team collaborated with the local radio stations in their counties to air CDTI jingle twice a rveek for two month based on the various schedule for distribution at each county with supporl from Sightsavers and APOC. The following local radio stations were involved in the media campaign, Radio Piso in Grand Cape Mount, EIRB Radio in Bomi and Radio Kakata in Margibi. In all the Counties CDDs, CBOs and town criers in the communities were use to disseminate information regarding CDTI activities in the community. They provided health education messages to community members on the important of Mectizan and the community roles and responsibilities in CDTI. l0 Mobilization and health education of communities including women and minorities have not been adequate. Most frontline health workers do not plan adequately for mobilization and health education of the target populations in the community. Despite the inadequacies on the part of health workers, there has been increased awareness, acceptance and demand for Mectizan treatment in the community. This fact is buttressed by the general increase in therapeutic coverage during the treatment round. Suggested ways to improve mobilization and sensitization of the target communities '/ Involve more community based organizations such as religious organizations, school teachers and pupils, road transport workers, in the propagation of CDTI messages in the community ,/ Mainstream CDTI in gender activities '/ Produce and distribute health education materials in endemic communities '/ Increase use of local languages when airing messages using local radio stations '/ Help Health facility staff to plan for HSAM before and during distribution 2.4. Gommunity. involvement Table 4: Communities participation in the CDTI Comment on: - Attendance of female members of the community at health education meetings - In general, how do you rate the participation of female members of the community meetings when CDTI issues are being discusses (attendance, participation in the discussion etc)? - Incentives provided by communities for the CDDs - Attrition of CDDs. Is attrilion a problem fbr the project? If yes, how is it addressed? - Other issues County Number of com munities/villages with community members as supervisors Number of CDDs and the communities involved Total no. com munities in the entire project area B4 Number with community members as su pervisors Bs Percentage Bo= BJ B. *100 Male CDDs B? Female CDDs B8 Total Bq= B?+Br Bomi 215 6J 29% 2t2 53 265 50 23% Crand Bassa 323 103 32% 103 5l 454 41 1,4%% Grand Cape Mount 551 189 34% 137 114 581 t37 25% Margrbr 344 '76 110 /LL /O 356 8 I 537 166 48% Rivercess 395 il0 28% .106 195 601 l8l 47% Total 1828 5{l 29% 1814 624 2438 581 32% ll The attendance of female members of the community at health education meetings has witnessed a steady increase in recent years due to testimonies from the beneficiaries of the Mectizan drug. There has been full participation of female members of the community in discussions during health education meetings there are no local norrns baning women from expressing themselves in community gathering. However in some communities there may be low attendance due to the farming schedule where women are engaged in the farm to plant rice during the months of May to July. It is important to take into account their farming schedule while planning HSAM in the community. Communities in the Project area have agreed on ways to motivate CDDs from cash incentives to non cash incentives. Rice, cassava and plantain are given to CDDs at the end of the distribution. Many communities are still reluctant to provide incentives to CDDs and this has affected their performance. CDDs attrition is a problem and the ways to address the issue of CDDs attrition includes training many CDDs and involving religious groups, schools and CBOs in CDTI to broaden participation and ownership of the program 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels. - Where frequent transfers of trained staff occur, state what the project is doing, or intends to do, to remedy the situation. (The most important issue to describe is what measures were taken to ensltre adequate CDTI impletnenlation v,here not enough knowledgeable manpower y,as available or if staff is frequently transferred during the course of the campaign). There are no frequent transfers of trained staffs in the Project area.332 (24%) out of the total 1391 health staffs in the project area were involved in the CDTI implementation in 2011. It observed that the management of the County Health Teams failed to provide effective oversight to the health personnel implementing CDTI and other Health Programs. There is no system for proper orientation of staff reassigned to new positions. It takes almost l2 months lbr newly appointed Oncho supervisors to become acquainted with demands of the position. t2 q) G u) U z Y Q +: U U llI(-)F q oor! rn l'. f.. a\ F.l oo LN 6 o) ri (\o an LN @ st r-(o GI oo r{ a\t F-l st co oI'r(\ ri r\ N N(o co F. cn Or <C N @ rJ' N FI @ r{ (ogl o o q) o\6 U L N O 1r)F- co Nr- In Ol co c\t q e) .a a' c!ti a): oo .c) Lc! z (, +_ O Q zv ilI(.) 6 +. a< c) q) c) o\ (,F ErdE,i +F'u" U U la IF ,9l< I +. q c) t) 0) () z rJ1(\ (\ N ao cOr\ Fl aO N sl r a\l(.o st lJ'') @ @(.o c\l an st co (O @ o r\t (o(.o N (n Ol rn Fl (n|J) F{ c) c) q) o\ N o\ €\. r -f @ ro m U J! Q cil LF I I a a J o a,) q) z =j- s r- (-- v N v a.l al s al o c) q) o\ s r- v \o \oa.l J a E o a d d d =o o o- U € 6 n oo d 2 Do o & J F F ca bO s o o t S o t o hO .E o a- o t o a. U.4t ! o Ut ,. g z o CJ E 0) O. F !U o cn o 0) 0)L ,0) *i () oo (d F a;; dJl _ol cdlFI U =l. Table 6: Type of training undertaken (Tick the boxes where specific training was caruied out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatment figures - If the project is not ochieving 100% geographicol coverage and a minimum of 65% theropeutic coveroge or the coverage rote is fluctuating, state the reasons and the plons being mode to remedy tltis. The number of target communities increased from 1449 in2010 to 1828 in 2011. This gives the impression that 379 new communities were covered in201l; instead it was the partitioning of the same old communities in 2010 that were transformed into more towns/villages in 201I There are plans to carry out geographical coverage survey to determine the actual coverage in the project area in view of the fluctuating number of communties being reported yearly. Trainees Type of training CDDs Other Communiry members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specifu) Program management How to conduct Health education Management of SAEs CSM SHM Data collection Data analysis Report writing Others (speciff) Partnership t4 tr) -\ + s bo o S M 0O \ .:\ q i -a $ I\ 1-U ;\Y\r! =t\o' :!d!e \=s\r!s-\PI :\U €aEt.T< E!!t 'i .r 3Bt$ s: F-'q! (5UI\S (, F '- v 0.) L(n P(.) o i,ULLe-!qla --!u -> .-M €B ,.: 6.: OJY \Ol) -;dlE l:dTe-o --os3t\<r.\ z.> -U .= 'ar -L()* !-dt\ , gS > e\J E qBa-ts o ;= - o=q +tE ?Nv.or tr or d'Y IF IA U zl- xl - \ldlLF -l Itl ar!ol=olXY EI E EI= *9l< 9l tr i. -l!l!aol ol c ,<' -t-l\ol ol- A ol ol (g !.ol ol: 3cl ol.u !LI AIF -ol ol .:EIEI Prl trl -i =l;t.iz zle a- +!. rilb \ t) o€ i:;.: ooo!i 99S >!wE8!rl !AYJPFN o o.o o >. o E E oa o 'o o Xo E o d c- o- d o a ol .) a d 9 o € d oo bJ o ood o =o E oo ,o EL o q^E ^eE!J*9,n4;='a #=9E?Ei: E5 3E 6?3ce g)Z EE Oo o o o o o o t3 Ee52te:t f.-f.- ro (o (of.- ocf) st(O(O b E€."E 8" E,l.i?g=5 Ns @s CO (os sro O cO st -?9U E"9z€ I rr) t-- $$lo rr) o\\o9- o\\o t-_ t.- (f) o\ to- sf Ot(\ r'lj N \1 6c;*EeE,Y rozb):'( zo-r; rc) N o\t- N Iro(n $oN. o\r N rn rf) lJ1$ o d q o O. -O6bo E e bs Fo \o o\ c.l r! @ \o o\q ri oo \o o\ n cO @ \o o\q a\ oo 6\6 o @ \oo\ .! N @ o =Ee69 L O::f oyZa ' rot- o. rot- osf (f)- (r) tr) F- O\- Irto It- co. roto sf(n co- o\ rc) @ O)od @ rn ?v?6U2E-o 7 ,oJ -o' FIJ No(fr- o\ NN N. N\o oto o. o o\ $ tr)q. N @ sfv o- sfN Nt- rolr)of.- a hii Q I u io .ei:E > c c dr-Y;- zE (v o(f)- o\ NN N. Nj\o o ro o. o o\ sf ra,q N @ sf$ o- sN Nf.* ro rf)o r.- a a) cn(d cr)q) E o(-) ll + !! 6Oo 6 Uro U.. v36 s\(o Ol \oo\ .l r.. O) x n? (O Ol >Rq cn Ot \oq l-. Or s c!(o O) = a) u c ctly !=6d - a- ): =F>-Zd o @o(! $ r-l .O ri co rJ'l oN rn Fr @ aO O(o F- tsu do= c d.: <l I -o' F9 () N coN cf) |J) ro !fs cf) to O) cf) @ r\l @ r-{ *=a'n'Aa * =)- ? o= ' E 6 -E E { S€ I b€ ga -f=oE'J rr) r N coN co r LO ro $s(Y) ro O) cr) @(\ co F-l .9<!rr o\ Eo q d (d q ! o c.(€ O d^ t)2 5 a d oo o p 'l F t- qq qJ Q\J V) + q) \ 4 9 a_\- -Ya L (n(d L6 d ;(, J o tr a -o U) frl V) 'o (d 0) 6,)LF r-r o-,l -tol cdlFI 2.6.2 What are the causes of absenteeism? Absenteeism was due to the lack of proper scheduling of distribution period with community members. 2.6.3 What are the reasons for refusals? The refusal is due to the fact that some persons still harbor the fear that if they take Mectizan they will have the same adverse reaction some people experience when they took the drug for the first time. This continue to happen even with repeated health education 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that Occurred during the reporting period and provide (in table 8) the required Information when available. The project did not have any case of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report No serious adverse events were reported during the treatment round x t6 dJtr- 396 <t c= " oooOl)- O (!oi, ai) -trs) LLJ o o o.2 EA 99p)Yo6- aO* (H: q9^ 6,= Q)()-c E&!a (F;C)- o aE A C) F tr!(!oo() O E,ir e o ;6>vqEi-. -:..'u () X (B ti o I 99'.i? =.o.l1 o ,J-a-O::Z -YLolo !6aG -.4 .!* 99- a> = o- a oo ! o o o bo(! xoa 0) oo * a r- q) q) r*\) -a ! t*q a.i qq q) Uq) 4 \ qJ\ -d q)q e) o_ o lr() o. bo L o. C)tr o ao ! -o oLL o o E a r! a a 0) OJ() t/)L() d a L 0)a (H o cn 0)a Q odr d)I -l_ol(tl FI 0) bo YL^'F ()Xr >:,rO O co xN @ $ co o\ F- s o)t\ o\ ...1 N oo o (d a. IJr ll r t o - bI) vP- F O6\ -o o xor! d x do r{ o\ coN {co \oo\t-- o\ cl(.I co ll r r,kl rd '5o =ooO d^Oh\od 90' 99. F >s col'. \oo\ O)(o >R rlN o\ F- o\ o\r- o\ N C\ 00 E] ,o -9ots 2a =oz2,o o. o ro r{ ooo m co tJ) u) .i lJ)(o oo Ol F- ro ro(o r- o\ ca \o oo o\O co ri tsoE 6.= ::o) U.o- FL) €r-ot. LnN oc! sfd sr(o sf(o O) rolr) @ N (--$ a- oo$ C\ t-- O t-- a ^rd-Ho _^Ed il: O a'o € 9(e+\-H 'ia6) s Or o u)OIr) rn Ol co O) r{N ,ri sl Ol ro o)N(o co o, $ o, \o ca r- c.lr- O t-- q) oo d o E o() ll * E: Li E] o o &D= - 6"\ o\oo t/") \o o F- o\ ao(O o\\o o\ \oo\ c.l \o o'\ EU= o- oJJ =F3 9d;; OUri >e oO rn xo n\ o\ ao(o o\\o o\ o\cl \o hl o'- ? ar: O E == e, z3- (O oO sl .j L') O)Nj o GJ N \o ra 3 <. O\o F- tso daa E:O)as' FU O LO LN ^i o(O rn ^i rn Ot ni o.$$ co N oo ood =a .dq>-oo> 9 f,h+ oi >.:: OaqqaF- tr v .28 EO oo o(O rn a.J' o(O rn ^i LO o) c.) o\ $$ @ N oo r', rr.l o\ o\ o\ ON O N c.l ON co N .f, N \n N \o a! r- o.l oo N O N N 6l oo -U) I U ! -c) (') q) boadEb t> I\Up .= l,s t-rS, "1 I\ 9=tri4 !.:L H\v o\a! n\:rh3 i'E0)qrO IAH e\6.) vou5 I 5Ei 5Gt2 oc)c)()oJtr -.+- ybDEAE0,, a:. t Lir! HHg) qr0 f- (.r .=. l.t ?.)f \ L 6tv.oooE:S oa300 .L 0J -ttg F =l a,)6-Ut :F)ILY6ql E c)(Jl IAEli cJ -Ol 6 !Y"P H!u!PU,-tr>o9^l-6E5EEY iJd HLI-(giJ 9a g LItr()e oF6l LH!t- '|i d .;-;c) .Yro-EG '.. tr(.i o\l '; 0)l o -l €l _uFl O. o\ Xo () 0.)H a oo }rE ao o ,-E 0) (.) o. C) J< ! cJ) o C\. r r x.E[i* -v€ 0J :x -q: e9(cP 0)o Oa ,.- 0)t.vd '(feE o-r t'"o?x6(D^ '-i (toe(-) -a'Ex<; -Yo -otr ocoC)- ()(d raO ts56j).* q!-o TJ'E E aa=KE tr >q)C2 -C 6iOPAFr. r- EH(): e0) @ N o 0) z --. 0) -o F u0 G q) t--l-- o\ ca N oo\o t-- oo - o\ m o. @ cl$ riNo LO r-l sl () X Ii O co t o\ F-(\ rn Ol F. Or () cq o '] € c.t ol $ $ c.) N o\\o ro rl aofo () D 00N o\a \o ca oo o\ co F- $ co C.l c.l \o ca N\o co c.l co \o O) ro No ro rn r_J EE o() o9 e (l) c.)r-F- c{ N (r- c\ N \o co @ $ 00 o\ w $ N o\ o\ N (o @ sl ro oo f.. r_l q) oU c) Ooo Ol O) ri oooO <t$ oO @O .o Oooj cn rn oOOOO a{ Ooo@t-$ r-l U) q) 6 N I c) 2, 0) z () () ooo oi O) r{ o @6 ao' rj',) (n Or- .i c\lfn r-l rro rnr! st OOOoo N sflr)(odo(oj o;i .L )\ -Y =Fo =oO. ^r;a io. t/)r\ rn @ a! r- a\,1 sl @ L(o co6r\ <f, @ O) ao co F{ (\ Oro O) @ @ O sr r_{ ro U E ca d 6 a cd o o o o-(!() -o (! 5 bo d oo o 'u I F t-( tr z tr z .>'I o()q a 0)ad 0) o. L 0) u ,* riU z tr r-2, L.I % IJ \ -o\$s q) *\c U q) U) \) S I -o 0) lio oE @ CS N o() 2 o 0) o.a o U) C) Lo c tr riU z D :riaa N oo z. q) 4 q) o' S EJ tU CJ ,. a)g I -o L .o ! C) E +, o o EL o .z l} o L o .: ot, E tr G o tr) GL o +. o U, tr L oEL o il c,i -7 How are the remaining ivermectin tablets collected and where are they kept? After the distribution, the remaining ivermectin tablets were taken to the health facilities and kept in the health facilities drug store List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. Health care personnel at Project level make requisition for Mectizan to NTDsAIIOTF Secretariat based on population figures from the endemic communities. When approval is given by NTDs Secretariat, the Mectizan drugs are collected from National Drug service. from where they are taken to County drug store. The district health officers sign and collect from the County Pharmacist Mectizan allocated to health facilities for the respective health districts. 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? If so. When? Orientati-on of 7 National facilitators for CSM was carried out in 201I actual rollout is expected in March 2012. Table I l: Communi self-moni and Stakeholders Meetin Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. The CSM is expected to be piloted in March 2012 in two counties in the project area. No of Cornmunities that conducted stakeholders rneeting (SHM) District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) Nil Nil Nil Nil Nir Nil Bomr Grand Bassa Grand Cape lr'Iount 215 323 551 Nil NilMargrbr 344 NilRivercess 395 Nil 1828 Nil NilTOTAL 2.9. Supervision 20 2.9.1. Provide a flow chart of supervision hierarchy. Central Level . NOTF o NOTF,NTDs - Secretariat County Level o County Health Officer (CHO) . Community Health Department Director (CHDD) o County Onchocerciasis Supervisor (COS) Distri Level o District Health Officer (DHO) Health Clinic /Health Center Officer in Charge (OIC) Clinic Staffs o o Communit), Level . Community/ leaders or town chief . Community Development Committee o CDDs 2.9.2. What were the main issues identified during supervision? The main issue identified during supervision was that, most of the private health facilities in Grand Bassa County did not facilitate Mectizan treatment because they were closed down during the accreditation of health facilities by MOH & SW. The affected private facilities failed to meet quality standard for service delivery set by the Basic packages of Health Services (BPHS). The Government facilities could not supervise those catchment communities that should have been covered by the private facilities. 2.9.3. Was a supervision checklist used? Supervision checklist was developed by the program but not used at all levels 2.9.1. What rvere the outcomes at each level of CDTI implementation supervision? At County Level o Supervision by DHOs to health facilities on CDTI was lacking and it rvas recommended that the DHOs should carry out integrated supervision using checklist. . Health workers were not providing regular supervision and monitoring of CDTI activities in the community. . Some private health facilities in Grand Bassa did not participate in the CDTI program because they were closed by the BPHS accreditation team. Government health facilities were asked to add up more communities to their clinic catchment area. 2t 2.9.5. Was feedback given to the person or groups supervised? Feedback was provided to everyone supervised on the spot. A general feedback was given to the county health team during the de-briefing with the County Health Team. 2.9.6. How was the feedback used to improve the overall performance of the project? Generally follow-up of feedback by the Project was very poor. There was no evidence that Grand Bassa County took necessary steps to address the lapses identified during the supervision. SECTION 3: Support to CDTI 3.r. Equipment Table 12: Status of equipment *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? The MOH and SW will collaborate rvith its health partners to budget and release funds for equipment purchases and maintenance. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No Condrtion No Condrtron No Condrtron No Condrtron No Condrtion l. Vehicle I wo 2. Motor cycle(s) 5 F 3.Motor cycle(s) Bicycles 150 F Generator Portable METS 3. Computer(s) Laptops 4. Printer(s) Cannon Desk Top Computer GX 280 5. Photocopier (s) 6. Fax Machine(s) 7. Others a) b) c) 22 3.2. Financia! contributions of the partners and communities Fill tables 13a, l3b and l3c If there are problems with release of counterpart funds, how were they addressed? The Program advocated to the Deputy Minister of Health Services and Chief Medical Officer of Liberia at the Ministry of health to facilitate release of counterpart funds. 23 ofIu oforr o- oooqqq NO(O(OOs s_ @_ ro_ erCO (v) @lr)(o o9noo;<ooxlf,ro --o c.i N or a o)(v) Nr- o$ ci9@:/$'- @ o9^oo=o3tsR - $ c\l(\l N @ @(t .g=, a Oq) co =o) =eo'=():, !9* tr o) E o, o JIl ,9t, 'o oc ts Get ]U -F o o G o .9)o o r-s^'c.l 3N61 <..i 8[ co 1933 c"i @ ooo o,s EN$ o) (o ooooc');D8 c.l F- r a-6 rr)\ ct @ @ c!(, s oq o co o)llo-;eE B N(O^OS(otr)"lr)s P;.4 oO E; oo o,o,f.- o(o@ ,q C') 6')t-r- 3s cY) u)Ntr)N oo o- ooq33 =joJ oq th- d O) oooooo oosoo(o rOr s-N- oo oN O)_ @@ u? @(*, @- rOo Ee ol{)OF-lr)(o o(v) l'-o @ oocqooro roo- o^ o @ @^ q) l"- o ci S_o O)N oq oo ,.()- (o oo'oo oooooro c.i - oq oo o- oq oo o^ oq o$\(\{ r oOO33 oJ -q oo osN o, r.) o, F- oo LO U)l.-(OEe I o cr(E EDotrF 't o e-9efrso (E E o)oL> .2de(J o foEFcA.e .Ez q O)(o Nt tr)o s8NS oq tlo t-^ ct oo + l.r) N oo oo(o- u? co O)(t) N o el ! o,t oo o o '6 .o t UJ L(l, 1' c o) IEo o o .9 o o. oL(! o 6l o!F c o flt L c o o F z. lU =zt IU o o E o) 0) ct) !, o -8ulEEHEE OOOOXovI'OLO '- r C0 l.r).o -33.o N:.=$ oo oO o- ooo otr)l.r)o o- Gl oo c\l F- o) oooooo ooooocor- (O^ (O_ \trN Oo oN O) co @ q o) @ @- co r Ics9qo) G, ar>;3ebo -bEg IcE c koG o Yso, = 0)Ih;(/)ti=t! 9 A --t'lh=7 :t I P .S:6 d EE E E'=Eb b 6 shU,>>o =q ?iE;:; o) .E c cO(oPo-(o.Og) c rr)90)d)kE 6c'6 !os A .=a\rEo.u E=-*UE (o5Eoot+--3,rg>EE;i; - v) l\ yeN(Y)$-!Qd ri ri rj qqg :tr)tr)> (4 t4 o t4 o a.xq) G tr o EE J J FoF oz tr o UJz J F trJ oo J o q) tr o G '6 q o tn io GOCoo>EE5 E E g SE E E ilEEi ; E I *;soooao.i:E€ > cl) < r g SE :::: ti< an AF oOY'i :GU\:r o= ]uoUiOI E'bE Eoro)! 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FNCOQ c.j c.j c"j Iq Eoq) FC6eP6tro(trO \Q !6tr(oGo) be b eEcEA)so icl)Q>IJ* 'to!bEg€=E\ - 0) c3'E^EIE ts 3,> EH F HiIX:>f -(a-NQIb = =; 0)o ,aE o)!o: ocg<oX#<oc< =.9q2-E9=Xb> .9 6 ;E 5: .=(oo-o)a)i9!(,ru>-oE? <INcosQ -. ro rrr o ro 5 J F oF oz t o rn c'l oo 'a tr a o oa C) oo ch t<do >. 0) C)fi a o lr ,o a li() li(d o- >' -o t/) o -o ! o o CB t ro c) 6F \o N I olooi(\ C Go\ oc\ (l o a.tn E oE o o- o)L o)tr 0, -o t t! (! !, g(! o c o) E o) oL frl .2t, 2 o)c L o CLtluIF o t, Lof olr tE Ll- lr) to cr)F- l.- l- u) 6rj c.j c.j tfi(o (o (o (o -- r- r- s- ooN ro ooN- ro oo$- N ooooNN rr) N (cJ$f.-lr) o q) E, o CO:o) E9o'Fo- oEO E3 -z oL o o o ! cn6 H$SS $ r s s rs r o v_ N |t.*sot-N c o lo L c o o Fz UJ Eztr UJ o o q) tt, L fo oSEo I o O(E tr)oCF 't otE; ei5 EE T'OfE =U_ -o .9E o_7tt6.e tr(E (o(o (o(o(o(o f.- ro N r-oN (o(o c"j N O) cf) N o o U'E d)E [!z J F uJ(, o J o c o G 'a o t4 So Goco^ oi.E . E :E E * -:dr s N H ot:4.!.=o€--Si € H € E rEE > (/) < r gSe - N a? $ € r-rJio U, AF oO ^-(Bu\:r{t 'iHe durc'Eb Eolo)*EE .Ecco6rotr EE i;; .e -E E='3e'.!.b-a:iss€ eG!5l;<..i oo '. c.i o.i I *: =(4= c o olc oc9Fb6=;l=fs +E E E(/)>LUg .je.ic",a c"j c"j c"j I v, tt, Oar>;3qto il -\tg ;cb c hoG o< E X :E E 5 ;El,!l/l'=7!b . Pc- ; hgE Eg, = Eb b6 s Q P2>s I JE;}H; 0)ocIo .0)o:(ax\ ,\OUO-cXeo(l)C= '^ o) -LE e E:>o H.=q-:t i6 +a SEcDI.UEOE ot <rNcQj,rj-S; J FoF o z tr o (nlr o >' 0.) 0) ,- th () li .o aL 0) tr o. -o a o -o ! c) (B o t-q I ro q) CEF Describe (indicate forms of in-kind contributions of communities if any) Community support to CDDs were in the following forms . Cash incentives provided per household or centrally contributed and given to CDDs at the end of distribution . In-kind contributions in form of food stuffs . Providing Iabor to work in CDDs farm o Exemption from some community labor or contribution 3.4. Expenditure per activity Indicate in table 13, 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 Indictate exchange rate used here I USD :70LD Any comments or explanations? SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4.1.1 Has the project ever been evaluated/monitored? (Tick any of the following which are applicable) x Year 1 Participatory Independent monitoring Mid Term Sustainabilitv Evaluation Yes 5 year Sustainability Evaluation Yes Intemal Monitoring by NOTF x Other Evaluation b1, other partners Internal NOTF monitoring of CDTI NOTF conducted joint monitoring in November 2010. The monitoring covered all CDTI Projects including South West Projects The specific objectives of the mission is to assess the status of CDTI implementation in 20L0 - Asses Mectizan treatment coverage's in the community - Carry out data verification - Assess community participation in CDTI - Determine the quality of training, health education and supervision at County, district and health facility levels - Assess planning of CDTI activities and contribution of county authorities to CDTI x 27 Interviews of community members and Health personnel * Interviews were held with members of household to document when ivermectin treatment began in the village/community and whether treatment have been provided annually (unintenupted ) since inception of the Project * interview was held with CDDs to document their experiences and also verify the information on the duration of treatment gathered from households interviews were held with community leaders to discus their participation in CDTI OICs were interviewed discussion were held with CHT on the implementation of CDTI Findings l) County Health Teams (CHT) - management of CDTI All the Counties visited had 2010 operational plans for CDTL IT could not be verified if the plans were incorporated into the County health plan and funds allocated for CDTI activities All the Counties acknowledged receipt of funds from APOC & Sight savers through OFM. The quality of management the funds varied from county to county. Some counties complained of late disbursement even at CHT level Implementation rate of CDTI activities increased, however quality of supervision and monitoring remained poor. All counties received adequate Mectizan supplies and Registers CDTI reporting forms rvere in short supply Best practicc in data re"'ie'uv and validation was found in Nlargibi county * * a O a a a a 2) Health Districts and Health Facility levels knowledge of health personnel on CDTI at health facility level had increased considerably compared to previous monitoring results Apart from a few health facilities. many Officers in-charge of health facilities had not found time to engage communities in proper mobilization, advocacy and health education. This function was delegated fully to CDDs by some OICs Supervision of CDDs by OICs and other health facility staff was found to be very weak 28 a a a Majority of the private health facilities were left out of the CDTI exercise especially in Grand Bassa In some facilities OIC were not empowered to conduct the training for their CDDs. It was not enforced during the OICs training in some counties that they (OICs) were fully responsible for the CDTI activities in their catchment areas. inadequate reporting forms at Health facility level Quality of CDD training needs improvement Inadequate logistics - transportation 3) Community Level Table l: showing Status of community decision making in CDTI in South West Project o Awareness on the drug and treatment was found to be very high in the communities . Community leaders have fairly good information on Onchocerciasis, but some decisions were taken by OICs and CDDs ( time and mode of treatment etc ) o Community involvement/participation in CDTI generally low Treatment co\/erage varied fiom County to County and even within districts. Some communities were still carrying on with Mectizan distribution at the time of the monitoring exercise o o a a a a o a Perv number of CDDs to cope with task of distribution to large populations Geographical coverage had improved greatly when compared with previous years County No of communties Community Decision Selection of CDD Mode of distr. Period of distribution Census Update Mectizan supply adequate Grand Bassa 3 2 (67%) 2(67%) t(33%) 3(1 00s) 1(33%) Cape Mount 2 2(r00%) t(s0%) 0 (o%) 2(r00%) 2(100%) Bomi 2 t(s0%) t(50%) o(o%) 2(100%) 2(100%) 7 s (71%) 4(s7%) t (14%) 7(100s) s(71%) 29 Strengths, Weaknesses opportunities and threats Strengths o Awareness of Mectizan and potency of the drug . Commitment of community leaders to facilitate CDTI in the community . Large number of committed CDDs . Increased knowledge of Health workers on CDTI . Increased geographical Coverage Weaknesses . Funds not properly applied to activities that impact on the community , most sensitization and advocacy programs are targeted at County level officials o late retirement of used funds to Office of financial management . Inadequate number of CDDs covering large populations in Grand Bassa resulting in non institutionalization of CDTI in many settlements and hamlets o Private /FBO Health facilities have not been fully involved in CDTI . CDD training was not carried out by catchment health facilities and quality of training in most cases was not adequate . Supervision and HSAM was weak and in some FLHFs it has not being carried out Opportunities o Existence of private agriculture plantations and CBOs to collaborate in CDTI o Selection of more CDDs to reduce the burden on existing ones o Initiate integrated supervision and monitoring Threats . High turnover of health staff at county and peripheral levels Challenges . Vehicles and motorcycles have all broken dorvn . Ivermectin coverage instruments were not properly filled out so it was not possibleto analyze data from some counties Recommcndations County Health Teams should ensure that CDTI is rolled out in all facilities including pri,''atelFBO facilities. Funds fbr sensitization and advocacl, should no more be used for programme at county level, rather such funds should be used to support HSAM in the community Counties should initiate partnership rvith Private organizations and CBO in their areas Communities should be empowered to select more CDDs , there should be at least 2 CDDs per community it could be more based on target population Counties should increase integrated supervision and monitoring of Health Programmes using checklist County Health Team should put in place mechanism to monitor CDDs training by FLHFS 30 a a a a a o aa APOC should facilitate the replacement of vehicles and motorbikes NOTF should provide adequate information on fund transfer to county accounts to facilitate proper follow-up NOTF should produce MIS forms centrally and distribute to Counties Extend the time for orientation of National monitoring team on instruments and protocol in next internal monitoring exercise a a Follow-up with Recommendations of NOTF Internal Monitoring '/ In 201 I CDD trainings were conducted by frontline health facility staff and training venues were located as close as possible to the CDDs within the health facility catchment area '/ Two health workers were trained per health facility and a staff was designated as CDDs supervisor and mobilizer in the community '/ MIS forms were produced centrally and distributed in large quantity to the counties '/ APOC management provided 5 motorbikes to the Projects/ NOTF provided technical support to Grand Bassa to conduct HSAM is areas identified to have weak community participation according the internal monitoring in 2010 '/ NOTF collaborated with Margibi and Grand Bassa to advocate to management of Agricultural companies which resulted in high level of involvement by these companies in CDTI activities in 201 l. APOC Sustainability evaluation rvas carried out in 2011 4.1.2. What rvere the recommendations? RECOMMENDATION IMPLEMENTATION "Planning" 1. Planning for CDTI should be an integral part of CDTI project implementation. lt should be partrcipatory and plans should be integrated wrth other health programmes 2. The three year draft sustarnability plan developed should be finalised for all the levels Priority: 1,2: HIGH lndicators of Success: 1. lntegrated plans rncluding CDTI and drawn up in a partrcipatory manner in place 2. A detailed and integrated sustarnabrlity plan containing all CDTI activities available. Who takes action COS, CHO Deadline for completion End of October 2011 "lntegration" 1 There should be effective integratron of CDTI rnto other existing health programmes Priority: HlGtl lndicators of Success: CDTI rs part of the essential package of health services at county levels. Who takes action COS, CHO. Deadline for completion: January 2012 31 " Mectizan@ Procat rement" Mectrzan@ orderrng should be based on accurate and yearly updated community populatron census figures. Priority: MEDIUM lndicators of Success: 1. Mectizan@ orders based on correct CDD population census. Who takes action: COS, OIC. Deadline for com pletion: November - December 2011 and yearly "Finance" 1 CDTI project implementers at county level should be effectively involved in the budgetrng process of CDTI activities. 2. County teams should allocate sufficient funds from their budgets for CDTI activities. 3. CDTI should be effectively integrated into other health programmes. Priority:1,2,3 : HIGH lndicators of Success: 1 County health team involved in budgeting, hence well informed about fund allocations for the different CDTI activities. 2. CDTI activities adequately funded by from dependable resources (by government). 3. Effective cost sharing in place involving activities of the CDTI project. Who takes action: COS, CHDD, CHO Deadline for completion January 2012 "Coverage" 1 . The project should have a GCR of '100% with a TCR of at least 80%. 2. There should be proper record keeping of CDTI project activities. 3. Treatment summary data should systematically be retained and filed at county level yearly Priority: HIGH lndicators of Success: 1. GCR of 100% and TCT of >80% sustained. 2. Summary of treatment records are available and well kept. Who takes action: COS, County surveillance officer, CHDD Deadline for com pletion : By end of September 2012 4.1.3. How have they been implemented? Mechanism is being put in place to implement these recommendations. All counties have been provided rvith reports of the evaluation and feedback and recommendations by APOC. The Counties will report back to NOTF in June how far they have gone with implementing the recommendations from the sustainability evaluation. 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting peri od? Yes Was a sustainability plan written? yes-! When was the sustainability plan submitted? Not fully What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 32 4.2.1. Planning at all relevant levels An integrated plan has been developed with Neglected tropical Diseases and CDTI already included in the national health plan 1.2.2. Funds Government at national and county levels will develop annual operational plans and budget which include CDTI activities 4.2.3 Transport The Oncho/ CDTI and other NTDs will share transport logistics Other resources Resources will be mobilized from other health partners to fund integrated program implementation of activities such as training, monitoring and supervision, printing of integrated IEC materials and integrated reporting forms 4.2.5. To what extent has the plan been implemented The implementation of the plan has started with advocacy at national level and county health team on the sustainability recommendations 4.3. !ntegration Integration at all level has improved greatly based on the inclusion of CDTI and other NTDs in the National health Plan and essential Package of Health Services. There is also integration with other program in the Ministry of Health and Social Welfare most especially Community Health Service Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration 4.3.1. Ivermectin delivery mechanisms Ir,'ermectin delivery mechanism is carried out through the National Drug Service (NDS) and the supply chain of MOH to the county and the health facilities Training Integrated training will be conducted with NTDs at all levels. Joint supervision and monitoring with other programs Joint supervision will also be carried out at all levels using integrated checklist Releasc of funds for project activities The release of fund is based on the financial rules and regulations of the Ministry of Health and Social Welfare. Is CDTI included in the PHC budgeP Yes CDTI is included in the national budget and the various county health team annual budgets as priority diseases of the Ministry of Health and Social Welfare. 4.3.2. {.3.3 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? . Fill tables 14 and 15 and provide describe other programmes that are using the CDTI structure and how this was achieved. What have been the achievements? o For each intervention listed in table 15, explain what were the roles played by the CDDs (census, mobilization, distribution, data collection, storage, collection of drugs, referral of SAEs, etc ...)? aaJJ {.3.4. {.3.5. The Neglected Tropical Disease Program is using the CDT|structure forthe implementation of the LF program o Explain what are the combinations of interventions co-implemented? o How were the interventions implemented? (At the same time?) 4.3.6. Describe others issues considered in the integration of CDTI. 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'=> Eq C) o (.) q) q) q) t- _c .:o P'= oxE= LP0J6 a oC O.)Oo '.;Nl(o .Jc -o .- L edJ .:2 -oo-6 a o_ co) .eE :(o _-o 6-5'F6fO oo- a Oc) cooN '= (tr _-o b!-o60Ji5> a z =J o .9 = _o .2o a (U E C) u0(D C(o.g - LC60)6EE oe -o a C .9 P(o <oCE '= o) (o= >6 a a a a a a a a a L o F q a oL 0)o_O- -cI \JO o 2a Eqo- 63 LL .2 E o cr) o .2 oa FU) o oo L cn (n z o o (d 2 o z d E o o HF a odL 6d (! U e (.) C) o. q (.) o I q) v s-(\ (\(\' \)q t\ ^t() (.) l< :)o trIa U oo a a() ai F d t< oo ol< o- ti 0) +) o la c) F a i 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. No operational research has taken place, but there are plans to mount training on operational research to build capacity to undertake operational research 4.4.2. How were the results applied in the project? No results SEGTION 5: Strengths, weaknesses, challenges, and opportunities Strengths ,/ Inclusion of CDTI and other NTDs into the National Health Plan and Essential Package for Health Services '/ Willingness of communities to continue to take the Mectizan Challenges ,/ Lack of logistic (Vehicles at national to carry out regular monitoring and supervision '/ The late arrival of fund for implementation Ll/eaknesses '/ Inadequate number of trained CDDs/high turnover rate ./ Poor commitment of some health workers in some health lacilities ,/ Low involvement of the community in decision making '/ Poor supervision and training of CDDs by health workers Opportunites/ Integration with other NTDs/ Privale organizations willingness to collaborate ,/ SEGTION 6: Unique features of the proiect/other matters a 38