(INDEPENDBNT PARTICIPATORY MONITORING OF CDTI PROJECTS GAIDELINES AND INSTRUMENTS Revised Monitoring lnstl.uments, WHO/APOC, 2002 I
GUIDELINES 1. MEETING WITH PERMANENT SECRETARY, WHO REPRESENTATIVE IN THE COUNTRY, AND CHAIR OF NOTF Brief the WR on the mission Frx date for debnefing session with WR Frx date with Permanent Secretary or Director of Drsease Control or Charr of the NOTF (which ever is apphcable), preferably before proceeding for field vrsits. Grve executlve summary of the report dunng the debriefing. If the project is in its fourth or fifth year, debrief WR, Pemranent Secretary or Director of Disease Control, NOTF Chair, on the evaluation findings and whether or not actions have been taken. rb. DEBRIEFING MEETING WITH PROJECT MANAGEMENT TEAM Frx date for debriefing Project Management team The meeting will be attended by the Director of Disease Control/Health Services, Natronal Onchocerciasis Coordinator (where applicable), Project Coordinator and Team members. During the meeting it is advisable that the Prolect Coordinator be the one to take the minutes. Debrief the District/LGA administration of findings of the monitoring exercise. 2. MEETING WITH NATIONAL COORDINATOR & NGDO PARTNER (Hqs). Discuss objectives, modalities for selection of site, local guides and field activities. Plan field activities. Discuss logistics and other needs of the monitoring team For third, fourth and fifth year projects; in debriefing draw attention to recommendations in previous monitoring and evaluation exercises. 3. MEETING BETWEEN EXTERNAL AND INTERNAL MONITORS Train monitors on instruments, data collection procedures and analysis (2 days) Develop Plan for field actrvities. Develop a template for data entry. Qualitative data, draw attention to narratives from FGDs that will be included in the report. 4. MEETING WITH PROJECT TEAM AT STATE / DISTRICT LEVEL Discuss objective, selection of site and field activities. Select villages to be visited. Monitors should be allowed 2 days in the district to select and train local guides (SEE SECTION B) Select local guides who are capable of working in the selected villages Train local guides to understand the instruments (especially concepts like mode and time of distribution, community perception of CDTI, community role in CDTI, the concept and responsibilities of the health system) Plan to send advance messages to selected villages. [t is advisable to inform communitles not more than three davs prior to arrival ofthe team 2 Revrsed Monitoring lnstruments, WHO/APOC, 2002 Discuss logistics and other needs of the monitoring team The monitors should, as soon as training of local guides has commenced, share out responsibrlities among themselves, in order to save time. METHODOLOGY Sample Selection A minimum of 30 villages must be selected by random sampling based on the Rapid Epidemiological Mapping for Onchocerciasis (REMO)). Please ensure that villages selected are spread across a minimum of 3 endemic Sub - Counties/LGAs/ Health Sub-Districts whrch are randomly selected wrthin the project area. Data Collection A. Monitors There will be a total of 7 monrtors made up of two extemal, four intemal and one community members. One of the internal monitors will be an NGDO or Project Coordinator whose proJect is not berng monitored. The NGDO monitor cannot monltor their counterpart NGDO project in another country. Both external and intemal ( except communiry member) monitors will be involved in data analysis and report writing. B. Local Guides Each team will work wrth two local guides, one from the prolect and the other from the community. Please note the community member is an official members of the monitoring team should participate in conductrng interviews for the household survey. Where necessary a project implementer can be required to act as the local guide in another project area. C. Checklist of Instruments and sample sizes Instruments Sample l. Village leader Interview Questionnaire 30 2. FGDs Guide 6 3. Community Meeting Guide 4 4. CDD Interview Questionnaire 30 5. Household Survey 30 6. Health Persorurel lnterview Questionnaire 6 or more 7. Interview Guide for Policy Makers/IVR as applicable Seven rnstruments must be administered: 1. Kev informant interview of villase leader. This instrument is to be administered to the village head or a representative of the village head. The head can ask another person to assist with the interview and to even have a say dunng the interview. Do not refuse. Most of the questions are structured. Circle appropriate codes. Do not prompt the responses; rather allow the respondent to answer while you circle the appropriate option to the respondent's answer. Listen to the chief and choose among the items provided. If he says something different select 'Other' and wnte the actual response in the space provided. communitv members ) 2. Groun discussions suide Rev ised Mon rtonn g lns tru ments, WHO/APOC, 2002 Conduct focus group discussions for women ln slx villages, one of whrch will be targeted at minorities (settlers, non-indigenes, pastorahsts, women in seclusion, etc). The six villages where the Eoup drscussions will be conducted must be purposively selected to represent eeo - ethnrc considerations. Ideally, each of the selected villages must be informed that the group discussions will only be for women before the monitoring team arrives in the vrllage. Arrange for a comfortable place that offers some privacy and enough places to stt. Each group must consist of 6-8 people. 3. Community Meetinss Community meetings should be conducted in 4 villages that are purposively selected also to take care of geo- ethnic consideratrons. The 4 villages selected must not be among those where group dtscussions are conducted. The recommended community meeting should have at least 30 community members (15 women and l5 men). This is to emphasize the need for attendance of a substantial number of both men and women. P lan n i n g/P rep aratio tt The day and time for the meeting should be determined in consultatron with community members. The community leader should be informed that all community members (men, women and youths) should attend this meetrng. Therefore, the decisron on the convenient day and time for the meeting should be made tn consultation with community members rn order to allow all sections of the community to attend. Location of the meeting Community meetings should not be held near the roadsides and trading centres nor in order to minimise the number of persons from other communities that would attend the meeting. In some places community meetrngs may not be conducted on market, funeral and other ceremonial days to enable most community members to attend. Facilitating the meettng o The team should arrive before the agreed hme o Make use of the participatory approach. . Request the community members to select 2 men and 2 women to assist in counting responses to questions related to issues like : o total number of men and women in attendance o treated, o received health education, o participated in selection of CDDs o decided on the period of distribution o supported the CDDs, and o those that will continue taking ivermectin. o Community members and visitors should be seated separated so that data is collected only from those who reside in the selected community. A good facilitator should be assigned the task of facilitatrng discussions after the communiry leader or his representative has made the introductions and invited the team to talk to his/her community members. The CDDs, health workers and other key persons involved in the CDTI should be assigned the task of recording minutes. This makes them feel appreciated, but it also prevents them from interfering with certain responses they do not like. It should be made clear before the meeting begins that the objective is not to lind fault with what has been done but to improve the overall CDTI implementation process. Participants should therefore be encouraged to freely express themselves during the meeting. All contributions are welcome. a a a 4 Revised Monrtoring lnstruments, WHO/APOC, 2002 aa a a The facilitator should purposively encourage women, youth, and other drsadvantaged indivrduals or groups to participate in the discussions. Sometimes it may be necessary for the CDDs or the community leader to give explanation on certain relevant issues as deemed appropriate. The facilitator should encourage exchange of vrews among communrty members without losing control of the meeting. After administering the question guide, the facilitator should allow the communlty members and visitors to ask questions. It is important that a key person who has been involved in the project implementation rs available to answer relevant questions. After, the facilitator should thank community members for their contnbutions and then hand over the meeting to the Communiry leader for closing. 4. In-depth interview of CDD This tool is should be administered rn all villages. Where a vrllage has more than two CDDs, at least lwo should be interviewed. The in-depth intervrew is to be administered in the same manner as the key rnformant interview. At the end of the interview ask the drstributor to get his tools: measunng stick, registers and remaining drugs. When a question requires multiple responses, do not forget to circle each appropriate response code. 5. Household Survey This insfument must be admrnistered rn all the thirry (30) villages. A minimum of l0 households should be surveyed in each village. ln a village wrth less than 10 households, survey all households. Otherwise, select the household in such a way that all the different parts of the village are adequately represented. Every member of the household should answer the questions. First, get from the head of household (male or female) or his representative the names of all members of the household. The head of household or any member of the household can answer for members who are absent and for the chrldren. If, in the absence of household head, the wrfe refuses to respond, go to the next household. Simrlarly, if there is no respondent in a selected household, go to the next household. For each person put the code corresponding to the answer in the required column. To ensure fair representation of women and girls among interviewees, it is advisable to include women as members of monrtonng teams. Cross-checking accuracy of dosage ln a minimum of 5 villages, efforts must be made to crosscheck accuracy of dosage. This will be achreved by taking heights of 5 randomly selected individuals and comparing the ideal number of tablets with the actual number of tablets given by the CDD. Hous e ho I d Memb ers p articip ation ln addition to the tasks earlier mentioned, use the household members participation section of the Household survey to collect information from the household head, two women and a youth of either sex. 6. Questionnaire for health personnel This questionnaire is administered on any health worker in the area who is directly involved in CDTI programme i.e. the health staff nearest to the village. The number of health personnel to be interviewed depends on the situation on the ground. A minimum of 6 health personnel who are supervisors of CDDs should be interviewed within the project area. After the interview ask the health personnel for the documents used for CDTI activities. 7. Interview guide for policy-makers/ WHO representative/ Programme Managers This interview is administered on Co-ordinators, Programme managers, representatives of NGDOs involved rn 5 Revised Monrtoring Instruments, WHO/APOC, 2002 CDT[, Ministry of Health policymakers (e.g. chair of NOTF) and the WHO representahve in the country. Where appropriate, documents such as registers should be requested before the formal interview so that information can be extracted for the report Treatment Register In addition to the instruments, treatment registers must be examined to obtain relevant informatron on: - Total population - Number of children under 5 years of age - Number of people 5 years and above treated - Number of refusals - Number of absentees - Number of ineligibles - Evidence of Up-date of census records Also, the treatment registers should be examined for accuracy of recording. Avord collecting information from the summary page. D. Information for Trainers This guide is to provide some instructions for using the different monitorrng lnstruments. The trarner should begin by discussing the APOC philosophy and the CDTI process and describrng what rs expected of programme implementers. The trainer should explarn m very clear terms the meaning of certain concepts ln the local language assisted by the internal monitor: l. CDTI : the process of entering the community, the role of the community in design and implementation, (the difference between CDTI and CBTI should be discussed ). 2. Time of distribution'. the season or the month 3. First distrihution: note that distribution may have been on-going in the area usrng other methods First distrihution refers to the first time the community will use CDTI approach 4. Last distrihution: this refers to the most recent distribution of ivermectin within the communrty. [t does not refer to the last time the individual was treated but the last time the entire community had their general distribution 5. Mode of distribution: this refers to the method of getting the drug to every individual wrthin the community e.g. central point, house-to-house or a mix central and house-to-house. lt is very important that the trainees have a general understanding in the local language of other terms that are frequently used by the community (e.g. Oncho programme, Mectizan /lvermectin tablets). At the begiruring the trainer should briefly explain the objectives of the monitoring exercise and the importance of collecting accurate data. The trainer should ensure that the trainees practice interviewrng and note-taking during the training period. Every participant should take part in role-play and in learning to use the various instruments. Trainer should demonstrate how to CIRCLE the appropriate responses, especrally the multiple responses. It should be emphasised that the interviewers and group discussion facilitators should not be in a hurry even rf there is some delay at the beginning of the exercise. They should take time to listen carefully to the responses and to probe or repeat the questions when they are not well understood by the respondent. E. Other Issues To avoid delay, it is recommended that the team send an advance notice (not more than three days before arrival) to the village head so that all the persons needed would be around when the team arrives in the vrllage. 6 Revised Monitorrn g lnstruments, WHO/APOC, 2002 Be on time if you have made an appointment. Do not delay or change the appointment wrthout glvrng any information to the community. The team should feel free to utrlise funds approved for repoft preparation or contingency for data entry and analysis. F Reporting Format for Independent Monitoring Team EXECUTTVE SUMMARY TNTRODUCTION - Brief background of the Country and Project rncludrng the NGDO lnvolved in the project - Indicate extent to which the recommendatrons of previous monitorrng and evaluatron exercises were implemented. - Terms of Reference METHODOLOGY - Sampling - Selection of villages - Instruments - Limitations - Data Analysis RESULTS - Community participation and programme ownership - Mectizan supply, collection and distribution - Coverage - Work CDDs - Health Education/Mobilisation/Sensitisation - Gender Issues and Minority groups/non-indigenous - Training, monitoring and supervision - Integration - Partnership - Resources Community-self monitoring (Indicate whether the project initiated community-self monitoring and how many communities are doing community self-monitoring). IMPORTANT coll' discussions must be used to reinforce the quantitative data in the linal report. DTSCUSSION AND CONCLUSIONS According to indicators comparingfindings with CDTI expectations, and drawing lessons learnt. RECOMMENDATTONS l. List of indicators 2. List of lnstruments 3. Guidelines 4. Other attachments including graphs, charts, histograms, maps5. Debriefing sessions with NOTFs and Country WRs ANNEX 7 Revrsed Monitoring lnstruments, WHO/APOC, 2002 TNDICATORS FOR INDEPENDENT MONITORING 1.0 Community participation and ownership 1.1 Proportion and number of target communities, which decided on the period, or method of treatment. 1.2 Proportion and number of target communities where the "community" selected their own CDD. 1.3 Proportion and number of target communities where all segments of the community including minorities that are involved in implementation. 1.4 Proportion and number of communities where community members carry out mobilisation, distribution and reporting. 1.5 Proportion and number of target communities which collected ivermectin from collection point/the health centre. 2.0 Mectizan Supply, Collection and Distribution 2.1 Proportion and number of communities/projects that experienced late supply or shortage of ivermectin. 3.0 Coverage 3.1 Proportion and number of refusals two months after distribution 3.2 Proportion and number of absentees that were later treated 3.3 Proportion and number of at-risk villages treated 3.4 Proportion and number of persons 5 years and above who receive ivermectin. 4.0 Work of CDDs 4.1 Proportion and number of communities where CDDs were changed by the community after treatment 4.2 Proportion and number of CDDs with measuring device for height 4.3 Proportion and number of communities with accurate treatment registers 4.4 Proportion and number of CDDs who had stopped carrying out CDTI activities 5.0 Health Education , Mobilisation and Sensitization 5.1 Proportion and number of communities which received education about importance of extended ivermectin treatment 5.2 Proportion and number of districUlGA policy makers who have been sensitized on CDTI Revrsed Moni toring lnstruments, WHO/APOC, 2002 8 5.3 Proportion and number of community leaders that have been mobilized lor CDTI activities 5.4 Proportion and number of community leaders that are involved education / supervision for CDTI activities 6.0 Training, Monitoring and Supervision 6.1 Proportion and number of communities with trained CDDs in mobilisation /health 6.2 Proportion and number of communities whose nearest health facilities have "severe adverse reaction" records 6.3 Proportion and number of target communities that were supervised/monitored during the last Mectizan distribution T.0Integration 7.1 Proportion and number health programmes which have adopted CDTI approach to the health services T.2Proportion and number of districts/LGAs that have CDTI integrated into annual plans/budgets 7.3 Proportion and number of health workers who combine CDTI with other health activities. 7.4 Proportion and number of target communities which undertook integrated community self monitoring 8.0 Gender Issues and Minority groups 8.1 Proportion and number of communities where there are female CDDs. 8.2 Proportion and number of health workers who are females 8.3 Proportion and number of communities that recognised that females could be CDDs. 8.4 Proportion and number of women that attend health education meetings. 8.5 Proportion and number of women who were treated during the last distribution 8.6 Proportion and number of health workers who participated in selecting the CDD 8.7 Proportion and number of women who participated in deciding the day of distribution 9 Revrsed Monrtolrng lnstruments, WHO/APOC, 2002 9.0 Partnership with NGDOs, CBOs, Districts, sub-counties or health sub- districts 9.1 Proportion and number of local partners, NGDOs andCBO providing technical support (training, health education, etc) at different levels 9.2 Proportion and number of partnersAlGDOs participating in routine planning and budgeting of CDTI activities. 9.3 Proportion and number of partners/IrlGDOs carrying out advocacy for CDTI activities 10.0 Contribution of resources (finances and others) by partners. l0.l Proportion and number of communities that support their CDDs. 10.2 Proportion and number of partners that contribute cash to CDTI implementation. 10.3 Proportion and number of NGDOs/Govemment Organisations that contributed to finances of the CDTI Revised Monrtoring lnstruments, WHO/APOC, 2002 10 KEY INFORMANT INTERVIEW: Community Leader This instrument is to be administered on the village head or a representative of the village head. The village head can ask another person to assist and to even have a say during the interttieu,. Do not refuse. Most of the questions are structured. Circle appropriasse codes. Do not prompt the responses; rather allow the respondent to answer while you circle the appropriate option to the respondent's answer. Listen to the chief and choose among the items provided. If he says something different select 'Other' and write the actual response in the space provided. Village Name : Village Code: Sub-county/LcA DistricUState:_ Country: Month and year of last distribution l. Please tell us about any programme concerning onchocercrasis treatment rn thrs village'l (PROBE FOR THE FOLLOWING TSSUES) - u,ho brought the idea of tlrc onchocerciasis programrue to this village? -when did the person(s) come to talk with you about onchocerciasis? -Did the person(s) meet with you and other village leaders first? - Did they askfor you to arrange a rueeting? - what did they tell you about contmunity responsibility a) Community participation and ownership; 2. How was the time (month/season) for distribution decided? l. at a village meeting 2. village elders meeting 3. village chief/leader 4. health worker 5. Village health committee 6.village committee meeting ?. other (specify 3. What mode of distributron was decided? l. house-to-house 2. central place (specify) 3. both house-to-house and central place 4. other (specify)_ 4. How was the mode of distribution decided? l. at a village meeting 2. village elders meeting 3. village chief/leader 4. health worker 5. village health committee 6. village committee meeting 7. other (specifr) ll Revrsed Monrtorrng lnstruments, WHO/APOC, 2002 ) 5. How were the persons (CDDs) selected to do the work? l. at a village meeting 2. village elders meeting 3. village chief/leader 4. Health worker 5. Village health committee 6. Village committee meeting 7. Other (specify)_ 6. Why did you choose these person(s)? 7 8 Have you changed any of your CDDs? 1. yes 2. No 3. Don't know If yes to Q7, why? 9. How many persons have stopped working as CDDs in your community on therr own accord? 10. Was there any community decision on how the drug should be collected from a collectron point? l. Yes 2. No 3. Don'tknow (b) Mectizan supply (collection and distribution) I l. Did any member of the community collect the drug from a collection point? 1. Yes 2. No 3. Don'tknow 12. If no to Ql l, why? 13. Did you get the drug the first time you went to collect it? (late supply) 1. Yes 2. No Please expla ln 14. Did you experience shortage of drugs during the last distribution? 1. Yes 2. No 3. Don'tknow 15. If yes to Ql4, how was the problem solved? Revrsed Monitolrng lnstruments, WHO/APOC, 2002 t2 (c ) Coverage 16. Does the community have a treatment regrster? l. Yes 2. No 3. Don'tknow 17. If yes to Ql6, where is the register kept? 18. Was the census of your village undertaken? l. Yes 2.No 3. Don't know 19. Ifyes to Ql8, at what penod was the census or census update done? I . Before drstribution 2. During distribution 3. After drstributron 4. I don't know 20. Do more people take the drug now that last year? l. Yes 2. No. 3. I don't know 21. Are there more refusals now than last year? l. Yes. 2. No. 3. Idon'tknow 22. Are there more absentees now than last year? l. Yes. 2. No. 3. Idon'tknow (d) Contribution of resources (finances and others) by partners. 23. What contribution did your community make in order to support this programme? 24. How was the CDDs supported? 25. Where do you go to collect ivermectin 26. What mode of transport is used to collect lvermectin from the collection point? l.Motor vehicle 2. Bicycle 3. walking 4. other Means (specify) 27 . How long does it take (in hours/minutes) to get there (using the mode indicated earlier)? (e) Gender Issues and Minority groups: Revrsed Monrtoring lnstruments, WHO/APOC, 2002 l3 28. How many persons (CDDs) in this village distribute the drug. 29. How many are male CDDs?_ How many are female CDDs? 30. Are there people rn this community who are not involved in the distribution exercrse. l. Yes 2.No 3. Don't know 3 1. [f'Yes' to Q30, please explain 32.Whattimeofthedaydoyounormalho1dgeneralcommunltymeetings?- 33. Do women in this community attend general community meetings? 1. Yes 2. No 34.IfyestoQ33,dotheyparticipateinthediscussions?- 35. If no, to Q33, please explain H EALTH ED UCATION, MOBILIZ ATION & SENS ITISATION 36. Have you (the communrty) received education on the importance of taking ivermectin/mectrzanl Oncho tablet annually for several years? l. Yes 2. No 3. Don't knoilCan't remember 37. If yes to Q36, ask: When did you leceive the education? (circle all that apply) l. During the hrst meeting 2. Before the first distribution 3. During distribution 4. Soon after distribution 38. If yes to Q36, what were you told? (Probe for: A. B. C. annual treatment for several years_ benefits community responsibil 39. How were you involved in mobilisation/health education? WORI( OF CDD 40. How well have the CDDs done the work? Training, Monitoring and Supervision 2. fair 3. poorl. well (Explain ) Revised Monrtoring Instruments, WHO/APOC, 2002 l4 41. Have the CDDs received any training? l. Yes 2. No 3. Don't know/ cannot remember 42. Who trained the CDDs? Health staff Village health committee member NGO partner Community member/chief Other (specify) 43.If yes to Qn41., when did they receive training? 1. Before the first distribution 2. During distribution 3. Soon after the first drstribution 4. Don't know/Can't remember 44. Do you superuse CDDs in your communily ? l Yes 2. No Integration 45. Are the CDDs in thrs community involved in other health activities? l.Yes 2. No 46. [f yes, what other type of health activities? 47. Was it the community that selected them for these other health activities l. Yes 2. No. 48. If no to Q45, why? 49. Do other health programmes offer health education to your community members l. Yes 2. No. 50. What other health programmes can be tackled in the same way lvermectrn is being distrrbuted in your community? 51. [s there anything you will like to tell/ask us? 1. 2. 3. 4. 5. IN.DEPTH INTERVIEW OF THE CDD To be administered in all villages. Interview 2 CDDs per village if there are more than one CDDs Preference should be given tofemale CDDs where present. Ask the distributor to let you see his tools: measuring devise, registers, remaining drug if it is the case. When a question requires multiple responses, remember to put a circle around each applicable response code. Probe where appropriate. Name of Village District/State Village code: _Subcounty/LGA: Revrsed Mon rtoring lnstluments, WHO/APOC, 2002 l5 12 aJ 4 5 6 7 I 2 3 4 Name of CDD Sex: 1. Female 2. Male Main Occupation: Month and year of first CDTI distribution in the village Month and year of last CDTI distribution in the village COMMUNITY PARTICIPATION AND OWNERSHIP Introductionz Please tell me about how the last distributiort of ivermectin was carried out irt this community 1. How was the time (month/season) for distribution decided? at a community meeting community elders' meeting co mmunity chief/leader health worker community health committee community committee meeting other (specify) 2. What mode of distribution was decided? house-to-house central place (specify) Both house-to-house and central place other (specify)- 3. How was the mode of distribution decided? at a community meeting community elders' meeting community chief/leader health worker community health committee community committee meeting other (specify) How were you selected to do the work? at a community meeting community elders' meeting community chief/leader health worker community health committee community committee meeting other (specify) 5. Has any CDD been changed after the first distribution? 1. 2. J. 4. 5. 6. 7. 4. 1. 2. 3. 4. 5. 6. 7. Revrsed Monitoring Instruments, WHO/APOC, 2002 16 l. Yes 2. No 3. Don't know 6. If yes to Q5, Why was the CDD (s) changed? 7. How many persons have stopped working as CDDs in your community? _ 8. What are the reasons for stopping work WORK OF CDD 9. Which categories of people would you not give the tablets (PLEASE CIRCLE YES OR NO FOR EACH RESPONSE) Individuals below 5 years of agelbelow 90cm Pregnant women Women who delivered less than one week before distribution Sick individuals Visitors Other (specify 10. How do you ensure that these categories of people eventually receive treatment? I 2 J 4 5 6 1. Yes 2. No l. Yes 2. No 1. Yes 2. No 1. Yes 2. No 1. Yes 2. No 11. Do you have drugs to take care of minor side effects? l. Yes 2. No 12. If no to Ql1, please exp lain 13. Do you have problems with record keeping? 1. Yes 2. No 14. Are you willing to continue as a CDD? 1. Yes 2. No Please exp lain 15. Is measuring device for height present? 1. Yes, seen 2. Yes, but not seen 3. No, Explain 16. How do you use it? Revised Monrtoring lnstruments, WHO/APOC, 2002 t7 12 aJ 4 5 6 7 8 9 17. Is treatment register present? 1. Yes, seen 2. Yes, but not seen (Explain) 3. No, explain 18. If Ql7 is "Yes, seen" EXAMINE TREATMENT REGISTER AND OBTAIN THE FOLLOWTNG TNFORMATION ON: Total population-- Age composition of people: Below 5 years_ 5 years and above_ Sexcompositionofthepopulation:MaIe-Female- Number of persons treated_Male_ Female_ Numberofpersonsunder-5yearswhoreceivedtreatment- Number of refusals Number absent during last treatment Number with severe side effects Number of tablets received 10. Number of tablets used 1 1. Number of tablets left in the drug kit MECTIZAN SAPPLY (COLLECTION AND DISTRIBUTION) 19. Did any member of the community collect the drug from a collection point during the last distribution? l. Yes 2. No 3. Don'tknow 20.If "no" toQ19, why? 21. Where is the collection point? 22.Did you experience late supply of drugs during the last distribution? 1. Yes 2. No Please exp lain 23. How do you normally determine the quantity of drugs required by the community? l. Census/registrationrecord 2. Previous treatment records 3. By counting the number of households 4. Other (specify) 24. Did, you experience shortage of drugs during the last distribution? Revrsed Monrtoring lnstruments, WHO/APOC, 2002 t8 1. Yes 2. No 25. lf yes, please explain 26. How do you determine the number of tablets to give to an individual? (CIRCLE YES OR NO FOR EACH RESPONSE) l. Take height measurement 2. Use weight 3. Visual observation 4. Age 1 5. Other (specify)_ l. Yes 1. Yes 1. Yes 2 2 2 No No No Yes No2 27. How long do you normally keep the tablets in the community? 28. How many days did you take to complete the last distribution? 29. Where do you normally keep the tablets? COVERAGE 30. What do you do about individuals who are absent during normal distribution period? 31. What do you do about individuals who refuse treatment? 32. Were women who were pregnant during distribution period treated after delivery 1. Yes 2. No 3. Can'tremember HEALTH EDUCATION, MOBILIZATION & SENSITISATION 33. Have you received education on the importance of taking ivermectin tablets arurually for several years? 1. Yes 2. No 3. Can't remember 34. If yes, what were you told? 35. Did you provide the community with education on ivermectin treatment? l. Yes 2. No 36. If yes to Q35, when did you provide the education to the community? (CIRCLE YES OR NO FOR EACH RESPONSE) Revrsed MonrtorinB lnstruments, WHO/APOC, 2002 t9 1. During the first meeting 2. Before the first distribution 3. During distribution 4. Soon after distribution 1. Yes 1. Yes l. Yes 1. Yes 2 2 2 2 No No No No 5. Other (specify) 37. If yes to Q35, what did you tell the community? (CIRCLE YES OR NO FOR EACH RESPONSE) Taking ivermectin annually for several years Benefits of treatment Community responsibility Side effects Other (specify) TRAINING, MONITORING AND S UPERVIS ION 38. Did you receive any training on how to treat community members? 1. Yes 2. No 39. If Yes to Q38, when did you receive training? 40. Who trained you? (CIRCLE ALL THAT APPLY 1. Hcalthpcrsonncl/Oncho coordinator 2. NGDO staff (specify)_ 3. Another CDD 4. Other (specify)_ 41. How long did the training last? 1 2 J 4 5 1. Yes 1. Yes 1. Yes 1. Yes 2. No 2. No 2. No 2. No 1't trainins 2'd traini;g- Last training_ 42. How many CDDs were trained together (size of the group)? l't training Last training_ 43. Where was the venue of the last training? 1. Within the community 2. Outside the community 3. Healthcare facility/hospital Revrsed Monrtoting Instruments, WHO/APOC, 2002 20 4. Other (specify) 44. Was the venue of training near to your community? 1. Yes 2. No 45. What were you taught during training about onchocerciasis (CIRCLE YES OR NO FOR EACH RESPONSE) Cause Symptoms Socio-economic importance Community mobilisation and education lvermectin as treatment for a long time Other (specify) 46. What were you taught about the drug? (CIRCLE YES OR NO FOR EACH RESPONSE) l. 2. J. 4. 5. 6. N N N N N, Yes Yes Yes Yes Yes o o o o o I 1 I 1 I 1. Yes 1. Yes l. Yes 1. Yes l. Yes l. Yes l. Yes 1. Yes 1. Yes 1. 2. 3. 4. 5. 6. 7. 8. 9. 10 Duration of treatment Coverage o f distribution Dosage determination by measuring height Expiration of drug after removing container seal Treatment of absentees and refusals Side effects (counseling and referral) Exclusion criteria Record keeping Census Other (specify)_ 2 2 2 2 2 2. 2. 2. 2. 2. 2. No 2. 2. 2. 2. 2. 2. 2. 2. No No No No No No No No I 2 3 4 5 6 47. What were you taught about reporting? (CIRCLE YES OR NO FOR EACH RESPONSE) Number of persons treated 1 Number of refusals 1 Number of absentees 1 Number of excluded persons I Number with severe side effects I Other (specify) 48. What other health issues were addressed during the training? 49. Have you been trained on other health issues? 1. Yes 2. No 3. Don't know 50. tf 'Yes', please specify 51. Have you ever been supervised? 1. Yes 2. No 3. Don'tknow No No No No No Yes Yes Yes Yes Yes Revrsed Monitoring lnstrumen rs, WHO/APOC, 2002 2t 52.If yes to Q51, who supervised you ? (IF NAME WAS MENTIONED, PLEASE ASK FOR TDENTTTY/POSITTON/STATUS OF THE PERSON) 1. Health staff 2. Village health committee member 3. NGO partner 4. Community member/chief 5. Other (specify) 53. What did the supervisor do? (CIRCLE ALL THAT APPLY) Checked the ivermectin inventory Checked the records/treatment register Collated the reports Advised on the treatment of absentees other (specify) 54. At what occasions were you supervised? (CIRCLE YES OR NO FOR EACH RESPONSE) 1 2 3 4 5 1. Before distribution 2. During distribution 3. Soon after distribution 1. Yes 1. Yes 1. Yes 2 2 2 No No No 1 2 3 CONTRIBUTION OF RESOURCES (FINANCES AND OTHERS) BY PARTNERS. 55. What kind of support do you receive from the community? (CIRCLE ALL THAT APPLY) Transportation for drug collection lncentives (specify Other (specify GENDER /SSUES AND COMMANITY GROAPS 56. How many female CDDs do you have in this community? 57. If there are no female CDDs, please exp lain INTEGRATION AND PARTNERSHIP IYITH OTHER ACTORS 58. Are there Community Based Organisations or Social Clubs/Age Grades that support the drug distribution in this community? 1. Yes 2. No 3. Don't know 59. If 'Yes' to Q58, what do they do? Revised Monrtorrng lnstruments, WHO/APOC, 2002 22 ) l. Mobilisation 2. Support for CDD 3. Supervision 4. Transport to collect Mectizan 5. Others (Please specify) 60. Are you involved in other health care or community development programmes? 1. Yes 2. No 3. Don'tknow 61. If 'Yes', which programme 62. How do you feel this programme may be sustained for a long period 63. How does the community respond to the CDTI exercise 64.What are the challenges to your work 65. What should be done to improve the programme? 66. Is there anything else you would like to talk to me about regarding your work as CDD? aUESTIONNAIRE FOR FRONT LINE HEALTH PERSONNEL This questionnaire should be administered on any health worker located nearest to the vitlage wlrc is involved in CDTI programme. A minimum of 6 health personnel should be interviewed. Examine documents (summary sheets, inventory, training manuals) and make notes. LGA/Sub-county: State/District Country Name of health personnel Sex: 1. Male 2. Female Revlsed Monrtonng lnstruments, WHO/APOC, 2002 23 No. of Oncho. Vi No. of CDDs in villages covered_ How many Male CDDs How many Female CDDs Position: Qualification Health Education, Mobilisation and Sensitisation 1. Did you receive any general orientation on CDTI? l. Yes 2. No 2. Please tell us what you know about the CDTI programme with respect to: Community responsibility (Probe community involvement in CDTI activities) 3. Were there initial meetings with the communities where CDTI was introduced? 1. Yes 2. No 4. If yes to Q3, what role did the health staff play in arranging the first meeting? (CIRLCE ALL THAT APPLY) Facilitated the meeting Met with village leader to arrange for the meeting Other (specify) 5. Who led the facilitating team to the community? Health staff Govemment administrative staff (non-health) NGDO staff Other (specify) Nobody 6. Were the communities (where you worked) educated on the importance of treatment with ivermectin tablets? 1. Yes 2. No 3. Don't know 7. If yes to Q6, what were they told? (CIRCLE YES OR NO FOR EACH RESPONSE) 1 2 3 1. 2. J. 4. 5. Revised Monrtoring lnstruments, WHO/APOC, 2002 24 1. Annual treatment for several years 2. Benefits of treatment 3. Community responsibility 4. Others (specify 1. Yes 2. 1. Yes 2. 1. Yes 2. No N N o o ) Mectizan supply (collection and distribution) 8. Was there been any delays in collecting ivermectin by the community during last distribution? 1. Yes 2. No 9. If yes to Q8, please explain 10. What constraints have you experienced in getting the drug? (CIRCLE YES OR NO FOR EACH RESPONSE) 1. None 2. Transport problem 3. lnadequate supply 4. Delay in supply 5. Other (specify) I 1. How do you estimate the quantity of drug required? 1. Not responsible 2. Number used during last treatment 3. Based on requests from the CDDs 4. Total population (with the formula) 5. other (specify)- 12.Do you have facility for storage of ivermectin? l. Yes 2. No 3. Don'tknow 13. Have you experienced loss of tablets due to pilferage? l. Yes 2. No 3. Don't know 14. How long do you norrnally keep the tablets for the Coverage 15. Are all the villages eligible for treatment receiving Mectizan? Probe for proportion of villages covered. 1 1 I I Yes Yes 2. No 2. No 2. No 2. No Yes Yes Revised Monrtorrng lnstrurnents, WHO/APOC, 2002 25 16. What percentage of the eligible population is receiving Mectizan? Probe for trends for the last three years. Training, Monitoring and Supervision Training 17. Did you receive training on how to train CDDs? 1. Yes 2. No 18. If yes to Q17, how long?_ 19. List the main topics covered 20. Were you taught how severe side effects should be managed? 1. Yes 2. No 21. Were CDDs in the communities (where you worked) trained for the CDTI programme? 1. Yes 2. No 3. Don'tknow 22. If yes to Q21, did you participate in the training of CDDs? 1. Yes 2. No 23. If yes to Q2l, how long did this training session last? tnitial training_ Retraining 24. Did, the training address other health issues ? 1. Yes 2. No 3. Don't know 25. If 'Yes'to Q24, what were those issues 26. Was the training targeted? l.Yes 2. No 3. Don'tknow 27.If Yes to Q26, please explain Revrsed Monrtonng lnstruments, WHO/APOC, 2002 26 S up e rv is io n/M o nito r ing 28.. Who supervised rhe cDDs (CIRCLE ALL THAT APPLY) 1. Not supervised 2. Village head 3. Village health committee member 4. health persorurel 5. Other (Specify) 29. [f supervised, how many CDDs did you supervise during the last distribution? 30. If not supervised, why? 31. At which occasions did you visit the CDD? (CIRCLE YES OR NO FOR EACH RESPONSE) 1 Before distribution 2. During distribution 3. Soon after distribution 4. Other (specify) 32. What tasks do you carry out during your visit to the CDD? (CIRCLE YES OR NO FOR EACH RESPONSE) Collection of unused drugs after distribution 1. Yes 2. No Reviewof records l. Yes 2. No Managementof side effects l. Yes 2. No Supervision of drug distribution 1. Yes 2. No Other (speci 33. What constraints do you have in supervising the CDD? (CIRCLE YES OR NO FOR EACH RESPONSE) Yes 2. No Yes 2. No Yes 2. No 1. 2. J. 4. 5. 1. No constraints 2. Inadequate/lack of means of transporUfuel 3. Too much work 4. lnadequate/lack of supervision allowance 5. lnaccessibility 1. Yes l. Yes 2. 1. Yes 2. 1. Yes 2. l. Yes o No N2. No No No 2. 6. Other (specify 34. Do you have treatment summaries for communities (where you are working)? 1. Yes, seen 2. Yes, but not seen (Explain) 4. No, ex 35. If Q34 is "Yes, seen" EXAMINE TREATMENT SUMMARIES AND OBTAIN THE FOLLOWING INFORMATION ON: Revrsed Monitoring lnstruments, WHO/APOC, 2002 27 ) Total Age composition of people: Below 5 Sex composition Male 5 years and above_ Female Number of persons treated_Male_ Female Number of persons under-5 years who received treatment Number of refusals Number absent during last treatment_ Number with severe side effects Number of tablets received Number of tablets used Number of tablets remaining Work of CDDs 36. How many persons have stopped working as CDDs in your area? _ 37. How do CDDs normally determine the quantity of drugs required by the community? 1. Census/registrationrecord 2. Previous treatment records 3. By counting the number of households 4. Other (specify) 38. How do CDDs determine the number of tablets to give to an individual? (CIRCLE YES OR NO FOR EACH RESPONSE) I 2 J. 4. 5. 6. 7. 8. 9. l0 ll 1. Take height measurement 2. Use weight 3. Visual observation 4. Age 5. Other (specify)_ 1. Yes 1. Yes 1. Yes 1. Yes 2. No 2. No 2. No 2. No 39. What do CDDs do about individuals who are absent during normal distribution period? 40. What is done about individuals who refuse treatment? 41. Do you have drugs to take care of minor side effects? l. Yes, seen 2. Yes but not seen 3. No Integration 42. What other health activities do you combine with Oncho Control Programme activities (PROBE FOR HEALTH ACTIVITY IN THE CDTI COMMUNITIESX Revised Monitonng lnstruments, WHOiAPOC, 2002 28 Gender and Minority groups 43. How many health staff are involved in CDTI within your area? 44. How many Male Staff How many Female Staff _ 45. To what extent are women and other minority groups involved in CDTI activities Contrihution of resources by partners 46. Are there other partners contributing to CDTI activities in your area? (Probe for other organisations e.g. CBOs, that are involved in CDTI activities) 47. What kind of contributions do they make towards CDTI activities? Probe for financial, human and material resources. Partnership with NGDOs and other actors 48. What have been the benefits of working with other local partners? 49. What have been the constraints of working with other local partners? 50. What do you think should be done to improve the programme? 51. Please tell me how you intend to improve the following activities a) Training of many CDDs to reduce their workload b) Participation of the community (support to CDD, treatment of ALL the eligible members of the community) c) Health education 52. Is there anything else you would like to discuss with me about CDTI in this area? Revised Monitonn g lnstruments, WHO/APOC, 2002 29 GROUP DISCUSSION GUIDE AMONG COMMUNITY MEMBERS In six villages conduct Jive group discussions for women and one for minority groups (women) With the permission of the village-head ask the CDD to arrange a comfortable place that offers some privacy and enough space to sit. Each group must consist of 6-8 people. The group discussion must be tape-recorded At the end of the session, play back the tape for a few minutes to be sure that the discussion was properly recorded. Label the cassettdNotes (Name of the community, the group identity, date). Make copious notes for use in the analysis. (a) Community participation and ownership: Please tell us what you know about the onchocerciasis treatment programme (PLEASE PROBE FOR THE FOLLOWTNG TSSUES.) i) The person(s) who brought the idea of the onchocerciasis programme to this community ii) The time when the person(s) came to talk with you about onchocerciasis iii) Whether there was a community meeting at that time. Probe for issues that were discussed at the meeting o Ownership of the programme . Objectives of the programme (key elements) o Expectation from the programme o Responsibility of the community Revrsed Monitonng lnstruments, WHO/APOC, 2002 30 1 2 Please describe how the community took decision on the time (month/season) and mode of distribution. PLEASE PROBE FOR: o Persons involved in decision-making o How the decision was made o Time of distribution . Why the time was chosen o Method of distribution . Why the method of distribution was chosen Please describe how the community took decision on the persons responsible for distributing the drugs to community members. PLEASE PROBE FOR: o Persons involved in decision-making o Who will be responsible for distribution o How the persons were selected . Why the persons were selected o Method of drug collection What changes have been made in the way the drug is distributed in this community? PROBE FOR . Type ofchange o Persons that brought the change o Change in CDD (number, sex) How will the community ensure that all its members receive the tablets every year for several years? Probe for o Arrangements in place, o Constraintsenvisaged, o Motivation to continue taking the drugs b) Gender issues and community groups How many people among those gathered here attended the last health education meeting? Probe for: o Number of meetings held last year . Conveniences of the meeting time and place o Issues discussed at the meeting o Suggestions to encourage female attendance and participation at meetings 7.How many of you would like to be CDDs? Probe for o Acceptance of the idea of female CDDs by the community o Constraints that may hinder interest of female in the CDD work o How the work may be made appealing to females (b) Mectizan supply (collection and distribution): How is the drug normally brought into the community and distributed to community members? PROBE FOR: J 4 5 6 8 Revrsed Monitoring lnstruments, WHO/APOC, 2002 3t o Point of collection o Person responsible for bringing it to the community, o Person responsible for distribution within the community o Mode of distribution o When was the drug swallowed 9. How convenient is the time and mode of distribution and person distributing to women in this community? PROBE For o Timeliness of supply to the community o Adequacy of supply o treatment of women especially those who were ineligible at time of distribution (c) Coverage 10. Which people who were not treated during the last distribution? Probe for: o Treatment of women, o children and o minorities(non-indigenes) o What were the reasons for not being treated? 11. Ask participants to comment on the willingness of people to continue with the treatment next year? Probe for: o Reasons for continuing treatment o Constraints to continuing treatment (d) Contribution of resources (finances and others) by partners. 12. How do you support the CDD? Probe for: o Incentives in cash or in kind o Provision of means of transport o Mobilization of community o Ensuring compliance Integration 13. Are your CDDs involved in other health/development activities? Probe for . Type of health activities 14. Who selected them (CDDs) to participate in those activities? 19. What do you think about the CDDs participation in other health activities? 20. How does their participation in other activities affect CDTI activities? 21. Ask the women to suggest what changes should be made to ensure their full participation. Revrsed Monrtorrng lnstruments, WHO/APOC, 2002 32 3GUIDE FOR CONDUCTING COMMUNITY MEETINGS Meetings slrculd he held in 4 communities wlrcre Group Discussiotts will not be held. It is important to ensure that both sexes are well represented in the meeting. The minimum for conductittg a comnrunity meeting is 30 people who are residents of that community, For details on how to conduct corumunity nteetings, see the guide. l. Attendance: Number of women (at least l3 years old). Numberofmen-(atleastl3yearsold).Totalinattendance Number of women who were treated Number of men who were treated 2. Please tell what happened after swallowing the ivermectin/Nfectizar/Oncho tablets. (issues tofollow up on are: side reactions and management, benefits, why some were not treated, whetlrcr those who experienced side effects or were absent came for treatment next time). What method/center was used in distributrng tablets in this vrllage? Was it convenrent for everyone? Were you part of the decision to select the place/method? (at every stage, count the nwnber of males /females responding to each question. Insist ott a show of hands. Ask why some did not pdrticipate? Ask how in future everybody's participation would be assured- do not lose sight of the women and other minoritie$. Facilitators sho seeking their own solutions. Who distributed the tablets? How was he/she selected? Were you part of that selection? (at every stage, count the number of males /females responding to each question. Insist on a show of hands). For those who did not take part, what was the reason? Are they things in the distribution exercise that you would like to be done differently? (The facilitator/or the Projector Co-ordinator can come in to take them through all the stages so that they can identifu which ones they were satisfied with and those they were not satisfied with- e.g. mobilisation, notice of day and time of distribution, convenience of treatntent centre/method, person distributing, duration of distribution, follow up on treatment of absentees, refusals, the sick and pregnant). How many of you did attend health education (Insist on a show of hands at this stagefrom both nrules andfemales)? For those who did not attend health education what do you know about this disease and how it is treated? For those who attended health education, what did you learn? For those who attended health education, where did you attend health education? (Was this place, day and time convenient? What suggestions would you like regarding place, day and time?) How many of you would like to be CDDs (no. of males and no. offemales)? How do you support your CDD (s)? (Ask the CDDs to tell the eatherins what he does and where he needs support?t Do you think having more CDDs is a good thing? If yes why? (For the facilitator: Note that being a CDD is not afor afew people, everyfamily may have a trained person who canfulfil the role of a CDD, Mention this to the meeting. ). At thrs point, ask the community members to raise any questions they have. It is important that those related with the project implementation be answered by the project co-ordinator. The facilitators may answer questions, which are related with this exercise. The communrty leader and the CDDs should be called upon to respond to questions that involve intra-community issues. After this, the facilitator should thank the people and hand over the meeting to the community leader for closure. 4 5 6. 7 8. Revrsed Monr torrng lnstruments, WHO/APOC, 2002 33 9 At the end of the meeting, the facilitator should sit with the community leader, all the distrrbutors and the prolect co-ordinator. The facilitator should provide a piece of paper and pencil to the community leader or one of the CDDs to sketch the village map. They should all agree that this sketch rs a fair representation of their comrnunlty. Then ask them to add on the sketch their communrty's structure (which group- kinship, tribe etc stays where), treatment centres, and homes of the CDDs and the chief. Ask them to locate the center where health education takes place. Ask them to indicate the area where the homes of most refusals and absentees are located. (This information can be linked with what has been mentioned in the meeting and later conrpared with quantitative information.) INTERVIEW GUIDE FOR POLICY.MAKERS/ WHO REPRESENTATIVE /PROGRAMME MANAGERS/ COORDINATORS Revrsed Monrtorrng lnstruments, WHO/APOC, 2002 34 This interview is administered on Co-ordinators, Programme mdnagers, representatives of NGDOs involved in CDTI, Ministry of health policymakers and the WHO representative in the country. It is similat" to the interview of health personnel. Documents such as registers should be requested before the fornrul interview so that information can be extracted for the report SECTION A: PROGRAMME MANAGERS/ ONCHO COORDINATORS (a) Community participation and ownership l. Please explain how communities are involved in CDTI? Probe for process of getting communities to take responsibility, decision-making and ownership. (b) 2 Mectizan supply (collection and distribution) Please explain process of recerving rvermectin. PROBE FOR: a. Timehness of supply o If there are any delays, at what level do they occur and why? b a a d. e c Adequacy of the quantrty received/shortage In case ofshortages, at what level are they expenenced and why? Process of collection and storage Ask for how it is done and if they are any constraints they experrence at the different levels of collection and storage (storage, transport, etc) Distribution to communities (opportunrties and constraints) In case of constraints, how are they managed? Pilferage (c ) Coverage3. EXTRACT INFORMATION ON THE FOLLOWING (relate to the level of operation e.g. State and LGA) a Total Population b. Number of villages in the area Number of villages with summary forms_ Number of villages treated Number with severe side effects f. Evidence ofreport update (check annual returns after distribution) l. Updated 2. Not updated(d) contribution of resources (finances and others) by partners. 4. FUNDING: Please probe for a. Delays in endorsement of letters of agreement c d e, Revised Monrtorrng lnstruments, WHO/APOC, 2002 35 whv? b. Trmeliness rn receiving funds o ln case of delays at what level do they occur and why? Disbursement of funds o Are funds released for CDTI activities? o fu'e funds released on time? [f not, at what level are the delays and why? o [s counter funding being done as stipulated rn the letter of agreement? Please explain your answer. d. Adequacy ofprevrous budget o If not adequate, why and for what activities? e Fund administration: o Are financial reports submitted in trme? o If not why? f. Comment on the trmeliness of feedback from APOC headquarters on financial reports (e) Gender Issues and community groups 5. Please can you tell me about the women involved in CDTI? Probe: The responsibilities of females in CDTI activities Opportunities and constraints c a o SECTION B: MOH POLICY MAKERS (Permanent Secretary/Director Disease Control) 6. Do you have a national Plan for the control of onchocercrasis (Probe for the importance attached to onchocerciasis control 7. What kind of support do you provide for Onchocerciasis control actrvities (PROBE FOR FINANCIAL INPUT) 8. Ask about the extent to which CDTI been integrated into other health programmes? 9. What post APOC plan is in place to sustain the CDTI actrvitres? 10. Ask whether there is anything else about the CDTI programme that they would hke to discuss. Revised Monrtorrng lnstruments, WHO/APOC, 2002 36 tt! N o. I =vi o E o0 C o c-. co C) CItr <n hoO I oz A E o q,) at) o _l q) tr(! C)l- U's o tr o z I c) oo E tr tr o(J o E(l, z E =E tr oO q,i o() o E' G ct ! o GI OJ €) Iq) o ah o OJ .a o ctr E:3<oc)(, C,)'tEE 8b;g 'oEE7,== =E 3g o..q? g=9(! a.rE9 eh60 o s*E eiot (!E eI -EI9 €0)i -v,;arrt o C,<E5 -p,I -E o Etsc) =9(!tuc, l< .Q(uaorc)(/) + (.) =x(n:(!o oo* -c -o c)*EE 'Iorc .trb UfiE -o= o'c o! H 8=*=o >\o-qt-= G)(l-)o q,rH9 >,o*p:< bEt3 9ol c ,v(EO:EEe-d'o gr36 Ea?X :9A :E E ;i 6JvAEEPiEFep =?)dq?o=ql.o <)AEE PH 8 'Eoo5-q >,o€i1' EEE. 'qf69 O EP1A* -rr€arF'^t! E E BE .=-co EfEE(l.)= q, IE^ooeYo-r<) o;,q)(E;:EE S E sI .-;ggEE E I3pLa O. !-- ;E g H.T lrail oh E1 & D(o eJ o t El cnp o -rl o >rOotr6-5€63 E5<ds -G6 o+. e '.= > >.* tr T lLI soo!'foB I :#gEEfl[ E E "E =E.eEEE 8,E c\ zo F cn rq Do OJ !.1 E ...E;H E - (-)G aJd=c;i >.<tt# <!= =;H;HT?t-.1 E hE,F/A Fa s.l D oF oz r& o 9 6 8E g?-^(gju o-O c o ll llIES€ g'6€>z =.t: iFIsI=?a Y o d-c = -A*€€P zo FU) tr.l q oF U) rrl f! o.=;tr!* EE " gE =1.H i E € E 9,€ E-r() - dl16 'Eto(o: B c..aa =eE 3E,8ii?a> aE 8>z s€ HF#g J (,>r > i'-E e 6o €-o iD > :EESB50 zo FaH o- PE-Eo-c PF"E 6 EP EEgEEEID o o0 5Ercn2l& 3 a;'oaOtr Eo fiE E > s?<r6zzE NN QI 3 cotr E o0 tr o co il C) r!) oE o C) E oo C)(.) E oo 0)! q) * * IF * ll E o o! q) * * * rn ltE C) tr c-. .oils.^ (nEY b co -J2€ll *o90 .r=ii tqIr E* fiFE € Ee c.t il c.l q)ll tr(l-) i-- eEtlUtrbtr ettr50 0) {j9€9(!Hb il oo o o o(J * * \i?r; o\ E'T ? ? ^'.5 tr 5 ir HEEEuE -E'iEg[h, gx c sE€ E d-r?? .:rxr EsXX € r EgH€c) O O o.-* (.) !aaedF t o' Na d(, 4 oE o E E E oo o: +i o ? q)\ c\ ql v,qJ t{q.i V1 Lq) q) o' ? q)\ Oo \ -i qJ t >-r\0)s>q) =\(,l >. -:Oq) GtRa<(Ji €q(rrS!s Esg.s 6SFTL .al lt il>z E OJo): E6l 6e! ,>.G O tl o> > 9a +. = E'F\ =v^-aE UU X ilil>z (u .P 4)tE ':Ic. V:EtvAc-i= -al- -a^- ^.-V-V ,r ._ ! >r.= !'l '-!v- =297,A L3E il[>z (u lt6.E= Ect --^ 5 -^W -Y-.-l.-L-^V ii .- A !>E = J'iE h E E.EN AE 5 t, ltz il o E5 r - I oo.- F -*-;Y ^.r I 3E E i E .- - ,r v VA L; E T .= e 5.E !^ = L9PE 67O 'l': .= (r t;? 3'F E s :: EE.EEEgJ! ilil>z +. I I -9s-ctst'tr= iiEgsEri clE o o oo xoa U)(u Gz tCONTRIBUTORS NAMES ADDRESS Prof. Oladele B. AKOGUN Parasite & Tropical Health Research, Department of Biological Sciences Federal University of Technology, Yola, Nigeria - Tel: (234) 75 626467 - E-mai[: ako e!!]b@trk arule].qo rn or ak o.qu no(rl ho t nr ai i [. c o rr r Dr. Sebastian Olikira BAINE Makerere University, Institute of Public Health, P. O. Box 7072, Kampala, Uganda - Tel: (256-41) 532-207 or (256) 7l 925-861(Mobile) - E-mail sotr:rine(iryahoo.co.uk or sbaine(r.diplr.ac. ue Mr. Paul BUKULUKI Makerere University, Department of Social Work and Social Administration, P. O. Box 7062Kampala, Uganda - Tel: (256-41) 534-114 or (256) 77 462-100 - E-mail: pbukulu trnail.ctlrrr Prof. Oladele O. KALE Department of EMSEH, Faculty of Public Health, College of Medicine, University College Hospital, Ibadan, Nigeria - TeVFax: (234) 2 8100397 - Mobile: 234 (0) 8022912224 - E-mail: ookale(4)skanrret conr or oolcaleGJlyahoo.corn Dr. Raphael B. M. KALINGA Head of Vector Borne Diseases and District Health Services Decentralisation, Ministry of Health, P. O. Box 9083 Dar-es-Salaam, Tanzania - Tel: (255) 22-2124500 or (255) 741-400230 - Fax: (255) 22-2123676 - E-mail: rkalinqa(c{.,2000yahoo.com or rkalinqa(g)molt. gcl. tz Dr. Moses KATABARWA Country Representative, The Carter Center, Global 2000 River Blindness Program, P. O. Box 12027, Kampala, Uganda - Tel: (256-41) 251-025 or (256-41) 345-183 - Fax: (256-41) 3 49 -139 - E-mail: rvbprrr(.i;starconr.co ug or nrkataba03 @'hoEnai l.conr Dr. Joseph OKEIBUNOR Department o f Soc io lo gylAnthropo logy, Uni versi ty o f Nigeria, Nsukka, Enugu State, Nigeria - Tel: (234) 42 771169 - E-mail: epscelon(g)aol.conr or j o l<ei b unorfgyahoo. corn Mr. Chukwu OKORONKWO National Onchocerciasis Contro I Pro gramme, Federal Ministry of Health, Room 915, Federal Secretariat, Phase II, lkoyi - Lagos, Nigeria - Tel: (234) | 4821285 - E-mail chukoro Christ@)yahoo.co.uk Monrtoring Instruments, WHO/APOC, 2002 40 e. I NAMES ADDRESS Prof. Detlef PROZESKY Faculty of Health Sciences, P. O. Box 667 Pretoria 0001, South Africa - Tel: 27-12-354-1147 -Fax:27-12-3541758 - Emai I : prozesklr(rDrnedi c. up. ac. za Dr. Eleuther TARIMO Consultant, c/o WHO Office, P. O. Box 33277 Dar-es- Salaam, Tanzania - Tel: (255) 22 2775891 or (255) 742 605025 - Fax: (255) 22 271720 - E-mail: e lc- u t hcr(ir) ud. c o. tz Dr. Uche AMAZIGO Chief of the Sustainable Drug Distribution Unit, African Programme for Onchocerciasis Control (APOC), 01 BP 549 Ouagadougou 01, Burkina Faso - Tel: (226) 34.29.53 or (226) 34.29.59 - Fax: (226) 34.28.75 - E-mail: a urazi qo ur,(/r,oncho.ours. [r [' Monitoring lnstruments, WHO/APOC, 2002 4t