SOUTHWEST CDTI PROJECT, LIBERIA TECHNICAL REPORT 2OI2 ntds.liberia moh ahoo.com ORIGINAL : Enelish ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) LINE FOR SUBMI To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICANPROGRAMME FOR ONCHOCERCIASTS CONTROL (APOC) I I I Prqiest I\aEe: South West CDTI Project COUNTRY/NOTF: Liberia Launchinq vear: 2000Appreval yearz 1999 From: January 2012 To: December 2012 ( Month/Year)ear) APOCfunrlineyear: (circleone) I 2 3 4 5 6 7- 8 9 10 11 12 13 APOC Pro.iect implementation year report: (circle one) I 2 3 1s678910111213 Date submitted: Partners: Partners: - Ministry of Health & Social Welfare - Sight Savers International - African Programme for Onchocerciasis Control (APOC) - Mectizan Donation Program (MDP) - communities ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) EI{DORSEMENT Please conlirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: Liberia N'l'Ds Program Director Name: K. Signaturer Date: .'+fn 8:"YA.# S ightsavers Country Director \. , .. ,'l Name: Mrd. Adoley Sonii o o Signature: /tnr*+.,{o* tsrtftf#efs This Report has been prepared By Name: NOTF Liberia Designation: NOTF Signature Date ,\r ll ll Table of contents 1.1. GpNeRel rNFoRMATIoN............. 1.1.1 Description of the project (brieJly)... 1.1.2. Partnership, ...,... . 1.2 Popu1erroN...................... SECTION 2: IMPLEMENTATION OF CDTI....... ........7 aJ 3 4 6 2.t. TrvrlmE oF ACTIVITIES ......... 2.2 Aovocecv .............. l0 2.3. Mogtr-tzerloN, sENSrrtzATIoN AND HEALTH EDUCATIoN oF AT RISK coMMUNITIES l0 2.4. CouuuNrry rNVoLVEMENT........ 2.5. CepecrrvBUrLDrNG.. l1 ...... l3 l4 14 17 17 2.6.5. Trend of treatment achievementfrom CDTI project inception to the current year l9 2.7. ORoeRINc,sroRAGEANDDELIVERvoFIVERMECTIN.............. ...............20 How eRE THE REMATNTNG IVERMECTIN TABLETS coLLECTED AND wHERE ARE rHev repr? 21 2.8. CoNaNaLNtry sELF-MoNrroRrNGeNo SrereHoLDERS MEnuNc 2t 2.9 SupeRvrsroN .................... .,'.....7 2.6.1 2.6.2 2.6.3 2.9.1. 2.9.2. 2.9.3. 2.9.3 2.9.4. 2.9.5. Treatment figures .......... What are the causes of absenteeism? What are the reasons for refusals?.... ......,......,21 3.1 23 EqurrueNr.. 23 3.2. FnhNcreL coNTRTBUTToNS oF THE pARTNERS AND coMMUNITInS...........................23 3.3 )A 3.4. 29 Provide aflow chart of supervisionhierarchy . .. .,..,. .................21 What were the main issues identi/ied during supervision? .............................. 22 Was a supervision checklist used? ............. 22 What were the outcomes at each level of CDTI implementation supervision? .... 22 Was feedback given to the person or groups supervised?...,..,......................... 22 How was the feedback used to improve the overall performance of the project? Ornna FoRMS oF coMMUNrrY s[]PPoRT ExpeNotruRE PER ACTIVITY SECTION 4: SUSTAINABILITY OF CDTI....... ...........29 4.1. INrenNar-; TNDEeENDENT pARTICIpAToRy MoNIToRINc; Ever.uartoN......... ...........29 4.1.1 Has the project ever been evaluated/monitored? (fick any of the following which are applicable) ........... ............29 4.1.2. What were the recommendations? ............. 29 4.1.3. How have they been implemented? .......,..... ................. 30 4.2. SusrnrNeerI-rry oF eRoJECTS: eLAN AND sET TARGETS (MANDAToRv AT Yn 3)....31 4.2.1. Planning at all relevant 1eve1s......... ...........31 4.2.2. Funds ....... ............... 31 4.2.3 Transport (replacement and maintenance) . ., ........ 31 4.2.4. Other resources 3I 4.2.5. To what extent has the plan been implemented............. 11r 3I 4.3. INrecRertoN........... 4.3.1. Ivermectin delivery mechonism.t......'........ """""""""' 32 5.2.1. Training.... """"""" 32 6.2.1. Joint supervision and monitoringwith other programs..........' """ 32 6.2.2. Release offunds for project activities """" 32 6.2.3. Is CDTI included in the PHC budgetT ..'.........'. """""' 32 4.3.6. Describe other health programmes that ore using the CDTI structure and how this was achieved. Wat have been the achievements?............. """""""""" 32 6.2.4. Describe others issues considered in the integration of CDTL ..... 32 4.4. OppnertoNAL RESEARCH ...... .........36 4.4.1. Summarize in not more than one half of a page the operational research undertoken in the proiect area within the reporting period. """" 36 4.4.2. How were the results applied in the proiect?......'...... """""""""" 36 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES... ....................36 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........36 ...........31 lv Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT MAP UTG wHo CHT OIC MERLIN CRC LSTM CO CHDD CHO BPHS UNICEF African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers Medical Assistant Program Ultimate Treatment Goal World Health Organization County Health Team Officer -in charge Medical emergency relief intemational Cavalla rubber corporation Liverpool School of Tropical Medicine County Onchocerciasis supervisor Community Health department Director County Health officer Basic Packages of health services United Nation Children Fund V Definitions (viii) (ix) (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Elieible calculated as 84%o 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 mesolhyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be explctid to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/tryper-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. Sustainabilitv: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilizedby the community and the government. Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full resporsibility of ivermectin distribution and make appropriate modifications when necessary. vl FOLLOW UP ON TGG RECOMMENDATIONS Using the table below, fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session Number of Recommendation in the Repofl TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROIECT FOR TCC/APOC MGT ASE ONLY Report Related (D Table 2: Correct the sum of meso and hyper endemic population - incorrect for Grand Bassa & Margabi (repeated). The total for meso and hyper endemic population were corrected for Bassa and Marsibi. (iD Table2: complete the column on UTG The UTG column was completed in the tablet Project Related (i) Implement the planned roll out of CSM in two counties; The planned roll out of CSM in two counties was not conducted because APOC did not authorized the use of the CSM funding that was in country (ii) Explore with APOC or other partners replacement of project vehicle;. Project vehicle was not replace by APOC (iii) Follow up on the implementation of the recommendations of sustainability plan and report progress in the next Annual Technical Report; Follow up on these recommendations were made which result are found in the technical report below in the sustainability area of the report. (iv) Streamline the ordering of drugs to tally with the need of the project (repeated); An inventory on drugs in the various conducted to the drug need ofeach county within the project area. (v) Continue to train more health staff in project area in CDTI (repeated); We could not trained more health staff in the project area due to limited funding for health worker training (vi) Continue to improve on the CDD to population ratio and aim to achieve 1 CDD to 100 populations (repeated). The ratio of CDD to 100 population has not yet been achieved due to limited funding to train the required number of CDDs 1 Executive Summary Prepare an Executive summary of the report in not more than w.page. 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 - CDD$, health workers, Total population (community) per CDD trained' 4. Challenges and how they were overcome. The southwest CDTI Project consists of five counties which include: Bomi, Grand Bassa, Grand Cape Mount, Margibi and Rivercess. This project was approved in 2002 Co-implementation of Onchocerciasis and Lymphatic Filariasis using Mectizan and Albendazole was conducted by MDA through CDI approach in four counties namely; Grand Bassa, Grand Cape Mount, tr/iargibi and Rivercess. Mectizan treatment for Onchocerciasis only was carried out in Bomi which is considered non endemic for Lymphatic Filariasis. During the year under review, out of a target population of 777,485 in the project area, 639506 persons were treated which constitute 82.3% therapeutic coverage. The numbers of communities treated were 1732 out of the targeted communities of 1898 in the project area which constitute 91% geographical coverage. The populations in the area were stable. The numbers of 204 health workers including all District Health officers, Health facilities staffs and County Health Team members were trained. A total of 3954 Community Directgd Distributors were trained/retrained. The training was integrated with all the priority NTDs diseases in Essential Package of Health Services. The challenges faced where the following; . Some communities unwillingness to support or motivate the CDDs ' Difficulty in conducting supervision & monitoring during the rainy season . Limited logistics (motocycles and fuel) for supervision' Actions taken to remedy the challenges include; o Collaboration with private agriculture companies in provision of logistic support to CDDs in their oPerational areas o lntegrated use of transportation logistics, motorbikes from other health programs were used for CDI/CDTI imPlementation . Advocacy to policy makers and partners to provide funds to start implementation early in the year, before the rain sets in 2 SECTION 1: Background information t1.1. General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate Population: activities, cultures, language Communication systems (roads... ) Administration 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 is located in the south Western part of Liberia. This project is bordered by the Atlantic Ocean in the south, on the west by the Republic of Sierra Leone, on the east by Cestos River and on the north by Bong County. The project consists of five counties which include: Bomi, Grand Bassa, Grand Cape Mount, Margibi and Rivercess counties. The project area 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-wheel 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, from Grand Bassa and Rivercess Counties, Kpelle from Margibi, Vaifrom Cape Mount, and Gola from Bomi County. The traditional leadership structure in the communities is hierarchical in nature. Large areas known as chiefdoms are under the authority of the paramount chiefs; and the paramount chiefs are the head of clan chiefs with authority over the clans that make up the chiefdoms. The towns/communities make up the clans. !n every village or town, there are councils of elders who are involved in decision making for the administration of the community. J Counties Population Bomi 108226 Grand Bassa 244548 Grand Cape Mount 186942 Margibi 169056 Rivercess 68713 Total 777485 Population of South East CDT! Project, Liberia from Census update by CDDs Table 1: Number of health staff involved in CDTI Counties Number of health staff involved in CDTI activities. Total Number of health staff in the entire project area Br Number of health staff involved in CDTI Bz Percentage Bs=Bzl Br *100 Bomi 254 30 12o/o Grand Bassa 218 39 18o/o Grand Cape Mount 367 71 19o/o Margibi 305 40 13o/o Rivercess 289 39 13o/o Total 1433 219 15o/o 1.1.2. PartnershiP lndicate the partners involved in proiect implementation at all Ievels [MoH, Sightsavers, (nationa!/international), communities, local organizations, etc.l Delscribe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, pianning, mobilization, etc) where all partners are involved. bt"t" p'ians, if ?try, to mobilize the state/region/districuLcA decision- makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. ln 2012, the Neglected Tropical Diseases program partnered with WHO/APOC, SightSavers, Liverpool Schoo] of Tropical Medicine (LSTM) and Medical Assistance Program in the implementation of theZOl2 mass drug administration. An integrated training-and supervision and monitoring were conducted with funds provided by these partners. All of these partners provided technical and financial support to the NTDs program' ProjecUCounty Level partnership took placed between county health teams and Agriculture /Mining concession companies. ln Grand Bassa the Liberia Agriculture Company (l-AC) assisted in the training and supervision of CDDs in the rubber plantation, while Buchanan Renewable Company another 4 concession company provided three Hundred United State Dollars for support to CDDs and mobilization in the port city of Buchanan ln Margibi the county health team established a partnership with the Salala Rubber Corporation (SRC) and Firestone Plantation company. Firestone assisted the county health team in the mobilization of their workers to participate in MDA and the recruitment of more CDDs. SRC provided half bag of rice to each CDD that participated in drug distribution in the plantation operational area. ln Bomi Sime Darby a private Oil Palm Plantation provided transport for the CDDs and mobilized the workers to take the drugs while the African Humanitarian Action assisted in supervision of the Mass Drug Administration. ln Rivercess County Africa Humanitarian Action (AHA), assisted in supervision, health education, sensitization, advocacy, mobilization and reporting during the integrated MDA. 5 \o >' J olr 0.) o _o!H Cd cd a() an a >. o aa)o cn (B +r(-) () o +{ o >. Lr o (€ o *< c.) € c.) N C6 bo l.< o 0.)Lr cs o B (.) ao C)aqr o o =ol-r o0 a >. tr UOH< o() 'a trg (.) +r o q) lti oLg q) € (6 Ial-r() ) a O cn F d b0(c $< o E oo 0.) oq.) U' o() Id B 0) (H 0) o b0 CB Lo >. a oO tr Lr(.) 0) bI) rr') o)L{ cg) o +< e oOq cn ooLr o v) $ro o v)'(.) Io c-.o0) r\ -o CB o)l -oldt;l €o'dz cdlEIl-l O3Et) +i 0)o o c..t 0)=Ho:lo5 b c''l U)claz r, 9? LHtsicq :J ;1 c.) 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Timeline of activities Fill in table 3, timeline of activities for areas treated in current year,indicating when the key activities were implemented by the month they began and the month they ended. 7 oo o) t-q) a o a5EE o U o oo L 0)I o o z t< 0)p o) o z LoI o o z Lq)I o o z oD-E+ .PE a- >. 0)3 q) aoa L 0.) -o o) ooa L os 0) aoa Lq) -o 0) aq) U) E o E L ah E ut fr o EOEE oI (t') bo 0)o q) o z C) -o (D z C) .o 0) o z Lr 0)! 0) o z b0-E .l- 1itr #E >' C) -o o) aoa tr C) .o o oa C) -o a) aoa tr 0) -o o a(.)a q) clEe ah o) q) Q -9:o.5EE o(J C) a bo (n b0 rn oo ah bo oD-c+ ?E 6= a- 0) l- t) bo t) oo <n oo P(n bo b! tr GL Fr o E o Q o o oo (t) oo ra oo (h 00 o!_E+ ?E a- 0) an oo) (n bo U) bo a th 00 -q) 5E s= -atroo -92 o EOEE I h CN z >. >' >' >. bD-trl +! .PE 6= aE d z >r >t >t o(J oo d cdo ! 6 o z oo.d(J ! d IJ p 'Eo 6 oo (.) & N c.l l<(g(,) >' o L<lr ao 0) €() (€ oL adq) L Cd 0) t< € cn o o CB(t< o c,) o) F ".iro)l -ol(gl FI
2.2. AdvocacY Stste the number of policy/decision makers mobilized at each relevant level during the current year; the ieison$) for undertaking the advocacy and the outcome. Describe dfficutiies/constraints beingfaced and suggestions on how to improve advocacy. ln ZOIZ, advocacy meetings were held in the five counties with county authorities, international organizations, local organizations, religious leaders, communities' leaders and CBOs. Gounty Level A total of 66 policies makers attended advocacy meetings held at county level. These policies makers include county superintendents, city mayors, county planning officers, county education officers, and religious leaders. District Leve! At the district Level, advocacy meetings were held with district commissioners, paramount chiefs, clan chiefs, principals of secondary schools and religious leaders. A total of 356 persons attended the advocacy meeting in the five counties. Community Level Advocacy meetings were held in the communities with town chiefs, women leaders, youth leaders, ieligious leaders and teachers. A total of 200 persons attended the meetings in the various counties. The reasons for the advocacY were: , To enlist support of various policy makers during program implementation . To introduce the new NTD drugs and the importance of taking the drugs . To advocate for community ownership of the program The outcome of these meeting were o Decision makers promised to mobilize their various communities to participate actively in the Program . lmproved community knowledge on Mectizan and Albendazole and willingness to take the drugs . The county, districts, and communities' leaders encouraged community members to turn out for the administration of the drugs. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on: - The use of media and/or other local systems to disseminate information - Mobilization and health education of communities including women and minorities - Response of target communities/villages - Accomplishments - Suggest ways to improve mobilization and sensitization of the target communities. The County Health Teams in collaboration with various local media organizations in airing Onchocercjasis and other NTDs messages. Airings of jingles was done twice a week and talk show once a week lor 1-2 months in the five counties. Support for the media campaign was provided by APOC, Sightsavers and Liverpool School of Tropical Medicine' 10 The following local radio stations were used: - Radio Gbehzohn, Radio Dugbah in Grand Bassa - Rivercess Broadcasting System (RBS) in Rivercess, - Radio Piso in Grand Cape Mount, - EIRB Radio in Bomi - and Radio Kakata in Margibi. Mobilization and health education was carried out at county, Districts and communities levels. HSAM involved women, youth groups, and religious leaders including patients who attended the Out Patients Department of the various health facilities during the Mass Drug Administration. lnformation was provided to the community members about the diseases and the drugs. IEC/BCC materials were distributed in the communities during health education and sensitization on Onchocerciasis and Lymphatic Filariasis though not enough number to go round . During the Mobilization and health education, Flip chart was used at the OPD, outreaches & market places during health education. Suggestion for improvement in HSAM 2.4. Gommunity involvement Table 4: Communities participation in the CDTI Comment on: - Attendance of female members of the community at health education meetings - ln 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)? - lncentives provided by communities for the CDDs - Attrition of CDDs. ls attrition a problem for the project? lf yes, how is it addressed? County Number of communities/villages with community members as supervisors Number of CDDs and the communities involved Number of communities /villages with female CDDs Total no. communities in the entire project area Br Number with community members as supervisors B. Percentage Br= BJ BI *IOO Male CDDs B7 Female CDDs Br Total Bc= Bz+Br Number of communities with female CDDs Br Percentage Brr= B'n/8.* 100 Bomi 218 76 3s% 254 28 282 27 L2% Grand Bassa 376 r10 29% 526 59 636 56 LSYo Grand Cape Mount 535 r93 36% 504 121 626 108 79o/o Margibi 375 85 23% 437 162 598 134 33% Rivercess 394 120 30% 524 61 585 5l L2% Total 1898 584 3t% 2245 43L 2727 376 L9% 11 Other issues The participation of female in CDTI activities is still low in most of the communities. About l9%o of female CDDs participated in the distribution. Incentive by community members for CDDs is very low especially in Grand Bassa County. There is need for operational research to understand the low community participation in the county. CDDs attrition is a problem because most of the CDDs are seeking jobs elsewhere to generate income for themselves. To address it, there is the need to train more CDDs to commensurate with the total number of CDDs to a population of 1 CDDs to 100 persons. However CDD training budget has not been adequate to address the needs. t2 o) 6lL ar) n nQ L o) z o -= + .U 6 Eu' +. q oo+ (o o F{ sf o)N (n rn l, tJ) <l CO @@ Fl o(Y1(o rf)(o(r) rn(o N oo sfo F{ l,o sf (a$(o rn sf COFl r{ o) : N 00 sfln or(o r{ F{F Fl N slNN s o (l) c) () I FO $ t) c.t ra) c.t\o @so r-l r-{ ro r{ o ahL C) .=6!rH L f-ro: iahoo .g) r- 6loh z i(J'e .U *S ,:qv t.szv o c.l a-.1 c.l c.l c.l c.l o ot r\ N soo C) C) () I (J a-.t N e.l a.l o) 4 0) cdL TE Eg -rEE> 2E oI E*?F-u' U+. e <f c{ r/) F-{ ot o ro r{N 6 sf 6 : (o F{ sl(n slN o F{ r\ : ln r'{ (n o)(o F( sf(\l Ft (O st \oc\ o 6) 6) q) q) QF =t(\ =t\o <. r- Or(O Fl ts CI th ah Fl o-(Jq) z)!l Lq) z E.l+F-(j +. z $ a.l c.l t-- co $ $ c.l (\ \o s c.l (o c! r\ rl o rl soo () 4) () I Utr $ r- s \o ro(\ J .9 .2 A oo (d d ca ! E o 2 o o. O E E oo d 2 o() (.) p, Fl Fr o t'r ca bo U s) o (B (l) o a F nOqi o a O o C)k .c)E E (l) (t o0 (ttrF .iir o.ll -oldtFI sh$Ts% hq- ,"i . seL.S xji R"'s Ei$. '.\ a)F!> v= trQ- .ES E\tsqr raFe(t.)B €8" >r \-E*E6es9t TQ ss ooX C.)q)PLEa) lr>. :P.S .=\ :S'es U)q) e!8* e's Ar. G) b.\ €R^EU S^ -c -$ .:!>Rc e *sas FLots: = t*o:s\_E3:'!+.$XESSU)eO E\)v(.) .i< q) Epoo +i P'FoF=(/) catr & rizEX}J(]\E HB irs=gs N5= x92 -t'ctr'*i S e3 s o'- Sr >;.L. -.S "r' a o (') (d lr() Boa d (') s C) b0 o o }( C) 'oCC E).EEZ 1rq -A!E - (,) OEGo)c€Gc>o€ C)tU)loA Nr c.l The capacity building training for 2012 mass drug administration was supported by APOC, Liverpool School of Tropical Medicine, Sightsavers and the government of Liberia. During the training the following categories of staff were trained, which included 26 District Health Officers, 169 health workers and 9 staffs from the County Health Teams. There is still a need to trained more health workers in the project area to be able to carry effective monitoring and supervision for MDA. 3954 CDDs were trained in the entire project area which constitute q8.SN of the total number of CDDs require at the ratio of 1 CDDs to 100 based on the present population of 777,485. Table 6: Type of training undertaken Qick the boxes where specific training was carried out during the reporting period) - Any other comments 2.6. Treatments 2.6,1. Treatment figures - If the project is not achieving 100% geographical coverage und a minimum of 65% introptuit" coverage or the coverage rate isfluctuating, state the reasons and the plans being made to remedY this. The Project achieved geographical coverage of 91Yo which falls short of 100% required. The program is verifying feographical coverage in Grand Bassa and Rivercess Counties it appears there is over reporting of target communities. Also the Program plans to conduct Trainees Type of training CDDs Other Community 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 (speci[) Partnership t4 geographical coverage survey and GPS mapping in20l3 to validate the coverages reported and target communities . 15 \o 3 \! ; 's L a, a) E a E6a L!riays! v{CBS agb"[iC6SBE3a- .: e. .= 3r !' o ia! i$ ari Hg-r$ o=t\B c.i Io.=oo*E ts E .9 'E.s 'SE .".S \b FE *s 5s sE '=.4 = .E 9E * .P bE IH BS 3i as S o )r- ag €E Eo o* t .a Jz.S Sd >; !! -Y $E .='i' SS ES EI dt\ 'R.d , gF E r > 9\J uE E 9B S(, 5 oi EO 9S .E * - (D!? 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E N(n$ $ Fr N ro N N @$\o F.sf rr) (o No l.rt ll {!,x l(,o ot) ^d^E.e bs Fo \oo\ o) CN @ \oo\ c.l Fl @ \oo\q (O @ s cO +@ ;R n(o r\ s e c{ oo b Er -o;()EbE ZtN i \o @o o\ tr) lc)$@ o\ \o rr) ro ro rfo roN$ lo @\rN ro (oo rn O)(n(O =()E 6.2 lE'o :=0.) < 94'FIJ \o ait c.r €a co$ +$ c.l Ns o\\o oo \otr) o\\o co tr- €\o ln @ sfNFI\ ! sB _ x gE €Egi: F5 ;;11o. o;e >E \o cl c.l ooo oo .+ ra) .t .t c.l c.l .t o\\o oo \o(.l o\\o c.t t'- oo\o rn 00slFF.F\ a(,) ) tr oO ilI,L- o (:) =9+i:aG OV Fo: 9g6 soo Fl \oo\ol'- \oo\oo r-l \oo\ F{ o) xO@ s r-l o) =o .E E Sgtr tr= o =c>ez6o 00FlN CN OlN st(!1 lJ) N =tfn rn st co N(f) l'. Fl tsoE 6.2 !i: ()I EtrFv oN @F-(a rO(f)!o rOt-(f) so,(a @ O'l@ !-'l ts'E 'E * .e. +t 2> 8.€ , E H -E E.q_&'€ a bg Ho .o5 = E bFO>L @ N (o F-(o rO(f) ro rtr)l-(f) $ o,(f) @ o) oo Fl .9<t;v o\ * cd c,a ! d o o.6 O !c !Eo6> 3 o0 z * oo o Fl tr 3 Bqq q) q) k- q oL \)L o t B q) 4 q) 5 .v C') Lr (d o CB() d d tr OJ o l< (n >.3 cn r! a € cd O € CU 0)t<F r-f orl -ol(st FI 2.6.2 What are the causes of absenteeism? The absenteeism was due to the time of distribution when most of the community members were busy with farming activities. 2.6.3 What are the reasons for refusals? The refusals were due to inadequate health education in some communities and reactions of the drugs on some people during the previous year's treatment. Briefly describe all known and verified serious adverse events (SAEs) that during the reporting period and provide (in table 8) the Information when available. Occurred required The project did not have any case of serious adverse events (SAE) during this reporting period but people had minor side effect. please tick in the box. No SAE case to report t7 _E*e9E 3E a <.E E L 3":, E EEE €oia == E E H"3x 6.:IJJOO (N o or.9 QE9C9q0 6E 0 00,)H(HY o:g9:- 7E E0)-c tr&96 g =d(-;(t)-O.9E C o) c q= doooO E di,.9 o =.;>eqEu' in5 lY qo H.Ee d €-gqp.E = , .o.li ()gHE!g E o. a ;i E olfo)tH 0.d h- 3 HSIN* .99od,:l (do>, o q) o0c =bO >5 x 0)a o bI) * 4a oo q) BA q) \.r o' t\q) "a i\\)q * a\ u 4q q)()q) k- ? oL v\ t I q) Fi q) 5 € Li 0,)g bo L oaotr c,) o0 Lr € 0)lrL)ooo (d a trl a (h tro C) C)alr(,) cB U))o LrO cn qi o cnq)(r,(g Q #r o.ll .ol cdlFI C) oo E Es -oO >sfn Ol sN @ x st@ \oo\ r- s(t) scl o{ oo s(".! cn oo o d q oA rr i t.T td ti o ^h0!, Ec - o6\ <. >v -o o >RoN r{ x r'{o r'l :R 00r\ 19o\s € \o o\F- scl ol oo s nN00 ll * hl ri E] 6\ o 5bo()d3b ooEOF :R @N x Ol(O s r'{N \o o\ r- qO o\ o\t-. s c..! c\ oo }R crl N @ ri ,o o6 ,o()5 4aEtr =Ozfr o. o(n r{ @o m @ln|n ri rn(o @ Olr\ ro r.o(O or-\o o\ c.t co \o oo o\ oo (o oln O) rn(o ri =o? 6.2 t uFFU oot\oNtnN oN sfd sf(O st(o Ol(n rn € N Or-$ t- €$\o c\t-rt1 tr)o t-- ln @ sfNNr\ Gq6 *3 +o .S'E o ho " .os€='Erc ' a 39 o lnol/t rJ'l Ol(n Ol F{\ rn st Ol |o o)N(o (f) o) o\$ra o\ \o ca ao \o r- o.lt-- ra) tr} ot- rn @slr-r\r\ oq) bo(d t (l) = o(J ll { HlI] t{ o9ffal- oo\ -o o x @ rjt soN N(n @ \oo\\o ca \o6\o scl \o o\ s o\ o.oo=E= EGIL+- :o ii I 9 r-i r.l Ool.t }R oo r/) xoN x CN(o ^\\oco 1O o s c..! \o o\ >RF-'l O) ti qO o'F a o = =Jotr E= U =E>F '704 (o @ st Fl rJ1 OlN F{ oNo N \o co o\t$ a\o c- N(o F Fl ti :()E 6.> =EoE H.g < 94'FU o(O rJ) 6i o(o rn N ln Ol r'{ (r1 o\ ao o\$$ oo c.l oo @ O) € F{ bo6 =qtI g IE + o= >':: E a r qEE trE o o(O rn N o rotn N ro o) (9 ra o\ c.) o\$$ ooN oo oo Ol@ rl & rr.l oa{ o c.l c.loo ol caoo ol $o a^l in N \o N r-O o.l ooo N o\oo c.l N cl *6t 6l o\ \qr s q! 0o q) ,s U) S) Si .S q) !o B q) s(,) () .E$ $qJ *oo ah 6l I 6l9 €) b0 cllL() () oH G L o CB q) (l) pr) 6l q) L b0 ah (l) E') (a cl €(q = € Gq)L cl I o) La()E L € 3 (l) (l) c{() 6) U) ctq) Fr e q]\ a.r \r\) $s +r .S EEq Q)5g c) q,lEF -t! -G5E Qtoc)c)q) EE. .9 s, atr -0)Ei c) l-l PUH OcOLO)rF >\ trel c) ril HFI > cdlool -Exo -ol6lo +. bI)trd9bE> E8LE *aou)EEtro)flEtrE .9)U]E\a .. c.i al(.)l -olcllFI c{ a(.) 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E E r! o u, IEL o +. o trl E L oEL o \N B --7 How are the remaining ivermectin tablets collected and where are they kept? - List and briefly describe the activities under ivermectin delivery that are being carried out by health care personnel in the project area. At the end of treatment, the balance tablets are collected from the community and taken to the health facilities drug storeroom. The figure for the balance in stock is sent to the NTDs focal person at district level than to the county and finally to NTDs office at national. ln20l2 all the balance tablets from 13 counties were collected and sent to Bomi County that was not implementing integrated program with Lymphatic Filariasis. Any other comments 2.8. Gommunity self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? The NTDs program have not conducted any training for Community Self-Monitoring during the year self-moni and Stakeholders Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. 2.9. Superwision 2.9.1. Provide a flow chart of supervision hierarchy. District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSNI) No of Communities that conducted stakeholders meeting (SHIvt) Grand Cape Mount Bomi Grand Bassa 218 376 535 Nil Nii Nil Nil Nit Nil Margibi 375 Nit Nil Rivercess 394 Nil Nil TOTAL 1898 2l Central Level Health Clinic /Health Center Community Level 2.9.2. What were the main issues identified during supervision? During the supervision, the issued identified were;/ -Communities without CDDs or inadequate number of CDDs t Communities with shortage of drugs and registers r' CDDs making errors in doing and recording/ lnformation on MDA not fully disseminated 2.9.3. Was a supervision checklist used? Supervision checklist was used 2.g.3 What were the outcomes at each level of CDTI implementation supervision? County Level - Drugs ind supplies were sent to the health facilities for subsequent distribution to communities - Health workers were trained using approved guidelines and resource materials Health facility Level. Communities without CDDs selected new CDDs CDD trainings were held drugs inventory was assessed to find out missed communities Community Level Error in dosing and recording were corrected on the spot during distribution Health talk was given where the response was not encouraging communities that ran out of drugs and registers were resupplied It was also observed that the communities' members were willing to take the drugs and willing to take ownership of the program. Some communities were not fully covered in Bomi and Margibi counties, the county health team and health facility staffs were advised to revisit these communities 2.g,4. Was feedback given to the person or groups supervised? Feedback meetings were held with the county health team, staffs, CDDs and town chiefs at each level of the supervision. ,l 22 2.9.5. How was the feedback used to improve the overall performance of the project? Prompt action was taken on the findings in the field, especially communities that were not covered that were later covered helped to maintain high coverage. SECTION 3: Support to CDTI 3.{. 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? Budget line will funds for maintenance and replacement of existing equipment with support from partners 3.2. Financial contributions of the partners and communaties Source Type of equipment APOC MOH DISTzuCT/ LGA NGDO Others No. Condition No. Condition No. Condition No. Condition No. Condition 1. Vehicle 1 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) Fill tables 13a, 13b and l3c 23 a If there are problems with release of counterpart funds, how were they addressed? Government counterpart contribution increased in20l2 with USDI4, 000 provided for procurement of stationery and CDD training g.g. Other forms of community suPPort Describe (indicate forms of in-kind contributions of communities d any) Communities have different forms of in-kind contribution for CDDs motivation in the project area. They include; - Exemption of CDDs from communal work - Feeding during distribution - Selection for other community based activities 24 tDcoo m trz m s o =Soo =a.(n a-r. ET qt oI 0lI a. 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E.e L(E 9EEFo; -o a C o (o c<9 CE '=(uE* >6 a a a o a a o a a o(,) o()a >,F a ah oL c)o-O^ OE \J c) (r) th c0 L t= C) o. J th lr)(n o .t) o a oa ts F(h oE oo d L(B z oL oo d k d z L (d z o C) EF 0 o(B t<(o (d Q ,h oo a rhlr 0.) o q) \ \ s S.. 4 -\f U 0) o (r) cO b0 a ao CB b0 o q (-) fi t-l() -6! E-{ a 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 operations research was conducted for CDVCDTI 4.4.2. How were the results applied in the project? SEGTION 5: Strengths, weaknesses, challenges, and opportunities Strengths r' Effective use of local radio stations and town criers to disseminate health education messages and other CDTI information in the community ,/ Integrated use of transportation logistics ,/ Dedicated staff ll/eaknesses ,/ Inadequate supportive supervision by facility staff r' Inadequate HSAM in the communitY Opportunitesf ^E*irt"rce of private sector organisations willing to collaborate in CDVCDTI ,/ Willingness of community to take the NTD drugs Threats t External cash incentives by other programs at community level ,/ Weak community structures SEGTION 6: Unique features of the proiect/other matters ln most part of the project area, the settlement pattern is dispersed, community structure is weak There is need to mount HSAM up to household level to engender community participation. ln this project the program needs to involve other local organizations, such as religious organizations to promote community participation. 36 a