Southeast CDTI annual project technical report submitted to Technical Consultative Committee (TCC): from January 2006 to December 2006

RESERVED FOR PROJECT LOGO/ITEADIIYG I COUNTRY/NOTF: LIBERIA Proiect Name: SOUTHEAST CDTI PROJECT Approvalyealz 2004 Launching year: 2004 Reporting Period: From: January 2006 To: December 2006 Proiect Year this renort: (circleone)(1) 2 3 4 5 6 7 8 9 10 Date submitted: July 19, 2007 NGDO nartner: SSI ORIGINAL : English ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) t ; TK2 sc) ,tol ,i c*lbi i't \1 Btfi ,flr (oP At+t 8Fa {n^*,1 r' +! '' .Iiri A4 *kli --.-1,-8q R ) ryr, r,brrrt i1 DEADLINE FOR SUBMISSION: To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) I g JUlt 2$fi7 1 t_ - - _--_._ _,. -.. _ WHO/APOC, 30 July 2007 l 1 i I I tANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) E,NDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: LIBERIA National Coordinator Name: Henry T. Salifu Signature: Date Zonal Oncho Coordinator Name: Signature: Date NGDO Representative Name: Verda Tarpeh Signature Date i This report has been prepared by Name : Henry T. Salifu Designation : APOC Signature : .... Date ll WHO/APOC, 30 July 2007 1.1. GENpRal INFoRMATIoN.. 1.1.1 Description of the proiect (briefly) L 1.2. Partnership 1.2. Popu1auoN............... SECTION 2: IMPLEMENTATION OF CDTI....... .......9 2.1. Tttrrel-rNe oF ACTIVITIES ............ ......-..9 2.2. Apvocacv .......'.'......'.'.' 10 2.3. MoetI.IzerroN, sENSITIZATToN AND HEALTH EDUCATIoN oF AT RISK coMMuNtrtps 10 2.4. Couvt-rNrry INVoLVEMENT......... ..... 11 2.5. Cepactrv BUILDING.. ...... 13 2.6. TReerupNrs.............. ....-17 2.6.1. Treatmentfigures.......... -.--......- 17 2.6.2 What are the causes of absenteeism? .......... ....-......-.-... 2l 2.6.3 What are the reasonsfor refusals?..........-.-..- ......--.....-.21 2.6.4 Briefly describe all known andverified serious adverse events (SAEs) that...2l 2.6.5. Trend of treatment achievementfrom CDTI project inception to the curuentyear2 j 2.7. ORoeRmc, sroRAGE AND DELIVERY oF IVERMECTIN............... .......-.-....24 2.8, COVTTAUNITY SELF-MONITORING ENO STETPHOLDERS MPETTNC ............26 2.9. SupERvtsIoN....... ......27 2.9.1. Provide aflow chart of supervision hierarchy. .......-......... 27 2.9.2. What were the main issues identified during supervision? ...........................-.- 27 2.9.3. Was a supervision checklist used? -.-.......-.- 28 2.9.4. What were the outcomes at each level of CDTI implementation supervision? 28 2.9.5. Wasfeedback given to the person or groups supervised?...............-..........-.-.-.28 2.9.6. How was the feedback used to improve the overqll performance of the project? 28 SECTION 3: SUPPORT TO CDTI ..............28 3 3 5 6 28 29 29 29 3.1. 3.2. 3.3. 3.4. EqurrueNr FTNIaNcIaL CONTRIBUTIONS OF THE PARTNERS AND COMMLINITIES. Orupn FoRMS oF coMMUNITY suPPoRT ............. ExppNolruRE PER ACTIVITY SECTION 4: SUSTAINABILITY OF CDTI....... .......... 30 4.1. INreRNal; INDEIENDENT PARTICIPAToRY MoNIToRING; EvALUATIoN.................... 30 4.1 .I Was Monitoring/evaluation carried out during the reporting period? (tick any of thefollowingwhich are applicable)............ ...........30 4.1.2. lilhatwere the recommendations? .............30 4.1.3. How have they been implemented? ............. .................30 lll WHO/APOC, 30 July 2007 ) 4.2. SuSraNeetLITY OF PROJECTS: PLAN AND SET TARGETS (vaNoerORY AT Yn 3) 4.2.1. Planning at all relevant levels.. 4.2.2. Funds....... 4.2.3 Tronsport (replacement and maintenance) . . . 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented..-..-......... .31 .31 .31 .31 .31 .31 .31 4.3. INrecRertoN............ 4.3.1. Ivermectin delivery mechonisms 4.3.2. Training.... 4.3.3. Joint supervision and monitoringwith other progroms.--...... ...-....31 4.3.4. Release of funds for project octivities ........ 31 4.3.5. Is CDTI included in the PHC budget? .............. .........-. 3l 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements?............. ...........'.--.-... 3l 4.3.7. Describe others issues considered in the integration of CDTI' ....- 31 4.4. OpenerroNAL RESEARCH 4.4. t. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. ........ 31 4.4.2. How were the results applied in the project?............- ... . ........-..... 31 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES.... ................... 31 SECTTON 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........32 ................ 3 I IV WHO/APOC,30 luly 2007 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT UNICEF UTG wHo African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Obj ective Community-B ased Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non- Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization V WHO/APOC,30 July 2007 DeJinitions (i) TolalpopulatiOn : the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84o/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 meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be e*plcted to reach the UTG ut tn. 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/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: delivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of Ivermectin distribution and make appropriate modifications when necessary. VI WHO/APOC,30 luly 2007 FOLLOW UP ON TCC RECOMMENDATIONS Using the table below, f,rll in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session }[ (Please add more rows if necessary) Number of Recommendution in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROIECT FOR TCC/APOC MGT USE ONLY That the Southeast CDTI project report be resubmitted to the next TCC meeting with all necessary corrections The Southeast CDTI Project was carefully scrutinized and all necessary corrections were made. WHO/APOC,30 luly 20071 Executive Summary Prepare on Executive sammary of the report in not more thon one 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 - CDDS, health workers, Total population (community) per CDD trained. 4. Challenges and how they were overcome The total communities in the Southeast CDTI Project area is 597 with the total population of 465,496 persons in the meso/hyper area. A total number of 303,007 persons were treated in this reporting period giving the therapeutic coverage of 65Yo. The Ultimate Treatment Goal (UTG) and the Annual Treatment Objective (ATO) are39l,0l7 and302,572 respectively. Population movements in the Southeast CDTI project area is very minimal. This part of the country has the highest hard-to-reach land areas due to bad roads and many rivers and streams. During the rainy season which runs for more than four months, project areas became inaccessible and the movement of people slows down considerably. This situation is sometimes advantageous to project management, because if we manage to get in the area on time, we can reach and treat many more persons than we could at routine scheduled time. Training of health staff and CDDs were carried out by county, district and community levels. A total of 2,995 CDDs (male: 2,217, female 784) were trained. There are 376 health staff in the project area and 152 are involved with CDTI activities. The major challenges of the Southeast CDTI project areas are the CDDs financial motivations and insufficient means of transportation and bad weather roads. In spite of the frequent trip made by NOTF to the project areas some CDDs are of strong opinion that some higher-ups at county and district levels are taking monies intended to be given them as incentive from APOC. They argue that like the COS, APOC must have some cash incentive that is not reaching them. Notwithstanding, the NOTF management have intensified advocacies and sensitizations at all levels and have reached an appreciable level of achievement. Additionally, APOC has ordered sufficient motorbikes that will be given out to COS to increase treatment coverage in the next round. 2 WHO/APOC,30 July 2007 SECTION 1: Bockground information 1.1. General information 1.1.1 Description of the project (briefly) Geographical location, topography, climate Population: activities, cultures, language Communication systems (roads ...) Admini s tr ati o n s truc tur e Health system & heatth care delivery (provide the number of health posts/centers in the project area if the information is available). Number of heatth staff in project oreo and number of health staff involved in CDTI activities. The Southeast CDTI project is located in five (5) of the endemic counties of Liberia (Grand Gedeh, Grand Kru, Maryland,, River Gee and Sinoe). The total population of these counties is estimated at 465 ,496 with a total number of health facilities and health workers at 72 and 37 6 respectively. A total number of 152 health workers are involved with CDTI activities. The terrain in the Southeastern project counties is rugged and covered with forest. Two large forest reserves are located here. The Grebo forest in Grand Gedeh and the Sarpo forest stretching from Sinoe into Grand Gedeh have high canopy of trees. The counties are traversed by many rivers and tributaries. Many of these rivers and their tributaries have breeding sites for black flies, the vector of Onchocerciasis volvulus. The coastal area is marked by mangroves, dwarf trees, small bushes and various grass types Palm trees grow wild and the area is fertile for both upland and low land cultivation of rice, the staple food of the area. The climate is tropical and humid all year round with significant variation between the dry Q.{ovember-March) and welt (Aprit-October) seasons. Most roads are unpaved, thus causing difficulty in movement in most of parts of the counties. The roads in the Southeast are the worst in the country and the area has been classified as hard-to-reach by relief organizations working in the area. During the rainy season, only four (4) wheel drive and heavy duty trucks are used to gain access to parts of Grand Gedeh, Maryland and other counties. During the dry season (November-March), access to the Southeastem counties is relatively easier on the unpaved but dusty roads. Distances between settlements are also traveled by motor bikes, canoes, and on foot. J WHO/APOC, 30 July 2007 County/District Total Number of health staff in the entire project area Number of health staff involved in CDTI B1 GRAND KRU Buah 20 Dorbor 10 Trehn 9 Jroah 16 Barclayville 19 Sub-Total 74 SINOE Tarsu 0 Butaw 14 Kpanyan 19 Jaedae 15 Taryuwuon 20 Jedepo 12 Dugbe 14 Gblonee 8 Greenville o Pyne 4 Sub Total 115 MARYLAND Harper 16 Bambo/Fariah 11 Karluway 11 Sodoken 12 Pleebo I Sub Total 59 GRAND GEDEH Tchien 11 Cavalla 12 B'Hai 10 Gbazon 10 Konobo 11 Putu 13 Sub Total 67 25 RIVER GEE Sarbo 0 Potupo 10 Tienpo 14 Chedepo 13 Gbeapo 10 Webbo 14 Sub Total 61 29 Total 376 4',1%152 Table 1 : Number of health staff involved in CDTI (Please add more rows if necessary) Number of health staff involved in CDTI activities Percen B,3=B.2181"100% 15o/o 40% 89o/o 44o/o 47o/o 42% 0o/o 43o/o 42% 33% 40% 25o/o 43% 38% 44o/o 0o/o 37% 44o/o 45o/o 45o/o 42o/o 22o/o 41% 36% 42o/o 40o/o 50o/o 27% 31% 37% o% 60% 57% 38% 4Oo/o 43% 48% B2 3 4 I 7 9 31 0 6 8 5 8 3 6 3 4 0 43 7 5 5 5 2 24 4 5 4 5 3 4 0 6 I 5 4 6 4 WHO/APOC,30 luly 2007 1.1.2. Partnership Indicate the partners involved in project implementation at all levels [MOH, NGDOs (national/international), c ommunities, local organizations, etc.J Describe overall working relationship among partners, clearly indicating specific areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. State plans, if any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The Community The community leaders select CDDs for training in preparation for Mectizan distribution and sensitize the population on the importance of takingMectrzan The CDDs, also part of the community, mobilize, sensitize and distribute Mectizan to their respective communities. The communities take ownership of the CDTI activities and pay CDDs incentives in kind or cash to distribute Mectizan. Community members and CDDs report side effects due to Mectizan and members with poor vision are referred to health centers for eventual follow-up by appropriate health authorities. Ministry of Health The Ministry of Health (MOH) and NOTF at all levels do the planning advocacy, mobilization, sensitization, and supervision of CDTI activities. At the end of treatment year, NOTF prepares all technical reports to be sent to APOC. NGDO During this reporting period, our lead NGDO, Sight Savers International (SSf, and Christian Health Association of Liberia (CHAL), all participated actively in the planning, advocacy and supervision of CDTI and Eye care activities in the country. The Mectizan Donation Program supplied the needed quantity of Mectizan requested and on time. 5 WHO/APOC,30 July 2007 r- O c.,l co Q o oo o (E CL o o. 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B (h o o >. c))l q) (.) b0 (B o r. q)\ \)r-L. u \) !\) s* q \ u L. 4q) () \o'$ S()$E .= o) -i' o (l)P 6JEE ;i O) o o II# II II +a(, G 5 o o E II I o E a-F a F !N \l\I S \) q) s e.I eo|\|\ U lr) v) o\ 2,2, Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe dfficulties/constraints being faced and suggestions on how to improve advocacy. In the southeast project area, advocacy was geared towards the newly elected representative to the National Assembly. This body of decision makers made numerous elections campaign promises to be elected to their present posts. Better health care being one of these promises, the eradication of Onchocerciasis as a public health problem cannot be over emphasized. At a routine advocacy meeting with NOTF management, this honorable body was reminded of the old saying that "prevention was better than care". A few Mectizan tablets taking once a year can go along way in saving the sight of a significant portion of the population. From the nodding of heads by the honorable members, we could tell that the message got across. The reason for this message was to increase the awareness on the importance of Mectizan as a sight saver. Brochures and Oncho posters were distributed and can be seen in public offices of the honorable members. Considering this success, we intend to do more advocacies, with hard to reach groups for the next round of treatment. 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 Re s p ons e of tar get c o mmunit i es/v i I I ages Accomplishments Suggest ways to improve mobilization and sensitization of the target communities. Prior to the civil crisis, mobilization, sensitization and health education of at risk communities were carried out on national radio and TV stations, schools, churches, cultural dance groups and social group meetings. In post war Liberia today, we are left with very limited means of communication in term of national radio coverage. The available radio stations that could carry health messages nationally are all FM stations that cannot be heard beyond city limits. Notwithstanding, CDTI management team used the newly installed United Nations rural radio stations to disseminate information. Cassettes carrying Oncho messages were produced in project area local languages and aired in the evenings when farmers have retired home from the daily work. From this exercise, we noticed that Mectizan refusals decreased significantly as shown on the CDD Registrars. In future, we intend to air more Oncho messages prior to annual Me ctrzan tre atm ent. 10 WHO/APOC,30 luly 2007 caO N L C) -o o z t a{ (J o * o $,, E gEE o.E It!Eg, oe6 =to * .= = oo tr)g .; o .9 = E o o o ott E Jz soo s O)t- s cf)|r) soo sNN s @ soo soo r soo soo soo s(o f.- soo r soo soo soo s(o o, sN@ soo oN (o NN o) @ $ (o o(f) @ (.)N o) @N o t- o, $@ os s @ trIEioc0Fil o)tr 8,,2 Eo oo EO dl =,t o oo o tE GI = o .9 =c EE o(, !,tr G oo o o o olt E z o lr) tr) lr)t- rr)t- oO) loo$ N(f) N t-t- lr)tr) (o$ o\f ro(o lr)t- @t\ (ao, lf)(o c,(\l o) (f) oN (o @ cf) r (o $N o) €C') o oN o$ @N rO(a o, (olr) (o @|r) oCA N c) osl f.- NN ss o)ro rr) @ o(q NNN t-lo rO rr) - lr) (os O) N(o rr)CO lr)CO @ (o(o s ooEDO8rr FE(.o$om(Dgb odlG =U' U'9o H' .E =th >6.'?9 .9Ee0, =>trtr o=OEEE9b6o -cl ,.tr ==z so so st- sN cr) sN sro so sCOc.) so st- so(o sN s so so so s(v' s$ ss o o lf) t- t- o) o N (a (f) t- CO cf) o o 6t(\t N N oN .f o cf) NN s (\t \r (o ocf) @ (oN (oN @N or t- o, (os $ o d. a o zf oo ftrY oz t o -co =(D L o -oL oo c .c. 0)LF -cooL - _0) '= GE o co E oFI .ct J U) IIJ o =o faL oF B G, =co c o c o o.Y ooEoo -) c o = = f - oF o o_ oEo -, q) -oOi J o ooc o -oo _0) 't c ooL(, oc(I E o .ct =o oz x. = Lq) o- L o - .C o'- o LL o -o E o co qq q) Q q + vL q) t\ t ! q) 4 \) 5 F oO C) (Bq o tidq ch o F o(-) .+t ol -ol(Bt FI # E o E o a: o .s t EI E E o(, 1N F-oO(\ o co O o ,Ji N oio E o : (n C)aa c)(r) o0 o -o(.) hd V)() (h(h F- t-.,1O 0) rl) b0 c) 0)d c\. 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(J -i.n th Q 3tr d cU].t'(Dd'yl oaiHX>lu) --u-.t9.i uVd!-9.i-)A/a):!Lb 6 r""'.= b 'E IL ,\ I *!!fv!9 E <,E &E < o oOrrrrr soo N\r lr) COr lr)lr) o @ s rO N$ N oY soo soo s @ N solo s o)(o soo soo so)@ soo soo soo s@o) s(Y' @ s t- soo r s(n @ soo soo N ro(o @o)\tsN N N(v) (o (o N oN t- @ o)ro (O r @ @ (o (o rr) t\tlolo oo rO(o rO|r) (olr) rr)t- rr)o r (olot lo o) CD(\o(o o(f) o)ro(o s r() Nlr) (o$ (f)sr o (o t@sN rr)cr) @N o) (oN t- @ @ rN lo @ Cf) o, NN o)f.- olo t-s toN (olr) CO@ o!l(9 (\N (o c.) rr)o, @ €!+ @N lit t*cf) F- (9o @$ lo @$ s(o cf) s F.- s@ sro sst scf) s(\ so s@ s sorO s@ s(o(f) s@ s\fso, srr)t- sN o o N s $ N @(f) O) @ N cf) N -r O) @ (O N (0(o o)ros(9 N @t @ (o N oN lr)N (o to@ cf)r c o)fz oE oa o -oq) q) o_ E o Il U) I IIJ o ul o oz t o c .o) -coF _o o G C) 'o Ib C oNo -o(, o -ooc o\z f fI E o Il o ut ul ot ul u ooL oa o o. f o o- o o.Eq) tr o o. 0)D 0) -cO o o_ oo -oo o -o -o o) = E o .ct o E o !,tr cl(, t-O N o o. o ca +. ;'^ : '- e0)E()(.)lrE€ C)a>tr iq: .=+ c) ;) =!9J C) €gRAg3 b)a7 =cdO0)- F o -b'=P.c- -q3EtralO >rd a -O !-)E cE '5(d() >'i €6'F sd=u) | *Q. u-dop 5q!- (g ,rv> U bE{.! q9($= a r-J OIJ il o= * OIJH _tro B'F s ',.-oEt- ocd ar Ee:(B =tro<dOro'5 =' -<dE\o -c 9)Egso ,,a :=od dE(/) .lj-F 9Hrn'P(Jv -ad) (-) t< q-.,i 'd9 oL2PaQ x - t-li Pr-itrtr L.] io(J*o -lJ >.qbp()u.!3 ti boq =! 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I (€ F F @$ o(f) rr)N oN (o N o(o rr)N o$ (f)lf) c)@ NN,!'oo)-tro rO@ lr)N rr)(.) orO o(.) tOoN loN o(o (o$ Nt\troN o(o ooN No No lr) os o o$ rO(o=r25 lo$ oc) o$ rr) @ o @ oo rOf.- lO @oof.- o@ oo o o(, orON ro @ o@ loF- o@ rOF- Oc,r ko o ro N o F-o o 1o (f) !o CO o N (o N r.c) o I(E0 o;.FY(\l o o(f) ro N o (f) N rr) N,!oFto o o t o o O o o o!o26 o o o o o o o No s rr) (f) t- cr) (o o bbE Elt-c o O E 6.= .sf s !Es Fz oE o.= eo)F(J o o @ F- t- NN N O t-oE,3ooFI @o ro o N (f) N o (,tO o N (o N NPt) o o o o o o o o oiE o o o o o o o o @ lO rO $ o $ $ N o$ bE LCL .tsE E Es EHE e,.,F() $ (o ro t lr) tN o lr) (o N (e cf) aY, o N N N N N o (t (,) o .gNooFI \t o (o o N N N N N o e)p3 (f) N (o o o oEU o o o o o o o o o O O o o o b3E b *'E .ct.= ertsuioiEzd6 o oL N N o rr) s (o r() @ @N o rO (o t* @ tf) @ (o $ N @rf o L o i5 #c =oo ltY oz t(, E N m o -o oo c o F o o --) 0) (E E $ c] E oFIlt fo lrJ oz -o oL(UF = (E co c(! c(o o.Y o) o o o --) o = - oF o o. 0)E 0) --) o o) o o) o) o -o C' _9 't c oq) (9 0) o- f oF .ct f U) ro o) o)N @lot roolot*@roro@ oo(\Iro l(, @|r)o (Y)$ rolo@$Ntr)str)o)u)(o o(oo@ tr) c.)(Y) (f)oN F- O c\ >. ca O op* o$ rr)N N Olo ro@ @N ot* F-$o) Ncf) @(f) @ t* t N o)F' o @ toN (oO) 1r)N ro(f) o@ \t ro(o lr)N oN rot- to NNo roN oc) ro o(0 o$ lr)N o(o@f.- lo(r) o@ loN olf) @$N o(o oN o r.- ro N otr)t- o(n(,) () F.- o ro loF- loNI- olr) lr)r-- roF. lr)(ootr)(f) tr) o(o oo ro o\t@ OoN ro(o o@ (f) ts @rto lo o N oo \t tro o o to t o N o ao o o o o o o o oo o o o o o o o o N CO $ $ tf ooN (o o (D N (f) N NN N o @o(o o oCO N N o) @ o o o o @oCO N N (D o oo o o o o o o o o o o oo o o o o o o N oorf, (o (f, $ (o NN o (f) $ (Y) lo @@ l^c) lo <. (o @$l $ N N \t o $ lr) { (o C') o oNCO N cr) (f) o N (o N (f) $ $ N (o @ ts@(o N (f) (f) o N (f) N (') N N \t o (f) o o o o o o o o o o O o o oo o o o (Y' I\ o lo oN @ tt N No !tNN@ v lo 1r) CY) (')N @ O) @ ro o to L o) o.L(! I .C(! G LL o -o E o m (! B E o)z E o) .Y oE oa o -o0) 0) o- E o -o:, U) J- UJo lrJ(, oz t o c .9 .CoF o 6 o O '6 Ib o N(E -oo o -oo oY f f o- E o lt =o TU uJ ot lrJ t ooL(U a o o- o o- o o. o) tr oo 0)!oc O o o_ o o o o -o -oo = 6 oF t U' E o E 6 o tr) bo o a o\ o I s B s a B o to N *p o * o a, e €s s B o t\ = oz 5 tr E t--a N O ca O o \o rt) (.) C) lr 0) x I $U L.q) :0 L o a-Ut\ q) b0 \ \ o q)\T\ vU s9 Io \ Q\\c '::'odt* bP!q) bOatr$ '= ,< cd -QLPq) .- -t >. F-t- \- riir Iot -ol(st FI (n() o a oo o. a aLo o \ \ \ \ v)Lo oJ o o or L o L +.i o +i o)(r€ >5 \ \ \ \ \ \ 9E(D-V(EEC)os 96' .=o cl ^.-o.i q +q G \ \ \ \ \ >. bo '=o ^6Li.^'= ot=a v:\r-o E Cotrtr() :Eoo*U trU ca \ \ a t-l t-l() \ bo ar ci -). t*FO a o c) LF o E() s9pbo: c o-v ;.r Cg =oou }Eoc) Jr Fri (H o C) o o0d.? Llf1s<za a v) Q 2ts U) o o 0) oo I n a a d d o oo L ti o a.o oo a a C) o 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving IOO% geographical coverage and a minimum of 65Yo therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. t7 WHO/APOC, 24 November 2003 F-O N ca o o. !;stt-tg o o o o o o o o o o o o o o o o E*,flt o<aaz o o o o o o o o o o o o o o o o n$ Eb Ez€ o @ N O) rOto rr)Ir o@ N(o e) N o, o$ N o(o rr)@ oU) rOt- o$ @CO != [et-E @$ N@ N(f) t-O) $lr) c) c) $ lr) r.-(O @@ of.- rOt.- cf)@ o(o N@ tr o g fo o(L oo lO o F-o II @o o .;rofo)o (E^CL!ro E 9eoo -coF s(o$ s(o!t s rr)$ s \t s$s s$$ s(o F- s O) @ sOF. s @ @ s O)(o sN(o s o,(o s t- s$ @ soN t-o!=f,E $N c", N F-\ N N. o, o,v$- v (, @- O) G' @(er- G'(\l $N ry ro @s cf) @ Nr- @ oF- O)- o o 6. @ NIr rO- @ $@ o-(o (oo(f)- rr) @N @ oN t* O) Ir- (o o Eo rE o.= =€EoE6 @(o r--_ v o(f) rO- N t-o o{ (Y) tt @ o- t- $(o tr)- it COt(, c.irt (o O) @- s (o lr) O)- rO oo rO (o$rt- o oF-(o F- oo(f)- @ ovN- lo lo @@ $ rO$ N lr) N r-- @ l(, oe:r tt so oo)cLE @ CO(Y)- t* N O) @ o o, cf)- oN @ O) @ o @o$- NN lO co$(o lr) NN. r\ o)lr) o, (r) N coN oN o- @ tr) @ F-N O)(o F-- N @rli rt- (f) N rO @$- F- (o rO- N(, (o$(f) o o 0) o)g o 0, .E f E E oo \fo E .9o -c cn r$s re- o soo soo soo soo soo soo soo soo soo soo soo soo soo soo soo soo aoo =EvE .,- E=H,*tr F- o5E'rtsz6 oN $ o(r) NN $ l'-N tf (o o(f) @ (oN (oN @N o t- O) No tso(E o.a = EE e (E.=uE6 oN $ o(f) NN s t-N $ (o ocr) @ CON (oN @N o F- O) o i€ s* *: * E!=EaE * oN $ oc) NN s t*(\l $ @ oc) o (oN (oN @N o t.- O) Fo dFo6 Fzf oo =tY oz t o G) co o -og oo c oLF o o -) q) oE o(I] E oF It fo tu oz -o fq GF = (E co (E c NoY o)o! o o - c o =f - oF o o. oE o) -) o) -oo o oq) o _o o 0) c o o o o o_ oo qq q)(.) q) \.- q i r. a)r. t q)q q) Ql JI C) fr (d rt (.) Lr (t J o lr a E >. a rrl a 6 (.) (t otrF t'- I a-rl -l -ol(dl FI (-- (\ O c.t op. o o C') CO lot-t s @(.o N |I, o\t- soo tr t* l'- E oF .o =o oo o o o o o o o oo o o o o o o o o o o o o o o o o o o oo o o o o o o o o o o o o o (o N o(o o@ F-@ @r.- F- @ c.) ci,t-(0_ F @N O)rr, olr) oN $ro C,) o(o rON lo (o N o)N oo NN$t (o N N (o ro olorO $G' o oCO (o oN s o ot- NN N @ @$ tocf) o@@lr) cr) oN os soi,- s 1f, ,o so(o sN F- s O)(o s r--(o s o)(o s(o(o s 1r) @ s$ r-- sO(o s$N s @ s @@ s(o i\ sot- s @@ s (o str) N s o) rO s(o(o l'-o o- coo(,) to(o o_ ro N o @- @ F- - N O)o t-N olr) tif- 1l) F- ce-(, o) lr)N O)- r- @N$- N (r) N $ ooo o @o @- (f) oo o- N Nt\tdt (f) o)(o t-(f)(o- @ ot-(o- cf) olr)lf) @ N @ o-(o @o O)- l(,tNd(\l loloto crtN Nt-to nio(r, o c.t r-N o(o r.-_ F- (9 O) @- OJ $(r)- (o N NNt* o N o- (t) @N @ (o$ c.i N @- !t @ O)N. @ @N o- s @ O)o o i-oo +(v) o!t @ @N o- lr) @o @- (Y) $ F-_ lO @N @_(o @ @ @- t- O)N. (f) (o O) o. t- lo (f) lr)- c) F- o, @ N o, Or_(9 C')tlO c.t(, lr) @ O) @ CON. N o u. lr)- ro o O)\ @ $f.-N- o $o O)- N (D c.,ol(0(t (o o)$- rl)(ot @rf @- $ @(Y) o)- rtr)o(o- o(o $Nlf, orlf lr) O)$-(o o -{- \t r-N$- O) soo soo soo sOo soo soo soo soo soo soo soo soo soo soo soo soo soO soo soo soO soo (o st s N$ scf) N G' sf (o @ N oN rtr)N (o ta,@ (f) O) @ (O N (o@ F o) ro (o rt $ N$ !tCO N @t @ (o N oN r.r)N (o rt@ (o o, @ (f) N (o(l, N o) r() (o rt $ Ni- $(r) N ot (o (o N oN lr,N (o lo@ o o) @ (o N (o(o F-o,ro oz J t E o) o. oI o (E lr o -o E(U G] (5 =E oY ov oE oa o -oo o o- E ol- .o Ja I lrJo ]U o oz t o .o oF o E oO '6 I co c oN(! -oo o -ooc oY o_ E oF tt o uJ uJ o E uJ e. o -oL(E a o o. o o- o o. .q)F o o. o)E oEo o o. o o) -oo o -o! o) = E oF lt)o E oF r-O c.,l ao O o o. - q) 00E !I\ a s\$\) bo \ vsFS U\/PEE d eE8.S'a*i- A:U ",aE -Esrv$ .=oni -cs\ 'E.sS ?-9Hf F9Sq, :: !sErrg'a=EEas3 EEs:$ -ra a\ -q\iB -\shUUYH.: gEi $ ss? \ qq) .: r Ssii s 'l'b9vh\ ol s SS :S i=* E i E$ L S \J-o * $: L S !S<0) Q >\ -o t ;EE & TGE s' sR A 'LVE i Nox x xt F .S S} s 3I :: SS EBEt $$ rtE\eh\ srE :US S'!r S P\E da,B S: u q)E s *i>l\ t\=' tt tt!P FS\ .s. c\ O x 0) 0)L 0) o 0.) (H o o -o z o ooF o o (.) LF XE o oL c) 0 oo (H o L a)! z d C)L(! o C) 'a Lr o. c) z r!& >. -o 0.) rE C) U)(s a C) Eo o o Eo 0) Ik C) >t U) C) qr o Lro -o oF oL(B o 0) 'a Lr o. o ao o o troG)OE*Ex .rE6g AAot ; oOI 6.) OI -l e(Exl : F -t !a 9t .- \ Ol rn chNl.g .n Lt >9t .- 6)t =gA ol .Y Hol : o *-ql 3 +iolo. o rl O Loto- o -ol - -otrl (d tr =l b azl? z !o o c)d F D \o o L obo !v,7^ 9S oo oF C) cd 0) bodL C) o o do- dL o0 o(,)() C) L o) bo L C) o(-) ^'"= \o o) a. cd o F o b, L o (, .c t- o tr + o l- C.;s+ + F Lr ,oH ts Lr f! tl 2.6.2 What ore the causes of absenteeism? The high rate of absenteeism was due to rapid movement of the internally displaced population. With relative peace in the country, people moved back to their original communities and homes to continue with their lives and never came back. 2.6.3 What are the reasons for refusals? In the Southeast CDTI project area there were 1,253 refusals. There are multiple causes for these refusals, outstanding among being the gross misunderstanding of the word refusal by the OICs and CDDs. According to inspected records of OICs, anyone that resided in the meso/tryper targetpopulation that did not show up to receive his/her tablets after mobilizatron were registered as refused. This was evident during monitoring and supervision visits. There were however others who refused because of mild reactions like headache and itching experienced by others. NOTF intends to intensiff TOT training and advocacy before the next round of treatment. 2.6.4 Briefly describe all known and verijied serious udverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required informotio n w h e n ava i lab le. In case the project didnot have any cases of serious adverse events (SAE) duringthis reporting period, please tick in the box. 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Cd,6ilE HI rr (L)lL E'oxE:Le,oE .N IPNH .J Bg >5 -7 Table 10: Mectizan@ Inventory (Please add more rows if necessary) Number of Mectizan tables Remainin Konobo 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Lost Wasted ExpiredRequested Received UsedDistrict/LGA GRAND KRU 0 8914,592 14,492 1 1Buah 14,592 0 957,895 10Dorbor 8,000 8,000 01040,990 0Trehn 41,000 41,000 0 019,400 19,400 19,385 15Jroah 0 044,900 44,900 44,878 22Barclayville 68 0 184127,892 '127,640Sub-Total '127,892 SINOE 0 4821,120 21,120 21,065 7Tarsu 0 319,503 19,503 19,490 10Butaw o 067,000 66,985 15Kpanyan 67,000 7633,605 3 0Jaedae 33,684 33,684 058,996 4 0Taryuwuon 59,000 59,000 0 026,673 26,673 26,645 28Jedepo 0 066,800 66,790 10Dugbe 66,800 0 1022,480 22,410 60Gblonee 22,480 0 091,965 35Greenville 92,000 92,000 3703121,829 0Pyne 22,230 22,230 430,490 430,490 429,780 0 507203Sub Total MARYLAND 01585,985 0Harper 86,000 86,000 34,890 o 0 101Bambo/Fariah 35,000 35,000 45 0 087,780 87,780 87,735Karluway 65 0 9787j62 87,162 87,000Sodoken 0 2335,472 35,395 54Pleebo 35,472 22'.|.331,414 331,005 188 0Sub Total 331,414 GRAND GEDEH 32,875 20 0 173Tchien 33,068 33,068 22 0 0Cavalla 11,212 11,212 1 1 ,190 20 0 B416,899 16,899 16,795B'Hai 0 5050,000 49,950 0Gbazon 50,000 18,670 25 0 39719,092 19,092 36,680 0 0 64Putu 36,744 36,744 166,160 87 0 768Sub Totat 167,015 167,015 RIVER GEE 30 0 44Sarbo 2,964 2,964 2,890 44 0 160Potupo 20,994 20,994 20,790 13J25 13,125 13,085 40 0 0Tienpo 22,875 22,875 22,775 13 0 87Chedepo 22,035 22,035 21,985 50 0 0Gbeapo 5,430 5,430 5,360 0 0 70Webbo 87,423 87,423 86,885 177 0 361Sub Total 1,'.|44,234 1,141,470 723 0 2,041Total 1,144,234 25 WHO/APOC, 24 November 2004 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. 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? Table 11: Community self-monitoring and Stakeholders Meeting (Add rows if needed) District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) 26 WHO/APOC,30 July 2007 TOTAL Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementqtion or how they would be utilized during the next treatment cycle, 2.9. Superuision 2.9.1. Provide aJlow chart of supervision hierarchy. Central Level o NOTF o NGDO CountyLeya.l o County Medical Officer (CHO) o County Onchocerciasis Supervisor (COS) o County Health Teams (CHT) District Level o Health Center Medical Officer o Clinic Nurse Community Level o CDDs o Community Members 2.9.2. Main issues identiJied during supervision? o Some CDDs refused to distribute Mectizan after training. o Verification of treatment form and how to fill them . High recorded figures of Mectizan refusals 27 WHO/APOC,30 July 2007 2.9.3. Was a supervision checklist used? Checklist were used by CHTsA{OTF 2.9.4. What were the outcomes at each level of CDTI implementation supervision? Some identified issues were solved on the spot while other were reserved for appraisal meetings. 2.9.5. Wasfeedback given to the person or groups supervised? Depending on the magnitude of the issues, feedback was giving back verbally, or in writing at o later date 2.9.6. How was thefeedback used to improve the overoll performonce of the project? When related issues such as CDDs incentives motivation, the project saw a slight improvement in therapeutic coverage. SECTION 3: Support to CDTI 3.1, Equipment Table 12: Status of equipment (Please add more rows if necessary) *Condition of the equipment (F:Functional, CNFR:Currently non-functional but repairable, WO:Written off). How does the project intend to maintain and replace existing equipment and other materials? Budgetary allocation has been made for the maintenance and repair of equipment and other materials. Negotiation is going on with Government of Liberia (GOL) for the replacement of existing equipment and other materials. Source Type of equipment APOC MOH DISTRICT/ LGA NGDO Others No. Condrtion No. Condrtron No Condrtron No Condition No Conditron 1. Vehicle 2 F 2. Motor cycle(s) 3. Computer(s) 4. Printer(s) 5. Photocopier (s) I F 6. Fax Machine(s) F 7. Others a) writing board I F b) c) 28 WHO/APOC,30 Iuly 2007 Contributor Year | ('provide the period') 2006 Year 2 ('provide the oeriod') Year 3 ('provide the period') TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (US$) TOTAL Cash Released (us$) MOH (Central * Provincial/State) 86,377 2,421 MOH (District/LGA) Local NGDO(s) ( if any) NGDO partner(s) 29,050 9,148 Others a) b) Communities APOC Trust Fund 122,569 84,994 TOTAL 237,996 96,563 3.2, Financial contributions of the Partners and communities Table 1 3; Financiol contributions by all partners for the last three years If there are problems with release of counterpart funds, how were they addressed? Additional comments 3,3, Other Jorms of community support Describe (indicate forms of in-kind contributions of communities if any) 3.4. Expenditure per activity Indicate in table 14,the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indicate exchange rate used here I US$: 50LD 29 WHO/APOC, 30 July 2007 Table l4: Indicate how much the project spentfor each activity listed below during the reporting period Any comments or explanations? SECTION 4: Sustainobili$ of CDTI 4.1. lnternal; independent participatory moniloring; Evaluation 4.1.1 Was Monitoring/evoluotion carried out during the reporting period? (tick any of thefollowing which are applicable) _Year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Intemal Monitoring by NOTF 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? Activity Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of Mobilization and health education of communities Iruirylg otQPD, Training of health staff at all levels Supervising CDDs and distribution Intemal monitoring of CDTl_activities * Advocacy visits to health and political authorities IEC materials Summary (reporting) forms for treatment Vehicles/Ivlglorgyg!es/.hiqyql.l$eiqleLre!_qe/fqel pf{ic_e Eqyiprygrt (9_.g co_mp-uters, prillers -elQ __ Others 3,300 5,500 - n)zo 1,500 2,868.75 200 22,633 1,000 2,577 -- tgs 22,3i APOC APOC APOC APOC APOCA4_O_.U MOH APOC,MOH APOC APOC APOC APOC.MOH.NDGO TOTAL 85,223.75 Total number of persons treated 303,007 30 WHO/APOC,30 luly 2007 { Other Evaluation by other partners community 4.2. Susfafnability ol projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? Was a sustainability plan written? _ Wen was the sustainability plan submitted? Wat arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning ot oll relevant levels 4.2.2. Funds 4.2.3 Transport(replacementandmaintenance) 4.2.4. Other resources 4.2.5. To what extent has the plan been implemented 4.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. 4.3.2. 4.3.3. 4.3.4. 4.3.5. Ivermectin delivery mechanisms Troining Joint supervision and monitoring with other programs Release offunds for project activities Is CDTI included in the PHC budgetz a 4.3.6. Describe other health programmes that are using the CDTI structure and how this wus ochieved. llhat have been the achievements? 4.3.7. Describe others issues considered in the integration of CDTI. 4.4. C)perational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. 4.4.2. How were the results applied in the project? SECTION 5: Strengths, weaknesses, challenges, ond opportunities 31 WHO/APOC,3O July 2007 aa List the strengths and weaknesses of CDTI implementation process List the challenges and indicote how they were addressed. Streneth The co-implementation of Onchocerciasis activities with NGDO Southeast Eye Care Program is a major boost to the Oncho program in the Southeast where resources and personnel are pooled for the benefit of both programs. Weaknesses Community support of CDDs is low Perpetual bad weather roads during the rainy season Challenges Late starting of Mectizan distribution in the project areas Collection and forwarding of computer data records from the field to central level SECTION 6: Uniquefeotures of the proiect/other motters With the formulation of National Policies and Plans for the control of Neglected Tropical Diseases QllTDs), the present co-implementation of the CDTI activities along the National Eye Care Program is a positive giant step towards the integration of activities, thereby encouraging partners to support co-implementation and flexible use of funds and resources to empower communities in the health care delivery. It is our hope that when integration among the various health activities is complete, coverage of interventions will significantly improve. 32 WHO/APOC,30 July 2007