Southeast CDTI annual project technical report submitted to Technical Consultative Committee (TCC): from January 2007 to December 2007

RESERVED FOR PROJECT LOGO/IIEADING SOUTHEAST CDTI PROJECT ORIGINAL :English ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) rl DEADLINE FOR SUBMISSION: .n 'fcclG To APOC Management by 31 Januarv for March TCC meeting To APOC Management by 31 Julv for September TCC meeting I I I I 1 v -sin cs} cor AHE atu Fa CE-- e) . ,:..Di fl f' :rpv ?flflf ) AFRICAN PROGRAMME FOR* ONCHOCERCTASTS CONTROL (APOC) COUNTRY/NOTF: LIBERIA Proiect Name: SOUTHEAST CDTI PROJECT Approval year: 2004 Launching year:2004 Reportins Period: From: January 2007 To: December 2007 Proiectyearofthisreport: (circleone)1 (2) 3 4 5 6 7 8 9 10 Date submitted: January 2007 NGDO partner: SSI F WHO/APOC, 30 July 2007 I I I ANNUAL PIIOJ ECT TIICHNICA [, ITEI'O[I'T TO 'r'HCr"rNrcAL coNSULT^TIVE COMMITTEII (]-CC) EiTt}ORSE.ME,I\T Plcasc confirm you havc read this rcport by signing in the appropriate space. 0FFICEIiS to sign the report: Country I- IBT]ITtA National Coordinator Narne: Mr. I-lcnrr, l'. Salilir SignaLure: I)ate .i".L t), L{" t ,.. fJt{uiJ Z<.tnal Oncho Coordinator Nanre: I{ONE Signalitrc: ... Datc: NGDO Representative Namc: Mrs. Vcrdp'l'iirpch tl / g1 Sigrrature, ....1.k,u.1c*. . .rd. .,. '1 nirrc: .&n'tr...6... C.. f . Y -/ cr,Y / 'l-his rcport has bcen prcpared by Name : I-lenry,'I". SalilLr Dcsigntrtion : APO Signaturc: ',/.- fr.., {: .). .,/,., r i"r"/ { l)atc \\/[ IO,ir\P0['. i0 .lulr' 2(X)7 I ll Table of contents ACRONYMS v DEFINITIONS.. VI FOLLOW UP ON TCC RECOMMENDATIONS .........I 1.1. GrNBnar. rNFoRMATroN............. 1.1.1 Description of the project (briefly) 1.1.2. Partnership 1.2. Popu1euoN............... SECTION 2: IMPLEMENTATION OF CDTI....... .......8 2.1. TwreltNn oF ACTIVITIES ............ .........8 2.2. Aovocacv.. ......9 2.3. MostLzertoN, sENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMLrNITtgs .9 Jj 5 6 2.4. CovvuNrry rNVoLVEMENT....... 2.5. CapacrrvBUrLDrNG.. 2.6. TnenrurNrs.............. 2.6.1. Treatmentfigures.............. 2.9. SupeRvrsroN............... 2.9.1. Provide aJlow chort ofsupervision hierarchy. 2.6.2 What are the causes of absenteeism?.......... .................21 2.6.3 What are the reasonsfor refusals?................ ...............21 2.6.4 Briefly describe all known andverified serious adverse events (SAEs) that Erueur ! Signet non ddftnl 2.6.5. Trend of treatment achievement from CDTI project inception to the curuent year 23 2.7. ORoEnlNc, sroRAGE AND DELIvERv oF IVERMECTIN ...........24 ...........27 ...........28 ........... 28 2.8. CovuuNrry sELF-MoNrroRING aNo SrereHoLDERS Meermc .... 10 .... t2 ....17 ....17 ..29 ..30 ..30 2.9.2. 2.9.3. 2.9.4. 2.9.5. 2.9.6. What were the main issues identified during supervision? .............................. 29 Was a supervision checklist used? ............. 29 Wat were the outcomes at each level of CDTI implementation supervision? 29 Was feedback given to the person or groups supervised?................................ 29 How was the feedback used to improve the overall performance of the project? 29 SECTION 3: SUPPORT TO CDTI ..............29 3.1 3.2 EqunveNr FmeNcral coNTRIBUTToNS oF THE pARTNERS AND coMMUNITIES... 3.3. Orssn FoRMS oF coMMUNITy suppoRT 3.4. ExpeNprruRE PER ACTrvrrY ........... 3 I SECTION 4: SUSTAINABILITY OF CDTI....... ...........32 4.1. INreRNal-; INDEIENDENT pARTrcrpAToRy MoNIToRING; EvALUATIoN.......... ..........32 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable)............ ........... 324.1.2. What were the recommendations? ............. 32 111 WHO/APOC,3O luly 2007 4.1.3. How have they been implemented? ............. 4.2. SusreNeeILITy oF eRoJECTS: rLAN AND sET TARGETS (ueNoeroRY AT Yn 3)... 32 aaJJ JJ 33 33 33 33 33 JJ 33 33 33 33 JJ 4.2, 4.2 4.2 4.2 4.2, 4.3. 4.3 4.3, 4.3 4.3, 4.3, 1. Planning at all relevant \eve\s......... 2. Funds....... 3 Transport (replacement and maintenance) 4. Other resources 5. To what extent has the plan been implemented.............. INrpcRRrroN ............ l. Ivermectin delivery mechanism,s............... 2. Training.... 3. Joint supervision and monitoringwith other programs. 4. Release offunds for project activities5. Is CDTI included in the PHC budget? ............ I I 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements?............. .................... 3-l 4.3.7. Describe others issues considered in the integration of CDTI. ..... 33 4.4. OppnarroNAl RESEARCH ..... 33 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. ........ 33 4.4.2. How were the results applied in the project?.... ........... 33 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, ANDOPPORTUNrTrES.... .................... 34 SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS...........34 lv WHO/APOC,30 luly 2007 Acronyms APOC ATO ATrO CBO CDD CDTI CSM LGA MOH NGDO NGO NOTF PHC REMO SAE SHM TCC TOT I-iNICEF UTG WHO African Programme for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organization Community-Directed Distributor Community-Directed Treatment with Ivermectin Community Self-Monitoring Local Government Area Ministry of Health Non-Governmental Development Organization Non-Governmental Organization National Onchocerciasis Task Force Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders meeting Technical Consultative Committee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund Ultimate Treatment Goal World Health Organization v WHO/APOC,3O July 2007 Definitions (iv) (v) (vi) (vii) (viii) (ix) (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). Elieible population: calculated as 84o/o of the total population in meso/hyper-(i i) 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. 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 coverag,e (normally the project should be expected to reach the UTG at the end of the 3'u year ofthe project). Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). 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). 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. 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. 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 July 2007 FOLLOW UP ON TCC 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 (Please add more rows if necessary) I Number of Recommendation in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT USE ONLY 2t0 The Report should be endorse by all partners Report was endorsed by all partners 2tt Intensify training at all levels Training is planned to be carried out at county, district and community levels Encourage involvement of more women at CDDs and supervisors Communities will be sensitized to involve more women CDDs WHO/APOC, 30 July 2007 Executive Summary Prepare an Executive summary of the report in not more than 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 Southeast CDTI project in this reporting period have total number of 700 communities with the total population of 465,722 people in the meso/hyper area. A total number of 304,562 persons were treated giving the therapeutic coverage of 65Yo. The Ultimate Treatment Goal (UTG) and the Annual Treatment Objective (ATO) are391,206 and302,719 respectively. Population movement in the Southeast CDTI project area was very stable. The Southeast has the highest number of hard to reach communities due to bad weather roads. In the rainy season which runs for more than 4 months, treatment areas become inaccessible and many times hinders the CDDs Mectizan distribution plans. Health staff and CDDs training was carried out on County, District and Community levels. A total number 3,001 (2,293 male, 708 female) CDDs were trained with a total number 459 health workers in 108 health facilities. A total number of 141 health workers are involved with CDTI activities. Challenges Outstanding among the many challenges in the Southeast CDTI implementation was the abandonment of duty at one point by the CDDs. It was apparently rumored and claims made among the CDDs that County Health Officers (CHO) were withholding monies meant for CDDs compensation. The National Onchocerciasis Management Team along with the OICs promptly stepped in and conducted community mobilization in all the counties using community radios and local dialects to avert the situation. The mobilization focused on sensitizing the community members to the benefits of Mectizan and their role in supporting their CDDs for eventual ownership of the projects. The strategy worked well as most of the CDDs returned to duty in their communities and distribution went on as planned. Bad weather roads are a perpetual challenge to CDTI implementation in the Southeast. During the rainy season, movement in project areas is very minimal as roads become inaccessible. Notwithstanding, APOC has ordered 23 motorbikes that are now being used to distribute Mectizan to areas vehicles cannot reach and this has definitely increased treatment coverage as reflected in the report. 2 WHO/APOC,30 July 2007 SECTION 1: Background information 1.1. General information 1.1.1 Description of the project (briefly) Geographical locatton, topography, climate Population: activities, cultures, languoge Communication systems (roads ...) Adminis tr ation structur e 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 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 465,722 with a total number of health facilities and health workers at 108 and 459 respectively. A total number of 141 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 with 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 significantvariation between the dry (l.trovember-March) and welt (April-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 Q.{ovember-March), access to the Southeastern counties is relatively easier on the unpaved but dusty roads. Distances between settlements are also traveled by motor bikes, canoes, and on foot. The communities are homogeneously indigenous in the rural areas and fairly heterogeneous in the townships and cities. In hamlets and villages, there are elected Chiefs who are guided by Counsels of Elders in decision making. The township and cities have Commissioners appointed by the President and Mayors elected by the residents. The main ethnic groups of this areaare Grebo, Krahn, Kru, Sarpo and Bassa. Their major occupation is rice and cassava farming usually done between January and September of each year. Table 1: Number of health staff involved in CDTI (Please add more rows if necessary) J WHO/APOC,30 luly 2007 County/District Total Number of health staff in the entire project area Number of health Perce staff involved in GDTI B1 82 GRAND KRU Buah 20 4 20o/o Dorbor 15 4 27o/o Trehn 14 6 43o/o Jroah 16 7 44o/o Barclayville 19 6 32o/o Sub-Total 84 27 32Yo SINOE Tarsu 0 2 0% Butaw 14 4 29o/o Kpanyan 19 5 260/0 Jaedae 15 5 33o/o Taryuwuon 20 5 25o/o Jedepo 12 3 25o/o Dugbe 14 5 360/o Gblonee 8 3 38o/o Greenville 9 4 44o/o Pyne 4 0 0o/o Sub Total 115 36 31Yo MARYLAND Harper 16 44%7 Barrobo/Farjah 11 7 64o/o Karluway 11 6 55o/o Pleebo/Sodoken 11 7 64o/o BarroboAtVhojah 10 2 20o/o Sub Total 59 27 460/o GRAND GEDEH Tchien 34 4 12o/o Cavalla 12 4 33o/o B'Hai 10 4 40o/o Gbazon 10 4 40o/o Gboe & Polowo 15 3 20o/o Gboa 10 2 20o/o Konobo 11 4 360/o Putu 13 3 23o/o Sub Total 115 28 24% RIVER GEE Sarbo 15 4 0o/o Potupo 20 4 2Oo/o Tienpo 14 4 29o/o Chedepo 13 5 38o/o Gbeapo 10 3 30o/o Number of health staff involved in CDTI activities 83=B2l81*100% 4 WHO/APOC, 30 July 2007 Webbo 14 21o/o 1.1.2. Partnership Indicate the partners irwolved in project implementqtion qt all levels IMOH, NGDOs (nat ional/ international), communities, local organizations, etc.J Describe overall working relationship qmong 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/regiorl/district/LcA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The Communitv Community leaders select the CDDs in preparation for Mectizan distribution and sensitize the population on the importance of taking Mectizan. The CDDs who are also members of the community mobilize, sensitize and distribute Mectizan in their various areas. The communities in turn pay incentives (transport, food, cash) as appreciation for distributing Mectizan. The CDDs along with community leaders do the follow-up and report side effects to the appropriate health officers. Ministrv of Health The Ministry of Health at all levels does the planning, advocacy, mobrlization, sensitizatiofl, monitoring and supervision of CDTI activities. At the end of the treatment cycle, NOTF prepares the technical report to be sent to APOC. NDGO The recent efforts by APOC on integration and co-implementation of CDTI with other interventions into the National Health System, the Sight Savers International (SS! under this reporting period focused on developing a consensus on how best to integrate the National Eye Care activities with CDTI in the most cost effective manner and increase treatment coverage. Along this line, NOTF in collaboration with Sight Savers put in place a strong and functional Eye Care Secretariat that will ensure eye care services delivery to all parts of the counffy. Additionally, Sight Savers is providing financial support in terms of salary top-offs for three positions in the Secretariat and there are plans to purchase a vehicle in 2008 for co- implementation of Oncho and Eye Care interventions. Sight Savers continues to actively participate in training, monitoring and supervision of CDTI activities. Mectizan Donation Program The Mectizan Donation Program supplied the needed quantity of Mectizan requested and on time. 3 5 27%86 23Sub Tota! 459 141 32%Total WHO/APOC,30 Jily 2007 ao N L 0) .o () o z +N O o * o \o o trl .9(! :r CL oG OE E te 6'E.:OF = E" 3 t-s o, o, (a rr) @ .t 1r)(o (o_ t- o, co @ c\l a.t- @- Nlo @ @ co [ot-o r.r) (9 lf)t- rr) (o$ o, F- (oolo o, (f) o) o)(o r()[o s. ro r (r)(o rod N r() @ c") t\(a(o l'- @ @ o{ o C') oE1()o<N+ .ei ErrE'@c{o b -a- .=> s* PH E Ns @- - t- F-\|r) t-@ @ co (o (o o @$f.- oN o @^ N(o l()slr) s N$o(o $ rO F-- @ o, 1o st_ o, t- (f)_ lr) N CO co o) o)(o @ t- o)(o ro o o)$(o s(at- co N(0 -t- o o se gEEg -e; E < IF B o(o @ o, o o) o) s (o No o, s[oo co t-\r o{ rr) tq t o)o <r_ (f) N COlo $ (o(oo $ sf o) o- t- @@ s_ @ $ sfN(o o) o)t- CO @$o .f @(o (f)- N rO r.r)(o 0) ro- oG' o 'EgEg= H 65sto tr'=ooYE*o N o- N t-@t- (o @ s N(o rO N o[r) lr) to(\t\lo (o(o r r()_ o)@(o- \r rr)(o (f) N o,N @_ N @o Gi oo(o_ $ o) sf(o- (f) N s $@ N (o(o @,(o(\t tr o o, E')g oo ,= E E oo o ott E z N o+E-o<NII(9 I o o.>o E figO=EFEO oN sl CO NN rr)\t N(v) $ (o o(9 @ (aN (oN @N o t- o) . ".EEi'=.= E l! BEgiETr = NS O'9L CL (o o r N \t @N @€ (o sl (aN N |r) t- rN t- (o (o 6t (! oE6'E o 9 o CtFEg= CL t- s o @ F- (ot N F- (o @ o) N cf) \r (o erO 6)aEb EE ..EEtE(E oti = ol:lcL -c .=oe9CL.EA E o N$ @- F-t-t- r() t- @@ CA (o (o- o @$t- oN o oq N(0 r()$lo $ Nso(o $lo t-- @ o, rO$_ o) t\ (o- rr) N(o co O) o,(a co t* o)(a r() o o)$-(o $(at- co (\t @ r+^ o o fi5 IUJ =OouU,o- ot L o ztr=oooo ftY oz t o E. o =(D o -oL oo cE oLF E oou -, _0) '= (E oL(! d) E oFIlt o ul oz o =oL GF =o =d] E(E c o o- :Z o)(U ooo - c o:, ==t oF o o- oao - o -o o)fo oq) E o -oo o) c o o o oc o_ E o ll =o ! o l< 0.)g bI) L oq otr C) b0 tr o H o (.) C6() tr ()lr C) Lr 0) (.) cl 0)Ld Iq) tre q) L q) o .v ct) Lr (c O -:. a.6 E '*'(r<(J> !y 2Ltro isL/E c.it q, 0)l Fi ^l q)El:-t-|3 E o !-fl IE - r)c oE IN a F F- N ca (-) ^ o B 4 Uq) U\\q) l (.) ^o o : u sB F.a '=\$Lh\ -q)9:t '$b \l:$p .sA *t s) :\ bO' PP sq) t\ $is ts ox $\JSq) %UUB ).x ^Ee s9 sa*BC !q) *-aBr E> -v {b ^. q) :5\d\a.9x\ ':ht' '-L59 su $.. *t .Y ri E' ol bo<o :bo .Y=:\ ild t\S\q) oz t = F- NN o{ o) € c.r- rolf (oo o{ o) c) (o N @_ N@ s-(o @ o)o ros rr) N o_ N (0 @6l t ct, N o)o NN t-(f) s o o) @- N $@oi o)sN. N (o c! o)(o s o)(o- (oo)(o \f(0 -+-o(0 (o o) @_ @ @ o,$-(o N(o @_ $ oF$_ F o(f)(0- @ @No o,(f) @No o (os oN NN o)- (f) r t\ @ o{ @ l(,olo- € o o, ro o (o CO\t- ololo lo (f) o)@ co $t- c.{ o @t\ o) o N o-tro NN\lo(0 t N(0 $_(o$ @(o or- os@ CO N(o- o) @@ @_ (f) to lo (o s t@ @- g) ro oo(9 (o N $oN- 1() s$- (f) @N lo_ t-t-(o- N @N(f) c.i lo o,o(") r (o ro (f) @ lo ry(o (0o @- CD ro o)o c\l o) o)N(f) (o oot- c") ot-(,o (o NN(f)_ (o o) (a tt- (0 lo^ ot $6t +- !t ro(Y' t\ o, s_ @(f) FN ro @ (os @_ o r @(o r F* r o)s(o co(9 Ns@ o, o(0 a9^(o(\l @@ o) o, (oo o) c., $ o) ryN @ ro ry @(a- t-o\l- o ro @_ (o N ryN Nlr) o, c", o)lr)(o_ (o roo lo_ (Y) o CD C\I ttr)(o o) It- n(a rt o) (a (o lr) s_ N o)(f)(9 ro (ot- s_ s \fo ro- CD(9 N (r) (o ro(a_ t-\r ot-N o)s(9 loo l- o)(o ro lr) Nt\ o- N (D CD @- N rr) (f) s (oN @s @N (o - (0 roN (o N t- (f)N oN roN (o tf ro (oN o, @ cr) N (o oo o)N or oN Ns oN N(e o, N @ \l oN (f) ro N (9 oN o) (o @ @ @ ro o)olo (o $ (o (o @ to lo(9 (o s $ CO (o t\ o s \f CA N (f) N ro s CD 0) N(os(os @(o o)_ os@ CO N(o_ o) @ @ @-(a[o ro (f) sr t(0 @^ o)lo oo (f) @N $oN ro s$_ (f) @N tr)- t- F-(o_ N (os oN NN o, c") t- @N co r.,o lo^ € o o,lr) o @(f) t-- f.- o|r)|r) lr) (a o)@ co $f--N o @F- o, o (\t o^$ro NN\ ro(0\f L o) o. L oT ! o .E otL o -ooL L o d) It o =fE o\l N + o 3 =E oY E ol< oEoa o -ooo o_ ! o '6' E o -ooL L o G) E oFlt =o IIJo uJ o oz tr o c .o) -coF (I, 6 oo 'o r co o =oo(L od oo -o(, oo -o(, c oNoo(, o -ooC oY f J(L ii oFlt o ul IJJ o u IIJ t o -oLoa o o. f o(L o o-c .oF o o- o)oo o o o. Go -o(, o -o -oo = E o lt =o o oF tr ut) o) a o EE I t< 0)p (.) o(.) o tr C) .o EOoo t-t lr 0)s (.) C) C) lrop Eoo(,) t-t l.i() -o (.) o C) l-.1 P-. 1itr oL CB ot< CB oL(B C)tr CU oLrd lr ar2 b! L EOEE Q C) q) tr o (.) 0) bD_E* ?E;? 0d >, CB >\d >.cd >.(o q) GI rt ah q) U o HE I >, >.d >.d >.Cd >.Cd F= .=e c!: ol<d -qo L<(o ol-r Cg Z o!(B C)ti(€ a AT Lti o tr5EE o U d CB >rCB xCd z >. CB Eo. 1itr Lr9. $<A. t<q t<P. Lrq aC) 5HG5Ni .otrool-l Iz *oEE o(J (1 otr(B\=z otr cd o t-<d -qolr CB a ot<(d z bD_EA li tr 6:(h' d Cd P\ (d (o cc) Cg >. c'0 >\ l.<d) (B 3 -aU< ri lrl o3&>FrOa F zD O o! C) tr(€! C) C)o $< 0) 'p, (B >\ *< CB z t<v Cd t<o o) o a € F-OO(\ >. co O o< |^l a C) O l v (€ d CO bo(') :. >rL.l 0)(-) €(H a* 9du ^9 UeLiS 6-) oPdF G) J.J o-!'^ 0-) FH) !(.) d .{tr 6)za(rt n )0)\J rr rir o.l -lalsH U XEu!u -c'au;ES-g €G 7r()'=691:i- 'i c) .{ -q sr 0)U\(hoH =g\'- Ed'StroboEeoo h.-ESts=().Y\a 'aes# k.=-L =Pe\u.2:E6-,4 ci\E-l AcsF.= .9i=x €s?uEiJEtr6sEli X-\.=q) =CJ!v€P1)6 =sd)lr ^6P -5dct)'c6 se Cu e\()'rul\lh !Jr.(ult .o 0) .=OeH .. a- Az:!:.=:F.US'r,.qr-p'5E',.r'ttrllE,'nE E e, 3 ,E O .ST (H = e EE 3 .P E .Ni E: o ..i6' c)v - ,', = EE F €f :E :5 cil6 . .EF ol = F -:. !rr5!lCBl3 N rr.tj Fl d 6.)k(d o(.) 'a lia 0) qi o (.) tr= otr o. C) (d a l-roE (.) (n F a; bo cd tro >. C) o rh C) th o C) !i o) () o0(n t<o >. ) oo H tr 0) (.) bo a C) L< Cd) +i a-.! .E 0) o- oot 1-Yps () d :. Pol\P€; 'ilvt =i'- =-Hdca 3€ gQ o- 'o_c q uPE o(H Oo 05 'E o.r dE"?A oI 4A l.O € € .. arnRJ'- tra=-c:ogE?) cd; azBg* c- ol O co O H oir I HIEEE TEEEEE E= EE# :tr s B'E o dth 0) - €a HE FHxXO a |. >;^ =rH-Av :';< Bu B ;*'EEEs bO()c6^pHctrH=\6 .iHvHvt-9-Qo-l E€ fE fq r 5 =E:€>€u = (B !d- o l. ii- -9, H 6i t{l 5EitrE€ ssA;;i rE?!E=UYv)JA -€u-vJL.!9- ,qfB s,9c; g:E S: E -E o = !4 d= ETE€BE BE: E E! E oE .9 'EE3;E HSu:€ E B sE E ?? I r.e ^^YL.HHvv.-:{!7) '-= o0 V '= u: TEg€ET .-ts!^U --tvdr,r iOti A gb;e uv#ctr€ O-'C(H Y €:co.EE e F:. E r Eo CA o.# -qir€Exi' .H r=.Ei e g$H tr I tsFA E{ E ;?gEEE .r')r:jr-jl-rl<e c.9.E i 8 e f aE'cE s = E H€E€LLo.:ZEZ .Sb .F .9 rSeJ: .QT U SEst E!s b 'i bo *s EE b .E\ y'r Et;4N .{ nr '{\'s .\ qas s 9-bt:\QN, S9i$!+i.S s * Q'J .f)R sE S :E 3 S! E.E * :N S S r-Np N} A P SU()\B's: S .sE frE ] SGBq)*VStsAi i \'s $o'ts 9s sp.N 3 $u <:= O S q);{ }8 *Ft\: qJ u sF\<q\ca ttttt ; o (B Lr .oH O oLr0. o o IIfl l- Ef E E ot, I otrL flt! I. o E otIfl G(, =E o tfl I G oE E E a! E o !Iflt! N II =oE o o i E o a- €l! N =tI! o = I G, aN C) P =PqY'S .= (.) 3E ESa >r 6)Lr(ctr6!ioox -Eia cB()* oQ(!o(L) .r P3 Lr;.)(E .r 0)=LF aY o: BH to ca cB()e u) id cd=0)E!C, t) .i c() b€ad n.P z8 a4AEcd =0)OU (Ja l-{ X ,o .:lHij OI)mtr-6 '6c; o.: E6 f *o0(B vEor 55qcE I €;J a2v eu !.)(!ii!r Eqrg tsFC) .E.g=ts=,oo,.!,!uq6, P'tsootrtr .oH(sEOcaHdL9= e qBEp'F d cB '- LrX.l o.rE o-ooc!3(s >Ji i- O3E 5 o(J -.:gR E .E< boE >.PH-o o. o0,)o)r) E s -(B-Pootrl= = o00- va.!'d/) cS () 'riAs badAeFex,a(E O(B()n it'=iitr=u)d/-9cEa.'tr H &-8 Iq J'o 3.s F2a* O ch-C '-r (d (, -,oo *UUe()lictr E € &'E rn C) 9< -Oi'd^:rts H V ',i()A - ElAV6 Fi*H H^*() v o-vEaaiUL^^ ' :i v vg.EE } € Fil g H HpESeHoiri -o -; p .E Ed€Pd+!- s -E.E s_#!i b0iig95A()E rr,I s€,5 e::ibI) -+Ydy bo-I.= d-.gv cbpE9 ^ 6kE: }E E S hS() 2-c 9/q >,F 5lsoi ,3 9';EOdq? .9:9 3b HE R-.Qo n, HooEE o HGEoEboo5'=a.? tr =eaSE95oHt q: Eooc E oC'5 Q co =HEE8.3 Ft9F69Hdfl'y-v- a cd-:,E (,) Y\J<E HZ \) -s u qj ! \i o I o q) >. su o\ b0 _\c .!- q) \ ,o S o d q)\ q) L \ q) L\ q) bo \ *S9H IDU\o rQt{lqr *>$\JLL a. $.Y B6\"s N: =u':b s.: -!2 \00 .rr =J s\ .Yx .3d$u -B N, Xgo .: .r\sO-S\,.\-E -L .a3s!i!l i. o.9st $U BS ra\ (, IE(, o ! !N $i o\ oo E')g ltoooLE .8= g,DsE-cE6 =x=Eoz 6 B.9o sooll- 1- *- Edo -m o E"(E +,c o(, o o. soo s o)l- sN rr) soor soN s o)lo soo o o E L .8 9.,, =€EBz =,go oN (o NN O) @r\ $ E o 6 .= !ttr(U ooooE b.= .8iEF 2a 00E +T\ m ll o)o E ot- l- @ N(o o)f- (r)6 o,ro oN(,) (o @ @ m 9o tE .i EOflo oN r (o \tN O) o@ o r\ m!e l-(o lr) (f)@ o,LO orO oo)(\I (ol- o .E o oll E o E .E 2o =oEO 8'E -o ,6 = =oo E)g oob= g= EF =Fz6 oo rF(otom r(, m o E')6 c oo o(L so so s @ sN CO s(o s$ sO lt) o L Pr, * !E Ei- [ o o rr) l- f- o) o t6 oLEx b.E. Ee9 hi= o. .E o ..oo.=trtr oF EE 'o o oN sr cf) NN lr)s N(9 s Fo e.F 9,o l-zf oo ftY oz t o -c(5 =m L o -oL oo C ! oLF E(o oL .? _o 't (E oL(U m E oFIlt = .n IJJ oz 6 J aL (UF r- c.l O co L,/ o 4q\) uq) 4 + r- U r- .x u q) 4 q) ts\\- F U 0)fl +.iE:o.=EtrLOo'5 -*o'5 EH II * fl()rr 'n -tJ5EiLHEE Orf(, :.$t I _ oit t -ol .61NFI a (r3 C) a a (c l<o (g F do o (d C) a o l-r cd () p l-< a E (s >' Ero- c)o-troE .r l-li b r\ o(JC)A o<a F6) Z*'.o Er. =u) .E :Eo-= aa(so N-r Oaox\i5 c)E .(o9l<6aAv) =o €Eirotl o.Er: E(d(du tP oY F() 5rHjJ Ctr()0) l<- soo s @N so 1() sNt soo r soo soo s(f) f- soo soo soo soo r s(o o) sf- @ soo sN(o r sN s(f)s s roN so CD ssN s @ CA soo s o)N s l.c) cf) @ 6tNo(e @r (f)N O)r @N or t* o, \t(0 - os $ - N$ l-cf) N lr) o ro (o (o N lo @ oN l- \f(o @ No @r o CA o ro to(0 ro co o s N @Nr coO) O) r (\to o)sO) @I'* o) @ N@ (o @ ro O) COo) r() N rotN oN l- rolo ros ro(a 1() N(o @N r o) o Ns (oN ro @ I\t@N !o(o O) l-N (o rocf) ocf) sF- cf)(o (orr) @F* ros @6) ci, F- @ o o, 1r)o r r (o @ F-(o @o) 1(llor\o)(o orr) (o ro N(o 1r)ro ol- o(o (o(o o) (o N@ so sl- F so cf) sNr sr r so so so sG)F ss ss F s @ s[r) r sN cf) so s60 s@ s(o s@ s(o s$ s|r) r s$ s(f) s@ Ncf) (f) N cf) cf) o o $t$t N N N 1r) O) N NN N r r r t- cf) N o co (f) N (o N @N o f- o) N (os sr @N cf)cf) @N oN r\(0 rf)N (o N f- (f)N oN roN (oF $ro r + (tr =fL(5Y N :tt (E = )E6\z c C) .Y oEo c/) o -ooo 0- .C(o 'd -c = o! ol-L(U c0 Et. oF lt |It lrJ o IrJ o oz t o c .oEo (5 (g (u o 'c I m o =o o(L 06 o)o -o(, (tr o -oo c oN(E -oo o -ooE oY J J CL E oF .ct to UI UJ(9 tr tJJ t c(t, c(U o-Y o(UE o(u - C of =)a(u o o- o)E o o -oo) =o o oC o -o(, _() '= c o o)L(, q) c (L E oF lt o oz J tr = o o. (E - l- G L.(olr o -oo L G c0 r- N >' cn o t soo r (o N (o !ot- oN r.c) 1o s cf) co =o) m c- C.l O co IJ 0. > N [-Io, o\ss oIY\- Ns O' ,^\-/ E P Es]=i E E 85" .=(Jolca u I Ett*:aS 6 - OSp tEbis :rEs: .H +3sF g;:E.U ts ts-SIE B'F.gSi EE<L\&s e-8 bs$ ZrE F $ ET EAi\ ^ -t=\\v!!$$-q-Nb b=tr =* E E tsXS o >rtr|.u % i,\- (.)'i\- E#,li -d-Eh .;6o'a i [i'.= -sE E 8.9 'rlJ )'-! .i V €! E'5 ER6 6HEFF ia6.;\9sS nL-=o ^.$ UONEtt trF-H€:$ EE€EsslEo_"TT E.E ilEb& .=[.E'E ^\' * ;$* = $Es! :s €:EE.-qT EF fiEEgE R'S gsE#\ *E EqEH$ ^sS g€AHF'\: > S a F C)*t e: 66F"Et ES il8re.SN- s: "E--c gS ux EEf EEir^ist-t--R E-$ dX^g ^\< .a.- U) l-l ra O * \N .EUY}S SFi E.Es'- E iE $gEEb r"$ aQx^\ "U* I FrE9I' bR i H 3 (sS SJ OH6trT i; ?i;.es S S qb.ooos X"; UEeRs d:_. o*Eo E ts$ EE?5A SSS 3EE.;i ,3d FJZo.tr El Et-E - .IfI fl a-(, t!e G(, a lO IN do d O (h() tha o cn oo 0) -o C)t< Cd a C) a a F l-.,1O C) t) bo q) 0)4^. H€\()L' v')6trc)fr= € UFV -)nd(.).i€oxE-v)t-i (.) Y(!(, 'r= h -Ecd-- <)?6'5i.io ,UA vd(! :Lit0) !dA.Cdtr'Pd)..o -ci c) slVA'otr --Y >r.O /\ Hr!HH,\ .i.AvEE H€ -v- Htr = a).o4 v d(tr H9PiO<BgEo9r.o() e'5 :5!.-'eEoY H N 6= O - *x c dA 6) v iQ€ E E b!virl'- 0i'= >< PH!UJ:!-9i:55trH-o-(s6 5.e .8:r = -rvaEoeU;hEti!nF = c.EEE 9': HU!H^-Ulo ^o -tl ar ..O_.ncnl)=trC!s'?ioaiao s d it.= 5.9 !9-r-9!i- b b Ao"E U'tr IEA a H E;5g \ H *H \ Vti oOrrtrr sf- rO CO r cf)|r) o cf)s s o, cf)N o -oL Ga N s o, @ soo soo soo s(o @ s(o N soo r @ @ N r(,(o C')Nr(, F*$ olo O)s t^c)s oo(Y) ooG) (o rr) @ rr) N O) o)(0 GIoN lr) cf) f-cf) (o CO (Y) N Gi' o)NNs o,(f) so rO s @ s(o cf) s @ s cr)s@ s N $ s trF (Dc, o) @ cf) Nr (oN ooN o o-) o CL o o-c .c)F ooo! o .C C) o o-(o o -o(, o -o -oo = E oF -o cD E oF caO N 0) .o () o z +N (-) o o. o ca o N E*sE !'8E lo o(!t6xFY (O o rt F. tI.- ro@ N@ oF. oNF' o tf ro ta) @ oF. I--I.- F-@ o O) O)@ g- rr,&,5 C') o)t t.-$ (')$ 1r,sl a9oN olr) sf(.) @ ro(t) la)t NN t-N $N t(., (o@ !{26 lr)ro loN @(f) slN roN N(o o@ o@ lo(o o(.) (,N ra,lr) o(o @(f) f.-lf) (oN Or.) Eo @o o) F.o N o oNro o lr) ()(o oF- lf)f.- @F,- oo) o oo oO) o +(E0 EH at o (Y) N t $ N ro (o (o N N o +FOFto N (f) @ o N (o N N o !o26 N N i\ o o o o o o o o bbe EET.C 0) 0)E' C CitErE eo)F(J (o @ @ @ O) C"(9 o rl |f) (?, F. (?) (f) o ,\oE3ooFfl @o N (r) (o N N N c{ (o N c! N (r) N N N pD N (f) (f) N N N N (o N N N (.) N N N i6 o o o o o o o o o o o o o o o o bE L.L !P -E E ;EEXI 9."F(J (o (o F- |f) @ (\a.t o) @ o) t- (o tr) () (o F- $ (., oE&OC'FI to (f) N (, (r) (f) (') (') lo (o c) o (r) (t) N (r) p8 (') N (?) (.) G' (.) o N (o N (t) EU o o o N o o N o o o o o e, E!E I€s E;T26R o o lo t .o (o (,N (o (o F- @ o) @ o) t lr) o L o o tr oo ftrY oz t(9 -c(E l m o -o oo c EF t(E e - -g 't op (E d) E oF tt =at, LrJ oz6 f o (E F = (E J d) E(! c(E o.Y o(E Eooa co l = 5 a(5 F o o.oEo - o -oc,fo o)oc o o(, -o '5 E oo o oE o. 44q) Q s) q- ? \ q) t q) Fi v U o (c (.) oq F U(H (n (,) C) C)l-r .!) o (6 bo tr (c LrF .iir ,l -oldtFI t-- c.l co L) o Or o sl(o 6 oort tt(ot (r)o o) rO 6t N N c{ N $N o @(o o(\I t oF o ao lr) F- (, O) ro@ oo o oo ro(oro oN o o ot o oN F. rf)f.- (\lo(n oro o@ ro\t roro otr) olo o(o o(o tr)@ oro lo(Y)(t o$ o(f) ros oF- os rosl olr) o(?, o ro(r, oN ot oN oN loN lot lr)N o$ rosl olo of., N o@ o@ ro(o ot- ot- ()F. F-@ |f)t (\tlollt o(.) oN lr)N ()(f) o(?) N tr)NN ooN ro (f) N oNN (o (f) N a.tt(t lo@ (o@ oO) lo@ @ ro@ @@ f..-@ roco(o $t- o@ oN @F. (f) $ N o () ro N N N (0 N N ro N N N N o (0 o) o o (o N o N o (o N (n o o F- o) $ t sf o)(9 $ st (f) t (o t (o t o)N (f) rf rf) (o sf (.) o (.) 6t N N c\,1 C{ N (t (?) N s N (o N N o @ N o o o f.t o o o ro N N o @ st (r) ra) rt tlt r() (o t ro (o \l $ (f, t(t O) (o @ o (o ro (o o o) N (t) N st N (o o (o (o lr) N (a (o N N (o o @ N (o N N N !i o (o s $ (, (o o o o o o G' o o o N o o o o 6a o o N c{(!, o) o (o (o N o @t oN N F- (o @ O) @ (o r.,@ (o co o, o) oz J G = o o. (uI -c(E '= (E LL o -oo od! +t (! =E(E Y NIt 6 =fE(5Y c oYoooa o _o o -g(L (u '6' E = o -oo (5 dl E oFttfo I lrJo ul(, oz u o E .qEoF (E 6 (o o '6 I o Eo N(U _o o oY f 5(L o = -9o(L (E o _o(, 6 oF .ctf U' uJ uJ ot ut tr o _o (E U) oo =o(L o o-E .9F oooEo -co r-O N >. cn o o 1o o(a oN |.c)N o o $ N rr) bo oU e € € o p s) s a s o M\ o Bp oU s o a. s -: B o t .. -s * (o N N C)$ oo(9 -oo(Y) roN to r,o e) $ ro rot @tf,ro (ot- (9lot N (n F) N @ @<) 1l, t (v) NN sl (oN o(o (\l ro (tN N @rl, @ @ N (ot c{N(\l (f, o) o,o (f) (o oF o F' F' oN (v)(o 6c{ o .o -oo = E oF llJ(r, E oF o t--OO(\ >. co o o. o \o th (.) tr oo L<(.) >. I t \ a. b0 r. o r. \) bo \ \ q) r-L. uq ul bo 9\.L U x- -'!-'6B -:z A:* ti ^,qi UQ) b0- '= )< cd-S!{J q) ()* Xl-F\- '.iir0)l -ol(dl FI aU o a o C)a(t) a o aL 0) (€ oJ (n o o P L o Lq-i(d a HL +t c)L)s 4l) 7 a-< 9EEor 9a .= o) = F.-6^.r fi s& >\ bO 'E 0) 6 O?Q -'E 6 ,-v)0) ='-r9 ts Eotrtr() 9vuiO EQ d a nQ 7 bo o)Na5 ->(HFO a C) 0) (! LF 0) E()(!bo bo: Ortr o-v -ir (B (.)u o-9*}Eoc) FJ< Ji qi o 0) o oo e.?H t+.ts<2A aQ +ra o o 0) o ad t-.,t a a >. (s 6 o o0 t< B t- o 0.)& e ooo cn a C) o 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 650/o therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. As a result of frequent annual treatment intemrptions during the civil crisis in the country that ended in 2005, the project managed to maintain the minimum 650/o coverage. However, because of increased mobilization and CDDs training, the project achieved a 100%o geographical coverage in this reporting period. NOTF intends to step-up community sensitization on the importance of taking Mectizan and train more CDDs to increase treatment coverage. T7 WHO/APOC, 24 November 2003 o o o oooo aa fiu r- i g !*EE$ F-al co U o (J oo o o oo o o o o o o oo o o o EU E6 zo o o o oNN o o o o o oNo o o E8 oq9bc6 ,nZa o oFN o o o o o o o oo oge*iE s N @ s N@ s @ s @@ s @ s @ s6 @ s N @ s @ @ s @ @ s @ s @ @ s @ @ s @ s @ s @ @ o50 =oodgIr ooEOF oo r!-@6oo Fo sts @ @N. @ N o @rt oo o- ts @ o. @ Nq o q oo ots @ a- N @N @. NN o @od @6- @_ @N o. N @o ci 6i Fo 99!659 E6dE59 ,oz o o o @o .{F oo oo N c.i N @ N@ o_ N @ @- o u2 N N @ qo @ @ No o o s- o o N" N oo NN .i@o --O do,= acoFE.qig6 N o @ N @ o o N o- o N @ oo @ No d o @ d N @ N @ F.o N @- N N o ts @ @- @ @- o @ N. N oF6 c,i @ o o n q oL .E.BEc9Eqq6 -3; t E6E5 o soo soo soo sao soo soo soo soo s r* o soo soo :Foo soo soo soo E EoF-bs6, I83 o o soo o 6 N @N @N o N o FoN NN N @ o .E E sE6riq o! E z o ts o F@ @ N @N 6N ooN NN o NNo Za iEo as6 N @ N 6N o F o FNN N @ @ H,t o =EO:;E9:Bi ! E'EEEt)o! E!t ceo o.: o o oN ooG .c ,= E E oo o o f o oc o6(, o c L G oF ! o oz J E = cE o F E o o t oF olo U oz6 a ot- ;6 fo c o c6 Y o o ! o o c o l!f a oF FI e.FL cl E2 , oo co f 6 o ! oo qq q) c)q) q l o\. a)t\ \ S ! \)q ! 5 J4a Li (c ch o t-id (s -] O Lr a E >' -o U) rrl a d C) CB(.) !F r-l orl -ol cdlFI s oE o -9 oE d E f d Y oz d(J o oo oooo oo r- cl ca (-) 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 o a o o o oo o N @ N o o o o o o @0o o o oN o o o o o o o o o o o sNN s @@ s @ s N@ s @@ so N s h @ s s @ s @ a @ s so @ s @ @ s N so @ s@ @ so @ s N @ s @@ s N@ sots s N @ oo ol o @ @ oo o N N oo d N @- o N @ @ @ oN. N F @ N r; N @ t' o o @- @ @ o @ o @\o @ Nod N N @ 5 @ d @ @ N- N 3 o q N o o- o N N o6q o F .,ioo @o o- N s- o o @ o @ N N N o o o@{o oo_N oo. oc?N oo- N oo@- Noao q @Fo.i oN.N @Nd @o@- No@ @Nq@ @i d @ oN NN o. N@ N @ 0q o oo o @ N. ts o o o o@ @ N ol o @ N o- o N o- NNts d @ @ o. o @ o o @. o o\ N o- @ 6 o' o o @N oN o d @No- tsts @- N s a soo soo soo soo :eoo s s 8 soo so o soo soI soo soo soo soo soo soo soo *o soo soo ;soo @N @ @N ts @ oN @ N N N oN N @ o N o @ N @F oo N @N @ 6N o F@ N @ N N N oN N @ N @ N @ts 0oF @N @ @N o ts@ N @ N N N oN N @ 6 N o @ N @F oo N E oE or o 66 t dilE6Y N 6 l NY c o e @ oo o .9L E6 ac = oo o @ o oF !Jo IUou(9 oz d o cIE F s o do 6Ib o '-9 o .d o ooo o ooo c o No o o tr oY ) a o G oF !Io EU og, U d oD o @ o l oo ooc eF oo o oc o o o ooo 6oo B o oF A ,o E o ! E e(9 soo r- C.l o c.) o o qJ ho\ a) I\ .3 .li s L boq\) Oa \ rh\-/ :.1 FS U/tr v$ -\(.) :-aLS(g .s vs(.)'5 A'.LE5\f \'Stfs .E '3^ i E!1'=.si a.:{t3EtE SsUO .=.1: FLiT6E: v=: oB'!ir=()o-ss =ni s ^SF;,SUI .S 'dstss\.U : i s[X \ sq)E T ESI R '=E'; : 3F 'o E IXc s ;Lql 3 '!q, - : teB S ti o- .: Y\qr S bSo S \:E $ss = h "B = 5 :( -\.iv(E ; \q)E H iS F - 95 .: rE0a ql A)S' S\ .t :l - s E$sr is)\ S'ss tss sE = s*\-q\ lrs sEs .i'FE S\s st o q'i:S {irt\ !t ='n ll !P PS\ ag C'l olol -lxl EI s1 Cd o)LI C) a] o 6) 3 o l< C) -o z olol -l o.rxl > El I EIF orl egl o)ol trot -=oL -(d tslt rl '9lE =l=Hl tr zl< d() L 63 9o(.) 'a L(g^ oL6)(i- 99O-o).='a^ LV :2(.) rrlr& =-o!.iu a takA.io: .:oc.1J taEd Fa =G)o.:()tr tr ol tra) ol =! -l HE II 3i Hl c.rd-) ,:t .-o. (!ltr .L 9l E8r $r -l tr -:l o)xl : El grl.! <l a fll s, qE .il .J ?l v) :Ii EI Eil a trl uoI= =tHituLtvut !- Ll -818 8l Ec*l = tr.l -X ol i1 ol trrlO rlf(.)lo- olE -ol -ol -trl cd trl co =l 'o =l oZl?- Zlt- o o od F s o (6 l< 0) o0F^C)X oo oF C) (6 r obo l<o oo o/- Eo\ (n t< oo ooo 0) (B L C) bo L c) o o(),,^ 9-\ op. Ho r- 6)l o0dlLl C)l BIol -tdlol -qlol(st l'<l s()l s trldl ol 5l ol$ bl -ql €l bd cl !l a EI6tol -l €l (dl 5l EI ol IJr I 2.6.2 What are the causes of absenteeism? The causes of absenteeism are during rapid movement of the internally displaced population coupled with cultural beliefs and fear of Mectizan side fficts. 2.6.3 What are the reasons for refusals? Cultural beliefs and the misunderstood fear of the side fficts of Mectizan are the major reasonfor refusals. In communities were cultural beliefs are high, some people believe Mectizan taking is aform offamily planning method to stop women and menfrom having children. Indeed, only high level community sensitization and mobilization could ever change their behovior. In case the project did not have any cases ofserious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report ./ 2t WHO/APOC, 24 November 2004 D oN Lop () z$(\ O L,, o. o FJr > c.lN B a. q) k- L a) .o LqJq tt -:. a S44q) Uq) q > L. g r. t 9 q)q e:- fr c) A. o0 tr og C) Lr 0.) bn H G)t<tr oo CB a r! a a C) 0) C)th l-<() (d a o tr 0)a(ri o a() rh O #r 6)l -l.oldlFI :H;i>tr -EE 5<.E E ;toBtr'.= tr ij d .I:(E()ia a)1ec!/X o.=U.loo (H o or .9 EAA= !? bn 6b. a Oa o!^ d.9 u0)-c tr&9d HG(*;()-O.2E Co c c=ULL'TdaooA =,! .OH99s o '.U?f,.: O H .E,.E (d € - I ep.E = = o.E ogEEIg oq a trE;Xo.l *.Y h o !f o.) !a66 =0)N+ 9!?- o> = o ob0cG.- =oo>6 Xoa 0) bI) * a r-O N c.) U o Or +r o E')(9g-ForN =Bo s F*f- sof- tr .9 (l, CL o o- oo8I EU @ ul o E')a't (Etr bs oo sOo s o ooilI-o) (oIIJ UJ o ul oEOfE"OG,9bs ooEOF s rr) @ slr) @ € UI b 9z9,- 68 E'[g l-o o- (f)o cf) N(o ro so cf) IJJ ?o .Eo,a =Ea)Eg6* Nf- ro- No cf) o) \No CO (0 UJ E t" Ee.*flE e (o O) s. rO(os NN\ rf)(os o6' ol rEl >l ol ot EI =lEI EI olol oo rrFro (\t uJ Lll(9 IIJ o cD9gGF0!o\ oo soo r soo oo rrFt-lrJ uJ(9 IIJ E .9 o, -E E)cL !EF6SFB6o o soo soo EBE E gE .''uFiSElJr =E';.:z6 o l- o,tr) oof- $t IIJ Eo .Eo,a =EEE 6= l- o)lo oof- ul !:.E &8bP E E tt= o ': r!-\ o '=EE E EFE O E85 5 .= F- O)|r) ool- u. lJJ t- o) o) @ o, o) o, o, o, r oooN ooN NooN (.)ooN sooN |r)ooN (o ooN NooN @ooN o,ooN o roN cn C.l -aa I5 s - - .9 GII q) bo -sb €B\e)\.1 r frL\J'sF tr)$L-LG!$S.Eg.s:FN Hl\\Ei \.1' '=;SE -\Ei&q,l v 'tJ 5q) Gt! x9e .5;ft A!. o)CJ:-()c)=d.4) vwtllE !{ Ilr phv .E:-; t- :,eqF9 -v=F9vni!?1U,bEI E-t? HAI :hiiEEI .)9!l iE-Ul E €)OI .- ENE.rYog I:'iue :oL +, t^, rH ctl-grY gd ;2 -str()e!)tr6)L i''i - -Ecl $r .9ra-E c.i orl ';Ol ra =l Gt* c)tutFI 0r F- (\ O co O { +r B n z tr z $ C.I q q) \ () q) o 4 a) bo + ! !\ A)r.q)\ o .Ei @ SN u a) + v q) r.U %\ q) 4 q) tr (tr o(.) (n 0) cr') a3()q L 0) o ctrPfr % !-r(3t< otZ s, r. L$ S B tr Htt r-a q)q q) S I >. C)l-r() (.) @ (tr N L) C) a e o(.)o ch L.q) > = $ELI'itu\rc\J T\ N2 a) .t Q q)q !q)SD =? Et-fl(, o ELL o I * o >L o .I -oE E Et! o EI GL ofl o EI E .IL oEL o tF IN 0) u')(n() EC >5 () Lr C) $r @ (d N oo z DistricULGA Number of Mectizan tables Requested Received Used Lost Wasted Expired Remaining GRAND KRU Buah 16,000 16,000 15,968 1 31 0 0 Dorbor 8,610 8,610 8,527 34 49 0 0 Trehn 18,500 18,500 18,446 54 0 0 0 Jroah 14,000 14,000 13,962 0 38 0 0 Barclayville 28,000 28,000 27,122 65 310 0 503 Sub-Tota! 85,110 85,110 84,025 154 428 0 503 SINOE Tarsu 6,000 6,000 5,956 0 44 0 0 Butaw 8,000 8,000 7,960 0 40 0 0 Kpanyan 24,560 24,560 24,310 75 59 0 116 Jaedae 13,000 13,000 12,528 245 85 0 142 Taryuwuon 15,500 15,500 15,070 89 321 0 20 Jedepo 13,000 13,000 12,350 340 95 0 215 Dugbe 24,000 24,000 23,810 45 67 0 78 Gblonee 7,500 7,500 7,134 68 124 0 174 Greenville 22,000 22,000 21,356 218 323 0 103 Pyne 12,000 12,000 11,268 230 349 0 153 Sub Total 145,560 145,560 141,742 1,310 1,507 0 1,001 MARYLAND Harper 61,000 61,000 59,950 656 394 0 0 Barrobo/Farjah 14,800 14,800 13,220 809 654 0 117 Karluway # 1 20,000 20,000 17,996 900 780 0 324 Karluway # 2 40,000 40,000 39,530 390 80 0 0 Pleebo/Sodoken 48,600 48,600 47,956 349 200 0 95 BarroboA//hoiah 14,000 14,000 13,915 69 16 0 0 Sub Total 198,400 198,400 192,567 3,173 2,124 0 536 GRAND GEDEH Tchien 35,000 35,000 34,474 57 23 0 446 Cavalla 8,900 8,900 7,682 215 185 0 818 B'Hai 5,200 5,200 4,462 79 86 0 573 Gbazon 28,000 28,000 27,180 326 450 0 44 Konobo 24,500 24,500 23,980 118 202 0 200 Putu Gboe & Polowo Gboa 17,750 17,750 13,660 228 232 0 3,630 3,500 3,500 2,700 347 83 0 370 4,800 4,800 4,258 35 65 0 442 Sub Total 127,650 127,650 118,396 1,405 1,326 0 6,523 RIVER GEE Sarbo 15,900 15,900 15,680 78 141 0 1 Potupo 13,000 13,000 12,320 323 87 0 270 Tienpo 8,600 8,600 8,1 00 75 109 0 316 Chedepo 18,000 18,000 17,704 115 181 0 0 Gbeapo 16,500 16,500 16,124 85 156 0 135 Table 10: Mectizan@ Inventory (Please add more rows if necessary) 25 WHO/APOC, 24 November 2004 Webbo 16 000 16 000 15,900 64 030 6 704 0 72888,000 95,828 74088,000Sub Total 0 9,291622,558 6,782 6,089644,720 644,720Total 26 WHO/APOC,30 July 2007 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. The remaining Ivermectin tablets are collected from the communities by OICs and transferred to the Health Ministry expiration date verification. If the expiration date is confirmed, the tablets are taking back to National Drug Service (NDS) for the next treatment cycle. If they are found to expire before the next treatment cycle, they are burned or discarded Personnel Activities The County Health Teams (CHTs) collect the Ivermectin tablets from Ministry of Health (MOHAIOTF) to the county health facilities. The OICs take delivery of their supplies from the health facilities for their various communities for distribution. a The CDDs distribute the Ivermectin tablets to their various communities 2.8. Gommuni$r self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? If so, When? NO Table 1 1: Community self-monitoring and Stakeholders Meeting (Add rows if needed) a a District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSV[) No of Communities that conducted stakeholders meetins (SHIvt) 27 WHO/APOC,30 July 2007 t TOTAL 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. Superuision 2.9.1. Provide aJlow chart of supervision hierarchy. Central Level o NOTF o NGDO County Level o County Health Officer (CHO) o County Onchocerciasis Supervisor (COS) o County Health Teams (CHT) a 28 WHO/APOC,30 July 2007 District Level a Health Center Medical Officer Clinic Nurse Community Level o CDDs o Community Members -a 2.9.2. Main issues identifted during supervision? CDDs complained of compensation with holding by CHOs Some CDDs refused to distribute Mectizan after training. Verification of treatment form and how to fill them 2.9,3. Was a supervision checklist used? Checklists were used by CHTs and NOTF during supervision 2.9.4. llthat were the outcomes at each level of CDTI implementation supervision? Most identified issues were solved on the spot while others were reserved for appropriate meetings. 2.9.5. Was feedback given to the person or groups supervised? Based on the degree of the issues, feedback was giving verbally or in writing explaining investigation and final results. 2.9.6. How was thefeedback used to improve the overall performance of the project? In the case of the CDDs complain that monies meant for them was withheld by CHOs, they clearly understood after the interventions by central administration that such was not the situation, rather that the community is responsible for their incentive and they accordingly went back to work. SECTION 3: Support to CDTI 3.7. Equipment Table 12: Status of equipment (Please add more rows i,f necessary) I t Source Type of equipment APOC MOH DISTRICTi LGA NGDO Others No. Condition No. Conditron No. Condition No Condrtion No Condrtion 1. Vehicle 2 F 2. Motor cycle(s) 23 F 3. Computer(s) 4. Printer(s) 29 WHO/APOC,30 July 2007 5. Photocopier (s) 1 F 6. Fax Machine(s) 7. Others a) writing board I F b) c) *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? Yearly budgetary allocation is made for the maintenance and repair of equipment and other materials. With integration and co-implementation of health interventions, the Govemment of Liberia (GOL) through the Health Ministry intends to co-share mega resources for the maximum benefit of all health programs. 3.2. Financial contributions of the partners and communities Table 13 Financial contributions by all partners for the last three years If there are problems with release of counterpart funds, how were they addressed? Additional comments 3,3. Other Jorms ol community suPPorf Describe (indicate forms of in-kind contributions of communities ,f any) a Contributor Year I ('provide the period') 2006 Year 2 ('provide the period') 2007 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 89,412 5,989 MOH (District/LGA) Local NGDO(s) ( if any) NGDO partner(s) 29,050 9,148 10,040 4,000 Others a) b) Communities APOC Trust Fund 122,569 84,994 95,699 74,639 TOTAL 30 WHO/APOC, 30 July 2007 a D3.4. 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 1 US$: 60LD a I 31 WHO/APOC,3O July 2007 Expenditure ($ us) Source(s) of funding Drug delivery from NOTF HQ area to central collection point of community Mobilization and health education of communities Training 9!CDD9 Training of health staff at all levels S up erv i s i n g Cp D s*11d_di sg! b ulo r"t Intemal monitoring of CDTI activities Advocac v vlslts to health and p_o,! tical authori ties IEC materials $ "ryg1ury_( 1ep orlqr g) *fo rnqq f_of treatment Vehicles/ _Motorcycles/ bicycles maintenance/fuel Office Equipment -(9._g c-o-qrpUtersr,p_rinters etc) __ Others 500 s60 1 5,1 88 9,369 4,450 6,835 1,800 5,600 490 9,646.65 1,622 tg2s6.t MOH APOCMOH& SSI APOC APOCiMOH& SSI APOC APOC APOCAVIOH APOC APOC APOC ___APqc APOC/MOH TOTAL 80,387.05 Total number of persons treated Table 14: Indicate how much the project spent for each activity listed below during the reporting period Any comments or explanations? SECTION 4: Sustainability of CDTI 4.7. lnternal; independent ParticiPatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation caruied 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 Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? 4.1.3. How have they been implemented? a ( 32 WHO/APOC, 30 July 2007 Activity I 4.2, Susfalnablrtty ol prolectst plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? Was a sustainability pl,an written? When wos the sustainability plan submitted? What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: a a 4.2.1. 4.2.2. 4.2.3 4.2.4. 4.2.5. Planning at all relevant levels Funds Transport (replacement and maintenance) Other resources To what extent has the plan been implemented a^ u 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechankms 4.3.2. Training 4.3.3. Joint supervision und monitoring with other programs 4.3.4. Release offunds for project activities 4.3.5. Is CDTI included in the PHC budget? 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. ll/hat have been the achievements? 4.3,7. Describe others issues considered in the integration of CDTI. 4.4. Operationat research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project areu within the reporting period. 4.4.2. How were the results applied in the project? JJ WHO/APOC,30 luly 2007 SECTION 5: Strengths, weaknesses, challenges, and opportunities - List the strengths and weaknesses of CDTI implementation process. - List the challenges and indicate how they were addressed. Strengths The project received twenty three (23) new motorbikes to enhance treatment coverage Govemment continue to pay it quota to CDTI activities People are anxious to take the Mectizan tablets. Weaknesses Community support for CDDs is low Project vehicle needs replacement Challenees Late collection of treatment data from the project areas Bad weather roads in the rainy season SECTION 6: Unique features of the project/other matters 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 inihe health care delivery. It is our hope that when integration among the various health activities is complete, coverage of all interventions will signifrcantly improve. o a ^t a 34 WHO/APOC, 30 July 2007