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NOTF

Approval year: Reporting Period (Month/Year): Project year of this report: (circle) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Date submitted:

ANNUAL NOTF SECRETARIAT TECHNICAL REPORT TO

TECHNICAL CONSULTATIVE COMMITTEE (TCC)

To APOC Management by 31 January for March TCC meeting

To APOC Management by 31 July for September TCC meeting

AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC)

ORIGINAL : English

WHO/APOC, December 15, 2004 i

ANNUAL NOTF SECRETARIAT TECHNICAL REPORT

TO TECHNICAL CONSULTATIVE COMMITTEE (TCC)

ENDORSEMENT

Please confirm you have read this report by signing in the

appropriate space.

OFFICERS to sign the report: Country : _______________________ National Coordinator Name: ……………………….. Signature: ……………………..

Date: …………..…………. NOTF Chair Name: ………………………. Signature: ……………….…… Date: …………………………. This report has been prepared by Name: ………………………. Designation: ………………….

Signature: …………………….

Date……………………………

TABLE OF CONTENTS

ACRONYMS ........................................................................................................................... II

DEFINITIONS........................................................................................................................III

FOLLOW UP ON TCC RECOMMENDATIONS .............................................................IV

EXECUTIVE SUMMARY..................................................................................................... V

SECTION 1: BACKGROUND INFORMATION................................................................. 1 1.1. GENERAL INFORMATION.............................................................................................. 1 1.2. POPULATION AND HEALTH SYSTEM............................................................................. 1

SECTION 2: SUMMARY OF CDTI IMPLEMENTATION.............................................. 2 2.1. DISTRIBUTION PERIOD ................................................................................................. 2 2.2. ADVOCACY AND SENSITIZATION................................................................................. 2 2.3. INFORMATION, EDUCATION AND COMMUNICATION STRATEGY AND MATERIALS DEVELOPMENT......................................................................................................................... 2 2.4. COMMUNITIES’ INVOLVEMENT IN DECISION-MAKING.................................................. 3 2.5. CAPACITY BUILDING ................................................................................................... 3 2.6. ORDERING, STORAGE AND DELIVERY OF IVERMECTIN ................................................. 5 2.7. TREATMENTS............................................................................................................... 5 2.8. SUPERVISION............................................................................................................... 9 2.9. COMMUNITY SELF-MONITORING AND STAKEHOLDERS MEETING ................................ 9

SECTION 3: OTHER ACTIVITIES OF THE NOTF........................................................ 11

SECTION 4: SUPPORT TO CDTI ...................................................................................... 12 4.1. FINANCIAL CONTRIBUTIONS OF THE PARTNERS ......................................................... 12 4.2. OTHER FORMS OF COMMUNITY SUPPORT ................................................................... 13 4.3. RESOURCE MOBILIZATION EFFORTS........................................................................... 13 4.4. EXPENDITURE PER ACTIVITY BY THE NOTF SECRETARIAT ....................................... 13 4.5. EQUIPMENT ............................................................................................................... 14

SECTION 5: EVALUATION FOR SUSTAINABILITY OF CDTI, INDEPENDENT MONITORING AND OTHER REVIEWS ......................................................................... 15

5.1. INDEPENDENT PARTICIPATORY MONITORING/EVALUATION ....................................... 15 5.2. SUSTAINABILITY OF PROJECTS: PLAN AND SET TARGETS (MANDATORY AT YR 3) ........... 16 5.3. INTEGRATION ............................................................................................................ 16 5.4 OPERATIONAL RESEARCH................................................................................................ 16

SECTION 6: STRENGTHS, WEAKNESSES, CHALLENGES AND OPPORTUNITIES.................................................................................................................................................. 17

ii WHO/APOC, December 15, 2004

Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective ATrO Annual Training Objective CBO Community-Based Organization CDD Community-Directed Distributor CDTI Community-Directed Treatment with Ivermectin CSM Community Self-Monitoring LGA Local Government Area MOH Ministry of Health NGDO Non-Governmental Development Organization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force PHC Primary health care REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers UNICEF United Nations Children’s Fund UTG Ultimate Treatment Goal WHO World Health Organization

iii WHO/APOC, December 15, 2004

Definitions

(i) Total population: the total population living in meso/hyper-endemic communities

within the project area (based on REMO and census taking). (ii) Eligible population: calculated as 84% 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 expected to reach the UTG at the end of the 3rd year of the 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: The bringing together of two or more health programs, removing

barriers between/among them, in order to maximise cost-effectiveness and permit free and equal association. For example 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.

iv WHO/APOC, December 15, 2004

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 _______

Number of Recommendation in the Report

TCC RECOMMENDATION

ACTIONS TAKEN BY THE NOTF

SECRETARIAT

FOR TCC/APOC MGT USE ONLY

(Please add more rows if necessary)

v WHO/APOC, December 15, 2004

Executive Summary Prepare an Executive summary of the report in not more than one page.

1. Summary of treatment and population data comparing projects, trends in treatment

over time i.e.- Total number of communities, communities’ treated, total population, UTG, ATO and persons treated.

2. Summary of training data of projects (nationally) for:

- Project Officer (training of trainers and/or other specific training), total number of CDDs and health workers trained, total population per active CDD trained.

3. Extent of integration of CDTI projects into the health system.

4. Strengths and weaknesses of the national onchocerciasis control program; challenges

and how they were overcome; and opportunities that will strengthen the program. 5. Key activities undertaken by the NOTF during this reporting period.

6. Progress on vector elimination activities (where applicable)

1 WHO/APOC, December 15, 2004

SECTION 1: Background information 1.1. General information

1.1.1. Description of the country program –CDTI and vector elimination (briefly)

- Status of National plan implementation, population at risk, number of projects being implemented, other relevant activities, infrastructure (eg. Adequate health facilities, is system decentralized or not, etc), logistics, administrative structure.

- Health system & health care delivery (state any problems related to health system that impede program implementation).

- Provide map locating all projects (CDTI and Vector Control, if any) within country.

1.1.2. Partnership

- Indicate the partners involved in project implementation at all levels (MoH, NGDOs -national, international)

- Describe overall working relationship among partners, clearly indicating specific areas of project activities where all partners are involved (planning, supervision, advocacy, resources mobilization, endemicity mapping / assessment, development of IEC materials, studies or surveys etc).

- State plans if any to solve any issues arising as regards CDTI implementation. 1.2. Population and Health system Table 1: Projects and population at risk in the entire country whether they are treated or not

during the reporting period. (Please add more rows if necessary) Name of CDTI Project

Total communities in meso/hyper-endemic zone

Total population in meso/hyper-endemic

zone

Ultimate Treatment Goal (UTG) by 2010

TOTAL Source: From Oncho Project reports: National census: Other source, specify____________________ Year of source: _______________________ 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 expected to reach the UTG at the end of the 3rd year of the project).


SECTION 2: Summary of CDTI Implementation 2.1. Distribution period Chart the actual distribution period for each CDTI Project in the country in the table below. Table 2: Overview of distribution undertaken by project (insert rows as needed)

Distribution Period Project Name Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Briefly note any problems/issues (one paragraph). 2.2. Advocacy and Sensitization

a) State the number and type of policy / decision makers mobilized at the national and lower (state and district level) during the current year; the reasons for the sensitization and outcome.

b) State progress made towards internal resource mobilization. c) Describe any policy-related constraints being faced by any particular project and

describe what was done to assist the project (outcome). Explain any plans on how to improve advocacy.

2.3. Information, Education and communication strategy and materials development

Briefly describe the IEC strategy being used in the country for CDTI. Note if any new IEC materials were developed or revised, the type of the material, the message and target audience, and where they were distributed. - How were the IEC materials developed ? - Are the materials reviewed to address upcoming issues (like decreasing refusals,

sustainability, maintaining compliance to long-term treatment, SAEs)? - Report if any KAP surveys have been done and how their results were used? Summarize information on: - The use of appropriate and innovative media and/or other strategies to disseminate

information among the projects; - Mobilization and health education of women and minorities – method and response - Major accomplishments; - Weaknesses/Constraints ; - Suggest ways to improve mobilization of the target communities among projects.


2.4. Communities’ involvement in decision-making Comment on community participation making comparisons among projects - Participation of female and youth members of the community at health education

meetings; - In general, how do you rate the participation of minority groups and female members in

community meetings, decision-making, (attendance, participation in the discussion etc.) other issues.

2.5. Capacity building Training of national, district level staff in CDTI and general management skills (computer applications, project planning, etc.) Briefly describe any training done by the NOTF for specific CDTI or Vector Control Projects (Objectives, participants, outcomes, any follow-up needed). Table 3: Type of training undertaken at national level by the GTNO/NOTF

(Tick the boxes where specific training was carried out during the reporting period) Type of training Project

staff MOH staff Opinion

Leaders Others(specify)

Program management

How to conduct Health education

Management of SAEs

CSM SHM Data collection Data analysis

Report writing Others (specify)

Briefly describe any technical assistance provided to the CDTI projects. Fill in table 4 on the next page.


Table 4: Summary of training done by projects (Please add more rows if necessary). Ensure that ‘New’ and ‘Refresher’ training are recorded separately. Make sure there is no double counting.)

Number of Project staff trained Number of Health

center/post staff trained

Number of other training of trainers ( TOTs)

Number of CDDs trained

Project name ATrO

C1

New

C2

Refr

C3

Total C4=

C2+ C3

ATrO

C5

New

C6

Refr

C7

Total C8=

C6+ C7

ATrO

C9

New

C10

Refr

C11

Total C12=

C10+ C11

ATrO

C13

New

C14

Refr

C15

Total C16=

C14+ C15

TOTAL

% Achievement % Achievement % Achievement % Achievement * Ensure that ‘New’ and ‘Refresher’ training are recorded separately. Make sure there is no double counting.


2.6. Ordering, storage and delivery of ivermectin Please describe how Mectizan® is ordered and how it gets to the communities. Please comment on whether ivermectin delivery has been integrated into the essential drugs delivery system at the national and lower levels or not. State activities under ivermectin delivery that are integrated into the national health care system in the country. Please state where any remaining Mectizan® is stored after the distribution cycle. Table 5: Mectizan® Inventory (Please add more rows if necessary)

Number of Mectizan® Tablets Who (MOH,WHO, UNICEF, NGDO)does the following to

Mectizan ?

Project Name

Requested Received Used Lost Wasted Expired Remaining Orders Stores Delivers - Any other comments 2.7. Treatments 2.7.1. Treatment figures Please fill in table 6 on the following page.


Table 6: Treatment and SAEs by Projects in all areas at risk (Please add more rows if necessary) Communities/Villages Population

Project

Total # of communities/ villages in the meso/hyper-

endemic areas D1

Annual Treatment Objective

D2

Number of communities/

villages treated

D3

Geographical coverage

(%)

D4= D3/ D1*100

Total population of the

meso/hyper-endemic areas

D5


D6

Number of persons treated

D7

Therapeutic coverage

(%)

D8= D7/ D5*100

Number of persons

who refused the treatment

Number of absentees

Number of SAEs

Number of serious adverse

events (SAEs) referred to the

health post/hospital

TOTAL

Formula for computing therapeutic and geographical coverages Therapeutic coverage rate = Number of people treated x 100 (%) Total population living in meso/hyper-endemic communities within the project area Geographical coverage rate = Number of communities/villages treated x 100 (%) Total number of meso/hyper-endemic communities as identified by REMO in the project area ATO coverage rate = Number of people treated x 100 (%) Annual Treatment Objective % UTG achieved = Number of people treated x 100 Total number of people to be treated in meso/hyper-endemic areas within the project area (UTG) 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. UTG = The maximum number of people to be treated in meso/hyper-endemic areas within the project area, ultimately to be reached when the project has reached full geographical coverage (normally the project should be expected to reach the UTG at the end of the 3rd year of the project).

WHO/APOC, December 15, 2004 7

- If the projects are not achieving 100% geographical coverage and minimum of 65% therapeutic coverage rate or if coverage rate is fluctuating, state reasons and plans being made to remedy this.

2.7.2 In general, what are the causes of absenteeism and refusals and how is the NOTF dealing with them?

2.7.3. Briefly describe all known and verified serious adverse events (SAEs) and

provide in table 7 the required information when available. 2.7.4. In case the country has had no case of serious adverse event (SAE) during this

reporting period, please tick in the box. Table 7: Cases of Serious Adverse Events (SAEs) that occurred during the reporting period

(Please add more rows if necessary) Name of project

Number of verified* SAE cases reported

Action taken Number of cases with sequelea

Number of deaths

* SAEs should be verified by project coordinator Sequelea is defined as those cases that have not recovered fully from the SAE and are left with lasting neurological or other debilitating effects.

No case to report


2.7.5. A summary of the trend of treatment achievement per project from inception of first CDTI project to the current year What is the ultimate treatment goal for the entire country? _______________________________ Table 8: Treatments and coverage by calendar year for the entire project area. (Please fill in the required data for the country as a whole – combine data from all CDTI projects into a national figure)

YEAR

Total # of communities/ villages in the meso/hyper-

endemic areas E1

Geographical coverage

(%) E4=

E3/ E1*100

Total population of the

meso/hyper-endemic areas

E6


E7

Therapeutic coverage (%)

E9=

E8/ E6*100

UTG Coverage

(%)

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010


2.8. Supervision 2.8.1 Note the supervision that was undertaken by the NOTF (Project supervised, date,

by whom, objective of supervision mission, outcome, follow-up needed) Table 9: Supervision undertaken by the NOTF (Please add more rows if necessary) Project Name Supervisor Date Objective of

supervision Outcome/follow-up needed

2.8.1. What were the main issues identified during supervision? 2.8.2. Was a standard supervision checklist used? 2.8.3. What were the outcomes at each level of CDTI implementation supervised? 2.8.4. Was feed-back given to the supervised, and how was the feedback used in

improving the overall performance of the project? 2.9. Community self-monitoring and Stakeholders Meeting Table 10: Community self-monitoring and Stakeholders Meeting (Please add more rows if

necessary) Project Name

Total # of LGAs or districts in the entire

project area

No. and % of LGAs or districts that carried out self monitoring (CSM)

No. and % of LGAs or districts that conducted

stakeholders meeting (SHM)

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.


2.10 Compliance to long-term treatment with Ivermectin Mention specific activities in the Table 11 that the NOTF has done to ensure that CDTI projects comply with long-term mass treatment with ivermectin? (For projects 4 and above years old) Table 11: Activities of that promote compliance to long-term treatment with ivermectin

Objective Specific Activities Project targeted 1. Promote Integration of CDTI with other health care services

2. Maintain high therapeutic (>65%) and geographic(100%) coverage

3. Promote strong community ownership

4. Promote high government commitment

5. Support strong partnership

6. Put in place a strong IEC strategy that encourages continued treatment

Other


SECTION 3: Other activities of the NOTF

3.1 Describe any additional activities undertaken by the NOTF (REMO, RAPLOA, KAP studies, vector elimination where applicable, etc).

3.2 What was done to coordinate CDTI Project activities?

3.3 Note meetings convened for the NOTF. (objective of meeting, issues

addressed, date, participants, outcome, constraints faced follow-up needed)

3.4 Note meetings attended to provide technical input to other projects, other

countries, or other sectors.

3.5 Briefly state any administrative duties undertaken - Number and type of reports reviewed (technical, financial), - Reports forwarded to APOC management, - Administrative assistance or trouble shooting for projects.

3.6 Insert the Plan of Action for the NOTF activities for the current year indicating activities by month, which were implemented.

3.7 Insert the Plan of Action for next year.


SECTION 4: Support to CDTI 4.1. Financial contributions of the partners Table 12: Summary of financial contributions by all partners to all CDTI Projects for the year under reporting

Contribution (money or items in kind released) Name of project

Ministry of Health NGDO Partner Local CBO/ communities

District Others

Total

Note: figures should include contributions in kind such as salaries paid by the MOH, etc.


If there are problems with release of counterpart funds, how were they addressed? - Comments State the number of projects that had no funding from APOC Trust Fund? _________ State the number of projects that had no funding from any outside source?_________ State the number of projects that are late in submission of the financial reports to APOC?____________________ 4.2. Other forms of community support - Describe (indicate forms of in-kind contributions of communities if any) 4.3. Resource mobilization efforts - Describe activities undertaken by the NOTF to raise funds or mobilize in-kind resources

and the outcome of those efforts. 4.4. Expenditure per activity by the NOTF secretariat - Indicate the expenditure on activities below in US dollars using the current United Nations exchange rate to local currency Table 13: Indicate how much the NOTF secretariat project spent for each activity listed below

during the reporting period

Activity of NOTF secretariat Expenditure ($ US) and

Source(s) of funding APOC MOH NGDO OTHER Drug delivery from NOTF HQ/entry point to projects, districts, etc

Monitoring and supervision of CDTI Projects

Training of Project officers, TOT, NOTF staff, etc.

Advocacy visits to health and political authorities at national level

IEC KAP studies, materials development,

Annual review workshops Bi annual NOTF meetings Fuel and maintenance of Vehicles, Maintenance of office equipment Stationery Others TOTAL Total number of persons treated

- Comments


4.5. Equipment Table 14: Status of equipment of NOTF Secretariat Project (Please add more rows if necessary)

APOC MOH Other donors

NGDO Private Source Type of Equipment Condition of the equipment * Please state

1. Vehicle 2. Motor cycle 3. Computers 4. Printers 5. Fax Machines 6. Others a) b) c) *Condition of the equipment (Functional, Currently non-functional but repairable, Written off). How does the project intend to maintain and replace existing equipment and other materials? - Describe the adequacy of available knowledgeable manpower at all levels. - Where frequent transfers of trained staff occur, state what project is doing or intends to do to remedy the situation (The most important issue is what measures were taken to ensure adequate CDTI implementation where not enough knowledgeable manpower was available or staff often transferred during the course of the campaign).


SECTION 5: Evaluation for sustainability of CDTI, Independent monitoring and other reviews 5.1. Independent participatory monitoring/evaluation

5.1.1 Was any independent Participatory monitoring and/or evaluation carried out during the reporting period? ____________ Table 15: Overview of when monitoring and evaluation undertaken (Please add more rows if necessary) Project Name (After Year 1)

participatory independent monitoring

Mid-term sustainability evaluation (3rd year)

Independent monitoring after 4th year

Evaluation For sustainability (5th year if necessary)

Internal monitoring by NOTF

Other evaluation by partners

5.1.2 In general, what were the recommendations?

5.1.3 In general, how have they been applied/ implemented?

5.1.4 Any other comments?


5.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) What arrangements have been made to sustain CDTI after APOC funding ceases in terms of : 5.2.1. Planning at all relevant levels. 5.2.2. Funds 5.2.3. Transport and equipment (replacement and maintenance) 5.2.4. Human resources 5.2.5. Which projects have submitted sustainability plan? 5.2.6. To what extent have the plans been implemented? 5.3. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration. 5.3.1. Ivermectin delivery mechanisms

5.3.2. Training 5.3.3. Joint supervision and monitoring with other programs

5.3.4. Release of funds

5.3.5. Is CDTI included in the PHC budget?

5.3.6. Describe other health programmes that are using the CDTI structure and how

this was achieved. What have been the achievements? 5.3.7. Describe other issues considered in the integration of CDTI 5.3.8. Describe the integration of other programs into CDTI in your country and the

results of this integration on CDTI (e.g. Is Vitamin A supplementation integrated and what are the results, is screening for cataract of primary eye care interventions integrated in all or some projects, if no integration has taken place, are there plans to pilot test a strategy, etc?)

5.4 Operational research 5.4.1. Summarize in half of a page the operational research undertaken in the country

area within the reporting period. 5.4.2. How were the results applied in the project?

5.4.3 Note the issues that have been identified by the NOTF for future operational research.


SECTION 6: Strengths, weaknesses, challenges and opportunities - List the strengths, weaknesses, opportunities and threats of CDTI implementation process. - List the strengths, weaknesses, opportunities and threats of the vector elimination project

(where applicable ). - Indicate how challenges were addressed. - Indicate how opportunities can be utilized to improve CDTI.

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