Guide for NTD Master Plan Ver Nov 5 2010

8/6/2019 Guide for NTD Master Plan Ver Nov 5 2010

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NEGLECTED TROPICALDISEASES (NTD)

PROGRAMME

DISEASE PREVENTIONAND CONTROL (DPC)

CLUSTER

GUIDE FOR PREPARING

MASTER PLAN

FOR NATIONAL NEGLECTED

TROPICAL DISEASES

PROGRAMMES

IN THE AFRICAN REGION

November 2010

DRAFT


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Guide for preparing Master Plan for national NTD Programmes

ii

World Health Organization

Regional Office for Africa


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iii

Contents

INTRODUCTION 4

PART ONE: SITUATION ANALYSIS 6

1. COUNTRY PROFILE 7 1.1. Administrative structure, demography an d Community Structure 7 1.2. Geography 8 1.3. Socio Economic Situation and indicators 8 1.4. Transport and Communication 8 2. HEALTH SYSTEM SITUATION ANALYSIS 9 2.1. HEALTH SYSTEM GOALS AND PRIORITIES 9 ANALYSIS OF OVERALL HEALTH SYSTEM 9 3. NEGLECTED TROPICAL DISEASE SITUATION ANALYSIS 11 3.1. EPIDEMIOLOGY AND BURDEN OF DISEASE 11 3.2. NTD PROGRAMME IMPLEMENTATION 12 3.3. GAPS AND PRIORITIES 12

PART TWO: NTD STRATEGIC AGENDA 13

2.1. OVERALL NTD PROGRAMME MISSION AND GOALS 13 2.2. GUIDING PRINCIPLES AND STRATEGIC PRIORITIES 14

PART THREE:OPERATIONAL FRAMEWORK 15

3.1 NATIONAL NTD PROGRAMME OBJECTIVES, STRATEGIES, TARGETS AND INDICATORS 15 3.2. STRENGTHENING GOVERNMENT OWNERSHIP, ADVOCACY COORDINATION AND PARTNERSHIPS 16 3.3. ENHANCE PLANNING FOR RESULTS, RESOURCE MOBILIZATION, AND FINANCIAL SUSTAINABILITY 17 3.3. SCALING UP ACCESS TO NTD INTERVENTIONS TREATMENT AND SERVICE DELIVERY CAPACITIES 18 3.3.1. SCALING UP PREVENTIVE CHEMOTHERAPY INTERVENTIONS 19 3.3.2. SCALING UP CASE MANAGEMENT NTD INTERVENTIONS 20 3.3.3.S CALING UP NTD TRANSMISSION CONTROL INTERVENTIONS 21 3.4. STRENGTHEN CAPACITY AT NATIONAL LEVEL FOR NTD PROGRAMME MANAGEMENT AND IMPLEMENTATION 22 3.5. MONITORING AND EVALUATION 23

BUDGET ESTIMATES 25

ANNEXES TO THE COMPREHENSIVE NTD MULTI YEAR PLAN OF ACTION 28


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4

INTRODUCTION

Master Plan for control of NTDs are essential for effective planning and implementation of sustainable NTD programmes in the African region. Each national NTD programme comprehensive multi year plan (the NTD Master plan) provides national NTD programme goals, objectives and a strategy for 3 5 years based upon extensive situational analyses, and addresses all components of the NTD programmes relevant to the country. It enhances synergies between various NTD initiatives (e.g., GWE, LFE, etc.) provide the basis for integrated / linked NTD project plans and includes costing and financing requirements for effective NTD programme performance. In addition, the NTD Programme Master Plan includes scenarios and strategies for financial sustainability that link to the health sector budgeting / planning cycles and encourages strong linkages with other programmes within and outside the health sector in each country.

The new thrust that NTD Programme Master Plan brings includes the following:

Ensures that the strategies in the plan are sufficiently comprehensive (includes both PCT and case management NTDs) and based regional priorities, targets and goals.

Plans by national strategic priorities rather than by disease or initiative;

Integrates and consolidates activities with other health interventions and within the NTD programme to solve shared problems;

Evaluates the costs and financing of the NTD Programme Master Plan in order to ensure financial sustainability and links the NTD programme to health sector planning and financing mechanisms.

Provides

a

strong

basis

for

country

Annual

NTD

Work

Plans

The preparation of NTD Master Plans is part of a process that includes analysis and NTD programme plan development, approval and dissemination of the national NTD strategy and operational plans. Therefore this guideline is to assist countries in the African Region to develop high quality strategic plans bearing in mind the need to meet the MDGs target for 2015. It also aims to provide all partners working in NTD in the African Region with a harmonized tool, which will facilitate the joint support to countries.

The document will also form the basis for integrated implementation of all NTD activities in each country. Progress in implementation of planned activities as well as programme performance / outputs will be monitored regularly and evaluated at appropriate intervals. The strategic plan will be the framework for partners coordination, harmonization and alignment. Therefore, consensus on the content will facilitate the implication, commitment and accountability of stakeholders for resource mobilization. In country consultations with all stakeholders will also serve as platforms for reviewing progress and lessons learned, based on which the national NTD multiyear plan may be updated or revised, as required (see the figure below).

It is organized around three main parts, the Situation Analysis, the NTD Strategic Agenda and the Operational framework.


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Figure 1: Stages of NTD MASTER PLAN preparation


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PART ONE: SITUATION ANALYSIS

This section of the NTD strategic plan should describe different environments within which the NTD

programme

will

be

developed

and

implemented.

These

are:

1. The National environment (Country profile and how the various elements of the profile affect the epidemiology of endemic NTDs and their control)

2. The health system environment within which the NTD Programme operates including the place of NTDs in the national health plan and the commitment of heath authorities to their control.

3. The NTD Programme environment including the major NTDs in the country and their disease burden, the previous strategic plans if any, partnerships, achievements and challenges.

Figure 2: The 3 elements of NTD Situational analysis


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1. COUNTRY PROFILE

As stated above this section should describe the national environmental and contextual factors that are critical to understand the distribution of NTDs as well as their control. It should include issues

related

to

the

a.

Administrative

structure,

demography

and

community

structure;

b.

Geographic

characteristic; c. Socio Economic Situation and indicators; d. Transport, Communication and Technology.

1.1. Administrative structure, demography an d Community Structure

This information will be important for determining denominators when assessing coverage of control interventions.

i. Describe the political and administrative levels of the country (provide a national map displaying districts, implementation units etc).

ii. Describe the population giving rural/urban distribution, general male/female ratio,

distribution by district and by different age groups targets of programmes (0 6 months, 6 59 months, under 5 years, 5 14 years; 15 years and above) ; population growth rates, primary school enrolment rates, numbers of health facilities and primary schools per district, health service coverage (distances and catchment population).

iii. Please indicate the date of last census. (Summarize the information in a table example in annex)

iv. Provide background information on the social organizations of communities. This may include information on:

Settlement patterns of the communities (e.g. hamlets, seasonal farmsteads, dispersed populations, ethnic group(s) in the communities, etc

v. Provide

information

on

the

communities

living

the

area

to

be

covered

by

the

NTD

programme:

Community leadership structure

Status of the community: migrants, nomads, refugees or internally displaced populations

Main occupation of communities and periods of major communal activities

Preferred channels of communication in the community

Existing active community associations/groups in the area (e.g. social, religious, etc.)

Established distribution systems in the community

Any previous experience of the community with development/health projects

Description of other anthropological characteristics of the communities.

Role of women group and other social organizations, in particular in relation to social mobilization, community based interventions etc.

Table 1: National Population Data

Province/ Region District

No. of villages/ communities*

Total Population

Under fives 5 14 years

No. Primary schools

No. health centers

* Where implementation units are not the same as administrative units (e.g., Onchocerciasis interventions target communities in a district.


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1.2. GEOGRAPHY

This section should provide information on elements that can affect the occurrence and the distribution of NTDs in the country: physical location of the country and its neighbors, drainage, relief, vegetation and seasons.

Describe

the

following:

i. The major geographic characteristic of the country. E.g. forest, desert, coastal zones, rivers, lakes,

ii. Meteorological data: monthly rainfall, seasonal pattern, rainy days per month, average monthly temperatures, and relative humidity.

iii. Please provide a map for illustration.

1.3. SOCIO ECONOMIC SITUATION AND INDICATORS

Information in this section should describe the possible impact neglected tropical diseases may have on the national economy and socio economic status of individuals either directly or indirectly. Examples of common economical bases are Industry, Agriculture (irrigation, rice growing, livestock ,

Tourism, Fishery, etc.)

i. Describe the main economic base of the country and their proportionate contribution to the Gross National Product (GNP). Describe the major sources of national income. Highlight occupational aspects that are risk factors for NTDs.

ii. Provide some socio economic indicators of the countrys economic performance, such as Gross Domestic Product, Human Development Index, Inflation rate, Unemployment rate, life expectancy, Infant mortality rate per 1000 live births, under five mortality rate, and percent stunted children.

1.4.

TRANSPORT

AND

COMMUNICATION

Information in this section should provide a description of the existing transport and communication systems that can assist in planning and implementing programme activities.

i. Describe the main transport and communication systems and their networks to districts and beyond districts.

ii. Describe available facilities and constraints concerning transport and communication beyond districts, specifically for health facilities and schools, including telephone network coverage and utilization rates. Include in this description the status of advancements in communication technology (e.g. cell phone, radio, etc) in the country that can affect implementation of NTD programmes.

iii. Indicate the extent to which the existing transport and communication systems can be relied on for disease surveillance and control activities, and what improvements (if any possible) will be required specifically in relation to NTD control activities.

iv. Provide a table with major cities and joining distances to be put in Annex (these tables are usually available in the country).


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2. HEALTH SYSTEM SITUATION ANALYSIS

2.1. HEALTH SYSTEM GOALS AN D PRIORITIES

In addition to describing the overall country profile, it is crucial to provide a clear analysis of the health system within which the NTD Programme operates. This section should describe the health system goals and priorities including the top ten health problems in your country, the process of priority setting the place of NTDs in the national and sub national lists of priority diseases.

ANALYSIS OF OVERALL HEALTH SYSTEM

Provide a clear view on the health system performance in delivering personal and population based services to those in need and when needed.

Analyze the equity in the health system in term of access, coverage and quality of health services, distribution and utilization of resources and finally the impact on health status indicators such as the

reduction of infant mortality rate.

Information in this section is important for detailed planning of programme activities in terms of sourcing for funds, co ordination at various levels, custodian of the program, integration etc.

The analysis should be done using the WHO framework for strengthening the health system with the six building blocks: a) Service delivery; b) Health workforce; c) Information d) Medical Product, vaccines & technologies; e) Financing; f) Leadership and governance.

a). Service Delivery

Please analyze the general functioning of the health care delivery system and mechanisms and describe how it affects the control of NTD. This includes the service delivery package, delivery models, management, safety and quality, demand for care, equitable access

b). Health work force

Please describe the general situation of human Resource, this includes the Issues and Challenges, the National workforce policies and investment plan, norms, standards and data, distribution, skill mix and describe how it can affects the control of NTD.

c). Health Information

Describe

the

general

situation

of

the

Health

information

system

and

describe

how

it

can

affects

the

control of NTD. This includes Health facility and population based information and surveillance systems, tools, production, analysis and use.

d). Medical Product Please describe the system in place for handling Medical Products including norms, standards, policies, reliable procurement, supplies and management systems and drugs quality assessment. Describe the constraints if any for the supply logistic for the control of NTD.


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e). Health financing

Please describe the system in place for financing health programmes including national health financing policies, budget allocation to the health sector and to the various functional units of the health system, tools and data on health expenditure. What proportion of the total government budget is allocated to NTD? What is the government policy on donor support to the health sector?

State the funding mechanisms put in place e.g. Sector Wide Approach and how NTD programmes will fit into it.

f) Leadership and Governance

i. Briefly describe the administrative hierarchy of the Ministry of Health and responsibilities at each level.

ii. Are there reforms to the health system, or parts of it, being carried out in your country? iii. Are existing conditions of health reforms and PHC supportive of NTD control activities even if

they are not a national priority? iv. Is there a national policy on NTD control or an institutional framework for NTD control?

v. Are NTDs included in the Health Sector Strategic Plan and included in the sub national health work plans?

vi. Is there a common National Coordinating body overseeing all control programmes or individual coordinating bodies are constituted for specific programmes?

vii. Provide an organizational chart (organograms) showing the position of NTD Programmes and Programme Coordinator and Managers.

viii. Describe the constraints if any for the leadership and governance systems in the control of NTD.

ix. Indicate what other Ministries (e.g. Agriculture, Local government etc) and government sectors are involved in health care in general and NTD control in particular. Describe the collaboration between the Ministry of Health and these sectors. For the Ministry of Education provide details on activities of school health programmes in general and specifically in control of Schistosomiasis and soil transmitted helminthiasis. Provide information on status of inclusion of NTD control in content of primary school curriculum.


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3. NEGLECTED TROPICAL DISEASE SITUATION ANALYSIS

3.1. EPIDEMIOLOGY AND BURDEN OF DISEASE

The information contained in this section should provide the current status of NTD endemicity and current control interventions and also guide the selection of areas that can immediately be targeted for NTD interventions. Information from surveys and health service data (health case records) are equally important in contributing to the known status of disease distribution. The latter is particularly important for case management diseases.

i. Provide a list of the NTDs that are endemic in the country giving levels of morbidity and mortality reported during the past 5 years.

ii. Describe the known distribution of each of the endemic NTDs from conducted studies and other sources of information in form of:

a. Table showing location/study site, prevalence, methods used, year of data collection and reference (see format below).

b. Country map showing the distribution of each of the NTDs and their overlap based on the reviewed literature in the table in Annex (this information will be used to construct a map)

Table 2: Disease: e.g. Schistosomiasis

District Location/ Site

Prevalence (numbers/ rate/proportion)

Method used Year of survey & Reference

GPS coordinates

Sikiliti Munzi 45% Urine filtration 2006

iii. Show

the

co

endemicity

of

NTDs

by

district

using

the

information

in

the

disease

specific

table(s) above. See example below Table 3: NTD Co endemicity

Region District Diseases

NTD1 NTD2 NTD3 NTD4 NTD5 NTD6 NTD7 NTD8

Silalo Sikiliti + + + + +

iv. Based on the information provided in tables above, please analyze the outstanding mapping needs for each endemic NTD in your country and summarize in Table as shown in example below.

Table 4: NTDs mapping status

Name of endemic NTD No of districts suspected to beendemic

No of district mapped or known endemicity status

No of districts remaining to be mapped

Schistosomiasis 25 20 5


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3.2. NTD PROGRAMME IMPLEMENTATION

i. List the past and on going NTD control programmes. This information should be organized in to two sections: a) interventions for PCT Diseases and b) Interventions for Case Management Diseases

ii.

Describe the interventions (past and on going) to control specific NTD. This Information can be summarized in a table as shown below.

Table 5: Summary information

NTD Date programme started

Total No. of districts targeted

No. of districts covered *(Geographic coverage)

Total population in target district

No. of (percentage) Population covered

Key strategies used

Key partners

LF 2001 110 50 2,800,000 1400,000 (50%) MDA

*Geographical Coverage = No. of districts covered by the programme Total No. of endemic districts in the country

3.3. GAPS AND PRIORITIES

Given the analysis conducted in the sections above (country profile, health system analysis, and NTD Programme status) conduct a SWOT analysis of the NTD programme and summarize this information in a table as per example below:

Table 6: SWOT analysis of NTD programme

Strengths Weaknesses

Opportunities

Threats

Based on the SWOT Analysis, what are the major gaps and priorities for the formulation of the strategic objectives?


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PART TWO: NTD STRATEGIC AGENDA

The NTD Master Plan, as a Multi year strategic plan, require a clear strategic agenda. The

Strategic

agenda

of

the

national

NTD

programmes

should

articulate

the

overall

programme

vision, mission and goals. It should also delineate the Strategic Goals and Major Programme Focus and Strategic Milestones. In addition, the Strategic Priorities and Strategic Objectives should indicate the main pillars of excellence as well as the continuous improvement objectives that the programme seeks to achieve during the life cycle of the Master Plan, as shown in the Figure below.

Figure 3 : NTD Strategic Agenda

2.1. OVERALL NTD PROGRAMME MISSION AN D GOALS

The goal of AFRO NTD strategic plan: To establish, by 2015, sustainable integrated national NTD control programmes capable of achieving the set goals of individual programs, thereby leading to the elimination of NTDs as public health problems in endemic countries in the African Region


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Example:

The vision for NTD control in the African Region To ensure that WHO provides leadership and technical expertise to national NTD control programmes in a manner that strongly embodies evidence and innovation in a well coordinated and well funded organizational climate that addresses all NTDs.

The mission of a control program is a sub component of the Ministry of Health mission and should reflect its unique role.

Example: provide the population in country X with the most effective tools and services for NTD prevention and control in an equitable manner.

2.2. GUIDING PRINCIPLES AN D STRATEGIC PRIORITIES

Indicate the guiding principles for the preparation of this NTD Master Plan. Priority interventions will be guided by the situation analysis and the country readiness for sustained control, pre elimination

and

elimination.

This

section

will

indicate

whether

the

country

is

in

accelerated

control,

consolidation

or moving to pre elimination and elimination.

Please describe how control of NTDs control will be managed in your countries specifically in relation to the four strategic priorities below:

Strategic Priority 1: Strengthen government ownership, advocacy, coordination and partnerships

Strategic Priority 2: Enhance planning for results, resource mobilization and financial sustainability of national NTD programmes

Strategic Priority 3: Scale up access to interventions, treatment and system capacity building

Strategic Priority 4: Enhance NTD monitoring and evaluation, surveillance and operations research

Please construct a strategic framework summary table as in example below

Table 8: Strategic framework summary STRATEGIC PRIORITIES STRATEGIC OBJECTIVESStrengthen coordination and partnerships

Strengthen coordinating mechanisms for NTDs at national and sub national level in the country.

Strengthen NTD steering committees.


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PART THREE:OPERATIONAL FRAMEWORK

The operational framework component of the NTD Master Plan should describe how a country will operate in practice to implement the planned activities. The plan should also explain what the countrys capacity needs are, how resources will be mobilized, how to deal with potential risks, and how the sustainability of the project achievements will be ensured. This part is an essential component and should clearly explain how the programme outcomes will be attained.

It is important that the operational plan is elaborated in consultation with involving stakeholders to allow wider coverage of activities, avoid duplication of resources and to yield desired results even within the existing constrained resources for NTD control.

3.1 NATIONAL NTD PROGRAMME OBJECTIVES, STRATEGIES, TARGETS AND INDICATORS

The NTD programme is an integrated package of a number of disease specific programmes. It is important to maintain disease specific focus goal, objectives, strategies in the integrated package. Integration is being promoted as a cost effect approach and maximizes use of limited resources.

Please provide a summary table stating disease specific global goals, Objectives, Strategies, national targets, and Indicators for the targeted NTDs in your country. Information in this table will be used when developing subsequent sections below.

Table : Summary of NTD Disease Specific goals and objectives

NTD

PROGRAMME

GLOBAL GOALS NATIONAL GOALS


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3.2. STRENGTHENING GOVERNMENT OWNERSHIP, ADVOCACY COORDINATION AND PARTNERSHIPS

This section should describe how NTDs control will be streamlined at the sector level to effectively

establish

longer

term

multi

sectoral

involvement

at

various

operating

levels,

as

well

as

being

responsive to the larger National Development Goals. The existing interaction between national actors, planners and Developmental Partners should be foundation for describing how streamlining of activities will be effected. They should ensure that, there is sufficient advocacy such that their relevance is kept high in the agenda.

Guiding points to develop activities : i. Streamlining and incorporation of NTD in national and sub national health strategic plan,

ii. Incorporation of NTD control activities in the health facility service delivery, social services, education/training, employment, local government resources and opportunities;

iii. Regular NTDs discussions and update in country coordinating mechanism at all levels

iv. Regular reviews of NTD program (steering, task forces, secretariat, stakeholder) v. Forge, maintain and seek for more Partners vi. Co ordination and oversight of control activities within the existing country structures of the

Ministry of Health vii. Media engagement

With the above guiding points in mind, please provide a summary table on the key activities you plan to implement in order to achieve the Strategic Objectives for strengthening government ownership, advocacy, coordination and partnerships.

Priority 1: Strengthen government ownership, advocacy, coordination and partnership

Strategic Activity Details (Sub activities) Timeframe Resources needed

Strategic Objective 1: Strengthen coordination mechanism for the NTD control programme at national and sub national levels.

Strategic Objective 2: Strengthen and foster partnerships for the control, elimination and eradication of targeted NTDs at national, district and community levels.

Strategic Objective 3: Enhance high level reviews of NTD programme performance and the use of lessons learnt to enhance advocacy, awareness and effective implementation.

Strategic

Objective

4:

Strengthen

advocacy,

visibility

and

profile

of

NTD

control

elimination

and

eradication

interventions

at

all

levels.


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3.3. ENHANCE PLANNING FOR RESULTS, RESOURCE MOBILIZATION, AND FINANCIAL SUSTAINABILITY

This section should describe how effective systems that will continuously observe the prevailing trends in health priorities and financing, and donor strategies, will be established. This will lead to identification of better strategies for NTDs resources mobilization, partnership and financial sustainability. The objectives should primarily aim at generating adequate resources as well as establish an enabling environment that would suit resource mobilization for the multi year comprehensive NTD plan

Guiding points

Formulation of annual operational plan for the control elimination and eradication of target NTDs at national and subnational country

Incorporate NTD in planning guide at national and subnational Production of resource mobilization strategies

Production and Use of evidence for resources mobilization Establishment of reliable processes and systems to support mobilization Institute better communication channels and information flow Ensuring the environment is enabled and supportive Good accountability systems for resources monitoring and control

With the above guiding points in mind, please provide a summary table on the key activities you plan to implement in order to achieve the four Strategic Objectives for enhancing planning for results, resource mobilization and financial sustainability of national NTD programmes.

Strategic Priority 2: Enhance planning for results, resource mobilization and financial sustainability of national NTD programmes.


Strategic Objective 1:


Strategic Objective 3



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3.3. SCALING UP ACCESS TO NTD INTERVENTIONS TREATMENT AND SERVICE DELIVERY CAPACITIES

Information in this section should give the detailed description of activities that will form the basis for scaling up NTD control activities.

Based on the WHO manuals on Preventive Chemotherapy and Approaches to implementation on integrated NTD programmes and also guidelines on case management diseases and other disease specific guidelines, the following three packages of interventions have been recommended by the WHO:

o Preventive chemotherapy; o Case management/chronic care; and o Transmission control (which includes vector and reservoir control as well as

improvements in sanitation and water quality and supply). ii. Use the information in the situation analysis section and relate this to the available disease

specific guidelines to make the decision on whether to intervene or not.

iii. Identify priority implementation units/communities for control activities for each NTD programme and summarize in table below.

Table:

Name of NTD Total No districts above threshold for intervention

Total number of districts where mapping is required

iv. State the main interventions/strategies as well as methods (delivery channels) that will be used to achieve the stated goals and objectives as well as the timing of delivery of interventions where this applies (e.g. MDA).

Mass drug administration, case management and transmission control are the major strategies common in the control of NTDs. Recognizing the commonalities existing in the disease specific strategies, NTD control can therefore be carried out jointly for a number disease specific programmes. Provide information in packages of NTDs that share the same strategy and present this information in separate tables for each package and a summary map for mass drug administration package according to types of MDAs required in the different implementation Units (districts).


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3.3.1. SCALING UP PREVENTIVE CHEMOTHERAPY INTERVENTIONS

Preventive chemotherapy is a package of activities that leads to and includes mass distribution distribution of drugs to target populations. This package of activities is summarized in Annex 1. Depending on the types of diseases targeted, and their overlaps, there are variations in types and numbers of the different drugs combinations distributed at a particular time. This information is

summarized in the Algorithm given in the Preventive chemotherapy Manual.

i. Based on the list of preventive chemotherapy diseases targeted in your NTD programme, provide a brief description of interventions and tabulate the package of activities as in Annex 1. (Package 1.1).

ii. Use the Algorithms to describe the types of mass drug administrations that will be required in your targeted districts. Please summarize this information as in table below.

Package 1.2 : Types of Mass drug administration

CROSS CUTTING MDA TYPES

Delivery channels Timing of treatments

Disease Combination Requirements Target (Districts) list

Other mass disease control interventions

MDA1, MDA4 & T1 One annual round of MDA ivermectin / DEC and albendazole one annual round of MDA with azithromycin school based treatments with (PZQ & ALB/MBD )

Community based campaigns / CDTI School based

Month 1 and Month 6

Lymphatic Filariasis,Onchocerciasis, Schistosomiasis, STH, trachoma

Training of Health Personnel Training of teachers & community volunteers. Social Mobilization. Supervision. Production of tools Logistics for drug distribution and management

EPI campaigns,ITN distribution and re treatment

iii. Please provide a summary table on the key activities you plan to carry out in order to implement

the PCT package as defined above.

Table : Activities for PCT interventions




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3.3.2. SCALING UP CASE MANAGEMENT NT D INTERVENTIONS

Case management is another package of activities that includes identification of patients of specific NTD and management of the patient. These actions require a package of activities which are summarized in Annex 2. Depending on the types of diseases targeted, and their overlaps, there may variations in types of activities that require to be carried out.

i. Based on the list of diseases that use case detection and management as their main strategy targeted in your NTD programme, tabulate the package of activities as in Annex 2. (Package 2.2).

ii. According to the disease combinations in the target areas, describe the various categories of interventions that will be conducted for a group of diseases in your targeted districts. Please summarize this information as in table below.

Package 3.2 : Case management and chronic care

CROSS CUTTING INTERVENTIONS

NTDS TARGETED REQUIREMENTS OTHER NON NTD OPPORTUNITIES FOR INTEGRATION

SURGERY Hydrocoele surgery (hydrocoelectomies) Trichiasis surgery Skin grafting

Lymphatic Filariasis hydrocoele, Trachoma trichiasis Buruli Ulcer late condition

Training of Medical Doctors and nurses Surgery kits, dermatome and mesh graft (for skin grafting) hospitals facilities or appropriate basic facilities with good surgical facilities Follow up/supervision

Capacity building for basic surgery at the district level

iii. Please provide a summary table on the key activities you plan to carry out in order to implement the case management package as defined above.

Table : Activities for case management and interventions


Strategic Objective 2:.


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3.3.3.SCALING UP NTD TRANSMISSION CONTROL INTERVENTIONS

Transmission Control activities are cross cutting for both vector borne and other diseases that do not involve a vector for their transmission. These activities include vector control and environment measures summarized in Annex 3. Depending on the types of diseases targeted, and their overlaps, there may variations in types of activities that require to be implemented.

i. Based on the list of NTDs are targeted in your NTD programme, tabulate the package of activities as in Annex 3. (Package 3.1)

ii. According to the disease combinations in the target areas, describe the various categories of interventions that will be conducted for a group of diseases in your targeted districts. Please summarize this information as in table below.

PACKAGE 3.2: Transmission Control

CROSS CUTTING INTERVENTIONS

TARGETED NTDS REQUIREMENTS OTHER NON NTD OPPORTUNITIES FOR INTEGRATION

Mosquito and sand fly control using: insecticide treated nets In door residual spraying Environmental management

Lymphatic Filariasis Leishmaniasis Dengue Malaria

ITNs, DDT, plastering of walls

Malaria vector control

Please provide a summary table on the key activities you plan to carry out in order to implement the transmission control package as defined above.

Table : Activities for transmission control




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3.4. STRENGTHEN CAPACITY AT NATIONAL LEVEL FOR NTD PROGRAMME MANAGEMENT AND IMPLEMENTATION

This section should give description of what is needed to strengthen the management and operational capacities of the NTD programme staff at different levels.

Guiding Points

Leadership and governance: structural reform within the health sector related to NTD programme, harmonization and alignment, oversight and regulation

Health workforce: Strengthening programme capacity (training needs in terms of enhancing human resources for the purpose of the control activities. Please indicate category (e.g. laboratory diagnosis), level, type or number of trainings required, unit for training)

Medical Product, vaccines & technologies: norms, standards, policies, reliable procurement, drugs, quality


Strategic Objective 4: Strengthening capacity at national level for NTD programme management and implementation

e.g. Training Quarter 1 Training modules

Leadership and management training Equipment

Scaling up plan

Based on identified priority areas for initiating programme activities in sections above, please describe how expansion of control activities will progress to attain total coverage within a specified period (Scaling up plan). This can be indicated in terms of phasing in targeted districts. The information can be presented in table form as below:

ACTIVITY Total No districts targeted by end of Master Plan

Geographic Coverage

Number and % of districts to be targeted each year

Year 1 Year 2 Year 3 YR4 Yr5


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EpidemiologicalContext

Socio-economicContext

(including SWAP,MTEF,Health Sector Reforms,

HiPC)

RESOURCE MOBILIZATION

FUNDING Internal andExternal Sources

HR - Availability, Competenceand Deployment

PLANNTD ComprehensiveMulti-year PlanNTD Annual OperationalPlan

COORDINATION, LINKAGESAND PARTNERSHIPS

NTD Steering Committeesand Disease SpecificTechnical Task ForcesProgramme ReviewsLinkages and integrationwith other programmes

NTD CONTROL PROGRAMMEIMPLEMENTATION

NTD Service Strengthening Integrated NTD PackagesApproachNTD interventions scale-up

CAPACITY BUILDINGNTD programme componentsInstitutions

People

MONITORING, DATA QUALITY ANDRESEARCH

Performance MonitoringData Quality monitoringResults-focused operationsresearchUse of Information for Action

NTDPROGRAMMESTRENGTHENED

Service deliveryDiseasesurveillanceLogisticsDrug supply andtrainingAdvocacy,communication& socialmobilization

Increased NTDServiceUtilization andCoverage

Reduced In-equity

IncreasedResponsive-ness

ImprovedCOMMUNITY

HEALTH

ReducedMORBIDITYfrom NTDs

CulturalContext

IMPROVEDSERVICES

AccessSafetyQualityImage

Coordination, Management process and ResourceTracking Implementation Monitoring

NTD controlMonitoring

CoverageMonitoring

ImpactMonitoring

Strengthen country NTD / health information system

Evaluation: Process, outcome, NTD control strengthening, impact

3.5. MONITORING AND EVALUATION

This section is one of the most important parts of the plan. It should contain information on monitoring and evaluation including the following: the indicators to be monitored for each disease, logical framework, and major M&E activities to be conducted. In the budget this section the M&E need to comprise 5 10% of the total budget.

Monitoring is the process of continuous observation and collection of data on the immunization programme to ensure that the programme is progressing as planned. Evaluation is the systematic and critical analysis of the adequacy, efficiency and effectiveness of the programme, its strategies as well as progress. Evaluation refers to long, mid term and annual analysis of performance in relation to the goals, objectives and target sets.

The WHO/AFRO regional framework for NTD programme monitoring and evaluation is shown below.


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The following guiding principles should be considered in developing your M & E plan: i. Please describe the existing system of M&E in the country including the HMIS and IDSR

system and how NTD information will fit in

ii. Describe the data flow from peripheral level to national level and periodicity

iii. Please also plan for period independent evaluation (e.g. at least every 3 years for outcome and every 5 years for impact depending on the type of disease to be evaluated).

Strategic Priority 4: Enhance NTD monitoring and evaluation, surveillance and operations research




Strategic Objective 3



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BUDGET JUSTIFICATION A ND ESTIMATES

A budget is a plan for future activities, and is a key management tool. It is essential for the national NTD programme to have a simple yet comprehensive budgetary plan in line with the multi year master plan. The budget of the multi year master plan should have the following key characteristics:

Comprehensive Concise Cost effective Accurate and persuasive to stakeholders

The information contained in this section will provide guidance on how to create a multi year NTD programme budget that is concise, comprehensive, realistic and cost effective, using Activity Based Costing (ABC) tool.

In each worksheet of the ABC tool, please enter the data as prescribed below.

Please enter text

Please enter numerical values

This is a protected cell containing formulas. Do not touch.

Sheet 1: Intervention

This sheet serves as a front cover. Please enter the following information.

Country name First year of budget projection (ex. 2011) Target population of MDA for Preventive Chemotherapy (LF, Onchocerciasis, Schistosomiasis,

STH and Trachoma)

Sheet 2: Population

This sheet auto estimates the projected population in the coming 5 years.

Please enter the following information in the yellow cells.

% of pre SAC population in total population (C3) % of SAC population in total population (C4) Population growth (%) (C5)


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Activity ResourcesProducts/

ServicesInputOutput

Activity ResourcesProducts/

ServicesInputOutput

TrainingPersonnelTransportMaterials

Strategic Priority 3

InputOutput

MDAPersonnelTransportMaterials

Input

MappingPersonnelTransport

Materials

Input

O u t p u

t

O u t p u t

2 nd Stage1 st Stage

TrainingPersonnelTransportMaterials

Strategic Priority 3

InputOutput

MDAPersonnelTransportMaterials

Input

MappingPersonnelTransport

Materials

Input

O u t p u

t

O u t p u t

2 nd Stage1 st Stage

If trachoma is also present in your country,

% 0 6 months population in total population (H3) % 6 59 months population in total population (H4)

Name of districts in your country (B10~)

Total population by district (C10~)

Sheet 3: Drug forecast

This sheet forecasts the number of drugs required for each PCT disease.

1) Please choose from drop down menu whether Onchocerciasis is endemic in your country or not (C3).

2) For each PCT disease (starting from LF):

Endemicity column : please enter the category of disease prevalence for each district. You can find the instruction on category by clicking the Endemicity cell in the heading of each disease (0,1,2 for LF, Oncho, Trachoma; 0,1,2,3,4 for Schistosomiasis and STH).

Year column (2011 2012 ): Please enter the planned number of MDA in each district for each year.

3) Please scroll down the sheet to reach Multi year drug procurement cost table. $ per tablet column : please enter the price of each drug. The default values are

international (WHO) price. Drug clearance cost cell (E841 L841): please enter the approximate cost incurred for

drug clearance for each year.

Sheet 4 7: Strategic Priority 1 4

In order to deliver each of the four strategic priorities, a series of activities will be performed in a national NTD Programme (e.g., mapping, training, MDA). And to perform each activity, various resources will be required, each of which incurs costs (e.g., personnel, transport, materials/equipment).


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1) Identify all the activities that should be performed to achieve each Strategic Objectives in the national NTD programme, and further identify sub activities (if necessary) .

2) For each activity (or sub activity), identify time frame and cost of resources that will be consumed (personnel, transport, or materials/equipment).

Cost drivers are the factors that cause changes in your overall activity cost. These sheets allow modification of Cost drivers (defined as Unit cost, Quantity, # days, # places, # times) in order to

explore various scenarios to reach the most cost effective option.

3) For each activity, identify cost drivers that cause changes in the activity cost. 4) In order to achieve cost efficiency, analyze the programme budget to see how you can change

the quantity of the cost drivers (e.g., through integration of interventions across diseases). For instance, see how the total cost changes when # training is reduced.

Sheet 8: Funding

This sheet provides the currently expected contributions by different donors and partners and the gap that needs to be filled in terms of funding and drug donation.

1) For each year, please enter the name of donors and partners that are currently supporting or expected to support your programme (eq. cell D3 J3 for 2011).

2) For each identified donors, please enter the expected amount of funds by Strategic Objective, or the amount of drugs to be donated by each donor (yellow cells D4 J8 for 2011).

Sheet 9: Summary

This sheet provides the summary of cost and gap in terms of funding and drug needs in the coming 5 years.

Sheet 10 15: Graphs 2011 2015

These

sheets

visually

illustrate

the

following

information,

based

on

your

data:

Cost breakdown by strategic objective Cost breakdown by resource category (personnel, transport, or materials/equipment) Donors contributions and funding gap

NB:

1. Requirements of districts (other than estimates of drugs) will not be reflected in this budget. These can be estimated by the districts using the same costing tool at district level.

2. Please protect the sheet, every time after you unprotect your sheet to modify the sheets, in order to protect the programmed formula.


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ANNEXES TO THE COMPREHENSIVE NTD MULTI YEAR PLAN OF ACTION

The following are the proposed Annexes to the Plan of action that will mainly provide justification for the budget estimates and support the various sections elaborated in the main body of the Plan.

PART ONE

Summary Population table

Table on distances between Major cities and district HQ

Organogram of MoH

Summary tables on available data on disease distribution

Table of Status of implementation of NTD programme.

Known NTD endemicity by district (programme operational unit)

PART TWO

PCT ALGORITHM

CASE MANAGEMENT ALGORITHM

WHAT TO DO BY DISTRICT (OPERATIONAL UNIT) BY OPERATIONAL PACKAGE

MDA

Case management

Transmission Control

PART THREE (Optional)

Disease specific Annexes


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Annex 1: Packages of NTD interventions

Package 1: Mass drug administration

Activity LF Oncho Schisto STH Trachoma

Programme coordination X X X X X

Advocacy X X X X X

Resource mobilization X X X X X

Social mobilization X X X X X

Training X X X X X

Mapping X X X X X

Drug distribution

CDI X X X X X

School X X

MDA campaign X X X X

Child Health Day X X

Immunization campaign X X X

Health &Nutrition Day X X

HSAM X X X X X

M&E X X X X X


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PACKAGE 2: Case management and chronic care

PACKAGE 3: Transmission Control 3.1 Vector/reservoir Control

Activity

Vectors and Associated NTDs

Mosquitoes Other Vectors

Snails Black fly Sand fly Tsetse fly

LF Dengue Malaria Schisto Oncho Leish HAT

ITN X X X X

IRS X X X X

Space spraying X X

Larviciding X X X X

Traps X

Prevention /Treatment of breeding sites

X X X x x ??

Key interventions Diseases / conditions

GW LEPROSY YAWS HAT LEISH BU

Complications LF TRICHIASIS RABIES ECCH CYST

Advocacy /Resource Mobilization

x x x x x x x x x x X

Strengthening Partnership


Intersectoral collaboration


Health Promotion x x x x x x x x x x X

Capacity building x x x x x x x x x x X

Mapping x x x x x x x x x x X

Passive case finding x x x x x x x x x x X

Active case finding x x x x

Medical Treatment x x x x x x x x

Surgery x x x x

Prevention of disability x x x

Integrated Vector Management/Reservoir control

x x x

Surveillance x x x x x x x x x x X


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3.2 Improvement of water/sanitation and operational research

Activity LF Oncho SCH STH Trach LEP Leish HAT GW BU Rabies Dengue

Partnership for water

supply improvement

X X X X

Partnership for sanitation improvement

X X X

Social mobilization

X X X X X X X X X X X X

Health Promotion


Operational Research


Table : Drug Estimates and Logistics

NTD Programme Name of Drug Source Drug Status of procurement

(donated/purchased)

Minimum lead time before delivery

In country Consignee

LFE, oncho IVM

LFE DEC

HAT Pentamidine/Melarsoprol

NEC/DFMO


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Name of Drug Source of drug Status of procurement

(donate/purchased)

Minimum Lead time before delivery


IVM

DEC

ALB

MEB

PZQ

Zithromax

Drug Forecasting and Logistics

Complete the following table to describe how essential NTD drug supplies will be obtained.

o Identify sources of drugs (procured or donated) o Describe management, logistics and monitoring system for delivering drugs to field distributions sites.

Table : Drug Estimates and Logistics

NTD Programme Name of Drug Source Drug Status of procurement

(donated/purchased)

Minimum lead time before delivery


LFE, oncho IVM

LFE DEC

HAT Pentamidine/

Melarsoprol

NEC

DFMO


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Results Framework for the WHO HQ AFRO APOC Strategic Plan, 2010 2015

Strategic Priorities Strategic Objectives Core Indicators

1: Strengthen Advocacy,

Coordination

and

Partnerships

I. Strengthen coordination mechanisms for the NTD control programme at regional, national and sub national levels

in the African Region

II. Strengthen and foster partnerships for the control, elimination and eradication of targeted NTDs at regional, national, district and community levels.

III. Enhance high level reviews of NTD programme performance and the use of lessons learnt to enhance advocacy, awareness and effective implementation of targeted interventions

IV. Strengthen advocacy, visibility and profile of NTD control elimination and eradication interventions at all levels in the African Region.

Minutes of high level NTD coordination meetings in

countries

Minutes of partnership events on NTDs

Number of high level advocacy events on NTDs

Number of partners involved in NTD Programme

2: Enhance resource mobilization and Planning for Results in NTD control

I. Support countries to develop integrated multi year strategic plans and gender sensitive annual operational plans for the control, elimination and eradication of targeted NTDs

II. Enhance resource mobilization approaches and strategies at regional, national and sub national levels for NTD interventions

III. Strengthen the integration and linkages of NTD programme and financial plans into sector wide and national budgetary and financing mechanisms

IV. Support countries to develop and update national NTD policies and elaborate guidelines and tools to guide

effective policy and programme implementation

No of countries with updated national integrated NTD strategic plans

No of NTD Guidelines and NTD planning and implementation tools developed

No of countries with adapted national guidelines and tools

Presence of NTD budget line

Total amount of financial resources available for NTD

activities

% of planned NTD funds received

3: Scale up access to interventions, treatment and NTD service delivery capacity, within the overall health system

I. Scale up an integrated preventive chemotherapy, including access to LF, STH, Onchocerciasis, Schistosomiasis and trachoma interventions

II. Scale up integrated case management based diseases interventions, especially the following:

a. Accelerate leprosy elimination activities

b. Intensify Guinea worm eradication and surveillance activities in order to interrupt

transmission in the three remaining endemic countries in the shortest time possible.

c. Enhance HAT control interventions

d. Strengthen national programmes to control Buruli Ulcer and endemic Treponematosis

e. Strengthen Leishmaniasis control and human rabies prevention

III. Strengthen capacity at national level for NTD programme management and implementation and accelerate

Number of countries withcompleted integrated mapping of NTDs

Drug administrative coverage

National coverage

Parasitological prevalence

% of Disease specific targets

achieved


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implementation of disease burden assessments and integrated mapping of NTDs

IV. Strengthening integrated vector management for targeted NTDs

4: Enhance NTD monitoring and

evaluation, surveillance and operations research

I. Develop and promote an integrated NTD M&E framework and improve monitoring of NTDs, within the context of

national health information systems; this will include strengthening the reporting and response to severe adverse events (SAEs) by leveraging on going efforts to strengthen pharmacy vigilance systems in AFR countries.

II. Strengthen the surveillance of NTDs and strengthen the response and control of epidemic [prone NTDs, in particular for dengue and Leishmaniasis.

III. Support operational research, documentation and evidence to guide innovative approaches to NTD programme interventions

IV. Establish integrated data management systems and support impact analysis for NTD in the WHO Africa Region, as part of the global NTD data management system and Global NTD Plan.

NTD Data completeness and timeliness

No of evaluation studies conducted and results disseminated

No of operational research conducted and results disseminated

Functional Data management system

Guide for NTD Master Plan Ver Nov 5 2010

Documents